What is Ehlers-Danlos Syndrome?

By Dr Sarah Varmalis, Senior Osteopath

Ehlers-Danlos Syndrome (EDS) is a group of genetic conditions that affect the body’s connective tissue. Connective tissue is what gives structure and support to things like ligaments, skin, blood vessels, and even internal organs. It’s essentially the “scaffolding” that holds everything together.

In people with EDS, this connective tissue is more elastic and less supportive than usual. This often shows up as joints that move more than they should (sometimes called hypermobility), skin that may be more stretchy or fragile, and a tendency toward injuries like sprains, dislocations, or ongoing aches and pains.

But EDS isn’t just about being “flexible.” Because connective tissue exists throughout the entire body, it can affect multiple systems. This means people may experience a wide range of symptoms; from joint pain and fatigue, to digestive issues, dizziness, or difficulty regulating energy levels. It can look very different from one person to another, which is part of why it’s often misunderstood or missed early on.

Learning More and Getting Diagnosed
For those wanting to better understand Ehlers-Danlos Syndrome, ‘The Ehlers-Danlos Society’ is one of the most trusted resources available. They provide up-to-date information on the different types of EDS, as well as guidance around diagnosis and management.
The current diagnostic criteria (particularly for hypermobile EDS (hEDS)) can be found here:
https://www.ehlers-danlos.com/heds-diagnostic-checklist/

Diagnosis is not always straightforward. It typically involves a combination of medical history, physical assessment (including joint hypermobility), and ruling out other conditions. For many people, the process can take years.

EDS also rarely exists in isolation. Because connective tissue is found throughout the body, it’s common to see overlap with other conditions and symptoms, including:

• Postural Orthostatic Tachycardia Syndrome (POTS), which can cause dizziness, rapid heart rate, and difficulty tolerating standing
• Gastrointestinal issues such as bloating, reflux, constipation, or food sensitivities
• Chronic fatigue and reduced energy capacity
• Headaches or migraines
• Pelvic or bladder dysfunction
• Increased sensitivity within the nervous system (often linked with chronic pain patterns)

Understanding these connections can be a turning point. It helps explain why symptoms can feel so widespread, and why a whole-body approach to treatment is often needed.

An Osteopathic Approach to Ehler-Danlos
Living with a condition like Ehlers-Danlos Syndrome (EDS) or ongoing chronic pain can feel confusing, frustrating, and at times, overwhelming. Many people go years trying different treatments, often being told that everything looks “normal” despite still feeling far from it.

From an osteopathic perspective, the focus shifts away from chasing symptoms and toward understanding how the whole body is functioning and more importantly, where it’s struggling to adapt.

What’s Actually Going On?
Ehlers-Danlos Syndrome is a connective tissue condition. In simple terms, the “glue” that holds the body together; ligaments, fascia, blood vessels, even organs have a different structure. This often leads to increased flexibility, but that flexibility comes at a cost: reduced stability.

Over time, the body works harder to compensate. Muscles overwork, joints become irritated, and the nervous system becomes more sensitive. This is where chronic pain can start to take hold.

But here’s the key thing; pain in these conditions isn’t just about joints being “loose.” It’s about how multiple systems in the body are interacting and, in many cases, becoming overloaded.

Why Traditional Approaches Don’t Always Work
A lot of treatments focus purely on strengthening or stabilising joints. While that can absolutely be helpful, it often doesn’t address the full picture.
In people with EDS or persistent pain, there are often underlying drivers such as:

• Nervous system sensitivity
• Circulatory or lymphatic congestion
• Organ (visceral) restrictions
• Fascial tension patterns that don’t follow typical rules

If these aren’t addressed, the body can stay stuck in a loop of compensation—no matter how strong someone gets.

A Different Way of Looking at the Body
Osteopathy takes a whole-body approach. Rather than asking “where does it hurt?”, the question becomes “why is the body under strain in the first place?”
Two techniques that are particularly useful in these cases are:

• Counterstrain
• Barral Approach

Both are gentle, precise, and designed to work with the body rather than forcing change.

Counterstrain: Calming the Nervous System
Counterstrain is a technique that focuses on tender points in the body, small areas that reflect dysfunction in muscles, nerves, blood vessels, or organs.
Rather than stretching or pushing into pain, the body is placed into positions of ease. These positions are held briefly, allowing the nervous system to “reset” its perception of that area.

In patients with EDS or chronic pain, this can be incredibly powerful. Why?
Because the nervous system is often running in a heightened, protective state. Counterstrain helps reduce that sensitivity, allowing muscles to relax and improving how the body coordinates movement.

A key part of this process is the cranial scan. By gently assessing points along the skull, practitioners can identify which systems in the body are under strain—whether that’s vascular, neurological, or visceral. It becomes a roadmap for treatment, rather than guessing where to start.

The Barral Approach: Supporting the Organs
When people think about pain, they rarely think about organs but they should.

The Barral approach (often called visceral manipulation) looks at how organs move and interact with surrounding structures. Each organ has its own natural rhythm and mobility. When that movement is restricted, it can create tension patterns throughout the body.

For example:

• Digestive restrictions can influence the spine and diaphragm
• Pelvic organ tension can affect hips and lower back
• Liver or stomach restrictions can alter posture and breathing

In EDS and chronic pain conditions, these subtle restrictions can play a much bigger role than expected. By gently improving how these structures move, the body often finds it easier to settle, stabilise, and function more efficiently.

Why Gentle Treatment Matters
One of the biggest misconceptions is that stronger or more forceful treatment leads to better results. In reality, for people with EDS or heightened pain sensitivity, the opposite is often true.

The body responds best to:

• Low-force techniques
• Precise, targeted treatment
• Allowing the nervous system time to adapt

Both Counterstrain and the Barral approach respect this. They work under the body’s tolerance, rather than pushing past it.

What Patients Often Notice
While every person is different, common changes patients report include:

• Reduced pain flare-ups
• Feeling more “stable” without forcing strength
• Improved digestion or breathing
• Better energy levels
• A sense that their body is finally starting to calm down

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Importantly, progress is usually gradual and layered—because the body is unwinding patterns that have often been there for years.

The Bigger Picture
Managing Ehlers-Danlos and chronic pain isn’t about finding a single “fix.” It’s about helping the body become more adaptable, more efficient, and less reactive over time.
Osteopathy, particularly when using approaches like Counterstrain and Barral, offers a way to support that process gently and intelligently.
It’s not about forcing the body into place—it’s about giving it the space and input it needs to find a better way of functioning.