Fatigue is associated with muscle weakness in Ehlers-Danlos syndrome: an explorative study



Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterised by joint hypermobility, skin hyperextensibility and tissue fragility. It has recently been shown that muscle weakness occurs frequently in EDS, and that fatigue is a common and clinically important symptom. The aim of this study was to investigate the relationship between fatigue severity and subjective and objective measures of muscle weakness. Furthermore, the predictive value of muscle weakness for fatigue severity was determined, together with that of pain and physical activity.


An explorative, cross-sectional, observational study.

Setting and participants

Thirty EDS patients, recruited from the Dutch patient association, were investigated at the neuromuscular outpatient department of a tertiary referral centre in The Netherlands.

Main outcome measures

Muscle strength measured with manual muscle strength testing and hand-held dynamometry. Self-reported muscle weakness, pain, physical activity levels and fatigue were assessed with standardised questionnaires.


Fatigue severity in EDS was significantly correlated with measured and self-reported muscle weakness (r=−0.408 for manual muscle strength, r=0.461 for hand-held dynamometry and r=0.603 for self-reported muscle weakness). Both muscle weakness and pain severity were significant predictors of fatigue severity in a multiple regression analysis.


The results suggest a positive and direct relationship between fatigue severity and muscle weakness in EDS. Future research should focus on the relationship between fatigue, muscle weakness and objectively measured physical activity, preferably in a larger cohort of EDS patients.


Fatigue is associated with muscle weakness in Ehlers-Danlos syndrome: an explorative study
N.C. Voermans, H. Knoop, G. Bleijenberg, B.G. van Engelen
Physiotherapy 1 June 2011 (volume 97 issue 2 Pages 170-174 DOI: 10.1016/j.physio.2010.06.001)