Hypermobile Shoulders and Pain: New Research on Conservative Treatment

5 min read

Shoulder Pain and Hypermobility: What Actually Works?

If you have hypermobile Ehlers-Danlos Syndrome (hEDS) or a Hypermobility Spectrum Disorder (HSD) and deal with shoulder pain or instability, you're definitely not alone. Shoulders are one of the most common problem areas for people with hypermobility. In fact, one study found that 84% of folks with hEDS or HSD report shoulder pain¹.

Why is that? Well, when your connective tissue is naturally more elastic, your joints can move more than they should. That flexibility can be a gift in some ways—but for the shoulder, which is already the most mobile joint in the body, it can turn into a recipe for pain, subluxations (partial dislocations), and chronic instability. Over time, this often leads to a frustrating cycle: pain, fatigue, fear of movement, and a serious drop in quality of life.

But here’s the good news: a new systematic review just dropped, and it pulls together some of the best evidence we’ve seen on non-surgical approaches for hypermobile shoulders. In this post, we’ll break down what the researchers found and how it aligns with what we do every day at Atomic Physical Therapy.

Why Shoulders Are So Vulnerable in Hypermobility

If your joints are extra mobile because of connective tissue differences, your shoulder—by nature already loose and mobile—can become unstable. That might mean your shoulder slips out of place, gets inflamed, or just hurts with daily stuff like reaching, pulling, or even getting dressed.

Understandably, a lot of people with hypermobility develop kinesiophobia (fear of movement). And when moving your shoulder feels risky or unpredictable, it’s easy to avoid it altogether—which then leads to weakness, stiffness, and even more instability.

Up until now, there’s been no gold standard for how to treat this. Should you only do gentle rehab? Is heavy strength training safe? Are braces helpful or harmful?

What the Research Says: The Latest Review

A 2024 systematic review¹ looked at over 17,000 studies and narrowed things down to just four high-quality ones that focused on adults with hEDS or HSD dealing with shoulder pain or mechanical symptoms. All the studies included non-surgical treatments, such as:

• Exercise programs: Physical therapy targeting strength, stability, and motor control

• Kinesiology taping: Elastic tape placed to support muscles or improve awareness

• Elastic compression garments: Things like shoulder vests or braces that improve posture or joint feedback

The programs varied in length—from just 48 hours to up to 24 weeks.

The Results? Really Promising.

Across the board, people with hypermobility saw improvements in key areas:

✅ Less pain
✅ Fewer instability episodes
✅ Better daily function
✅ Increased strength

Both low-load and high-load exercise programs were helpful, which is huge. This means you can safely build strength—even with lax joints—when you do it gradually and with support.

That said, the review noted that kinesiophobia didn’t improve as much, so education, reassurance, and building trust in your body are key pieces of the rehab puzzle.

How We Approach This at Atomic Physical Therapy

This is one of those moments where research finally catches up with what many of us in the clinic have seen for years. At Atomic, our hypermobility approach already checks every box this review highlights:

• Conservative First, Always
  We don’t jump to aggressive options. We start with smart movement, neuromuscular retraining, and education.

• Progressive Loading
  We guide you through “start low, go slow… but go.” That might mean beginning with activation and control work, then gradually adding resistance as your body adapts.

• Whole-Person Focus
  Your shoulder isn’t operating in a vacuum. We look at your posture, breathing, core strength, balance, and even factors like fatigue or dizziness.

• Support + Empowerment
  Our patients aren’t left to figure it out alone. We combine in-person coaching with strategic home exercises and regular check-ins.

• Tools When Helpful
  We’ll use things like kinesiology tape or braces strategically to help you succeed in your movement—not as a crutch.

So, What Should You Take Away from This?

• Yes, conservative care works. Structured rehab can reduce pain and improve function.

• Yes, progression matters. Healing takes time—most changes took weeks to months in these studies.

• Yes, strength training is safe. You just need the right guidance and pacing.

• And yes, mindset is part of rehab. Addressing fear and helping you trust your shoulder again is just as important as loading it.

This new review is a big step forward in validating what many patients and providers have known intuitively: people with hypermobility don’t need to avoid strength training—and they don’t need to rely on bracing forever. With the right approach, you can feel stronger, more stable, and more confident.

If you’re struggling with hypermobile shoulder pain and feel stuck, we’re here to help. We know the rehab game is different for you—and we’re ready to build a plan that meets your body where it’s at.

Let’s get started. Book a consult with our team and take the first step toward a more stable shoulder—and a more confident you.

Reference:
¹ Schubert, A., Spahr, N. J., Malek, S., & Sciascia, A. (2024). The Effectiveness of Conservative Interventions on Pain, Function, and Quality of Life in Adults with Hypermobile Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorders and Shoulder Symptoms: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy, 54(3), 1–13. https://doi.org/10.2519/jospt.2024.11770