The Hypermobility Puzzle: Understanding EDS (Ehlers-Danlos Syndrome) with Dr. Marcia Perretto

For millions of people, being "really flexible" was never just a party trick — it was the first sign of something far more complex. Ehlers-Danlos syndrome and hypermobility spectrum disorders affect not just joints, but the cardiovascular system, the nervous system, digestion, and more — often going undiagnosed for years. Dr. Brent Anderson is joined by Dr. Marcia Perretto, a doctor of physical therapy, founder and CEO of Actify Physiotherapy and Wellness in Boca Raton, Florida, and a nationally recognized expert in hypermobility-informed care.

Dr. Perretto — who lives with hypermobile EDS herself — breaks down the difference between hypermobility and a clinical diagnosis, explains how collagen dysfunction affects the whole body, and offers a clear framework for building toward safe, successful movement. Together, she and Dr. Brent explore why fear can amplify pain, how the nervous system gets caught in a downward spiral, and what it actually takes to interrupt that cycle and get people moving again — without making things worse.

IN THIS EPISODE:

• What Ehlers-Danlos syndrome is and how the 13 subtypes fall under the broader connective tissue umbrella
• Why hypermobility and hEDS are not the same thing — and how to tell the difference
• How collagen dysfunction affects the heart, gut, skin, nervous system, and more
• The role of fear and the amygdala in amplifying chronic pain for hypermobile patients
• Why the nervous system needs "predictable movement" to begin rewiring toward safety
• How to stage a graded return to movement — from proprioceptive awareness to strength
• Why consistent small successes beat occasional big efforts for this population

RESOURCES MENTIONED:

• Dr. Marcia Perretto — Actify Physiotherapy and Wellness: actifypt.com
• Unlocking the Secrets to the Hypermobility Puzzle — book by Dr. Marcia Perretto
• The Beighton Hypermobility Score — referenced as a standard screening tool
• 2017 International Classification of hEDS — the updated criteria discussed in the episode
• Panjabi and Comerford's neutral zone concept — referenced in the movement staging discussion
• Paul Hodges and Carolyn Richardson (University of Queensland) — foundational research on spine stabilization referenced by Dr. Brent

SOURCES AND CITATIONS:

• Malfait F, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26.
• Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32(5):413-418.
• Panjabi MM. The stabilizing system of the spine. Part I: Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5(4):383-389.
• Comerford MJ, Mottram SL. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Man Ther. 2001;6(1):3-14.
• Hodges PW, Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997;114(2):362-370.

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