Practices
How EDS is managed today and how it was managed in the past. Clinical guidance and historical folk practice appear on the same page, each labeled by the kind and strength of its evidence. Nothing here is a recommendation.
Physical therapy
Clinical guidance gives individualized physical therapy (strengthening, proprioceptive work, and pacing) a central role in managing hEDS and HSD. A 2017 paper on physical therapy by Engelbert and colleagues says the research on managing these conditions is limited in size and quality, so the advice rests more on expert consensus and clinical experience than on large trials.
Medication
Chopra and colleagues' 2017 review describes chronic pain as common in EDS and often one of the first symptoms. It traces pain to causes including subluxations and dislocations, earlier surgery, muscle weakness, and proprioceptive problems, and discusses physical therapy, medications, and equipment such as cushions, compression garments, and braces. The authors say studies of these treatments are few and insufficient to guide management.
Procedures
Local anesthetic resistance in EDS: patient reports, two surveys, and a 2026 trial
practiceevidence: establishedindependent evidence agreescautionPeople with EDS often report that local anesthetics fail or wear off early. In a survey reported in 2005, 58% of 172 women with joint hypermobility syndrome said a local anesthetic had not been as effective as it should have been, against 21% of 53 age-matched controls without hypermobility. In a 2019 online survey, 88% of 980 people with EDS who had a dental local anesthetic recalled inadequate pain prevention, against 33% of 249 people without EDS. A randomized cross-over trial published in 2026 (135 participants, 91 with EDS) found that fewer participants with EDS still had numbness 15 and 30 minutes after a lidocaine injection, which the authors read as a shorter-lasting effect.
Fragile tissue, poor wound healing, and, in vEDS, the risk of arterial rupture make surgery a weighed decision. The National Academies' 2022 report says all conservative, nonsurgical measures should be exhausted before surgery is considered for people with EDS or HSD.
Psychological support
Studies of the diagnostic journey in hEDS describe medical gaslighting and post-traumatic stress, and management guidance includes psychological support. A 2025 qualitative study of people with hEDS says physicians should be aware of possible medical post-traumatic stress disorder and highlights the importance of trauma-informed care.
Folk practice
Before modern physiotherapy, management of joint instability centered on rest and immobilization: bandaging, splinting, and restricting activity. Clinical consensus has since moved the other way, toward active strengthening.
The “elastic” performers of travelling shows trained and protected their flexibility as a working skill. The sources describe how they lived with hypermobility, not a treatment for it.
Historical management of connective-tissue fragility included dietary measures and general constitutional tonics, the usual response to a poorly understood systemic condition before specific therapies existed. None has a validated mechanism in EDS.