Ehlers-Danlos, Hypermobility, and Fear-Free Movement with Dr. Marcia Perretto

For millions of people, being "really flexible" was never just a party trick — it was the first sign of something far more complex. Ehlers-Danlos syndrome and hypermobility spectrum disorders affect not just joints, but the cardiovascular system, the nervous system, digestion, and more — often going undiagnosed for years. Dr. Brent Anderson is joined by Dr. Marcia Perretto, DPT, PT, COMT, Cert. DN, INHC, founder and CEO of Actify Physiotherapy and Wellness in Boca Raton, Florida, and a nationally recognized expert in hypermobility-informed care. Dr. Perretto — who lives with hypermobile EDS herself — breaks down the difference between hypermobility and a clinical diagnosis, explains how collagen dysfunction affects the whole body, and offers a clear framework for building toward safe, successful movement. Together, she and Dr. Brent explore why fear can amplify pain, how the nervous system gets caught in a downward spiral, and what it actually takes to interrupt that cycle and get people moving again — without making things worse. IN THIS EPISODE: What Ehlers-Danlos syndrome is and how the 13 subtypes fall under the broader connective tissue umbrella Why hypermobility and hEDS are not the same thing — and how to tell the difference How collagen dysfunction affects the heart, gut, skin, nervous system, and more The role of fear and the amygdala in amplifying chronic pain for hypermobile patients Why the nervous system needs "predictable movement" to begin rewiring toward safety How to stage a graded return to movement — from proprioceptive awareness to strength Why consistent small successes beat occasional big efforts for this population RESOURCES MENTIONED: Dr. Marcia Perretto — Actify Physiotherapy and Wellness: actifypt.com Unlocking the Secrets to the Hypermobility Puzzle — book by Dr. Marcia Perretto The Beighton Hypermobility Score — referenced as a standard screening tool 2017 International Classification of hEDS — the updated criteria discussed in the episode Panjabi and Comerford's neutral zone concept — referenced in the movement staging discussion Paul Hodges and Carolyn Richardson (University of Queensland) — foundational research on spine stabilization referenced by Dr. Brent SOURCES AND CITATIONS: Malfait F, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32(5):413-418. Panjabi MM. The stabilizing system of the spine. Part I: Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5(4):383-389. Comerford MJ, Mottram SL. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Man Ther. 2001;6(1):3-14. Hodges PW, Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997;114(2):362-370. ABOUT LIVE ALIGNED WITH DR. BRENT Live Aligned explores the relationship between pathology and movement — helping patients, practitioners, and everyday people understand what's happening in their bodies and how to move forward with confidence.