Finding Breath: A Hypermobile Journey Back to the Body
Why hypermobile bodies so often struggle to breathe well, and what changing that can do for pain and tension.
Claire Feldkamp
Think about the last time you felt really stressed. Chances are your shoulders crept up towards your ears, your chest felt tight, and your breathing went shallow and fast. Now imagine that pattern isn’t occasional - it’s how your body breathes, all day, every day, without you ever realising it could be different.
This is the reality for most people who have a connective tissue disorder. If you’re hypermobile, have HSD, hEDS or EDS you’ve probably been told plenty about why your joints are loose and unstable, but almost nothing about why your breathing may be impacted. Yet breathing dysfunction is probably one of the biggest contributors to the muscular pain, fatigue and dizziness that are key features of connective tissue disorders.
My first introduction to breathwork was over twenty years ago when I started practicing yoga. I immediately started to notice how and where I breathed and the effect that it had on my mind and body. At that time I didn’t know I had hEDS, but I know that the breathwork which was taught to me helped me to feel better in my body. It was a powerful tool and remains one of my main practices.
In my work with chronic pain and hypermobile clients, I see dysfunctional breathing patterns regularly, but I know that we have a key that can unlock nervous system regulation, deep relaxation, stability, and pain relief. That key is working with the breath.
The stretchy scaffolding
Connective tissue does not only hold joints together; it forms the scaffolding for muscles, fascia, blood vessels and the respiratory apparatus itself, including the diaphragm and rib cage. In hEDS and HSD, altered collagen structure can affect the elasticity and load-bearing capacity of this scaffolding throughout the body, including the structures involved in breathing (Chohan et al., 2021).
Your main breathing muscles are the diaphragm and the muscles between your ribs, the intercostals. When joints and surrounding tissues can't provide enough passive stability, the body increasingly calls on other muscles to hold posture upright, including ones that are only meant to assist breathing occasionally, not run it full time.
Over time, these accessory breathing muscles, such as the sternocleidomastoid and scalenes in the neck, the upper trapezius across the shoulders, and pectoralis minor in the chest, get recruited into a near-constant job of stabilising the trunk and shoulder girdle. Breathing then shifts away from a relaxed, diaphragm-led pattern into a shallower, upper-chest pattern reliant on these accessory muscles. This altered pattern then feeds back into posture, reinforcing the very instability it was compensating for
Breathing Problems
A variety of breathing problems have been reported in hEDS and EDS, including dyspnoea (shortness of breath), dysphonia (hoarseness), nocturnal coughing or wheezing, and asthmatic symptoms (Bascom, Dhingra and Francomano, 2021). Dyspnoea in particular is one of the most commonly reported, yet standard lung function tests in people with hEDS and HSD usually come back normal (Chohan et al., 2021). This mismatch between subjective breathlessness and normal spirometry (how much air you can inhale and exhale) has prompted researchers to look beyond the lungs themselves and toward how breathing is sensed and controlled."
A notable recent study addressed this directly. Researchers compared lung volume perception and ventilatory control between people with hEDS and healthy controls, and found that accuracy of lung volume perception was significantly impaired in the hEDS group, alongside erratic breathing patterns when participants performed a concurrent cognitive task (Hakimi et al., 2024). In other words, the problem may not simply be weak or restricted breathing muscles, but an impaired ability to sense and regulate breathing in the first place - a proprioceptive deficit applied to respiration, echoing the joint-position-sense deficits already well documented in hypermobility.
Structural changes have also been documented directly. Case reports using dynamic digital radiography have shown reduced diaphragm motility in people with EDS, with one case describing a markedly elevated, poorly mobile diaphragm contributing to progressive breathlessness following pregnancy (Calabrò et al., 2025). More serious complications, including diaphragmatic rupture, have been reported in connective tissue disease, underlining that the diaphragm itself is not exempt from the tissue fragility seen elsewhere in the body (Amin and Waibel, 2017).
The link to PoTS
Breathing pattern disorders intersect heavily with autonomic symptoms common in people with PoTS (postural orthostatic tachycardia syndrome), where the heart rate spikes and blood pressure drops when you change position, often causing dizziness, a racing heart or feeling faint on standing. According to Sirpa UK, many people with PoTS also show features of hyperventilation syndrome, where breathing exceeds what the body actually needs (Sirpa UK, 2024). Autonomic testing in JHS/EDS populations has similarly shown abnormal responses during simple breathing and breath-holding tests, pointing to a broader dysregulation between breathing and the autonomic nervous system (Celletti et al., 2017).
Why all this matters
The diaphragm is not just a breathing muscle. It is a core stabiliser, working together with the deep abdominal and pelvic floor muscles to control intra-abdominal pressure and support the spine during movement. When the diaphragm is recruited inefficiently — or overridden by accessory muscle breathing — that stabilising function is lost, and the body has to find stability elsewhere, often through compensatory tension in the neck, shoulders or low back (Russek, 2017).
This compensation has knock-on effects throughout the body: chronic overuse of accessory breathing muscles, low back and sacroiliac pain, reduced exercise tolerance, sleep disturbance, and heightened sympathetic nervous system activity (Russek, 2017). For a population already managing joint pain, fatigue and dysautonomia, an inefficient breathing pattern is rarely a minor inconvenience — it is plausibly one of the threads holding the whole symptom picture together.
How breathwork helps
Direct trials of breathwork in hypermobile populations are still scarce. However, breathwork has a reasonably established evidence base in related conditions involving dysfunctional breathing, and the mechanisms it targets — diaphragmatic recruitment, postural awareness, reduced reliance on accessory muscles — map closely onto what is seen in hypermobility.
In one trial, people with asthma who also had dysfunctional breathing patterns were given a short course of structured breathwork with a physiotherapist (what the study itself called “breathing retraining”). Over half of them saw a real improvement in their quality of life, and a good number kept that improvement six months later (Thomas et al., 2003). In another study, people with a whole range of unexplained physical symptoms did a five-week breathing programme - just learning to notice their breath, breathe through their nose, and slow things down - and came away with less pain, better wellbeing, and steadier breathing chemistry three months on (Svenningsen et al., 2025). And in a case series of people whose neck and back pain hadn’t budged with manual therapy alone, adding structured breathwork helped almost all of them - 93% had a meaningful improvement in pain or function once their breathing was addressed (McLaughlin, Goldsmith and Coleman, 2011).
For people with hypermobility, the practical implications of the evidence, point toward a few sensible starting points (Russek, 2017).
Building awareness of current breathing patterns (where the breath moves, and which muscles are doing the work)
Practising diaphragmatic breathing in supported positions before progressing to upright and dynamic postures
Pairing breathing work with core and postural stability training rather than treating it in isolation
Because impaired lung volume perception appears to be part of the picture, working with a therapist who can give external feedback — visual, tactile or verbal — is likely to be more effective than self-directed practice alone (Hakimi et al., 2024).
Breath and Movement
As we breathe, we move. As we move, we breathe. The body is never really still, and once you start paying attention to that, it changes how you approach both. Moving away from rigid or forced breathing techniques and learning to find space in the body instead lets us move with far more ease.
But understanding that in theory is one thing. Feeling it in your own body, especially when that body has spent years bracing and guarding, is another. For a lot of people, that part isn't smooth at all.
But breathwork makes me feel worse
I often have clients telling me that they were unable to do their home practice because it made them feel anxious or agitated, or that they found it too challenging. This is not uncommon and if you have ever felt like this, then take heart, it’s quite normal. There are lots of reasons why breathwork can be challenging:
When we start to change the breath, it changes our physiology. The breath is a powerful thing so we need to go slowly to begin with and not expect or ask for too much to happen.
Forcing the breath to fit the vessel, e.g. taking a really big inhale or forcing an exhale can make it painful to breathe. Developing the ability to observe without forcing takes time. We have to let go of the idea that things will change quickly, but embrace the idea that they will change given time
Sometimes breathwork is hard because the nervous system isn't ready for it. This can happen if you're stuck in fight or flight, or if you've experienced trauma. It can also happen if you're neurodivergent. Turning inward and focusing on the breath can increase anxiety, especially if interoceptive signals already feel confusing. If this is you, don't push through. Start with regulation instead. Try external cues like sound, movement or counting, rather than internal body-scanning. Let the nervous system settle first (Eccles et al., 2024).
We need to treat breathing as part of stability and not separate from it. This is because the diaphragm is just as much a core muscle as it is a breathing muscle. Therefore breathing work tends to be most effective alongside gentle core and postural stability training, not just on its own (Russek, 2017). With stability in mind, breathing and making small movements can be very helpful to allow us to experience the breath in a different way. I always encourage clients to observe how their breath is always moving, so that when they move their bodies the movement can start to come in conjunction with the breath (rather than forcing the breath to fit the movement).
My most important advice to anyone is to be patient with yourself. If you have a dysfunctional breathing pattern it likely took years to build. Therefore, it will take consistent, gentle practice to unwind and change it.
Change the breath, change ourselves
Our breath can tell us how we feel, and if we bring intention and awareness to it, we can change how we feel. This works on every level – mind, body and emotions. Regular breathwork can give us increased awareness of our bodies, better proprioception, relaxation, nervous system regulation skills and improved sleep. Breathwork isn’t only way to influence your autonomic nervous system, but I believe it is one of the most accessible. You don’t need equipment, a clinic appointment, or anyone’s permission, you can start influencing how you feel with the very next breath you take.
References
Amin, R. and Waibel, B.H. (2017) ‘Spontaneous diaphragmatic rupture in hypermobile type Ehlers-Danlos syndrome’, Case Reports in Surgery, 2017, Article 2081725. doi: 10.1155/2017/2081725.
Calabrò, E., Cè, M., Rabaiotti, F.L., Macrì, L. and Cellina, M. (2025) ‘Dynamic digital radiography in Ehlers–Danlos syndrome: visualizing diaphragm motility impairment and its influence on clinical management’, Diagnostics, 15(11), Article 1343. doi: 10.3390/diagnostics15111343.
Celletti, C., Camerota, F., Castori, M., Censi, F., Gioffrè, L., Calcagnini, G. and Strano, S. (2017) ‘Orthostatic intolerance and postural orthostatic tachycardia syndrome in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type: neurovegetative dysregulation or autonomic failure?’, BioMed Research International, 2017, Article 9161865. doi: 10.1155/2017/9161865.
Chohan, K., Mittal, N., McGillis, L., Lopez-Hernandez, L., Camacho, E., Rachinsky, M., Santa Mina, D., Reid, W.D., Ryan, C.M., Champagne, K.A., Orchanian-Cheff, A., Clarke, H. and Rozenberg, D. (2021) ‘A review of respiratory manifestations and their management in Ehlers-Danlos syndromes and hypermobility spectrum disorders’, Chronic Respiratory Disease, 18. doi: 10.1177/14799731211025313.
Hakimi, A., Bergoin, C., De Jesus, A., Hermand, E., Fabre, C. and Mucci, P. (2024) ‘Impairment of lung volume perception and breathing control in hypermobile Ehlers-Danlos syndrome’, Scientific Reports, 14, Article 8119. doi: 10.1038/s41598-024-58890-2.
McLaughlin, L., Goldsmith, C.H. and Coleman, K. (2011) ‘Breathing evaluation and retraining as an adjunct to manual therapy’, Manual Therapy, 16(1), pp. 51–52. doi: 10.1016/j.math.2010.08.006.
Russek, L. (2017) Hypermobility 109: Breathing Issues in HSD. Potsdam, NY: Clarkson University. Available at: https://webspace.clarkson.edu/~lrussek/docs/hypermobility/Russek_HSD109.pdf (Accessed: 30 June 2026).
Sirpa UK (2024) Hypermobility from a Mind Body Perspective. Available at: https://www.sirpa.org/hypermobility-from-a-mind-body-perspective/ (Accessed: 30 June 2026).
Svenningsen, H., Stub, T., Courtney, R. and Karlsen, T-I. (2025) ‘Breathing therapy for patients with medically unexplained physical symptoms and dysfunctional breathing: a pilot and feasibility trial’, PLOS One, 20(7), e0325951. doi: 10.1371/journal.pone.0325951.
Thomas, M., McKinley, R.K., Freeman, E., Foy, C., Prodger, P. and Price, D. (2003) ‘Breathing retraining for dysfunctional breathing in asthma: a randomised controlled trial’, Thorax, 58(2), pp. 110–115. doi: 10.1136/thorax.58.2.110.
Opening Hours
Wednesday 10am to 7pm
Thursday 10am to 7pm
Friday 10am to 7pm
Saturdays by appointment
Areas I serve
Macclesfield
Poynton
Stockport
Wilmslow
Alderley Edge
© Claire Feldkamp 2026 |Terms & Conditions | Privacy Policy | Sitemap