What You Need to Know About Hypermobility + Massage

Guest post by hypermobility specialist osteopath and founder of Hypermobility HQ Alex Orfanides M. Ost. GOsC 10375

Have you ever had a massage and felt great at the time, but terrible the next day?

Or maybe you've reached the point where you feel nervous about booking one at all, because you can't predict how your body will react and you don't want to risk triggering yet another flare?

If you're hypermobile or have a hypermobility-related condition, including but not limited to hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), massage is, like most things, complicated.

I've always been a big proponent of massage. Done by the right professional in the right way, it can have genuine therapeutic benefit. But as I've seen over many years of clinical work, and experienced personally as someone with hEDS, it can also trigger symptoms when it's done without hypermobility-specific consideration.

So here's what I tell my patients when they ask me about massage.

1. Massage therapy is a specialism in its own right

It's worth saying upfront that while I'm trained and certified in Active Release Techniques (ART), I am not a massage therapist, and there's an important distinction between the two.

ART is a hands-on, movement-based technique that works with muscles, ligaments, tendons, and fascia, using a diagnostic process combined with guided movement to locate and address soft tissue dysfunction. It's the approach I use in my clinical practice and one I find particularly useful for many of the complex presentations I see in hypermobile patients.

Massage has a much broader scope than manual therapy techniques like ART, which represent just one corner of the hands-on treatment world. Where ART is highly specific and protocol-driven, massage encompasses a wide range of techniques and styles, from Swedish and deep tissue, myofascial release, and more. Each type of massage targets different tissue layers, different physiological systems, and different aspects of connective tissue health. The potential benefits include restoring normal muscle tension, improved circulation, decreased pain sensitivity, nervous system regulation, and improved tissue mobility. For people who are hypermobile and who often carry significant chronic muscle guarding, widespread pain, and nervous system dysregulation, those benefits can be significant when massage is applied with an understanding of how hypermobile tissue behaves.

That last part is the key. A massage therapist who is experienced in working with hypermobile clients and who is willing to work collaboratively with hypermobility-informed healthcare providers will approach your treatment very differently to one who isn't. It is worth doing your research and finding someone who has expertise in and who clearly understands your unique needs as someone who is hypermobile.

2. Sometimes less pressure is more effective

For a long time I defaulted to asking for deep tissue massage only, and in doing so I probably did myself a disservice. A lighter touch can be just as therapeutic. It targets more superficial layers of fascia and different nerve fibres, and for hypermobile bodies, it's often a less risky starting point.

If you've never tried light touch massage, it's worth experimenting to see how your body responds. Even if you generally tolerate deep tissue work well, you may find that certain areas respond better to a gentler approach. If you have access to a massage therapist with hypermobility experience, or an informed healthcare provider, ask them which areas they would approach more cautiously on you.

Lighter pressure doesn't mean ineffective. It just means targeted differently.

3. Be cautious between the shoulder blades

This is one area that seems to almost reliably worsen symptoms in hypermobile people when deep tissue work is applied. The dorsal scapular nerve runs between the shoulder blades and the spine, and because it also sits above the ribs, it has very little room to move. Excessive pressure compresses it directly into bone. This area needs precision and care particularly in patients with chronic neck pain or “coathanger syndrome” pain. As someone with a history of chronic neck pain and coathanger pain myself, I am very cautious when it comes to anything regarding my interscapular region (area between my shoulder blades) as it previously was a big trigger for my neck pain and headache symptoms.

4. Being in the same position for too long can be a problem

If prolonged static positions cause you pain or discomfort in daily life, the same principle applies on a massage table if you’re not sufficiently supported. Hypermobile joints rely heavily on muscle for stability because the ligaments are already more lax, so tissues can overload more quickly than expected.

Let your therapist know that you have joint hypermobility.. A good therapist will have more positioning options than you might expect, and bolsters and rolled towels can make a real difference in supporting your joints throughout the treatment.

5. Assisted stretching should only be done with significant caution

Some massage styles incorporate stretching, but hypermobile tissue already has an increased range of movement. Taking a joint to end-range, even unintentionally, can worsen instability and pain rather than relieve it. If your therapist includes stretching, ask them to stay well within range and avoid end-range positions. There are plenty of other techniques with equivalent therapeutic benefit if stretching isn't appropriate or safe for you.

Hypermobile bodies have different needs, and that includes massage

Hypermobility exists on a spectrum, and some conditions have additional considerations beyond what's covered here. If you're unsure whether massage is appropriate or even safe for you, please be sure to check with your healthcare provider first.

Want more tips for navigating life in a hypermobile body? Check out my book Help! I'm Hypermobile, available now at helpimhypermobile.com.