Knee Hyperextension: Its All In Your Mind!

Hyperextension of the knees happens because some people have loose ligaments and tendons around the knee joint.

Often these people have looseness globally. They also may have pelvic misalignment like anterior pelvic tilt, posterior pelvic tilt or hyperextension of the the hip joint (or sway back). So how can you help someone correct something that is basically a structural, genetic issue? Mind control.

A person with hyperextension of the knees needs to be conscious of how they stand and walk. They need to retrain what "straight" feels like and learn to not go to their "bony end-point". They don't get the pleasure of standing with a "locked out" knee. When the knee is locked it is very stable ligament-wise and it is easy to stand with little to no muscles needed. Keeping your knees "soft" takes some muscular work, including core work, and its hard to remember. 

I have been surprised by clients lack of awareness of their knee hyperextension. Once you bring attention to this, clients may experience improvement in knee pain immediately. But they would never have thought to stop hyperextending. Although knee pain is not necessarily a side effect of hyperextension in the short run, in the long run hyperextension of the knee will damage the joint. Hyperextension can also cause plantarfasciitis. Why? Read on.

What happens when the knees hyperextend?

1. Quadriceps Hypertonic: The quadricep group extends the knee, so it makes sense that when the knee is hyperextended  the quads would be hypertonic.

2. Soleus Hypertonic: Because the ankle is in relative plantar flexion when the knee is hyperextended, the soleus becomes chronically shortened. The gastrocnemius, which is the other plantar flexor, is not shortened because it also crosses the knee and is lengthened over that joint, basically canceling out the shortness over the ankle. But the soleus is a one joint muscle, so it will become chronically shortened when the knees hyperextend. And when the soleus is chronically shortened, it can cause plantarfasciitis because the achilles tendon--which is shared by the soleus and gastrocnemius-- becomes shortened, it pulls on the fascia of the foot and creates heel pain, i.e. plantarfasciitis.

*Interesting fact: people faint when standing in knee hyperextension because the shortened soleus compresses the soleal vein and stops venus return to the heart.

*Second Interesting Fact: The soleus is sometimes called "the second heart" because it is responsible for pumping the blood back up to the heart by contracting while walking. That is why walking is so important for circulation and overall heatlh!

3. Hamstrings long. When the knee is in a hyperextended position the hamstring is in a relative lengthened position.

Strategies for Correcting Hyperextension of the Knees:

Mental Training

As I discussed above,  awareness needs to be brought to standing and walking with a little "sponginess in the knees."

Physical Training

-Always correct pelvic misalignment first. Anterior Pelvic Tilt, Posterior Pelvic Tilt, and Hyperextension of the Hip Joint all can be a cause (or result) of hyperextension of the knee joint.

-Toe raises with soft knees. Have client hold onto a bar or a wall for balance and have them soften their knees, bringing the tibia forward over the ankle joint. Do 10 toe raises, not allowing the head to go up and down, but rather the knees to go forward as toes rise up. Then try single leg 10x on each side. After this exercise, have the client walk around. It brings a great awareness to how the lower limb should be aligned over the ankle.

-When doing Footwork on the Reformer have client stop before they are at their "bony end point." Have them stay in their muscles and not go into full lock out. Putting a squishy ball between the knees can help feel the muscles at end range. Have client squeeze ball while extending knee to feel the muscles stay engaged.

-Hamstrings on the Reformer. Lying prone on Long Box.

-Standing Ball squeeze. With foot pointed, holding onto barre or wall for balance. Strengthens Hamstrings and plantar flexors.

-Bridging with neutral pelvis. Cueing client to send knees forward over ankle joint and pull heels toward the bottom at the top of the bridge. Strengthens Hamstrings.