Physical Therapy Management of Upper Cervical Spine Instability in a Patient With Hypermobile Ehlers-Danlos Syndrome: A Case Report

BACKGROUND: Individuals with the co-occurrence of hypermobile Ehlers-Danlos syndrome (hEDS) and upper cervical spine instability (UCI) present complex rehabilitation challenges with limited published outcomes to guide rehabilitative or conservative care. CASE PRESENTATION: A 35-year-old woman with hEDS, UCI and multisystem comorbidities presented with severe neck pain, presyncope, and profound functional limitation. Examination confirmed generalized joint hypermobility and high symptom irritability, supporting a modified, consensus-guided approach to safely initiate physical therapy rehabilitation. OUTCOME AND FOLLOW-UP: The patient completed 80 visits over 12 months of individualized rehabilitation, including education, neuroplasticity-based motor-control retraining, and progressive strengthening tailored to symptom irritability. Treatment was based on a recently published consensus report outlining a framework for assessment and intervention. Pain decreased by 55%, neck disability improved by 49%, and function improved by 50%. She regained partial independence and reported a significantly improved quality of life. DISCUSSION: This case demonstrates that consensus-guided conservative rehabilitation, adjusted for symptom reactivity, may be associated with meaningful clinical improvement in patients with hEDS and UCI.