Loading Joints that Hyper-extend

It's a myth that it’s dangerous to load joints that hyper-extend, but we need to clear up some points in order to talk about this sensibly.
Ashleigh Flanagan
September 25, 2021

Loading Joints that Hyper-extend

As a physio who works with many dancers, aerialists, and acrobats, I get asked a LOT about whether we should load hyper-extended joints or if we need to keep them bent when we load them. 

It is a pervasive myth that it’s dangerous to load hyper-extended joints, but a few points need to be cleared up before we can discuss this topically sensibly.

- In the truest sense, joints such as knees and elbows rarely extend beyond an individual’s normal range of motion. Going beyond what is structurally available for a joint means that structural damage has occurred. This is a hyper-extension injury. This usually requires significant shear force across a joining that results in a lot of trauma. 

- When I am asked about loading into hyper-extension, I am usually being asked about loading joints that move more than the average person. Arbitrarily, it has been decided that knees and elbows that extend more than ten degrees’ hyper-extend’, but it’s important to appreciate that this does not necessarily indicate pathology, it isn’t an injury, and there is nothing wrong with this joint. It simply means this elbow or knee moves more than most peoples. The ability to move 10 degrees or more into extension (knee and elbow) is the NORMAL range for many people.

- In knees and elbows (and most joints), full-extension is the most stable joint position. These joints have the most structural support when extended due to ligament / capsular tightness and bony concurrency. It means that full extension is an advantageous range to take load. Many skills that require high levels of strength, stability and balance will necessitate loading in extended joint positions (Think gymnastics, ballet and handstands).

-Full-extension, no matter how great the range, represents increased proprioception due to the tension in ligaments and joint capsule. 

- If an individual’s normal range is more than normal, stabilising joints is already harder. It is counter intuitive to avoid the range that is inherently more stable and provides better feedback (ie full extension). These individuals may have less rigid connective tissue that means that full extension isn’t as stable, but it still provides more stability for loading than mid-range. 

- Undoubtedly, individuals whose knees and elbows extend more than usual will need or be forced to load their full extension at some stage. If they are not conditioned to take this load, as they have avoided strengthening through their full range under the false belief that loading their joint through its full range is dangerous or damaging, this will ultimately lead to injury. 

Ok now I feel like we can start.

Loading Joints that Hyper-extend

To reduce the risk of injury when loading elbows and knees in extended positions, we need to develop strength and control through our full available range and condition our joint tissues to the load. 

Knee and elbow injuries in extended positions are overload overuse injuries. This can be one incident, eg being kicked in the knee cap, where the force overcomes the integrity of our structures or, more commonly, repeatedly overloading the joint with inadequate recovery. In both scenarios, the joint is not robust enough to tolerate the load applied to it. This is irrespective of the normal range an individual has available.

We can’t do as much to prepare our joints for sudden overload, but we can work to prepare our joints specifically for what we want to use them for.

The principles are the same for individuals with joints that move more than others, but because they have more range and often less feedback, they will have to work even harder to build a strong, resilient, and stable joint. It will take longer and require more persistence, but it will be worth it because these individuals will benefit most from loading in their full extended positions. 

In an *ideal* world we shouldn’t be encouraging these individuals to modify their positions to avoid loading in extension due to fear of pain or injury. Instead, we should be reducing the load of the exercise in ways that mean they can load, condition and become more stable at their end range position. This may not be possible in a group setting or can upset an individual if they feel like they are being regressed. In this case, ‘keep a little bend in your knee as you slide forward’, or ‘bend the elbow a little as you take load in it” means they can participate, but it does not help them strengthen through their full range, and it increased their risk of injury in the future. 

To learn about other overload overuse injuries: Read the blog

To learn about bracing or taping joints: Read the blog

To book in with a physio comfortable working with joints that move more than usual: Book a physio appointment

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