Hypermobility & Common Comorbidities Part 4: Fatigue

Fatigue is a very common—and often overlooked—symptom for people living with hypermobility, hypermobile Ehlers-Danlos syndrome (hEDS), and hypermobility spectrum disorders (HSD).

According to a global survey conducted by the Norris Lab, 98.6% of people with hEDS and 94.5% of people with other Ehlers-Danlos syndromes reported fatigue as a primary dysautonomia symptom. Norris Lab: Fatigue in Ehlers-Danlos Syndromes

What Is Fatigue?

Fatigue is more than simply feeling tired after a busy day. It can involve extreme physical or mental exhaustion that isn’t fully relieved by rest or sleep.

Fatigue can also vary in duration:

• New-onset fatigue: Less than 1 month
• Prolonged fatigue: More than 1 month but less than 6 months
• Chronic fatigue: 6 months or longer

For people with hypermobility, fatigue may be influenced by a number of factors, including autonomic dysfunction, pain, poor sleep, deconditioning, the increased muscular effort required to stabilize hypermobile joints, and other comorbid conditions.

Fatigue vs. ME/CFS

It is important to distinguish chronic fatigue from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

ME/CFS is a complex, chronic illness with a hallmark symptom known as post-exertional malaise (PEM). PEM refers to a significant worsening of symptoms following physical, cognitive, or emotional exertion that can be disproportionate to the activity and may last for days or longer.

Because exertion can worsen symptoms in people with ME/CFS, pacing is a particularly important management strategy.

Why Pacing Matters

Pacing means learning how to balance activity and rest so that you stay within your available energy limits rather than repeatedly pushing through exhaustion.

For someone experiencing PEM, the goal isn’t simply to “exercise more” or push through fatigue. Instead, activity needs to be individualized and carefully managed to avoid triggering a crash.

For other types of fatigue that do not involve PEM, treatment may look different and can include:

• Gentle, appropriately prescribed movement or exercise
• Pacing and energy conservation
• Addressing sleep and recovery
• Cognitive behavioral therapy when appropriate
• Social connection and community support
• Identifying and addressing contributing medical conditions

Listen to Your Body

Fatigue isn’t a character flaw, a lack of motivation, or something you should simply push through.

For people with hypermobility, understanding why you’re fatigued is an important part of finding the right approach. What helps one person may worsen symptoms for another—especially when PEM is present.

Working with healthcare professionals who understand hypermobility, dysautonomia, chronic pain, and ME/CFS can help you develop a treatment and movement strategy that respects your body’s limits.

Fatigue is real. Rest is productive. And finding the right balance between movement and recovery matters.

References: https://www.thenorrislab.com/post/fatigue-in-ehlers-danlos-syndromes