top of page

Link Between Hypermobility and POTS/Dysautonomia

In this blog post, we'll explore the connection between hypermobility, POTS, and other forms of dysautonomia. We'll examine how your sixth sense (proprioception) influences the nervous system, the physical effects hypermobility can have on blood pressure, and how to determine if you yourself are hypermobile.


What is POTS?

First, let’s define POTS. Postural Orthostatic Tachycardia Syndrome (POTS) falls under the umbrella of dysautonomia—a group of conditions related to dysfunction of the autonomic nervous system. The term “autonomic” means “self-governing”, referring to the system that controls involuntary functions you don’t consciously think about. This includes breathing, digestion, heart rate, blood pressure, body temperature, sweating, and more.


While some individuals with dysautonomia can identify a single cause, many cases result from a combination of multiple factors.


For more information about causes of POTS: Click Here


POTS and Hypermobility


How It Works

Proprioception (joint position sense)

Proprioception is your body's ability to sense its position and movement in space—often called the “sixth sense.” When a person is hypermobile, this sense can be impaired, leading to decreased awareness of their body's position. For example, someone with inaccurate proprioception might believe their ankle is straight when it’s actually slightly tilted, or think their arm is tucked in when it’s marginally extended. This misperception can result in frequent twisted ankles, bumped elbows, and other injuries.


All these bumps and sprains can lead to hypervigilance. Growing up, children with conditions such as joint hypermobility syndrome (JHS) or Ehlers-Danlos Syndrome (EDS) have to learn to pay more attention to their position and surroundings than their peers.


This hypervigilance causes us to dial up the autonomic nervous system, particularly the sympathetic nervous system, which is responsible for fight, flight, or freeze responses. Over time, these high levels of adrenaline affect how we react to the world, living with higher rates of anxiety.


This constant upregulation of the adrenaline system can also result in an immune system that is constantly on high alert, potentially increasing susceptibility to mast cell activation syndrome and heightened reactivity to vaccines, infections, and stress. As a result, people with hypermobility may be more prone to developing chronic health conditions- such as POTS.


Physical Effects of Hypermobility

People with hypermobile joints may also have more flexible blood vessels. This can impair the systems responsible for regulating blood pressure when transitioning from a reclined to a standing position. Normally, when a person stands, their blood vessels contract to maintain an appropriate blood pressure; however, in individuals with hypermobility, the structures that control this contraction can be less effective. Instead of contracting, these vessels expand, leading to blood pooling in the legs and away from the heart and other vital organs.


This, combined with increased adrenaline levels resulting from proprioceptive dysfunction, can create a cycle of heightened physical responses to activity and stimulation.


Many people may notice early signs such as fainting or feeling faint during sports or experiencing tiredness or heaviness when standing for long periods of time. This predisposition often becomes more pronounced during adolescence and young adulthood, influenced by hormonal changes during puberty or increased stress from exams and work as one transitions into adulthood. This is why many seemingly active and healthy young people develop POTS in their late teens and early twenties.


Am I Hypermobile?

If these traits or experiences sound familiar, or you have a history of being unusually flexible—perhaps excelling in activities like gymnastics, ballet, or dance—it could indicate hypermobility.


How to Test for Hypermobility

The Beighton score is a test that detects joint hypermobility syndrome. The test uses a nine-point scoring system that measures the flexibility of the following joints:

  • Base of both thumbs

  • Elbows

  • Knees

  • Knuckles of pinky fingers

  • Spine

Beighton test

The test consists of two sections: the first involves a physical exam to assess joint flexibility, while the second includes questions about the patient's history of hypermobility and joint pain.


Click here for more information about the Beighton test.


Note: Around 3-10% of the population is hypermobile. Being hypermobile doesn't automatically mean you have or will develop POTS. It's important to remember hypermobility is just one piece of a larger picture, and each person's condition is unique.


Conclusion

I hope readers find the information in this post, along with the further reading provided below, helpful (and maybe relatable) in shedding light on some of the underlying factors contributing to POTS.


Useful Links:



Hypermobility and POTS video: https://youtu.be/Cm16Hryi6eE?feature=shared


Comments

bottom of page