How Are Hypermobility and POTS Connected? Understanding the Overlap and How Physical Therapy Treats Both
Part of the Femina PT POTS & Orthostatic Intolerance Series | Complete Guide: POTS & Orthostatic Intolerance Physical Therapy in Los Angeles
For a lot of women, the POTS diagnosis is only one piece. The double-jointedness you were praised for as a kid, the joints that dislocate, the pain that no imaging explains, and the lightheadedness on standing can all be part of the same connected picture. Understanding the hEDS-POTS overlap often reframes years of seemingly unrelated symptoms.
What the overlap is
Trouble with the autonomic nervous system, the part of the body that runs automatic tasks like heart rate (autonomic dysfunction), including orthostatic intolerance (trouble staying upright), is linked with hypermobile Ehlers-Danlos syndrome (hEDS, a condition that makes the joints very loose and flexible) and related hypermobility spectrum disorders (HSD), along with chronic pain and a raised sensitivity to pain throughout the body (generalized hyperalgesia)[1]. Hypermobility disorders often show up alongside POTS, and many POTS patients present with hEDS, chronic pain, or both[1]. In one community-based study of women with hEDS/HSD, a majority (58%) reported a POTS diagnosis[2], a clear sign of how tightly these conditions travel together.
To clarify, these are documented associations reported in clinical literature and observational studies, not proof that one condition causes another. But for treatment planning, the association is enough to justify looking at the whole person rather than one system at a time.
Why it changes how physical therapy is done
Hypermobile joints and fragile connective tissue change the calculus of exercise. Aggressive stretching or end-range loading can aggravate unstable joints, so a program built for a hypermobile body emphasizes control, stability, and joint protection rather than flexibility. At the same time, the POTS side of the picture still calls for graded, lying-down-first conditioning that strengthens the calf and thigh muscles that pump blood back to the heart (venous return)[3] and is well supported by randomized evidence[4]. Our women’s-health PT practice is built to solve this kind of connected problem: stabilizing hypermobile joints while gently reconditioning a circulatory system that struggles with standing. See how the graded POTS exercise program works.
The pelvic-floor connection
Connective tissue does not stop at the knees and shoulders. Hypermobility is also linked with pelvic floor problems, a pelvic organ dropping down from its normal position (prolapse), and pain in the genital and pelvic area (genito-pelvic pain) in women[5][6], which is why, for many of our patients, hEDS, POTS, and pelvic symptoms are best assessed together. Read the full pelvic-health picture.
At Femina Physical Therapy, evaluation accounts for all of it at once: the dysautonomia, the joint instability, the pain, and the pelvic floor. In your body, they were never separate, and comprehensive assessment and treatment is a foundation of our practice.
“In your body, the dysautonomia, the joint instability, the pain, and the pelvic floor were never separate.”
📍 Femina Physical Therapy treats POTS and orthostatic intolerance across Los Angeles, with offices in Sherman Oaks, Pasadena, and Beverly Hills. Telehealth and Coaching consultations are available for patients whose symptoms make travel difficult.
FAQ — PEOPLE ALSO ASK
Autonomic dysfunction including orthostatic intolerance is documented in association with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders, and hypermobility is a common POTS comorbidity. Many people have both, along with chronic pain, though the association does not prove one causes the other.
Often the emphasis shifts away from stretching. Hypermobile joints usually need control, stability, and joint protection rather than more flexibility. A physical therapist experienced with hypermobility can tailor exercise to stabilize joints while still addressing POTS through graded, recumbent-first conditioning.
Yes. These conditions frequently overlap in women and are best treated as one connected picture. An integrated program can address dysautonomia, joint instability, chronic pain, and pelvic floor symptoms together rather than sending you to manage each in isolation.
Clinical literature documents an association. Hypermobility is linked with pelvic floor dysfunction, prolapse, and genito-pelvic pain in women, with pelvic floor physical therapy commonly recommended. For many patients, hEDS, POTS, and pelvic symptoms are best assessed together.
>> Living with POTS in Los Angeles? One connected plan can address the whole picture. Book your evaluation at Femina Physical Therapy.
References (Peer-Reviewed Sources)
[1] (Class C) Symptomatic Joint Hypermobility: the hypermobile type of Ehlers-Danlos syndrome and the hypermobility spectrum disorders. 2019. [pubmed.ncbi.nlm.nih.gov/31582002]
[2] (Class C) Sexual dysfunction in women with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders: an online community-based study. (PMC11964486) [ncbi.nlm.nih.gov/pmc/articles/PMC11964486]
[3] (Class C) Stewart JM, Medow MS, Montgomery LD, McLeod K. Decreased skeletal muscle pump activity in patients with postural tachycardia syndrome and low peripheral blood flow. Am J Physiol Heart Circ Physiol. 2004;286(3):H1216-H1222. [doi.org/10.1152/ajpheart.00738.2003]
[4] (Class A) Fu Q, VanGundy TB, Shibata S, Auchus RJ, Williams GH, Levine BD. Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension. 2011;58(2):167-175. [pubmed.ncbi.nlm.nih.gov/21690484]
[5] (Class C) Joint hypermobility syndrome for the urogynaecologist – a narrative review. 2026. [pubmed.ncbi.nlm.nih.gov/41512700]
[6] (Class C) Characterizing sexual dysfunction in females with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorder and genito-pelvic pain through cross-sectional analysis. Rheumatol Int. 2026. [pubmed.ncbi.nlm.nih.gov/42283871]
Related Reading: POTS & Orthostatic Intolerance at Femina Physical Therapy
→ POTS, dysautonomia, and pelvic floor health in women
→ The POTS-MCAS overlap: mast cell activation and dysautonomia
→ Complete Guide: POTS & Orthostatic Intolerance Physical Therapy in Los Angeles (Pillar)
Medical disclaimer: This article is for informational purposes only and is not intended as medical advice. Always consult your medical doctor before beginning this or any program that may affect your health. Reading this article does not create a patient relationship with Femina Physical Therapy.