Many athletes with hypermobile knees can extend their knees farther than normal. You may notice these athletes standing around on one leg with their knee completely locked out—or even pushed backward into hyperextension.
This position might feel stable because the athlete is resting on the structures behind the knee instead of actively using their muscles. Because of their hypermobility it takes them more effort to actively contract their muscle to stand without bending their knee the wrong way. But repeatedly hanging out in this position, and especially tumbling or landing in this position during sport, often causes pain in the knee over time.
One common problem I encounter with these individuals is that they can experience pain in the front of their knee as well as the back of the knee. And when they experience pain in the front of the knee they often receive an incorrect diagnosis of patellar tendinitis or Osgood-SChlatter’s Disease. These diagnoses are treated differently than pain caused by knee hyperextension which leads to frustrated athletes receiving rehab for longer than expected without significant result.
Front-of-Knee Pain Can Be Deceiving
When an athlete reports pain near the kneecap or patellar tendon, they may be diagnosed with patellar tendinopathy. Younger athletes with pain near the top of their shin may be told they have Osgood-Schlatter’s disease.
These are legitimate causes of anterior knee pain, but the location of the pain does not tell us the entire story. An evaluation should also look at how the athlete stands, walks, lands, changes direction, and controls their knee.
In my experience if an athlete has a tendency for instability in single leg stance or landings and has a habit of locking out their knee for stability, then hypermobility is likely related to their knee pain.
Traditional treatment often emphasizes strengthening the quadriceps which is important for many types of knee pain. But this is not a good idea for someone who frequently straightens their legs too much.
When hyperextension is contributing to the problem, rehab should instead focus on the athlete’s ability to control the knee with the hamstrings.
Why the Hamstrings Matter
The hamstrings bend the knee, but they also help protect the knee from moving too far into extension. They provide muscular control instead of allowing the athlete to depend on the joint’s passive structures for stability.
For a hypermobile athlete, simply having flexible joints is not necessarily the problem. The bigger concern is whether the athlete has enough strength and control to manage that extra range of motion.
Effective rehab typically needs to address three important areas.
1. Protect the Knee From Repeated Hyperextension
The first priority is helping the athlete recognize and control the position of their knee.
Many athletes do not realize that they are standing with their knees locked backward. And they may not have made the connection between locking out their knee and worsening pain. They may need to relearn how to stand with a small amount of knee bend while keeping the muscles around the joint active.
Rehab should emphasize hamstring strengthening to help the athlete gain better control as the knee approaches full extension. The goal is not to prevent the knee from ever straightening. It is to prevent the athlete from repeatedly collapsing into the end of their available range without muscular control.
Early in treatment it’s often a good idea to use tape behind the knee to provide helpful feedback and temporary support. Athletic tape can offer firm restriction to complete block end range of knee extension. This is important when an athlete has significant instability. A less restricting form of taping is the use of KT tape. This tape is stretchy and allows for full knee extension while assisting the hamstrings in their effort to add control to the position. Taping should be selected and applied based on the individual athlete—it is an aid, not a replacement for strengthening and movement training.
2. Improve Stability Throughout the Entire Leg
Knee hypermobility often does not exist by itself. Hypermobile athletes often also have increased movement at the ankles, hips, or lower back.
As a result, these athletes often struggle with single-leg stability. They frequently lock their knees to create an artificial sense of support, in addition to their knees knocking together on landings or collapsing inward from poor hip control.
This becomes important in sports because athletes spend a significant amount of time on one leg. Running, cutting, jumping, landing, kicking, and changing direction all require the body to control force through a single leg.
Rehab should challenge the athlete’s ability to maintain a stable foot, knee, hip, and trunk. These exercises should gradually become more difficult and more similar to the demands of the athlete’s sport.
3. Build Power From Stable, Protected Positions
Improving strength and balance is only part of the rehab process. Athletes eventually need to produce and absorb force quickly.
However, adding speed and power before the athlete can control their knee may reinforce the same movement pattern that contributed to their injury in the first place.
Power exercises should begin from positions in which the athlete can keep the knee stable and protected. From there, rehab can progress to jumping, landing, sprinting, cutting, and other sport-specific movements.
The goal is not only to make the athlete stronger. It is to teach them how to use that strength when the speed and intensity of their sport increase.
Treat the Movement, Not Just the Location of the Pain
Two athletes can experience pain in the same area for completely different reasons.
That is why a thorough evaluation should look beyond where the athlete hurts. It should identify how the athlete uses their entire body and whether repeated knee hyperextension is contributing to the problem.
For athletes with hypermobile knees, rehab may need to include hamstring control, single-leg stability, and progressive power training—not only exercises focused on the front of the knee.
When we identify the movement contributing to the pain, we can build a more complete plan that helps the athlete return to sport stronger, more confident, and better prepared.
Ready to Stop Locking Out and Start Moving Better?
If your knee pain continues to return—or you have been strengthening your quads without seeing enough improvement—knee hyperextension may be part of the problem.
At Baldi Movement Group, we evaluate more than the painful area. We identify how you stand, move, land, and produce force so we can build a personalized rehab plan for the demands of your sport.
If you are ready to understand what is contributing to your knee pain and return to sport with greater strength and control, schedule an evaluation with our team today.