At New Moon Physiotherapy in Baltimore, Maryland, Dr. Noelle Schlegel , PT,  is a connective tissue disorder specialist who specializes in hEDS physical therapy, working with clients whose bodies don’t respond well to generic, one-size-fits-all rehab plans.

If you’ve been diagnosed with hypermobile Ehlers-Danlos Syndrome (hEDS), you’ve probably already heard “you should try physical therapy” more times than you can count. What you may not have heard is what that actually means, because hEDS physical therapy looks very different from the PT most people picture after a sports injury or surgery.

This guide walks through what hEDS treatment really involves, why it differs from standard physical therapy, and what you can expect if you’re searching for a physical therapist for hEDS in the Baltimore area.

Why hEDS Needs a Different Approach to Physical Therapy

Hypermobile EDS is a connective tissue disorder. The collagen that should give your joints, ligaments, and tendons stability is looser and less supportive than the “average” person. That means your joints can – and often do – move beyond a typical range of motion, whether you want them to or not.

This changes the entire calculus of rehab. A treatment plan designed for a typical joint sprain or post-op recovery often assumes the surrounding tissue is stable and simply needs to heal or regain strength.

With hEDS, the tissue itself is the underlying issue, not just the injury layered on top of it. That means:

• Aggressive stretching can make instability worse, not better
• Manual therapy techniques need to be adapted to avoid over-mobilizing already-loose joints
• Traditional strength progressions (heavy load, low reps, open chain exercises) can trigger subluxations, flare-ups, or pain
• Fatigue and autonomic symptoms (common in hEDS, especially alongside POTS or MCAS) affect how much a person can tolerate in a session

This is why finding a physical therapist for hEDS who actually understands hypermobility disorders – not just someone who treats “flexible patients” – makes such a big difference in outcomes. Dr. Noelle works in an EDS Society designated Center of Excellence, one of a handful in the Nation. Schedule an Evaluation with Dr. Noelle.

What hEDS Treatment Actually Looks Like

1. A Thorough, Hypermobility-Specific Evaluation

hEDS treatment doesn’t start with a generic strength or range-of-motion test. A good evaluation looks at:

• Beighton score and joint-by-joint hypermobility mapping
• Movement patterns and compensation strategies (many hEDS patients have unconsciously learned to “lock out” joints instead of stabilizing them muscularly)
• Areas of chronic instability, subluxation, or pain
• Co-morbid conditions like POTS, MCAS, or chronic fatigue that affect exercise tolerance
• Daily function: what tasks are hard, painful, or being avoided altogether

This assessment shapes everything that follows. There’s no standard hEDS protocol pulled off a shelf; Dr. Noelle will build a treatment around your specific joints, symptoms, and goals.

2. Low-Load, High-Repetition Strengthening

The cornerstone of hypermobile EDS physical therapy is joint stabilization through muscle strength, but the loading strategy matters. Instead of heavy weights and low reps, hEDS exercise programs should use:

• Light resistance with higher repetitions
• Closed-chain movements that encourage joint centration (keeping the joint aligned and supported), rather than open-chain movements that can pull joints toward end range
• Isometric holds to build stability without moving through unstable ranges
• Very gradual progression — increasing load or difficulty only after the previous stage is pain-free and controlled

The goal isn’t to build maximum strength quickly. It’s to build the kind of muscular support that keeps joints from moving into positions where ligaments alone are doing the work.

3. Proprioception and Joint Position Training

Because hEDS affects the connective tissue that normally helps you sense where your joints are in space, many people with hEDS have poor proprioception. Their brain isn’t getting accurate feedback about joint position. This contributes to instability, falls, and reinjury.

hEDS physical therapy typically includes specific proprioceptive drills: balance work, joint position matching exercises, and controlled movement through mid-range positions where the joint is best supported. This retrains the nervous system to protect the joint actively, rather than relying on ligaments that are already too lax to do the job.

4. Manual Therapy Used Carefully, Not Avoided Entirely

Manual therapy isn’t off the table for hEDS, but it looks different. Rather than aggressive joint mobilizations meant to increase range of motion (the opposite of what most hEDS patients need). Dr. Noelle uses manual techniques to:

• Address soft tissue restrictions and compensatory muscle tightness
• Support pain relief without increasing joint laxity
• Assist with short-term symptom management around a flare

The emphasis stays on stability, not increasing mobility that’s often already excessive.

5. Pacing, Energy Conservation, and Flare Management

Many people with hEDS deal with fatigue, pain flares, and reduced exercise tolerance, especially if POTS or dysautonomia is part of the picture. Effective hEDS treatment accounts for this by building in:

• Pacing strategies so exercise doesn’t trigger a days-long flare
• Guidance on modifying activity during flare periods without losing progress
• Education on activity thresholds specific to your body, rather than generic “push through it” advice

This is often the piece that’s missing from PT experiences that didn’t work in the past. Physical therapy for hypermobile EDS must respect the nervous system and energy limits of the person doing it, not just the joint being treated.

6. Education You Can Actually Use

A large part of New Moon Physiotherapy’s hEDS treatment is teaching you to understand your own body: how to recognize early signs of subluxation, how to modify daily movements to protect vulnerable joints, and how to advocate for appropriate care from other providers. This education piece is what allows progress made in the clinic to actually hold up in daily life.

What a Typical Session Might Include

A session with a physical therapist experienced in hEDS might combine:

• A quick check-in on symptoms, flares, or recent activity tolerance
• Joint-specific stabilization exercises for the area(s) of focus
• Proprioceptive or balance work
• Dry Needling
• Manual therapy or soft tissue work as needed
• Pacing and home program adjustments based on how the week went

Progress in hEDS physical therapy is usually slower and more incremental than in typical orthopedic rehab, and that’s expected, not a sign that something is going wrong.

How to Choose the Right Physical Therapist for hEDS

Not every clinic is set up to treat hypermobile EDS well. When looking for a physical therapist for hEDS, it helps to ask:

• Have you treated hEDS or hypermobility spectrum disorders before?
• How do you modify strengthening programs for connective tissue laxity?
• How do you account for fatigue, flares, or co-morbid conditions like POTS?
• What does progress typically look like, and over what timeline?
• Do you work in an EDS Society designated Center of Excellence?

A therapist who listens to these concerns and adjusts their approach accordingly is far more likely to help you make real, lasting progress.

hEDS Physical Therapy in Baltimore, Maryland

At New Moon Physiotherapy, Dr. Noelle Schlegel works with hEDS and hypermobility patients throughout Baltimore, White Marsh, Towson, Perry Hall, Bel Air, and surrounding areas in Maryland, building individualized treatment plans around joint stability, proprioception, pacing, and sustainable strength, not generic protocols that weren’t designed for connective tissue disorders in the first place. If you’re looking for hEDS physical therapy near Baltimore and want a plan that accounts accounts for how your body works, contact Dr. Noelle to experience the difference an expert can make.