26. Strength Training & The Hypermobile Body - with Dr Melissa Koehl (Physical Therapist)

Strength Training for Hypermobility: Building Stability Without Burnout | Dr. Melissa KoehlEpisode SummaryCan strength training actually help a hypermobile body feel stronger, more stable, and less painful?In this episode of The Invisible Podcast, Dr. Ashton Wilson is joined by Dr. Melissa Koehl, Doctor of Physical Therapy, Pilates instructor, and hypermobility specialist, to explore one of the most important topics in hypermobility management—strength training.Together, they discuss why building strength is essential for people with hypermobile Ehlers-Danlos Syndrome (hEDS), Hypermobility Spectrum Disorders (HSD), and symptomatic joint hypermobility, while also explaining why traditional fitness advice often doesn't work for this population.Dr. Melissa shares practical strategies for exercising safely, managing recovery, avoiding post-exertional crashes, and learning how to work with your body rather than against it.The conversation also covers the latest insights from the EDS Global Learning Conference, including exciting developments in understanding orthostatic intolerance and POTS.Whether you're newly diagnosed, living with chronic pain, or simply trying to find an exercise approach that actually works, this episode offers practical guidance grounded in both clinical expertise and lived experience.What You'll Learn in This Episode

Why strength training is one of the most effective tools for managing hypermobility symptoms How muscle strength improves joint stability and protects hypermobile joints Why recovery matters more than the workout itself The biggest mistakes people make when starting strength training How to find your own exercise capacity without triggering symptom flares Why "more exercise" isn't always better for hypermobile bodies The importance of pacing and progressive overload How dysautonomia, POTS, and orthostatic intolerance impact exercise tolerance Why rest between sets is essential—not lazy Safe ways to include stretching without overstretching joints Simple programming strategies for beginners and intermediate exercisers How compression garments can improve symptoms for people with orthostatic intolerance Practical recovery strategies to reduce post-exercise fatigue

Key TakeawaysMeet your body where it is todayYour body's capacity changes from day to day. Instead of judging your workout by how you feel during exercise, evaluate how you feel over the following 24–48 hours.Start with less than you thinkOne of the biggest mistakes people make is doing too much, too soon. Beginning with around 50% of what you think you're capable of allows your body to adapt safely and reduces the risk of setbacks.Recovery is part of trainingStrength gains happen during recovery—not during the workout itself. Proper rest, nervous system regulation, hydration, pacing, and allowing your heart rate to recover between sets are all essential components of successful training.Highlights From This Episode

Dr. Melissa's experience attending the EDS Global Learning Conference New research surrounding orthostatic intolerance and POTS Why many patients don't need a tilt table test to begin receiving treatment The emotional importance of clinicians believing patients' symptoms Melissa's personal journey from competitive gymnast to hypermobility specialist Why Pilates, strength training, and yoga each play different but complementary roles Understanding post-exertional malaise and exercise recovery Why consistency matters more than intensity How strength training differs for hypermobile individuals compared to the general population

Questions AnsweredDoes stretching make hypermobility worse?Not necessarily. Stretching can still be beneficial when performed safely. Dynamic stretching, using props, and avoiding prolonged end-range positions can help protect joints while improving muscle flexibility.Why do my knees hurt during strength training?Knee pain isn't always caused by the knees themselves. Weakness or instabili