What Is Joint Hypermobility? Signs, Symptoms, Beighton Score, and When to Seek Help

What Is Hypermobility?

Growing up, I was always told that being flexible was a good thing. I could sit in positions that seemed comfortable to me, but looked unusual to others, bend my fingers farther than most people, and move my joints in ways that often surprised friends and family. For many years, I simply assumed that flexibility was a unique trait and never considered that it might be connected to some of the symptoms I was experiencing.

This is a story I hear often from patients.

Many people with hypermobility spend years thinking they are simply "double-jointed" or naturally flexible. In reality, hypermobility exists on a spectrum. Some individuals are flexible without experiencing any problems, while others develop symptoms that affect their daily lives.

Joint hypermobility refers to the ability of a joint to move beyond the range of motion considered typical for that joint. This increased flexibility occurs because the connective tissues that support joints, including ligaments and joint capsules, are more elastic than average.

For some people, hypermobility is simply a physical characteristic. For others, it may be associated with conditions such as Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS).

Flexibility is a common feature in hypermobility

Common Signs of Hypermobility

Many people are surprised to learn that hypermobility involves more than touching your toes or performing gymnastic movements.

Some common signs include:

• Frequently being described as "double-jointed"

• Easily placing palms flat on the floor while keeping the knees straight

• Fingers, elbows, or knees that bend farther than expected

• Being unusually flexible during childhood

• Frequently sitting in unusual positions

• Recurrent joint sprains or strains

• Joints that crack, pop, or feel unstable

• Feeling as though joints "slip" or partially dislocate

Many adults lose flexibility over time, which could make hypermobility more challenging to recognize later in life.

Symptoms Associated With Hypermobility

One of the biggest misconceptions about hypermobility is that it only affects the joints.

Because connective tissue is found throughout the body, symptoms can extend far beyond flexibility.

Symptoms may include:

• Chronic joint pain

• Neck and back pain

• Frequent injuries

• Muscle tightness

• Fatigue

• Poor exercise recovery

• Headaches

• Dizziness upon standing

• Digestive complaints

• Easy bruising

• Chronic tension and muscle guarding

Many patients describe feeling as though their muscles are constantly working overtime just to keep their joints stable. As someone who lives with hypermobility myself, this description resonates deeply with me and is one I hear frequently in clinical practice.

Understanding the Beighton Score

One of the most commonly used tools for assessing generalized joint hypermobility is the Beighton Score.

The Beighton Score evaluates flexibility in nine points:

• Pinky fingers bending backward beyond 90 degrees

• Thumbs touching the forearms

• Elbows extending beyond 10 degrees

• Knees extending beyond 10 degrees

• Ability to place palms flat on the floor with knees straight

Points are awarded for each movement, resulting in a score from 0 to 9.

A higher score suggests greater generalized joint hypermobility.

Testing joint range of motion

The Limitations of the Beighton Score

Although the Beighton Score is a useful screening tool, it is not an exact measure of hypermobility.

One limitation is that it evaluates only a small number of joints. The Beighton Score is an important screening tool for generalized joint hypermobility, but it should be interpreted alongside a thorough medical history and physical examination rather than used in isolation.

Many people experience significant hypermobility in areas not assessed by the Beighton Score, including:

• Shoulders

• Hips

• Ankles

• Jaw

• Spine

• Rib cage

• Feet

  
  

I've worked with patients who score relatively low on the Beighton assessment, but demonstrate clear signs of hypermobility elsewhere in the body.

Another challenge is that flexibility often changes with age. Individuals who were extremely flexible as children may lose some range of motion over time due to injury, muscle tension, arthritis, or natural aging. As a result, some adults with hypermobility may no longer meet Beighton criteria despite having a lifelong history of hypermobility-related symptoms.

This is one reason a comprehensive clinical evaluation is often more valuable than relying solely on a numerical score.

When Does Hypermobility Become a Problem?

Not everyone with hypermobility experiences symptoms.

However, hypermobility may become problematic when joints are unable to maintain adequate stability.

Over time, this can contribute to:

• Chronic pain

• Recurrent sprains

• Subluxations or dislocations

• Tendon injuries

• Fatigue

• Reduced exercise tolerance

• Difficulty recovering from physical activity

Many patients spend years searching for answers before realizing that hypermobility may be contributing to their symptoms.

When Should You Seek Evaluation?

You may benefit from further evaluation if you:

• Experience chronic joint pain

• Frequently sprain or injure joints

• Feel unusually fatigued without explanation

• Have recurrent joint instability

• Notice dizziness when standing

• Have multiple symptoms affecting different body systems

• Have a family history of hypermobility, HSD, or EDS

The earlier hypermobility is identified, the sooner supportive strategies can be implemented to help improve quality of life and reduce injury risk.

How Naturopathic Medicine Can Help:

At Pacific Clinic of Natural Medicine, I take a comprehensive approach when evaluating patients with hypermobility. Rather than focusing solely on joint pain, I look at the bigger picture. This may include assessing nutrition, digestion, sleep quality, inflammation, autonomic nervous system function, hormone balance, and lifestyle factors that may influence connective tissue health. Every person with hypermobility presents differently. Some struggle primarily with pain, while others experience fatigue, digestive concerns, dizziness, or frequent injuries. Identifying these patterns can help guide an individualized treatment plan designed to support overall health and resilience. If you have ever wondered whether your flexibility is simply a unique trait or part of a larger picture, a comprehensive evaluation may help provide answers. If interested, consider scheduling a virtual or in-person complimentary consultation below:

Schedule a free 15-minute visit to see if we are a good fit

References:

1. The 2017 International Classification of the Ehlers-Danlos Syndromes. Malfait F, Francomano C, Byers P, et al. The 2017 International Classification of the Ehlers-Danlos Syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2017;175C(1):8-26. This is the international consensus paper that established the current hEDS diagnostic criteria and diagnostic framework.

2. Hypermobile Ehlers-Danlos Syndrome. Alan Hakim, Brad Tinkle, Levy H, et al. Hypermobile Ehlers-Danlos Syndrome. GeneReviews®. University of Washington, Seattle. Updated periodically. This is an excellent clinical reference that summarizes diagnosis, associated manifestations, and management.

3. Updates in Clinical and Genetics Aspects of Hypermobile Ehlers-Danlos Syndrome. Baeza-Velasco C, Gély-Nargeot MC, Bulbena A, Bravo JF. Updates in Clinical and Genetics Aspects of Hypermobile Ehlers-Danlos Syndrome. Balkan Medical Journal. 2018;36(1):12-16. A concise review of the Beighton score, diagnostic criteria, and multisystem features.

4. Hypermobile Ehlers–Danlos Syndrome: Diagnostic Challenges and the Role of Genetic Testing. Genes. 2025. Reviews current diagnostic challenges, explains why hEDS remains a clinical diagnosis, and discusses the strengths and limitations of existing criteria.

5. The Ehlers-Danlos Society. Hypermobile Ehlers-Danlos Syndrome (hEDS) Diagnostic Criteria. A useful patient-facing resource that summarizes the 2017 diagnostic criteria and current clinical approach.

6. Beighton P, Solomon L, Soskolne CL. Articular Mobility in an African Population. Annals of the Rheumatic Diseases. 1973;32(5):413-418. This landmark paper introduced the Beighton scoring system, which remains the most widely used screening tool for generalized joint hypermobility.

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