Hypermobile Singers: From Pretty Impressive to Pretty Painful
Originally published on 17/01/2025 – Last update on 28/03/2025
I’m a hypermobile singer and voice teacher; and some of my clients are as well. The challenges we face are unique, and at the same time, our strengths are too! Here’s an overview of what’s important to know when you’re (working with) a hypermobile singer.
Unlike my other blog posts, this article is quite dry with lots of bullet points, so your brain can absorb the info easily.
If your brain prefers audio or video over reading this article, watch or listen to the podcast Working with Hypermobile Singers – BAST Singing Teachers Talk Podcast.
They have invited me for their podcast after reading this blog post. What an honour!
Let’s get one thing straight right away: Hypermobility itself isn’t a disease or a medical condition. It’s simply a physical trait, like for example having flexible fingers or a double-jointed thumb. In fact, most people have at least one hypermobile joint due to past injuries or from repetitive movements, like playing an instrument. A single hypermobile joint doesn’t mean you have a disorder. It’s just how your body works.
However, when multiple joints are hypermobile, especially in the spine and limbs, we classify it as Generalized Joint Hypermobility – GJH. This doesn’t mean it’s a problem in itself, but it does provide a framework for understanding the body’s mobility and flexibility.
The focus of this article is Hypermobility Spectrum Disorders – HSD , which occurs when joint hypermobility is accompanied by other symptoms. It is an umbrella term covering various levels of symptom severity, ranging from mild discomfort to significant impairment. Not everyone with GJH has HSD, but everyone with HSD has some form of joint hypermobility.
I will not go deeper into two conditions that need a clinical diagnosis that also have hypermobility as a symptom:
- Hypermobility Ehlers-Danlos Syndrome – hEDS
- Postural Orthostatic Tachycardia Syndrome – POTS
If you want to know more on those, scroll down to the resources.
What are Hypermobility Spectrum Disorders - HSD?
Connective tissue (for example fascia) provides support to your skin, musculoskeletal system, blood vessels, and organs. In people with HSD, the connective tissue is weakened & too stretchy due to a defect in collagen production. The tissues don’t have the ability to hold everything together as they should.
- More women than men are hypermobile.
- HSD is more common in the artist population.
- There’s possibly a link with neurodivergence.
- This is not supported by research at all, but I wonder whether there’s a link with HSP (Highly Sensitive Person) too, as I recognize this in all the people I know who are hypermobile – including myself.
Potential Physical Symptoms
It’s possible that you are asymptomatic or only have positive symptoms. However, you can become symptomatic later in life.
Keep in mind that hypermobility presents differently in every body. If you’re hypermobile, you won’t necessarily have all of these symptoms!
- Excessive range of motion in your joints, which can lead to chronic pain, easy dislocation / subluxation and early-onset degenerative arthritis. It also gives you the talent to do what this dancer is doing. Look at her overextended knees, elegant hands and bendy fingers! Further down, I’ll focus on the impressive skills hypermobile singers can have.
It’s important to note that hypermobility and flexibility are not the same! You can be hypermobile and extremely inflexible at the same time. Read Can You Be Hypermobile but Not Flexible? for a great explanation.
Assess the flexibility of your joints with the Beighton test (general) or the Lower Limb Assessment Score – LLAS (more specific for dancers and athletes). If you know that you are hypermobile, please, be mindful. Sometimes these assessments can make you flare up a little bit.
- Scoliosis
- Difficulty maintaining postural alignment & standing for a long time. This can lead to compensatory tension and stiffness in various parts of your body, particularly in your neck and surrounding areas, shoulders, jaw and abdominal muscles. If the connective tissue in your ligaments are not able to create some form of stability in your joints, then your muscles are going to try to take over for stabilization, which is why your musculature starts to fatigue and starts to get really overworked.
- An under-regulated vestibular system (balance), which can lead to dizziness and fatigue
. This can also lead to muscles not firing when they’re supposed to during movement, with for example weak glutes or hyperextended knees as a result.
- Breathing problems, for example slipping ribs or paradoxical breathing.
- Hypermobile children might have limited physical control, be “floppy” and have difficulty holding a pen for a long time.
- Hyper-elastic, soft and fragile skin that tears easily. Wounds sometimes heal more slowly with abnormal scarring.
- Frequent micro injuries: slight injuries that may not show up on tests or MRIs, but can occur repeatedly in the same area of connective tissue without completely healing.
- Slower healing of connective tissues in general.
- Gastrointestinal issues like constipation, acid reflux or gastro-oesophageal reflux disease (GERD).
Make sure to read my 2 blog posts for a detailed explanation on reflux: - Pelvic floor and bladder issues.
- Hormonal issues.
- Sensitivity to allergens and post-nasal drip.
- Higher level of pain and fatigue, both acute and chronic.
- If you want to review your hypermobility symptoms that are possibly due to underlying Ehlers-Danlos syndrome: Fill out the Hypermobility Screening Tool – HST. created by Callahan, Squires and Greenspan.
- The Spider is a very accessable multisystemic symptom impact tool that also reviews pain, fatigue, neuromusculoskeletal, cardiac dysautonomia, gastrointestinal, urogenital, anxiety and depression symptoms.
Other potential symptoms
Poor interoception
You might have less awareness of internal body signals, such as hunger, thirst, heart rate, or muscle tension
. This makes it difficult for you to recognize physical or emotional states. It’s maybe challenging for you to be aware of your limits regarding your body, stress regulation, and overall well-being
.
Poor proprioception
This is the sense of self-movement, force, and body position. Your brain responds to signals coming from your connective tissue. When the tone of that tissue is not organized well enough, your brain has difficulty knowing where you are in space, which way is up and what direction you are moving in.
Anxiety
You brain can feel unsafe due to your connective tissue not holding everything together as it should
. Your “threat bucket threshold” is possibly lowered. Because your brain is constantly scanning the world for threat, you might be hyper-vigilant.
I’d like to end this chapter on potential symptoms with a quote by Celest Pereira:
“Hypermobile people are like the canary in the coal mine.
They feel if something is bad for EVERYBODY before others feel it:
- Not eating well
- Too much stress
- Not resting enough
- Pollution
- Not enough hydration
We need to listen to them to give us guidance!”
Can Hypermobility be a Strength for Singers?
Yes – Just like the dancer in the pictures above, hypermobile singers can have unique talents. But remember, HSD presents differently in every body!
- You might notice that you have an extended vocal range without having to train hard for it. The extreme highs and lows are just there, waiting for you to use them in your artistic expression. Sometimes you have easy access to whistle register.
- It may be very easy for you to sing softly and with a breathy voice, thus creating an intimate atmosphere. In case you didn’t know, this can be a challenging skill to acquire for other singers and they might be jealous of you. Celebrate your talent!
- Because your larynx consists of a big collection of joints and they can be affected by HSD too, you might have an unusually flexible voice. This makes it easy for you to perform riffs and runs.
- Changing vocal qualities / registers / vocal modes throughout your range can be easy peasy for hypermobile singers, which gives you great stylistic versatility. However, sometimes the extreme opposite presents itself.
The Possible Challenges for Hypermobile Singers
Unfortunately, I also have bad news. First, I’ll repeat this disclaimer:
It’s possible that you are asymptomatic or only have positive symptoms. However, you can become symptomatic later in life if you don’t practice enough self-care.
Keep in mind that hypermobility presents differently in every body. If you’re hypermobile, you won’t necessarily have all of these symptoms!
Collagen is a major component of the human vocal folds – it makes up 43% of the total tissue protein. People with HSD have a weaker collagen production. As a result, up to 74,6% of hypermobile singers face voice problems, as opposed to 45% of singers without HSD. These problems may present 20 to 30 years sooner than in singers without HSD.
- Overuse can quickly lead to voice pathology.
- Hypermobile singers experience vocal fatigue, hoarseness, loss of stamina, voice-related pain and hypofunction
more rapidly.
- It’s more difficult to make the vocal folds approach, which can lead to “pushing”. The combination with under-regulated interoception (recognizing tension in your body) is quite unhelpful.
- It might be harder for you to sing loudly, powerfully and intensely. Some hypermobile singers have big or powerful voices, but in that case, it might be challenging to control.
- Your voice might feel unstable and you might experience sudden loss of function and / or progress. This unreliable and inconsistent nature of your singing can lead to performance anxiety and stress.
- You maybe have a hard time changing vocal qualities / registers / vocal modes, although some hypermobile singers experience the extreme opposite (see above).
- Producing & sustaining your desired pitch might be troublesome.
- Maybe you experience skeletal-muscular issues like TMJD (tension in your jaw) and / or postural imbalances in your back and / or neck
. Compensatory tension in the muscles around your larynx (MTD – Muscle Tension Dysphonia) and tongue can lead to changes in the soft tissues of your throat and muscles that raise your larynx. This has an impact on your vocal control and resonance.
- Breath management might feel like a constant challenge, because your diaphragm might be taking on a stabilization role rather than functioning for respiration.
What’s Good for You When You’re Hypermobile
I’ll start with repeating the quote by Celest Pereira and adding the second part of it:
“Hypermobile people are like the canary in the coal mine. They feel if something is bad for EVERYBODY before others feel it. We need to listen to them to give us guidance!
- Not eating well
- Too much stress
- Not resting enough
- Pollution
- Not enough hydration
They can do fascinating things with their bodies. They thrive if given the right foundation:
- Enough proprioceptive stimulation
- Enough neuromapping of where their body is in space
- The right tools to manage anxiety
- Being taught that they are a superhero and resilient, not that they are fragile.”
And how about this quote by Adam, The Fibro Guy?
“Your body isn’t broken and doesn’t require repair; rather, it just requires understanding.”
So… What’s good for you – and every body, not just the hypermobile ones?
- Make sure that all the therapists and teachers you’re working with understand hypermobility. Maybe send them this blog post?
- Regular physical therapy. Hypermobile people often have cranial cervical instability. So be careful with work at the base of the skull, the suboccipital muscles and the myodural bridge. Releasing the suboccipital region could destabilise your whole body.
- Osteopathy
- Craniosacral therapy & therapies that regulate your nervous system
- Somatic approaches:
- Alexander technique
- Feldenkrais method
- Tai chi & Qi gong
- Pilates
- Yoga
- Massages are proprioceptive stimulation for your brain, so a good thing!
Experiment with what works best: deep tissue / light touch / vibration / hot / cold/ sharp / dull. - Be mindful about going to all kinds of extremes like the limits of your strength and flexibility.
- Strength training of your whole body, with a focus on the muscles around your vulnerable joints.
- Train reflexive stability (context-dependent activation of your muscles), not static strength.
- Do not go for passive stretching. Instead, work on active and dynamic stretching.
- Train toward the end range of active motion, but against resistance (an isometric). The goal is to shrink the gap between the active and passive ranges of motion, as this lowers threat for your brain. A muscle isn’t just about how it contracts and shortens to strengthen something, it has to have the appropriate length tension relationship.
- Short-term use of braces / kinesiotape to support unstable joints.
- Since syndromic hypermobility is linked to collagen deficiency, protein consumption is essential.
- People with hypermobility often require higher fluid and salt intake (re electrolyte balance) to manage symptoms related to blood pressure and circulation.
- Monitoring by a medical team to prevent and / or manage complications.
- Psychological counseling.
- Find strategies to deal with anxiety.
Make sure to read the blog post Psychological Flexibility: Use ACT to Reduce Performance Anxiety for an explanation on Acceptance and Commitment Training. - Help your brain feel safe by:
- Developing your sensory perception, with extra focus on your auditory and visual system.
- Training your interoception, with extra focus on your kinesthetic feedback.
- Training your proprioception, with extra focus on your vestibular system.
Make sure to read the blog post Is it Safe to Sing? Hack Your Brain and Sing with Ease! for a more detailed explanation on all of this!
If you want to dive right into these exercises, subscribe to The singsing! Sofa Library and watch the recording of the webinar Is It Safe to Sing? Brain-Based Exercises for More Ease, Stability, and Efficiency in Your Voice.
- Last, but certainly not least, another quote by The Fibro Guy: “Many people with hypermobility find it frustrating when they are told to “be careful,” “stretch more,” or “move less.” However, those general suggestions completely miss the mark. They ignore the delicate equilibrium your body is attempting to preserve, where flexibility, strength, and stability must all coexist.”
What’s Good for You When You’re a Hypermobile Singer?
Obviously, all of the above. And if you’re also experiencing hypermobility in your voice or are working with hypermobile singers, the following advice will be helpful:
- Activate your whole body through movement while singing.
- Be mindful about all kinds of extremes like going to the limits of your volume, range, opening your jaw, etc.
- If you can sing with high volume, don’t do it for too long.
- Adjust your repertoire and genre, as well as the duration of your rehearsals and performances.
- If necessary, see specialists such as a speech therapist and laryngologist. Make sure they understand hypermobile voices! Maybe send them this blog post?
- Reduce excessive tension around your larynx and jaw with manual therapy. Tell the therapist you’re hypermobile, so they can be cautious of dislocation and / or subluxation.
Subscribe to The singsing! Sofa Library and watch the 3rd webinar of Releasing a Tense Voice: Releasing the Larynx, Tongue and Jaw to learn stretches and massages that you can safely do by yourself!
- Avoid “pushing” / too much air pressure due to challenged interoception with good microphone technique and monitoring.
Subscribe to The singsing! Sofa Library and watch the webinar Microphone Technique, led by Beo Van Haver!
- Extra focus on vocal hygiene, resonance training and SOVTs.
Subscribe to The singsing! Sofa Library and watch the 3 webinars of SOS Voice to learn everything about taking care of your voice and SOVTs!
- Address breathing issues like, for example, paradoxical breathing. Because your diaphragm is taking on a stabilization role rather than functioning for respiration, you need to help it come back into some respiratory state. A nice exercise for that is holding at the end of the exhale for 2 to 3 seconds and then inhale from that vacuum.
Subscribe to The singsing! Sofa Library and watch the webinar Breath Management!
- If you’ve been taught by certain Yoga / Pilates / voice teachers that you should be holding in your belly at all times: The pelvic floor is not evolved to be lifted and gripping all the time! An engaged core is not a more stable structure. We create better lumbar stability with a relaxed core.
You’re not going to achieve more stability by conscious control. It’s a reflexive thing, your brain is lightning fast, much faster than you can do consciously.
This means that you need to train reflexive stability: context-dependent activation of your muscles. Here are a few exercises I’ve learned from Celest Pereira:
- Sing with a weight in one hand while standing on one foot.
- Vestibular drills: Sing while standing on one leg and alternatively look to your left and right.
- Train your proprioception with perturbation:
Sing with your feet together and ask your teacher (or somebody else) to give you little pushes .Tie a strap around you and attach it to the wall / door / furniture while singing.
Added on 23/01/2025:
This blog post is going viral! The response I’m receiving is overwhelming ❤️ And you know what makes me extra happy?
Most of the people sending me these messages are professional singers and voice teachers. This means that even though hypermobile singers face challenges, it does not necessarily mean that they can’t do what they love the most: 🎶 SING! 🎶
Did you know that Billie Eilish is hypermobile? And maybe Maria Callas was too!
Also: non-hypermobile people face different challenges. Heck, we ALL face challenges!
As I’ve written at the top of this blog post: HSD is more common in the artist population. Is it because of our sensitivity – which I consider a strength?
Here’s a selection of the heartwarming reactions, click on the image to enlarge.
RESOURCES
Research Papers:
- Laryngological Complaint Prevalence in Hypermobile Ehlers-Danlos or Hypermobility Spectrum Disorders – Menton et al. (2023)
- Throat and voice problems in Ehlers–Danlos syndromes and hypermobility spectrum disorders – Birchall et al (2021)
- Laryngological Symptomatology in Patients with Ehlers-Danlos Syndrome – Sharma et al (2023)
- Research shows how hypermobility can negatively impact singing ability – Tracy Jeffrey (2022)
- Impact of hypermobility on the voice – Research paper by Alien Partljič (2024)
Other resources:
- Hypermobility Syndromes Association
- BAPAM Factsheet: Hypermobility
- ENT Symptoms & Treatment for EDS & Hypermobility Disorders: A Speech & Language Therapist Perspective – Lecture by Gary Wood for The Ehlers-Danlos Society
- Voice, breath and Ehlers-Danlos syndrome – Webinar by Imogen Roux for Ehlers-Danlos Support UK
- Anatomy Nerds: Hypermobility and the Voice – Webinar by The Visceral Voice (Christine Schneider) & The Singing Athlete (Andrew Byrne)
- Hypermobility Care in Performing Arts: Early Detection in Dance Medicine – Integrating Contemporary Screening Tools and Lived Experience in Hypermobility Management – Webinar: by Dr. Tina Wang, Dr. Clifton Chan & Bonnie Southgate for PAMA
- Celest Pereira:
Webinar: Flexible Thinking – Understanding Hypermobility and Neuroanatomy
Book: Too flexible to feel good - Working with Singers with Hypermobility Spectrum Disorders, Hypermobile Ehlers-Danlos Syndrome and Postural Orthostatic Tachycardia Syndrome – Poster Presentation at Pan-European Voice Conference 2025 in Santander by Joanne Bozeman, BM
- Exploring Hypermobility and Its Impact on the Voice: Christine Schneider interviews Alien Partljic for The Visceral Voice podcast
- Rare and Most Common Types of EDS, Focusing on the Most Common-Hypermobility Christine Schneider interviews Eloise Stager, craniosacral therapist, for The Visceral Voice podcast
- Working with Singers with POTS – Christine Schneider interviews Marita Stryker for The Visceral Voice podcast
- Hypermobility and the Voice – What You Might Not Realize – blog post by Christine Schneider
- Cleveland clinic: Postural Orthostatic Tachycardia Syndrome (POTS)
- Het syndroom van Ehlers-Danlos (EDS) – Article by Gezondheid.be
- Z-Health, a brain-based approach to movement and rehabilitation developed by Dr. Cobb. Z-Health focuses on integrating neuroscience, proprioception, and motor control to improve physical performance and address issues like balance, stability, and tension.
- The Fibro Guy has the mission to help those with chronic pain and hypermobility syndromes take back control over their health.
In the webinar Is It Safe to Sing? Brain-Based Exercises for More Ease, Stability, and Efficiency in Your Voice, Bjorn Poels helps you to hack your (hypermobile) brain with proprioceptive, vestibular, and visual exercises.
Make sure to subscribe to The singsing! Sofa Library and watch the recording of this 2-hour session. You’ll experience the effect immediately on your singing.
As always, feel free to send me your thoughts, questions, and feedback in the comments below this blog, via the contact form or in the singsing! online community 
Cordially,
Sarah