An Interventional Pain and Sports Medicine Practice

An Interventional Pain & Sports
Medicine Practice

How We Diagnose and Treat Hypermobility Syndromes at Barr Center

Physical therapist applying supportive tape to a patient’s knee during evaluation or rehabilitation.

At Barr Center for Innovative Pain & Regenerative Therapies, we frequently see patients who have been told for years:

  • “All your imaging is normal.”
  • “You’re just flexible.”
  • “It’s anxiety.”
  • “Nothing is wrong.”

Yet they live with persistent pain, joint instability, fatigue, and recurrent injuries. Often, the missing piece is hypermobility syndrome, including hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD). This blog explains how we approach diagnosis and treatment differently.   Close-up of a hand with fingers bending dramatically backward and sideways, demonstrating extreme finger joint hypermobility Collage of photos showing joint hypermobility, including very stretchy skin, fingers bending far back, elbows and knees extending beyond normal range, wide-spreading toes, and a person bending forward with palms on the floor.

Understanding Hypermobility

Hypermobility means joints move beyond the normal range. While flexibility can be advantageous in athletes and dancers, pathologic hypermobility can cause:

  • Joint instability
  • Frequent sprains or subluxations
  • Chronic pain and muscle spasm
  • Early degeneration of discs and joints
  • Autonomic symptoms like POTS
  • Fatigue and poor recovery
  • MCAS

Over time, unstable joints overload surrounding tissues, including tendons, ligaments, fascia, and nerves. The problem is not too much flexibility. The problem is insufficient stability and poor connective tissue integrity.

How We Diagnose Hypermobility Syndromes

Diagnosis requires listening carefully and looking beyond imaging.

Clinical History

We assess:

  • Recurrent sprains or joint “giving out”
  • Childhood flexibility or being “double-jointed”
  • Chronic tendonitis
  • Family history of hypermobility
  • Easy bruising or slow healing
  • Dysautonomia symptoms such as lightheadedness or palpitations
  • GI or mast cell issues

Many patients have seen multiple specialists before this pattern is recognized.

Physical Examination

We perform:

  • Beighton score assessment
  • Ligament stress testing
  • Functional stability assessment
  • Core and scapular stability testing
  • Gait and movement analysis
  • Assessment of breathing patterns and core muscle function
  • Evaluation for embodied PTSD or reverse breathing patterns when relevant

The Beighton score is helpful, but it is not enough by itself. Some patients lose flexibility with age yet remain unstable.

Musculoskeletal Ultrasound and Bending X-Rays of the Back and Neck

We frequently use diagnostic ultrasound to evaluate:

  • Ligament laxity
  • Tendon degeneration
  • Micro-tears
  • Effusions
  • Joint capsule thinning

Ultrasound allows dynamic assessment, which is something MRI often misses. Motion X-rays of the spine help assess underlying ligament laxity and micro-instability that can contribute to chronic myofascial pain.

Root Cause Evaluation

Hypermobility is rarely isolated. We assess:

  • Inflammation patterns
  • Hormonal influences, since estrogen can affect ligament laxity
  • Nutrient status, including vitamin C, copper, zinc, methylated B vitamins, and collagen cofactors
  • Mitochondrial health
  • Autonomic nervous system balance
  • Other connective tissue disorders when appropriate

This whole-body approach is critical.

How We Treat Hypermobility at Barr Center

There is no one-injection solution. Treatment requires stabilization, regeneration, and nervous system retraining.

Targeted Regenerative Injections

These treatments are not covered by health insurance. We may use:

  • PRP (platelet-rich plasma)
  • Orthobiologics
  • Prolotherapy
  • Precision-guided ligament injections

These treatments aim to:

  • Improve collagen signaling
  • Strengthen ligament integrity
  • Reduce micro-instability

The goal is not just pain reduction. It is structural stability restoration.

Stability-Focused Rehabilitation

Traditional physical therapy may overstretch hypermobile patients. We emphasize:

  • Closed-chain strengthening
  • Muscle re-education
  • PRI and postural re-education
  • Proprioceptive retraining
  • Scapular stabilization
  • Core activation
  • Low-load, high-control movement

The objective is to teach the nervous system to better protect the joints.

Autonomic Nervous System Regulation

Many hypermobile patients experience dysautonomia. We incorporate:

  • Breathing retraining
  • HRV optimization
  • Gradual conditioning protocols
  • Stress modulation techniques

Stability improves when the nervous system is better regulated.

Connective Tissue Support

We optimize:

  • Protein intake
  • Collagen support
  • Micronutrients involved in collagen synthesis
  • Anti-inflammatory strategies such as low-dose naltrexone (LDN)
  • Peptides that may support healing, improve muscle development, and reduce inflammation

Tissue quality matters.

Hormonal Considerations

Ligament laxity may fluctuate with hormonal shifts. We evaluate:

  • Perimenopause
  • Estrogen dominance
  • Cycle-related symptom patterns

Stability can change dramatically across life stages.

Why Early Diagnosis Matters

Undiagnosed hypermobility can lead to:

  • Early osteoarthritis
  • Recurrent surgeries
  • Chronic opioid use
  • Central sensitization
  • Loss of athletic identity

Proper identification can change the trajectory.

Our Philosophy

At Barr Center, we view hypermobility syndromes not as a limitation, but as a stability challenge that can often be improved with precision care. We combine:

  • Advanced diagnostics
  • Regenerative therapies and peptides
  • Neuromuscular retraining
  • Functional medicine insights

The result is a personalized stabilization strategy.

Common Questions

Is hypermobility curable?

No, but symptoms can often improve significantly with structured stabilization and regenerative support.

Is surgery helpful?

Surgery may fail in hypermobile patients if the underlying instability is not addressed.

Can regenerative medicine help?

In properly selected patients, yes, particularly for ligamentous laxity and chronic tendon overload. If you or someone you love has chronic joint instability, unexplained musculoskeletal pain, or has been told “everything looks normal,” we invite you to explore a deeper evaluation. Stability is strength, and strength can be rebuilt.

INNOVATIVE PAIN & REGENERATIVE THERAPIES
INNOVATIVE PAIN & REGENERATIVE THERAPIES
Expert care for spine, joint, nerve, sports injuries, and chronic pain.

Find Relief From the Conditions Holding You Back

Dr. Lisa Barr is a leading pain management physician in Virginia Beach with over 35 years of experience diagnosing and treating spine, joint, nerve, and musculoskeletal pain. As a Board Certified PM&R specialist, she focuses on whole-body, non-surgical solutions that uncover the true root cause of pain. She is also the international bestselling author of Outsmart Your Pain and one of the region’s most experienced experts in regenerative medicine, PRP, and advanced biologic therapies.

Spinal Conditions
  • Neck Pain
  • Mid Back Pain
  • Low Back Pain
  • Pelvic Pain
  • SacroiIiac Joint Pain
  • Hypermobility
  • Myofascial Pain
    • Trigger Point
      injections
    • What is Sarapin?
  • Fibromyalgia
  • EOS/Hypermobility
    Syndrome
  • Autoimmunity
    • LDN (Low dose
      Natrexone)
    • Testing
  • Prolotherapy
  • Neuroprolotherapy
  • Neural Therapy
  • Cold Laser
  • Entrapment Neuropathy
    • Carpal Tunnel Syndrome
    • Radial & Ulnar Nerve Entrapment
    • Lower Extremity Entrapment
    • Occipital Neuritis
  • Scar Tissue
  • Peripheral Neuropathy
    • Fatty Acid Testing & Specialized Therapies
    • Cold Laser
    • Nutritional Support
  • Neck Pain
  • Mid Back Pain
  • Low Back Pain
  • Pelvic Pain
  • SacroiIiac Joint Pain
  • Hypermobility
  • Inner Arsenal
  • Vagus Nerve Support
  • Power over Pain Mindset
  • Breathing Practices
Resources

Chronic Pain Management Articles

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OVERVIEW

The Barr Center for Innovative Pain and Regenerative Therapies, led by Dr. Lisa Barr, is dedicated to helping people in pain. With over forty years of experience, Dr. Barr and her staff offer a range of evaluation and treatment options, including osteopathic assessment, trigger point injections, prolotherapy, and regenerative therapies. They prioritize a caring atmosphere and involve patients in their own care, ensuring they understand the recommended treatments. If necessary, they collaborate with other professionals to provide a comprehensive approach. Dr. Barr’s expertise has been recognized with the Top Doc award for thirty years.

FAQ

Pain Management and Treatment

The Barr Center for Innovative Pain & Regenerative Therapies is located at:

933 First Colonial Road, Suite 200
Virginia Beach, VA 23454

Phone: 757-578-2260
Email: info@BarrCenter.com

Monday–Thursday: 8:30 am–5:00 pm

Friday: Closed (note: physician on call)

Not always. Some insurance plans—especially HMOs—require a referral before seeing a specialist. To confirm what your specific plan requires, call your insurance provider or contact our office at 757-578-2260.

We accept most major insurance plans (except Medicaid). If your plan requires a referral or pre-authorization to see a specialist, you will need one for your first visit. After your initial consultation, our office obtains any future pre-authorizations, sometimes with assistance from your referring provider. Visit our Patient Resources page for details.

Yes. We offer telemedicine visits for certain appointment types, including follow-up visits and treatment discussions. Some procedures require in-office evaluation, and our team will help determine whether a virtual visit is appropriate.

Conditions and Treatment Questions

Led by pain management specialist Lisa Barr, M.D., the Barr Center provides comprehensive musculoskeletal and pain treatments including:

• Acupuncture
• Mind-body medicine and lifestyle optimization
• Interventional spinal procedures
• Sports medicine
• Physical therapy
• Regenerative medicine (PRP, prolotherapy)

We treat a wide range of pain and musculoskeletal conditions, including:

• Neck, shoulder, hip, back, and knee pain
• Sports injuries and repetitive strain conditions
• Posture, sleep, and movement-related pain
• Car accident injuries, including whiplash

Our approach provides proven alternatives to surgery and long-term medications through targeted injections, hands-on physical therapy, acupuncture, lifestyle guidance, and regenerative medicine.

If your pain is persistent, recurring, or limiting daily activities, it is time for an evaluation. We assess how your joints move, how your muscles function, and whether lifestyle factors are contributing to your symptoms.

We offer a comprehensive, root-cause approach to pain in a boutique practice setting.

Our team is highly specialized, and we combine interventional pain medicine, regenerative therapies, physical therapy, and whole-person care—all under one roof.

Our team includes board-certified physicians, licensed physical therapists, regenerative medicine specialists, acupuncture providers, and experienced clinical support staff with focused expertise in musculoskeletal medicine and pain management.

Preparing for your First Appointment

To help make your first visit efficient, please bring:

• Photo ID
• Insurance card
• Referral (if required by your insurance)
• Completed new-patient paperwork
• Co-pay, if applicable

If you have MRIs, CT scans, X-rays, or lab results, please have your referring provider fax them to our office. You may also download our Medical Records Request Form to expedite the process.

Experiencing Pain? Reach Out For Medication-Free Treatment