The Many Faces of Ehlers-Danlos Syndrome: A Neurological Look at the Full Spectrum
There is a reason you are feeling frustrated. You have been searching for answers that make sense.
You have been told you are “just flexible,” or that your chronic pain is unrelated to your stretchy skin or frequent injuries. You may have seen countless specialists who only look at individual symptoms—dislocated joints, digestive issues, fatigue, dizziness—but never the full picture. When your symptoms seem to shift across systems and defy standard treatment, you need more than reassurance. You need clarity.
At Georgia Chiropractic Neurology Center, we understand that the body is deeply interconnected—and nowhere is this more evident than in Ehlers-Danlos Syndromes (EDS). These complex genetic conditions do not just affect the connective tissue. They can ripple into neurological, vascular, digestive, and autonomic systems—making daily life unpredictable, exhausting, and at times, disabling.
This post will help you understand the full spectrum of EDS subtypes, how each is diagnosed, their genetic differences, and why chiropractic neurology offers a systems-level view that brings relief and clarity.
What Is Ehlers-Danlos Syndrome?
Ehlers-Danlos Syndrome is not one single condition. It is a group of heritable connective tissue disorders that primarily affect collagen, the protein that provides strength and elasticity to skin, ligaments, blood vessels, and internal organs.
But EDS is not just a musculoskeletal condition. It is systemic. That means it may impact:
- Joint stability
- Proprioception and motor control
- Blood vessel integrity
- Gut motility
- Autonomic nervous system regulation
For this reason, many people with EDS find themselves bouncing between rheumatologists, cardiologists, neurologists, and gastroenterologists—without ever receiving a cohesive diagnosis.
The Thirteen Subtypes of EDS: One Name, Many Faces
As of the 2017 International Classification by the EDS International Consortium, 13 subtypes of EDS have been identified. Each has its own diagnostic criteria, clinical features, and genetic mutations.
1. Classical EDS (cEDS)
- Features: Hyperextensible skin, atrophic scarring, and generalized joint hypermobility.
- Genetics: Mutations in COL5A1 or COL5A2, which affect type V collagen.
- Diagnosis: Based on major criteria like skin hyperextensibility and scarring plus joint hypermobility, confirmed with molecular testing.
2. Classical-like EDS (clEDS)
- Features: Similar to cEDS but without atrophic scarring.
- Genetics: TNXB mutations (Tenascin-X deficiency).
- Diagnosis: Genetic testing is critical as clinical features overlap with cEDS.
3. Cardiac-valvular EDS (cvEDS)
- Features: Severe joint hypermobility and progressive cardiac-valvular problems.
- Genetics: COL1A2 mutations affecting type I collagen.
- Risks: High risk for cardiovascular complications, requiring regular cardiac monitoring.
4. Vascular EDS (vEDS)
- Features: Thin translucent skin, arterial/organ rupture risk, easy bruising.
- Genetics: COL3A1 mutation (type III collagen).
- Critical: Life-threatening and often underdiagnosed. Requires vascular imaging and genetic confirmation.
5. Hypermobile EDS (hEDS)
- Features: Generalized joint hypermobility, chronic pain, dysautonomia, and fatigue.
- Genetics: No known gene yet identified. Diagnosis is clinical and exclusionary.
- Note: This is the most common and often misdiagnosed subtype.
6. Arthrochalasia EDS (aEDS)
- Features: Congenital hip dislocation, extreme joint laxity, muscle hypotonia.
- Genetics: COL1A1 or COL1A2.
- Implication: Significant motor delays and frequent joint dislocations.
7. Dermatosparaxis EDS (dEDS)
- Features: Fragile, saggy skin and hernias.
- Genetics: ADAMTS2 mutations.
- Impact: Reduced collagen processing leads to extreme skin fragility.
8. Kyphoscoliotic EDS (kEDS)
- Features: Congenital muscle hypotonia, progressive scoliosis, eye fragility.
- Genetics: PLOD1 or FKBP14 mutations.
- Neurological Relevance: Can affect proprioception and balance due to spinal deformity.
9. Brittle Cornea Syndrome (BCS)
- Features: Thin cornea, high risk of rupture, and hearing loss.
- Genetics: ZNF469 or PRDM5 mutations.
- Impact: Often presents to ophthalmologists before connective tissue involvement is recognized.
10. Spondylodysplastic EDS (spEDS)
- Features: Short stature, hypotonia, skeletal abnormalities.
- Genetics: B4GALT7, B3GALT6, or SLC39A13.
- Presentation: Overlaps with skeletal dysplasias.
11. Musculocontractural EDS (mcEDS)
- Features: Congenital contractures, skin fragility, craniofacial features.
- Genetics: CHST14 or DSE.
- Significance: Early developmental involvement.
12. Myopathic EDS (mEDS)
- Features: Muscle hypotonia, joint contractures, and progressive muscle weakness.
- Genetics: COL12A1 mutations.
- Overlap: Shares features with congenital myopathies.
13. Periodontal EDS (pEDS)
- Features: Severe gum disease, easy bruising, and joint hypermobility.
- Genetics: C1R or C1S mutations.
- Oral Clues: Often first identified through aggressive periodontal loss.
Why Is Diagnosis So Difficult?
Some EDS subtypes are rare and severe with distinct signs, while others like hEDS are more common but harder to diagnose, due to the absence of a known genetic marker.
Diagnostic Challenges:
- Symptoms overlap with other disorders (fibromyalgia, POTS, chronic fatigue syndrome).
- Genetic testing may only identify the rare subtypes.
- Many patients, especially with hEDS, are dismissed as “just flexible” or psychosomatic.
Diagnostic Tools:
- Beighton Score: Measures joint hypermobility but does not account for age, sex, or trauma.
- Brighton and 2017 hEDS criteria: Include systemic features, family history, and exclusion of alternative diagnoses.
- Genetic testing: Essential for non-hEDS types.
- Multidisciplinary assessment: Often required to identify and manage comorbidities.
How EDS Affects Daily Life
Living with EDS can feel like navigating a world that was not built for your body.
Physical Symptoms:
- Frequent sprains, subluxations, and dislocations.
- Chronic fatigue and post-exertional malaise.
- GI problems (gastroparesis, IBS, GERD).
- Orthostatic intolerance or POTS.
- Migraines, TMJ dysfunction, and vision issues.
Neurological and Autonomic Symptoms:
Many EDS patients also experience dysautonomia, sensory processing difficulties, and coordination challenges. This is not surprising when you understand how connective tissue abnormalities affect the nervous system, particularly the proprioceptive input from joints and fascia.
- Poor proprioception → poor joint stability → overactivation of compensatory muscles → chronic tension and pain.
- Vagal nerve compression or tension → disrupted autonomic balance → nausea, dizziness, heart rate variability.
- Fascia dysfunction → altered sensory feedback to the brain → pain amplification, movement inefficiency, and fatigue.
A Chiropractic Neurology Approach to EDS
In chiropractic neurology, we do not chase symptoms. We look at how the nervous system is processing input from the body—and how it can be optimized.
Here is how we approach care for someone with EDS:
1. Functional Neurological Evaluation
- Assess joint proprioception, balance, eye movement control, and vestibular function.
- Evaluate dysautonomia and vagal tone using heart rate, blood pressure changes, and pupillary response.
2. Myofascial and Sensory Integration Work
- Gentle manual fascial therapy to support fascial glide without overloading hypermobile tissues.
- Techniques to reduce neural tension and improve blood flow and lymphatic drainage.
3. Neurocognitive and Vestibular Training
- Improve proprioceptive accuracy through balance and eye-head coordination exercises.
- Frontal lobe activation strategies to support executive function, coordination, and attention.
4. Nutritional and Lifestyle Support
- Address nutrient deficiencies common in EDS (vitamin C, magnesium, electrolytes).
- Recommend collagen-supportive protocols to enhance tissue repair and resilience.
- Pacing strategies and autonomic regulation tools (like diaphragmatic breathing and vagal stimulation).
You Deserve Answers—and a Plan
EDS is not “just joint hypermobility.” It is a multisystem, genetically rooted condition that affects connective tissue, the brain, and the nervous system. Whether you have been diagnosed with a rare subtype or are still searching for answers under the hEDS umbrella, understanding your unique neurological profile can be the turning point in your journey.
You do not need to manage this alone. At Georgia Chiropractic Neurology Center, we specialize in complex cases that other systems often overlook. We see the full picture—and we know how to work with the body to help it stabilize, adapt, and thrive.
If you or someone you love is suffering from Ehlers-Danlos Syndrome and you would like to learn how chiropractic neurology can help, contact the team at Georgia Chiropractic Neurology Center today. We look forward to hearing from you.
Written by Sophie Hose, DC, MS, DACNB, CCSP
Peer-Reviewed References
- Malfait, F., Francomano, C., Byers, P., et al. (2017). The 2017 international classification of the Ehlers–Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 8–26. https://doi.org/10.1002/ajmg.c.31552
- Castori, M., Tinkle, B., Levy, H., et al. (2017). A framework for the classification of joint hypermobility and related conditions. American Journal of Medical Genetics Part C, 175(1), 148–157. https://doi.org/10.1002/ajmg.c.31539
- Chopra, P., Tinkle, B., Hamonet, C., et al. (2017). Pain management in the Ehlers–Danlos syndromes. American Journal of Medical Genetics Part C, 175(1), 212–219. https://doi.org/10.1002/ajmg.c.31555
- Hakim, A. J., O’Callaghan, C., De Wandele, I., & Stiles, L. (2021). Hypermobility syndromes and autonomic dysfunction: Practical guidance for clinicians. British Journal of General Practice, 71(709), 8–9. https://doi.org/10.3399/bjgp21X714797