A hyperextended knee refers to a situation where the leg excessively straightens at the knee joint. The angled shape gives it the nickname “banana knees”. This can occur during movement as an injury, or it can be a naturally hyperextended knee as a result of postural adaptation created over time. In this article, we will address how common hyperextended knee exercises address symptoms, and how Functional Patterns addresses root causes.
Knee hyperextension can occur due to muscle imbalances in the legs. Specifically, it can result from tight quadriceps and weak hamstrings, or tight hamstrings and weak quadriceps. In the first case, tight quadriceps pull the knee joint into extension, while weak hamstrings are unable to counteract this force, leading to hyperextension.
Conversely, in the latter case, tight hamstrings can pull the pelvis to overly tuck under and place weight primarily on the heels, while weak quadriceps are unable to maintain stability and control, causing hyperextension.
Stretching the quadriceps is a common treatment for knee hyperextension, often performed by bending the knee backwards and pulling the ankle to the back with an arm. While many believe this is an effective treatment because it is thought to lengthen tight muscles, this is not entirely accurate. Muscles with adhesions, or knots within the fascia surrounding the muscle, may feel tight, and stretching would only lengthen the areas around the adhesion, but not the adhesion itself. Furthermore, excessive stretching can lead to hypermobility and destabilization of the joint, further disconnecting a muscle from its neighboring muscle groups.
This photo is an example of how the conventional quad stretch lengthens tissues and ligaments above and below the adhesions but does not address the adhesions themselves.
Another common exercise for knee hyperextension is the hamstring curl. This is usually performed on a hamstring curl machine or laying face-down with ankles strapped to a cable or band. The intent is to shorten the hamstring muscle in order to stretch the quadricep. While this exercise is on a better trajectory towards fixing knee hyperextension than the previous one, it is still shortsighted in many ways. Firstly, knee hyperextension is displayed when the person is standing and walking. This means that the person’s entire body is being balanced on the feet. How that person places his/her weight on the foot influences how the knee is placed. When a hamstring curl is performed, there is no connection between the leg contracting and the ground. It simply shortens the hamstring without any regard for weight distribution and other neighboring muscle groups. Second, constantly bringing the knee in its end-range knee flexion will encourage the quad to fire from that position into extension, thereby repeating knee hyperextension.
Stretching the quad does not address the adhesions that are bound in the tissue, and contracting the hamstring to bring the foot to the glutes only encourages a stronger knee hyperextension. There’s no way around it–in order to fix the problem, a holistic approach is needed.
Let’s now go into how a Functional Patterns practitioner would address knee hyperextension on a client.
A client comes in complaining of hyperextended knees. When the FP practitioner is looking at the client's posture photos, she notices the client is displaying an excessive anterior pelvic tilt, which is putting excessive pressure on the lumbar spine. The practitioner also notices that when the client is breathing, she is excessively pushing her ribcage upward, which creates a rib cage flare and a rounding of the upper back. The practitioner spends the session helping her client connect her ribcage to her pelvis, creating an even stacking of the rib cage and pelvis via intra-abdominal pressure. Then she helps her client create an efficient contraction of her upper back to hold an upright posture. A few sessions later, the client is displaying a more neutral pelvis. Because the pelvis is more neutral, the posterior (backside) is more readily engaged, and can contract evenly with the anterior (frontside) of the body, which is where the tight quadriceps are located. Now that both sides of the body are more evenly distributed in tension, the quadriceps do not overly tighten, which means the knees do not hyperextend.
A powerful exercise that the practitioner may use is the Functional Patterns step press. In this exercise, the client stands on one leg and holds onto a handlebar attached to a pulley machine. The client then takes a step forward while pressing the arm forward, engaging the feet, legs, hips, ribs, arms, and neck to propel the body forward. This exercise is particularly beneficial as it incorporates rotational movements that are similar to the gait cycle, which is a fundamental human movement. Moreover, the step press is superior to the hamstring curl as it utilizes the feet-ground connection, requiring clients to balance their weight on one foot while moving forward. This movement challenges the body's ability to maintain stability and balance, resulting in a stable knee joint, which is crucial for preventing knee hyperextension. By engaging multiple muscle groups and promoting proper alignment, the step press can effectively address knee hyperextension and improve overall functional fitness.
Results by Functional Patterns practitioner India Madjaric and her client. Relaxed posture after 12 sessions.
In conclusion, knee hyperextension is a condition that can occur due to postural adaptation or as a result of an injury. While stretching the quadriceps and performing hamstring curls are common exercises used to address symptoms of naturally hyperextended knees, they do not address the root cause of the issue. Functional Patterns practitioners take a different approach, focusing on creating an even distribution of tension throughout the body by correcting imbalances and postural misalignments. We have mentioned one approach to addressing knee hyperextension. However there are many variables to consider, which is what FP practitioners have been trained to navigate when working with a client. By doing so, they are able to solve this postural issue, while avoiding unwanted side-effects associated with traditional knee hyperextension treatment. By addressing the root cause, the practitioner is able to provide long-term relief and prevent future occurrences.
