To the untrained eye, a hypermobile teenager might simply appear to have a talent…effortlessly bending, twisting and stretching beyond the norm. It might even appear to give them a competitive edge. But beneath the surface, Hypermobility Syndrome presents a hidden challenge for young athletes. The condition affects connective tissue and can lead to joint instability, fatigue, pain and frequent injuries. Managing hypermobility isn’t about pulling a teenager out of sport, but rather giving them the support they need to thrive with it. With the right strategies, physios can play a big role in supporting hypermobile athletes for the long game.

Let’s face it, many people can have very flexible joints. It’s when this flexibility comes with pain and other symptoms that it’s important to be on the lookout for Hypermobility Syndrome.Typical signs can include:

• Frequent sprains or dislocations
• Persistent joint or muscle pain, particularly after activity
• Poor coordination or clumsiness
• Early fatigue during physical exertion
• A history of delayed motor milestones or growing pains

The Beighton Score is often used as a screening tool, assessing hypermobility on a 9-point scale. It looks at: knuckle of both little/fifth/pinky fingers, base of both thumbs, elbows, knees and spine. A positive score is anything greater than 6/9 points in children before puberty and 5/9 in adults.

For many teenagers with Hypermobility Syndrome, the physiotherapist is often the first health professional to connect the dots between frequent injuries and an underlying connective tissue condition. By identifying it early, physiotherapists can work with patients to prevent long-term complications and overuse injuries.

Consider this scenario: a 13-year-old netballer presents with recurring ankle sprains, knee pain after games, and fatigue. She’s brushed off as "just not fit enough", until a physio performs a Beighton Score and suspects Hypermobility Syndrome. With an early intervention plan, her injuries reduced dramatically. Through accurate assessment and timely referrals, physios play an essential role in shaping a long-term pathway that enables, not limits, participation in sport.

Physiotherapy-led programs should focus on:

• Strength training that gradually builds joint stability
• Core and pelvic control to improve postural support and balance
• Proprioceptive training to enhance body awareness and reduce injury risk
• Movement retraining, especially in hypermobile joints

Sessions need to be progressive, gentle and consistent, pushing just enough to build strength without triggering flare-ups. For example, introducing slow, controlled lunges or step-ups might build quad and glute strength in a hypermobile teen without overloading their knees.

Teenagers with hypermobility often overcommit, training multiple days a week, competing on weekends, and juggling school sports. Physios can help when it comes to monitoring recovery and adjusting training intensity during growth spurts or flare-ups. They can also educate about pain neuroscience, helping teens understand that pain doesn't always mean damage. By balancing activity with rest and adding in gentle forms of movement, such as Pilates, teens can continue the sports they love. Supporting a hypermobile teenager is a team effort. When everyone is on the same page, the chances of long-term success, both on and off the field, increase dramatically.

Parents and coaches are often unfamiliar with Hypermobility Syndrome. To them, a teenager who seems “lazy” or frequently injured might just need to “toughen up”. A physio’s role includes explaining the condition in accessible language and outlining why certain activities may need modification, not elimination. By liaising with coaches and parents, limitations and goals can be set in place, alongside warm-up and cool-down modifications to help with training intensity, rest periods and expectations.

Of course, teenagers often want to keep up with their peers. They may under-report symptoms or push through pain to avoid missing out. They also often measure themselves against peers with faster recoveries, stronger stability, and fewer setbacks. This can lead to frustration or burnout if not carefully managed. A key goal is to ensure the teen continues to feel confident participating in physical activity, whether they pursue elite sport or simply stay active for health and enjoyment.

Not all teens with hypermobility follow the same path, and some may require further investigation or specialised care. Referral to a rheumatologist, sports physician, or psychologist may be needed if:

• Symptoms suggest possible hEDS or another connective tissue disorder
• There’s ongoing pain or fatigue that limits daily functioning
• Mental health concerns arise from chronic injury, isolation, or anxiety

As these young people transition into adulthood, giving them tools to manage their bodies becomes just as important as the interventions themselves. Educating teens about injury prevention, recovery strategies, listening to their body’s cues and when (and how) to seek help lays the foundation for healthy, independent movement far beyond their teenage years.

Supporting teenage athletes with Hypermobility Syndrome is rarely a quick fix. As physiotherapists, our goal isn’t to hold these athletes back, but to guide them forward. The long game isn’t just about keeping them on the field today, it’s about setting them up for a lifetime of confident participation in physical activity. And that’s a win in anyone’s book.