Hypermobility Part Three

So you’ve got knees or elbows that hyperextend - the next question I always get asked is “is that okay?”

So you’ve got knees or elbows that hyperextend – the next question I always get asked is “is that okay?”


Because there isn’t extensive clinical research in this area, there is no simple answer to this question. The general consensus is that it depends on the joint and today we are going to discuss why!


Before we start talking about leaning into our hyperextension we need to talk about the structure of our joints. In each of our joints, we have active and passive stabilisers. Active stabilisers are our muscles (and tendons) which actively control our joint position and movement. Passive stabilisers are structures like our ligaments, joint capsules and bones. 


The problem with leaning into our hyperextension is that we are relying on – and stretching – our passive stabilisers, which over time causes them to stretch. It also means that we are not using our active stabilisers to control and protect our joints. Unlike stretching a muscle, stretching our passive stabilisers is permanent and can cause issues later down the road as it just creates more laxity. For these same reasons, we really do not want to be forcing our knees, elbows or feet into hyperextension while weightbearing or stretching as this can cause the same permanent changes. 


If we look at the anatomy of the knee, we can see the knee straight and bent. 


When our knee is bent, we are controlling our knee using our muscles. However, when lock our knees into hyperextension, we are relying on those passive structures to  support our weight. In addition to this, you can see that we don’t have a bony block in our knees to prevent our knees from hyperextending. 


hypermobile physiotherapy

hypermobility physio hampton


For these reasons, it is highly recommended to not stand with your knees in hyperextension as this will only exacerbate your issues and encourage more laxity over time. We are always weightbearing through our legs as well, which puts continuous stress on our knees. 


Now let’s look at an elbow:


physio yarraville


As you can see on the elbow, the olecranon (as labelled) provides bony support when your elbows are fully extended or straight. Additionally, we don’t usually weightbear through our elbows, which means there is overall less stress through those joints. 


But what about handbalancing and handstands? This is a little more tricky and the advice varies depending on your physiotherapist. While we are weightbearing through our elbows in these activities, there is a lot more passive support in your elbow joint compared to your knees, and you spend comparatively less time on your hands than on your feet. The important thing is to have excellent control and strength into your hyperextension – and if you don’t, it is best to work on this before leaning into your hyperextension. 


So hanging out into knee hyperextension is not good for you long-term, but elbow hyperextension can be okay if it’s not causing you issues. This leads us to our next point – what can we do about it? 


We need to strengthen our end-range and close the gap between our active and passive flexibility. 


Check out our instagram to see these exercises to help your end-range strength. Start with 2-3 sets for 8-12 depending on your strength. If you experience any pain at all – see your local physiotherapist for advice!

  • Clams

Lying on your side with your head supported on your arm or on the floor and hips stacked. Rotate your top leg at the hip – you can place a hand on your hip to make sure you are not rotating your pelvis. The movement should only be at the hip joint itself. Perform this exercise slowly and to the end of your range. 

  • Terminal knee extension 

With a heavy power band, fix one side to a very stable item. Starting with a bent knee, slowly straighten your knee until it is almost locked, then bend the knee again. If your knees naturally hyperextend quite a lot, you will be training into a little bit of hyperextension but not locking the knee. 

  • End-range pushups 

This exercise can be done in 4 point kneeling, on your knees or on your toes – depending on your level. We will be performing a push up in the end range only. Starting halfway into the push-up, we are going to push ourselves slowly up until the elbows are almost locked, and then coming down again. The aim is to train as much into our hyperextension as we can without locking through the joints. If you are weak around the shoulder blades – do pay attention that the folds of your elbows are facing each other and not rotating outwards.


To learn more about hypermobility or to get a Physiotherapy assessment contact us on 8319 9945