It has always been my opinion that Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder were incorrectly classified as collagen disorders based on genetic polymorphisms relating to the collagen protein. My belief is that these conditions (with some exceptions) are neurological in origin, particularly the mechanoreceptive neurons in ligaments, tendons, and fascia. I believe that these nerve cells develop an inability to sense, essentially losing function. This would lead to a change in the perception of where one's limb or spine is in space at a non-conscious level and would mean the brain and spinal cord couldn't regulate tone. Instead, it would be too late to restrict motion in joints that would keep the alignment of said joints. This is a normal reciprocal co-contraction and stretch reflex mechanism. Without this, joints can sublux or dislocate. As we already know, all people are generally hypermobile under general anaesthesia, so it would make sense that hypermobility syndromes mimic a milder form of this, at least in the respective sensory neurons. This would be on top of the fact that nociceptors (also known as pain receptors) would be more active as they are sensing the increase in motion or are damaged too, and therefore are more sensitive, which is not an unusual response to such changes.
In a 2023 paper, Colman et al. found that EDS patients have higher thresholds to fire for mechanoreceptors (meaning they have lost sensitivity) and heat thermal sensory neurons, yet lowered thresholds for pain and cold receptors. These are all indications that small fibre neurons have been damaged. These neurons are particularly sensitive to chemical neurotoxicity, far more than large fibres like motor neurons, but they change the behaviour of motor neurons towards aberrant, confused activity.
It's time we start looking at this condition differently, as hormones, electrolytes, hydration and many other factors play into symptoms. I propose a neurological approach with a focus on neurotoxicity as an underlying causative factor, either in utero, during childhood or teenage years.
Reference
Colman M, Syx D, de Wandele I, Rombaut L, Wilie D, Malfait Z, Meeus M, Malfait AM, Van Oosterwijck J, Malfait F. Sensory profiling in classical Ehlers-Danlos syndrome: a case-control study revealing pain characteristics, somatosensory changes, and impaired pain modulation. medRxiv [Preprint]. 2023 Feb 26:2023.02.24.23286404. doi: 10.1101/2023.02.24.23286404. Update in: J Pain. 2023 Jun 26;: PMID: 36865307; PMCID: PMC9980260.