In dance aesthetics and safety don’t often go together. Ah, functional dysfunction. It’s what makes dance so breath-taking. A few examples of this: Back bends, pointe work, and what we’ll be talking about today: knee hyperextension, or genu recurvatum.

 

Many professional dance schools select for dancers with knee hyperextension because it makes “lines look nicer”. I have very little genu recurvatum, adding to a long list of physcial attributes making my body imperfect for ballet. I got over it.

Many dancers who can hyper-extend their knees are also generally hypermobile, meaning they have a greater than normal range of motion in most joints, not just the knees. Being hypermobile makes the aesthetic side of dancing easier, but requires more strength and caution to control.

Let’s talk about the image below. On the left, the dancer is sitting passively into her end range knee extension (hyperextension). You could say she’s relying on bones and ligaments for stability. Not an ideal strategy for longevity, by the way.

image from Dance magazine

On the right she is clearly using some muscle strength to hold her knees in a safer position. Aka, not being lazy.

Note also that her left knee looks more hyperextended than the right, as dancing can tend to exacerbate this hypermobility in an asymmetrical way (more about that later). This is important to note, because this leads me to believe that her right hip and ankle probably have different training needs to help support that wacky knee range of motion. But that’s a topic for another day.

If you choose to remember anything from this post, or those last two paragraphs, remember this:

Using muscles actively for stability > using bones and ligaments passively for stability

Hypermobility: a double-edged sword.

But isn’t every sword double edged? you ask. I thought so too until a few “blade enthusiaste”  friends showed me otherwise. Take the scimitar, for instance. A curved, single-edged sword of oriental origins. But anyway…

Unlike the scimitar, knee hyperextension (and all forms of hypermobility) really is a double edged sword: It looks pretty, making it a highly coveted genetic trait in dancers, but it comes with some risks.

Genu recurvatum is a congenital trait. Please do not try to stretch your knees into more hyperextension. It’s just a bad idea, and you know this if you’ve ever done it by accident. Either you were born with looser knee ligaments or you weren’t.

And if you’re one of the former with substantial ligamentous laxity, here is what you should know about those pretty knees of yours:

  • Your knees (but not just your knees) are at a higher risk for injury due to their looser ligament support.
  • With less support from ligaments, you must learn to use your muscles to support the knee and prevent injury (glutes, hamstrings and adductors to name a few)
  • Supplemental strengthening exercises should be an important part of your life to reduce said injury risks and increase strength to aforementioned supportive muscles
What’s happening at the joint/soft tissue level?

When the knee is in end-range hyperextension, stress is placed on the PCL (postreior cruciate ligament), which prevents the knee from overextending.

Dancers are often encouraged to live at end range knee extension. I had a teacher once who cued me to lock my knees because I don’t have genu recurvatum. Obviously this led to little improvement and only caused me to tense my entire body.

End range knee extension is not an ideal position from which to perform quick changes in direction, fast or high jumps, land (softly) from leaps, balance or turn on one leg, and any of the other infinite movement possibilites dance allows for. And doing so in terribly unsupportive footwear (or no footwear), to boot.

What about pointe shoes? They just accentuate genu recurvatum. Part of what makes it so pretty.

The knee is kind of a stupid joint. The knee doesn’t create much movement. It’s built more for stability than mobility. What happens at the knee is dictated mostly by what you do with the joints above and below it- The hips, ankles and feet.

You can see this pretty clearly in many of the fascial chains presented in Anatomy Trains by Thomas Myers, such as the lateral line shown below:

That said, I feel that in an article about knee hyperextension, it would be silly not to mention other parts of the body above and below the knee.

Take a look at the picture below. What other postural tendencies do you see globally in addition to the knee hyperextension (on the left) compared to the photo where she is better stabilizing her knees (on the right)?

Photo from Anatomy Trains, by Thomas Myers

Notice on the left that her foot is in a more “pointed” position due to the shin angle with the floor. She has a more anteriorally tilted pelvis, more flexed hips, a more arched lower back, with what looks like zero control over her abdominals. Also notice her forward head position on the left compared to the right. Is it all because of her knee hyperxtension? Probably not, but they’re definitely related.

So it’s not just the knees you should be worried about, but the tension holding patterns that are also common in the ankles, hips, pelvis, lower back and even neck, and the various areas of weakness this causes elsewhere in the body. Start looking at the body more holistically, not in parts.

A few common things you could assume (though you should never assume anything, ever), in those who present with knee hyperextension are:

  • Locked long, weak hamstrings (all that stretching doesn’t help matters either)
  • Locked short, tight, overused quads, but that aren’t necessarily strong (constantly being used in their shortest position- maximum knee extension)
  • Inability to activate glutes (or get remotely into hip extension)
  • Possible loss of dorsiflexion range of motion  (although many hypermobile people have excellent ankle mobility regardless, so don’t assume anything)

What are the implications for dance training?

While genu recurvatum is another one of those lovely functional dysfunctions that makes dance dance, you need to be aware of some implications for managing it in dance.

Here are some simple things to consider in your dance classes (dancers/teachers alike):

1) Dance teachers should encourage them to NOT lock the knees, but to discover what “straight legs” feels like. If you have to cue the crap out of your dancers until they hate you, do it.

2) Taping the back of the knee. Feeling the tape pull tighter if they hyperextend gives some proprioceptive feedback to the dancer, and will draw their awareness to their tendency to lock the knee.

3) In first position keep the heels together, and use the strength of the leg muscles (adductors, quads, hamstrings) to hold the position, don’t just press the backs of the knees together. Feel the top of the thighs pulling together while pushing your feet through the floor and elongating the spine.

4) While doing exercises like tendus or anything off one leg, same cues as above apply. Does the girl in the picture below look ready to releve or jump off of her supporting leg? Nope. Because she have no msucle engagement. Pure bone on bone action.

Also note that if the dancer is standing in hyperextension, the  hyperextended supporting leg is likely to be working at a different functional length than the action leg in order to keep the hips level with each other, and if this dancer continues to work on one side more than the other (favoring the right side, for example, for turns), then this asymmetry will become a part of the dancer’s resting alignment over a longer period of time.

And please stop doing silly stretches like this.

It’s just not necessary. Yes, I see that your knees have no ligament support. I’m so impressed. I’d be more impressed if I saw you doing planks and hip bridges.

What are the implications for supplemental training?

Like I mentioned earlier, postural re-education and supplemental strength training are necessary for dancers who have serious genu recurvatum.

An important part of minimizing the damage and gaining control of your hyperextended knees is re-training yourself to stand better. To feel what it’s like to support your knees with muscles, rather than bone and ligament support. Start doing that now. Today. Yesterday…

  • Feel the 3 points of your feet equally on the floor and press down through it
  • Stand with knees soft, not locked
  • Try to posteriorally tilt the pelvis to get out of the anterior tilt habit, if you have that, but don’t tuck under excessively. 
  • Elongate the spine, unlock your jaw, and feel the back of your skull floating up to the ceiling

Things to focus on strengthening include the anterior core, hamstrings, adductors, and obviously the glutes, which should all addressed in a balanced strength training program (like Dance Stronger, my free online 4 week training program for beginners. Check it out).

Not being a dance teacher  and not having needed to correct excessive knee hyperextension in myself, I am curious to hear what cues have worked for you, as a teacher or dancer. Let me know in the comments below!