Why Treating Pain Without Improving Load Tolerance Keeps You Stuck
If you have hypermobility, there’s a good chance you’ve experienced this pattern: something flares up, you rest or get treatment, you feel better — and then it comes back. Maybe in the same place, maybe somewhere new. The details change but the cycle doesn’t.
This isn’t bad luck. And it isn’t a failure of effort. It’s what happens when treatment focuses on relieving pain without addressing why the pain keeps returning in the first place.
Pain is real, and managing it matters. But pain is a signal — it tells you the system is under stress. Treating the signal without improving the system’s ability to handle stress is a temporary fix at best. The underlying problem remains, and the cycle continues.
For people with hypermobility, this distinction is particularly important. Your nervous system is often exquisitely good at detecting stress. Your tissues are often genuinely under strain. But the reason they’re under strain frequently has less to do with the painful area itself and more to do with how your body is managing — or failing to manage — load across the whole system.
What “Load” Actually Means
Load isn’t just lifting weights. Load is any demand placed on your body — sitting at a desk, carrying groceries, walking upstairs, standing in a lineup. Every movement requires your body to generate force, control how that force moves through your joints, sustain that control over time, and recover from the effort.
When those capabilities are insufficient, your body compensates. Compensations aren’t failures — they’re your nervous system solving a problem with the resources it has available. But compensation has a cost. Over time, the structures absorbing that cost accumulate stress, and eventually something signals that the cost has become too high. That signal is pain.
Treating the pain without improving the underlying capabilities means the compensation continues. The cost continues to accumulate. And the next flare becomes a matter of when, not if.
The four things your body needs to move well under load
Rehabilitation that addresses load tolerance rather than just symptoms works by building four interconnected capabilities:
Force — The ability to generate enough strength to meet the demands of daily life without compensation. When force production is insufficient, your body finds other ways to get the job done — ways that weren’t designed for that purpose and that accumulate strain over time.
Control — The ability to move smoothly, accurately, and safely within a single movement. This means decelerating a load gradually, stabilizing a joint as force passes through it, and coordinating muscle timing precisely. Think of placing a full cup of coffee down carefully — that’s control. Poor control distributes force unevenly across joints, tendons, and ligaments, often in ways that don’t hurt immediately but create problems over time.
Capacity — The ability to maintain force and control repeatedly, across a full day or a full workout, without breaking down. Many people with hypermobility can move well in the first few reps of an exercise or the first hour of the day. It’s what happens under fatigue that matters — and capacity is what determines how long good movement lasts before compensation takes over.
Power and deceleration — The ability to manage loads that are already moving through space at speed. Where control is placing a cup down carefully, power and deceleration is catching something falling off the counter — absorbing and redirecting force that’s already in motion. Strength gets you to the shelf. Power and deceleration get the heavy bag there safely and back down without injury. This capability becomes increasingly important as rehabilitation progresses toward real-world function.
Hypermobility Isn’t the Problem. Load Tolerance Is.
Research on collegiate athletes tells us something important: studies of NCAA athletes across multiple sports find hypermobility rates of roughly 15-24%, many of whom compete at high levels without significant pain or dysfunction. These athletes aren’t less hypermobile. They’ve simply developed sufficient load tolerance — enough force, control, capacity, and power — that their system can meet the demands placed on it without breaking down.
Hypermobility becomes a clinical problem when the demands of daily life or sport exceed what the system can manage. That gap between demand and capacity is where rehabilitation should focus — not on the hypermobility itself.
Why This Changes How Rehabilitation Works
The goal of rehabilitation is both to reduce pain and to improve how your body tolerates, regulates, and adapts to the real demands of your life — so that the same activities that used to trigger a flare no longer push your system past its threshold. Pain management remains part of that picture — you can’t build load tolerance when pain and fear of movement are too high. But it’s the starting point, not the destination.
That requires understanding what’s actually limiting your system on any given day. Not just where it hurts, but what biomechanical component was deficient and why. What domain is limiting function today. What is your system currently capable of tolerating. What can be trained, and what needs to be protected.
Traditional rehabilitation often answers those questions subjectively — through how a movement looks, how much pain you report, or manual muscle testing that can miss meaningful deficits. These approaches have value, but they have limits.
That’s why objective measurement matters. Force transducer technology — the same systems used by professional sports organizations and performance labs, including VALD dynamometry — allows us to measure actual force output, bilateral asymmetry, rate of force development, and how your system responds under fatigue. Your program is guided by what your body is actually producing, not just what it looks like from the outside or how you feel on a given day.
This matters particularly for hypermobile patients, whose symptoms fluctuate significantly from day to day. A measurement taken on a good day and a bad day looks very different subjectively. Objectively, the data tells a more consistent and actionable story. Pain fluctuates. Data doesn’t.
The difference between chasing symptoms and building capacity is the difference between feeling better temporarily and building a system that holds.
For more on how this framework applies in practice, see the related article on this site.
(Reference: Reuter PR, Fichthorn KR. Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students. PeerJ. 2019 Sep 11;7:e7625. doi: 10.7717/peerj.7625. PMID: 31565567; PMCID: PMC6744937.)
About the Author
Brian Kitzerow is a physiotherapist practicing in Calgary, Alberta, specializing in hypermobility, Ehlers-Danlos Syndrome, POTS, and complex connective tissue disorders — as well as high-performance sport rehabilitation for competitive and elite athletes.
With over two decades of clinical experience and a Doctorate in Physical Therapy, Brian has worked with a broad spectrum of athletes including NCAA volleyball, track and field, collegiate soccer and basketball, wrestling, professional dancers, competitive fighters, farm league baseball, and the United States Special Forces. This breadth of experience across load-demanding populations directly informs how he approaches hypermobility — because building a system that performs under stress is the same problem, whether you’re an elite athlete or someone trying to get through a full day without a flare.
Practicing at Strive Physiotherapy in Calgary, Brian uses objective measurement tools including force transducer technology and movement analysis to build individualized, data-driven rehabilitation programs for hypermobile patients, athletes, and those with complex chronic conditions who haven’t found answers through standard rehabilitation approaches.
Brian Kitzerow, PT, DPT, OCS, CMPT — Calgary, Strive Physiotherapy
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