Summer is here! Water parks, beaches and pools have been drawing large crowds in recent weeks. Previously, we discussed exercises that are beneficial for people with Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD), with swimming being one of our suggestions. Swimming and its benefits for EDS/HSD patients will be discussed in greater detail in this post as it can be a great option to keep active, burn calories, and develop your muscles without placing too much strain on your joints.
Due to the buoyancy of water, swimming is gentler on your joints compared to other activities and can be an excellent form of exercise for joint health. However, extra monitoring is required, especially for certain patient groups typically observed in EDS cases, such as those with repeated joint subluxations, shoulder issues, or spine instabilities. Improper training methods or too much effort might aggravate these issues. As a result, we strongly advise everyone, especially those with an EDS/HSD diagnosis, to visit their doctor before beginning a swimming regimen.
One of the remarkable advantages of swimming is its ability to engage multiple muscle groups simultaneously. By incorporating the four main swimming styles—freestyle stroke, backstroke, breaststroke, and butterfly stroke—you can effectively target various muscle groups throughout your body. This comprehensive muscle engagement makes swimming a great full-body workout for individuals with EDS/HSD.
Pain is a common complaint among people with EDS/HSD, and swimming has been found to offer relief. Studies have shown the Pain-Relieving Effects of Swimming for individuals with EDS/HSD, making it a recommended exercise for managing pain symptoms.
In addition to its joint-friendly and pain-relieving properties, swimming provides significant Cardiovascular Benefits. Regular swimming sessions help to improve circulation, expand lung capacity, and strengthen the heart. You can improve your cardiovascular health while reducing the strain on your joints by including swimming in your routine.
Not only is swimming good for your physical health, but it's also good for your mind. Swimming has a lot of a positive effects on mood and general well-being. Recent studies show that swimming regularly can improve mood and lessen depressive symptoms, making it a fun and therapeutic activity for people with EDS/HSD.
The best way to begin a swimming practice is to start slowly and build up to a higher frequency and intensity of sessions over time. It is crucial to pay attention to your body's limits and refrain from pushing yourself past them, in contrast to the "no pain, no gain" philosophy frequently associated with exercise. This mindful approach ensures a safe and sustainable swimming routine.
Do you swim regularly or are you planning to start swimming after reading this post? We would love to hear about your experiences and thoughts! Please let us know in the comment section below.
Author: Ozan Soyer, MD
I have central sensitivity, POTS & HSD. I actually never learned to swim… But a few years ago when I had finally found a PT who recognized central sensitivity syndrome, she referred me to “aqua therapy,” a form of physical therapy in a heated pool. Luckily, I’m treated at a medical center that offers it.
Unfortunately, the pool PT wasn’t as well-versed in central sensitivity, and I didn’t know at the time that I had POTS, though I had been diagnosed with small fiber neuropathy. For the first month of sessions, I felt sick—almost like flu-like symptoms. After sessions, I would feel dizzy, lightheaded, body aches, tingling in my legs and fatigued for days. Then it would get better, I’d have another aqua session and the same thing would happen. He didn’t understand what was going on, and neither did I because I didn’t know my pain conditions as well as I do now.
Finally, I reached out to my regular PT (who I had paused seeing while I was in aqua therapy), and I guess she recognized the potential triggers immediately: It was the classic “too much, too soon”—while the buoyancy of water helps, the resistance can make some things much more challenging, and even so the drastic change in environment was causing my nervous system to protest to try to protect me, because of the central sensitivity. And the pool was heated to “therapeutic” level, which was much warmer than a normal pool—the heat was exacerbating my small fiber neuropathy. Really it was my POTS, but we didn’t know it yet.
Finally, she gave him strict instructions not to keep me in the pool longer than the session, and shorter if needed. When I got out of the pool, I had to do it very slowly to allow my blood flow time to adjust. The number of repetitions of exercises had to be scaled much further back and increased slowly so my body/brain could adjust and minimize the post-exertion malaise.
My aqua PT, like many I’d seen before him, was confused because while I appeared strong enough to do what he asked, my body would still respond so strongly. Thankfully, they believed me.
Ultimately, aqua therapy was a game changer. I was able to teach my body in the water that core and lower body exercises done in the pool were safe, and do enough without severe flare-ups to get strong enough to do them out of the pool.
It was a huge help, but those first 4-5 weeks were really bad. I decided to share this because many with HSD/EDS also have POTS, fibro and central sensitivity that might create a situation where we’re more sensitive to a change in exercise program or environment. The pool is supposed to be so much more “gentle,” but like with anything it has its challenges and our bodies tend to respond strongly to change.
I blamed my body and myself for things going wrong. While the PT didn’t realize what was going wrong, it’s also their responsibility to listen to me and help keep me safe, and he didn’t take it seriously for a while. It makes me sad to remember that I blamed myself.
It’s a great idea to remind us it’s always best to speak with a physician before starting a program, but I did talk to my PCP. The only person who figured out the problem was my original PT, over a month later. I wish that more providers were aware of these conditions so we wouldn’t have to rely so much on luck, experimenting, intense research on our own and always advocating-advocating-advocating for ourselves. It’s been 8 weeks since I returned from the EDS Clinic and the waiting game and confusion with communication upon leaving and trying to continue my work-up has been frustrating, but I’m trying to be patient. I’ve now spoken to all of my specialists at home with what new information I have so far. None of them treat POTS, HSD, or fibromyalgia, including my PTs. I can’t find an OT who treats any of the above either. My rheumatologist and others have said it “falls out of their scope of practice.” It’s so disheartening.
That said, while I’ve still not learned to swim, the pool definitely helped me. The hard work was worth it, though there’s more to do.
My daughter found out 4 yrs ago that she has EDS because of a sweet knowledgeable pediatrician she established her young son with. He sent my grandson (at 7) to a Geneticist and he was diagnosed with EDS along with his Mom (I never knew, nor did her Pediatricians or Family Physicians, growing up😥) Her younger daughter also has been diagnosed with EDS. Mom and children also have a few other not so nice syndromes that can sometimes also be present with EDS,(MCAS and dysautonomia). I feel so bad for them all, especially the children to have to start this journey at such a young age. 😥🙏❤️
That is very tough! But I’m hoping for them this means they’ll be able to grow up supported and encouraged and with access to care. Often the average wait time for diagnosis is more than 3 years and sometimes even longer for individuals.
I never learned to swim, either. However, I've learned a lot of stretches from water aerobics--I do not worry about cardio, just regaining flexibility and strength. I also saw someone doing Tai Chi in the water! You probably know moves that work for you: there are books with exercises that you can add to your routine. If I take a class, I go slow, amend movements as needed. I have MCTD with the fibromyalgia piece, and the time in the pool is pretty pain free. There are PTs who specialize in the EDS portion, but you might have to talk about what moves would transfer well to the water. There are books with specialized moves. If you cannot find one at the library, one I found online is Water Exercises for Fibromyalgia (Ann Rosenstein). Lifestyle wise, go non-processed, low sugar on food and keep moving as you can.
Your progress sounds terrific. Keeping the muscles strong is a key that I only found out about as I got old and lost muscle strength. My hypermobile joints and hEDS fell "out of their scope", and I am afraid it just means they don't know. I would really like to see the EDS Society to put focus on informational materials for health professionals. It took me 2 doctors plus 3 Orthopods before I found a Regenerative medicine doctor who knew what was wrong and how to treat! AND treatments very often avoid surgeries!
Oh wow this is so great to finally read. I have not been completely diagnosed but after 16 1/2 years of chronic pain I’m getting closer. I have HSD but it’s like pulling teeth to get a practitioner to say it. My PCP said I had a connective tissue disorder and sent me to a Rhemy - he said I didn’t have Lupus but was hyper mobile. And sent me on my way. My PT s are totally supportive but say there is really nothing to be done expect stability exercises. It’s been such a long road and such a painful one that I am filled with tears writing this. Everyone, and I mean everyone in my life has had a diagnosis and wondered why I just didn’t get well. It wasn’t until my daughters classmate in Grad school alerted me to EDS as she did her thesis on it that I even know it existed. None of my myriad docs and therapists have used the words hEDS, EDS or HSD until I did . God I am behind frustrated and don’t even know what I should be doing next! Thanks for posting- it’s also the first post I’ve seen on this platform???
Oh wow, welcome if this is your first post you’re seeing?!
I’m so sorry this happened to you, and you haven’t had answers or maybe even an affirmation. But I’m glad you found your way here, if this helped you. The EDS/HSD blog is really helpful for a place to start, and so is the EDS Society: https://www.ehlers-danlos.com/
There are also many bloggers and PTs who host sites about EDS, POTS and hypermobility.
I believe the EDS society has a provider directory on their website.
It’s beyond frustrating that so many providers (rheumatologists, PCPs, orthopedists, etc.) consider EDS and HSD (and fibromyalgia and every other chronic pain condition it seems) “outside their scope of practice.” In my experience, PTs are most likely to be familiar with the physiological aspects of it, yet they don’t have authority to diagnose it. They can send you to a physician…but odds are they won’t feel “comfortable” diagnosing it!
I could rant about that forever. Thankfully, there are a lot of online resources you can find if you look up hEDS and hypermobility. If physical pain is your primary symptom, stability exercises can go a long way to improving them. You kinda need a PT who’s experienced with hypermobility or willing to do the research on best practices though.
If you feel you may have other systemic symptoms related to hypermobility, it is even harder to find a provider. I’m not sure how much you might want to pursue further evaluation, but in my area the closest EDS clinic wait list was 2 years. I waited about 9 months to be seen at Mayo Jacksonville’s clinic.
But there are options, and there is treatment, and you can access it or learn a lot even without that. I think deciding what to do next depends on what you feel is most important, which symptoms if any you’re interested in addressing.
Where are you located? You might be able to find an online PT with experience with hypermobility too.
Thank-you. I do have supportive PT and recently another specialty PT . My problems started in 2007 with a shattered Femoral head. When 2 yrs later I was In so much pain I wanted to drive
Off a cliff I was diagnosed by my surgeon with CRPS. I so wanted a diagnosis that had a remedy that I went through every therapy, drug and PT to get well which never happened- my very convoluted long story progressed when I received a TKR on Dec 2021. During the rehab of that a leg length decrepency and re-education of
Muscle function made
Me believe that finally I was going to get better- the gist
Of it all being I’d been walking with a collapsed gait that was causing everything to malfunction and cause pain. But throughout this I also believed it was something in the soft tissue - or more accurately the connective tissue. When I was introduced to hEDS it just explained me way too well. BUT here is the dilemma - what other problems are involved. My back perhaps? My pain is so Dynamic. But last November was the straw that had made everything so much worse. I woke up and my other leg had a pain in the groin area. I have not been able to fix this and walking hurts. I really feel like I lost all hope and acceptance is all I have but it is so difficult to live in so much pain. And do I need a diagnosis?? What are your thoughts on that? My new PT , who has her own issues, says I probably have an undiagnosed connective tissue issue that will never be named! I guess I just accept this? Idk what my next step should be. I just went to a new Physitrist who is going to inject my back. After that there is nothing else to do.
I am on the EDS wedsite , but it is not interactive like this so - I am open to try anything. I’ve found that at least that gives me a little hope which is a beautiful thing. I am in Northern California- close to Reno Nevada, Sacramento and 3 hours to San Francisco.
Thank you for sharing.
I learned from my care team that pain can change. While we might always need to live with some level of pain, it doesn't always have to be so severe or limiting. But one mistake with chronic pain is that it's easy for us to look for something physical to "fix," but chronic pain is different than acute pain such as a broken arm. With a broken arm, you can ideally address the fracture and in time, hopefully the pain goes away. But chronic pain is different--it's usually systemic, like in hypermobility. And/or it involves insistent pain signals in the nervous system that keeps the pain cycle going, sometimes even if you do address physical causes. I don't want to get stuck in the weeds of chronic pain, but that was one major thing I learned that helped me decide on my next steps >_<
Do you think you want to look more into hypermobility as a potential diagnosis? Could that be an option? If so, maybe you could look for a physician or physical therapist in your area who has experience with hypermobility. The EDS Society has a provider finder here: https://www.ehlers-danlos.com/healthcare-professionals-directory/
The thing is, it can be really difficult to find a phyiscian; the wait could be really long. In my experience, it can be more direct to find a physical therapist. You might get more information and potentially more relief, more quickly by doing a consultation with a PT well-versed in hypermobility. Even if it's short-term, if you could get information and guidance to bring to your own PTs, that could help.
Even before I was diagnosed, PT was always my preference because regardless of a certain diagnosis, they could look at what I'm experiencing right now and help come up with a plan to improve my function. If you feel confident your medical team has ruled out conditions that would be more life threatening, it's been my experience that I didn't have to have a formal diagnosis. I was always less interested in the label, only because I wanted relief and improvement in function more. But that's just me...and knowing that if I had done nothing else except chase doctors in the 3 years it took to get my first diagnosis of inflammatory arthritis, that would have been a long time in pain potentially not making much progress or feeling frozen.
There are also a TON of online resources for hEDS and HSD. It's not that I'm saying not to listen to your doctors or forgo medical treatment or anything like that, but sadly a lot of us have to DIY pain management because of the shortage of providers or other barriers to access.
I wouldn't say there's "nothing to be done" (that is one of my least favorite phrases relating to chronic pain) except stability exercises. That's one intervention of many, but I would agree PT has been the foundation of pain management for hypermobility for me. PT is the #1 thing that's had the biggest impact on my pain and quality of life, but it has to be appropriate for hypermobility--if it's not, it can hurt more than it can heal (which has also happened to me too many times, sigh).
One other thing that really helped me was patient education and research--learning about chronic pain as a symptom of a stressed out nervous system and why hypermobility causes pain, fatigue, etc., why PT and other strategies help, and what type of PT is safest and most effective, all helped me gave me hope and ideas for what I might be able to do on my own and with support from the right care team.
Maybe learning more about things that can help might keep you hopeful and give you some ideas on how to move forward?
I found this physiotherapist (in the UK I think?) with a YouTube channel and blog that had a lot of brief educational videos, along with examples or exercises if it might give a starting point: https://www.youtube.com/@JeannieDiBonHypermobility/streams
The groin pain and walking issues began my intro into my hEDS. Finally found out it was coming from a hyper mobile SIJoint extending to meet unequal leg lengths created from a hip ball joint replacement. Walking around for 4 years with that created damage in the other hip ... It also stretched the Illiopsis ligament that connects the back to the pelvis. The fix was prolotherapy that tightened the loose ligament and keeps the SI Joint mostly in place. I say mostly because it does still move slightly out of place but a knee to the chest realligns the joint. I will also add that the ligament was totally tight before it overstretched. Lying along the side of the bed and dropping the leg will stretch that ligament.
Hope you find help ... Regenerative Medicine is one place to try