by Elizabeth Kwon, SPT

Ehlers-Danlos Syndrome (EDS) is a genetically inherited connective tissue disorder that can result in joint hypermobility, skin extensibility, and tissue fragility.  As a result, many patients with EDS experience chronic pain related to joint instability. Past studies have demonstrated that resistance training can increase the stiffness of tendon structures for healthy individuals, and in the case of EDS, these physiologic changes to tendon properties may be beneficial in improving joint stability and function. This pilot study observed three subjects diagnosed with classical Ehlers-Danlos Syndrome (cEDS) who underwent a resistance training program to examine its feasibility and efficacy.

  • Subjects were between the age 28-64 years old with two females and one male subject included.
  • No extreme adverse reactions to training were recorded for any of the subjects
  • Training protocol was for 3 days a week consisting of both upper and lower body exercises. Resistance was slowly progressed first using a familiarization period over the course of 12 sessions followed by increasing the load per each individual’s specific capacity.
  • Researchers examined patellar tendon mechanical properties, muscle power and strength, balance, body composition, fatigue levels, and patients’ subjective opinion of the program.
  • Trends examined:
    • Stiffness (N/mm) of the patellar tendon increased 38.4% and maximal deformity (mm) decreased 14.9% across subjects
    • Isometric strength of leg extension increased 7.97% and leg extension power increased 10.6% across subjects
    • On average, lower body exercises load increased 31% and upper body load increased 34% using a 5 RM test.
    • Subjects all improved in their functional strength and balance test parameters
    • Fatigue decreased 15.6% and 21.4% respectively for the written measure and subjective measure across all subjects.
    • Overall, subjects had a positive experience with training with minor complaints about the program relating to speed of progression and frequency of treatment. Additionally, subjects generally reported no change to their pain levels before or after treatment, and all subjects reported feeling “more tired” during training.
  • Study limitations:
    • This study was limited to only three subjects so that the statistical significance of the findings was unable to be examined.
    • Authors acknowledge that resistance training may not be appropriate for all cEDS patients given the variability of each individual’s symptoms and capabilities and may be most appropriate when tailored for each individual’s specific needs and problematic body regions.

While further studies are necessary to determine the effectiveness of resistance training, this study demonstrates that resistance training can be feasible and safe for patients with EDS. Additionally, the results indicate that resistance training may serve to improve the biomechanical properties of tendinous structures as well as improve balance, strength, and fatigue. At Physical Therapy First, your physical therapist can develop and individualized and safe resistance training program for your own rehabilitative needs. If you have been diagnosed with EDS, talk to your physical therapist about what interventions are appropriate for you at this time for the most optimum treatment and benefits.


Moller MB, Kjaer M, Svensson RB, Anderson JL, Magnusson SP, Nielsen RH. Functional adaptation of tendon and skeletal muscle to resistance training in three patients with genetically verified classic Ehlers Danlos Syndrome. Muscles, Ligaments and Tendons J. 2014; 4 (3): 315-323.