Strength Training for Hypermobility: Building Stability Without Burnout | Dr. Melissa Koehl

Episode Summary

Can strength training actually help a hypermobile body feel stronger, more stable, and less painful?

In this episode of The Invisible Podcast, Dr. Ashton Wilson is joined by Dr. Melissa Koehl, Doctor of Physical Therapy, Pilates instructor, and hypermobility specialist, to explore one of the most important topics in hypermobility management—strength training.

Together, they discuss why building strength is essential for people with hypermobile Ehlers-Danlos Syndrome (hEDS), Hypermobility Spectrum Disorders (HSD), and symptomatic joint hypermobility, while also explaining why traditional fitness advice often doesn't work for this population.

Dr. Melissa shares practical strategies for exercising safely, managing recovery, avoiding post-exertional crashes, and learning how to work with your body rather than against it.

The conversation also covers the latest insights from the EDS Global Learning Conference, including exciting developments in understanding orthostatic intolerance and POTS.

Whether you're newly diagnosed, living with chronic pain, or simply trying to find an exercise approach that actually works, this episode offers practical guidance grounded in both clinical expertise and lived experience.

What You'll Learn in This Episode

Why strength training is one of the most effective tools for managing hypermobility symptoms
How muscle strength improves joint stability and protects hypermobile joints
Why recovery matters more than the workout itself
The biggest mistakes people make when starting strength training
How to find your own exercise capacity without triggering symptom flares
Why "more exercise" isn't always better for hypermobile bodies
The importance of pacing and progressive overload
How dysautonomia, POTS, and orthostatic intolerance impact exercise tolerance
Why rest between sets is essential—not lazy
Safe ways to include stretching without overstretching joints
Simple programming strategies for beginners and intermediate exercisers
How compression garments can improve symptoms for people with orthostatic intolerance
Practical recovery strategies to reduce post-exercise fatigue

Key Takeaways

Meet your body where it is today
Your body's capacity changes from day to day. Instead of judging your workout by how you feel during exercise, evaluate how you feel over the following 24–48 hours.

Start with less than you think
One of the biggest mistakes people make is doing too much, too soon. Beginning with around 50% of what you think you're capable of allows your body to adapt safely and reduces the risk of setbacks.

Recovery is part of training
Strength gains happen during recovery—not during the workout itself. Proper rest, nervous system regulation, hydration, pacing, and allowing your heart rate to recover between sets are all essential components of successful training.

Highlights From This Episode

Dr. Melissa's experience attending the EDS Global Learning Conference
New research surrounding orthostatic intolerance and POTS
Why many patients don't need a tilt table test to begin receiving treatment
The emotional importance of clinicians believing patients' symptoms
Melissa's personal journey from competitive gymnast to hypermobility specialist
Why Pilates, strength training, and yoga each play different but complementary roles
Understanding post-exertional malaise and exercise recovery
Why consistency matters more than intensity
How strength training differs for hypermobile individuals compared to the general population

Questions Answered

Does stretching make hypermobility worse?
Not necessarily. Stretching can still be beneficial when performed safely. Dynamic stretching, using props, and avoiding prolonged end-range positions can help protect joints while improving muscle flexibility.

Why do my knees hurt during strength training?
Knee pain isn't always caused by the knees themselves. Weakness or instability in the hips, feet, or surrounding muscles may increase the workload on the knees. Improving movement quality, alignment, and overall strength can often help.

What's the best exercise for someone with hypermobility?
The best exercise is the one you can perform consistently. However, strength training offers one of the greatest long-term benefits for improving joint stability and managing symptoms.

Memorable Quotes "Your body doesn't always tell you its true capacity during the workout—it tells you over the next 48 hours."
"You can always do more later. You can't undo doing too much."
"Strength training is the main course. Pilates and yoga are the side dishes."
"Consistency doesn't have to be perfect to be effective."
"Meet your body where it is—not where you wish it was."

Resources Mentioned

Strength training for hypermobility
Pilates for joint stability
Orthostatic intolerance
POTS (Postural Orthostatic Tachycardia Syndrome)
Compression garments for dysautonomia
Progressive overload
Post-exertional malaise
Hypermobility Spectrum Disorder (HSD)
Hypermobile Ehlers-Danlos Syndrome (hEDS)

Connect with Dr. Melissa Koehl
Follow Dr. Melissa for evidence-based education and practical resources on hypermobility, strength training, and movement.

Instagram: @dr.melissakoehl.pt
YouTube: Dr. Melissa Koehl, PT

Enjoyed this Episode?
If you found this conversation helpful, be sure to subscribe to The Invisible Podcast, leave a review, and share this episode with someone navigating hypermobility, chronic pain, POTS, or connective tissue disorders.

Every share helps more people access evidence-based information and reminds those living with invisible illnesses that they're not alone.