What is the syndrome where ligaments are loose? Understanding Joint Hypermobility Syndrome

October 2, 2025 •

4 min read

Affecting around 10% of children, Joint Hypermobility Syndrome is the term used to describe the condition where ligaments are loose, allowing joints to move beyond their normal range. This article provides an authoritative overview of this connective tissue disorder and its broader implications for health.

Quick Summary

The syndrome characterized by loose ligaments is known as Joint Hypermobility Syndrome (JHS), a common connective tissue disorder that results in joints with a greater-than-normal range of motion. This can cause a range of symptoms, from mild flexibility to chronic pain and instability, and may sometimes indicate an underlying genetic condition like Ehlers-Danlos syndrome.

Key Points

Syndrome Name: The condition where ligaments are loose is called Joint Hypermobility Syndrome (JHS), also known as Hypermobility Spectrum Disorder (HSD).
Collagen Defect: JHS is caused by a genetic defect in collagen, the protein that provides strength and elasticity to connective tissues like ligaments.
Common Symptoms: Symptoms include chronic joint pain, frequent dislocations or sprains, fatigue, and poor balance due to unstable joints.
Hypermobility vs. Instability: While hypermobility is increased joint range of motion, instability is uncontrolled movement that causes symptoms. A person can be hypermobile without being unstable.
Management is Key: Treatment focuses on protecting joints and managing symptoms through physical therapy, low-impact exercise, and pain relief, as there is no cure.
Ehlers-Danlos Connection: JHS can be a sign of a more complex connective tissue disorder called Ehlers-Danlos Syndromes (EDS), especially the hypermobile type (hEDS).
Diagnosis: Diagnosis typically involves a physical exam and is often confirmed using the Beighton score to measure joint flexibility.

What is Joint Hypermobility Syndrome (JHS)?

Joint Hypermobility Syndrome (JHS), also known as Hypermobility Spectrum Disorder (HSD), is a condition where the connective tissues, especially ligaments, are more flexible and stretchier than normal. Ligaments are crucial for providing stability to joints, holding bones together to prevent excessive movement. When these ligaments are loose, the joints become unstable and can move beyond their typical range, a trait often referred to as being 'double-jointed'. While many people have joint hypermobility without any associated issues, JHS is diagnosed when this hypermobility causes pain and other symptoms.

The Role of Collagen

The primary cause of JHS is a defect in the body's collagen formation, a protein that provides strength and elasticity to connective tissues. This genetic difference can result in weak or lax ligaments, which are less effective at stabilizing the joints. This condition often runs in families, suggesting a strong hereditary component. This collagen abnormality is also a key factor in other, rarer, connective tissue disorders, such as Ehlers-Danlos syndrome (EDS).

Common Symptoms of JHS

The symptoms associated with JHS can vary widely in severity and presentation. For some, hypermobility remains asymptomatic, while for others, it can significantly impact quality of life. Common symptoms include:

Chronic joint and muscle pain: This is one of the most common and debilitating symptoms, often worsening with activity or at the end of the day.
Joint instability: This leads to frequent joint sprains, subluxations (partial dislocations), and full dislocations with minimal trauma.
Fatigue: Many individuals with JHS experience chronic fatigue, which can be linked to the increased energy required for muscles to stabilize lax joints.
Clumsiness and poor balance: Due to reduced proprioception (the body's ability to sense its position) associated with unstable joints.
Musculoskeletal stiffness: Despite loose ligaments, surrounding muscles may become tight in an attempt to compensate for the lack of joint stability.
Extra-articular manifestations: Some people experience non-joint-related symptoms, such as gastrointestinal issues (e.g., irritable bowel syndrome), thin or stretchy skin, and postural orthostatic tachycardia syndrome (POTS).

Diagnosis and Management

Diagnosing JHS typically involves a physical examination by a healthcare professional, who will assess the range of motion in your joints. One common tool is the Beighton score, a nine-point scale that measures hypermobility in specific joints. A detailed medical history is also essential to rule out more serious genetic conditions and to understand the full scope of symptoms.

Treatment and Lifestyle Strategies

There is currently no cure for JHS, but a variety of treatments and management strategies can help alleviate symptoms and improve quality of life. The focus is primarily on joint protection and pain management.

Physical Therapy: Working with a physical therapist is crucial for strengthening the muscles around the joints to improve stability. They can also help with posture and balance, while often advising against excessive stretching.
Exercise: Low-impact activities are highly recommended to build muscle strength without overstraining joints. Good options include swimming, cycling, and walking.
Pain Management: Over-the-counter anti-inflammatories or other pain relievers may be used for mild to moderate pain. For more severe cases, a doctor might prescribe stronger medication or refer to a pain clinic.
Supportive Devices: Braces, shoe inserts (orthotics), and supportive shoes can provide additional joint stability and help with flat feet, a common issue in hypermobile individuals.
Dietary Adjustments: Some research suggests a link between hypermobility and gastrointestinal issues like IBS. A healthcare provider might recommend an exclusion diet to test for food intolerances.

Comparison: Hypermobility vs. Instability

It's important to differentiate between hypermobility and joint instability, as they are not the same thing, though they are related. A person can have hypermobility without instability, but instability is a key symptom of JHS.


Feature	Joint Hypermobility	Joint Instability
Definition	An increased range of motion in a joint beyond normal limits.	A lack of effective neuromuscular control over a joint, leading to uncontrolled movement, especially under load.
Symptomatic?	Not always. Many hypermobile people are asymptomatic.	Usually symptomatic, often presenting with pain, weakness, and giving-way episodes.
Risk Factor	Can be a risk factor for developing joint instability, especially with repetitive strain.	Can develop as a consequence of hypermobility when the surrounding muscles are unable to compensate for lax ligaments.
Example	A gymnast who can easily do the splits without pain.	A person whose kneecap frequently subluxates or dislocates with minimal force.

Hypermobility and Ehlers-Danlos Syndromes

For some individuals, JHS is not an isolated condition but rather a symptom of a broader, more serious genetic connective tissue disorder, most commonly Ehlers-Danlos Syndromes (EDS). EDS are a group of inherited disorders that affect collagen and other connective tissues, causing fragile skin, extremely loose joints, and potential complications with blood vessels and internal organs. The most common type is hypermobile EDS (hEDS), which shares many symptoms with JHS. The 2017 international criteria for EDS now distinguish between hEDS and the broader Hypermobility Spectrum Disorder (HSD), with hEDS having stricter diagnostic criteria. A genetic evaluation is often necessary to confirm a diagnosis of hEDS or another EDS subtype.

Conclusion

What is the syndrome where ligaments are loose? It is primarily known as Joint Hypermobility Syndrome, or Hypermobility Spectrum Disorder. While increased joint flexibility can be a benign trait for many, it can also lead to chronic pain, joint instability, and other systemic issues for those with JHS. For a small but significant number of people, this hypermobility may be a sign of an underlying connective tissue disorder like Ehlers-Danlos Syndrome. Early diagnosis and a comprehensive management plan—including physical therapy, pain management, and protective lifestyle adjustments—are essential for managing symptoms and improving long-term quality of life. For more in-depth information on diagnosis and management of hypermobility disorders, the resources from reputable organizations like The Ehlers-Danlos Society can be extremely helpful. Link: The Ehlers-Danlos Society

Frequently Asked Questions

The primary cause is a genetic defect in collagen, a protein that makes up connective tissues. This defect makes the ligaments weaker and more elastic, resulting in increased joint flexibility.

No, not necessarily. Many people are 'double-jointed,' meaning they have joint hypermobility. Joint Hypermobility Syndrome is diagnosed when this hypermobility causes additional symptoms, such as pain, joint instability, and fatigue.

Common symptoms of JHS include chronic joint and muscle pain, frequent joint dislocations or sprains, persistent fatigue, and poor balance.

Diagnosis is typically made by a healthcare provider based on a physical examination, medical history, and often involves using a scoring system like the Beighton score to assess joint flexibility.

JHS can exist on its own or be a feature of a broader connective tissue disorder like EDS. EDS, particularly the hypermobile type (hEDS), has stricter diagnostic criteria and can involve more complex systemic issues beyond joint hypermobility.

Physical therapy is a cornerstone of management. It focuses on strengthening the muscles around unstable joints to improve stability and reduce pain. Therapists also help with posture and balance.

There is no cure for JHS, as it is a genetic condition. However, symptoms can be effectively managed through appropriate strategies, including exercise, physical therapy, and pain management.

Yes, low-impact exercises are recommended to build strength without stressing the joints. Good examples include swimming, cycling, and walking. High-impact sports or excessive stretching should generally be avoided.