If you’ve been told you have Hypermobility Spectrum Disorder (HSD) instead of hypermobile Ehlers-Danlos syndrome (hEDS), you may have felt relief, confusion — or even dismissal.
Many people ask:
Is HSD less serious?
Does it mean my symptoms are milder?
Will treatment be different?
Let’s unpack this clearly and gently.
In 2017, international criteria separated hypermobility-related conditions into two categories:
The key word here is symptomatic.
HSD is not “just being flexible.” It describes people who experience pain, instability, injury, or other complications related to joint hypermobility — but who do not meet every requirement for hEDS.
The distinction is based on diagnostic thresholds, not on how much someone is struggling.
There are several common scenarios:
You may have significant joint instability and chronic pain but not enough systemic connective tissue features to meet hEDS criteria.
You may narrowly miss the Beighton score cut-off, especially if you are older and have naturally lost flexibility over time.
You may not have a confirmed family history.
Or your presentation may not fit cleanly into the hEDS framework, even though hypermobility is clearly contributing to symptoms.
In these cases, HSD is the appropriate diagnostic category.
Not necessarily.
The hEDS criteria include systemic connective tissue features and family history patterns. That does not automatically mean symptoms are worse.
Some people with HSD have significant daily impairment. Some people with hEDS function relatively well.
Diagnosis reflects pattern recognition — not a severity scale.
This is where confusion often increases.
People with both HSD and hEDS can experience:
These patterns are not exclusive to hEDS. Research is still evolving, but clinically, overlap is substantial.
It can feel invalidating if someone with HSD is told, implicitly or explicitly, that associated symptoms “don’t count” because they don’t meet hEDS criteria. In practice, support should be guided by presentation — not by label alone.
In most cases, management principles are very similar.
The core challenges in both HSD and hEDS involve:
Because these drivers overlap, management strategies overlap too.
For both HSD and hEDS, strengthening is typically more helpful than stretching.
The focus is usually on:
The aim is stability, not increasing flexibility.
Pain in hypermobility conditions often has multiple contributors: mechanical strain, micro-instability, and central sensitisation.
Management may include:
Again, these approaches are similar across HSD and hEDS.
Many people with both diagnoses experience fatigue patterns, “wired but tired” states, or autonomic symptoms.
Management may involve:
The diagnosis does not usually change this framework.
Both HSD and hEDS can benefit from coordinated care when symptoms are complex.
This might include:
The need for team-based care is determined by functional impact — not the label.
There are some situations where distinctions matter.
If someone clearly meets hEDS criteria and has a strong family history, clinicians may:
If red flags suggest another connective tissue disorder (such as vascular EDS or Marfan syndrome), assessment pathways change significantly.
However, between HSD and hEDS specifically, day-to-day symptom management is often aligned.
If management is similar, why does the label matter at all?
Diagnosis can influence:
For some people, receiving an hEDS diagnosis feels affirming. For others, HSD feels clearer and more accurate.
Both are legitimate medical diagnoses.
Hypermobility exists on a spectrum. The 2017 criteria were designed to create research clarity and diagnostic consistency. They were not designed to divide people into “serious” and “less serious” categories.
If you have HSD and your symptoms are affecting your life, that impact deserves care. If you have hEDS, the same applies. The more useful question is not “Which label is worse?” but “What patterns are driving my symptoms, and how can we stabilise them?”
If your symptoms are escalating, if you experience frequent dislocations, severe pain, or systemic features that don’t fit neatly into your current diagnosis, review with a clinician experienced in hypermobility conditions may be helpful.
Urgent assessment is important if there are signs suggestive of other connective tissue disorders, particularly those involving vascular complications.
HSD and hEDS share far more similarities than differences when it comes to lived experience and day-to-day management. Your care should be guided by function, safety, and stability — not by whether you crossed a diagnostic threshold. Labels help structure medicine. They do not determine the legitimacy of your symptoms.
