Sixty-four patients with hypermobility spectrum disorder (HSD) and chronic shoulder complaints were randomized to receive either high-load strengthening shoulder exercises (HEAVY, n=34) or low-load exercises (LIGHT, n=30) over a 16-week period. The primary outcome of interest was the trajectory of shoulder pain measured weekly. Secondary outcomes included exercise-induced pain (change in pain pre- to post-exercise), pain medication use, and adverse symptom flare-ups. Outcomes were assessed weekly over the 16-week period. Overall, the results of the study revealed that both groups experienced a reduction in shoulder pain over time, with no statistically significant difference in pain trajectories or exercise-induced pain between groups. These findings suggest that high-load exercises do not cause greater pain and may be a safe option in this population when properly monitored.