Hypermobility and pelvic floor dysfunction
This week I ran my monthly mentor call for my hypopressive teacher trainees and we discussed Hypermobility.
I wanted to share what we discussed and how hypopressives might help you if you are hypermobile and how you might want to adapt your practice to make it more successful.
Hypermobility is the tendency for joints to move beyond their normal range - it is widely recognised as a musculoskeletal condition affecting joints throughout the body.
What is far less often discussed is its profound effect on the pelvic floor.
The pelvic floor is a group of muscles, ligaments, and connective tissue forming a hammock-like structure at the base of the pelvis. In hypermobile individuals, the connective tissue throughout the entire body is more lax than usual and the pelvic floor is no exception.
1 in 5 people have some degree of hypermobility
80%of hypermobile people report pelvic symptoms
3×higher rate of pelvic organ prolapse in hEDS
There are different categories of hypermobility
Hypermobility Spectrum Disorder (HSD): Describes individuals who have symptomatic hypermobility but do not meet the strict diagnostic criteria for connective tissue disorders. It is diagnosed when joint looseness causes tangible problems like pain, instability, or recurring injuries.
Hypermobile Ehlers-Danlos Syndrome (hEDS): The most common form of EDS. It is a genetic connective tissue disorder characterized by joint hypermobility, joint instability (such as dislocations), and varying degrees of soft, stretchy, or fragile skin. Contraindicated for hypopressives- leave out apnoea
Other Connective Tissue Disorders: Rarer conditions such as Classical EDS, Marfan syndrome, or Stickler syndrome also feature hypermobility, but carry specific additional risks (such as cardiovascular or eye. Contraindicated for hypopressives- leave out apnoea
Pelvic floor dysfunction in hypermobility rarely presents in a straightforward way. The lax connective tissue means the pelvic floor is often poorly supported from the outset but the body's response to instability complicates matters further.
In an attempt to compensate for joint instability throughout the body, many hypermobile individuals develop a chronically hypertonic (overactive, tight) pelvic floor.
This might seem counterintuitive surely a lax pelvic floor would be weak? But tightness and weakness are not opposites. A pelvic floor can be both simultaneously: holding excessive tension as a bracing response while still lacking the coordinated strength needed to function properly.
Common symptoms
Urinary urgency and frequency
Stress or urgency incontinence
Pelvic organ prolapse
Pelvic pain or heaviness
Painful intercourse
Bowel dysfunction
Generic pelvic floor advice- "just do your Kegels"- is often counterproductive here. Strengthening a hypertonic floor increases tension and worsens symptoms.
Pelvic floor function does not exist in isolation. In hypermobility, the whole system is involved: the deep core (transversus abdominis and multifidus), the diaphragm, the hip stabilisers, and the nervous system all interact with pelvic floor behaviour.
Many hypermobile individuals also live with a sensitised nervous system, sometimes accompanied by dysautonomia (dysfunction of the autonomic nervous system). This contributes to bladder hypersensitivity, urgency, and the kind of whole-body fatigue that makes exercise feel disproportionately depleting.
The goal in hypermobility is always stability over flexibility. The pelvic floor needs to be coordinated, responsive, and strong, not simply tighter or looser. Rehabilitation should build neuromuscular control, not just muscle bulk.
Hypopressives offer something that most conventional rehabilitation does not: a way to train the deep stabilising system without loading unstable joints or increasing intra-abdominal pressure.
This makes them particularly well-suited to hypermobility. Here is why:
→They target the right muscles. Hypopressives activate the transversus abdominis, multifidus, and pelvic floor - the deep stabilisers that hypermobile joints most depend on for support.
→They are non-ballistic. No explosive loading, no end-range stress, no momentum. This aligns precisely with the slow, controlled approach that hypermobility demands.
→They improve proprioception. The postural component of hypopressives trains body awareness and axial elongation - often poor in hypermobile individuals who habitually "hang" into their joints.
→They calm the nervous system. The breath and apnoea work has a documented regulatory effect on the autonomic nervous system- directly relevant where dysautonomia or bladder hypersensitivity is present.
→They address the hypertonic floor. By improving coordination and reducing the compensatory bracing patterns that drive high tone, hypopressives can reduce the pelvic floor tension that underpins many symptoms.
While hypopressives are well-matched to the needs of hypermobile individuals, a few adaptations ensure the work is safe and effective:
If you're hypermobile watch out for these......
Hyperextending the lumbar spine in postures
Locking out the elbows and knees
Rib flare
Dizziness during apnea if dysautonomia is present
Adding these principles into your practice can make it more successful.....
✓Start in lying or sitting positions before standing
✓ Soft knees, neutral pelvis, ribs down
✓Keep apnoea brief initially, slow and small; build slowly
✓ Use blocks, bands, the wall and balls to provide more stability to the poses
✓ Don't skip the cues- they help engage the muscle chains that increase stability
✓ Avoid overstretching and end range movements
✓Pair with a broader stability programme
I have many classes that suit those with hypermobility syndrome and more will be added in the future.
You'll be able to find these flows in my Keep It Up Club Membership Portal.
If you're a movement coach or professional and want to learn more about how hypopressives can help your client my next teacher training is in November - head here for more details