Fit, Healthy & Still Exhausted? How Hypermobility can tire you out

By Monica Williams Advanced FSM Practitioner | Naturopath | IICT Member 30 years in clinical practice | Maroochydore, Sunshine Coast QLD

The short version: Hypermobility isn't just about bendy joints and flexible movement. For a lot of people, it comes with a pattern of symptoms that don't look obviously connected on the surface — crushing fatigue, a racing heart on standing, stubborn low iron despite a good diet, and a strange paradox where staying still feels worse than training hard. The thread running through most of it is your vagus nerve, and once you see that thread, the whole picture makes a lot more sense.

This article covers what hypermobility actually is, why it so often comes with fatigue and autonomic symptoms, and how working with the vagus nerve directly may support a way through it.

Key Takeaways

• Hypermobility affects connective tissue everywhere in your body — including around your vagus nerve and gut, not just your joints

• Two separate mechanisms link hypermobility to vagal dysfunction: ongoing micro-tissue injury signalling your brain that something's wrong, and literal physical traction on the vagus every time you stand up

• POTS (postural orthostatic tachycardia syndrome) shows up in 15–41% of people with hypermobile EDS — a racing heart, dizziness, and fatigue on standing that can be mild enough to miss [1]

• An infection — including EBV — can suppress vagal function on top of a system that's already working overtime, deepening fatigue significantly

• Low stomach acid, often a downstream consequence of poor vagal tone, can cause iron deficiency even with a genuinely good diet

• A lot of active, hypermobile people really do feel better when they're moving and worse when they're still — that's a real physiological pattern, not laziness or simple deconditioning

1. The Person Who Can't Stop Training (Even Though It's Exhausting)

You train hard. Multiple sessions a week — maybe martial arts, maybe the gym, maybe a team sport — and on the days you train, you generally feel better. Then there's the fatigue. Not the good kind of tired after a hard session. A bone-deep, can't-get-off-the-couch exhaustion that doesn't seem to track with how hard you've actually pushed yourself.

You move because moving helps. You dread stopping because stopping makes it worse. And it's genuinely confusing — you're motivated, you're fit, you're doing everything that's supposed to make you feel good, and you still feel like you're running on empty more often than not.

If any of that sounds familiar, hypermobility is worth putting on the table — even if nobody's ever mentioned it to you, and even if you've never thought of yourself as someone with a "joint problem."

2. What Hypermobility Actually Is

Hypermobility means your joints and tissues move beyond what's typical — and it comes from how your connective tissue is built. Connective tissue isn't just in your joints. It's the scaffolding that holds your entire body together: skin, blood vessels, organs, the gut wall, and the tissue surrounding your nerves.

There's a simple screening tool clinicians use called the Beighton score — can you bend your thumb back to touch your forearm? Bend your little finger past 90 degrees? Straighten your elbows or knees past neutral? Put your palms flat on the floor with your knees locked? A score of four or more out of nine generally points to hypermobility. [2]

Hypermobile Ehlers-Danlos Syndrome (hEDS) is the genetic, more clearly defined version of this. Hypermobility Spectrum Disorder (HSD) describes essentially the same picture without a confirmed genetic marker — same mechanisms, same treatment approach, often a less severe presentation. Neither is rare, and neither is "just" being flexible.

Because connective tissue is everywhere, hypermobility can show up in ways that have nothing to do with your joints: digestive issues, easy bruising, poor healing, dizziness, anxiety, sensory sensitivity, and — very commonly — fatigue. [2]

If you've collected a handful of seemingly unrelated diagnoses over the years, hypermobility is often the thread running underneath them.

3. Why Bendy Joints Affect Your Energy: The Vagus Nerve Connection

Here's the part that surprises most people: your vagus nerve — the nerve responsible for digestion, heart rate regulation, and calming your nervous system down — runs straight through connective tissue. When that tissue is more lax than it should be, two separate things start happening to it.

1. Constant background irritation. Every joint subluxation, every overstretched ligament, every bit of micro-tissue damage that comes with looser connective tissue releases tiny tissue fragments your immune system reads as injury signals. Your brain picks these up via the vagus, and in survival mode, your brain's response to ongoing injury signals is to suppress the vagus — because being calm and digesting food isn't the priority when your body thinks it's under threat. With hypermobility, this kind of micro-injury is essentially constant, so the vagus stays suppressed essentially all the time.

2. Physical traction. This one's more literal. Your vagus is physically attached to the connective tissue around your gut. Every single time you stand up, the weight of your abdominal contents pulls down on that connective tissue — and with looser tissue, that pull translates into a small traction injury on the vagus itself. Stand up, sit down, stand up again, all day, every day. It adds up.

The result is a vagus nerve that's chronically under-functioning — which matters enormously, because your vagus is responsible for an enormous amount of what keeps you feeling well: heart rate regulation, digestion, stomach acid production, inflammation control, and your ability to shift out of "alert" mode and into genuine rest.

Professional Insight — Monica Williams, Advanced FSM Practitioner & Naturopath (IICT): When someone comes in fit, motivated, and exhausted, I'm always looking at their joints — even if nobody's ever raised hypermobility with them before. Can they bend their thumb to their forearm? Are their elbows hyperextended? It changes the whole conversation, because once I know if vagus could be structurally compromised, fatigue, POTS, low iron, and a worse-when-still pattern all start making sense as one connected picture rather than a list of unrelated complaints.

4. POTS: The Piece That Often Gets Missed

Postural orthostatic tachycardia syndrome — POTS — is one of the more common autonomic consequences of hypermobility, showing up in somewhere between 15% and 41% of people with hEDS depending on the study. [1] It means your heart rate climbs sharply when you stand up, often alongside dizziness, lightheadedness, and fatigue.

The reason POTS gets missed so often in active people is that it doesn't have to be dramatic. You don't need to faint for it to count. A racing heart on standing, feeling wiped out after being upright for a while, or feeling oddly worse after a hot shower, a hot day, or a long day on your feet can all be mild POTS quietly draining your energy in the background — easy to write off as "just being unfit" when you're actually anything but.

It's also a genuinely common companion to chronic fatigue specifically. Fatigue is recognised in the research as a significant, frequent feature of hypermobile EDS in its own right, not just a side effect of pain or poor sleep. [3]

5. When an Old Infection Tips the Balance

Infection is one of the most reliable ways to suppress an already-struggling vagus nerve further — and EBV (Epstein-Barr virus, the virus behind glandular fever) is a particularly common culprit, partly because so many people carry it without ever realising, until it shows up incidentally on bloodwork.

Research into post-viral fatigue has consistently found EBV reactivation associated with persistent fatigue and autonomic dysfunction. [4] Your vagal afferents pick up signals of infection the same way they pick up signals of tissue injury, and your brain responds the same way — suppressing the vagus further while your body fights it off. If your vagus was already under strain from hypermobility alone, an EBV history adds another layer on top of a system with very little spare capacity left.

This is also why a run of ordinary colds can land so much harder than it should. Each infection is another hit to vagal function, on top of one that was already compromised. If you've noticed your fatigue stepping up a level after even minor illnesses, that's a genuine physiological pattern — not you being dramatic about a cold.

6. The Low Iron Puzzle: Why Eating More Meat Doesn't Fix It

This one trips a lot of people up. You're eating plenty of red meat, your diet looks solid on paper, and your iron is still low. It doesn't add up — until you look at stomach acid.

Your vagus nerve drives the cephalic phase of digestion — the acid response that's supposed to kick in before food even arrives. When vagal tone is low, stomach acid production drops with it. And stomach acid isn't optional for iron absorption — it's required to convert dietary iron into a form your gut can actually take up. Research has shown that low stomach acid (hypochlorhydria) causes measurable iron malabsorption, including reduced absorption of the heme iron found in meat, and that this persists even after iron deficiency has developed. [5]

So the iron is in the food. The problem is what's supposed to unlock it. This is the same vagus nerve story playing out in a different organ system — and it's a good example of why chasing each symptom individually (more iron-rich food, an iron supplement, another blood test) so often misses what's actually going on underneath.

7. Why Moving Helps and Resting Doesn't

This part genuinely confuses people, including a lot of practitioners. Shouldn't rest help fatigue? For a lot of hypermobile, POTS-leaning bodies, it doesn't — and there's a real reason why.

Movement, particularly using your legs, relies on your muscles acting as a pump that helps push blood back up toward your heart — which matters a great deal when your autonomic system isn't regulating blood flow and heart rate well on its own. Movement also genuinely supports vagal tone. Stop moving, and that support disappears; circulation gets sluggish, your already-struggling autonomic system has even less to work with, and fatigue often gets worse rather than better.

This is part of why a lot of motivated, hypermobile people instinctively keep training even when it's hard — their body is telling them the truth that staying active genuinely helps.

The piece that's usually missing isn't motivation or movement. It's addressing the vagal, autonomic, and viral load underneath, so the body that's working this hard to keep itself upright can finally get some help doing it.

8. Does This Sound Like You?

Worth exploring this approach if:

• You're double-jointed, or have been told you're unusually flexible, even if it's never been formally assessed

• You experience fatigue that feels disproportionate to your activity level, or doesn't improve — and may even worsen — with rest

• You feel noticeably better on days you train or move, and worse on days you don't

• You notice your heart rate climbing, or feel dizzy or lightheaded, when you stand up or have been upright for a while

• You have a history of EBV, glandular fever, or another significant viral illness — known or only discovered incidentally on bloodwork

• Your fatigue has stepped up a level after a recent cold or infection

• Your iron runs low despite a diet that should support it

• You also deal with digestive issues, easy bruising, poor healing, or joint pain that doesn't show up clearly on scans

9. How I Use FSM for This

Frequency Specific Microcurrent (FSM) therapy uses gentle, sub-sensory electrical currents paired with specific frequencies to work with your body's own regulatory processes.

For this presentation, I'm working at several layers:

• Restoring vagal tone — this is the central piece. Frequencies that support vagal nerve function directly address the regulatory gap behind the fatigue, the POTS-type symptoms, and the digestive knock-on effects, including stomach acid production.

• Supporting autonomic regulation carefully — where POTS or POTS-like symptoms are present, I monitor heart rate response closely, since autonomic work in this group needs a measured, careful approach rather than a generic protocol.

• Calming the inflammatory load from infection — research has shown specific microcurrent frequencies significantly reduce inflammatory cytokines [6], which matters when a viral history is adding to an already taxed system.

• Working with the connective tissue itself — alongside the nervous system work, addressing the joint and tissue laxity that's driving the ongoing micro-injury signalling in the first place.

• Supporting cellular repair — the rise in cellular energy production microcurrent supports [7] gives your tissue the environment it needs to actually recover, rather than just patch over symptoms.

This sits alongside naturopathic support — addressing iron status properly once absorption improves, supporting recovery from viral load, and working with your training and recovery pattern rather than against it. I'm not asking you to stop moving. I'm aiming to give your body more capacity, so the activity that's already helping you can keep helping you, without the crash that's been following it.

For more on what a session involves, the FSM FAQ is a good starting point.

Frequently Asked Questions

Is FSM therapy for hypermobility and fatigue available in Queensland, Australia?

Yes. I'm based in Maroochydore on the Sunshine Coast, Queensland, and see clients from across South East Queensland including Brisbane, the Sunshine Coast, and the Noosa region. A free 15-minute phone consultation is a good first step to talk through your situation.

Can hypermobility really cause this much fatigue?

Yes — and the research backs this up. Chronic fatigue is recognised as a significant, common feature of hypermobile EDS in its own right, and the mechanism runs through vagal and autonomic dysfunction, not simply deconditioning or being unfit. For people who are genuinely active and still exhausted, this is often the missing piece.

I'm fit and train regularly — could I still have POTS?

Yes, and this is exactly the group POTS gets missed in most often. You don't need to faint for it to count. A racing heart on standing, fatigue that builds through the day, or feeling worse after being upright for a while can all reflect a mild, easy-to-miss POTS pattern — particularly in people whose fitness masks how much effort their body is putting into staying upright.

Should I stop training if I'm this fatigued?

Not necessarily — and for a lot of people in this picture, movement is genuinely part of what's keeping them functional. The goal isn't to take away what's helping. It's to address the vagal, autonomic, and viral load underneath, so your body has more genuine capacity, and training stops costing you as much as it currently does. This is worth discussing properly in a consultation rather than guessing at it alone.

How is FSM different from just treating my iron levels or my fatigue symptoms?

Supplementing iron and managing fatigue symptoms can both genuinely help — but if low stomach acid from poor vagal tone is the reason your iron won't hold, you'll likely keep needing more of both. FSM aims at the regulatory layer underneath: restoring vagal function so your body can actually do what it's supposed to do — produce stomach acid, regulate heart rate, manage inflammation — rather than needing external support indefinitely.

How many sessions would I need?

This depends on how long the pattern has been building, what's driving it, and how your nervous system responds. Most clients start with 6–8 sessions and we reassess from there. Because this picture usually involves several layers — connective tissue, vagal function, viral load, iron status — progress tends to be steady rather than instant. A free 15-minute phone consultation can help set realistic expectations for your situation.

Ready to Talk?

If you're motivated, active, and still running on empty more often than not, it's worth finding out what your body's actually dealing with underneath.

Email me to book your free 15-minute discovery call

Bendy joints and being flexible could be more signficant than you think.

About the Author Monica Williams is an Advanced FSM practitioner and naturopath with 30 years of clinical experience. A member of the International Institute for Complementary Therapists (IICT), Monica completed advanced training in Frequency Specific Microcurrent through the Frequency Specific Seminars programme founded by Dr Carolyn McMakin. She works with people navigating complex and chronic health conditions at her Maroochydore clinic on the Sunshine Coast, Queensland.

References

[1] De Wandele I, Calders P, Peersman W, et al. Autonomic symptom burden in the hypermobility type of Ehlers-Danlos syndrome: a comparative study with two other EDS types, fibromyalgia, and healthy controls. Seminars in Arthritis and Rheumatism. 2014;44(3):353–361. View on PubMed

[2] Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2017;175(1):8–26. View on PubMed

[3] Hakim A, De Wandele I, O'Callaghan C, et al. Chronic fatigue in Ehlers-Danlos syndrome—Hypermobile type. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2017;175(1):175–180. View article

[4] Rohrhofer J et al. Association between Epstein-Barr-Virus reactivation and development of Long-COVID fatigue. Allergy. 2023;78(1):297–299. View article

[5] Betesh AL, Santa Ana CA, Cole JA, Fordtran JS. Is achlorhydria a cause of iron deficiency anemia? American Journal of Clinical Nutrition. 2015;102(1):9–19. View on PubMed

[6] McMakin CR, Gregory WM, Phillips TM. Cytokine changes with microcurrent treatment of fibromyalgia associated with cervical spine trauma. Journal of Bodywork and Movement Therapies. 2005;9(3):169–176. View abstract

[7] Cheng N et al. The effects of electrical currents on ATP generation, protein synthesis, and membrane transport in rat skin. Clinical Orthopaedics and Related Research. 1982;171:264–272.

The content in this article is provided for general educational information and is not a substitute for personalised medical or mental health advice, diagnosis, or treatment. Please consult your healthcare provider regarding your individual health needs.