Hypermobility occurs when joints, ligaments, and connective tissues have more motion than they can safely control. At Manhattan Pain Medicine, we evaluate hypermobility spectrum disorder, hypermobile Ehlers-Danlos syndrome, localized joint instability, unresolved sprains, recurrent subluxations, muscle guarding, nerve irritation, dysautonomia, mast cell activation, and the biomechanical patterns that can develop when the body works overtime to stabilize loose joints.
Hypermobility affects more than flexibility. Dr. Siefferman explains how specialized care can help manage pain and improve function.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hypermobility is a spectrum disorder, with Ehlers-Danlos Syndrome (EDS) representing one end of that spectrum. Because EDS includes several uncommon genetic subdiagnoses, genetic testing is often performed to ensure specific screening requirements for those subsets are met.
Treatment begins by identifying three types of sensitization within the body:
Neurological Sensitization: Includes conditions such as headaches, craniocervical instability, small fiber neuropathy, and peripheral nerve entrapments.
Inflammatory Sensitization: Can be a primary inflammatory condition or Mast Cell Activation Syndrome.
Psychological Sensitization: May occur due to craniocervical instability, pre-existing stress, or long-term pain.
These layers of sensitization must be addressed first because they affect how the rest of the body experiences pain.
Hypermobility involves laxity in supporting structures, making joints “wobbly”. This causes the body to develop compensatory biomechanical patterns to protect the unstable joint, which unfortunately shifts stress to other hypermobile joints. Symptoms include clicking, popping, subluxations, dislocations, recurrent joint pain, and postural difficulties caused by ligaments failing to support the body against gravity.
Addressing hypermobility requires a step-wise approach to specific areas of pain:
Pelvis and Hips: Hips must be stabilized first to normalize pelvic tilt.
Shoulders and Neck: Unstable shoulders move forward, pulling the shoulder blade and neck into a painful posture. Treating craniocervical instability without first treating the shoulder will not result in a durable response.
The treatment process involves discovery, finding effective treatments, and a maintenance phase for optimal functioning. Hallmark treatments include regenerative medicine—such as dextrose prolotherapy and platelet-rich plasma—to strengthen ligaments and stabilize joints. This is combined with physical therapy to retrain compensatory biomechanical patterns. At Manhattan Pain Medicine, a variety of providers work to diagnose and treat hypermobility and its associated conditions from multiple angles.
Hypermobility is not simply being flexible. For many patients, the issue is that the ligaments, joint capsules, and connective tissues do not provide enough passive stability. When joints move too far or sit too loosely in their sockets, the body must create stability another way.
Often, the nervous system responds by tightening the surrounding muscles. These muscles act like functional splints, working constantly to protect joints from slipping, subluxing, or moving into positions that cause injury. Over time, this guarding can create stiffness, pain, nerve compression, fatigue, and compensatory movement patterns.
At Manhattan Pain Medicine, we evaluate hypermobility by asking which joints are unstable, which muscles are guarding, which nerves or tissues are being irritated, and which systemic factors may be amplifying the pain pattern.
Hypermobility often requires collaboration across pain medicine, rheumatology, rehabilitation, regenerative medicine, pain psychology, and other clinical perspectives. At Manhattan Pain Medicine, care is coordinated around the patient’s full pattern, including joint instability, connective tissue laxity, muscle guarding, nerve symptoms, inflammatory activity, autonomic dysfunction, and functional limitations.
Patients may benefit from evaluation when joint pain is associated with clicking, popping, subluxations, dislocations, recurrent sprains, muscle tightness, unexplained stiffness, pelvic or hip instability, shoulder or neck pain, TMJ symptoms, nerve pain, dizziness, fatigue, or flares after activity that seem larger than expected.
Hypermobility is not treated by chasing every painful joint separately. We work to identify the unstable structures, understand the compensation patterns, control inflammatory or nervous system sensitization when present, and guide treatment in an order that supports more durable stability.
Your evaluation may include a detailed history of joint pain, subluxations, sprains, stiffness, prior injuries, activity limitations, systemic symptoms, and prior treatment response. The team may assess joint mobility, posture, muscle guarding, nerve symptoms, inflammatory signs, autonomic symptoms, and whether certain joints need dynamic imaging or diagnostic testing to clarify instability.
When joints are unstable, the body often creates stability through muscle guarding, altered posture, and compensatory movement. These strategies may protect the joint in the short term, but they can also create secondary pain, nerve irritation, and fatigue over time. Understanding which joints need stability helps determine the right treatment sequence.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
Hypermobility means that joints move beyond the range that the body can safely control. This may happen because ligaments, joint capsules, and connective tissues are more lax than expected. Some people are generally hypermobile, while others have localized instability after an injury, sprain, or trauma.
Not always. Hypermobility exists on a spectrum. Some patients meet criteria for hypermobile Ehlers-Danlos syndrome, or hEDS, while others have hypermobility spectrum disorder, or HSD, or localized joint instability. Genetic testing may be used in selected cases to evaluate for other connective tissue disorders, although the most common form of hEDS does not currently have a single confirmed genetic test.
Many hypermobile patients feel stiff because their muscles are guarding. When ligaments do not provide enough stability, the nervous system may tighten surrounding muscles to protect the joints. This can create the stiffness paradox: the joints are loose, but the body feels locked up.
Unstable joints can cause muscles to guard, spasm, or enlarge over time. Those muscles may irritate or compress nearby nerves. Joint instability can also change posture and movement, placing tension on nerves in the neck, shoulder, pelvis, hip, or limbs.
Connective tissue laxity can affect blood vessels as well as joints. Stretchier blood vessels may allow blood to pool in the legs when standing, contributing to dizziness, rapid heart rate, fatigue, and orthostatic symptoms. Hypermobility may also overlap with craniocervical instability, mast cell activation, and small fiber neuropathy, which can further affect autonomic regulation.
Some patients with hypermobility also experience mast cell activation, which can contribute to flushing, swelling, itching, food or medication sensitivity, inflammation, and pain flares. Mechanical strain on tissues may also contribute to inflammatory reactivity in some patients. When mast cell activation or inflammation is active, it may need to be addressed before structural treatment is pursued.
Evaluation may include a detailed history, physical examination, joint mobility assessment, review of prior injuries, imaging review, dynamic imaging when needed, and diagnostic testing. In selected cases, diagnostic injections may help determine whether instability in a specific joint is driving muscle guarding, referred pain, or nerve irritation.
Standard MRI is often performed lying down, which removes the load of gravity. Some unstable joints temporarily realign when the body is unloaded. Dynamic imaging, flexion-extension studies, weight-bearing imaging, or specific positional views may be needed when symptoms suggest instability that does not appear on standard imaging.
Corticosteroids may weaken or soften connective tissue in some settings. When the primary problem is mechanical laxity, the goal is usually to support and strengthen connective tissue rather than further reduce its integrity. Treatment decisions are individualized, but steroid injections are used cautiously when instability is a major concern.
Dextrose prolotherapy is an injection treatment that uses a concentrated sugar solution to stimulate a controlled healing response in ligaments, tendons, or joint capsules. In selected hypermobility cases, it may be used to help tighten and strengthen lax connective tissue over time.
Dextrose prolotherapy is often used to stimulate ligament tightening and connective tissue support. Platelet-rich plasma, or PRP, uses concentrated platelets from the patient’s own blood and may be considered for more advanced tissue healing needs, such as persistent tendon, ligament, labral, or meniscal injury. The right choice depends on the joint, the tissue involved, and the treatment sequence.
Hypermobility often responds best to controlled, stability-focused rehabilitation. This may include Pilates-based, closed-chain, or proprioceptive training that teaches the nervous system where the joint is in space and builds endurance in deep stabilizing muscles. Aggressive stretching or poorly controlled strengthening may worsen symptoms in some patients.
If inflammation, mast cell activation, dysautonomia, migraine, or nervous system sensitization is active, the body may overreact to treatment. MPM works to understand what needs to be calmed first, which joints need stabilization, and how rehabilitation should be sequenced so the patient can build progress without triggering repeated flares.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If joint pain, stiffness, subluxations, recurrent sprains, muscle guarding, nerve irritation, or unexplained flares may be related to hypermobility, our team can help evaluate which structures are unstable and what treatment sequence may support better stability.
Hypermobility occurs when joints, ligaments, and connective tissues allow more motion than the body can safely control. This may involve hypermobility spectrum disorder, hypermobile Ehlers-Danlos syndrome, or localized instability after an unresolved sprain, injury, or trauma.
At Manhattan Pain Medicine, we do not evaluate hypermobility only by asking whether a joint can move far. We ask whether the joint can remain stable under load, whether the muscles are guarding to protect it, whether nearby nerves are being irritated, and whether systemic factors such as inflammation, dysautonomia, mast cell activation, or nervous system sensitization are amplifying the pain pattern.
Ligaments and joint capsules help hold the skeleton together against gravity. When these structures are too lax, the joint may sit loosely in its socket or move beyond its stable range. The joint may click, pop, shift, sublux, or repeatedly irritate nearby cartilage, labrum, tendons, ligaments, or nerves.
This instability can create repetitive microtrauma. A loose hip may place repeated stress on the labrum. An unstable shoulder may change the position of the shoulder blade and neck. An unstable upper cervical spine may contribute to headache, facial pain, dysautonomia, or jaw dysfunction. Over time, a local instability pattern can influence the entire body.
When ligaments cannot provide enough stability, the nervous system often asks the muscles to do the job instead. Muscles that are meant to guide motion become functional splints. They tighten, guard, and work overtime to prevent the joint from slipping or moving into a painful position.
This is why many hypermobile patients do not feel flexible. They feel stiff, locked up, exhausted, and sore. The stiffness is often a protective response. The joint may be loose, but the muscles around it are working constantly to create stability.
Gravity naturally pulls unstable joints into less efficient positions. Knees may lock, the pelvis may tilt, the shoulders may roll forward, and the head may drift forward. These positions can help the body feel temporarily stable, but they also shift stress onto other joints, muscles, nerves, and connective tissues.
Over time, this can create a snowball effect. A hypermobile hip may alter pelvic mechanics. Pelvic mechanics may affect the low back, pelvic floor, and nerves. Shoulder instability may pull the neck into a guarded posture. Neck guarding may contribute to headache, TMJ dysfunction, and autonomic symptoms.
Hypermobility often presents as stiffness. Patients may feel tight, rigid, or unable to relax. This does not contradict hypermobility. It often reflects chronic muscle guarding around joints that lack passive stability.
Patients may report clicking, popping, slipping, partial dislocations, recurrent sprains, or pain that returns after seemingly minor activity. Some patients can identify a specific unstable joint. Others feel that the entire body is working too hard to stay aligned.
Guarding muscles can compress or irritate nearby nerves. For example, pelvic and hip instability may contribute to pelvic floor overactivity and pudendal nerve irritation. Shoulder or neck instability may contribute to arm symptoms, headache, or facial pain. The nerve pain may become the loudest symptom, even when instability is the driver.
Hypermobility can overlap with dysautonomia, mast cell activation, and other systemic conditions. Blood pooling, dizziness, rapid heart rate, flushing, swelling, food sensitivity, fatigue, brain fog, and widespread pain may all influence the treatment path. These overlapping systems must be understood before treating the joints in isolation.
Discovery begins with the pattern. We ask which joints feel unstable, which areas feel guarded, which symptoms are mechanical, which symptoms are neurologic, and which symptoms suggest inflammation, dysautonomia, mast cell activation, or central sensitization.
Evaluation may include physical examination, joint mobility assessment, posture and movement analysis, imaging review, and dynamic imaging when standard studies do not explain the symptoms. Because standard MRI is often performed lying down, it may miss instability that appears only under gravity, movement, or load.
In selected cases, diagnostic injections may help clarify whether instability in a specific joint is driving pain. A joint or capsule may be temporarily distended or stabilized with fluid to see whether surrounding muscle guarding, referred pain, or nerve irritation improves. The response can help confirm whether the joint is a key driver.
Genetic testing may be considered when the history suggests a connective tissue disorder that requires specific screening or risk assessment. While the most common form of hypermobile Ehlers-Danlos syndrome does not currently have one definitive genetic test, testing may help evaluate for other forms of EDS or related collagen disorders.
Treatment focuses on stability, sequence, and system control. The goal is not to stretch already unstable joints. The goal is to help the body gain better control, reduce guarding, and strengthen the structures or movement patterns that provide support.
Hypermobility is often a whole-system problem. Treating one unstable joint may help, but only if the broader system is ready to respond. If inflammation is active, a regenerative treatment may create a larger flare. If dysautonomia is uncontrolled, rehabilitation may trigger crashes. If migraine or craniocervical instability is active, the nervous system may stay highly reactive.
MPM works to identify which system needs to be calmed first, which joint needs stabilization first, and which compensatory patterns need retraining next. The right order can make treatment more tolerable and more durable.
Maintenance begins when the unstable structures are clearer, the major sensitization patterns are better controlled, and the patient has a practical plan for supporting the body over time.
Patients may learn how to pace strengthening, recognize early signs of joint overload, avoid end-range dependence, manage flares, support posture, and continue proprioceptive training. The goal is to help the body become less reactive and more stable, while giving the patient a clearer understanding of how to move, strengthen, and recover safely.
