Causes Of A Hyperextended Knee
Hyperextension typically occurs when the knee absorbs strong, sudden force while the leg is straightened. This can happen for a variety of reasons:
- During activities such as basketball or sports that involve a lot of jumping and changes in direction at high speeds
- During sports that revolve around flexibility such as gymnastics
- During a car accident when the knee is smashed
- Falling while the foot is caught
- Having weak quad muscles unable to support the knee
- Instability of the knee joint from previous ligament injuries
What Questions Should I Ask My Doctor
- Will I need any imaging tests?
- Do I have an ACL or PCL tear?
- How long should I rest and avoid sports and other physical activity?
- Will I need surgery?
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How much time will I miss? Is this a serious injury? Am I done for the season?
These are all questions that run through your mind when you hyperextend your knee. Fortunately, most hyperextended knees dont require surgery, and youll be able to recover at home with over-the-counter treatments and by giving your body time to rest and heal.
If you do experience a more severe injury like a ligament tear you should still make a full recovery and get back to the sports and activities you love.
What Structures Can Be Injured When The Knee Hyperextends
A hyperextended knee can occur without significantly damaging any structure. Pain and swelling can occur as an inflammatory response due to simply hitting the end of the normal range of movement. More significantly a bone bruise or cartilage response can occur on the joint surfaces. These will often be acutely painful but will respond well to physiotherapy management.
Hyperextended knee injuries where a pop is heard at the time of the injury and swell quickly often involve the anterior cruciate ligament . This may also be associated with the knee feeling unstable or giving way. If you think that you have sustained this type of injury you should immediately seek advice from a physiotherapist. This may require diagnostic imaging such as an MRI scan to confirm the extent of the injury.
There are then injuries that dont rupture the cruciate ligament, in these injuries the knee has hyperextended enough to cause a tear in one of the collateral ligaments, usually the medial collateral which is on the inside on the knee and likely to be very tender.
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Treatment For Less Severe Cases
Most of the hyperextended knee cases that occur on the sportsfield are treatable without surgery. The depth of care depends from case to case, but the following elements are normally helpful:
Getting plenty of rest with your leg elevated is a must. Youve got to give the ligaments enough time to heal. For minor cases, recovery time can be between 2-4 weeks.
Ice and compression should be part of your treatment. They speed up the healing process and provide relief from the pain and inflammation.
If the pain is too much to bear, you can take over-the-counter pain medications like ibuprofen.
You may benefit from the use of a knee brace while you get back on your feet. Knee braces help prevent further injury.
You should definitely consider a chiropractor. Contrary to popular belief, chiropractors arent just for your spine. A chiropractor who works with all joints can be of invaluable assistance.
What Factors May Contribute To Knee Hyperextension
Hyperextensions of the knee can occur to anyone, but are frequently the result of athletic injuries. Athletes who compete in contact sports like football, soccer, or lacrosse are most commonly affected. Other sports, like skiing, may cause the knee joint to suddenly be moved out of position and cause this injury.
When To Seek Care
If your hyperextended joint causes mild pain or swelling, you may be able to treat the injury at home with the self-care measures as described above. However, if the pain, swelling, or bruising is more severe, its a good idea to call your doctor.
Your doctor will want to perform a physical examination and examine the injured joint as well as the surrounding muscles, ligaments, and tendons. They may also order a set of X-rays to help confirm the diagnosis.
If you dont have any other injuries, your doctor may suggest some self-care measures that you can do at home.
Seek medical attention immediately if a bone is protruding through your skin or if your joint looks twisted or deformed. These types of severe injuries often require more significant treatment, including surgery.
A hyperextension injury to the neck can be mild, but theres also the potential for damage to the spinal column. As a general rule, its always a good idea to seek medical attention for any type of neck injury.
Its all too easy to say, Ill just be careful. Sometimes that works, but sometimes you need to be more proactive to minimize your risk of a hyperextension injury.
Here are some other steps you can take to reduce your risk:
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What Is A Hyperextended Knee Injury And How Is It Treated
A hyperextended knee injury happens when excessive pressure or force pushes your knee past its normal extension range of motion, while the knee is in a straightened position, and bends the knee backward. This usually happens while bearing weight on the limb. These injuries are not uncommon in athletes when landing from a jump to an extended knee position, or from an outside force to an extended knee, and are typically seen in basketball, volleyball, and gymnastics. Another possible hyperextension injury scenario is walking or running, and catching your foot in something like a pothole. This occurs because your foot and leg are placed and stable in the pothole, while the bodys momentum is still moving forward. This momentum causes the hyperextension force. Hyperextension injuries can range from mild to severe depending on the amount of damage done to the stabilizing structures in the knee, i.e., knee cartilage, anterior cruciate ligament, menisci, and popliteus tendon.
Initial symptoms may include swelling, pain at the back and sides of the knee, pain with walking, and a feeling of instability with sport. You may also hear a pop with a hyperextension injury this is usually with a forceful hyperextension and is indicative of a ligament tear, usually the ACL .
How Do You Diagnose A Hyperextended Knee
Typically an MRI and/or x-rays are performed. In some cases, imaging will not need to be used for a doctor to diagnose an athlete with a hyperextended knee. If, however, surgical intervention is expected to be used as treatment, imaging will be necessary in order to develop plans for the procedure and recovery.
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Should I Be Concerned About Knee Hyperextension
Lets start by defining hyperextension. This is a word that can be confusing because it can be used in two different ways. The first way that the term hyperextension can be used is to describe a basic, normal movement. Hyperextension is extension past the point of neutral when we are standing in anatomical position. So, if I extend my arm at the shoulder joint from a flexed position and return it to my side, I have done extension of the shoulder joint. If I keep going with that movement until my arm is behind my body, I have now technically done hyperextension of the shoulder joint.
There is a second way that the term hyperextension can be used, which is to describe the condition of hyperextension. This condition can describe the position of multiple different joints in the body, but is probably most commonly applied to the knee joints and the elbow joints.
Other Causes Of Genu Recurvatum Include:
- A defined disorder of the connective tissue
- Laxity of the knee ligaments
- Instability of the knee joint due to ligaments and joint capsule injuries
- Irregular alignment of the femur and tibia
- A deficit in the joints
- A discrepancy in lower limb length
- Certain diseases: Cerebral Palsy, Multiple Sclerosis, Muscular Dystrophy
- Birth defect/congenital defect
- Knee giving way into hyperextension
- Difficulty with endurance activities
- Pinching in the front of the knee
A careful evaluation must be performed to determine if there is any cruciate ligament tear, posterolateral corner injury, or a medial knee injury to include the superficial medial collateral knee and posterior oblique ligament. In some circumstances, none of these more commonly known structures may be injured and all of the injured structures are in the back of the knee.
Our anatomic and biomechanical research has discovered a tibial attachment of the oblique popliteal ligament which, when injured, can result in increased knee hyperextension.
The best way to clinically diagnose the amount of hyperextension of the knee is to measure the patients heel heights. If there is a normal contralateral knee to compare to, an increase in heel height can be diagnostic for genu recurvatum.
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How Is A Hyperextended Knee Diagnosed
Your healthcare provider will diagnose a hyperextended knee with a physical exam and imaging tests. Theyll look at your knee, talk to you about your symptoms and see how limited your ability to use your knee is.
Youll probably need at least one type of imaging test, including:
These will help your provider see the damage inside and around your knee. Theyll also show if you have a more serious injury like a torn ligament.
Mcdavid Knee Support Brace
This is a more mid-range knee brace for hyperextension. This brace offers hinged sidebars for support and to prevent knee hyperextension. It is made of flexible material and fitted with straps above and below the knee joint to ensure a secure fit. The tight fit will help with knee proprioception and therefore help to prevent hyperextension.
Additionally, it has been designed to be breathable and moisture-wicking at the back of the knee for heat and moisture regulation, to avoid skin irritation, and improve comfort.
This is a very good knee brace for hyperextension, for those who need moderate support. Or those recovering from a moderate knee hyperextension injury.
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What Is The Immediate Management Of A Hyperextended Knee
The first thing to do is apply your basic first aid management of a tissue injury. By applying PRICE and weight bearing as able for the first 24-72 hour period the symptoms will hopefully start to settle. The knee should then start to feel less acutely painful, accept load more readily and remove the sensation of giving way or buckling under load. If not, then seek an urgent physiotherapy opinion. During this phase anti-inflammatory medication may be of benefit and consulting your local pharmacist worthwhile.
Treatment For Genu Recurvatum
If a patient does not have an associated cruciate ligament and/or collateral knee injury present, the usual treatment is to attempt a rehabilitation program to see if the patient can improve their overall quadriceps strength to compensate for the symptomatic knee hyperextension. If this does not work, then possibly a biplanar proximal tibial osteotomy, where the patients posterior tibial slope is increased, may be indicated. While these are extensive surgeries, they have been well documented to decrease knee hyperextension and allow patients to return to a high functioning level.
Our treatment for isolated genu recurvatum is a proximal tibial anteromedial or anterolateral osteotomy that increases the patients posterior tibial slope. These surgeries have been found to be very effective in decreasing a patients knee hyperextension and returning them to increased activities after the osteotomy heals.
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How Do You Prevent Hyperextended Knee
Knowing what leads to hyperextended knee makes it easier to stop it from happening in the first place.
If you play high contact sports, you may not have control over the actions of the other athletes on the field. But doing your part can go a long way. Especially when it comes to practicing adequate technique.
Dont overexert yourself. Know your limits and stay within them. If you havent been active in years, dont start out running miles and miles.
Always stretch and warm up. Skipping stretching is just inviting something to go wrong.
Use good form. And avoid doing cardio on hard surfaces if possible. Because pavement doesnt give under your step, it places more stress on your joints.
Preventing hyperextended knee is extremely important. If it happens to you once, you may permanently damage your ligaments, increasing the chances of it happening again.
Common Knee Hyperextension Injuries
With a hyperextended knee it is common to injury one or more of the structures in and around the knee. In mild cases, knee hyperextension is not serious but if the knee bends back too far, usually more than around 10 degrees, then other structures, typically the knee ligaments and cartilage, can be damaged which can be more serious.
The most common injuries associated with a hyperextended knee are:
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How To Know If You Have Knee Hyperextension
Symptoms of a hyperextended knee include the following:
- Knee Pain. You may feel mild to severe pain in your affected knee.
- Poor Movement. You may find straightening or flexing your affected knee to have become difficult.
- Swelling. Swelling and stiffness may develop around your affected knee.
- Poor Stability. Your affected knee may feel weak, making it difficult for you to walk or stand.
Diagnosing The Knee That Is Hyperextended
Most of the time, a musculoskeletal physician such as a sports medicine specialist, an orthopedic surgeon, or a physiatrist can evaluate the knee and should use a diagnostic ultrasound with which they can classify the injuries. After the evaluation, if intra-articular damage is supected, they can send you for an MRI on the knee!
BUT, there are some simple things you can do on your own to see if you need to see a specialist to further investigate. Consider the following tests.
- Weight-bearing If you can stand on a single leg then that is a good sign, but if you are unable to weight bear on that leg, then potentially a bone bruise or ligament damage causing substantial instability can be present so you should see a specialist.
- Tenderness to palpation Compress the tissue around the knee and if you are not able to tolerate deep palpation without significant pain, the potential for high-grade injuries to the ligaments/tendons surrounding the knee exists.
- Swelling / bruising Inspect the top of the knee cap with the leg extended and if you are able to make out the quadriceps muscle and knee cap then significant swelling in the joint is unlikely, but if the contour is gone and puffy then its recommend to have a physician check it out!
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What Is The Treatment And Recovery Period For A Hyperextended Knee
For minor injuries, you may be able treat by using the above first aid protocol. Most minor injuries will settle down within a few days to a few weeks and may not always need a physiotherapists opinion. In more significant or major injuries or in an injury that persists beyond a few weeks you will require a proper assessment. Anything other than a minor injury will require a clear diagnosis and is where a physiotherapist will assess exactly what has been injured and the severity of the injury.
For moderate injuries the next focus is on getting the knee moving. Be careful straightening your knee as the body can remain protective for quite some time. But simply bending and straightening the knee within pain limits will encourage recovery. More importantly you will need to progressively load the knee during function and carry out a strengthening program given to you by your physiotherapist. This will concentrate on strengthening the quadriceps, hamstrings and calf muscles.
For more significant injuries you may also require a brace or crutches and may even require surgery. If you have this type of injury you need to have specialist physiotherapy advice and guidance throughout the recovery. Hyperextension injuries are difficult to self assess and some of them may require urgent care or surgery.
What Are The Symptoms Of Knee Hyperextension
Symptoms of a hyperextended knee may vary from mild to severe depending on how far backward the knee was pushed and the severity of damage to the ligaments and surrounding tissues.
Common symptoms of a hyperextended knee include:
- Feeling of weakness: Feeling a sensation of giving out or buckling of the knee.
- Instability of the knee: The affected knee is less stable or sturdy than the healthy one.
- Knee pain: Moderate to severe localized knee pain, mild to sharp pain in the back of the knee, or pinching pain in front of the knee joint.
- Limited mobility: Difficulty bending or straightening the injured knee due to damaged ligaments, swelling of the knee, and weakness in the joint and pain.
- Popping sound: A hyperextended knee that is accompanied by a popping sound or sensation indicates that one of the knee ligaments is torn.
- Swelling: Fluid accumulates within the knee joint called water on the knee, causing swelling that reduces knee mobility.
- Visible bruising: Mild or severe bruising may appear on the skin in response to the injured soft tissues, ligaments, and/or cartilage.
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