In our clinic, we see many neurological patients who come in through our doors with a laboured walking pattern. They may be quadriplegic or hemiplegic, and one of the most obvious problems is walking on a knee that seems to bend backwards more than it should when walking. This is known as hyperextension.
Why do I get a hyperextending knee?
When you walk, you need coordination of major muscle groups such as the hip stabilisers (gamelli, obturators and glute medius and minimus) and the prime movers (the glute max, hamstrings and psoas) to enable you to stand on your leg and use it to control your posture so you can swing the other leg. Because the knee can lock easily in the backward position, you can use it to stand on your leg without exerting much force.
It feels safe, and usually doesn’t hurt – so what’s the problem?
The problem relates to masking. A hyperextending knee, when left unchecked, results in further mobility impairment because every time this is done there is a backward force that your body has to work against with each step, which adds to fatigue. This is an inefficient way of walking, and over time, can lead to more permanent knee damage and reduced options for going over different surfaces. The more this pattern is ingrained, the less your muscles work optimally and a downward spiral can follow.
What can I do about it?
1. Understand the problem
The first thing to understand is the hyperextending knee needs to be treated like a symptom, and not the primary problem. The primary problem usually relates to weakness of the muscles above and below the knee, and my experience this is more of a problem than spasticity, which can also affect the muscles that cross the knee (the rectus femoris and the quads).
It can also relate to not enough range in the ankle to allow the knee to stay forward over the foot, and instead, travels backwards over the foot. This significantly makes the foot have to work harder to try and propel the limb forward, and often manifests in toe clawing.
2. Exercise your hips
Proximal hip control is a strong determinant of the treatment of knee hyperextension, as there are plenty of powerful muscle available here. The hamstrings and hip abductors, work together to maintain the pelvis, and hold the top of the thigh in place. What’s important here is getting the timing and force production just right, which is why you may need to seek professional help here to guide the muscles in activating properly in the gait cycle to ensure this can permeate through bad habits. Useful activities include bridging exercises, wall sliding squats and controlled walking in the water.
3. Get range in your ankle
In a chronic hyperextending knee, there are usually problems in the ankle joint. It can either be stiff at the joint or there may be calf muscles that are stopping the ankle from bending upwards. Stretching the calves, splinting and exercises for managing spasticity may be helpful in this instance. Other strategies include, training of the muscles that help bend the ankle upwards (dorsiflexion) such as the tibialis anterior, peronei and toe extensors to fire earlier and better when walking.
If the foot does not sit well on the floor, there may be dystonia or spasticity, in which case you should seek professional help from a neurological physiotherapist or rehabilitation physician who specialises in neurology.
4. Be friends with the wobble
Over time, the hyperextending knee often becomes your BFF and you have become so accustomed to it that it is really hard to stop doing it.
Because like all bad habits, shaking them off is hard but it’s possible! Often in the recovery phase, you will find that your hemiplegic limb will shiver, wobble and even bounce around a bit, and this is normal in the recovery process. Rest assured that this is usually temporary, as the brain relearns and regains control of the muscles. Don’t give up!
5. Challenge yourself on different terrains
As you get used to a new way of moving, the important thing is the practise on different surfaces. Our feet are marvelously adaptable things that are capable of trekking all over our natural world, adapting to new surfaces. To consolidate your new habits, you need to walk up and down slopes, steps and different speeds to get your brain to learn how to control your knee in different situations.
That is when your brain can store this chunk of muscle memory in the long term bank, to pull out whenever you need it!
Got more questions? Give us a call on 8502 2659 today for a free no obligation chat now!