hEds, HSD, Chronic Pain and Fascia: Who is affected and why?
hEDS (Ehlers Danlos Syndrome) and HSD (hypermobility spectrum disorder) are complex connective tissue conditions involving joint hypermobility, chronic pain, fatigue and often have multisystem symptoms—including digestive and neuroimmune issues.
New research positions fascia (the body’s connective tissue web) as central —a site of chronic low-grade inflammation, immune dysregulation and mechanical instability with altered pain signalling.
These conditions often overlap with other chronic pain states (fibromyalgia, IBS, migraine, MCAS) likely because of shared mechanisms in fascia, immune and nervous system function.
In my practice I have long seen these clusters of conditions in clients and it is what has shaped me as a manual therapist over the last ten years.
Why are women more affected?
hEDS and HSD shows up a lot more for women than men and it is thought to be because of genetics and hormones.
Estrogen impacts connective tissue by influencing collagen and fascia, making ligaments looser and more vulnerable to pain especially during hormonal shifts in puberty, menstruation, pregnancy and menopause.
Trans, gender diverse and queer humans:
During my recent deep dive into the most current research about fascia, chronic pain and hEDS I suddenly had the realization that a lot of the humans that come see me in my practice, who fall in these TGD and Queer communities, often have chronic pain and indication of hypermobility. So I started looking for research and lo and behold! TGD humans are much more likely to be diagnosed with hEDS/HSD than their cisgendered peers.
Multiple studies in 2024-2025 found hypermobility-related disorders at rates 15-18 times higher in TGD humans than cisgender groups- regardless of the use of hormone therapy!
My Practice
Most of my chronic pain clients arrived undiagnosed, with symptoms that fit a bigger picture of hypermobility and multisystem pain.
Over the last 10 years of working with chronic pain clients and tracking their inflammation responses and stress levels has shaped my practice and the education I seek. Fascial techniques, chronic pain strategies and finally going back to school to become a Manual Osteopath so that I have tools for joints, fascia, lymphatics, nervous system regulation, visceral manipulation etc!
My recent dive into the current research showed me that I have been building the right skill set for these clients! Adapting manual therapy for inflammatory disorders, visceral, fascial, hypermobility and multifactorial pain, especially for clients who don’t feel seen by “typical” models of care.
If you’ve been looking for a practitioner who holds space for your myriad of symptoms and pain — you’ve found me and I would really enjoy working with you.
Please reach out if you have any questions.
Samantha
Sources / Further Reading:
Wang TJ. Fascial Pathophysiology in Hypermobility Spectrum Disorders. PMC, 2025.pmc.ncbi.nlm.nih
TMJ Research Foundation. Chronic Overlapping Pain Conditions (COPCs). Research Advances, Mar 2025.tmj
Wang TJ. Fascial Pathophysiology in Hypermobility Spectrum Disorders. PubMed, 2025.pubmed.ncbi.nlm.nih
Gennev. Ehlers-Danlos Syndrome & hEDS Symptoms in Menopause. 2021.gennev
Prevalence of Hypermobile Ehlers-Danlos Syndrome in Transgender and Gender-Diverse Populations. PubMed, 2025.pubmed.ncbi.nlm.nih
Shirvani P et al. Mitochondrial Dysfunction and hEDS. PMC, 2025.pmc.ncbi.nlm.nih
Stein T et al. The prevalence of hypermobile Ehlers–Danlos syndrome in the TGD community. PubMed, 2025.pmc.ncbi.nlm.nih
Hubbard E. The Disproportionate Effects of EDS on Women. EDS Canada, 2025.edscanada
Stein T et al. The prevalence of hypermobile Ehlers–Danlos syndrome. Sage, 2025.journals.sagepub
Prevalence of Hypermobile Ehlers-Danlos Syndrome in TGD Individuals. Liebert, 2025.liebertpub
The HMSA (UK). Hormones and Hypermobility. 2024.hypermobility