EDS Exercises & Functional Rehabilitation

The purposes of having Exercises and Functional Rehabilitation for EDS people is to be away from things like – “UNNECESSARY SURGERIES, INJECTIONS, & OVERUSE OF MEDICATIONS” and to have better life as early as possible. Injections, surgery and strong drugs usually are not the cure but your “MOVEMENT IS MEDICINE”. The evidence advocating the benefits of exercises and functional rehabilitation are positively overwhelming for EDS remarkable issues people as per researchers and physical therapists in treating and managing EDS.  One has to accept what one has but there are many benefits to Exercises and Functional Rehabilitation and they are –

• Feeling more confident about moving

• Improving the flexibility of stiff parts of the body

• Allowing to resume activities

• Improving stamina

• Improving the body’s muscle endurance

• Stress and tension release

• Losing weight and increasing muscle tone

• Improving fitness levels

• Improving self-esteem

• Lessening medicine

But before start practicing and adopting both Exercises and Functional Rehabilitation one should always ensure that you are initially cleared to be able to exercises by any medical practitioner whose care you may be under (cardiologist, gastroenterologist, rheumatologist, GP, pain management, neurologist, etc.) prior to undertaking any form of Exercises and Functional Rehabilitation program. Ehlers-Danlos Syndrome / Hypermobility Spectrum Disorder symptoms have postural and movement qualities that can be certainly remedied through precise physical training. This requires careful consideration and a holistic approach. Kindly understand that everyone is an individual and EDS / HSD affects everyone in different ways.

The areas which has been covered here are -

• Spine disorders (neck, back, and pelvic pain)

• Scoliosis Management

• Functional performance

• Hand Rehabilitation

• Fibromyalgia

• Chronic pain management

• Cervicogenic / tension-type / migraine Headache

• Cervicogenic Dizziness

• Concussion Management

• Temporomadibular dysfunction (TMD)

• Peripheral Vertigo (BPPV)

• Vestibular dysfunction (Dizziness, unsteadiness, visual disturbance, disequilibrium)

• Balance / Coordination disorders

• Postural orthostatic tachycardia syndrome (POTS)

• Gut

• General orthopedic conditions (shoulder, elbow, hand, fingers, hip, knee, ankle, and foot)

• Joint Replacement Rehabilitation

• Men’s and Women’s pelvic health issues (pain related)

• Vagus Nerve & Vagal Tone

One should always have skilled Physical Therapist or neurologic physical therapist who understands the Physical Therapy Management techniques like - Gentle breathing, Relaxation / Visualization, Cognitive-Behavioral Therapy, Myofascial Trigger Points Release / Dry Needling, Joint Mobilization / manipulation, Deep Neck muscle strengthening, Postural / sensorimotor training, Aerobic exercise  and Self-monitoring coping / pacing skills.

Both Exercises and Functional Rehabilitation and two different attributes for EDS remarkable issues people's body. The approach and benefits of Exercises and Functional Rehabilitation are also different. One should initially start with Exercises and than Functional Rehabilitation.

📍Exercises: 

EXERCISES is highly important for Ehlers Danlos Syndrome (EDS) / Hypermobility Spectrum Disorder (HSD) remarkable issues people. Exercises for EDS are crucial to counteract weak connective tissues by building muscular strength, which stabilizes joints and prevents dislocations. Targeted, low-impact exercise reduces chronic pain, improves proprioception (joint awareness), and boosts energy levels, which are often diminished by the condition.

Exercise does regulate myokines, a protein facilitating anti-inflammatory function, it improves comorbidities and cardiovascular risk factors. Exercises had always appeared to be recommended therapy for EDS / HSD people with joint degeneration, chronic whole body pain. Exercises actually prevents "vicious cycle" of chronic systemic inflammation.

Benefits of Exercise for EDS / HSD

• Improved Joint Stability: Strengthening the muscles around hypermobile joints reduces the likelihood of dislocations and subluxations.

• Pain Management: Regular movement increases blood flow, reduces stiffness, and releases endorphins, the body’s natural pain relievers.

• Enhanced Proprioception: Exercises that improve balance and coordination can help with proprioception, the body’s awareness of joint positioning.

• Improved Energy Levels: Gentle exercise combats fatigue by improving circulation and overall fitness.

• Mental Health Benefits: Physical activity is known to reduce stress and anxiety, fostering a sense of accomplishment and well-being.

• Food & Liquid Intake: It makes to have normal food and liquid intake as per your age and height.

Tips for Exercising

• Start Slow: Begin with short, low-intensity sessions and gradually increase as your body adapts.

• The Pattern: Do start your exercises slowly with 1 - 2 minutes first day, then 2 - 3 minutes the second day, and then 3 - 5 minutes per day. Do always start with low count and slow procedures. Maybe 2 - 5 minutes in initial week, followed by next 5 - 8 minutes next week, followed by 8 - 10 minutes the third week, than 10 - 15 minutes fourth week and gradually to 30 - 45 minutes per day 5 days a week. Please understand your limitations and strength on daily basis, and don't exceed neither your limitations nor strength.

• Warm Up and Cool Down: Gentle stretching or mobility exercises before and after workouts can help prepare your muscles and reduce post-exercise soreness.

• Listen to Your Body: Pain is a signal that something is wrong. If an exercise causes discomfort, stop and reassess your technique or try a different activity.

• Use Supportive Equipment: Braces, compression garments, or kinesiology tape can provide additional support and reduce the risk of injury during exercise.

• Stay Hydrated: Dehydration can exacerbate fatigue and joint pain, so ensure you’re drinking enough water before, during, and after exercise.

• Work with a Professional: A physiotherapist or fitness trainer experienced with EDS can design a programme tailored to your abilities and goals.

Exercising with EDS / HSD is not just possible; it can be life-changing. By strengthening your muscles, improving joint stability, and enhancing your overall well-being, the right exercise program can empower you to lead a more active and fulfilling life. Again do remember to approach exercise with patience, listen to your body, and seek guidance from professionals who understand the complexities of EDS / HSD. With the right support, you can move towards better health—one step at a time.

Let’s now begin with the feet initially and then the respective body areas viz. always bottom to top. 

The comorbidities exercises are -

➡️Foot or Foot Arch:

In our body the foot is a very complicated structure. There are 26 bones, more than 30 small joints, and more than 100 muscles, tendons and ligaments that must all work together in order for the foot to function properly. The foot has to cope with varying roles and movements. There is evidence that people with EDS / HSD do get more foot problems than the rest of the population, but importantly many of these problems will respond very well to better footwear, or self-management program based on exercise and staged activities and they are -- 

• The foot needs to be both stable and mobile simultaneously for proper function. 

• The foot needs to be stable and mobile at the same time for good foot mechanics. It is super important to understand the relationship between the foot and the rest of the body.

• The foot will impact the knee, hip, lower back, and upwards from there. Even asymptomatic hypermobile feet and ankles can contribute to pain all the way up the body.

• There are two major foot movements that we need to be able to do for healthy foot mechanics – pronation and supination.

• Pronation sees a flattening of the foot and internal rotation of bones. Supination sees a lifting of the arches and external rotation of bones.

• Research shows that people with joint EDS / HSD can have multiple alterations in walking patterns, including reduced walking speed, altered stepping patterns, and stiffened joint movement when walking (probably an effort to avoid pain or protect the joint).

• This points to a need for gait training and learning how to effectively move our feet.

• Importantly, the muscles in the foot can be deconditioned just like any other muscle in the body. 

• To try - foot mobilization exercises with a spikey ball, standing on one leg whilst holding on.

• Achilles tendon and plantar fascia stretch - Loop a towel around the ball of your foot and pull your toes towards your body, keeping your knee straight. Hold for 30 seconds. Repeat three times on each foot.

• Plantar fascia stretch - Sit down and rest the arch of your foot on a round object, such as a tin of beans. Roll your foot on the tin in all directions for a few minutes. Repeat this exercise twice a day.

• Sitting plantar fascia stretch - Sit down and cross one foot over your knee. Grab the base of your toes and pull them back towards your body, until you feel a comfortable stretch. Hold for 15-20 seconds. Repeat this three times.

• Wall push – They are

(a) Facing a wall, put both hands on the wall at shoulder height and place one foot in front of the other. The front foot should be around 30cm (12 inches) from the wall. With the front knee bent and the back knee straight, bend the front knee towards the wall, until the calf in your back leg feels tight. Relax and repeat 10 times.  

(b) Repeat (a) but bring the back foot forward a little, so that the back knee is slightly bent. Repeat this 10 times.

• Ankle range of motion - Bend your ankle up towards your body as far as possible, then point your toes away from your body. Repeat this 10 times.

• Ankle rotation - Move your ankle around slowly in a circle. Do this 10 times one way, then repeat in the opposite direction.

• Towel pickup - Sit down with a towel on the floor in front of you. Keeping your heel on the ground, pick up the towel by scrunching it between your toes. Repeat 10 to 20 times. As you improve, add a small weight, such as a tin of beans, to the towel.

• Standing heel raise - Using a counter or chair for support, rise up on your tiptoes, with your knees straight. Slowly lower your feet back down. Repeat this 10 times.

• Toe spread - With your feet resting on the floor, spread your toes apart as far as possible. Hold for five seconds. Repeat this exercise 10 times.

• Alphabet writing - While sitting down, write the alphabet in the air with your big toe, by only moving your ankle. Try to write the whole alphabet twice a day.

• Ankle out - Make a loop out of a piece of elastic fitness band, and hold it in place, either with the leg of a table or chair, or with your other foot. Place one foot in the loop. Keeping your heel fixed on the ground, turn your toes outwards against the resistance of the band. Bring your foot back to the original position slowly. Build up to repeating this 10 times, and doing the set three times a day.

• Basic balance - Using a stable object such as a kitchen counter for support, balance on one foot. Build up how long you do this for, aiming for one minute. Try to do this three times, and repeat the set twice a day.

                   Take any opportunities to practice standing on one leg - building it into your daily activities will help you improve. 

When you feel confident with this basic balance exercise, you can make it harder by standing on a cushion or pillow. Build up the amount you do slowly.

                 When you can easily balance on a pillow, and if you’re feeling confident, go back to standing on the floor and repeat the basic balance exercise with your eyes closed.

• Proper footwear and custom orthotics should be used to have an external structural support that compensates for ligament laxity in hypermobile feet.

• Walking or regular walking is always a great form of exercise. If you are experiencing pain while walking, you may need to address foot strength and gait mechanics. Wearing supportive shoes and custom orthotics can also be helpful in the meantime. 

➡️Knees:
In EDS / HSD the concept of cortical maps / somatosensory maps is very important. These cortical maps play a vital role in how our brain perceives the position and movement of our joints, and any distortion of these maps can lead to an increased risk of joint instability, such as knee instability in hypermobility. These maps are responsible for processing sensory input from your body and coordinating motor actions. They help the brain understand the position and movement of various body parts, a sensory ability known as proprioception. In EDS / HSD individuals, sometimes these cortical maps can become distorted or “smudged” due to repetitive subluxations or dislocations and the resulting into an inflammation thereby resulting into knee instability and weakness.

Knee exercises for EDS) / HSD focuses on low-impact strengthening, stabilization, and proprioception to prevent dislocations and pain. Key exercises include gentle quadriceps sets, seated knee extensions with bands, and bodyweight squats while avoiding hyperextension. One should always maintain a slight, "soft" bend in the knees to avoid locking, and start slowly to prevent pain flares.

• Straight-leg raise (sitting) - Sit back in your chair, with a straight back. Straighten and raise one of your legs. Hold for a slow count to 10, then slowly lower your leg. Repeat 10 times with each leg.

• Muscle stretch - Lie down on your back with a rolled-up towel under the ankle of your leg. Bend the other leg at the knee. Use the muscles of your straight leg to push the back of your knee firmly towards the bed or the floor. Hold for a slow count of five.

        Repeat at least five times with each leg. This exercise helps to prevent your knee from becoming permanently bent. Try to do this at least once a day when lying down.

• Leg stretch - Sit on the floor with your legs stretched out straight in front of you. Slowly bend one knee up towards your chest, sliding your foot along the floor, until you feel a stretch. Hold for five seconds. Straighten your leg as far as you can and hold this position for five seconds.

            Repeat 10 times with each leg. If you can't get down onto the floor, sit on a sofa and use a board or tea tray as a surface to slide your foot along.

• Straight-leg raise (lying) - You can do this on the floor or lying in bed. Bend one leg at the knee. Hold your other leg straight and lift your foot just off the floor or bed. Hold for a slow count of five, then lower.

                 Repeat five times with each leg every morning and evening.

• Step ups - Step onto the bottom step of stairs with your right foot. Bring up your left foot, then step down with your right foot, followed by your left foot. Hold on to the bannister if necessary.

             Repeat with each leg until you can't do any more. Rest for one minute and then repeat this another two times. As you improve, use a higher step, or take two at a time.

• Sit / Stands - Sit on a chair. Without using your hands for support, stand up and then sit back down. Make sure each movement is slow and controlled.

           Repeat until you can't do any more. Rest for one minute then repeat another two times. If the chair is too low, start with rising from a cushion on the seat and remove when you don't need it anymore.

• Quads exercise with roll - Sit on the floor, sofa or bed, with your legs stretched straight out in front of you. Put a rolled-up towel under one knee. Push down on the towel as if straightening your knee. Pull your toes and foot towards you, so that you feel your calf muscles stretch, and so that your heel lifts off the floor. Hold for 5 seconds, then relax for 5 seconds. Do this 10 times, then repeat the exercise with the other leg. 

• Leg cross - Sit on the edge of a table, seat or bed and cross your ankles. Push your front leg backwards and back leg forwards against each other until your thigh muscles become tense. Hold this for as long as you can, then relax. Rest for one minute and then repeat another two times. Switch legs and repeat. 

➡️Hips:
The Hip exercises for EDS / HSD focuses on stabilizing hypermobile joints through strengthening the surrounding muscles rather than deep stretching. Key, safe exercises include gentle glute bridges, clamshells, side-lying leg lifts, and isometric hip adduction (squeezing a ball between knees) to build strength and control.

• Leg raise - Lie face down, though you might want to turn your head to one side if this is more comfortable. Tighten your stomach and buttock muscles to lift one leg slightly off the floor, while keeping your hips flat on the ground. Hold this position for 5 to 10 seconds and repeat 3 times.

• Bridging - Lie on your back with your knees bent and feet flat on the floor or bed. Lift your pelvis and lower back off the floor. Hold the position for five seconds and then lower down slowly.

• External hip rotation (sitting) - Sit with your knees bent and feet together. Press your knees down towards the floor using your hands as needed. Alternatively, lie on your back and part your knees, keeping your feet together. Take the movement up to the point you feel a stretch, hold for around 10 seconds and relax. Repeat 5-10 times.

      This may not be suitable for you if you've had recent hip surgery. Speak to a healthcare professional if you're unsure.

• External hip rotation (lying) - Lie with your knees bent and feet flat on the bed, hip width apart. Let one knee drop towards the bed then bring it back up. Keep your back flat on the bed throughout.

• Heel slide - Lie on your back. Bend your leg and slide your knee towards your chest. Slide your heel down again and straighten your knee slowly.

• Hip flexion - Hold on to a work surface and march on the spot to bring your knees up towards your chest alternately. Your physiotherapist may recommend that you don't raise your knee above hip level.

• Hip extension - Move your leg backwards, keeping your knee straight. Clench your buttock tightly and hold for five seconds. Don't lean forward. Repeat with the other leg. Hold on to a chair or work surface for support.

• Hip abduction (standing) - Stand with one hand resting on the back of a chair or a work surface for support. Lift your leg straight up to the side. Hold for five seconds and then slowly lower your leg. Try to keep your body straight throughout. Repeat five times on each side. You can also do this exercise lying sideways.

• Heel to buttock - Bend your knee to pull your heel up towards your bottom. Keep your knees in line and your kneecap pointing towards the floor.

• Squats - Hold onto a chair or work surface for support. Squat down until your kneecap is directly over your big toe. Your knees should not go in front of your toes. Return to your normal standing position.

            Repeat until you can’t do anymore, rest for one minute, then repeat another two times. As you improve, try to squat a little further, but don’t bend your knees beyond a right angle.

• Short arc quadriceps exercise - Roll up a towel and place it under your knee. Keep the back of your thigh on the towel and straighten your knee to raise your foot off the floor. Hold for five seconds and then lower slowly.

• Quadriceps exercise - Pull your toes and ankles towards you, while keeping your leg straight and pushing your knee firmly against the floor. You should feel the tightness in the front of your leg. Hold for five seconds and relax. This exercise can be done from a sitting position as well, if you find this more comfortable.

• Stomach exercise - Lie on your back with your knees bent. Put your hands under the small of your back and pull your belly button down towards the floor or bed. Hold for 20 seconds.

• Knee lift - Lie on your back. Pull each knee to your chest in turn, keeping the other leg straight. Take the movement up to the point you feel a stretch, hold for around 10 seconds and relax. Repeat 5-10 times. If this is difficult, try sliding your heel along the floor towards your bottom to begin with, and when this feels comfortable try lifting your knee as above.

• Glute Bridges - It strengthen the glutes, hips, and core with minimal strain by lifting the hips while lying on your back. Lie on your back with knees bent, lift your hips until shoulders, hips, and knees are aligned, squeezing buttocks.

        Focus on a slow, controlled motion, keeping the lower back protected by engaging your core, and lifting until knees, hips, and shoulders align. Do perform 2-3 sets of 10-15 reps, focusing on squeezing the glutes at the top.

• Side-Lying Leg Lifts - Lie on your side, keeping the top leg straight and hips aligned. Lift the top leg straight up about 12 inches, hold for 6 seconds, and slowly lower.

• Clamshells - Clamshells are a targeted, side-lying exercise designed to strengthen the gluteus medius, hips, and deep hip rotators to improve hip stability and reduce knee or lower back pain. Done by lifting the top knee while keeping feet together, they are a staple in physical therapy for strengthening muscles crucial for movement. 

         Lie on your side with knees bent and stacked. Keeping feet together, lift the top knee to strengthen hip rotators. Do perform 3 sets of 10–15 repetitions on each side.

• Isometric Hip Squeeze: Sit in a chair with a ball or cushion between your knees and squeeze gently to activate the inner thighs and pelvic floor.

              This isometric hip adduction strengthens the inner thigh muscles (adductors) by squeezing an object, like a ball or pillow, between the knees or ankles while holding the contraction without movement. Common techniques include lying supine with bent or straight legs, or lying on your side, holding for 2–6 seconds per rep, 10–15 times. Do perform 2 sets of 10 repetitions, 2–5 times a week.

• Standing Clamshells / Balance: Standing with a resistance band around your knees, slightly bend and move one knee out to the side, ensuring the pelvis stays level.

• Straight Leg Raises: Lie on your back, tighten the thigh muscle (quadriceps), and lift the leg straight up (approx. 45 degrees) to stabilize the hip flexor. 

➡️ Pelvic Floor or Pelvic Diaphragm:
The EDS / HSD remarkable issues people seems to have bladder problems, pelvic floor dysfunction, prolapse, pelvic congestion syndrome, bladder control problems, lower back and neck pain, hip problems (such as hip labral tears, hip pain, gluteal tendinopathy), endometriosis related pain, persistent genital arousal disorder, chronic Sacroiliac Joint (SIJ) pain, tailbone pain, Pudendal neuralgia, vaginismus, vulvodynia, chronic c-section scar pain and others.

The pelvic floor or pelvic diaphragm consists of the bony opening of the pelvis, muscles, fascia, ligaments, connective tissue, and nerves. It provides support for the abdominal and pelvic organs. The pelvic floor muscles extend from the pubic bone at the front of the pelvis to the tailbone at the back of the pelvis and from one sit bone to another. The pelvic floor can often try to act as a trunk stabilizer which leads to tightness not just in the pelvic floor but with all its close relations like the hip, lower back, and abdominal muscles. In turn, this presents as tightness and pain.

This all happens as normally, the spine, hips and pelvis undergo tremendous forces with daily activities therefore a weak, strained, or overly tight pelvic floor muscles does leads to pelvic floor dysfunction.

The pelvic floor exercises for EDS / HSD focuses on gentle stabilization, coordination, and awareness rather than high-intensity strengthening, which can cause joint subluxation. Key techniques include diaphragmatic breathing, pelvic tilts, and gentle Kegels, often performed in supine or supported positions to avoid excessive strain. It is crucial to work with a specialist pelvic physical therapist to manage hypermobility and avoid over-tightening.

A qualified pelvic floor physical therapist do evaluate pelvic floor muscle function, tone, injury, and muscle pain, This pelvic floor physical therapist do work and help to restore bladder function, muscle pain and reduce pelvic pain by treating the whole body, reducing muscular trigger points, enhancing deep core muscle stabilization and pelvic floor muscle function, optimizing the postural alignment to the best, enhance the bladder and bowel function and retraining movement patters.

The best practices to manage pelvic floor issues are – (Begin pelvic floor exercise training with an empty bladder. Gravity-assisted positioning - hips higher than the heart, such as supported bridge or elbows/knees position)

• Contract–Relax - Do tighten the pelvic floor as if attempting to stop urine flow or hold back gas. Hold for 3 to 5 seconds and relax for at least the same length of time. Repeat up to 10 times (if performed with proper technique)

• Quick Contractions - Do perform quick, repeated contractions of the pelvic floor muscles while maintaining a normal breathing rate and keeping accessory muscles relaxed. Try for 15 to 20 repetitions per set.

• “Elevator” Exercise - Do imagine riding in an elevator. As it goes up from one floor to the next contracts the pelvic floor muscles a little more. As strength and awareness improve, add more “floors” to the sequence of the contraction.

           Another way to increase difficulty is to relax the muscles gradually, as if the elevator were descending one floor at a time. This component requires an eccentric contraction and is very challenging.

• Kegel - It consists of an isometric contraction of the pelvic floor muscles. To do a Kegel exercise, follow these steps -

  • • • • Start by holding your pelvic floor muscles in for 5 seconds. It is important to keeping breathing during this contraction.

        • After holding for 5 seconds, slowly and completely relax your muscles for 5 seconds.

        • Repeat this process 10 times, at least 3 times every day.

The pelvic floor muscles may get fatigued during this exercise. If this happens, stop and do the exercise at a later time. Don’t recruit the abdominal, adductors or buttock muscles when doing this exercise.

Exercises can be progressed by increasing the time you hold and rest your  pelvic floor muscles. Start with 5 seconds, and slowly build up the time each week until you’re holding in and resting for 10 seconds.

• Reverse Kegel -The Reverse Kegel is a technique to mindfully relax pelvic floor muscles. To perform a Reverse Kegel, follow these steps:

Start by gently contracting the pelvic floor to feel what tightening the muscles 

 feels like -

• • • • • • Relax, and release the tension to feel the difference between tension and relaxation.

          • Then, try to visualize that the muscles between the pubic bone and tailbone lengthen by gently moving the pubic bone towards the ceiling (if you are lying on your back), and gently move your tailbone towards the surface you are lying on. Imagine that the pelvic floor muscles are getting longer as this happens creating more space in your pelvic floor.

          • During the above action, be sure to breath normally.

As you perform a Reverse Kegel, be sure you keep your pelvis and spine still. These can be performed in sitting and standing as well.

• Transverse Abdominis Activation (TrA) - Transverse abdominis activation can be progressed based on body position, increasing hold times, and increasing sets. Activation can first begin in low-load body positions, including supine, quadruped, sitting, or standing. TrA activation can be challenged by adding arm and/or leg movements and movements like walking or balancing on a tilt board. The plank is a great exercise for TrA.

• Biofeedback - Biofeedback is an instrument-assisted intervention that allows patients to observe real-time pelvic floor muscle activity. Biofeedback can be used to strengthen weak pelvic floor muscles and to relax hypertonic pelvic floor muscles.

            Biofeedback exercises consist of alternating periods of contraction and relaxation. Biofeedback interventions may improve sensitivity and neuromuscular control of the pelvic floor muscles. When using biofeedback with a patient, be sure you measure baseline pelvic floor muscle activity before beginning exercise.

• Hypopressive exercises (HE) - Hypopressive exercises (HE) have been used in the treatment of PFM dysfunctions, such as urinary incontinence. Hypopressive exercises are postural exercises which relax the diaphragm, reduce intra-abdominal pressure, and activate abdominal and pelvic floor muscles (PFM) without voluntary activation. They can be performed in different positions such as supine, sitting or standing, kneeling, quadruped and with varying position of arms and legs. This performance in combination with apnea (breath hold at end expiration), while drawing-in their abdomen and opening their rib cage. The resulting pressure changes has been described to activate the postural muscles, such as the deep abdominal muscles and pelvic floor muscles.

             In all of the hypopressive postures, patients perform the “hypopressive maneuver,” as follows. Patients are asked to: Take a deep breathe; Exhale breathe completely (that action elevates diaphragm); Close their glottis; Then asked to expand their rib cage such that, theoretically, intra‐ abdominal pressure drops.

• Pelvic clock Exercise - Pelvic clock exercises help in developing proprioceptive awareness and pelvic movement control. This exercise may also be performed in side-lying, quadruped, sitting, or standing positions.

• Integral Movement Method (IMM) – An Integral Movement Method (IMM) technique is helpful.

• Support Devices for Prolapse - Pessaries are small, removable devices inserted into the vagina to help support the prolapsed organs. Non-surgical and customizable, pessaries provide immediate relief and reduce prolapse symptoms, especially for those unsuited for surgical intervention due to connective tissue fragility.

• Yoga – Yoga does reduces muscle tension and promotes relaxation. Yoga such as Malasana (Garland Pose), Setu Bandhasana (Bridge Pose), and Supta Baddha Konasana (Reclining Bound Angle), strengthen, lift, and relax the pelvic muscles to improve bladder control, reduce incontinence, and relieve tension. Integrating deep, coordinated breathing—inhaling to relax and exhaling to lift the pelvic floor—is essential for effectiveness.

• Bridge Pose - The bridge pose targets the pelvic floor and engages the core and glute muscles. Follow these steps to perform the bridge pose: 

  • • • • Lie on your back with your knees bent and feet hip-width apart.    

        • Place your arms at your sides, palms facing down.   

        • Inhale and lift your hips towards the ceiling, engaging your pelvic floor muscles.   

        • Hold the pose for 10-15 seconds while maintaining steady breath.   

        • Slowly lower your hips back to the floor and repeat for 10-15 repetitions.

• Squats - Squats are excellent for working the muscles in the lower body, including the pelvic floor. Here's a guide to performing squats correctly:

  • • • • Stand with your feet shoulder-width apart.   

        • Lower your body as if sitting back into a chair, keeping your chest and back straight.   

        • Engage your pelvic floor muscles as you lower and rise.   

        • Aim for three sets of 10-15 squats, gradually increasing the intensity as your strength improves. 

• Pelvic tilts -  Pelvic tilts help strengthen your lower back and abdominal muscles, contributing to pelvic floor stability. Follow these steps:   

  • • • • Lie on your back with your knees bent and feet flat on the floor.   

        • Tighten your abdominal muscles and press your lower back into the floor.   

        • Hold for a few seconds, then release.   

        • Repeat this movement 10-15 times, gradually increasing as your muscles become stronger.   

• Bird dog -  The bird-dog exercise activates multiple muscle groups, including the pelvic floor. Follow these steps to perform the exercise:  

  • • • • Start on your hands and knees, aligning your wrists under your shoulders and your knees under your hips. Keep your back straight.   

        • Engage your core muscles and retract your shoulder blades down toward your hips.   

        • Simultaneously extend and raise your left leg and right arm, maintaining a neutral body position. Hold this position for a few seconds.   

        • Gently lower your arm and leg to the starting position. Repeat the movement with the opposite arm and leg.  

➡️GASTROINTESTINAL (GI): 

The gastrointestinal (GI) issues—such as constipation, slow motility, and reflux— are managed with gentle, controlled exercises to improve core stability and autonomic function. The GI movement is important because –

• Relieves constipation - Physical activity activates the muscles in your digestive tract, helping food and waste move more efficiently.

• Eases bloating - Exercise reduces gas and waste buildup, relieving that full, uncomfortable feeling.

• Improves Irritable Bowel Syndrome (IBS) - Regular movement may help ease IBS symptoms like cramping, bloating, gas, and irregular bowel movements.

• Prevents stress-related gut issues - Exercise is a natural stress reliever — and less stress can lead to fewer digestive flare-ups.

The GI exercises are –

• Walking - Through walking, the digestive system is activated into movement. This movement stimulates our digestive tract to contract, allowing the passage of food and waste through our intestines. This makes for more regular bowel movements and less gas and bloating throughout our gastrointestinal tract. Do aim for 20 to 30 minutes of walking 3 to 5 times a week to start.

• Core & Abdominal Stability - Core strength is crucial for managing GI symptoms. Perform pelvic tilts, gentle crunches, and "the hundreds" (Pilates) while in a supine position (on your back).

• Diaphragmatic Breathing - Deep breathing exercises can help improve vagal tone, which influences digestion.

• Controlled Movement - Focus on slow, controlled movements rather than high-impact, to avoid joint subluxation while strengthening the core.

• Strengthening Posture - Incorporate exercises that improve sitting posture to prevent pelvic collapse, such as using a chair for support while doing gentle leg extensions.

• Gentle Mobility - Prone exercises like "the dart" can help with spinal strengthening and stability.

• Pelvic Floor Activation - To exercise your pelvic floor muscles, squeeze and draw in the muscles around your anus (and vagina for women) so that they feel as though you are lifting them in an upward motion. Breathe slowly in through your noses and out through your mouth as you squeeze and relax. Avoid squeezing your buttock muscles and keep your thighs and legs relaxed. Over time, this will help tighten your pelvic floor muscles which will help with bladder control and bowel movements. This is a great exercise for those who experience bowel control issues. Start with 20 to 30 repetitions daily. Speak with your doctor about the best way to practice this exercise for you. 

• Child’s pose - This relaxing stretch targets your spine, hips and lower back. This simple pose also helps improve digestion by stimulating the internal organs in the abdomen, it can also help reduce stress and fatigue during a busy day.

      Try to kneel on the floor and sit back onto your heels. Stretch your arms forward and lower your chest towards the ground.

• Cat cow - This slow, rhythmic movement engages your core while gently stretching your spine. Cat cow is great for digestion since it relieves tension along the spine and massages other internal organs like the kidneys and liver.

    Try to start on your hands and knees. As you inhale, arch your back downwards and lift your head. Then, round your back and tuck your chin to your chest as you exhale.

• Knees up to the chest - Pulling your knees in applies gentle pressure to your abdomen, easing gas and bloating. Try it before bed or right when you wake up.

    Try to lie on your back and hold your knees at your chest for several breaths.

• Thread the needle - This gentle twist opens up your back, shoulders and chest while loosening tight muscles through your torso. Twisting motions are great for your gut. This helps loosen tension that might be slowing down your digestion.

      Try to start on your hands and knees. Slide one arm under your opposite arm, while lowering your shoulder and head to the floor, twisting through your torso.

• Diaphragmatic breathing - Sometimes, the best way to support digestion is just to breathe – but with intention. Breathing is one of the most powerful tools you have to help your digestive system work well.

     Try to breathe in through your nose and out through your mouth while expanding your belly, ribcage and back.

• Yoga – The brain and our gut are connected as Gut-Brain Axis (GBA). The vagus nerve (a thick cable of neurons running between the base of the brain and our gut) allows the brain and the gut to communicate with each other, with information flowing bi-directionally. The yoga which are beneficial are – wind relieving pose, forward fold, virasana, twisting chair, child’s pose, cobra, bow, seated spinal twist, bridge and waterfall; and definition are –

• Wind relieving pose - This pose relaxes the abdomen, hips, thighs, and buttocks. Relaxing your body, especially your bowels and intestines, can help you pass gas and thus make going to the bathroom easier. Doing this pose may also help with bloating and trapped gas through compression and release. It’s steps are –

1. Lie on your back; bend your knees and bring your legs to 90 degrees.

2. Place your hands at the top of each shin or reach for your elbows.

3. Inhale and expand your belly while moving your knees towards the bottom of the mat.

4. Exhale and draw your knees in towards the chest.

• • • • • • • Forward Fold - The forward fold compresses the digestive organs and stimulates circulations which helps to encourage digestion. It’s steps are -

1. From a standing position; place your toes together with heels slightly apart; fold at the hips, and rest your stomach on your thighs.

2. Place your fingers next to your toes on the mat and bend your knees as much as needed to allow for that, with your weight shifted to the balls of your feet.

3. Gaze to your stomach.

4. Lift sitting bones to the ceiling to lengthen and continue folding.

• Virasana - The kneeling in this pose creates stimulation in the stomach area, which is good for relieving bloating and can improve digestion. It’s steps are -

1. Kneel on the floor with your knees touching.

2. Slide your feet apart, slightly wider than hips, with the tops of your feet flat on the mat.

3. Remove skin and flesh of calf muscles away to make room to sit down between feet (using a block to support sitting bones if they don’t rest comfortably on the mat).

4. Press thigh bones into the mat while lifting your sternum.

5. Widen your collar bones, and lay hands in your lap.

• • • • • Twisting Chair - The act of twisting helps improve mobility and motility. It’s steps are -

1. From a standing position; with your toes together and heels slightly apart, sit in an imaginary chair and shift your weight to your heels.

2. Hands to prayer position in front of your heart and twist to the right, bringing your left elbow to your right knee.

3. Pull left hip back to keep knees aligned and repeat on the other side.

• • • • • Child’s Pose - This pose gently stretches your spine, thighs, hips, and ankles. It can also be used as a resting pose during yoga practice before and after more advanced poses. The light compression on your stomach in this pose can activate digestion. It’s steps are -

1. Sit on mat with knees touching. Bring toes together and spread knees to either edge of the mat; enough for the torso to lower between thighs as sitting bones draw towards feet.

2. Bring your forehead and bridge of the nose to the mat, relaxing your neck with arms overhead on the mat and palms facedown.

3. With each inhale lengthen the torso, exhale draw sitting bones towards the feet.

• • • • • Cobra - This pose stretches belly muscles, improves posture and supports general digestion. It’s steps are -

1. Lie on your stomach, with your feet hip-width apart.

2. Place your palms flat on the floor by lower ribs, with your elbows bent.

3. Extend your legs, press the tops of your feet & all toenails into the mat, and keep your pelvis on the mat.

4. Press into your hands, slowly straightening the arms while bringing your head and sternum up & forward. Roll your shoulders back and down.

• • • • • Bow - This posture can increase blood flow to the digestive system, helping with constipation, digestion, and bloating. It’s steps are -

1. Lie on your stomach with your legs straight and hands to your sides with palms up.

2. Bend your knees and bring your feet as close to your buttocks as possible.

3. Reach back and gently grab your ankles; keep knees hip-width.

4. While keeping your pelvis on the mat, lift your feet skyward, lifting your thighs away from the mat.

5. At the same time, lift your chest and head upward.

• • • • • Seated Spinal Twist - This pose massages the intestines and abdominals and stimulates blood flow, which can increase movement in the digestive tract. It’s steps are -

1. Sit on the floor, with your legs straight out in front.

2. Take your left foot and place it flat on the ground on the outside of the right knee.

3. Place left hand at the base of the spine with fingers facing away.

4. Inhale and bring the right arm up to lengthen.

5. Exhale and place your elbow on the outside of the left knee; slowly twisting to the left, while bringing your gaze over the left shoulder.

6. Repeat on the other side.

• • • • • Bridge - A mild inversion that helps move blood flow in the opposite direction, encouraging digestion. It’s steps are -

1. Lay on your back and bend your knees.

2. Bring your feet close so your fingertips can almost touch the back of your heels.

3. Press your feet into the mat and slowly lift your pelvis using your hamstrings. Keep your chin neutral and gaze skyward.

4. Lift your sternum and ribs skyward, while tucking your arms underneath the body with your fingers interlaced or arms pressed into the mat, elbows bent and fingers skyward.

• • • • • Waterfall - This pose reverses blood flow which stimulates circulation and digestion. It’s steps are -

1. Lie on your back and extend your legs skyward, one at a time and flex your feet.

2. Rest arms comfortably at sides.

3. Can also be done with your butt up against a wall.

➡️SPINAL INSTABILITY:

➡️SHOULDER RECONSTRUCTION:  

➡️TEMPOROMANDIBULAR JOINT (TMJ): 

➡️CRANIO CERVICAL INSTABILITY (CCI) / NECK:

The Craniocervical instability (CCI) / Cervicopathy exercises for especially for EDS  / HSD remarkable issues people are to focus on gentle, isometric strengthening of deep neck muscles and postural realignment, rather than heavy lifting. Key exercises include chin tucks, isometric neck holds, and scapular stabilization, which help create an internal "brace" for the upper cervical spine. Exercises should be slow, controlled, and stop immediately if neurological symptoms like dizziness occur. Kindly do –

• Avoid stretching the neck – this can cause instability and pain

• Listen to your body – if an exercise causes pain, discontinue it.

• Little and often – consistency is key to building stability.

The different types CCI exercises are –

• Chin Tucks (Supine) - Lie on your back with knees bent and head supported. Gently tuck the chin toward the chest to engage deep neck muscles, holding for 5 seconds.

• Isometric Neck Stabilization - Place your hand on the side of your head and gently press your head into your hand without moving the neck. Repeat on the other side and in front/back.

• Upper Back / Scapular Strengthening - Focus on strengthening the scapular muscles to support the neck, rather than just the neck muscles themselves.

• Lift the Heart - Improve posture by lifting the chest to naturally pull the shoulders back and align the head over the pelvis.

• Proprioception Exercises - Use mirrors to monitor movement and ensure muscles are not overworking.

• Slow Movement Training - Use slow, controlled, and small-range movements to increase stability

• Sensorimotor Retraining Program (SRP) - Sensorimotor retraining program consists of step-by-step exercise implementation into a progressive interaction of all relevant coordinated systems (somatosensory, proprioceptive, visual, vestibular, and central integration). Throughout the implementation of sensorimotor retraining plan, neurologic physical therapy should also include the treatment of musculoskeletal impairments of pain/stiffness/spasms in the neck and the improvement of postural correction using manual therapy/dry needling/breathing/relaxation techniques. 

            Please consult the neurologic physical therapist for knowing more in detailed and its practices.

          SRP is being done for those who are affected by neurological and spinal manifestations from cervical instability (i.e. Cranio-Cervical Instability (CCI), Arnold-Chiari Malformation, Upper Cervical Ligament Laxity). Commonly associated symptoms among EDS with CCI include neck pain/stiffness, heaviness of controlling head or feeling of bobble headedness, blurry vision, dizziness, headache, sleeping disorder, hearing impairment, speech impairment, swallowing and imbalance, and dysautonomia.

• Rotator cuff (Shoulder Exercise) - The rotator cuff is responsible for stabilizing and controlling the shoulder. Usually, we are not able to directly treat the root cause of the issue until we begin to decrease the irritability of your shoulder otherwise we run the risk of flaring your symptoms up. The nerves are our "wires" to the shoulder muscles and we need to make sure the connection is not impeded. If the cervical and thoracic spine joints are not moving well, chances are that the nerves are struggling to move a well.

        During this process, we could utilize a plethora of different techniques: myofascial release, gentle stretching, dry needling, gentle joint mobilization, and isometric strengthening to name a few. As the irritability decreases, we can begin to more directly treat the root issue while we respect the nature of healing process. At this stage, treatments would be more directly tailored to treating the root area with techniques like isotonic strengthening, joint mobilizations, and functional strengthening / re-training.

• Deep Neck flexors (DNF) - The deep neck flexors are the muscles at the front of our neck that help to stabilize and support the spine. With forward head posture, the deep neck flexors are generally long and weak, while the muscles at the back of the neck are tight and short. Strengthening the deep neck flexors will help to also lengthen the tight back muscles. It requires slow, controlled, low-load exercises to improve stabilization without overstretching or straining fragile tissues.

To strengthen the deep neck flexors: STANDING

o Standing with your head back against the wall with your knees slightly bent and your lower back relaxed against the wall also.

o Slightly nod your chin in and lengthen your neck by sliding the back of your head slightly up the wall towards the ceiling.

o It is important here to also consider correcting your vision to horizontal here. Usually if you have forward head posture and then correct your posture with this exercise, you will feel as if you are looking downwards.

o Hold for a count of 10-20 seconds. Repeat to fatigue. Aim for 2 set of 8 - 10 repetitions. This is an endurance exercise and should be gentle to moderate in nature.

o Try to apply this to day to day posture as well!

To strengthen the deep neck flexors: LAYING DOWN

o Laying down, with or without a pillow, whichever is most comfortable

o Nod your chin in while lengthening you neck along the floor/pillow. Imagine making your neck longer.

o  Remember to keep breathing while holding the nod.

o You may touch your neck muscles at the front. You want to feel a small tightening of the muscles at the front of the neck, especially up under the jaw. Try to avoid pulling with the bigger muscles.

o Hold for a count of 10-20 seconds and repeat to fatigue. Aim for 2-3 sets of 10 repetitions.

• Scapular Stabilization – Scapular stabilization exercises strengthen the muscles surrounding the shoulder blade (scapula)—primarily the serratus anterior and lower trapezius—to improve posture, reduce neck/shoulder pain, and correct scapular dyskinesis. Key exercises include scaption, IYT raises, band pull-aparts, and plank plus, which enhance shoulder function and stability and they are -

o Scapular Push-ups (Push-up Plus) - In a plank or knee-plank position, keep arms straight and move only the shoulder blades together (retraction) and apart (protraction).

o I-Y-T Raises - Lying face down, raise arms in "I", "Y", and "T" positions to target different back muscles.

o Banded Pull-Aparts - Standing, pull a resistance band apart at chest height, focusing on squeezing shoulder blades together.

o Scapular Clock/Circles - Lying on back, hold a light weight and make small, controlled circles to activate stabilizers.

o Resisted Serratus Hug - Using a band, hug forward against resistance to strengthen the muscle that prevents "winging".

• Scapular Functional – The scapular functional improves shoulder stability, posture, and movement mechanics by strengthening the muscles that control the shoulder blade (scapula), such as the serratus anterior, trapezius, and rhomboids. Key exercises include scapular pushups, prone rows, Y-raises, side-lying external rotations, and scapular wall slides to fix dyskinesis and reduce pain. This scapular functional exercises are –

o Scapular Pushups/Planks - In a high plank or on knees, keep arms straight and move the chest toward the floor (squeezing shoulder blades) and then push away, rounding the upper back.

o Prone Rows/Retraction - Lying face down, lift the chest slightly and squeeze the shoulder blades together, holding for 10 seconds.

o W-Raises/Y-Raises - Standing or prone, lift arms to form a "W" or "Y" shape, focusing on pinching the shoulder blades down and back.

o Side-Lying External Rotation - Lie on your side with the top elbow at 90 degrees against your side; rotate the shoulder to lift the dumbbell toward the ceiling.

o Serratus Punch (Supine) - Lying on your back, push your fist toward the ceiling, allowing your shoulder blade to lift off the floor.

o Lawn Mower Pulls - A diagonal movement starting with the hand at the opposite knee, pulling upward and backward to squeeze the shoulder blade.

• Progressive Postural Control (PPC) – The PPC practices gives significant improvements in pain, disability, and core endurance. The progressive core exercises helps in managing chronic low back pain, enhancing overall outcomes through pain relief, functional improvement, and core stability. The PPC exercises are -

o Wall Posture Correction - Stand with feet out, tilting hips back to touch the wall with the lower back, tucking the chin, and raising arms.

o Bird-Dog - On hands and knees, extend opposite arm and leg to improve core coordination.

o Single-Leg Stance - Stand on one leg for 10-30 seconds, progressing from eyes open to eyes closed.

o Swiss Ball Rotation - Seated on a stability ball, perform trunk rotations to challenge balance.

o Heel-to-Toe Stand - Stand with one foot directly in front of the other (tandem stance), holding for 20 seconds

• Physical Therapy - Specialized exercises can help strengthen the neck muscles to provide better support to the unstable joints. However, this approach must be handled carefully to avoid worsening the instability.

• Cervical Collar - Temporary use of a cervical collar can provide relief by stabilizing the neck, but it is not a long-term solution.

• Pain Management - Medications like NSAIDs, muscle relaxants, and nerve pain medications can help alleviate the pain and discomfort associated with CCI.

➡️DISLOCATION & SUB LAXATION:

A dislocation is defined as “displacement of a bone from its natural position in the joint”. This is where the two bones that form a joint fully separate from each other. If we consider a shoulder for example, which is a ball and socket joint, a dislocation occurs when the ball (which forms the top of the arm bone) slips entirely out of the socket it should sit in within the shoulder. This can happen in any direction, but the main point is that the two bones completely separate. 

A subluxation is basically defined as “a partial dislocation”. It can be no less painful than a full dislocation, but the two bones that form the joint are still partially in contact with each other. So once again, if we consider the shoulder joint as an example, the ball which completely came out of the socket in the dislocation example above would still be partially sitting in the socket in a subluxation. 

These events can happen in any joints, but are more common with shoulders, knees, thumbs, and ankles. However, they don’t need to ruin your life and can — with patience, effort, trust, and time — be managed. Not necessarily completely eliminated, but symptomatically managed. 

The ways to manage DISLOCATION and SUB-LAXATION are -

1. Breathe: Use slow deep, relaxed breaths. Try using some relaxation techniques, there are lots of different ones out there. As painful as it is, and as difficult as it may sound, you need to start to try to take control of this situation. So start to learn how to breathe through it.

2. Support the joint: You need to try to make yourself as comfortable as possible (I know it’s not easy). Use pillows or a sling if you have one. Find a comfortable resting position as much as possible. This allows the muscles to relax and stop spasming.

3. Try heat: Hot water bottles, wheat bags, and a warm bath can all help to relax spasming, overactive muscles.

4. Distraction: Try to take your focus away from the pain and the situation. Listen to music, watch a movie if you can, talk to friends/family, try a relaxation CD/MP3. This can be helpful as a short-term pain relieving strategy. Again it can help muscles relax.

5. Gentle massage: Sometimes gentle massage around the joint can help relax the muscles enough to be able to gently relocate the joint or for the joint to just slip back into place by itself.

6. Physical therapy: Physical Therapy to learn to control the muscles around joints and to use the right ones

7. Rehab: Rehab to improve proprioception

8. Supports / Braces: The possible use of supports / braces if required

9. Stress / Anxiety: Trying to manage stress and anxieties

10. Use painkillers: Take some appropriate painkillers (analgesia) if you have some. However, note the word “appropriate”. You should only ever take analgesia according to the dosage indicated by your prescriber. Never take more than the suggested dose. You might feel like it may not be enough at the time, but if it can take some of the edge off, then that’s a great start. Please don’t ever overdose.

Finally, prevention is better than cure! It is obviously better if we can prevent these situations occurring in the first place as opposed to having to deal with them. To that end, the following can hopefully help to reduce the frequency of such occurrences:

• Physical therapy to learn to control the muscles around joints and to use the right ones;

• Rehab to improve proprioception;

• The possible use of supports/braces if required;

• Trying to manage stress and anxieties.  

But ultimately, stay calm! The more you stay calm when these events happen and manage it yourself, the easier it should get each time.  

 
When should one go to the hospital or get help?

• If the limb starts to change color due to a lack of blood supply.

• If your hands get swollen

• If your limb goes completely numb

• If you have tried all above strategies 1-10 above, have waited a reasonable amount of time and are still desperately struggling

➡️FIBROMYALGIA:

Fibromyalgia is a pain-processing disorder, more precisely a chronic disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. It’s more common in women. It’s mainly due to the way our brain and spinal cord process painful and nonpainful signals which increases the overall sensitivity to pain. Stress can make your symptoms worse or cause them to flare up more often. It could also increase your chances of developing depression.

There is no direct relationship nor any proven scientific evidence that a person having Ehlers Danlos Syndrome (EDS) / Hypermobility Spectrum Disorder (HSD) will also have Fibromyalgia (FM) or vice versa or both.

Fibromyalgia changes how pain is felt but EDS / HSD changes how the body is built. That difference matters because when doctors mistake one for the other, patients lose years of proper care and treatments. Kindly understand that EDS / HSD is a genetic defect in collagen production, while FM is considered a disorder of pain processing (central sensitization). EDS is diagnosed via clinical criteria and genetic test, while fibromyalgia is a diagnosis of exclusion based on widespread chronic pain.

The management of both EDS / HSD and FM involves pain control, but they require different approaches. Fibromyalgia often responds to medication targeting the central nervous system (e.g., nerve pain medication, antidepressants). EDS / HSD requires managing tissue fragility and protecting joints through bracing, specialized physical therapy, and avoiding high-impact activities.

It is known that both EDS / HSD and Fibromyalgia (FM) are different from each other? Both generate pain but the root cause are different for pain being generated either by EDS / HSD or FM though the treatments can be same.

Yes, EDS can sometimes be misdiagnosed as Fibromyalgia because both conditions share symptoms like chronic pain, orthostatic intolerance, and fatigue. A person having FM doesn’t mean would also having EDS / HSD?

Clinically looking into whole-body approach and genetic test does distinguishes EDS / HSD from FM. More often EDS / HSD is mistaken from FM and people goes in many years of false positive believe in having EDS / HSD.

The people who have fibromyalgia they also have:

• • • • Headaches.

      • Jaw and facial pain due to temporomandibular joint (TMJ) disorders.

      • Irritable bowel syndrome.

      • Anxiety.

      • Depression.

The exercises and key activities needed for fibromyalgia are walking, warm-water therapy, gentle yoga, tai chi, and light resistance training, starting with 10 minutes daily and gradually increasing. Consistency is crucial, focusing on movement rather than high intensity.

• Exercise / Physical therapy - Regular exercise helps people with fibromyalgia reduce pain and depression. Aerobic exercise and strength training do the most to relieve symptoms, but yoga, tai chi, Pilates, swimming, and Nordic walking also work. The idea is to start at a low intensity and work up to a moderate one. Be gentle when you begin. It may take about 6 weeks before you see any benefit. A physical therapist can help you get started with an exercise program or advise you on which activities to try.

• Talk therapy - Talking with a counselor or psychologist can help you to deal with your stress. Cognitive behavioral therapy (CBT) is a type of talk therapy that teaches you how to change your thoughts to lessen emotional distress. Research shows that a higher belief in your ability to complete a task or goal is linked to lower levels of pain and depression.  

• Acupuncture - Acupuncture can reduce pain and improve the quality of life in some people with long-term pain.

• Yoga & Meditation - Yoga's combination of stretching and meditation seems to ease multiple fibro symptoms including poor sleep, anxiety, and depression. Seated yoga positions can be practiced on a chair or the floor. Or try a restorative pose: Lie on the floor with your legs extended straight up a wall.

• Music & Dance - Moving to music around the house can be more enjoyable and beneficial. 

• Pilates - The focus of Pilates is muscle toning and flexibility, and it is a low impact form of exercise. The Pilate exercises helps to strengthen sore (and often weak) back muscles. Pilates focuses on all muscles that attach to the spine and this may make pain in this area be reduced

• Tai Chi - This is basically a coordinated form of deep breathing and relaxation. Tai chi does tone muscle, improves balance and endurance.

➡️MYOFASCIAL:

Myofascial pain is a chronic discomfort in Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSD). It occurs because muscles overwork to stabilize joints weakened by lax connective tissue, leading to muscle spasms, trigger points, and pain. Effective management includes specialized physical therapy, manual techniques, and targeted exercises.

The primary mechanisms of myofascial release are psychological and neurological. Fascia carries varied meanings across professions, but mainly it has two main definitions:

1. Fascia: A sheath, sheet, or dissectible aggregation of connective tissue beneath the skin that attaches, encloses, and separates muscles and internal organs.

2. Fascial System: A three-dimensional continuum of soft, collagen-containing connective tissues that permeate the body, encompassing structures like adipose tissue, neurovascular sheaths, ligaments, and tendons. It surrounds and integrates all organs, muscles, bones, and nerves, supporting functional structure and systemic integration. 

Fascia in depth can be understood as fascia is arranged in layers in the body that encase and connect the structures they surround, in particular muscles and the sheaths encasing tendons, nerves and blood vessels. These fascial layers slide and glide over each other to allow free and easy movement in response to the demands we put on our bodies. However in people with EDS / HSD this gliding function is often reduced which means there is more strain put on joints every time they move. The reduced gliding can result from inflammatory changes in the ECM which can lead to problems like joint instability, subluxation and dislocation, and pain. The movement at joints is provided by the tendon- muscle units. Tendons connect muscles to bones which allow joints to move. These units should adapt to the demands of movement, for example in walking or running. However in hypermobility syndromes the tendons are more elastic than normal and overstretch on movement resulting in joint instability.

The exercises and key activities needed for myofascial are - Myofascial release therapy (MRT) and Myofascial stretching (MS). 

• Myofascial Release Therapy (MRT) is a wonderful way to alleviate tough and stubborn aches and pains. The MRT can be helpful as it helps to rebalance the body as a whole. All parts of the fascial network are interconnected so if one part changes, then the whole network changes and adapts to accommodate this. By releasing tension in the fascia myofascial release helps to reduce restrictions in overworked fascia, reduce muscle tension and take some of the strain off joints without destabilising them. This in turn results in a reduction in pain.  

• Myofascial stretching (MS) does offers a gentle and targeted approach that aligns with the needs by providing:

- Controlled Movements with slow, deliberate movements that prioritize joint stability.

- Focus on Alignment which prevents strain on already vulnerable joints.

- Pain Management by releasing fascial tension.

Some of the Myofascial stretching exercises are - 

1. Seated Neck Stretch to relieve tension in the neck and shoulders.

How to do it:

◦ Sit in a comfortable position with your back straight.

◦ Gently tilt your head to one side, bringing your ear toward your shoulder.

◦ Place your hand on the side of your head for slight added resistance.

◦ Hold for 20-30 seconds, then switch sides.

2. Hip Flexor Release to reduce tension in the hips and improve pelvic alignment.

How to do it:

◦ Kneel on one knee with the other foot in front, forming a 90-degree angle.

◦ Gently press your hips forward until you feel a stretch in the front of the hip.

◦ Hold for 20-30 seconds, then switch sides.

3. Thoracic Spine Stretch to improve mobility and posture in the upper back.

How to do it:

◦ Sit on the floor with your legs crossed.

◦ Place your hands behind your head and gently twist your upper body to one side.

◦ Hold for a few seconds, then return to the center and twist to the other side.

◦ Repeat 5-6 times on each side.

➡️NEURO MODULATION:

The Neuromodulation techniques, particularly non-invasive vagus nerve stimulation and rhythmic sensory stimulation, show promise in treating chronic pain, autonomic dysfunction (POTS), and gastrointestinal issues associated with Ehlers-Danlos Syndrome (EDS).

Peripheral nerve stimulation with a transcutaneous electrical nerve stimulation (TENS) unit, applied at high intensity over multiple sessions, also has been shown to improve pain and fatigue in fibromyalgia patients. Additionally, transcranial magnetic stimulation and transcranial direct current stimulation have been found to reduce pain perception and fatigue in those with fibromyalgia.

➡️POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME (POTS):

POTS is a nervous system dysfunction, which prevents the autonomic nervous system from properly regulating the heart rate. The connective tissue surrounding nerves can be overly stretchy or fragile or compressed or dysregulated or deformed, leading to improper signaling which includes the vagus nerve. When vagus nerve signaling is disrupted, it contributes to POTS, a form of dysautonomia.

Collagen is a key component of connective tissue that provides strength to blood vessels. Person having connective tissue disorders, including conditions like EDS / HSD, do contributes to weak blood vessels. When connective tissue is weakened (as in EDS / HSD), blood vessels are more elastic or "stretchy," making it difficult for them to constrict, which directly contributes to excessive blood pooling in the legs.

Normally, upon standing, the nervous system tells blood vessels in the lower body to constrict (tighten) to fight gravity. In POTS, this contraction does not happen efficiently. Because vessels do not tighten, a significant amount of blood (approx. 500ml) pools in the abdomen and legs instead of returning to the heart and brain. The resulting poor circulation in the limbs can cause a reddish-purple color in the legs and hands. 

The body does attempts to compensate for low blood pressure in the brain by triggering the carotid body (a sensor in the neck), which causes hyperventilation and a sensation of breathlessness. Dysfunctional breathing patterns can develop, sometimes leading to low CO₂ levels (hypocapnia), which exacerbate symptoms like lightheadedness and fatigue. It’s also believed that there is an abnormal connective tissue in the veins precipitating the venous pooling phenomenon, there is poor cerebral perfusion, and Sympathetic overdrive leading to dysautonomia or POTS.

When someone has POTS and hypermobility, constipation normally becomes unavoidable and it’s not only uncomfortable but it’s very complex. People with POTS experience chronic sympathetic overdrive, especially in the evening hours when the body is supposed to be winding down. Instead of transitioning smoothly into parasympathetic “rest and digest” mode, their autonomic nervous system stays stuck in high gear—wired, anxious, heart racing. It’s a nervous system that forgets how to slow down.

Reactive hypoglycemia after eating is one of the most misunderstood POTS symptoms. Basically our autonomic nervous system is struggling to regulate blood sugar properly. When our POTS improves, typically the blood sugar stabilizes too.

POTS has been found to be more severe in women than men. Also, it is found that women’s heart attack symptoms are different than men’s.

The understanding about the mechanics of POTS and it's sub types are very important for POTS management. Also, an understanding of any overlap of POTS sub types in an individual is highly important. 

The different types of POTS are - Neuropathic POTS, Hyperadrenergic / Adernal POTS, Hypovolemic POTS, Secondary POTS, Deconditioning POTS and Mixed Type POTS. The causes of POTS may vary from person to person.

⏰POTS Daily Activities:

💧Water (1–3 liters/day): Dehydration worsens symptoms. More fluids = more blood volume = more stability.

🧂Salt (6–10 grams/day): Salt helps your body retain that extra fluid to keep blood pressure up and prevent dizziness.

🚴Graded, recumbent exercise: Starting with exercises lying down (like rowing or recumbent biking) helps build blood volume and strengthen the leg muscles that pump blood back to your heart. Over time, this retrains your body to handle being upright.

🥗Low-carb eating: Big carb-heavy meals can pull blood into your belly. Lowering carbs can help reduce this post-meal “pooling” and the energy crashes that follow.

🛏️ Head of bed elevated: Keeping your head elevated 6 - 8 inches while sleeping helps prevent overnight fluid loss and makes it easier for your body to maintain blood volume in the morning.

🧦Compression: Lower extremity and abdominal compression helps movie fluid back into your vascular system and back to your heart and brain (wear compression socks!!).

💦POTS exercises:

Supervised exercise programs have been shown to be the most effective for the management of PoTS either with Physiotherapists or Exercise Physiologists or PoTS trainer. PoTS does has different exercise capacities so it’s important that one sets its own personal baselines when getting started. It is also encouraged that to start with a conservative approach, which could involve introducing a baseline of 60 seconds of exercise and then progressing this over time.

It is highly recommended that individuals with PoTS should gradually introduce gentle exercise into their routine with the aim of building up to 3-4 exercise sessions per week, with the option of further building to 5-6 sessions per week after a minimum 3-month successful training period. Of these training sessions, it is recommended that 1-2 of these sessions could be a resistance training session while the focus remains on aerobic exercise.

• Exercising with POTS – The Tips for Success:

1. Avoid Exercising in the Heat – Exercising in hot conditions can worsen PoTS symptoms.

2. Minimize Postural Changes – Plan workouts to limit the need for frequent changes in posture, reducing the strain on your cardiovascular system.

3. Hydration and Electrolytes – Consuming fluids and electrolytes 20-30 minutes before working out helps expand blood volume, potentially reducing exercise-induced symptoms. Keep hydrated throughout your session to maintain blood volume.

4. Medication Timing – Timing exercise with the peak effectiveness of your medication can improve exercise tolerance and reduce symptoms whilst exercising.

5. Food Timing – Avoid eating 2 hours before exercising to minimize gastrointestinal discomfort and reduce blood flow diversion to the intestines for digestion.

6. Pace Yourself – It’s crucial to progress at your own pace. Active recovery and rest are just as important as progression, ensuring that every step forward is sustainable.

• POTS Exercises in 60 seconds:

Exercise can be an effective strategy for the management of PoTS. PoTS does has different exercise capacities so it’s important that we set our own personal baselines when getting started rather completely denying.

Exercise certainly helps as - it helps increase blood volume, it builds skeletal muscle mass that helps the heart push blood around, and it makes our bodies work more efficiently. Exercise prevent further deconditioning, it’s strengthen the muscles in legs and core to help the blood vessels pump blood back up so it doesn’t pool. To continue to reap the benefits of exercise, the EDS / HSD remarkable issues people have to keep it up

Do Start low, go slow and move ahead with below exercises as quick as possible -

1 – Bird dog

2 – Superman

3 – Cat Camel

4 – Cobra

5 - Hip Bridge

6 – Thread the needle

7 - Archer

It can take 6-12 weeks of exercising before noticing any change within yourself.

It’s always important to understand the limits EDS / HSD people are against and why they're different and require different responses.

First, there is the limit of strength and / or cardio fitness. Second is the limit of PoTS physiology.

Let’s push against that first limit – “strength and cardio” -- and by pushing expand that limit. That's the point of exercise.

If we push against that second limit -- our PoTS physiology -- we don't expand that limit. We just wear ourselves out, and risk passing out/crashing. Importantly, pushing against this second limit -- a futile effort -- steals energy from pushing against the first limit of strength/cardio. So, we want to minimize pushing against the limit of our POTS physiology as much as we can (by doing recumbent exercise, for example), while maximizing our ability to push against the strength/cardio limit. Otherwise, we're not training as efficiently as we could be.

Now, you might choose to push up against the PoTS physiology limit for reasons -- enjoyment is a big one; necessity is another. Let’s focus on pushing against the strength / cardio limit, because that's what expands the PoTS limit.

• PoTS Exercises in 7 minutes:

Here are the 12 exercises where each exercise is done for 30 seconds, followed by a 10-second rest:

1. Wall Sit: Sit with your back against a wall, knees bent at a 90-degree angle. This helps build leg strength without putting too much strain on the heart.

2. Chair-Assisted Push-Ups: Use a sturdy chair to perform push-ups, either standing or kneeling. This reduces the intensity while still working the upper body.

3. Seated Marching: While sitting, lift your knees alternately to engage your core and leg muscles without standing up.

4. Seated Leg Raises: While seated, extend one leg at a time, engaging the thigh muscles and strengthening the legs.

5. Chair-Assisted Squats: Stand up from a seated position using a chair for support, then sit back down. This mimics everyday movements and strengthens the legs and core.

6. Wall Push-Ups: Stand facing a wall, place your hands on the wall, and perform push-ups by leaning into it. This low-impact movement strengthens the chest and arms.

7. Seated Shoulder Press (using light resistance bands or body weight): Sit and press your arms overhead as though lifting weights, building upper body strength without overexertion.

8. Seated Side Leg Lifts: While sitting, lift one leg out to the side, then switch. This targets the hips and outer thighs while maintaining a low-impact, seated position.

9. Seated Toe Taps: Tap your toes in front of you while seated, engaging your leg and core muscles without standing.

10. Chair-Assisted Step-Ups: Using a low step or sturdy platform, step up and down, holding onto a chair or railing for balance. This exercise gently elevates the heart rate while strengthening the legs.

11. Seated Side Twists: While sitting, twist your upper body from side to side, engaging the core muscles.

12. Plank (Modified to Kneeling): Perform a plank from your knees, keeping your core engaged. This strengthens the entire body without requiring a standing position.

• Reclined Exercises:

This help improve circulation, prevent muscle atrophy, and keep the body moving while minimizing strain. The examples of Reclined Exercises are -

o Leg Pillow Squeeze: Place a pillow between your knees and squeeze for 10 seconds.

o Arm Pillow Squeeze: Squeeze a pillow between your hands, mimicking a prayer position, and hold for 10 seconds.

o Alphabet Toes: Spell your name or the alphabet in the air with your toes while lying down.

o Side and Front Leg Lifts: Lift your legs while lying on your back or side to build strength in the lower body.

o Gentle Stretching: Stretching while reclined can improve flexibility and relieve stiffness.

• Chair-Based Exercises:

If you have limited endurance for upright exercises, chair exercises offer an excellent way to build strength without putting stress on the heart and legs. These exercises are accessible and can be done at home. The examples of Chair Exercises:

o Seated Marching: Lift your knees alternately while seated, engaging your core and legs.

o Chair-Assisted Squats: Stand up from a seated position and sit back down to strengthen the legs.

o Seated Toe Taps and Side Twists: Tap your toes or twist your upper body to engage the core and legs without standing up.

• Pool Exercises (Aquatherapy):

Water exercises are an excellent option because the pressure of water can help improve circulation, prevent orthostatic symptoms, and allow EDS / HSD remarkable issues person to exercise for longer periods without discomfort. The buoyancy of water also supports the body, making it easier to move without straining muscles.

                                  Aquatherapy can be particularly helpful for patients who cannot tolerate dry-land exercises. It provides a low-impact way to get the cardiovascular benefits of exercise without worsening symptoms. If you try aquatherapy, make sure to exercise in a safe environment, such as a pool with a lifeguard, and do avoid very warm water.

• Yoga:

Yoga combines gentle movement and relaxation, making it a fantastic low-impact exercise for POTS. Here are some beginner-friendly poses to try -

1. Child’s Pose - Kneel on the floor and sit back onto your heels. Extend your arms forward and rest your forehead on the floor. Breathe deeply for 30 seconds to one minute.

2. Seated Twist - Sit cross-legged or in a chair. Place one hand on your opposite knee and gently twist your torso, looking over your shoulder. Hold for 15 seconds on each side.

3. Bridge Pose - Lie on your back with knees bent and feet flat on the floor. Keep your arms alongside your body and your palms down. Slowly lift your hips off the floor, engaging your glutes and core. Hold for 3-5 breaths, then gently lower down. Repeat 3-5 times with rest between each lift.

4. Legs-Up-the-Wall Pose - Lie on your back with your legs extended up a wall. This restorative pose promotes blood flow back to your heart and can help reduce dizziness.

Yoga for POTS not only enhances circulation but also helps calm the nervous system—a crucial benefit for managing symptoms.

➡️VEGUS NERVE / VEGAL TONE:

➡️INTERDISCIPLINARY: 

📍Functional Rehabilitation:

Functional rehabilitation is a comprehensive, multi-phase program that restores movement, strength, and coordination to help individuals return to daily, work, or sport-specific activities. It goes beyond traditional therapy by targeting the whole body, reducing compensation patterns, and accelerating recovery through tailored, goal-oriented exercises.

Functional training's goal is to teach to move better, feel better, and perform better. Functional training emphasizes upright, everyday movement patterns that target multiple muscle groups at once in a coordinated way to be very efficient in movement patterns. The focus of functional training is really to gain quality of movement control, strength, and power so that one can then directly utilize with the specific movement patterns one is trying to enhance.

One can begin functional rehab as soon as your injury recovery allows. With this type of physical therapy, your rehabilitation usually follows a multi-phase program of progressive steps, beginning with controlling inflammation and pain, to restoring motion, finally to developing muscle strength, power and endurance. The benefits of functional rehabilitation include:

• Better muscle memory because it engages your muscles with repetitive, functional exercises

• Higher endurance because it helps build cardiovascular stamina while improving endurance during high-intensity activities like weightlifting or running

• Improved posture and balance by engaging the core to help keep your spine in proper alignment

• Less joint pain because it strengthens the joints and prevents overuse to alleviate pain and restore joint mobility

• Improved flexibility by retraining your muscles to become more flexible, significantly reducing the chances of reinjury while alleviating pain and discomfort

In functional rehabilitation, you use three-dimensional movements to strengthen isolated, previously injured muscles. The process prepares your whole body to return to daily activities or sports. You come away from functional rehab stronger and more flexible.

📍DISCLAIMER:

The above EXERCISES and FUNCTIONAL REHABILITATION should only be taken or practiced under the guidance and advice of a doctor or qualified healthcare professional. Self-exercises or any form of functional rehabilitation until unless not recommended can be dangerous, as "natural" does not mean safe, or over doing, in some cases, can be fatal. 

The information here is for educational and informational purposes only and does not constitute any medical advice, diagnosis, or treatment. Please consult qualified SPECIALIST / HEALTH PROVIDER / DOCTORS for any suggestion, trail, implementation and any questions regarding a health condition. Please never disregard professional medical advice or delay seeking it because of having an information found here.