The Hyperextension Dilemma

The Hyperextension Dilemma

“Would you LOOK at those lines?! Her KNEES! Beautiful!!”

Lines…a HOT topic in the circus world, and something we ALL care about! If your knees don’t straighten all the way, or are just barely straight, you are likely on an ENDLESS quest to kill the microbend. But what about those of us who’s knees go…past straight? If you HAVE hyperextension, it can feel like a loaded gun…hard to know how to handle it…is it bad? Is it good? What do you do with it?!

This a huge issue in performing arts: Our aesthetic of “beauty” is often defined by nice lines– flat splits or over-splits, a nice toe point, high arches, and knees that are AT LEAST straight, and hopefully hyperextended…(I hope you caught the sarcasm in that “hopefully”)…

Many sports medicine providers tell us hyperextension is BAD and you should STAY AWAY FROM IT AT ALL COSTS. Then, they stick their heads in the proverbial sand, and just ignore it (and you), hoping it (and you) will go away.  However, the circus world tells us that hyperextension is beautiful, and something you should PUSH. So- what’s the truth?! This post will explore the biomechanics of hyperextension, its implications on knee health, and discuss a few ways to deal with it safely and responsibly.

Genetic Predisposition to Mobility

Speaking in very, VERY broad terms, there are two categories of mobility on a genetic level: people who trend towards hypermobility, and people who don’t.

Hypermobility is a spectrum, and is NOT synonymous with muscle flexibility. This refers to a person’s natural ligamentous and joint stability- how loose or stable are their ligaments and joints.  People who fall somewhere on the hypermobility spectrum often have some degree of knee hyperextension- and really, there’s nothing you can do about this. Once you have it, it’s just…there. Short of acute injury or surgery, that hyperextension is NOT going anywhere. It’s extra important that people who are hypermobile understand the health implications, both in performing arts and in daily life.

The Problem With Hyperextension

 

Here’s the issue: most research indicates that hyperextension likely predisposes you to injuries, from your feet all the way up to your low back (see references at end of post). As a result, people on this spectrum ABSOLUTELY MUST be on a strength and stability program to counteract this underlying instability.

Another issue more closely related to circus and performing arts is what we discussed at the beginning of this post: aesthetically, our culture values hyperextension as a desirable quality; and is one that many (more traditional) instructors will encourage students to “push.” This is detrimental for almost everyone- hypermobile or not- because this practice decreases static stability of our knee. It stretches out ligaments, joint capsule, and non-elastic connective tissue. Once stretched, these structures will likely NOT return to their pre-stretched state. It’s kind of like a tattoo…outside of extreme medical intervention, its PERMANENT. When these are stretched beyond normal, our knees have less inherent stability, and we must then rely even MORE on the muscles that cross this joint to provide strength.

Hyperextension and the Modern Circus

So! You have hyperextended knees, and you do circus. Sports medicine providers tell you it’s BAD, while performing arts culture is LUSTING after your lines. It’s a confusing place to be- what should you do?! Should you use this “superpower,” or should you try to stay away from accessing hyperextension at all costs, for fear of long term knee damage?

**OPINION ALERT**

Up until now, this article was based on best available research, biomechanics, and widely accepted beliefs in sports medicine and circus (see references at bottom of post). HOWEVER, we have now reached the opinion section. Data on therapeutic interventions for hyperextension in performing arts is SO PAINFULLY UNREMARKABLE that its difficult, if not impossible, to formulate a general recommendation for circus artists from this paucity of data. Therefore, the following recommendations are my opinion, which has been formed by my experience in the perfomring arts world– both personally, as an artist, and professionally, as a licensed physio and athletic trainer.

I’d also like to be VERY clear that these recommendations are ONLY for the hypermobile performing artist WITHOUT KNEE PAIN. Once you have knee pain, all bets are off. Go find a physio and get it taken care of! Now, without further ado, the recommendations:

General Safety Recommendations for the Hyperextended Circus Artist

  • Don’t. Push. It. EVER. You already have hyperextension, you don’t need more. I don’t care what your contortion coach says, DO! NOT! PUSH!! Don’t prop sandbags on your knees with heels elevated on a chair. Don’t press on your knee in an oversplit. Please, just don’t. My ligaments are having sympathy pains just thinking about it.
  • DO: strengthen the CRAP out of it! If you HAVE hyperextension, AND you do circus (or an art that values “lines”), you should probably make sure that you are FREAKIN STRONG in your hyperextension. This means training your glutes, quads, and hamstrings to be strong and supportive of your knee through its full range of motion…including hyperextension. This should not be a scary end range of motion in which you feel unstable- uncontrolled hyperextension is a HUGE injury risk factor! See the exercise at the end of this post for an example of how to strengthen your hyperextended knees.
  • DON’T hang out in hyperextension in your muggle life. Standing with knees locked in hyperextension is NOT a resting posture- save it for special occasions. When you’re standing in line at the grocery store, please stand with knees straight or in a microbend. Change positions often: fidget. It’s good for you.
  • DO: Strengthen your glutes, in weight bearing and non-weight bearing positions. You guys, strong glutes are going to save the world. Or at least save YOU from injury. Study after study shows that strong glutes in positions functional to your sport decreases injury risk EVERYWHERE: here are a few injuries that strong glutes helps to avoid: plantar fasciitis, ankle sprains, patellofemoral pain, IT band friction syndrome, hip labral tears, low back pain. And that’s the short list!! See this blog for ideas on circus-specific glute strengthening. Or check out my Instagram. I post about glutes LITERALLY ALL THE TIME.
  • IF YOU CHOOSE TO TRAIN FLEXIBILITY, DO:
    1. Find a qualified flexibility or contortion coach. Your coach should understand the implications of hypermobility on flexibility training. Notice I’m not saying to STOP training flexibility. I’m saying get a GREAT coach who makes your muscles, not your joints, feel the burn!! I strongly believe that hypermobile performing artists can SAFELY train flexibility.
    2. FOCUS ON ACTIVE FLEXIBILITY: this is how you prevent injuries. Active flexibility and end-range control strengthening exercises. Not sure how to do this? Check out my active flexibility programs– they’re safe for both hyperextended an non-hyperextended students, and focus on ALL the important muscle groups needed for safe flexibility.
  • DO: show off your strong, gorgeous lines!! …at select times. Your hyperextension isn’t going anywhere, so after you strengthen as discussed above, you should absolutely feel free to show it off…in non-weight bearing, controlled positions! For example: in a straddle or split handstand, inverted on your apparatus, or the moving leg in an arabesque or leg scale. I typically don’t recommend standing in hyperextension. I prefer the standing leg in arabesques or leg scales to be straight vs hyperextended. This avoids accidentally pushing into more hyperextension and further stretching out the passive structures of your knee. It also encourages optimal co-contraction of quads, hamstrings, and glutes on the stabilizing leg.

Again: these recommendations are formed by my unique perspective as a (hyperextended) dancer and circus artist, as well as a well-educated, qualified, and licensed physio. These are my opinions, and not scientific fact written in stone. Everyone is different, and if you’re unsure what the best way is for you to live your hhyperextended circus life, go get evaluated by a physio! Not sure how to find a qualified physio? Check this post to learn more.

Starter Exercises for the Hyperextended Artist: Strengthening and Stabilizing

Here are two awesome exercises to get you started on your quest towards strengthening your glutes and your hyperextension, without stressing the ligaments and other passive structures.

Terminal knee extensions, standing and piked

This is an awesome drill to train those lazy quads to engage appropriately during straddle and pike inversions, and KILL the microbends. Forever!

The trick here: you need a superband. A normal theraband won’t cut it, your quads are strong and stubborn, and the giant, looped superband is the only thing that can whip them into shape. You should be STRUGGLING to straighten your leg during each repetition- it should be HARD.  You can find super bands online, search on amazon and you’ll get a bunch of colorful options. Or check the link in my story for my personal fav. And now, the exercise:

Key points:

  • Anchor the band knee-height, around a STURDY piece of furniture.
  • Band around knee, facing the anchor point. Step back until there’s a decent amount of tension on the band.
  • S-l-o-w-l-y bend your leg, and S-l-o-w-l-y straighten. Hold 3-5 seconds with knee straight. There should be enough tension so this is SUPER hard. If you hyperextend, hyperextend up until JUST before your max and hold THERE.
  • Repeat in a pike with a FLAT back: if this means putting hands on a yoga block or other elevated surface, do that.

Miniband Ballet

This exercise is one of my favorite glute strengtheners for performing artists. It will help strengthen and stabilize hyperextension, while assisting with active flexibility AND decreasing risk of injury.

KEY POINTS:

  • Don’t let your hips hike up! Pelvis should be level. This should be a very small rotation coming exclusively from your hip- with a stable pelvis! ⠀⠀
  • Don’t lift your leg too high! Your foot should be inches off the ground, not feet- just enough so the band stays tight, and you can keep your pelvis level!⠀⠀
  • Try rotations to the side, to the back, and then circles from the side to the back. ⠀⠀
  • keep quads engaged the WHOLE time to keep your leg straight- no hyperextension, no microbend. ⠀
  • This series biases your glute med and glute max- you should feel it in BOTH legs: the standing leg, and the lifted leg.

**DON’T DO THESE IF YOU HAVE KNEE PAIN** If you have pain, go see a physio….GO!!

Sets and Reps

For both of the above exercises, do 8-12 repetitions before training to activate all the muscles that stabilize your knee. You can also do 2-3 sets to fatigue, 2-3 times per week for long term strengthening.

**Note to other licensed medical providers**

As stated, these guidelines are purely my (educated) opinion. I would love to open a dialogue with you, if you have opinions that differ from mine. I plan to revise these guidelines at least annually, so if you’d like to respectfully share your opinion and rationale with me, I would absolutely love to chat. Email me to get the conversation started: jen@cirquephysio.com

Resources and Further Reading

Joint Hypermobility and Joint Range of Motion in Young Dancers  

Hypermobility and dance: a review 

Altered lumbopelvic movement control but not generalized joint hypermobility is associated with increased injury in dancers. A prospective study. 

Joint laxity and the benign joint hypermobility syndrome in student and professional ballet dancers 

A hypermobility study in ballet dancers 

Generalised joint hypermobility and benign joint hypermobility syndrome. II: epidemiology and clinical criteria 

 


 

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