Joint Hypermobility

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If you have ever entertained your friends with body contortions, excelled at ballet, yoga or gymnastics, or been called “double-jointed,” you may have hypermobile joints that are able to extend beyond what is considered normal range of motion. The condition affects up to 15 percent of the population, and women are three times more likely to be hypermobile than men.
Many people with hypermobile joints experience few problems, but for some, hypermobility can cause pain and instability during physical activity, a condition called joint hypermobility syndrome, or JHS.
While hypermobiliy can be advantageous in certain sports and activities, hypermobile joints can be highly unstable, making you vulnerable to injury. As you age, joint hypermobility can contribute to balance issues that increase your risk of falling. In older adults, hypermobile joints are more prone to osteoarthritis from wear and tear.

Why Physical Therapy Alone May Not Resolve Your Condition

Physical therapy is a valuable and effective approach to resolving musculoskeletal pain and dysfunction, but in many cases, physical therapy does not provide a stand-alone solution. Prior to beginning physical therapy, patients often need to address underlying issues that contribute to their pain and disability.

Unfortunately, mainstream physical therapy clinics are often not adequately equipped or experienced to identify and treat complications that undermine the effectiveness of physical therapy. They often rely on one-size-fits-all treatment protocols that overlook the unique characteristics of the individual condition, opting to treat the symptoms and not the patient.

Issues that should be addressed prior to beginning physical therapy include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury
Block PT

Holistic Non-Invasive Diagnosis and Regenerative Therapy

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to do so can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

At NYDNRehab, we use a broad range of advanced technologies and innovative therapeutic approaches to resolve issues that can potentially undermine the success of physical therapy.

Our talented staff is certified in a diverse array of treatment methodologies, rarely found in run-of-the-mill physical therapy clinics. Our one-on-one sessions are personalized, based on the patient’s unique diagnostic profile.

Obstacles to physical therapy success include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury

Joint Hypermobility Causes

Loose or elongated ligaments within the joint capsule are the primary cause of hypermobile joints. The condition is largely hereditary, resulting from longer than normal ligaments, or from overly elastic connective tissue. Weak or overstretched muscles and connective tissue can contribute to hypermobility. In addition, some people inherit a rare genetic disorder known as Ehlers-Danlos syndrome (EDS). EDS affects connective tissues in the skin, joints, and blood vessel walls. EDS symptoms include overly flexible joints that easily dislocate, translucent elastic skin that bruises easily, and dilation or even rupture of major blood vessels.
Joints that are most prone to hypermobility include:
  • ankles
  • knees
  • shoulders
  • wrists
  • fingers
  • elbows
While hypermobility imposes the greatest risk to joints of the extremities, it can also affect the head, neck, trunk and low back. Activities that demand extreme joint range of motion like dance, gymnastics and yoga can increase joint hypermobility.

Joint hypermobility syndrome symptoms

Many hypermobile people never report health problems associated with lax joints, while other experience symptoms ranging from nagging to severe.
Hypermobility symptoms include:
  • Stiff painful joints and muscles
  • Joints that click or pop
  • Frequent dislocated joints
  • Fatigue
  • Recurrent sprains or other injuries
  • Digestive issues
  • Thin stretchy skin
When occurring in conjunction with hypermobility, these symptoms indicate JHS.

Ehlers-Danlos Syndromes (EDS)

One unique subset of JHS are Ehlers-Danlos Syndromes, a group of connective tissue disorders characterized by hypermobile joints, hyperelastic skin and fragile tissues. To date, 13 subcategories of Ehlers-Danlos Syndrome have been identified, each with its own peculiar characteristics. The syndromes are thought to be hereditary, and many symptoms overlap from one category to the next.
Most symptoms of Ehlers-Danlos Syndromes affect the joints and skin, which are often fragile and painful:
  • Joints: Joints are loose and unstable, and often painful and prone to dislocation.
  • Skin: Skin is velvety-soft and tears and bruises easily; wounds heal slowly.
  • Less common: Fragile arteries, intestines and uterus; scoliosis, poor muscle tone, mitral valve prolapse and gum disease.

Diagnosis of JHS

In addition to a health history and clinical exam, your therapist may use a goniometer to measure your joint angles, and ask you a number of questions, including:
  • Can you bend forward and place your palms flat on the floor without bending your knees?
  • Does your thumb bend back far enough to touch your arm?
  • Can you perform a full split
  • Are you prone to dislocation of shoulders, elbows or knees?
  • Have you been called “double jointed?”

Your therapist may also use diagnostic ultrasound to view your joints and muscles in motion. High resolution diagnostic ultrasonography is especially advantageous for patients with JHS, and reveals much more than can be obtained from MRI imaging. Ultrasound imaging lets us view the joints in real time, with the patient in motion, to get a full picture of the muscles, bones, nerves and ligaments.

In many cases, patients with EDS and JHS have subclinical nerve compressions that cause pain and impair movement. Dr. Kalika’s expertise in diagnostic ultrasound enables him to detect compressed nerves, which can then be therapeutically treated.


The sports medicine specialists at NYDNRehab are experts in diagnostic musculoskeletal ultrasonography, including recent technological innovations like sonoelastography that allows us to measure muscle stiffness and visualize the joints in motion. This new technology is available to patients, right in our clinic. It lets us pinpoint which part of the muscle that controls the hypermobile joint can be activated by the patient, and why. Sonoelastography helps us find an effective muscle activation strategy and monitor the progress of treatment.

Please explore more advanced diagnostic option unavailable anywhere else:


Regenerative Technologies
for Myofascial Pain

The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.

Dr. Kalika’s unique approach emphasizes tissue normalization using regenerative technologies. He also uses specialized physical therapy methodologies, such as dynamic neuromuscular stabilization (DNS) to promote global joint control and stabilization, and the Integrated systems Model (ISM) for local control and stabilization. Dr. Kalika has over 20 years of experience in DNS therapy, with a proven track record of success. He is an expert in ultrasound guided dry needling, with multiple scientific publications on the topic.

Therapeutic treatment options at NYDNRehab include:

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields, causing a disturbance that triggers a regenerative response. EMTT waves can penetrate deep tissues up to 18 cm beneath the skin’s surface, to target difficult-to-reach tendons, muscles, bones and nerves.

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to accelerate the healing process.

High Energy Inductive Therapy (HEIT)

HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to stimulate healing of nerves, muscles and blood vessels.

INDIBA CT9 Radiofrequency Device

INDIBA CT9 Radiofrequency Device

Our INDIBA Tecar therapy machine converts electrical current into a stable radio frequency current of 448 kHz, designed to increase and stabilize the exchange of ions in damaged cells, evoking a regenerative response that accelerates healing. INDIBA can be used to successfully treat joint and muscle disorders, low-back pain, sports injuries, surgical incisions and various pain syndromes. Another therapeutic effect of INDIBA is extreme and prolonged cellular hyperthermia. Due to this effect, INDIBA therapy combined with manual therapy and soft tissue tissue manipulation enables instantaneous release to occur, significantly shortening the number and duration of physical therapy sessions. What is normally accomplished in two months of physical therapy can be accomplished in 3-4 sessions with INDIBA.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to lower back pain. Dry needling is an outpatient procedure that inserts non-medicated needles into the trigger point to evoke a twitch response, releasing the trigger point and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing pain and discomfort for the patient.

Regenerative Ultrasound Guided Injection Therapies

Ultrasound Guided Injection

Injection therapies use natural/neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

Focused Shockwave Therapy

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start healing in chronic injuries and accelerate repair in acute injuries.

Proliferation Therapy, aka Prolotherapy

Prolotherapy uses a biologically neutral solution, often containing dextrose, saline or lidocaine. The solution irritates the affected connective tissue, stimulating the body’s own natural healing mechanisms to encourage growth of new normal ligament or tendon fibers.

Electromagnetic Transduction Therapy (EMTT)


NYDNRehab offers the only outpatient gait and motion analysis lab featuring research grade technology. Our unique C.A.R.E.N system (computer assisted rehabilitation environment) integrates 3D gait and motion analysis with a 6-degrees-of-freedom moveable force plate platform, to help us identify faulty movement mechanics in hypermobile joints.
KINEO is an artificial intelligence technology invented by and for professional soccer teams, to prevent and rehabilitate injuries. This technology has proven to be especially useful for treating patients with joint hypermobility.
Kineo provides advanced muscle analysis and rehab technology to measure concentric/eccentric muscle strength and balance. Kineo’s multimodal muscle strengthening capability offers two unique features for patients with joint hypermobility:
  • Viscous mode allows completely safe targeted strengthening similar to aquatic exercise
  • Elastic mode offers reactive neuromuscular training, which is crucial to restoring muscle firing speed so the joints can be protected in time
Proteus Motion System Revolutionizes Resistance Training
Proteus is a multimodal technology for shoulder rehabilitation. It is based on collinear resistance that allows for optimal strengthening of the rotator cuff muscles. This is extremely important for hypermobile patients who suffer from shoulder pain.

Hypermobility physical therapy treatment

There is no cure for JHS, but you can manage your condition with physical therapy and exercises designed to balance muscle tension and increase joint stability. Your therapist may use real time ultrasound to help you activate and retrain deep muscles to improve overall stability. Postural correction therapy can help protect your joints by putting them in proper alignment to reduce excessive stress. Gait analysis and retraining can identify and correct motor deficiencies that increase your risk of injury while walking or running.
One promising new therapy for JHS leverages the benefits of aquacise to provide a pain-free and effective method of joint stabilization. Kineo viscous water therapy applies the principles of water viscosity for concentric and eccentric loading, where the load adapts precisely to the actual strength of the patient. The water viscous method is particularly effective for the knee joint, providing progressive increases in the viscous load to promote strength and stability.
Following are the most beneficial characteristics of the viscous method:
  • The resistance load increases or decreases according to speed of movement and level of viscosity.
  • Speed depends on the amount force applied by the patient, allowing them to avoid pain.
  • Due to buoyancy, there is no inertia. Once movement stops, joint loading resets to zero, increasing patient safety.
  • Biphasic load: concentric and eccentric loads can be adjusted independently.
  • The ability of the patient to adjust the load by altering speed empowers them to actively participate in their own rehabilitation.
For athletic and physically active individuals, a therapist can design an individualized training program specific to your sport or activity, to increase joint stability and reduce your risk of injury. Athletic taping, elastic bandages or padding may add increased protection.
If you are hypermobile, you can take a proactive approach to increase your joint stability and reduce your risk of injury. A physical therapist can prescribe a personalized exercise regimen to help you achieve optimal joint function and mobility.

Hypermobility specialist NYC

If your hypermobile joints are causing you pain or keeping you from being physically active, the sports medicine team at NYDNR can help. We combine state-of-the-art technology with world-class expertise to give our patients the very best care and treatment. Make an appointment with NYDNR today, and see why we are the very best rehabilitation clinic in NYC.



In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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