Joint hypermobility means some or many joints move beyond the usual range. Many people have no symptoms.

When it causes pain, instability or other difficulties, assessment may consider a hypermobility spectrum disorder (HSD) or, in some people, hypermobile Ehlers-Danlos syndrome (hEDS).

HSD and hEDS are not diagnosed from flexibility alone.

Research reports an association between anxiety and symptomatic joint hypermobility. Findings vary with age, symptoms and the groups studied.

The connection appears less consistent in people whose flexible joints do not cause problems.

Hypermobility does not mean someone will develop anxiety. Anxiety does not cause the underlying joint laxity.

Some people with HSD or hEDS also experience orthostatic intolerance: symptoms that worsen when upright and improve on sitting or lying down.

This can include dizziness, palpitations, shakiness and fatigue. POTS is one possible diagnosis, but not the only one.

Not everyone with hypermobility has POTS. The reasons for the overlap are still being studied.

A racing heart and trembling can happen with anxiety or autonomic conditions. They can also occur together.

Symptoms linked to standing, heat or prolonged upright activity are useful clues to share with a clinician.

POTS is not diagnosed from feelings or a single pulse reading. Assessment considers heart rate, blood pressure, symptom duration and other possible explanations.

• Change position and sit for tasks when helpful.
• Break demands into manageable parts.
• Use comfortable support and avoid forcing joints to end range.
• Ask a physiotherapist about joint control and suitable strengthening.

Adapt activity to pain, stability and energy. If you have post-exertional malaise, avoid pushing through or fixed increases in exercise.

For diagnosed autonomic conditions, ask about an individual plan. Extra salt, fluids or compression may suit some people, but need consideration of other health conditions.

A GP can assess pain, instability and upright symptoms, review medicines and arrange suitable referrals.

Physiotherapy may help joint control and function. Autonomic care can address diagnosed orthostatic problems.

Support for anxiety may help distress and coping alongside physical care. It should not replace investigation of physical symptoms.

Call 000 in Australia for severe chest pain, severe breathing difficulty, collapse with poor recovery or new stroke-like symptoms.

This connection spans Laxity / Connective Tissue and Anxiety / Autonomic. Pain, fatigue, sleep and emotional wellbeing may also matter.

A supported seated task may reduce joint strain and upright symptoms. Clear plans may also reduce uncertainty.

These are practical connections, not proof that every symptom shares one cause.

• NHS: Joint hypermobility.
• Role of anxiety in generalised joint hypermobility — systematic review.
• Joint hypermobility and psychological distress — systematic review and meta-analysis.
• Raj and colleagues (2022): POTS diagnosis and management.