Hypermobility Spectrum disorders - Is it About Nature or Nurture?
A strong connection exists between joint hypermobility spectrum disorders, trauma, and chronic pain, raising questions about which occurs first?
Genetics (Nature) establish connective tissue laxity, while lived experiences (Nurture), such as injuries or emotional stress, dictate how the nervous system processes that laxity, frequently creating a self-reinforcing feedback loop of threat, tension, and chronic pain. While trauma doesn't cause hypermobility, it can shape how symptoms are processed and maintained, which has the tendency to increase physical symptoms.
Factors which may contribute to heightened pain sensitivity and the likelihood of traumatization in Hypermobile populations:
Heightened sensitivity to internal sensations - The nervous system and connective tissue continuously interact, influencing pain sensitivity and responses to internal sensations. Individuals with hypermobility often experience heightened threat detection due to elevated sensitivity to internal bodily sensations. This biological wiring makes their nervous system highly reactive, amplifying internal signals and interpreting them as danger.
Reduced proprioceptive feedback from the joints - Many hypermobile people have reduced joint position sense, meaning the brain receives fuzzier information about joint locations, which can result in guarding, muscle tension, avoidance, over-control, and pain as a protective signal.
Interoceptive Mismatch - Hypermobile individuals often have altered processing of internal signals, meaning their brains may either over-amplify or poorly categorize bodily sensations (e.g., heart rate spikes, temperature shifts). Lax connective tissue, fluctuating blood pressure and fascial tension send erratic sensory data to the brain. The brain’s prediction of how the body should feel does not match the actual, unpredictable physical feedback.This makes it difficult to interpret these feelings as "safe" or “threatening”. Because of this constant internal unpredictability, the brain may perceive harmless but overwhelming bodily sensations as actual threats, leading to heightened arousal and eventually to autonomic dysregulation.
Tendency toward autonomic freeze states - Due to struggles with interoceptive accuracy (sensing and accurately interpreting internal bodily states) and proprioception (joint position awareness) signals from the body are frequently misread by the brain as danger or pain, keeping the threat-detection centers perpetually engaged. When their physical or emotional systems are overloaded by background pain, tissue laxity, or sensory overload, the nervous system often defaults to an autonomic freeze response, a form of parasympathetic shutdown, as a protective measure.The parasympathetic shutdown results in immobilization, emotional numbness, and dissociation, which can feel profoundly inescapable and overwhelming. Because the physical sensation of immobilization can be so intense and seemingly inescapable, the brain is more likely to encode these intense episodes as traumatic, compounding the overall emotional toll.
Resistance to local anesthetics - A higher prevalence of resistance to local anesthetics results in more painful medical procedures, leading to a higher rate of medical trauma.
Exploring the Connection Between Joint Hypermobility Spectrum Disorders and Trauma
There is a strong correlation between trauma, whether physical injury, acute emotional trauma, medical trauma or early life stress, transgenerational trauma and hypermobility symptoms, rooted in the interaction between the brain and body. Trauma doesn’t necessarily mean a single or several catastrophic events. Many people experience trauma as repeated injuries, years of unexplained symptoms, being told “everything looks normal,” feeling dismissed, or pushing through pain because rest wasn’t an option.
Recent discussions emphasize the link between Hypermobility Spectrum Disorders and trauma, suggesting that epigenetics or inherited trauma might influence the severity and specific expressions of HSD. Emerging evidence reveals that various trauma forms can affect both biological and psychological functions through stress-response systems. This perspective is crucial when examining these disorders, as they may represent expressions of the system rather than merely medical anomalies. However, viewing these conditions exclusively through the trauma lens can be detrimental, as individuals with HSD often already feel misunderstood by the medical community. Reducing their experiences to mere reactions may intensify this sense of misunderstanding.
Additionally, focusing exclusively on 'why' can entrap individuals in a cycle of endless questioning, distracting them from proactive measures to improve their health and well-being. While understanding their condition can nurture self-compassion, it may not be enough to create a life that respects their innate nature. Instead, efforts should concentrate on rewiring responses shaped by both nurturing and intergenerational influences, while also respecting the innate nature of the individual’s organism and building habits that best support that.
Comprehensive understanding of this condition is a requirement for establishing an effective treatment plan
An effective approach often includes improving joint control and strength, restoring awareness of body position, supporting nervous system regulation, reducing pain sensitivity, and rebuilding confidence in movement. People who have experienced chronic stress or trauma may get stuck in habitual movement and tension patterns. Improvement begins by identifying triggers and relationships, and gaining the mental and physical tools needed for safety and resilience.
From my clinical experience, integrating somatic work to help change our responses to pain and to build more accuracy in reading and perceiving our internal sensations, together with movement-based practice that both helps reduce protective tension while building more proprioceptive accuracy, has been proven to produce the best patient outcomes. Working with a hypermobile body with heightened pain and threat sensitivity always means that progression is expected to be slower, but part of the work is also learning to respect our innate nature rather than working against it.
Check out my package that integrates Somatic work with Postural restoration treatment in case you are interested in this type of treatment designed with your individual needs in mind: https://app.paperbell.com/checkout/packages/142709
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-Ansku
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