The Thinking Practitioner

Ep 170: 🎙 Hypermobile Ehlers-Danlos, Fascia, and Pain (with Tina Wang) Listener Favorite

Why do people with extra-flexible tissues often hurt more, not less? What does fascia actually look like on ultrasound in someone with hypermobility — and why did the findings surprise even the researchers? Dr. Tina Wang — a board-certified physical medicine and rehabilitation physician whose research uses ultrasound to study fascial dysfunction in hypermobile patients — joins Til and Whitney for a wide-ranging conversation about Ehlers-Danlos syndrome, the paradox of mushy tissue that won’t glide, and why the deep fascia may be where most myofascial pain actually lives.

This is one of our most listened-to episodes ever — a listener favorite we’re bringing back for those who missed it and those ready for a second listen. Dr. Wang also offers a 1-hour class on hypermobility in the A-T subscription library (get a free month with code thinking: https://a-t.tv/subscriptions/)

✨ Topics covered in this episode include:

• The hypermobility paradox: why people with EDS have tissue that feels “mushy” and spongy yet lacks fascial glide
• The diagnostic framework for hypermobile EDS — Beighton scores, systemic manifestations, body proportions, piezogenic papules, and why 30% of the population is hypermobile without pathology
• Dr. Wang’s ultrasound research: sternocleidomastoid fascia that was profoundly thicker in EDS patients than expected, and the surprising elastography findings about stiffness
• Why the deep fascia — not muscle alone — appears to be the primary source of myofascial pain in 75% of cases
• Ultrasound-guided fascial injections and the role of different tissue layers in pain
• The connection between EDS, neurodivergence, autism, and ADHD — and Dr. Wang’s case that hypermobile EDS may be neurodevelopmental
• Why some patients respond to treatment with fevers, catatonia, and autonomic dysfunction — and what that tells us about their nervous system
• Interoception, exteroception, and why people with EDS often have heightened sensory processing
• The fibroblast–nerve–immune cell crosstalk happening at the tissue level
• Why “go slow and form the connection” may be the most important clinical advice for working with this population
• Dr. Wang’s personal experience as a clinician with EDS and co-occurring autism

✨ Resources:

• Dr. Wang’s 1-hour course: https://advanced-trainings.com/product/hypermobility-for-hands-on-therapists/
• Dr. Wang’s clinical practice: https://tupelopointe.com/
• Dr. Wang’s neurofascial inflammation seminars: https://www.thebraincelledu.com/seminars

✨ Selected research:

• Wang, Tina J., and Antonio Stecco. “Fascial Thickness and Stiffness in Hypermobile Ehlers‑Danlos Syndrome.” American Journal of Medical Genetics Part C: Seminars in Medical Genetics 187, no. 4 (December 2021): 446–52. https://doi.org/10.1002/ajmg.c.31948
• Wang, Tina, Roya Vahdatinia, Sarah Humbert, and Antonio Stecco. “Myofascial Injection Using Fascial Layer-Specific Hydromanipulation Technique (FLuSH) and the Delineation of Multifactorial Myofascial Pain.” Medicina (Kaunas, Lithuania) 56, no. 12 (December 20, 2020): 717. https://doi.org/10.3390/medicina56120717

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✨ Watch the video / connect with us:
• YouTube: https://www.youtube.com/@AdvancedTrainings/podcasts
• Til Luchau – https://advanced-trainings.com | https://facebook.com/advancedtrainings | https://instagram.com/til.luchau
• Whitney Lowe – https://academyofclinicalmassage.com | https://facebook.com/WhitneyLowe | https://twitter.com/whitneylowe

📧 Email us: info@thethinkingpractitioner.com

The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies — bodywork, massage therapy, structural integration, physical therapy, osteopathy, and similar professions. It is not medical or treatment advice.