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Originally researched and written by Haydee Ferguson of Portside Physiotherapy. Summarized below by Richelle Stevenson. Read the full article here
This article covers all things hyperextension! The author is a physiotherapist with 25 years of dance experience and she uses anatomy and examples to explain how and why dancers need to control hyperextension. I'll touch on my favorite points below and I encourage you to read the full article at the link above.
Wait, don't I want hyperextension?
Although hyperextended knees can create a beautiful line in ballet, this coveted aesthetic can be extremely dangerous if not controlled properly. Before we dive into what to do about hyperextension, it would help to first understand the difference between flexibility and hypermobility.
Flexibility refers to muscles, which are contractile tissues. This means that muscles are designed to be stretched and then contract; they are intended to increase in length with stretching because they can return to a normal length afterward. It is possible to overstretch a muscle (called a 'strain') but this is not as serious as the permanent damage which can occur with overstretching ligaments. This is also why dancers are encouraged to improve their flexibility. Hypermobility on the other hand refers to ligaments and anatomical structures in your joints which are not contractile. The author describes ligaments as "the “seat belts” of our joints. They are our back-up system to stabilize our joints if our body moves in a way that would otherwise take a joint beyond its normal range of motion." Unlike muscles, if ligaments are stretched they will remain lengthened (and not be a very good 'seat belt' for our joints)! Increasing hypermobility does not increase your flexibility; in fact muscles surrounding hypermobile joints often hold more tension in a subconscious attempt to protect the joints.
It comes down to this, stability will increase a dancer's longevity, power and balance (read the article for a more detailed description). And as the author states, "When the leg is elevated in any position (not bearing weight), it is OK to allow the knee to hyperextend for that beautiful line. However, the dancer must always pull up the leg (using the thigh muscles, protecting the knee joint), whether the leg is weight bearing or not. Control of your joints is of utmost importance!" So, how do I control my hyperextension? Lisa Howell has an excellent progression of exercises to help dancers use their muscles to extend their legs instead of sinking in their joint and using gravity. This article lists one version and the clinician's corner below will describe another version. Read more below!
Clinician's Corner
Stronger, Safer Lines
Richelle Stevenson, LAT Finding a truly straight line can be difficult for most dancers with hyperextension. This is especially the case if dancers have excessive tightness in their hip flexors or hamstrings. (Stay tuned for more information on this and check out our post below about Dry Needling!) When dealing with hyperextension, I like to think of it this way: when your joint is aligned, your leg is the longest (in other words, you are your tallest). Try this: if you are standing parallel and move from a plie to "straight legs" the correct position is just before you lose height. If you find yourself sinking, you know you have "fallen into hyperextension". Unfortunately it isn't always this simple. Notice in this image how bones are stacked straight when the center of the joint is aligned verses when the joint is pressed backward. (Hint: the first version is correct)
It might also help to imagine you have 'loose' knees. Often teachers will cue dancers with hyperextension to slightly bend their knees but most dancers overcompensate and struggle to have a stable supporting leg. Perhaps this analogy will help.
1) Stand in parallel with your feet hip width apart, lifting up and out of your core. Imagine there is a long skewer through your sitz bone diagonally through the front part of your hips. Now imagine someone is pulling evenly upwards on both sides of the skewer. Are you still engaging your core?
2) Now that you are in this lifted position, bend one knee completely without letting the 'skewer' lower. Without altering your position, pull the knee cap vertically (directly upward) by activating your quads without pushing the knee backward. 3) Now switch. Lift up and out of your core while straightening the first leg and bending the second. 4) You should be able to switch quickly between legs without "loosing height" or altering your pelvic position. The standing leg in this activity is a properly straightened leg: "loosely held" because the joint alone is aligned vertically while supported with the quad (knee cap pulling up) instead of falling backward.
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