How to get the most out of your physical therapy for hypermobility

​Congratulations! You’ve chosen to start physical therapy, the most effective way of addressing hypermobility - related musculoskeletal concerns and symptoms in individuals with hypermobility spectrum disorder (HSD) and Ehlers-Danlos Syndrome (EDS). Please take the following suggestions to heart in order to maximize the benefit of your therapy, prevent future problems and help you achieve your highest possible level of function.

1. The hypermobile body changes more slowly than the average body does. Be prepared for a long-term investment in your health. Physical therapy is about building a stronger, better-functioning body, and this does not happen overnight. The time you’ll need to meet your goals varies greatly, but several months to a year (and for some more) is a safe ball-park figure. 
2. Physical therapy is about examining your body, finding out what the “weak links” that are contributing to your symptoms are, and correcting them. This correction is a gradual process, and the exercises and recommendations for lifestyle changes you’ll receive are not intended to be palliative and give instant relief. Their effects are gradual.
3. A crucial part of this corrective process is your home program. This consists of therapeutic exercise and the application of new skills and abilities to your activities of daily life. Both are equally important, and the success of one depends on the other. All movement practices have value, but most are not specifically designed to correct the weak links of your hypermobile body. Attempting to compensate for low adherence to your PT with your favorite movement hobby is a mistake, as it lacks the specificity needed. Allowing physical therapy to first correct weak links will help you safely enjoy other forms of movement later.
4. Watch out for the trap of passive, palliative care. Massages, medications, hot packs, injections etc all have their place, but it is crucial to remember that your symptoms are arising for a reason, and that that reason is not addressed by merely addressing symptoms. As an example, even when a headache medication works the need for correcting the reasons headaches happen still remains. Even when a massage feels good, the reason muscles feel tight or uncomfortable in the first place remains. Actively working to eliminate the underlying reasons moves you in the right direction, whereas merely using passive measures may well keep you trapped in the cycle of pain. 
5. Does the therapy seem gentle, like it focuses on details, stability as opposed to movement, and doesn’t make you sweat and move as vigorously as some forms of movement do? That’s because we need to, logically, start from the beginning. The body needs stability before strength and speed can be safely added. Changing movement patterns and other habits has to happen at slow speeds. Once you’ve mastered stability, lighter resistance and correct motion at slower speeds you can absolutely – and I would argue should – work your way towards exercise that requires great effort, speed and involves both sweating and great effort. But quality has to precede quantity!
6. Physical therapy should not hurt. If your exercises hurt, you are either performing them incorrectly or  you’re not yet ready for them. Please let your therapist know so that your exercises can be adjusted accordingly. You should understand the rationale behind all interventions. If you don’t, please ask. You should be clear about your goals, both the overall long-term goals and the goals for each exercise and lifestyle change.
7. Your exercises are very much like a Rx drug: perform them exactly as prescribed, with the recommended frequency and duration. They will not have the desired effect unless you approach them with great consistency. Do yourself the favor of giving your body the best chance to show it’s highest potential!
8. Your health has biomechanical, biochemical, psychological, sociological and many other dimensions. The effect of health on various planes is cumulative and synergistic. Physical therapy works best when you enjoy deep sleep, good nutrition (with sufficient protein being very important for both tissue growth and repair), are well informed, have social support and low levels of stress. Medical interventions can facilitate physical therapy, and various therapies can enhance one another. Think of your health broadly and don’t underestimate the importance of getting the basics right.