Exercises for Hyperextended Knees

What Are Hyperextended Knees?

Hyperextended Knees is where the knee joints are bent further than the normal range whilst in the standing position.

It is also referred to as Genu Recurvatum or having “Banana knees”.

Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. For more information: Medical disclaimer.

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What are the Causes?

a) Laxity/Hypermobility

An excessive amount of flexibility in the structures of the knee can predispose the knee joint to hyperextend.

b) Poor control of muscles

Over extension of the knee can result from an imbalance in the muscles that stabilize the knee.

c) Weak and/or Overstretched muscles at the back of the knee

The following muscles are responsible for minimizing the amount of end range extension available in the knee.

• Lower Hamstrings
• Upper Gastrocnemius
• Popliteus

d) Certain postures

• Anterior Pelvic Tilt
• Sway Back Posture
• Rotated Pelvis

e) Poor Ankle Dorsiflexion

Poor ankle mobility can force the knees to compensate.

f) Structural

Due to the shape of the bones and joint, some knees are genetically in the hyperextended position.

Is it bad to have Hyperextended knees?

If you have naturally hyperextended knees, your body weight is resting on the passive structures in the knee joint.

This can to lead to injuries to certain structures:

a) BACK of the knee

There is overstretching of the following knee structures:

b) FRONT of the knee

There is compression of the following knee structures:

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Hyperextended knee test

Not sure if your knees are hyperextended? Try this quick test.

Instructions:

• Take a photo of your side profile whilst standing.
• Draw a line between the ankle and hip joints.
• Locate the center of the knee joint.
• What is the position of the knee joint relative to this line?

How to tell if you have Hyperextend Knees: The knee will be positioned behind the line between the ankle and hip.

Note: It is completely normal to have the ability to hyperextend the knee to ~5 degrees. Issues may arise if you overly lock your knee in this position whilst standing.

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Exercises to fix a Hyperextended knee

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1. Releases

Releasing the tight and/or overactive muscles that encourage the overextension of the knee is important.

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a) Quadriceps

Instructions:

• Lie facing downwards on the floor.
• Position the front of the thigh on top of a foam roller.
• Apply as much of your body weight on the foam roller as you can comfortably tolerate.
• Make sure to cover the entire thigh.
• Continue for 2 minutes.

b) Lower calf muscles

Instructions:

• Sit on the floor with your legs straight in front of you.
• Position the back of the lower calf muscle on top of a foam roller.
• Place your other leg on top and apply a downward pressure.
• Keep your foot completely relaxed.
• Rock your leg from side to side over the foam roller.
• Make sure to cover the entire lower portion of the calf muscle.
• Continue for 2 minutes.

Note: Be careful not to over extend the knee in this position.

c) Achilles tendon release

Instructions:

• Sit down on a chair.
• Place your foot onto the other knee.
• Using your thumb and pointer finger, firmly grip the top of the Achilles tendon.
• Whilst maintaining this pressure, slide your grip down towards towards the heel.
• Repeat 10 times.

2. Stretches for Hyperextended knees

Tightness and/or overactivity of the following muscles need to be stretched to minimize overextension of the knee.

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a) Quadriceps stretch

Instructions:

• Stand up.
• Hold onto something for balance.
• Bend your knee backwards.
• Hold onto your ankle and pull your foot towards your buttock.
• Keep your knees together and aligned with one another.
• Engage your buttocks and push your hips forwards.
• Aim to feel a stretch at the front of the thigh.
• Hold for 30 seconds.

b) Soleus stretch

Instructions:

• Assume the lunge position with back leg bent. (see above)
• Sink your body weight onto your back leg.
• Think about getting your shin bone as close to the floor as possible.
  • Do not lift your heel!
• Aim to feel a stretch in the back of your calf.
• Hold for 30 seconds.

3. activation Exercises

– Popliteus

The Popliteus is a muscle that is located behind the knee. Strengthening this muscle will help reduce the unlocking of the knee into hyperextension.

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a) Tibial internal rotation

Instructions:

• Sit down on a chair with your hip/knees bent at 90 degrees.
• Hold your knee straight with your hands.
• Without moving the knee, pivot your lower leg inwards.
  • (Internal rotation of the tibia bone)
• Make sure your foot does not lift off the ground.
• Repeat 30 times.

– Hamstrings

The Hamstrings are the main muscles which will resist the hyperextension of the knees. It is important that you know how to activate them!

Note: If you are not used to engaging your Hamstrings, it is possible that you may get a cramp with some of these exercises. Be careful!

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a) Standing leg curl

Instructions:

• Whilst standing, hold onto something for support.
• Keep your knees together.
• Lift your foot and bend the knee as firmly as you can.
• Aim to feel a firm contraction in the Hamstring.
• Hold this contraction for 30 seconds.

b) Heel drag

Instructions:

• Sit down on a chair.
• Place your heel on the ground in front of you.
• Dig your heels into the floor and drag your heel backwards as hard as you comfortably can.
• Aim to feel the activation of the Hamstring.
• Repeat 30 times.

c) Heel drive with leg extended

Instructions:

• Sit down on a chair.
• Place your foot onto a support that is the same height as your chair.
• Keep your leg slightly bent.
• Dig your heels into the support as hard as you comfortably can.
• Aim to feel the activation of the Hamstring,
• Hold this contraction for 30 seconds.

4. Taping to limit hyperextended knee

Taping the knee will help limit the amount of Hyperextension in the knee.

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You will need Kinesio tape (KT) and some help from a friend to apply the tape for you.

Instructions:

• Lie down on your stomach.
• Place a pillow underneath your ankles.
• Apply 2x tape in a cross pattern to the back of the knee.
• Use 30% stretch.

Note: Irritation may occur if the skin behind your knee is sensitive to the adhesive in the tape.

5. Knowing your Knee’s limit

It is essential to know and feel where the ideal position of your knee is.

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Here’s how to find it:

• Start in the standing position with both knees slightly bent.
• Slowly straighten your knees.
• Gain a sense of the exact moment when the knees are just about to transition into the hyperextended position.
• Remember this position! This is the knee position that you will need to maintain in the following exercises.

6. Anti-Hyperextension Exercises

These exercises will help balance out the muscular control around the knee joint.

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a) Controlled leg drop

Instructions:

• Place weights around your ankle.
• Lie on your stomach.
• Place a tolled up towel underneath the knee.
• Slowly lower your leg down without hyperextending the knee.
• Repeat 20 times.

b) Heel drive with end range extension (Sitting)

Instructions:

• Sit down on a chair.
• Place your foot on a chair that is approximately the same height as the chair
• Drive your heel down into the chair to engage your hamstring muscles.
• Whilst keeping the hamstrings activated, slowly bring your leg into end-range extension.
• Do not hyperextend the knee.
• Repeat 20 times.

c) Heel drive with end range extension (Standing)

Instructions:

• Whilst standing, place your foot in front of you.
• Keep your leg straight.
• Lean forwards.
• Drive your heel down into the ground to engage your hamstring muscles.
• Whilst keeping the hamstrings activated, slowly bring your knee into end-range extension.
• Do not hyperextend the knee.
• Repeat 20 times.

d) Heel Raises

Instructions:

• Stand on one leg on the edge of a step.
• You can hold onto something for balance.
• Keep your leg as straight as possible without over extending the knee.
• Lean slightly forwards.
• Move onto your toes.
• Slowly drop your heel downwards.
• Repeat 20 times.

e) Alternating leg lift

Instructions:

• Sit on the floor with your legs straight in front of you.
• Place your hands on the floor behind you to support your torso.
• Drive your heels into the floor through the exercise.
• Lift your hips upwards.
• Alternate lifting your foot off the floor.
• Do not allow the knees to hyperextend.
• Repeat 20 times.

f) End range extension in single leg stance

Instructions:

• Stand on one leg.
• Whilst keeping the hamstring muscle activated, slowly straighten the knee as much as possible without hyperextending.
• Repeat 20 times.

g) End range extension with resistance band

Instructions:

• Wrap a resistance band around the front of your knee.
• Tie the other end to a stationary object that is behind you.
• Step away from the anchor point as to increase tension on the resistance band.
• Stand on one leg.
• Engage the hamstring muscle.
• Slowly straighten the knee without hyper extending.
• Repeat 20 times.

h) Single leg hinge

Instructions:

• Stand on one leg.
• Engage your hamstring muscle.
• Straighten your leg as much as possible without overextending the knee.
• Slowly hinge forwards.
• Repeat 20 times.

7. Check your ankle

If the ankle is locked in a degree of plantarflexion (pointed foot), the body is going to have a difficult time getting the body on top of the base of support. This can force the knee to compensate by hyperextending.

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Does your ankle have the ability to assume the neutral position?

If you have tight ankles: Here is a blog post which goes through a complete list of exercises to help improve your ankle mobility.

You can start with these:

a) Traction

Instructions:

• (To perform this exercise, you will need assistance. So – go grab a friend!)
• Lie on the floor.
• Instruct your friendly helper to firmly grasp your ankle below the bony bits on the side. (see above)
• Relax your leg as your assistant pulls your foot away from you.
• Hold for 30 seconds.

b) Dorsiflexion with band

Instructions:

• Attach a resistance band to something behind you. (Make sure it doesn’t move!)
• Lace the band around your ankle.
  • Make sure the band is below the bumps on side of the ankle.
• Move away from the anchor point as to increase tension in the band.
• Assume the lunge position with your ankle on a bench. (see above)
• Lunge forward.
• Do not allow for your foot arch to collapse.
• Repeat 30 times.

c) Ankle Dorsiflexion Strengthening

Instructions:

• Whilst sitting, slightly slide your foot underneath you whilst keeping your foot flat.
• Lift the front part of your foot off the floor.
• Aim to feel the activation of the muscles in the front of your shin.
• Hold for 10 seconds.
• Repeat 10 times.

8. Address posture

The following postures tend to encourage the knees to hyperextend in the standing position.

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a) Anterior Pelvic Tilt

This is where the pelvis tilts forwards.

This can angle the femur bone backwards and result in the over extension of the knees.

(For more information: Exercises for Anterior Pelvic Tilt.)

b) Sway Back Posture

This is where the pelvis is pushed forwards relative to the feet.

With this posture, it is common to see the thigh muscles over contracted which can lead to hyperextended knees.

(For more information: Exercises for Sway Back Posture.)

c) Rotated Pelvis

The twisting of the pelvis towards one side can result in having only one knee that is hyperextended.

(For more information: Exercises for Rotated Pelvis.)

9. Quick Tips

• When standing, keep your knees soft and relaxed.
• Do not lock your knees straight.
• Stand with your hips directly on top of your ankles.
• If you tend to sleep with hyperextended knees, place a pillow underneath your knees whilst sleeping on your back.

10. Conclusion

Having knees that bend further than they normally should does not necessarily mean that you will have issues. However – it does potentially place more strain on the structures of the knee.

If you are having issues related the Hyperextension of the knees, this can be effectively addressed with the exercises mentioned on this blog post.

I encourage you to persist with these exercises for at least 12 weeks.

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