What is hyperextension in ballet?

In the ballet world, when we talk about hyperextension, we almost exclusively refer to knee hyperextension. It is worst noting that there are other joints in your body that can hyperextend: your elbows, your wrists, your shoulders, your spine, your fingers, etc. But usually, dancers refer to knee hyperextension, known as genu recurvatum.

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Knee hyperextension is the ability for the knee joint to extend beyond the range its typically designed for. Visually, instead of seeing a straight leg line, the leg has a curved line towards the back as demonstrated here by Margherita Venturi.

Recently, hyperextension has become a trend as it is believed to be more aesthetically appealing. Some dancers, and some teachers, promote hyperextension, increased genu recurvatum with daily routines to increase knee flexibility.

Take a few minutes to watch this video with Margherita Venturi, who has naturally hyperextended knees, and Cathy Laymet as they review for us the effects of hyperextension on her posture and technique.

What does dance science tell us about hyperextension?

Excessive knee hyperextension, or genu recurvatum, is often observed on dancers with overall hyper mobile joints (hypermobility syndrome). It is often associated with pain at the back of the knee (popliteal pain) and/or increased pressure and irritation of the infrapatellar fat pad because the knee cap lies lower, resulting in pain or swelling below the knee cap. It is felt as worse when standing or walking and are relieved by rest. Excessive hyperextension also changes the contact between the femur and the tibia potentially increasing the compression at the front of the knee, resulting in increased incidence of anterior cruciate knee ligament or medial meniscus injuries. That’s a lot of soft tissue strain and potential injuries for the sake of a nice leg line. You want to be able to extend your knees but not hyperextend your knees.

Hyperextension of the knee is associated with insufficient co-contraction of the hamstrings and quadriceps. The balance between the two groups of muscles is distorted. The dancer does not recruit the quadriceps to lift the knee cap and tract it up and the hamstrings and calves to control the extension of the knee. It’s quite a passive way of stretching your legs, passive in terms of muscle activity. This often results in dancers with visually ‘big thighs’ because their quadriceps are under-toned and a slightly bulging lower abdomen.

Do you still want knee hyperextension?

How does it feel to have hyperextension?

Let’s say that you are willing to take the risk because ballet requires sacrifices and injuries are part of a dancer’s life.

If you ask dancers with hyperextension, these are the common technical difficulties they say they experience that are due to going into hyperextension:

  • difficulties closing the 5th position tight without bending the knees,

  • hard to maintain balance in quick sets of dégagés with change of the supporting leg,

  • experiencing tightness in the front of the ankle,

  • pain at the back of the knee, under the knee cap,

  • inability to engage full turn-out capabilities when standing (visible difference during floor barre exercises for example).

From a technique standpoint, any qualified teachers will notice that hyperextension distort your axis which makes balance harder, near to impossible.

Bow legs or hyperextension ?

Excessive knee hyperextension, genu recurvatum, is sometimes confused with bow legs, genu varum in the dancers population. This is because hypermobile dancers often combines hyperextension of the knee with internal rotation of the femur and over-pronation of the feet at the end range of the extension. In other words, when standing and stretching their legs the dancer hyperextends the knees so much that he or she allows for her femur to turn in and his or her feet to over-pronate. Standing in parallel, it looks like you have bowlegs as the knee separates. In reality, it is hyperextension, genu recurvatum, and not bow legs, genu varum. It matters because the cues to enhance muscle controls might differ in each case.

Am I hyperextending my knees?

Ballet comes with a slight dose of hyperextension, the practice requires it because our center of gravity needs to be a little forward on the foot. So how do you know if you’re in the ‘too much’ range?

Seating: with your legs extended in front of you. Bend the knees and stretch the legs: if your heels are rising off the floor, as demonstrated by Manuel Garrido on the picture, then you’re hyperextended. I know, I know a lot of people just dream of being able to have the heel off the floor… Don’t! It’s not worth it!

Maybe your heels are still on the floor but to you stretching your legs feels like pushing the knees down towards the floor then you are also promoting hyperextension of your knees and must starting thinking and moving differently before it’s too late.

How to improve knee extension and avoid going into hyperextension?

If you are in pain and your hyperextension is causing your trouble: consult a health physician. It takes time and effort to get better at extending the knee so don’t take a chance to do it on your own. If it’s just a recent bad habit, you can include some awareness and muscle control exercises to your routine to reverse this habit.

Your health physician, PT, ballet teacher will recommend a ‘treatment’ aiming at decreasing the tendency to stand at the end range of the knee extension. You want to extend your knees but not hyperextend your knees. This includes:

  • the most advanced cases require orthotic correction such as splints,

  • re-education to improve knee proprioception, control and feel ‘when to stop extending the knee further’,

  • exercises to enhance muscle control, and learn to co-contract hamstrings and quadriceps to hold the knee in extension without going into hyperextension, both non-weight bearing and weight bearing,

  • exercises to improve muscle control and awareness of the rest of the leg and body: control foot pronation, internal rotation of the hip and trunk stability

  • awareness and exercises to maintain good knee alignment during daily life and sports.

Sources:

  • Alan J. Hakim, Rosemary Keer and Rodney Graham in Hypermobility, Fibromyalgia and Chronic Pain, 2010

  • Claire LeBlanc, Kristin Houghton, in Textbook of Pediatric Rheumatology (Sixth Edition), 2011