Joint Hypermobility Syndrome

About JHS

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.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Hypermobility Specialist Dr. Lev Kalika

Dr. Kalika is a world-class specialist with 25 years of experience treating pain syndromes and movement disorders. With multiple scientific publications to his credit, Dr. Kalika’s knowledge and expertise are unrivaled in NYC. He has studied and trained under several of the world’s most recognized human movement specialists, and has earned multiple certifications in cutting-edge therapeutic techniques. Dr. Kalika is an expert in diagnostic musculoskeletal ultrasonography, an invaluable tool for visualizing the body’s structures in motion. The clinic at NYDNRehab is one of the few physical therapy clinics in the USA to feature the latest research-grade ultrasound equipment, providing patients with accurate and convenient on-site diagnostic imaging. Dr. Kalika’s in-depth comprehension of human anatomy and the factors involved in joint stability and mobility make NYDNRehab your clinic of choice for joint hypermobility therapy in NYC.

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 and blood vessels
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury

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.


Symptoms and Causes of JHS


  • ankles
  • knees
  • shoulders
  • wrists
  • fingers
  • elbows


  • Stiff painful joints and muscles
  • Joints that click or pop
  • Frequent dislocated joints
  • Fatigue
  • Recurrent sprains or other injuries
  • Digestive issues
  • Thin stretchy skin

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.

  • 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.


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 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.


Our Regenerative Therapies are
Game-Changers for JHS

Your body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Non-invasive regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level.

Focused Shockwave Therapy

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT technology produces high frequency sound waves to reduce pain and inflammation and stimulate the body’s own reparative mechanisms.

Myofascial Acoustic Compression Therapy (MyACT)

Our new PiezoWave shockwave machine features MyACT, a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain.

This innovative shockwave technology transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Its versatile system of controls lets us fine-tune its output levels for precise and personalized patient care. With MyACT, we are able to repair and regenerate damaged tissues by stimulating the body’s own reparative mechanisms.

Myofascial Acoustic Compression Therapy (MyACT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, also called radial shock wave therapy, is not a true shockwave, but uses mechanical pressure waves that are much weaker than focused shockwaves. EPAT is most useful in regenerating fascia fibroblasts and eliminating fascia densifications.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT transmits high energy magnetic pulses that synchronize with your body’s own magnetic fields, triggering a regenerative response in tendons, muscles, bones and nerves.

Extracorporeal Magnetic Transduction Therapy (EMTT)

INDIBA Radiofrequency Therapy

INDIBA Radiofrequency Therapy

INDIBA therapy helps to restore the ionic charge of damaged cells, for faster injury healing.

NESA Neuromodulation Therapy

The NESA device generates a biphasic low-frequency electrical current that travels through autonomic neural pathways, to restore optimal neural signaling to the brain.

NESA Neuromodulation Therapy


High Energy Inductive Therapy (HEIT)

High Energy Inductive Therapy (HEIT) is a new technology that uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT relieves pain by restoring peripheral nerve function.

Laser Therapy

Laser therapy is a non-invasive approach to treating chronic pain that reduces inflammation, eliminates pain and speeds up tissue healing. The treatment uses light energy to penetrate your skin, muscle, nerve, and connective tissues, stimulating a photochemical reaction that changes the chemical and physical properties of the affected area at the molecular level

Phoenix Theralase Laser Therapy


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.

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.


Ultrasound Guided Hydrodissection

Hydrodissection is a technique for treating peripheral nerve entrapment. It uses a saline solution to separate entrapped nerves from surrounding fascia adhesions or adjacent structures.

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.


Treatment for JHS in NYC

If your hypermobile joints are causing you pain or keeping you from being physically active, the sports medicine team at NYDNRehab 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 NYDNRehab today, and see why we are the very best rehabilitation clinic in NYC.

Clinical Case Studies

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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    Range of Available Unique Physical Therapy
    Treatments at Nydnrehab


    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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