Hypermobility And Pelvic Pain

Hypermobility And Pelvic Pain

You may have heard of Ehlers Danlos Syndrome or EDS, Hypermobility Spectrum Disorder or HSD or hypermobility but not associated it with pelvic pain because you know that it is a connective tissue disorder that also has joint instability and pain. While most hypermobile individuals are aware of the general joint pain and overall postural instability, most people miss the connection between pelvic pain and postural instability. In this blog post, we’ll break down the basics, exploring what hypermobility is, what factors can contribute to pelvic pain, and why the connection between hypermobility and pelvic pain is often overlooked.

What Is Hypermobility?

Hypermobility is a connective tissue disorder that affects all connective tissue in your body and can show up with many faces. In this blog, we are looking at how it can impact the joints and postural stability, and how they contribute to pelvic pain. Imagine driving a car and reaching an intersection; with hypermobility, instead of stopping at a crosswalk, you drive onto the crosswalk, and depending on the spectrum of hypermobility, you may end up in the intersection! This is what extreme range of motion, subluxation of the joint, and dislocation are like.

I recommend you refer to my Hypermobility Collection blogs to understand more about hypermobility.

What Causes Pelvic Pain?

Pelvic pain is a common complaint, affecting both men and women. While infection and issues related to reproductive issues can cause pelvic pain, it is the muscle spasm, lack of synchronicity of the soft tissue, and the misfiring (or relaxation) of the muscles in movement. The last factor, muscle involvement, is the main issue with the bendy population and their postural stability challenge.

Why Pelvic Stability?

The pelvis serves as the foundation for the spine and plays an important role in supporting the body’s weight, movement, and balance. Yet, its significance is frequently overlooked when assessing and addressing pelvic pain. Pelvic stability is the key to a healthy and pain-free pelvis. When the pelvis lacks stability, various issues can arise, including pain and discomfort.

How Is Hypermobility Linked To Pelvic Pain?

Joint stability is a challenge among the bendy population because of the connective tissue involvement.  The pelvic region, being a complex network of bones, muscles, and connective tissues, is particularly vulnerable to instability in hypermobile individuals. This happens as a result of:

  • Joint Hyperextension / Hyperflexion

Hypermobile individuals tend to go beyond the normal range of motion and this impacts the stability of the joint. The soft tissues that are to support stability become the sole provider of support and when the natural design and progression of soft tissue involvement changes, injuries and pain are expected. This unnatural movement puts strain on the surrounding muscles and ligaments, contributing to pelvic pain over time.

  • Muscle Imbalance:

Hypermobility can result in muscle imbalances as certain muscles work overtime to compensate for the lack of joint stability. In the pelvic area, this imbalance can lead to tightness, spasms, and ultimately pain.

  • Connective Tissue Strain:

Serving as a scaffold, connective tissue plays a crucial role in maintaining the shape and integrity of organs while allowing communication between different tissues to provide proper functioning of the body’s complex architecture. The connective tissues that hold the pelvic bones together can get strained due to hypermobility leading to inflammation and pain.

  • Impact On Pelvic Floor Muscles:

You cannot have an unstable pelvis without impacting not only the pelvis but the spine and hips which are connected to the pelvis. You also cannot have issues with the pelvis stability without impacting the muscles outside and inside the pelvis; this includes the pelvic floor which is the floor to the ‘space’ that holds your internal organs such as the intestine, bladder, uterus and ovaries, or prostate. When the whole area is unstable and not strong enough to perform its job, inflammation and pain occur.

The biggest mistake in my opinion is to give medication for pain without addressing the cause, or only work on the muscles of the floor internally, thinking the issue is solved.

Why Is Pelvic Stability Important For Pelvic Pain And Hypermobility?

You can’t fix the ‘floor’ when the ‘house’ is unstable, right? Then how is it that when it comes to the health of the pelvis, hypermobility or not, we don’t attend to the right things first? If you are in pain, sure, take medicine to make your day easier but what are you doing about the cause of your pain? Broaden your focus lens to address the root of the problem which can be more than one factor. The one thing that has to be present is the stability of the structure which has the issue. That is irrelevant to what else is going on and should not be put off because you may have other issues related to the area!

If you have pelvic floor dysfunction, if you are hypermobile, if you have had many doctor visits and are still feeling lost and without understanding what is going on, contact me, I can help. We now have a telehealth coaching option for those far away and overseas.

Dr. Shakib

Pelvic Floor Dysfunction In The HyperMobile Population

Pelvic Floor Dysfunction In The HyperMobile Population

Pelvic floor dysfunction is much more common than most realize. While not everyone with pelvic floor dysfunction has hypermobility, every hypermobile person has pelvic floor dysfunction. As bold as this statement may seem, in this blog, we will explore the following:

  • What pelvic floor dysfunction is
  • Why do all hypermobile individuals have pelvic floor dysfunction
  • How to address postural instability which is the common denominator between pelvic floor dysfunction
  • Hypermobility, who to seek treatment by, and where to start

What Is Pelvic Floor Dysfunction?

Pelvic floor dysfunction refers to a collection of symptoms ranging from incontinence and pelvic pain to chronic pain in the tailbone, sacroiliac joint, and lower back to poor posture. While the ‘stories’ as to why it is present in an individual may vary from a person to a person, the common theme is the presence of postural instability. You can read about the subtle and not-so-subtle signs and symptoms of pelvic floor dysfunction in a blog I have written.

While women who have gone through childbirth and individuals of advanced age are commonly associated with pelvic floor issues, it is essential to recognize that pelvic floor dysfunction can affect anyone, regardless of age or gender. Another fact to consider is that because hypermobile individuals lack stability in the transitional sections of their body with the connection of the lower back spine to the pelvis being one of those transitional areas, all bendy bodies have pelvic instability and therefore pelvic floor dysfunction.

How Are Posture, Pelvic Instability And HyperMobility Related?

If pelvic floor dysfunction was the name of a book, it would have many chapters with pelvic instability being one of them. The pelvis is the base and foundation of the torso with the legs connected to them. This base not only has to manage the ‘structures’ above but has to somehow do so while the legs do the ‘walking’ and with any limitations or dysfunctional movements in the lower extremities, this job of stabilization becomes even harder. With this lack of stability of the pelvis, the ‘house’ that the pelvic floor is the ‘floor’ of, it is hard to avoid pelvic floor dysfunction.

Hypermobility often affects multiple joints, including those in the pelvic region, making it difficult for individuals to maintain a stable and aligned posture.

What Is HyperMobility?

Hypermobility is a condition where joints move beyond the normal range of motion. It is a connective tissue disorder typically due to increased mast cells, the type of white blood cells that lead to histamine production. While those individuals with hypermobility have other non-musculoskeletal (muscles, joints, ligaments, and bones) symptoms, we will focus on the postural and movement presentations that typically exist with hypermobility.

There is a difference between flexibility and instability and hypermobility is instability that may appear as being flexible. Most hypermobile individuals at some point in their life, primarily younger years, shine in the field of gymnastics, acrobatics, ballet and dance, cheer, or sports excess movements put them at a higher level of notice.

This only becomes problematic because the structures that support the joint end up going beyond their roles to stabilize the joint and since the ‘job’ of these structures is to support the move and not necessarily become the main ‘stabilizers’, they get injured and damaged.

When it comes to the pelvis, it is a foundation for the spine and the entire musculoskeletal system. In hypermobile individuals, maintaining a stable pelvis becomes a significant challenge. As we move, stand, or sit, the pelvis may shift and tilt unpredictably; this instability can contribute to chronic pelvic pain, urinary and bowel issues, and a range of other symptoms associated with pelvic floor dysfunction that providers and people, in general, don’t necessarily associate with pelvic floor dysfunction.

How Are HyperMobility And Pelvic Floor Dysfunction Connected?

The instability in hypermobile individuals places strain on the pelvis, pelvic floor, pelvis wall, and whatever is connected to the pelvis. Simultaneously, the dysfunctional pelvis exacerbates pelvic instability, creating a feedback loop of discomfort and dysfunction on the hypermobile joints.

Poor posture, a common feature in hypermobility, feeds this cycle too. Slouched or misaligned postures can increase pressure on the pelvis and contribute to pelvic instability. As hypermobile individuals may struggle to maintain a consistently stable posture, the risk of pelvic floor dysfunction increases.

How Is Pelvic Floor Dysfunction Addressed In The Bendy Bodies?

Recognizing the connection between hypermobility, posture, and pelvic floor dysfunction is the first step toward effective management and prevention. A holistic approach that combines whole body exercises vs specific regional exercises, lifestyle modifications, and understanding the positions, movements, and activities that put the body in a more vulnerable state is crucial in the treatment of pelvic floor dysfunction in all populations, hypermobile or not.

I wrote a blog on a comprehensive treatment list for pelvic floor dysfunction and when it comes to the hypermobile, EDS, hEDS, HSD, and MCAS population, I STRONGLY suggest seeking clinicians that TREAT the same population. Being able to treat and knowing what these acronyms stand for are not the same.

In my practice, treating a high number of the hypermobile population I can assure you that the response, awareness, strengths, and weaknesses of the bendy bodies are unique and different from the non-bendy people and many subtle and non-subtle factors can easily be missed if the clinician is unaware.

As explained in my blog, the treatment length varies depending on the following factors:

  • “The extent of the instability of the pelvis
  • How dysfunctional your movement is [and bendy bodies have a higher than average number of dysfunctional patterns of movement]
  • How balanced you are with movement
  • What portions of your brain with regards to balance and coordination are weak
  • Are the muscles in your lower back, hips, and pelvis moving in coordination or skipping function
  • How strong is your cortical connection (the connection of the brain to the body part when it comes to following a command) is
  • How motivated you are in performing the exercises you are given
  • How compatible your work environment is
  • How weak the muscles of your lower back, hips, and pelvis (internal and external) are
  • If you have any comorbidity such as EDS, other hypermobility, nerve, or tissue association with your pelvic floor dysfunction
  • If you have had any surgeries or scar tissue”

Who Do I See If I am HyperMobile And Have Pelvic Floor Dysfunction?

Seek care only from clinicians who are familiar with the hypermobile population; consult the EDS society website for the clinicians near you, ask other bendy friends, your existing providers, and social media!

Make sure you have a short session with the provider you are considering to see how their method of treatment is different and how much of their practice is the hypermobile population. Finding a clinician that does functional movement and stability, pelvic floor dysfunction and treats hypermobility is not common but not unheard of.

My practice has a high majority of hypermobile patients because of the style of movement practices that I guide them through and because of my overall mission of teaching them how to be so they can live their lives the way they wish to live. A combination of functional movement, pelvic floor dysfunction, and hypermobility care and awareness has allowed me to help many, and am here to help you either myself or with a referral elsewhere if I know someone in your area. Do not hesitate to contact me.

Dr. Shakib

HyperMobility, Pelvic Floor, and Pelvic Pain

HyperMobility, Pelvic Floor, and Pelvic Pain

Hypermobility, hypermobile joint syndrome, EDS, HSD, MCAS, and hEDS are terms that are used interchangeably, all being connective tissue disorders. While the connective tissue is targeted with these conditions, other symptoms and signs are commonly seen such as:

  • POTS
  • Cranio-cervical instability (CSI)
  • Headaches
  • Chiari malformation
  • Digestive issues
  • Increased heartbeat
  • Anxiety
  • Pelvic instability
  • Wrist and ankle pain
  • Hip, elbow, and knee pain
  • Unexplained swelling of feet and hands
  • Clumsiness
  • Some sort of daily pain and/or bendy-ness in joints

In my practice, I see many patients with pelvic floor dysfunction and hyper-mobility who have no idea they have it hypermobility. They have suffered and been gaslit throughout their life by other doctors, health care providers, and family members. This blog looks into the correlation between the pelvic floor, hypermobility, and pelvic pain.

How Are Connective Tissue and The Pelvis Related?

The pelvis is the base of your spine and torso, and its stability directly impacts how you maintain your balance and movement. It is the ‘house’ that the pelvic floor is the ‘floor’ of and holds important organs such as the uterus, ovaries, prostate, intestine, and bladder. The 3 pieces of the pelvis are connected to each other, the spine, and hips with ligaments and tendons. Any laxity of those connective tissues leads to instability of these structures to say the least.

Unstable joints, when used, become painful to the point that sometimes breathing can cause pain. Breathing, by the way, impacts the pelvis (positively when done right and negatively when done wrong). The connective tissue connecting different parts of the pelvis to the tailbone can be involved in causing pelvic pain with walking, sitting, standing, and at rest.

With the laxity of the connective tissue, other soft tissue takes on the roles that are beyond their ‘workload’. This then can lead to tension in muscles that the hypermobile person experiences while they appear ‘normal’ to an untrained clinician. It is of utmost importance for the bendy population to seek care and advice only from clinicians who have treated hypermobility vs learning about it from a text book.

Does Posture Play A Role In Pelvic Pain & HyperMobility?

With hypermobility and its associated pelvic floor dysfunction, instability shows as flexibility. Joints sublux often which means they go beyond where they need to stop. That is like stopping in the middle of an intersection vs at the crosswalk. When it comes to pelvis instability, this means pain in the lower back, hip pain, labral tear, compressed soft tissue, clicking when moving, and forward or backward pelvic tilt.

Hyperextension of the knees, a common finding with hypermobility, pushes the top of the thigh bone toward the front of the hip socket causing pain in the hip joints. The integrity of movement and joint functionality of the hips directly impact the pelvis, what it holds inside, and what supports its stability. You cannot have a strong pelvic floor if the ‘house’ is unstable.

What Is The Holistic Treatment For Pelvic Floor Dysfunction And Pelvic Pain?

Hypermobility is a condition that you are born with and managing different ‘chapters’ of that ‘book’ is something that you should invest your time in. When it comes to postural instability impacting the pelvis, pelvic pain, and pelvic floor dysfunction, here are my recommendations to my patients:

  • Breathing

Learning proper biological breathing techniques is underestimated and undervalued and yet, it should be the focus of every musculoskeletal condition. This breathing is what we all did as babies and is not a version of breathing but is the core breathing that we know from studying babies. Place your hands on the side of your rib cage and as you breathe through your nose, push your sides outward. Not as easy as it sounds but certainly something you will be able to do easily with practice.


  • Postural Neurology

This is how we can see what the blueprint of your movement looks like and then present you with exercises that strengthen what seems to be weak from the assessment. To learn more about postural neurology, visit my website on functional mobility.

  • Functional Mobility Exercises

That means rehabilitating what is weak and tight with movement exercises. The question is which ones? To isolate an area to work it out is a mistake IMO. Your body works as one unit and working out an area in isolation is not going to solve the problem. With that said, I am a huge fan of developmental exercises such as Dynamic Neuromuscular Stabilization. If a helpless infant can become a running toddler without going to a gym and if we all have gone through that process, then common sense tells me that those are the right exercises to do and my brain and body are already familiar with them. Why reinvent the wheel?

  • Lifestyle Changes

Your lifestyle directly impacts your body and the wrong choices in a hypermobile person can make a much more negative impact. This goes from nutrition to workspace, to sleeping styles, and exercises. I strongly suggest you visit my blog on lifestyle.

  • Supportive Garments

In some cases, individuals with hypermobility may benefit from wearing support garments like high-top shoes and garter belts that go higher up to the belly button. Also things like rolling a towel or small blanket at the bottom of their feet on the bed to limit ankle extension.

Hypermobility is not a life sentence and learning how to manage it brings great comfort to your day. You can visit the EDS website for the list of providers familiar with the bendy population. If you have pelvic floor dysfunction and are hypermobile, I strongly encourage you to contact me.

Dr. Shakib

Hypermobility and Pelvic Wellness

Hypermobility and Pelvic Wellness

Pelvic health requires a balance in the pelvis, the house that the pelvic floor is the ‘floor’ of and hypermobility is more about instability vs flexibility. Hypermobility and pelvic health, therefore, are intimately related and important subjects to explore in this blog.  In this blog post, we’ll explore the relationship between hypermobility and pelvic wellness and provide tips for managing both conditions.

Hypermobility vs Instability

Hypermobility is a condition that affects the connective tissues in the body, causing them to be more flexible than normal. This can result in joints that move beyond their normal range of motion, leading to pain, inflammation, and instability. Hypermobility can be genetic or acquired, and is more common in women than men.

Hypermobility when at a younger age in elementary through even early 20s seems to be the advantage when doing gymnastics, cheer, acrobatics, and dance. This is always exciting and encouraging to participate in the activities that make you ‘shine’; however, the overuse of already unstable body parts over time will catch up later on mostly in the 30s and beyond.

One of the areas that can be most affected by hypermobility is the pelvic region. The pelvic floor is made up of muscles, ligaments, and tissues that support the bladder, uterus, and other organs. Of course, there is more to the dysfunction in the pelvis than just the internal organs. You can read all about what pelvic floor dysfunction can look like in my blog.

The Subtle Symptoms of Pelvic Floor Dysfunction?

Pelvic floor dysfunction can cause a range of symptoms, including incontinence, pain during sex, and chronic pelvic pain. Individuals with hypermobility may be more susceptible to developing pelvic floor dysfunction because the connective tissues in their body are less able to provide the necessary support. Here are the subtle signs of pelvic floor dysfunction that are most often missed and considered their own separate issues! You can learn more about this in my blog: ‘ Pelvic Floor Dysfunction Symptoms’.

  • “Lower back pain
  • Pain in the back joints of the pelvis (SI Joints)
  • Pain in the front pubic area
  • Arched lower back
  • Slouched lower back
  • Slouched mid-back or hunchback
  • Military posture with the chest pushed out
  • A V-stance where the torso is positioned behind the hip joints on the side view
  • Chronic forward neck
  • Inability to bend down below the knees
  • Habitually standing on one leg with the other leg bent
  • Chronic one-sided pain in the lower extremity
  • Hip pain on one or both sides”

Tips To Manage Hypermobility & Pelvic Wellness

  1. Exercise regularly but your exercises need to be low-impact and specific. I find Dynamic Neuromuscular Stabilization (DNS),  baby exercises, to be the most effective type of exercise. So much so that it has become the source of attraction among hypermobile and EDS individuals in my region.
  2. Practice good posture: Good posture helps reduce the strain on your joints and pelvic floor muscles which is easier said than done. I use Postural Neurology to work on the brain because if the brain gives the command to move and hold your posture a certain way, your body will follow. This is why gadgets and tools claiming to help you with your posture do NOT work! UNLESS they work on changing the map of movement (Homunculus) and posture in your brain the effects won’t last.
  3. Use proper lifting techniques: When lifting heavy objects, make sure to use proper technique to avoid putting unnecessary strain on your joints and pelvic floor. I strongly suggest you follow me on IG and subscribe to my YouTube channel for the specifics of movement.
  4. Maintain a healthy weight: Being overweight can put additional strain on the joints and pelvic floor muscles. This increases the risk of both hypermobility and pelvic floor dysfunction. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this risk.
  5. Consider pelvic floor therapy: Not all physical therapists and chiropractors are trained in pelvic floor dysfunction and not every pelvic floor therapy treatment involves internal manual treatment. In my practice, I first start stabilizing the pelvis, the house that the pelvic floor is the floor of, BEFORE anything else. No sense in working on anything else when the whole house is shaky and unstable.
  6. Be mindful of your activities: if playing sports, take it easy during ovulation and/or menstruation when the level of relaxed soft tissue goes even higher.
  7. Hypermobile toes and ankles

    Hypermobility and Pelvic Floor Dysfunction

    Wear DuoJoint, a brace I have designed for hypermobile ankles to be worn at night to address the over-extension of the ankles and feet at night. This is important because your feet are the points of contact with the ground and without stable feet and ankles, everything above is unstable. DuoJoint at the time of writing this blog is not available but search for it online to see where you can purchase it now.

  8. Manage stress: Stress can contribute to both hypermobility and pelvic floor dysfunction. Finding ways to manage stress, such as meditation, yoga, or therapy, can help improve overall well-being and reduce the risk of these conditions.

Dr. Shakib