Pilates for Hyper-Extended Knees

Sierra Portera

January 1, 2016

Costa Mesa, 2014-2015

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Abstract

Hyper-mobility Syndrome occurs when a persons’ joints are able to produce excessive

extension in some of his/her body parts. Hyper-mobility can be seen in hips, elbows, knees,

fingers, the list goes on. Typically, this kind of mobility is genetic and can be seen passed down

through generations. This kind of extreme mobility usually stems from looser surrounding

ligaments and muscles. Depending on whether the hypermobility is present throughout the entire

body, or is more isolated to one or two joints, changes the approach on how to strengthen the

neighboring muscles.

Knee hyperextension is one of the common forms of hyper-mobility syndrome. When

knees hyperextend, the effects are seen throughout the entire body. The pelvis is pulled into an

anterior tilt causing tight hip flexors, the stomach splays out losing abdominal strength, and the

upper back is left slightly rounded creating a tight chest.

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Table of Contents

Abstract……………………………………………………………………………………………2

Anatomical Description………………………………………………………………………….. 4

Case Study………………………………………………………………………………………...7

Conditioning Program…………………………………………………………………….8

Conclusion……………………………………………………………………………………….11

Bibliography/Work Cited………………………………………………………………………..12

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Anatomical Description

According to the online site The Medicine Net, hyper-mobility syndrome “is a condition

that features joints that easily move beyond the normal range expected for a particular joint.”

Hyper-mobility usually occurs when the joints holding the tissues of said joint together are too

loose. Common occurrences of hyper-mobility are seen in the knees, hips, shoulders, and elbows

(Medicine Net). Because people that have hyper-mobility syndrome are capable of having a

greater range of motion than joints are supposed to endure, those with hyper-mobility are more at

risk for injury. There is not only “a higher incidence of joint dislocation and sprains of involved

joints,” but people with hyper-mobile joints tend to fall into learned behaviors that can cause

more issues throughout the rest of their bodies due to the compensation (Medicine Net).

Focusing on hypermobility of the knees, which is called genu recurvatum, Rael Isacowitz

discusses in Study Guide: Comprehensive Course that the knee joint is made up of two joints: the

tibiofemoral and the patellofemoral. Normal flexion of the knees happens between 120 – 145

degrees and extension/hyperextension occurs between 0 – 10 degrees. The knee is considered

completely straight at 0 degrees and hyper-extended past that point (see diagram A). Most people

are born with varying, if any, ranges of hypermobility and tend to lose the excessive mobility as

they age; however, some bodies do not outgrow the hypermobility.

Diagram A

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Dynamic stability, which is provided by the ligaments and muscles, is crucial to the well

being of the knee joint. There are four joints that help the knee joint keep its stability those

being: the medial and lateral collateral ligaments and the anterior and posterior cruciate

ligaments as seen in diagram B. The MCL and LCL “prevent the knee from moving too far from

side-to-side” and the ACL and PCL “control rotation and the front-to-back motion of the knee”

(Isacowitz, Study Guide. 78). The medial and lateral menisci, two pads of cartilaginous tissue,

assist in increasing articulation while providing shock absorbency and promoting stability.

Diagram B

The two muscle groups that work with the knee the most are the quadriceps femoris,

which cause knee extension, and the hamstrings, which produce knee flexion. Both, along with

the gastrocnemius, improve knee stability and shock absorption. The gastrocnemius “prevents

hyperextension of the knee in the terminal stance phase of the gait cycle” (Isacowitz, Study

Guide. 78). There are other muscles that interact and cross the joint that support flexion,

extension, and rotation. Below the break down of both the quadriceps and hamstring muscle

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groups can be seen, as well as the gastrocnemius.

Diagram C

Diagram D

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Case Study

Name: Zachary

Age: 23

Sex: Male

Occupation: Digital Media advertising

Physical Background:

Zachary, or Zach, is a young man who recently graduated from college. He rarely

exercised while in college besides the occasional trip to the gym to do weight lifting exercises

and a bit of cardio. Zach was born with extreme mobility throughout various joints in his body,

but his knees tend to cause the most irritation. The habitual locking of his knees in his daily life

has become a learned behavior that radiates through the rest of his body. In order to see what was

going on in his body, I had him start our first session with a roll down. Upon first glance, I could

see that Zach locked his knees back into a hyper-extension position. Because Zach locked his

knees, he tended to grip his feet and ankles. When his pelvis locks backward in an anterior tilt,

he loses abdominal control. This was obvious as he continued his roll down and wobbled a little.

As he rolled back up, the consequences from his locked knees could be seen. When he finished

his roll down and had rolled back up, his upper back slightly rounded in and his shoulders caved

in to some extent most likely a result from his desk job.

Zach hopes to correct some of his postural deviations caused by his genu recurvatum by

both strengthening and stretching different muscle groups creating a stronger, more harmonized

body.

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Conditioning Program

Below is an example of one the sessions that I created using the BASI Block System in

order to restore balance to Zach’s alignment by strengthening his knee extensors (quadriceps

femoris) and stretching his knee flexors (hamstrings). I used this outline after Zach had taken

about 10 sessions, so some of the exercises are categorized under fundamental and others are

considered intermediate. I did this because I saw more progress through some parts of his body,

while others still needed a little more attention. Although the lower extremities were the main

focus of my sessions with Zach, I still made sure that I worked on other parts of his body.

Exercise Muscle Focus Objectives

Warm-Up Mat

Pelvic Curl Chest Lift Chest Lift with Rotation Leg Lifts Spine Stretch

Abdominals Obliques

Hamstrings Back Extensors

Warming up his body so that he can be ready to focus on more isolated muscle groups.

Foot Work Reformer Parallel Heels Parallel Toes V Position Toes Open V Heels Open V Toes Calf Raises Prances Prehensile Single Leg Heel Single Leg Toe

Hamstrings and Quadriceps

Ankle Plantar Flexors

Hamstrings and Quadriceps

Warm up

Hip extensor strength Knee extensor strength Ankle plantar flexor strength Ankle plantar strength Hip extensor strength Knee extensor strength Ankle plantar flexor strength

Abdominal Work Reformer Double Leg Double Leg with

Abdominals and Obliques

Abdominal strength Hip Flexor Strength

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Rotation

Pelvic lumbar stabilization

Hip Work Cadillac

Frog Circles (Down, Up) Walking Bicycle Hip Extension

Adductors and Hamstrings

Adductor strength/control Hip extensor strength Hip disassociations Pelvic lumbar stabilization

Spinal Articulation

Stretches Reformer Standing Lunge Kneeling Lunge

Hip Flexors and Hamstrings

Hip flexor stretch Hamstring stretch

Full Body Integration

Reformer Round Back Up Stretch 1 Elephant Reverse Knee Stretch

Abdominals Back Extensors

Trunk stabilization Shoulder stabilization Hip extensor control/strength Knee extensor control/strength Hamstring stretch Shoulder stretch Abdominal strength Hip flexor strength

Arm Work Cadillac Chest Expansion Hug-A-Tree Circles (Up, Down) Punches Biceps

Latissimus Dorsi Pectoralis Major

Shoulder Extensors Horizontal Adductors

Triceps Biceps

Shoulder extensor strength Elbow extensor strength Trunk stabilization Shoulder horizontal adductor strength

Full Body Integration A/M

Leg Work Reformer Hamstring Curl Jumping Series: Parallel Position V Position Single Leg Parallel Leg Changes

Hamstrings Quadriceps

Foot Plantar Flexors Hip Adductors

Knee flexor strength Hip extensor strength/control Foot plantar flexor strength Pelvic lumbar stabilization Hip adductor control Knee extensor strength

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Lateral Flexion/Rotation

Mat Side Lift

Abdominals with Oblique Emphasis

Lateral flexor stretch Abdominal strength Control with oblique emphasis

Back Extension Ladder Barrel Swan Prep

Back extensors

Trunk stabilization Back extensor strength

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Conclusion

The effects of Zach’s genu recurvatum on the rest of his body’s alignment were quite

obvious when we first began our sessions together. However, overtime the progress he made was

incredible to see. The goals for this particular conditioning program were to strengthen the knee

extensors and stretch the knee flexors while also trying to correct some postural deviations. By

honing in on the knees themselves, I found that his alignment slowly started becoming more

typical. As our time together increased and his body became stronger, I started to introduce new,

and more difficult exercises that he would not have been able to perform on the first day but

excelled at later on. The program above was designed specifically for Zach and evolved as time

went on depending on where I saw progress and where I thought problem areas still existed (i.e.

his strengths and weaknesses).

Pilates helped re-educate the way that Zach’s muscles worked in order to take the first

steps in decreasing his degree of hyper-extension. By learning how to properly engage his

muscles, Zach can now move through exercises with measured and controlled movements. As

we continue our work together, I hope to see him achieve even more stability.

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Bibliography/Work Cited

Books:

Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, 2013.

Isacowitz, Rael. Movement Analysis Work Book: Cadillac. Costa Mesa, California: Body Arts

and Science International, 2013.

Isacowitz, Rael. Movement Analysis Work Book: Ladder Barrel. Costa Mesa, California: Body

Arts and Science International, 2013.

Isacowitz, Rael. Movement Analysis Work Book: Mat. Costa Mesa, California: Body Arts and

Science International, 2013.

Isacowitz, Rael. Movement Analysis Work Book: Reformer. Costa Mesa, California: Body Arts

and Science International, 2013.

Websites:

Colie, Kate F. "Dancer Health: Hyperextension of the Knees." NoHo Art District . N.p.,

20 Nov. 2014. Web. 1 Jan. 2016. <http://nohoartsdistrict.com/industry-art/gotta-

dance/item/2655-dancer-health-hyperextension-of-the-knees>.

Shiel Jr. MD., William C. "Hypermobility Syndrome (Joint Hypermobility Syndrome)." The

Medicine Net. Ed. Catherine B. Driver, MD. N.p., 29 Apr. 2015. Web. 1 Jan. 2016.

<http://www.medicinenet.com/hypermobility_syndrome/article.htm>.