Long COVID · Hypermobility · EDS

Some of the most stubborn Long COVID cases turn out to be undiagnosed Ehlers-Danlos syndrome. Here’s the connection — and what a deeper evaluation can actually find.

Months after the infection cleared, the symptoms didn’t. The fatigue that sleep doesn’t fix. Brain fog that makes work feel impossible. A heart that races when you stand. Body-wide pain that every scan calls “normal.” If that’s you — and a chest X-ray, an ECG, and routine labs all came back clean while you still feel broken — you are not imagining it.

For a meaningful subset of patients, stubborn Long COVID is sitting on top of a connective-tissue difference that was there all along and was never diagnosed: hypermobility. A physician-led Long COVID evaluation is built to look for exactly that.

Long COVID is the cluster of symptoms that linger weeks, months, or years after a SARS-CoV-2 infection. It is common — as many as 1 in 8 adults report lingering symptoms — and the CDC and the NIH RECOVER initiative now recognize more than 200 of them.

The clusters we see most often in clinic are the ones with a physical, examinable basis: crushing fatigue and post-exertional malaise (a crash after activity), diffuse muscle and joint pain, brain fog, a racing heart and dizziness on standing, breathlessness, and GI and sleep disruption.

Read that symptom list again, because here is what surprises most patients: it is almost identical to the core symptoms of hypermobility. Fatigue, post-exertional malaise, widespread pain, brain fog, and dysautonomia / POTS are defining features of hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) as much as they are of Long COVID.

Independent research has found hypermobility in a striking share of patients with ME/CFS, fibromyalgia, POTS, and Long COVID. When two conditions share this much, it is worth asking whether one is hiding inside the other.

Our founder, Dr. Jacques Courseault, MD, co-authored peer-reviewed research making exactly this case. In a 2024 paper in PM&R, his team argued that some of the hardest-to-resolve Long COVID cases are, in fact, undiagnosed hypermobility — and that the two conditions share a common thread (Yang, Logarbo, Courseault, et al., PM&R 2024). A separate 2024 review in Frontiers in Neurology reached a similar conclusion: Long COVID and hypermobility spectrum disorders appear to share underlying pathophysiology.

There is even a proposed mechanism at the tissue level. Researchers have suggested that the same fascial myofibroblasts behind “viral fibromyalgia-ness” may help explain the stubborn, body-wide pain — connecting a viral trigger to the connective tissue itself. Dr. Courseault’s own work goes further, linking a common MTHFR / folate-pathway variant to the connective-tissue differences seen in hypermobility — which points toward drivers that are both testable and treatable.

A “Long COVID” label, on its own, does not tell you what to do next. But finding an underlying, hypermobility-aware driver does. It can turn an open-ended diagnosis into a concrete plan — because hypermobility, dysautonomia, and the metabolic pieces underneath them can be screened for, tested, and managed.

To be clear: the goal is not a magic cure. No honest clinic promises to “cure” Long COVID. The goal is to find the contributing problems your earlier workup did not look for, and actually treat them.

This is the difference between a 12-minute “everything looks normal” visit and a structured, physician-led assessment. A Long COVID evaluation built around connective tissue typically includes:

Consider a hypermobility-aware evaluation if your Long COVID symptoms have not resolved and any of these sound familiar:

If that list sounds like you, it is worth a closer look.

• Long COVID Evaluation in Beverly Hills & Los Angeles — the full, physician-led assessment described above.
• The Hypermobility & EDS protocol — how our structured, physician-led program works.
• Understanding the Basics of Dysautonomia — more on the POTS and autonomic symptoms that overlap with Long COVID.
• The peer-reviewed research (PM&R, 2024) connecting Long COVID to underlying hypermobility.

This article is for general education and is not a substitute for individualized medical advice, diagnosis, or treatment. Every case is different, and results vary from person to person. Always consult a qualified clinician about your symptoms.