Pilates for Hypermobility: Safe Strength for Bendy Joints

By Katherine, Lead Instructor, Certified Pilates Instructor

Pilates can be a reasonable option if you are hypermobile, as long as the work is built around control rather than stretching: small ranges, supported joints and no hanging on the end of your range. The research on Pilates specifically for hypermobility is limited, so the most important nuance is to plan it with your health care provider and an instructor who adapts to you.

Key takeaways

• Joint hypermobility often causes no symptoms; when it does cause pain or instability it may be called a hypermobility spectrum disorder (HSD) or, if full criteria are met, hypermobile Ehlers-Danlos syndrome (hEDS) (Castori et al., 2017).

• Evidence is limited. One 2026 non-randomized online Pilates study found modest improvements, and about 17% of people who tried it reported some increase in pain or a flare of an existing problem (Russek et al., 2026).

• A Toronto hospital clinic's program for hypermobility builds stability and control before adding load, and teaches people to find neutral joint positions and avoid hyperextension (Mittal et al., 2021).

• Reformer and mat Pilates can both be adapted; neither has been shown to be safer for hypermobile people.

• Sharp joint pain, a joint slipping out of place, or numbness are reasons to stop and seek advice.

What does "hypermobile" actually mean?

Joint hypermobility means a joint moves further than is typical. When it affects many joints at once it is called generalized joint hypermobility, often screened with the Beighton score, the most commonly used tool for this (Castori et al., 2017). How far joints move is strongly influenced by age, sex and ethnic background, and joint hypermobility is often present without any symptoms.

When hypermobility comes with pain, joint instability or other musculoskeletal problems, clinicians may use the term hypermobility spectrum disorder (HSD) (Castori et al., 2017). Hypermobile Ehlers-Danlos syndrome (hEDS) sits at the far end of that spectrum, but the features of HSD and hEDS largely overlap and the degree of disability varies across the groups (Castori et al., 2017). hEDS is diagnosed by a clinician using the 2017 international criteria, which also look at features beyond the joints (Malfait et al., 2017). The Ehlers-Danlos Society describes hEDS and HSD as overlapping, and researchers are still refining how to tell them apart (Ehlers-Danlos Society). Only a clinician can tell you where you fall; this article does not diagnose anything.

Is Pilates safe if you are hypermobile?

It can be, with the right adaptations, but "safe" depends on you, your symptoms and how the session is run. If back pain is part of your picture, our guide to Pilates for lower back pain covers what that evidence says. There is no large, high-quality trial showing that Pilates is safe or effective for hypermobility, so we cannot promise a result.

The closest evidence is a 2026 pragmatic trial of an eight-week online Pilates program designed for people with symptomatic hypermobility. Of the 671 people who completed the initial questionnaires, 420 completed the eight-week questionnaires (200 in the Pilates group and 220 on a waitlist), and people were not randomly assigned. The Pilates group improved on measures of hypermobility impact, body awareness and fear of movement, and the changes were still present at six months. The authors called the gains modest and noted high dropout and an unsupervised format. About 17% of people in the Pilates group who answered the follow-up survey reported some increase in pain or a flare of an existing problem that they put down to the Pilates; about half said it was temporary or that they could modify or skip exercises (Russek et al., 2026).

Read honestly, that is encouraging, not proof, and a reminder that individual adaptation matters.

Why does stability matter more than stretching?

In a hypermobile joint, the challenge is often controlling where you stop, not how far you can go. The aim is for your muscles to control the range you already have, not for passive structures to be doing the holding. For the wider picture, see our guide to whether Pilates improves flexibility.

Clinical programs reflect this priority. The GoodHope Ehlers-Danlos syndrome clinic at Toronto General Hospital describes an 8-week exercise program (20 weeks including follow-up visits) that teaches neuromuscular stabilization before resistance training, and teaches people to find neutral joint positions and avoid hyperextension (Mittal et al., 2021). That paper describes the program without reporting efficacy results, so treat it as a framework, not proof.

Pilates fits this thinking in principle, because it emphasizes slow, precise, controlled movement. It can also be taught in a way that works against a hypermobile body, for example by chasing deep stretches.

What does the evidence say about exercise for hypermobility in general?

It is honest to say it is thin. A 2014 systematic review of exercise for joint hypermobility syndrome found only four eligible studies; all showed improvement over time, but there was no convincing evidence that exercise beat a control or that one type of exercise was better than another (Palmer et al., 2014). A 2018 review of physical therapies for lower limb symptoms in children with HSD or hEDS found two randomized trials (86 children in total) and concluded that the evidence was very limited and could not definitively guide which physical therapy to prescribe (Peterson et al., 2018).

This does not mean exercise is useless or unsafe, only that the research has not shown which approach is best.

What cues help you avoid locking your joints?

These are common, practical cues for hypermobile bodies. Your instructor will choose among them depending on the exercise:

• Soft knees and elbows. Stop a little short of straight, with the muscles around the joint switched on, instead of pushing back into the stop.

• Stop at the first sense of resistance. Treat the point where you feel the movement end as the limit, not a target to go past.

• Use muscles to hold the position. Press gently through the hand or foot and hold the joint with muscle effort.

• Smaller range, slower tempo. Controlled movement through mid-range often feels harder than a big, fast one.

• Add support. Props, a different position or the reformer's springs can take load off a joint.

Good control is a skill, not a squeeze; our post on what "engage your core" actually means explains more. In our sessions we adapt exercises to you as your control improves.

Reformer or mat Pilates for hypermobility?

Both can work, and we have not found a study comparing them for hypermobile people. The reformer's springs and straps can add support, but the moving carriage can also draw a limb toward the end of its range if the setup is wrong, so it is not automatically safer. Mat work uses body weight and gravity, which can make control harder. Our guide to reformer versus mat Pilates explains the general differences.

How should you work with your clinicians?

If you have a diagnosis of HSD or hEDS, or have been told you have lax or unstable joints, tell your Pilates instructor and share any precautions from your doctor, physiotherapist or occupational therapist. Pilates is exercise instruction, not medical care, and does not replace a physiotherapist who can assess your joints. Our guide to Pilates or physiotherapy explains how the two can work together.

If you have frequent dislocations or partial dislocations (subluxations) or unexplained widespread pain, speak with your family doctor before starting; they can refer you for assessment.

Safety note: This article is general information, not medical advice, and it is not a substitute for an individual assessment. If you have been diagnosed with hEDS or HSD, or suspect you may have a connective tissue condition, check with your family doctor, physiotherapist or specialist before starting Pilates, and share their guidance with your instructor. Stop and seek advice if you feel sharp joint pain, a joint slipping or catching, numbness or tingling, or faintness or dizziness during or after a session. We adapt sessions around the information you and your health care provider share with us and we work alongside your care team; our instructors are not physiotherapists and do not diagnose or treat medical conditions.

Starting safely with us in Markham

If you are hypermobile and want a careful, individual start, Private 1:1 Pilates with Lead Instructor (1 hr) gives us time to learn how your joints behave and to build movements around control. A Posture Assessment + 1:1 Pilates Intro (1 hr 15 min) is another way to begin. We are in Markham, serving York Region. You can book your session here.

Frequently asked questions

Is being hypermobile the same as being very flexible?

Not exactly. Hypermobility describes joints that move further than is typical, while "flexible" usually means how far you can stretch. Many hypermobile people have no symptoms at all (Castori et al., 2017), and we focus on how well you control your range, not how far it goes.

Will Pilates make my joints less hypermobile?

The studies we reviewed measured outcomes such as symptom impact, body awareness and fear of movement, not changes in the underlying range of your joints (Russek et al., 2026). A realistic goal is better control and confidence.

What should I tell my instructor before the first session?

Share any diagnosis, joints that tend to slip, past injuries, movements that have felt uncomfortable, and any precautions from your doctor or physiotherapist. Also mention any dizziness or fainting during exercise. This helps us adapt the session from the start, and written guidance from your physiotherapist is welcome.

Sources

1. Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A (2017). A framework for the classification of joint hypermobility and related conditions. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175C(1):148-157. https://ern-ithaca.eu/wp-content/uploads/2020/12/Castori_EDS_hypermobilityscore_AJMGc2017.pdf

2. Malfait F, Francomano C, Byers P, et al. (2017). The 2017 international classification of the Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1):8-26. https://pubmed.ncbi.nlm.nih.gov/28306229/

3. Ehlers-Danlos Society (n.d.). hEDS and HSD Criteria Review Study. https://www.ehlers-danlos.com/heds-and-hsd-criteria-review-study/

4. Russek LN, Di Bon J, Herbland A, et al. (2026). An online Pilates program for people with hypermobility: a pragmatic clinical trial. Journal of Multidisciplinary Healthcare. https://doi.org/10.2147/JMDH.S564972

5. Mittal N, Santa Mina D, Buryk-Iggers S, et al. (2021). The GoodHope Exercise and Rehabilitation (GEAR) Program for People With Ehlers-Danlos Syndromes and Generalized Hypermobility Spectrum Disorders. Frontiers in Rehabilitation Sciences, 2:769792. https://pmc.ncbi.nlm.nih.gov/articles/PMC9397788

6. Palmer S, Bailey S, Barker L, Barney L, Elliott A (2014). The effectiveness of therapeutic exercise for joint hypermobility syndrome: a systematic review. Physiotherapy, 100(3):220-227. https://pubmed.ncbi.nlm.nih.gov/24238699/

7. Peterson B, Coda A, Pacey V, Hawke F (2018). Physical and mechanical therapies for lower limb symptoms in children with Hypermobility Spectrum Disorder and Hypermobile Ehlers-Danlos Syndrome: a systematic review. Journal of Foot and Ankle Research, 11:59. https://pmc.ncbi.nlm.nih.gov/articles/PMC6222981/