The Link Between Long COVID and Hypermobility

Over the past three years, I’ve noticed a significant increase in the number of long COVID patients seeking support in my clinic. As the pandemic has evolved, so too have the symptoms and challenges associated with long COVID (LC). What’s particularly striking is the range of presentations, from lingering fatigue and brain fog to unexplained physical discomforts. Interestingly, a connection has emerged with joint hypermobility, a condition where joints move beyond the typical range. Joint hypermobility can occur as part of specific conditions, such as Hypermobility Spectrum Disorders (HSD) or hypermobile Ehlers-Danlos Syndrome (hEDS), and is often accompanied by symptoms like joint pain, fatigue, and issues with the autonomic nervous system, which regulates vital functions like heart rate and blood pressure.

What’s particularly striking is the growing recognition that these symptoms—fatigue, muscle pain, blood pressure irregularities, and even "brain fog"—are not only common in people with hypermobility but also in many individuals dealing with long COVID. Researchers are now exploring how these overlapping symptoms might be connected, particularly since both groups often experience similar inflammatory responses and immune system challenges. This emerging link between hypermobility and long COVID symptoms may offer important insights into why some people continue to struggle with recovery and could pave the way for more effective, comprehensive approaches to managing these persistent, life-altering symptoms.

The Overlap of Hypermobility with Chronic Conditions

Joint hypermobility has been documented in up to 30-57% of patients with chronic conditions such as myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS), fibromyalgia, postural orthostatic tachycardia syndrome (POTS), and, more recently, long COVID. This rate is notably higher than what is observed in the general population, suggesting an underlying link between hypermobility and these conditions.

In particular, symptoms seen in LC patients—such as musculoskeletal pain, autonomic dysfunction, cognitive challenges, and persistent fatigue—closely resemble symptoms associated with HSD. Additionally, ME / CFS, which is known to have symptom overlap with HSD, often presents similarly to LC, further indicating a possible shared pathology among these conditions.

One potential explanation for the association between LC, ME / CFS, and hypermobility lies in the role of chronic inflammation. In both LC and ME / CFS, research has pointed to an increased occurrence of mast cell activation and degranulation, which can lead to hyperinflammatory states that may damage connective tissue. Over time, such connective tissue damage could contribute to or exacerbate hypermobility symptoms in these patients.

For patients with LC and ME / CFS, this persistent inflammation may not only induce hypermobility but could also worsen existing hypermobility spectrum disorders. This inflammatory cascade might contribute to a cycle of connective tissue vulnerability, pain, and further hypermobility, complicating recovery for those affected by LC.

Given these connections, it is crucial to screen for hypermobility and associated conditions in patients with long COVID. Screening can identify individuals with conditions like fibromyalgia, POTS, ME / CFS, chronic pain, and joint pain, providing insight into the full scope of their symptoms.

By understanding and addressing the underlying connections between LC, hypermobility, and chronic conditions, more nuanced, effective care can be offered. This holistic approach including setting the foundations of movement, nutrition and sleep is essential for managing the complex interplay of symptoms, promoting quality of life, and supporting the long-term well-being of patients facing these overlapping conditions.

References:

Daylor, Victoria BFA; Gensemer, Cortney PhD; Norris, Russell A. PhD; Bluestein, Linda MD. Hope for Hypermobility: Part 2—An Integrative Approach to Treating Symptomatic Joint Hypermobility. Topics in Pain Management 38(9):p 1-10, April 2023. | DOI: 10.1097/01.TPM.0000933968.28098.59

Ganesh R, Munipalli B. Long COVID and hypermobility spectrum disorders have shared pathophysiology. Front Neurol. 2024 Sep 5;15:1455498. doi: 10.3389/fneur