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Joint Hypermobility Physical Therapy

To physically function and perform at your peak, you need joints that are both mobile and stable, and capable of withstanding force loads multiple times your body weight. Joint hypermobility syndrome (JHS) is a hereditary condition where lax ligaments allow the joints to extend beyond their optimal functional range of motion. Joint hypermobility is a key symptom of Ehlers Danlos syndrome (EDS), a set of connective tissue disorders caused by defects in collagen structure and production.

Dancers, gymnasts and acrobats may benefit from hypermobile joints, but people with JHS and EDS often suffer from physical instability and a higher-than-average risk of injury. Specialized physical therapy can help improve joint stability by strengthening the structures that support hypermobile joints, and by equipping patients with effective strategies for managing their condition.

We’re located on 25th street in Manhattan NYC.
Open Monday-Friday, 10am-8pm.

Who are doctors Kalika and Brosgol? What are the characteristics of joint hypermobility and Ehlers-Danlos syndrome? What makes NYDNRehab the best clinic in NYC for joint hypermobility treatment? What is the role of fascia in promoting joint stability? How is joint hypermobility diagnosed at NYDNRehab? What therapies and methodologies are available at NYDNRehab for joint hypermobility treatment? What are the risks of joint hypermobility? What are some strategies to prevent and manage joint hypermobility? Can medications or environmental toxins affect JHS/EDS? Joint hypermobility FAQs

Dr. Lev Kalika

Clinical director & DC RMSK

Dr. Kalika and Dr. Brosgol are Pioneering Next-Level JHS Therapy

Dr. Lev Kalika, DC has over 20 years of clinical experience in successful injury rehabilitation, and effective treatment of pain syndromes and movement disorders. Throughout his career, Dr. Kalika has remained on the cutting edge of new research, advanced technologies and innovative therapies that support the human body’s innate ability to regenerate and self-heal. Dr. Kalika is a recognised expert in diagnostic ultrasonography, with multiple research publications to his credit. He is certified in the Stecco method of fascial release therapy.

Dr. Yuri Brosgol

Orthobiologic specialist

Dr. Yuri Brosgol, MD is a neurologist with 20+ years of experience in treating pediatric and adult myofascial pain. When emerging research on the critical role of fascia in human mobility captured Dr. Brosgol’s interest, he pursued training in orthobiologics and fascial release techniques. Dr. Brosgol has become a pioneer in the use of orthobiologic solutions and fascial plane hydrodissection, paving the way for transformative advancements in the treatment of myofascial disorders.

Together, Dr. Kalika and Dr. Brosgol are combining their skills to revolutionize the way myofascial pain is diagnosed and treated. By leveraging the most advanced, evidence-based approaches, they are dedicated to improving the quality of life of JHS/EDS patients in NYC.

Characteristics and Symptoms of
JHS and EDS

Joint hypermobility syndrome is a genetic condition characterized by joints that move beyond their normal range of motion. JHS patients often report chronic joint pain, fatigue, and frequent soft tissue injuries like sprains or dislocations. JHS is thought to be related to lax ligaments and tendons, and irregular collagen fiber arrangement in connective tissues.

Symptoms of joint hypermobility syndrome include:

Chronic or recurring joint and myofascial pain
Joint instability that reduces movement efficiency
Frequent joint dislocations

Chronic fatigue
Mildly stretchy skin
Digestive issues

Unlike JHS which is mostly isolated to connective tissues at the joints, EDS has a broader scope, often affecting multiple systems including joints, skin, blood vessels, and organs. EDS is associated with genetic mutations that cause defects in collagen – a protein that serves as a primary building block for the body’s connective tissues, affecting skin, bones, tendons, ligaments, and cartilage. EDS symptoms are typically more severe than those of JHS, and some can be life-threatening.

Symptoms of EDS vary from one type to another, and may include:

Joint hypermobility
Chronic pain and fatigue
Stretchy hyperextensible skin
Gastrointestinal disorders
Cardiovascular issues
Blood vessel dysfunction

Why Choose NYDNRehab for JHS/EDS Therapy?

When faced with joint hypermobility, most physical therapy clinics rely on one-size-fits-all exercise protocols, with the goal of strengthening the structures that stabilize the joints. But advancements in research show that muscle and tendon strengthening is not enough to reduce symptoms, improve joint function, and enhance physical performance in JHS patients.

At NYDNRehab, we treat the whole patient, not just your symptoms. We not only address the structural stability of joints – we use dynamic ultrasound imaging and advanced diagnostics to discover other factors that contribute to joint dysfunction. Ultrasound lets us visualize the body in motion, in real time, to see how the various structures interact, and equips us with sonoelastography to test tissue stiffness.

Our state-of-the-art motion analysis lab and proprietary software give us objective data about critical movement parameters that govern joint mobility and stability. With these insights, we are able to create personalized treatment protocols, customized to the patient’s specific needs.

Our revolutionary approach to joint hypermobility disorders makes NYDNRehab the clinic of choice in NYC for JHS/EDS diagnosis and treatment.

Fascia and Joint Hypermobility

Fascia is a thin fibrous web of connective tissue that separates, connects and encases muscles, joints, organs, nerves and blood vessels throughout the body. It works together with muscles to guide and control movement by providing tensegrity – elastic tension that holds structures in place as you move.

Fascia is primarily made up of collagen, elastin, and a gel-like substance composed of hyaluronic acid and water. Fascial tissue is tough, elastic and slippery, allowing it to stretch and glide among the body’s structures without friction. Fascia is dynamic and adaptable, but when injured, inflamed or dehydrated, it can lose its functional properties, causing pain and inhibiting mobility.

Fascia is richly embedded with proprioceptors – specialized sensory receptors that provide the nervous system with information about the position, movement, and tension of joints – serving as a communication pathway between different parts of the body. Thanks to proprioception, you can perceive your body’s position, motion, and equilibrium without visual input.

Myofascial pain is a common symptom in JHS patients. Recent research suggests that damaged fascia may be an important factor that causes pain and inhibits mobility in JHS patients. When damaged, fascia can become dense and sticky, losing its elasticity, adhering to other structures, and entrapping nerves and blood vessels in its layers.

Damage to fascia can disrupt proprioception, leading to reduced accuracy in signaling that causes the brain to misinterpret information about the body’s spatial position, such as joint angles or muscle tension. This can cause balance issues, poor muscle coordination, and compensatory motor patterns that increase injury risk. Damaged fascia can also heighten pain signaling due to nerve compression.

Research shows that when fascial gliding is restored, it improves motor unit recruitment patterns and wakes up dormant and inhibited muscle stabilizers. Dr. Kalika specializes in myofascial release techniques that restore the elastic and slippery properties that enable fascial gliding. This critical step is often missing in conventional JHS physical therapy, resulting in failed attempts to relieve pain and improve joint stability.

Advanced Diagnosis of Joint Hypermobility

Diagnosis of JHS is mostly joint-focused and symptoms-based, while hypermobile EDS (hEDS) often involves skin, organs, and other tissues. In both JHS and hEDS, diagnostic criteria are based on the Beighton Score — a diagnostic tool for joint hypermobility that assesses joint flexibility in 5 areas of the body, with a maximum score of 9 – the higher your score, the greater your joint laxity.

You can use the Beighton Score to assess your own joint mobility:

Clinicians typically use the Beighton Score along with other diagnostic criteria, such as reported symptoms of skin hyperextensibility, tissue fragility, chronic pain, and family history

High-Resolution Diagnostic Ultrasonography

NYDNRehab is one of the few private clinics to feature high resolution musculoskeletal ultrasonography. When used as a diagnostic tool, ultrasound lets us visualize the body's tissues and structures in motion, to observe how they interact. With real-time imaging, we are able to identify damaged fascia, detect entrapped nerves and blood vessels, and observe inefficient muscle recruitment patterns that contribute to JHS pain and dysfunction.

Sonoelastography

At NYDNRehab, we use ultrasound elastography – a specialized imaging technique that measures both the thickness and stiffness of deep fascia. In hypermobility disorders, deep fascia is often thicker than normal, and less stiff, indicating changes to connective tissues that characterize JHS and hEDS. Sonoelastography equips us with an advanced diagnostic tool that provides insights leading to a more accurate diagnosis, resulting in more targeted and effective treatment.

Lower Quarter Stability Motion Analysis

We use advanced technologies for objective and comprehensive analysis of the stability of the lower kinetic chain. These tests provide insight into how the patient's muscles, joints, and connective tissues work together to provide support, control movement, and prevent injury, helping us to customize the treatment protocol.

Running 3D Motion Analysis
at NYDNRehab clinic

Showmotion / neuralign

DATA- & FEEDBACK-DRIVEN
REHAB

3D Motion Analysis on C.A.R.E.N

Scapular Ultrasound Detects Mechanical Deficiencies

Imaging of the scapula using high-resolution ultrasound is an important tool for observing how the scapula moves relative to the humeral head of the shoulder joint. Accurate interpretation requires a skilled clinician with a comprehensive knowledge of human anatomy. Combining scapular ultrasound with ShowMotion technology provides substantial information for comprehensive shoulder rehabilitation.

Scapular imaging is especially useful for patients with rotator cuff tears, joint hypermobility syndrome (JHS), or Ehlers-Danlos syndrome (EDS) whose joints are prone to excessive movements and instability. In such cases, the connective tissues surrounding the shoulder joint tend to be lax and weak, causing poor joint stability and increasing the risk of shoulder subluxation/dislocation.

The scapula compensates for shoulder instability by acting as a stable base for positioning the glenoid fossa, to optimize positioning of the humeral head. Dynamic scapular stabilization requires well-coordinated muscle activation patterns, especially of the rotator, deltoid, trapezius and rhomboid muscles. Scapular dysfunction can increase strain on the rotator cuff and labrum, contributing to pain and instability.

Dynamic scapular imaging lets us observe the complex interactions of the shoulder girdle kinetic chain, to pinpoint issues such as deficiencies in muscle activation, glenohumeral joint subluxation, and capsular laxity that contribute to shoulder instability. For patients with rotator cuff tears , JHS/EDS patients, scapular ultrasound can be a game-changer, ensuring they receive proper rehabilitation that enhances stability after a shoulder dislocation.

Joint Hypermobility Treatment Options

Thanks to advanced technologies and regenerative therapies, there are new and innovative treatment options for JHS/EDS, but you won’t find them at most physical therapy clinics. NYDNRehab is one of the few private clinics in NYC where you can access a wide array of evidence-based advanced therapies for JHS treatment.

Ultrasound-Guided Orthobiologic and Injection Therapies

Ultrasound-guided fascial layer-specific hydro manipulation (FLuSH)

is an evidence-based technique for treating myofascial pain, based on the premise that multiple fascial layers are responsible for myofascial pain. The procedure involves the injection of normal saline into specific layers of the myofascial unit, causing the layers to separate and promoting tissue mobility.

Prolotherapy injections

Platelet-Rich Plasma (PRP) therapy

uses a high concentration of platelets, extracted from a sample of the patient’s own blood, injected into damaged tissues to stimulate a regenerative response. PRP contains growth factors and stem cells that accelerate tissue healing and reduce inflammation in damaged tissues.

Nerve hydrodissection

is a minimally invasive procedure used to release nerves entrapped within fascial planes. Saline is injected under ultrasound guidance into densified fascial layers that surround the nerve, freeing it from entrapment and restoring its ability to glide.

Botox/Xeomin Injections

help to relax hyperactive muscles and reduce myofascial pain. This method targets specific tissues under ultrasound guidance, helping to improve muscle balance and reduce muscle spasms that contribute to joint instability and pain.

Manual Myofascial Release

It is estimated that densified fascia is responsible for up to 50% of musculoskeletal pain and reduced mobility. Research shows that deep friction fascial manipulation can help to separate densified hyaluronic acid (HA) chains, disentangling them to restore their functional properties. Dr, Kalika is certified in Stecco Fascial Manipulation, an evidence-based methodology for treating densified fascia that restores its ability to stretch and glide.

Ultrasound Guided Percutaneous Neuromodulation (PENS)

During PENS treatment, filament-thin needles are inserted through the skin into muscle tissue adjacent to the targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate the dysfunctional nerve. PENS normalizes nerve activity, improves brain plasticity and optimizes muscle coordination patterns.

Specialized JHS/EDS Physical Therapy

Physical therapy introduces exercises designed to promote muscle balance, strengthen stabilizing structures, and optimize coordinated muscle activation patterns.

Functional Patterns Training

The human body is uniquely designed to walk and run on two legs, and to throw and carry objects. Functional patterns training is a methodology designed to optimize biomechanics in ways that promote movement efficiency and eliminate pain, aligning the body with its biological blueprint.

Blood Flow Restriction Training

BFRT is an innovative method of increasing muscle strength and size at much lower training volumes than conventional resistance training. The reduced load spares injured or unstable joints while strengthening the muscles and tendons that provide support and stability.

New Research Identifies Risks of
Joint Hypermobility

Connective tissue ruptures and joint dislocation are common risks in a number of sports. In this meta-analysis, the researchers set out to see if athletes with hypermobile joints were at a higher risk of traumatic shoulder injuries. They looked at several qualified studies involving a total of 2335 college-aged participants. They concluded that athletes with hypermobile joints were three times more likely to sustain shoulder injuries.

In another systematic review, researchers reviewed multiple eligible studies involving a total of 4,391 patients to explore the relationship between joint laxity and patellar instability. They concluded that hypermobile joints were a risk factor for patellar instability, and that patellar stabilization surgery resulted in poor outcomes for EDS patients.

One recent research article links alterations in proprioception in JHS patients to emotional dysregulation. The authors suggest that, due to deficits in proprioception, hypermobile joints can behave unpredictably, sending inaccurate signals to the brain and creating a heightened sense of anxiety and lack of confidence in people with JHS.

Preventing and Managing Hypermobile Joints

Ligaments are tough fibrous connective tissues that attach bones to bones, providing joint stability. Ligaments are not very elastic, and their length is more-or-less fixed in adults. But otherwise-normal joints can become hypermobile when subjected to injury or repeated stress. For example, an ankle sprain can cause ligaments to stretch or tear, creating ankle instability.

Activities like yoga, ballet, gymnastics and acrobatics whose training includes extreme stretching can lengthen ligaments, causing joint hypermobility and instability. Balancing those activities with strengthening exercises like resistance training can help to preserve ligament integrity and provide additional joint support through stronger muscles and tendons.

By contrast, JHS and DHS are hereditary conditions that cannot be prevented – only managed. Specialized physical therapy can help to increase strength, promote balance and coordination, and build confidence in hypermobility patients. Activities like swimming and water exercise can help to strengthen and stabilize joints without serious risk of injury. Optimizing lifestyle behaviors can improve overall health, reducing the burden of managing hypermobile joint disorders.

Beware of Agents that Can Make Your Condition Worse

It is important to note that hypermobile patients appear to have a heightened sensitivity to certain medications and environmental toxins that affect connective tissue integrity. Certain drugs that interfere with hormonal balance, collagen regulation, or mitochondrial function may cause increased tissue laxity, poor structural tone, and even neurologic or autonomic symptoms. Drugs known to affect connective tissues include:

Statins, broadly prescribed to treat high cholesterol, are known to cause muscle weakness and promote muscle and tendon ruptures.
Fluoroquinolones, a class of antibiotics used to treat a wide range of bacterial infections, can increase JHS/EDS symptoms.
Finasteride, used to treat benign prostate enlargement (BPE), has been shown to cause loss of skin tone, fascia dysfunction, and musculoskeletal complaints in JHS/EDS patients.
Mycotoxin exposure (especially from mold) is known to contribute to tissue laxity and systemic inflammation, making symptoms worse.

Get Advanced Therapy for Joint Hypermobility that Really Works

Despite their best intentions, conventional approaches to treating joint hypermobility have a poor track record of success. In fact, traditional physical therapy can actually make the condition worse. Most therapists lack the training or expertise to effectively address JHS/EDS, and pain management efforts like steroid injections do not produce long-term relief. Surgery is often recommended as a last resort, but surgery for EDS has a high rate of failure.

At NYDNRehab, our unique and comprehensive approach is based on years of experience and continuing education in advanced methodologies. Dr. Kalika and Dr. Brosgol are pioneers in cutting-edge therapies that are changing the game in rehabilitative medicine, providing new hope for JHS/EDS patients.

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Treatments at Nydnrehab

Clinical Case Studies
NYDNRehab

Case Study: Ultrasound Guided Dry Needling for Scoliosis-Related Pain and Mobility

Our Patient Our patient is a 30 year-old male who had been diagnosed with Ehlers-Danlos syndrome – a condition characterized by joint hypermobility. The patient’s medical history included frequent fractures and chronic pain in the lower back and buttock regions. The persistent pain was significantly impacting the patient’s daily activities and overall well-being. The patient […]

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Case Study: Lateral Epicondylitis

Our Patient Our patient is a 56 year-old male jeweler who came to us with lateral elbow pain. The patient is a very athletic tennis player who works out at the gym on a regular basis. He stated that his pain initially started at the front of his elbow and eventually moved toward his lateral […]

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Case Study: Joint Hypermobility Syndrome

Our Patient Our patient is a tall, slender 36 year-old female complaining of joint pain throughout her body, with her right (dominant) elbow causing the worst pain, and significantly interfering with her job and recreational activities. She also reported bloating, sluggish bowel movements and constipation. She had seen a number of doctors, including orthopedic surgeons, […]

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What is joint hypermobility?

Hypermobile joints are able to move beyond normal functional range of motion. Some people naturally have longer and/or looser ligaments – the structures that attach one bone to another at the joints. Joint hypermobility is genetic, but not everyone with hypermobile joints has stability issues. In fact, hypermobile joints can be advantageous for certain sports or activities, like gymnastics or yoga. But for some people, joint hypermobility is associated with chronic pain, reduced mobility and stability, and increased risk of injuries.

Is JHS the same as being double-jointed?

“Double jointed” is a non-clinical and inaccurate term for describing joint hypermobility – it implies you have extra joints! Joint hypermobility means your joints are extra mobile compared to most people, which may or may not be a problem for you. It’s estimated that up to 20% of people have some degree of joint hypermobility.

How can I manage my JHS?

Low intensity exercise like swimming or water exercise can help to strengthen your joint stabilizers with a low risk of injury. Physical therapy can help with muscle control and posture. Some people use a brace or elastic bandage to provide extra stability during physical activity. Avoid activities that focus on moving the joints beyond their functional range of motion, like yoga and ballet.

Will my JHS get worse over time?

A lot of factors can influence your JHS as you age. Most people’s joints become a bit stiffer with age, but that can vary widely from one person to the next. Women are more likely to have hypermobile joints than men. If you’re sedentary and overweight, your symptoms can worsen over time. Early intervention can help you enjoy a better quality of life as you age.

Certificates and Continuing Education

Research at NYDNRehab

2024Eccles, Jessica A., et al. "A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility." Philosophical Transactions of the Royal Society B 379.1908 (2024): 20230247.

2024Heighes, Libbi Anne, et al. "The relationship between joint hypermobility and patellar instability: A systematic review." Journal of Orthopaedics (2024).

2021Langevin, Helene M. "Fascia mobility, proprioception, and myofascial pain." Life 11.7 (2021): 668.

2021Liaghat, Behnam, et al. "Joint hypermobility in athletes is associated with shoulder injuries: a systematic review and meta-analysis." BMC musculoskeletal disorders 22 (2021): 1-9.

2021Malek, Sabeeha, Emma J. Reinhold, and Gemma S. Pearce. "The Beighton Score as a measure of generalised joint hypermobility." Rheumatology international 41.10 (2021): 1707-1716.

2021Wang, Tina, et al. "Myofascial injection using fascial layer-specific hydromanipulation technique (FLuSH) and the delineation of multifactorial myofascial pain." Medicina 56.12 (2020): 717.

Physical therapy and rehab can be time consuming,

and a faulty diagnosis can make treatment a total waste of time.

Failure to accurately diagnose a condition in its early stages can lead to chronic
problems and sometimes devastating results

Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.

Below is a prime example of how ultrasound can take the guesswork out of diagnosis.

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Accurate Diagnosis Is the ONLY way to

Successful Treatment

A bad physical therapy experience is one of the primary causes of unnecessary surgery

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medical innovation

We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.