Hyperextended knees, aka Genu Recurvatum, is when the knees are extended backwards and fall behind the line of gravity. This is a super interesting topic to me. In the medical world, hyperextended knees are viewed as a type of structural deformity. In the dance world, especially in ballet, they are viewed as a desirable aesthetic that makes the legs look straighter and higher in the air.
If you haven’t already, go ahead and read Part 1 of this Hyperextension series tagged here! In part 1 I discuss more local compensations that happen with knee hyperextension. Now in part 2, we will talk about the global compensations the body makes.
Lack of Stability Globally
What happens when we mess with the line of gravity?
The skeletal system is the key to our balance. If we can achieve correct alignment in our structure, we can achieve balance. If we can do this in relation to gravity, we can balance forever. Imagine a plumb line from the top of your head through the center of your body to the floor. This would be the optimal “line of gravity” that the body is trying to orient itself around for optimal function.
Hyperextended knees fall behind our line of gravity. If our skeletal system wasn’t able to counteract for this, we would be perpetually tilted backwards. This would not work because our body arranges itself around our eyes. Our eyes need to stay on the horizon so we can see straight in front of us.
When the knees shift into hyperextension, this brings the weight to the back of the feet. Now something has to shift forward. Make your way up the body from the knees and you will find the pelvis shifts forward to compensate! Oh no! Now the body is perpetually tilted forward so ribcage falls backwards. Now the head shifts forward and there we go, compensated balance achieved. It is so important to factor in the global connection of the body . Check out this picture to see the global effect of hyperextended knees!
Changing habits isn’t as easy as it seems…
I hate to break it to ya, but it isn’t going to be as easy as doing a few exercises to correct deeply ingrained movement patterns. As much as I would like to say I have the best exercises that will magically help, it doesn’t work that way. It is going to take mindful repetition, and lots of patience. If you have knee hyperextension, you can attest to the fact that your body feels normal in knee hyperextension. This goes for anyone that has any type of misalignment/compensation issue. Whatever state the body is in, it feels “natural”. Putting yourself in a different position feels “unnatural”.
May I challenge you today with this..
The only reason you feel “natural” in your misaligned/compensated body, is because of repetition. In order to actually reorganize your body in the most efficient way possible, you need to work on increasing your proprioception in order to retrain the brain/body dynamically.
For people with hyperextension, the legs feel straight and you feel like you are in proper alignment. Unconsciously, the brain has mapped this location in the somatomotor cortex and checked it off as good. So, in order to correct your hyperextended knees, you have to uncheck the box, and retrain the proprioception to tell you the new place.
Because I love analogies:
My husband and I just moved recently and in a weird way, proprioception change is a bit like forwarding mail to our new mailing address. As we get things in the mail at our new place, it alerts us that we need to update our address. We do, and then things are sent to the right address from then on. In a couple of months, all of the mailers will have our new address. It is a process to update, but by going through the process, you know that your address is changed everywhere and you are officially known as your new address.
Trying to “rep out” exercises, or “rep out” contacting mailers about the address, is just a lot of work that seems unnecessary. Instead focus on doing less reps, but with more intention and awareness so you are training the brain as well as the body. Then through the process of slow changes over time, you ultimately end up with a new pattern. Quality > Quantity.
Hyperextended knees inhibit external rotation of the femurs:
Hyperextended knees have a global effect on the body. But it is not all compensations made in the sagittal plane! The transverse, or rotational, plane is affected too as seen in the femurs. There is an internal rotation of the femurs associated with hyperextended knees.
Due to what is called the “locking mechanism” of the knee, when the knee is in its last 20-30 degrees of extension it is paired with a slight internal rotation of the femur relative to the tibia when weight bearing. This is an energy efficient mechanism to allow the condyles of the femur/tibia to screw around each other to “maintain the knee in extension over prolonged periods of standing without requiring muscular contraction…” [2].
People with hyperextension tend to have increased internal rotation when they are standing. This makes sense because since the legs are “over straight” that rotation is over emphasized. Just look at someone’s hyperextended knees and you will probably notice the knees pointed slightly towards each other. Probably with a bit of an anterior pelvic tilt as well. Activating the external rotators to bring the knees forward will help to counter the locking mechanism and bring the knees in a more neutral position. This is described in Exercise 2 below!
Exercise 2: engage your external rotators to inhibit hyperextension in the knees [2]
Standing in parallel, plié tracking the knees over the toes. Let your knees fall in so the medial sides are touching each other. Now imagine your external rotators activating as you pull the knees back into parallel. Slowly straighten the legs trying to maintain the knees tracking and letting the external rotators guide this straightening. Repeat multiple times.
This is a great exercise to help activate the external rotators and inhibit medial rotation of the femurs and may also help reduce the anterior pelvic tilt.
Phew! Lots of info to digest! That is how I felt editing this post! Have any questions//comments? Let me know below!
Sources:
[1] Mushrush, Anne Mercedes, “Genu Recurvatum in Dance Training: Assessing and Addressing the Structural Deformity in Dancers” (2015). Undergraduate Honors Thesis Collection. 258. https://digitalcommons.butler.edu/ugtheses/258
[2] Clippinger, Karen S. Dance Anatomy and Kinesiology. Champaign, IL: Human Kinetics, 2007. Print.