In this solo video, Dr. Aaron Hartman explains how connective tissue (fascia) underlies many chronic health problems. He introduces the concept of "Pentad Super Syndrome," a cluster of five conditions that frequently co‑occur with hypermobility: hypermobility spectrum disorder, mast cell activation syndrome, autoimmune disease, gastrointestinal dysfunction, and dysautonomia/POTS. Hartman describes hypermobility not merely as being double‑jointed but as a systemic laxity of fascia that leads to heightened sensory nerve signaling, trauma‑related sensitization, and later age‑related fascial tightening that produces pain. He cites prevalence data (≈20% of children, ~12.5% of college‑age adults, dropping to 3‑5% in older adults) and explains why fascia tightens over time, creating new pain pathways. The video outlines the nutritional needs of hypermobile patients—higher vitamin C, collagen‑rich protein, and a broad spectrum of trace and rare‑earth minerals—linking these to collagen synthesis and tissue repair. Hartman also teaches the Beighton scoring system for self‑assessment, emphasizing its role in identifying hidden hypermobility that may be driving persistent illness. Throughout, he argues that unaddressed fascial laxity can keep patients stuck in chronic disease, and that recognizing and supporting connective tissue health is essential for recovery.
Chapters
It's all connected. Everything in our body is connected. We're connected to the outside world. We're connected to the earth. It gets kind of— can get a little weird and woo-woo, but these are actual things that we have data for and scientific information for. So why did I start with it's connected? We talk about why are you not getting better? Why are you still sick? One of the things I've discovered in my practice and my research and studies recently is the idea of your connective tissues, your fascia. The stuff between your organs, the stuff that holds your organs in place, the stuff that holds your cells in place. It's really interesting. There's not a, you know, in science, we have a cardiologist, we have a rheumatologist, we have an orthopedic surgeon, we have, you know, our cancer specialist, but who is the connective tissue fascia specialist? And because it's hard because the fascia are different. The fascia in your nervous system are different than the fascia holding your organs in place. Or different in the fascia with, with each one of your organs. And this fascia itself, if you have hypermobility spectrum disorder, loose fascia, that by itself can set you up for chronic health issues. So there's this thing called the Pentad Super Syndrome. And what it is, it's 5 things that tend to live together. So if you see one, you look for the other ones. Um, hypermobility, mast cell activation syndrome, autoimmune issues, gastrointestinal problems, and POTS or dysautonomia. So if you have any one of those, you always look for the others because they can come together. And there's a lot of these associations, you know, gut immune brain, you know, we talk about a lot, adrenal thyroid pancreas. There's system organizations we've seen in science and historically that actually are associated. And one of the things that connects all of this are your fascias. So if you're not getting better, you feel like you're stuck, why aren't you getting better? It could be because you're hypermobile. Now, What's the problem with this? Well, let me explain that a little bit. What is hypermobility? Hypermobility is not just being double-jointed, not just being able to do cool tricks when you're a kid. Like, I'm not double-jointed. I can't take my thumb and, you know, touch this. I can't push my pinky up past 90 degrees. My elbows, you know, are bent this way. They don't like flop backwards. The thing about it's not just joints and not just being able to do cool tricks. It's actually everything holding everything in place. Another way to think about your fascia as well, Is this like if you're if you think of your body as a as a big computer, as a supercomputer, the semiconduct the semiconductor, the stuff that kind of sort of is an insulator but also can communicate signals is your fascia itself. The silica that goes into making chips for use for all kinds of stuff are your fascia. Think about like that. The other thing about it is that with your nervous system, like you have like your vagus nerve, you have sensory nerves, you have your. sympathetic, autonomic, you have gain, all these kinds of things in your nervous system. But 80% of the innervation in your tissues is sensory back to your brain. So most of what your nervous system is doing is sensing your body. What's going on in my gut, liver? What's the kidney doing? What's the spleen doing? Um, it's your skin with your outside environment. And if that tissues are, those tissues are loose, you'll get more activation of your nervous system, which can be interesting when you start getting into trauma and limbic kindling and vagal nerve dysfunction, all these things. If you're hypermobile, you have more activation of your nervous system from the get-go, which can be a superpower, but it can also be a kryptonite. So is hypermobility common? Is it uncommon? This is a conversation I have a lot. People have different opinions. You know, Ehlers-Danlos, which is not what I'm talking about here, is an extreme version of hypermobility. It's, you're so hypermobile, you actually just dislocate joints. Your shoulder might just pop out while you're sleeping, hip might pop out. Um, you might, you know, I remember I was riding bikes with my son one time and he was like going around the turn and his shoulder kind of popped out. He's hypermobile, popped out, went back into place. But that happens pathologically, which means it happens with pain. Um, that's a, that's a severe version. 1 in 500 people have that. But what about hypermobility in general? And this is where seeing people, being a clinician, talking with other experts, other pediatricians, other psychiatrists. It's really interesting in my mind. I go to conferences, I talk with pediatric neuropsychiatrists, pediatricians that work with autism, ADHD, PANDAS, OCD stuff. I say, hey, you know, there's an association with hypermobility and all those issues. They're like, oh my gosh, you're right. Because they see how common this double-jointed kids are, but they didn't realize there's a connection between that and the neuropsychiatric symptoms that the, um, other patients are having. And based on the research articles and literature I've looked at, maybe 1 in 20, I'm sorry, sorry, well, 20% of kids were hypermobile. Okay. So that's 1 in 5. That's pretty common. Um, when you go to college, another research article I was looking at said 12.5% of college adult or college students were hypermobile. So that's a pretty big drop. And you get in adulthood, it kind of peters out and, you know, maybe it's, you know, 5%, 3%. It gets a lot smaller. Well, what's happening is it's not that the hypermobility is healing and going away. That'd be great if it was. What happens in our bodies, and this is a really interesting phenomenon with your fascia, is from being stretchy over time, they will actually start to contract. Your fascia actually have these fibrils that you can make microscarring tissue, right? So you get these tightening, you get these cords, these bands, this tightness in your fascia. So all of a sudden you'll see someone who's hypermobile in their 50s. Oh, my back is tight. I'm not flexible at all. I can't bend over and move, but their pinkies still goes back. Their elbows still go back. Their knees still go backwards, but they lean over like, you know, they can't touch the, they can't even touch their knees hardly. You ask them when you're a kid, oh, I could do, I could turn back and I could do the scorpion and stuff. And it's a phenomenon that happens particularly in people that are hypermobile, that their fascia gets tighter as they age. As that happens, all of a sudden now you get more pain, more activation of a different part of your nervous system—the pain part of your nervous system. So hypermobility is a really interesting thing. I'm actually going to do a whole series on it, talking about it's all connected. I don't want to spend a lot of time on that here, but the point is hypermobility is super common and sets you up for certain things. You people that are hypermobile tend to bruise easier; they tend to bleed easier. If you're an athlete, you might. Train, get stronger, but you get injured. Why am I getting injured? I've had some patients actually injure themselves out of college sports because they're not eating appropriate and overtraining. You have a higher need for vitamin C if you're hypermobile because vitamin C is important for making collagen. You know, a severe example of that would be scurvy, right? Vitamin C deficiency, bleeding gums. You know, we think about that, you know, low vitamin C, but we don't realize you bruise easy, you bleed easy, you get these little skin tears. Measure vitamin C level. It might be undetectable. It's amazing how many undetectable vitamin C levels you'll see on patients. The other thing that's needed is more protein because you get these micro tears and micro injuries. Um, more protein is needed, especially collagen type protein. Maybe that's one of the reasons why collagen protein has become so popular recently, particularly in middle-aged women, because you have a whole bunch of people, maybe 20% of the population. Um, that's, well, half of the population are women, actually more than half the population. That's gained in age, 20% of them being hypermobile. All of a sudden you're uncovering the need for more protein because of loss of estrogen. It's really, all these things are really quite, quite interesting. But in general, people with hypermobility need more protein, um, specifically collagen. So maybe that's another reason why bone broth has become super popular. And trace minerals, rare earth minerals, manganese, strontium, silica, barium, just all these things that, um, beryllium, Um, um, iodine, um, chromium, um, zinc, a whole bunch of trace minerals and rare earth minerals. And there's about 96, uh, trace and rare earth minerals, most of which we don't know what they do. Um, people with connective tissue, like hypermobility, need all these. And that's where organ meat, that's where bone broth comes into play, drinking mineral water, all this kind of stuff. But all of a sudden, if you're hypermobile, um, are you meeting your nutritional status? And also, Hypermobility sets you up for dysautonomia, POTS, mast cell activation syndrome, autoimmune issues. And so all those patients that come to my clinic, I'm looking for hypermobility. Again, we'll do a whole series on this, but if you're hypermobile, there's a thing called Beighton score, B-I-G-H-T-O-N score you can do. It's actually made to be self-administered or administered by any, by any healthcare practitioners for educational purposes, but to also realize, hmm, you might be hypermobile. Again, that's for EDS. If, if an adult has a score of 4, Or greater, in my book, they're hypermobile. A kid 5 or greater, they're hypermobile. But it's really interesting how many people might have a score of 2 or 3 and they're super tight. And you'd ask them, how were you when you were 12? Oh yeah, I could do all those things. And that's where part of it, getting the history is important as well. But it's all connected. Your connective tissues connect everything. And if you are hypermobile, this could be setting up for a lot of health issues. And if you're not literally addressing the stuff that holds everything together, that might be one of the reasons why you're stuck. While you're still sick and not getting better. So food for thought. Hopefully this information is helpful. Take care. We'll talk to you soon.
