Some people can barely touch their toes. Others can bend, twist, and fold themselves into positions that look almost unnatural.

That difference isn’t always flexibility.

According to Dr. Eric Krohn, an orthopedic surgeon with Monument Health, and Codi Grable, a physical therapist, what many people describe as being “double-jointed” is often something called ligament laxity.

And understanding the difference can explain years of unexplained pain, repeated injuries, or joints that never quite feel stable.

Ligament Laxity vs. Flexibility

Flexibility is something you can change.

“You can stretch muscles,” Grable explained. “You can improve flexibility with exercise and movement.”

Ligament laxity is different.

“Ligaments are meant to stabilize joints,” Dr. Krohn said. “Some people are born with connective tissue that’s simply more elastic.”

That elasticity can make joints move farther than they should. Unlike muscles, ligaments don’t really tighten back up, even with surgery.

“That’s why this is something you’re born with,” Krohn said. “It’s part of your biology.”

A helpful comparison is the kid in school who could bend their fingers backward or drop into splits without trying. They weren’t training for it. Their body just worked that way.

How Providers Identify Ligament Laxity

Clinicians use a screening tool called the Beighton score, which looks at how joints move. It includes elbow and knee hyperextension, finger flexibility, and whether someone can place their palms flat on the floor with straight legs.

“Most people fall somewhere on a spectrum,” Krohn said. “Being higher on the scale doesn’t automatically mean there’s a problem.”

Issues tend to show up when pain enters the picture.

Signs It Might Be More Than “Being Flexible”

People with ligament laxity often don’t seek care because they assume their symptoms are normal.

But Grable says certain patterns are worth paying attention to.

“Recurrent ankle sprains, hip pain that comes and goes, feeling clumsy, or joints that don’t feel stable,” she said.

Hip pain, in particular, is common.

“When the ball-and-socket joint isn’t as stable, surrounding muscles have to work overtime,” Grable said. “That extra work can lead to irritation and pain.”

Over time, untreated instability can contribute to joint breakdown.

“We see people in their thirties and forties who end up needing joint replacements,” Krohn said. “Often they’ve had pain for years and were told nothing was wrong.”

Why Physical Therapy Is the First Step

Even when ligament laxity plays a role, surgery is rarely the starting point.

“Physical therapy is low risk and very effective for many patients,” Grable said. “We focus on improving strength and movement patterns to increase joint stability.”

Education is a major part of treatment.

“When people understand what’s happening in their body, it takes away a lot of fear,” she said.

If symptoms improve, surgery may never be needed.

If they don’t, the care team looks deeper.

Diagnostic Injections Help Confirm the Problem

One challenge with joint pain is that it doesn’t always come from where it hurts.

“Nerves, tendons, even the spine can masquerade as hip pain,” Krohn said.

To narrow things down, providers sometimes use diagnostic injections with short-acting numbing medication.

“If pain temporarily goes away, we know exactly where it’s coming from,” he said.

That step helps avoid unnecessary procedures and ensures the right issue is being treated.

When Surgery Makes Sense

If instability is caused by bone shape or alignment, surgery may be the best option.

“You can’t tighten stretchy ligaments,” Krohn said. “But bone can be repositioned to better contain the joint.”

Recovery is a commitment.

“Six to eight weeks of limited or no weight-bearing is common,” Grable said. “That time investment protects the joint long-term.”

Physical therapy before and after surgery is essential.

“Surgery isn’t the finish line,” she said. “It’s one piece of the process.”

Staying Motivated Through Recovery

Rehabilitation can be challenging, especially for active patients.

“We remind people what they’re working toward,” Grable said. “Hiking, hunting, sports, everyday movement without pain.”

Krohn added that surgery without rehab doesn’t work.

“If therapy feels hard before surgery, it’s harder after,” he said. “You have to commit to the process.”

A Reassuring Takeaway

Ligament laxity doesn’t mean someone is broken.

“We’re all built differently,” Krohn said. “Being flexible or hypermobile can be completely normal.”

But pain is worth paying attention to.

“If you have laxity and pain, it’s very treatable,” he said.

Often, the solution starts with the right explanation, the right team, and a plan that treats the whole person, not just the joint.