Hypermobility spectrum disorder can cause joint pain, instability, recurrent injuries, headaches, dizziness, GI symptoms, pelvic pain, nerve irritation, and complex chronic pain patterns.
This video explains how hypermobility spectrum disorder can contribute to chronic pain, joint instability, headaches, autonomic symptoms, GI symptoms, pelvic pain, and overlapping conditions.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hypermobility is a spectrum disorder, with Ehlers-Danlos Syndrome (EDS) representing one end of that spectrum. Because EDS includes several uncommon genetic subdiagnoses, genetic testing is often performed to ensure specific screening requirements for those subsets are met.
Treatment begins by identifying three types of sensitization within the body:
Neurological Sensitization: Includes conditions such as headaches, craniocervical instability, small fiber neuropathy, and peripheral nerve entrapments.
Inflammatory Sensitization: Can be a primary inflammatory condition or Mast Cell Activation Syndrome.
Psychological Sensitization: May occur due to craniocervical instability, pre-existing stress, or long-term pain.
These layers of sensitization must be addressed first because they affect how the rest of the body experiences pain.
Hypermobility involves laxity in supporting structures, making joints “wobbly”. This causes the body to develop compensatory biomechanical patterns to protect the unstable joint, which unfortunately shifts stress to other hypermobile joints. Symptoms include clicking, popping, subluxations, dislocations, recurrent joint pain, and postural difficulties caused by ligaments failing to support the body against gravity.
Addressing hypermobility requires a step-wise approach to specific areas of pain:
Pelvis and Hips: Hips must be stabilized first to normalize pelvic tilt.
Shoulders and Neck: Unstable shoulders move forward, pulling the shoulder blade and neck into a painful posture. Treating craniocervical instability without first treating the shoulder will not result in a durable response.
The treatment process involves discovery, finding effective treatments, and a maintenance phase for optimal functioning. Hallmark treatments include regenerative medicine鈥攕uch as dextrose prolotherapy and platelet-rich plasma鈥攖o strengthen ligaments and stabilize joints. This is combined with physical therapy to retrain compensatory biomechanical patterns. At 91视频, a variety of providers work to diagnose and treat hypermobility and its associated conditions from multiple angles.
Hypermobility spectrum disorder, often called HSD, describes symptomatic joint hypermobility that causes pain, instability, recurrent injuries, or functional limitation but does not meet criteria for hypermobile Ehlers-Danlos syndrome or another specific connective tissue disorder.
HSD is not simply being flexible. Some people are hypermobile without symptoms, while others experience significant joint pain, repeated sprains, muscle guarding, headaches, dizziness, fatigue, abdominal symptoms, pelvic pain, nerve irritation, and complex chronic pain patterns.
At 91视频 (MPM), evaluation begins with a diagnosis-first approach. The goal is to understand whether pain is driven by joint instability, muscle overuse, nerve irritation, autonomic dysfunction, headache pathways, pelvic mechanics, GI overlap, central sensitization, or another medical condition.
For patients looking for hypermobility spectrum disorder treatment in NYC or hypermobility pain management in Manhattan, MPM evaluates symptoms through a full-body, systems-aware lens. The team considers joint instability, recurrent sprains, muscle guarding, tendon pain, nerve irritation, headache patterns, autonomic symptoms, pelvic pain, GI-related pain, and chronic pain sensitization.
MPM does not reduce hypermobility care to one painful joint or one isolated injury. Evaluation may include movement assessment, joint stability review, pain generator mapping, diagnostic ultrasound when appropriate, review of prior imaging or specialist workups, and coordination with rheumatology, genetics, cardiology, neurology, gastroenterology, gynecology, pelvic floor therapy, physical therapy, or other specialists when needed.
Treatment may include acupuncture, Feldenkrais, biofeedback, pain psychology, diagnostic ultrasound, ultrasound-guided injections, trigger point injections, prolotherapy, PRP, BMAC, peripheral joint injections, stellate ganglion blocks, C1/2 facet injections for selected CCI-related pain patterns, or sacroiliac joint stabilization procedures only when clinically appropriate.
Jason W. Siefferman, MD
Medical Director | Interventional Pain Management | Headache Medicine
Luis Aranguren, MD
Interventional Pain Management
Adam Rosenberg, PA-C
Board-Certified Physician Assistant
Tayyaba Ahmed, DO
Physical Medicine & Rehabilitation | Pelvic Pain
Nino Mikaberidze, MD
Director of Rheumatology & Internal Medicine
Deborah Barbiere, Psy.D., L.Ac.
Pain Psychology
Jordan Shankle, PA-C
Board-Certified Physician Assistant
Many patients with hypermobility spectrum disorder spend years being treated for separate symptoms before the broader pattern is recognized. A patient may be evaluated for joint pain, migraines, dizziness, abdominal pain, constipation, pelvic pain, fatigue, sprains, nerve symptoms, or anxiety around medical care without anyone connecting the full clinical picture.
HSD can be difficult to identify because imaging may not always explain the severity of pain. Joint laxity, proprioceptive strain, soft tissue overload, muscle guarding, nerve irritation, dysautonomia, GI symptoms, pelvic floor dysfunction, and central pain sensitization can all contribute to symptoms even when standard tests are unrevealing.
MPM鈥檚 diagnosis-first model is designed to identify treatable pain generators while coordinating with the right specialists when symptoms extend beyond pain medicine alone.
Hypermobility spectrum disorder can intersect with all of MPM鈥檚 Zones of Expertise. In Musculoskeletal issues and Hypermobility, HSD may contribute to joint instability, sprains, tendon pain, muscle guarding, SI joint pain, and orthopedic symptoms. In Headache, it may overlap with chronic migraine, CCI, Chiari malformation, intracranial hypertension, CSF outflow concerns, and neck-related headache patterns.
In Autonomic dysfunction, hypermobility may overlap with POTS, dizziness, orthostatic intolerance, fatigue, temperature sensitivity, GI symptoms, and autonomic instability. In Pelvic Pain, it may overlap with pelvic floor dysfunction, endometriosis-related pain, pudendal neuralgia, abdominal pain, and sacroiliac dysfunction. In Complex Chronic Pain and Psychology of Pain, HSD may overlap with central sensitization, fibromyalgia, medical PTSD, post-viral pain, and the emotional burden of prolonged diagnostic uncertainty.
MPM evaluates these relationships carefully so treatment is based on the patient鈥檚 specific pain pattern, not a generic hypermobility protocol.
I cannot say enough good things about 91视频. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional 鈥� knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit 91视频 because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I鈥檝e suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I鈥檓 feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor鈥檚 office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at 91视频. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I鈥檓 finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Hypermobility spectrum disorder is a condition in which joint hypermobility causes symptoms such as pain, instability, recurrent injuries, fatigue, or functional limitation, but the patient does not meet criteria for hypermobile Ehlers-Danlos syndrome or another specific connective tissue disorder. HSD can be clinically meaningful and can affect daily function, even when imaging or routine testing is normal.
No. HSD and hypermobile Ehlers-Danlos syndrome can look similar, but they are not the same diagnosis. HSD applies when symptomatic joint hypermobility is present but full criteria for hEDS or another connective tissue disorder are not met. Patients with HSD can still have significant pain, joint instability, fatigue, headaches, autonomic symptoms, GI symptoms, or pelvic pain that deserve careful evaluation.
Yes. HSD can contribute to chronic pain through joint instability, ligament laxity, recurrent injury, muscle guarding, tendon overload, nerve irritation, myofascial pain, pelvic floor dysfunction, headaches, and central pain sensitization. Pain may be localized to one joint or involve multiple regions. MPM evaluates which pain generators are most active before recommending treatment.
Hypermobility can make joints move beyond their usual range and place extra stress on ligaments, tendons, muscles, and joint capsules. This can contribute to sprains, strains, subluxation-like symptoms, overuse injuries, and compensatory muscle guarding. Some patients also have altered proprioception, meaning the body has more difficulty sensing joint position and controlling movement under load.
HSD can overlap with headache and neck pain in several ways. Some patients have chronic migraine, tension headache, cervical muscle guarding, TMJ dysfunction, cervical instability concerns, CCI, Chiari malformation, intracranial hypertension, or CSF outflow-related symptoms. Not every headache in a hypermobile patient is caused by hypermobility, so careful headache evaluation is important.
Hypermobility, POTS, and MCAS-like symptoms are commonly discussed together because some patients report overlapping joint hypermobility, dizziness, palpitations, fatigue, flushing, allergic-type symptoms, GI symptoms, and pain flares. These conditions should still be evaluated individually. MPM considers autonomic and inflammatory symptom patterns while coordinating with cardiology, allergy or immunology, rheumatology, gastroenterology, or other specialists when appropriate.
Some patients with HSD report abdominal pain, constipation, bloating, nausea, reflux, gastroparesis, or other motility-related symptoms. These symptoms may involve GI motility, autonomic dysfunction, pelvic floor coordination, medication effects, connective tissue differences, or overlapping pain sensitization. MPM does not replace gastroenterology care, but can evaluate pain contributors that may coexist with GI symptoms.
Hypermobility can overlap with pelvic pain through pelvic floor dysfunction, sacroiliac joint dysfunction, hip instability, abdominal wall pain, pudendal neuralgia, endometriosis-related pain, and central sensitization. Pelvic pain often has more than one driver, so MPM evaluates pelvic floor, nerve, hip, SI joint, abdominal, gynecologic, and musculoskeletal contributors when clinically relevant.
Hypermobility-related pain evaluation begins with a detailed history, physical exam, movement and joint stability assessment, symptom mapping, review of prior imaging, and consideration of overlapping conditions. MPM evaluates whether pain is driven by joint instability, nerve irritation, muscle guarding, headache pathways, spine or pelvic mechanics, autonomic symptoms, GI overlap, inflammatory conditions, or chronic pain sensitization.
Treatment depends on the pain generator. Options may include stabilization-focused physical therapy coordination, Feldenkrais, acupuncture, biofeedback, pain psychology, medication management coordination, diagnostic ultrasound, ultrasound-guided injections, trigger point injections, peripheral joint injections, prolotherapy, PRP, BMAC, or other selected interventions. The goal is to support function and reduce symptom burden while avoiding unnecessary or poorly matched treatment.
Regenerative options such as PRP, prolotherapy, or BMAC may be considered in selected patients when a specific ligament, tendon, joint, or instability-related pain generator has been identified. These treatments are not appropriate for every patient with HSD and should not be presented as a cure for hypermobility. MPM reviews diagnosis, anatomy, goals, risks, and evidence before considering regenerative care.
A specialist evaluation may be helpful when hypermobility is associated with chronic pain, recurrent sprains, subluxation-like symptoms, frequent injuries, dizziness, headaches, GI symptoms, pelvic pain, nerve symptoms, family history, or functional limitation. Depending on symptoms, care may involve rheumatology, genetics, cardiology, neurology, gastroenterology, gynecology, physical therapy, or pain medicine.
Seek urgent medical evaluation for sudden severe headache, new weakness or numbness, fainting, chest pain, shortness of breath, sudden severe abdominal pain, new bowel or bladder changes, fever, major trauma, rapidly worsening neurologic symptoms, or severe unexplained pain. Some symptoms may reflect conditions outside HSD and require emergency or specialist evaluation.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If hypermobility spectrum disorder, joint instability, headaches, POTS symptoms, GI symptoms, pelvic pain, nerve symptoms, or complex chronic pain is affecting your life, MPM can help evaluate what may be contributing. Our diagnosis-first approach looks beyond one painful joint to understand the full pattern of pain, function, and overlapping conditions. Request an appointment to discuss your symptoms and care options.
Jason W. Siefferman, MD
Jason W. Siefferman, MD
MPM
Hypermobility spectrum disorder describes symptomatic joint hypermobility that causes pain, instability, recurrent injury, or functional limitation. It is used when a patient has clinically meaningful hypermobility symptoms but does not meet diagnostic criteria for hypermobile Ehlers-Danlos syndrome or another specific connective tissue condition.
This distinction matters. A patient does not need to meet hEDS criteria to have real pain, significant disability, or complex symptoms related to hypermobility. HSD can affect daily life through joint instability, muscle guarding, repeated sprains, fatigue, headaches, dizziness, GI symptoms, pelvic pain, and nerve irritation.
Hypermobility-related pain can develop through several mechanisms. Joints that move beyond their usual range may place extra stress on ligaments, tendons, muscles, and joint capsules. Muscles may tighten or guard to stabilize joints that feel unstable. Recurrent sprains, subluxation-like episodes, tendon irritation, myofascial trigger points, and peripheral nerve irritation can all contribute to pain.
Some patients also develop central sensitization, where the nervous system becomes more reactive over time. This does not mean pain is imagined. It means the pain system may become easier to trigger and harder to calm, especially after repeated injuries, prolonged symptoms, poor sleep, medical trauma, or overlapping inflammatory and autonomic conditions.
Joint instability is one of the most common pain drivers in HSD. Patients may report frequent sprains, joints that slip or feel unstable, pain after small movements, recurring tendon pain, or difficulty building strength without flaring symptoms.
Common areas of concern may include the neck, shoulders, wrists, hips, knees, ankles, sacroiliac joints, ribs, jaw, and pelvis. Conditions such as chronic sprain, anterior pelvic tilt, shoulder instability, TMJ dysfunction, cubital tunnel syndrome, peroneal nerve entrapment, and peripheral nerve entrapment may overlap with hypermobility-related mechanics.
MPM evaluates whether pain is coming from instability, muscle compensation, joint irritation, nerve compression, tendon overload, or a separate pain generator.
Headache and neck pain are common concerns among patients with symptomatic hypermobility. Some patients have chronic migraine, tension headache, TMJ-related headache, cervical dystonia, trigeminal neuralgia, or trigeminal autonomic headache patterns. Others are concerned about craniocervical instability, Chiari malformation, CSF outflow obstruction, intracranial hypertension, or other structural contributors.
MPM evaluates headache and neck pain through a careful clinical lens. The goal is not to assume that every headache in a hypermobile patient is caused by instability. Instead, the evaluation considers headache type, neurologic symptoms, neck mechanics, jaw function, autonomic symptoms, prior imaging, and red flags that may require neurology, neurosurgery, ophthalmology, or other specialty input.
Many patients with symptomatic hypermobility report symptoms of autonomic dysfunction, including dizziness, palpitations, fatigue, heat intolerance, nausea, brain fog, weakness, or symptoms that worsen when standing. POTS, or postural orthostatic tachycardia syndrome, may coexist with hypermobility in some patients.
Patients may also report MCAS-like symptoms, including flushing, allergic-type reactions, GI symptoms, itching, swelling, or symptom flares. These symptoms require careful evaluation and should not be assumed based on hypermobility alone.
MPM鈥檚 role is to evaluate how autonomic symptoms may interact with pain, function, headache, GI symptoms, and chronic pain sensitization while coordinating with cardiology, neurology, allergy or immunology, rheumatology, gastroenterology, or primary care when needed.
HSD can overlap with gastrointestinal symptoms such as abdominal pain, chronic constipation, gastroparesis, bloating, nausea, reflux, early fullness, or bowel motility concerns. These symptoms may involve autonomic dysfunction, connective tissue differences, pelvic floor coordination, medication effects, visceral sensitivity, or overlapping GI conditions.
MPM does not replace gastroenterology care. For patients with hypermobility and abdominal or GI-related pain, MPM evaluates pain contributors that may coexist with digestive symptoms, including abdominal wall pain, nerve irritation, pelvic floor dysfunction, autonomic symptoms, medication effects, and central sensitization.
Pelvic pain in patients with HSD can be complex. It may involve pelvic floor dysfunction, pudendal neuralgia, endometriosis-related pain, abdominal wall pain, hip impingement, labral tears, sacroiliac joint dysfunction, piriformis syndrome, anterior pelvic tilt, or central pain syndromes.
Hypermobility may affect pelvic stability, hip mechanics, SI joint loading, and pelvic floor muscle guarding. Chronic pelvic pain may also overlap with bowel, bladder, sexual, gynecologic, neurologic, and musculoskeletal symptoms.
MPM evaluates pelvic pain through a coordinated model, working alongside gynecology, urology, GI, pelvic floor therapy, orthopedics, rheumatology, neurology, and other specialists when needed.
Some patients with HSD experience nerve-related symptoms such as burning, tingling, numbness, electric pain, weakness, radiating pain, or positional nerve symptoms. These may reflect peripheral nerve entrapment, cubital tunnel syndrome, peroneal nerve irritation, cervical or lumbar radiculopathy, small fiber neuropathy, autonomic neuropathy, or other neurologic conditions.
Joint laxity, altered mechanics, repetitive compression, and tissue sensitivity may increase nerve vulnerability in selected patients. MPM evaluates the full nerve pathway rather than assuming symptoms come from one location. Diagnostic ultrasound, ultrasound-guided injections, or nerve hydrodissection may be considered only when anatomy and findings support that plan.
Many patients with hypermobility-related pain are told that imaging is normal or that lab results do not explain their symptoms. This can be frustrating, but it does not mean the pain is not real. Pain can come from instability, soft tissue strain, muscle guarding, nerve irritation, dysautonomia, pelvic floor dysfunction, or sensitized pain pathways that may not be obvious on routine imaging.
MPM evaluates the clinical pattern, not just the imaging report. Prior imaging, labs, specialist notes, and treatment responses can be useful, but they must be interpreted alongside the patient鈥檚 symptoms, exam findings, function, and goals.
Treatment for HSD-related pain should be individualized and stepwise. Many patients benefit from stabilization-focused physical therapy, pacing, activity modification, movement retraining, bracing when appropriate, sleep support, and symptom-specific care.
MPM may consider acupuncture, Feldenkrais, biofeedback, pain psychology, medication management coordination, diagnostic ultrasound, ultrasound-guided injections, peripheral joint injections, trigger point injections, prolotherapy, PRP, BMAC, C1/2 facet injections for selected CCI-related pain patterns, stellate ganglion blocks for selected autonomic or pain patterns, or sacroiliac joint procedures when supported by the diagnosis.
These treatments are not automatic and are not appropriate for every patient with hypermobility spectrum disorder. Procedures require careful diagnosis, risk discussion, anatomy review, and clinician supervision.
Patients with HSD often ask whether regenerative medicine can help unstable or painful joints. Options such as prolotherapy, PRP, or BMAC may be considered in selected cases when there is a specific ligament, tendon, joint, or instability-related pain generator.
These treatments should not be described as curing HSD, repairing all connective tissue, or permanently stabilizing every joint. They are considered only after careful review of diagnosis, anatomy, severity, evidence, prior care, and goals.
Many patients with hypermobility-related pain have experienced years of dismissal, delayed diagnosis, painful procedures, unclear explanations, or repeated medical encounters. This can contribute to medical PTSD, fear of movement, anxiety around appointments, and increased nervous system threat response.
Pain psychology, biofeedback, and trauma-informed care can help support coping, nervous system regulation, sleep, pacing, and function. These tools do not mean pain is psychological or imagined. They are part of a broader strategy to reduce threat, improve predictability, and help patients reengage with care safely.
Hypermobility symptoms should be evaluated urgently when there is sudden severe headache, new weakness or numbness, fainting, chest pain, shortness of breath, sudden severe abdominal pain, bowel or bladder changes, fever, major trauma, rapidly worsening neurologic symptoms, or severe unexplained pain.
Some symptoms may reflect other connective tissue, autoimmune, neurologic, endocrine, inflammatory, genetic, vascular, or structural conditions. These may require additional specialist evaluation, emergency care, or diagnostic workup beyond pain medicine.
MPM approaches hypermobility spectrum disorder through a diagnosis-first, coordinated model. The goal is to understand the patient鈥檚 full symptom pattern, identify active pain generators, avoid overly simplistic explanations, and coordinate care across the right specialties.
For patients looking for hypermobility spectrum disorder treatment in NYC, hypermobility care in Manhattan, or HSD pain management, MPM offers a structured pain medicine perspective focused on joint instability, headache, autonomic symptoms, pelvic pain, nerve pain, GI overlap, and complex chronic pain.
The goal is not to cure HSD or treat every symptom with a procedure. The goal is to clarify what is driving pain, support function, and build a coordinated plan that reflects the patient鈥檚 actual condition, risks, and goals.