Why do my knees hyperextend and will stretching help?

Introduction

Banana knees, not the most flattering term for a body dysfunction but it does give a striking visual. Hyperextended knees is when the knee joint bends too far backwards resulting in legs that appear to bow backwards, hence the term banana knees.

In this article we will look at the chronic condition Genu Recurvatum Syndrome  (naturally hyperextended knees) where the knee naturally rests back into hyperextension whenever the leg is straight. A persistent condition that is usually associated with ligament laxity or various medical conditions, chronically hyper extended knees can result in symptoms such as:

• Front Knee pain
• Inner knee pain
• Outer knee pain
• Pain behind the knee
• Knee pain walking on stairs
• Swollen Knees

Why do knees hyperextend?

As mentioned prior chronically hyperextended knees are generally caused by issues such as ligament laxity and connective tissue disorders, genetics will also play a role. 

In our view it is too reductionistic to say that these directly cause this issue, just as it is also too narrow a view to say that certain weak or tight muscles are a cause, these are partially correct but they overlook the system at large. In reality the causal factors vary greatly, it could be tight quads driving the knees into hyperextension and the pelvis into an anterior pelvic tilt, or potentially tight upper hamstrings and tight lower quads driving the knees back and the hips forward, perhaps the calves are facilitating a backward shift of the knees, a pronated ankle could be destabilizing the leg and prompting the knee to shift inwards and then into hyperextension. The list goes on. As such hyperextended knee treatment and exercises lack the multi varied approach needed to address the issue. Rather than zoom in and isolate we have to zoom out and look at the entire system through the lens of integrated movement. 

The Gluteus maximus

One muscle that has an enormous influence on our posture is the Gluteus Maximus. This muscle was one of the key factors in our standing upright and walking and running through a bipedal motion. In 100% of clients I have seen with hyperextended knees the glute muscles are effectively dormant, they will stand with forward shifted hips and knees bent backwards. In this position the glutes are not supporting the upper body and the client is essentially resting on their knees, hips and lumbar spine. When we rely on our joints for stability instead of our collective tissues we open up the door for pain and degeneration. When training new clients that present with knee hyperextension one of  the first things we teach them is to properly engage their glutes, not just engage the glutes in isolation but in the context of standing, walking and running. When the gluteus maximus is properly functioning to extend the hips then it is virtually impossible to bend the knees too far back.

The Superficial backline (SBL) and Superficial Frontline (SFL)

It is important to remember that the map is not the territory, however maps can provide some useful insights into the territory and give us a broader view. An example of a more accurate map is Anatomy Trains as mentioned earlier. When we examine these two ‘lines’ we can see a direct relationship between the front and the back of the body. When we zoom in we see that the quads are direct antagonists of the hamstrings, but, when we zoom out we see that the SBL is a direct antagonist of the SFL, so as an entire system of muscles and fascia contract so too does an entire system of muscles and fascia lengthen, or stretch. This happens all over the body throughout movement and highlights the importance of training the body through whole body movements, not isolated stretches and exercises.

Pictures by Anatomy Trains - Thomas Myers

The human body is effectively a collection of bones, joints, muscles, fascia, ligaments and tendons. None of these things operate in a vacuum, they all work together. Makes perfect sense, right? It would seem so, but having seen many clients come to us after having been on the carousel of various modalities and training approaches it would seem one obvious variable is missing in the treatment of hyper extended knees, or joint instability in general. What variable is this? Gait.

Before we take a dive into Gait and its importance in addressing our physical health (in this case hyperextended knees) let’s have a look at some approaches that exist currently and why they may fall short in dealing with this particular dysfunction. 

Stretching

Typically a program of stretching “tight” muscles and strengthening “loose” and weak muscles is prescribed for hyperextended knees. This thought process is not entirely wrong but it does fail to take into account what may be causing the issue. Typically when we stretch we are aiming to somewhat release the feeling of tightness we feel in our muscles. The problem with this approach is that stretching doesn’t really affect the adhesions and calcification built up in the tissues that are contributing to the tightness and it doesn’t take into account that a functional stretch is something that must happen as a result of a mechanical driver, or in less technical terms a functional movement such as walking, running and throwing. Another factor to consider is that often when we feel tightness it is because a muscle is already in a lengthened state and in actuality that muscle and surrounding tissue needs shortening. As an example, in the case of hyperextended knees the lower hamstrings are already in a lengthened state, along with the upper calves, so hamstring stretches (as they are generally performed) will actually just exacerbate the issue. 

Stretching in isolation as shown in this picture will only serve to disconnect our muscles from the movements that they are designed to perform. Stretching needs to account for tension across the whole body, not just one muscle group.

In the case of sprinting many muscles are stretching and contracting simultaneously all over the body, this is what we would deem to be functional stretching as it is happening as a result of movement, as opposed to standing or sitting still and just stretching one muscle. Our bodies either adapt or maladapt and when we perform routine isolated stretches we effectively “shut off” our muscles from working as part of an integrated system.

Isolated strengthening exercises

Along with stretching for the treatment of hyper extended knees another focus is to strengthen weak muscles such as the quadriceps. Exercises such as the Bulgarian split squat are supposed to help build strength in the quads and in turn stabilize the knees. While this may have some relevance and it will build strength, what it ignores is the fact that the quads are part of the whole body and have functions rooted in gait. It’s as if we have dissected the body in order to study it and then forgot to put it back together in order to train it. The quadriceps are part of a chain of muscles called the “superficial frontline” (As mentioned before) and therefore do not affect the knee joint in isolation, rather the entire chain of muscles affects it. Simply just training the quads in isolation ignores the role they play in walking and running, and as a result we will be effectively kicking the can down the road.

The knee hyperextension brace

A passive support that limits the range of motion in the knee, not allowing it to hyperextend past 0 degrees. In some cases of severe weakness as seen in multiple sclerosis it may be valid but even so we have seen amazing results at Functional Patterns with people that have MS. In the case of acute injury again the brace may be useful until inflammation settles and weight bearing can be achieved. The problem, however, with the knee brace as a long term passive support is that it effectively takes away the body's need to actually support that structure, thus further weakening and destabilizing the knee joint.

So, how do we reverse hyperextended knees?

Earlier I mentioned a major variable in addressing this issue, Gait (walking and running). At Functional Patterns this is what we prioritize most in our training. As humans adapted to stand, walk, run and throw throughout our evolutionary path it makes sense that we need to look at the dysfunctions of the body through this lens and then correct them through the same lens. Exercises designed to mimic our bipedal gait pattern, build the collective muscle and fascial connections of this movement and then optimizing those connections are what produces the amazing results we have seen worldwide from people utilizing our system. Our training approach looks at the entire body as the cause, not just individual muscles and this allows us to address knee hyperextension with a higher degree of accuracy and efficacy.

Results by Jon Mills Functional Patterns HBS2

To conclude, knee hyperextension is a biomechanical issue that can be solved by taking a gait first approach. Thankfully at Functional Patterns we have been coding this remedy for well over a decade and dialed it to an exact science, meaning that correcting it is not only possible, but very probable. If you are someone that has been dealing with this issue then look no further, we have a team of Human Biomechanics Specialists all across the globe trained and ready to help you develop a high functioning body without the pains.