Management and clinical care

Physical therapy, pain management, and cautions about anesthesia and surgery, with the strength of the evidence behind each.

By Hraness · Drafted with AI assistance.

• Physical therapy and exercise are the main management approach

  practiceevidence: probablecaution

  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.

  hEDS, HSD · Management and clinical care

• Local anesthetic resistance in EDS: patient reports, two surveys, and a 2026 trial

  practiceevidence: establishedindependent evidence agreescaution

  People 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.

  all EDS types · 2026-03 · Management and clinical care

• A 2017 review of pain management in EDS

  practiceevidence: probable

  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.

  all EDS types · 2017-03 · Management and clinical care

• Surgical and tissue-handling caution

  practiceevidence: probablesignificant risk

  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.

  all EDS types · Management and clinical care

• Psychological support and trauma-informed care

  practiceevidence: probable

  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.

  hEDS, HSD · 2025 · Management and clinical care