As someone diagnosed with hypermobile Ehlers-Danlos Syndrome (hEDS) recently, I was intrigued to discover Francesca dePasquale's Hypermobile Musician, a resource aimed at educating and supporting teachers and musicians about hypermobility. I spoke with Francesca about her experiences and the importance of raising awareness around hypermobility in the music industry. Read the full interview below.
Hypermobility (and particularly Ehlers-Danlos Syndrome) is still relatively unknown and misunderstood. There are often misconceptions about what it means. Can you explain to us what hypermobility is?
Hypermobility is the greater-than-average range of motion of the body's joints, caused by loose connective tissue. It can exist locally (one joint or group of joints in the same area) or generally (many joints or groups of joints in the body), and it can be inherited (genetic) or acquired (for instance, through injury).
Hypermobility can present with or without joint instability and with or without accompanying symptoms. When there are accompanying symptoms and certain criteria are met beyond the extended range-of-motion itself, hypermobility can then be considered a feature of hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobile Spectrum Disorder (HSD). It's worth noting that there are other syndromes that can feature hypermobility, such as other forms of EDS or Marfan Syndrome.
The biggest misconception that I see amongst musicians is a lack of recognition that hypermobility exists on a spectrum and that all forms of hypermobility can have an impact on playing an instrument. Your student has double-jointed fingers? That's localized hypermobility. You have greater range of motion than average, but no accompanying symptoms or pain? This points to generalized hypermobility, versus hEDS or HSD which involve a range of symptoms such as muscle pain and fatigue, as well as comorbidities such as dysautonomia (disruption of the autonomic nervous system) or mast cell activation syndrome (overactivity of histamine production by the body's mast cells).
When did you become aware that you were hypermobile? What led you to suspect this?
I always knew that I was “flexible,” but I did not learn about hypermobility until my first injury during conservatory years. Even after I discovered that I was hypermobile, I did not learn about hEDS or receive my diagnosis until I was in my thirties—when I did, it felt like receiving an explanation for my entire lived experience thus far!
You have a very successful career as a musician. How did your hypermobility affect you as a student, and what methods do you use to manage symptoms as a professional musician today?
Winging scapulae [Photo Credit: Tanya Rosen-Jones]
My hypermobility affected me as a student in a few ways: though there wasn’t anything explicitly wrong with my technique, the way my body related to this technique was not “correct” due to the different biomechanics of a hypermobile body. As a result, I suffered from some playing-related injuries (as an example, I tore a tendon in my shoulder due to increased wear caused by winging scapula). I also experienced increased muscle strain, pain, and fatigue, as well as unexplained dizziness (from dysautonomia) and allergic reactions (from mast cell activation syndrome).
I am a highly disciplined person, which is helpful for remaining consistent with the many methods I utilize to manage symptoms as a professional musician. I am consistent with strength training (utilizing programs overseen by a hypermobile-aware physical therapist), movement, nutrition, and sleep to promote muscle growth and stabilization as well as recovery. If it’s a day when issues crop up, I have many tools that I rely upon (as examples, a lacrosse ball to release tight muscles or kinesiology tape to support a joint that has had a recent, partial-dislocation). When I travel, I take extra care: I wear a soft, cervical collar to support my cervical instability during takeoff and landing when flying, and I use an added waist strap to my instrument’s backpack straps as well as a rolling bag to take strain off of my shoulders.
Hypermobility itself isn’t particularly rare, and it doesn’t always cause problems - it very much depends on the individual. However, is it something we should be particularly aware of when learning or teaching an instrument? Does playing an instrument make you more prone to encounter injury if you are hypermobile?
I completely agree that hypermobility itself is not particularly rare! A recent study put the prevalence of generalized joint hypermobility at 57% of the population. The latest research puts the prevalence of hEDS at 1 in every 500 people—and the research continues to evolve.
Students and educators should absolutely be aware of hypermobility when learning or teaching an instrument—the way a hypermobile body relates to instrumental technique is inevitably going to be different. If it is not managed (and sometimes, even when it is managed properly), hypermobility can lead to injury—whether that is from playing an instrument or other functional tasks like opening a door or lifting a suitcase. Awareness can mitigate injury and/or aid recovery through informed practices.
I have noticed many people with EDS in particular are also creatives: I see many musicians, dancers, and artists in our local support groups. Why do you think this is?
I share the same observation. I believe that, while there are challenges, there are also clear benefits of hypermobility in musicians, dancers, and artists. The extended range of motion, if managed properly, can actually give a competitive edge. Additionally, there is a noted prevalence of neurodivergence in those with hypermobility, which can also be associated with creative thinking.
My collapsing finger joints were probably one of the most obvious signs of my hypermobility when I was learning music as a student. What other signs can teachers look for?
Collapsing finger joints is one of the most common and clear signs. Others include scapular winging (protruding shoulder blades when they would otherwise lay flat), difficulty sensing the body’s relationship to space due to poor proprioception (does your student frequently bump into the doorframe when entering or exiting a room?), seeking or lacking support (does your student lean against the wall or the side of the piano when standing, can’t seem to sit in one position comfortably, or otherwise struggle to support their posture?), as well as muscle pain and strain. Ironically, muscle tension or locked joints should also be explored—just because a joint has greater range of motion does not mean that the muscles around it will be flexible or that the joint itself can’t lock—in fact, muscles are often tight and joints can lock in an unconscious effort to stabilize or from lack of control.
What should teachers and students do if they suspect hypermobility?
If a student or a teacher suspects hypermobility, I suggest they search the Ehlers Danlos Society’s directory to find a medical professional familiar with hypermobility in their location. A diagnosis is so important, even without a cure, as accurate information leads to effective management and care. I then suggest looking at the specific ways hypermobility impacts playing the instrument—as an example, if your finger joints collapse, you will want to work on exercises both without and with the instrument to strengthen and improve load-bearing of the joints.
Can you talk a bit about related conditions or symptoms and how they can also affect practice and performance (such as brain fog, chronic pain, anxiety, neurodivergence, dysautonomia, MCAS etc).
This is such an important conversation. Those with symptomatic hypermobility often have symptoms that inevitably impact both practice and performance as a musician—luckily, there are ways to improve many of them.
A student with dysautonomia may struggle during long rehearsal hours—compression socks as well as salt and electrolytes can help prevent blood pooling in the legs during prolonged sitting or standing, which can help mitigate brain fog and dizziness. Any performing musician needs to understand their relationship to anxiety, and also, this is super important for hypermobile musicians in particular to understand as a component of dysautonomia, which can impact both heart rate and blood pressure. Students with neurodivergence may need different strategies for effective practicing. Wearing fragrance is generally not permissible in orchestral settings—for those with MCAS, it can trigger a reaction that makes playing difficult or impossible. And obviously, chronic pain can severely impact the ability to practice or perform.
Poor posture or technique was often blamed for causing my injuries and pain, but I now understand this was most often due to my hypermobility. How beneficial is being aware of hypermobility early on in preventing injuries?
I’m so sorry to hear that this was your experience. Unfortunately, it is not uncommon, and this is why it is so important for music teachers to educate themselves on hypermobility and how it impacts playing the instrument. Being aware of hypermobility (at any stage, but particularly early-on) is extremely beneficial in preventing injuries. As an example, if a student (and their teacher) understands that they are raising their shoulders to compensate the angle from winging shoulder blades, they can not only prevent possible injury in the future, but also improve their body’s relationship to their technique as well as the technique itself.
Can you tell us more about your resource, ‘Hypermobile Musician’?
Hypermobile Musician (hypermobilemusician.com) was launched in September of 2024–it is a free resource on hypermobility, specifically for musicians. It summarizes the different types of hypermobility, highlights the most common points of impact for musicians (including instructional videos on collapsing finger joints and scapular winging), and provides educational information on strengthening and movement, nutrition, and sleep, as well as tools and resources.
Beyond the website, Hypermobile Musician also offers coaching for individuals or groups who wish to learn more or receive personalized insight—I offer free, 15-minute consultations to anyone who inquires, and I work with coaching clients both in-person as well as via Zoom.
You can also find additional Hypermobile Musician content on Instagram (@hypermobilemusician) and YouTube (@HypermobileMusician).
I created Hypermobile Musician so that both hypermobile musicians and their educators will have greater access to information and awareness on how hypermobility impacts musicians. It’s the resource I wish I’d had as a music student!
