Fixing Hyperextended Knee Posture

Fixing Hyperextended Knee Posture - Somastruct
16/06/14 22:06
Fixing Hyperextended
Knee Posture
Genu recurvatum is a posture where the
knees appear to bend backwards in
standing. The recurvatum appearance is
due to the knees being placed in a
hyperextended position. The posture is
easily identified when looking at a person
from the side by the curved alignment of
the legs. From the front, recurvatum
standing posture can make the kneecaps
appear to point inwards.
http://www.somastruct.com/genu-recurvatum/
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A while back I received this question in

regards to another post on posture:
Question: As well as anterior pelvic tilt,
I also have hyperextended knees, do you
know of any stretching or strengthening
exercises to treat/prevent this?
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In healthy individuals without a history

of knee injuries there are three main
causes of genu recurvatum:
Joint laxity (very flexible knees)
Weakness of muscles around the knee
Postural habits
The body will use knee hyperextension as
a strategy for standing when it finds the
position more stable or efficient than
standing with the knees in neutral.
Having loose joints makes it easier for
the knee to go into a hyperextended
position, but to explain why someone is
standing this way we need to look beyond
the knees. Knee alignment is influenced
by both the alignment of the pelvis and
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hips above, and the ankle and foot below.
People who stand with their knees locked

out often have an anteriorly titled pelvis
and increased lumbar lordosis. Anterior
tilting of the pelvis causes relative flexion
of the hip. The flexed position of the hip
is countered by extension at the knee,
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leading to a hyperextended posture.

These postural changes can be caused by
weak glute and core muscles and tight hip
flexors.
Below the knee there may be a lack of
ankle flexibility causing the ankles to
remain slightly plantar flexed. Collapsing
of the arch at the foot level and related
weakness of the arch supporting muscles
can also be a factor.
Effects of Knee Hyperextension

In a healthy population, genu recurvatum
is not often seen as problematic. There
are several consequences to keeping this
posture however that deserve
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consideration:
Increased compression stress in the
front inside corner of the knee
Increased tensile stress on the back
outside (posterolateral) corner of the
knee
Increased stress on the ACL
Increased genu recurvatum has been
found to be a predictor of ACL injury. The
reason may be because knee
hyperextension makes the hamstrings
(the muscles in the back of the thigh) less
efficient by placing them in an elongated
position, or from increased anterior
(forward) translation force on the lower
leg.
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Improving Proprioception
People who stand with their knees
hyperextended can have poor
proprioception control in the terminal
degrees of knee extension. These
individuals may perceive the
hyperextended position as normal. The
first step in correct this posture is
increasing awareness of the difference
between neutral knee alignment and the
hyperextended position.
Gaining awareness of knee alignment can
be done by using a mirror to provide
feedback. The knees are brought to a
neutral position by shifting the pelvis and
hips forward so that a straight line would
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pass through the hip, knee, and ankle.

Body weight should be balanced between
the front of the foot and the heel. Once
proficiency is achieved at sensing the
difference between extension and
hyperextension, work on maintaining
neutral knee posture without a mirror.
Single leg balancing activities can also be
used to increase joint position awareness.
Building Strengthening
Its commonly suggested for correcting
knee hyperextension to focus on
quadriceps and gastrocnemius
strengthening, as these muscles directly
control extension of the knee. But really
there are no un-important muscles in the
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body. Strengthening muscles in isolation

doesnt acknowledge or address the
complexity of biomechanics.
A better approach is building overall
strength and motor control, with
emphasis on muscle balance and
targeting muscle groups that are
commonly underused in our modern
lifestyles. (e.g. glutes, calves).
For example, people with lax knee joints
often going into hyperextension when
bending forward (e.g. brushing their
teeth). The Romanian dead lift (video)
can be used to improve eccentric control
of the hips while keeping the knee in
neutral alignment. Exercises that are
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used to correct anterior pelvic tilt would

also help encourage good overall
alignment.
Other Exercises:
Squats
Lunges
Hip Thrusts
Ankle Mobility
Calf Raises
Be mindful when working on these
exercises to avoid locking out the knee or
throwing the knee back into extension.
Gait Training
To improve gait mechanics for someone
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with knee hyperextension, practice

maintaining a slight bend in the knee
while walking. This trains the muscles
around the knee to work together in
creating stability. At first walking with a
slightly bent knee will feel taxing, but
over time the muscles of the leg adapt to
working from a new position. Pay
attention to not letting the trunk lean
forward, or allowing the knees to move
inward.
On stairs, focus on using a slow and
deliberate motions. Avoid using
momentum, especially during step-ups.
Hyperextended knee posture is often
reduced when wearing heels, but this is a
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double edged sword. Wearing heels too

frequently encourages knee
hyperextension when barefoot or wearing
flat shoes.
Sports Specific Training

People with hypermobility should refrain
from forcing their joints past their end
range to reduce the risk of injury. The
feedback systems within hypermobile
joints can be less effective, so caution
should be used when working at
endrange during activities that require a
high degree of flexibility, such as yoga.
Athletes will want to work on preventing
hyperextension and controlling knee
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position during sport specific activities,

such as:
Planting and cutting maneuvers
Jump landings
Sudden stops
References
1. Loudon JK, Goist HL, Loudon KL.
Genu recurvatum syndrome. J Orthop
Sports Phys Ther. 1998 May;27(5):3617.
2. Loudon JK, Jenkins W, Loudon KL.
The relationship between static
posture and ACL injury in female
athletes. J Orthop Sports Phys Ther.
1996 Aug;24(2):91-7.
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3. Ramesh R, Von Arx O, Azzopardi T,

Schranz PJ. The risk of anterior
cruciate ligament rupture with
generalised joint laxity. J Bone Joint
Surg Br. 2005 Jun;87(6):800-3.
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