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Thread: hyperextended knee

  1. #1

    hyperextended knee

    Does anyboby know if there is any long term affects to walking on a hyperextended knee?

    Im a full time walker, using one crutch. My problem is that my left leg is very strong, while my right leg is alot weaker and is always sitting back in a hyperextended fashion.

    Bracing has never been suggested to me. I wore an afo for the first 6 months but that was purely for my ankle lift.

    My physio told me that i will get no long term affects from walking this way, but im starting to question this as have experienced pain in right knee when walking for extended periods.

    Has anyone out there experienced this problem and fixed it? If so how? If i keep exercising it and strengthen the muscle will my knee naturally fix its self an stop hyperextending?
    Thankyou

  2. #2
    Senior Member mr_coffee's Avatar
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    i'm suprised a doctor would tell you that, common sense says yeah, thats going to screw your knee if u keep walking with it constantly hyperextending. But then again all the Docs i seem to find seem to of gotten their degree out of a cracker jack box.

    I also had your problem, It ended up screwing my knee up and sending me back a ton in progress. I went from taking steps without any device, no braces, to a wheelchair becuase of my knee injury from not proper bracing. Now i'm back to walking again with forearm crutches and an unlcoked kafo.

    My only solution was putting a huge a$$ KAFO on my left leg, that way it kept it from hyperextending. I took the latch out so i could still kick my quads in when i take a step.

    I tried cutting my KAFO down to an AFO and it would still hyperextend it. But you might have more return than me, i'm unable to do a leg curl or a hamstring curel in my left leg but i can ride a recumbant bike that kicks it in.
    Last edited by mr_coffee; 06-27-2006 at 12:21 AM.
    Injured:10-16-04
    C7/C8, T1 incomplete;


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  3. #3
    aussie chick, I experience hyperextension similar to what you describe. I walk with a cane and my right leg, much weaker than my left, will hyperextendif I walk unbraced. I use an AFO which is quite effective in protecting my knee, because that is what this particular AFO is designed to do.

    I disagree with your therapist, there are some very serious long-term issues with knee hyperextension. To learn more, do a web search on "genu recurvatum", the medical term for the condition. I, too have had a PT tell me that I didn't need any support for knee hyperextension. However, I know my body better than a PT and this is not the case for me.

    If you cannot correct this by strengthening your muscles, particularly your hamstring, it can be corrected with bracing. From my understanding, knee braces are usually not effective in the kinds of issues people with SCI usually have. AFOs often work well. There are two reasons for this. I will try to explain.

    First, many of us have trouble dorsiflexing, that is raising our foot up. If you don't dorsiflex well, when you swing your leg through for a heel strike, you don't land on your heel. This puts you at a disadvantage as it becomes easier to hyperextend your knee as your body moves over your foot and weights your leg.

    An AFO will give you a good heel strike because it will keep your foot up. Then as you move your body over your leg to weight it, this is what happens. The AFO, because of the support of the plate under your foot, the top of your shoe over your arch, and at the back of your calf below your knee, prevents your knee from snapping back as you weight it. It may seem counter-intuitive since it is below your knee, but an AFO can provide a lot of stability and support to your knee, if it is designed to.

    In some extreme cases, it takes a KAFO to protect the knee. Cory, I don't know if you are really in this category or not.

    To both of you, I strongly recommend you find an orthotist who is skilled in working with people with gait problems due to neurological deficits. I am not an expert in this. But I know what has worked for me, and I have had to advocate on my behalf to get what I need. In my case, my rehab doctor has been helpful as he recognized some years ago that these issues could be a problem for me. But I have done quite a bit of research on my own on this topic to satisfy myself that this is both necessary and prudent.

    The down side to bracing is that it does compensate for weak muscles. It is very important to keep those muscles strong through appropriate exercises, as well as make sure you don't lose range of motion in your ankle.

  4. #4
    Senior Member mr_coffee's Avatar
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    Bruce,

    My bad leg (the one with the kafo) on it has more push than my good leg. But when i try to walk with just an AFO (by just taking the top piece off) my leg will rotate inward, it doens't hyperextend like it use too from constant stimming of the hamstring. But the inward rotation is what kills me i think, putting stress on ligaments around the knee espeically the vastus lateralis.

    I know your not an ortho guy but u know your stuff. Do you think a proper AFO would prevent this? ALso my foot doens't even stay in the afo, I can feel it coming out of the afo when i take a step and then my kneel will dig into the afo when i take a step. What do you use to keep your foot in the AFO other than the shoe? I have 2 velcro straps.


    i'm going down to state college to live soon so hopefully i can find a good ortho there that can give me other bracing options rather than just saying, well cut this brace down.


    Thanks!

    -Cory
    Injured:10-16-04
    C7/C8, T1 incomplete;


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  5. #5
    Thanks for your helpful info guys,
    I agree, i think i better do something about this knee before i do permanent damage. I've been on a 2mth break from pt, going back next week so i will be pushing to see a orthotist asap.

    Bruce, i have dorsi flection in right ankle, but can not raise it as high as left. I sometimes try to walk on a slightly bended knee but it snaps back straight away. Will you have to wear your afo forever?

    So Mr Coffee if i want to stop my knee hyper- reflexing do i have to work my hamstrings? Im hoping i can correct this problem with exercise alone. Just not sure what area to exercise. Can u suggest any exercises to help?

    I kind of look at returning to an afo as a step backwards, but if its what i need then thats what I'll do. I just couldn't stand wearing it through summer, which is why i ditched it. i think by not wearing it my ankle actually got stronger. I know this will not be the case with my knee.

    Mr C, ive also got a recumbant bike. i think its been helpful to my recovery also.

    I will keep u posted once i see my PT. Thanks

  6. #6
    Senior Member mr_coffee's Avatar
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    Aussie, It sounds like you can functionally work your hamstring with maybe ankle weights. As Bruce said, you need to strengthen your hamstring mainly to prevent hyperextension. I greatly reduced my hyperextension problem
    with constant e-stim but took forever. It will be alot faster for you if you can do actual exercises for your hamstring.

    You can lay on your stomach, strap a ankle weight on your bad leg, and do hamstring curels or you can also do standing hamstring curels maybe with the support of a walker if your worried about balance. The motion is trying to bring the kneel of your foot your butt. You can also try to do bridges, that will work your hamstring as well as your glutes/abs.

    Goodluck!
    Injured:10-16-04
    C7/C8, T1 incomplete;


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  7. #7
    I can not beleive that a colleague would say that there is no harm from knee hyperextension. Ask the the therapist to walk with that gait pattern for a couple of weeks and see if they are hitting the ibuprofen. Bracing should be used/monitiored and justed to make sure that provides the necessary support as muscle function changes.
    Wildwilly

  8. #8
    I just went to an orthotist today concerning whether or not i had "drop foot" and a hyperextending knee. After a conversation with "mr coffee" i began to question myself. I honestly didn't think i did have drop foot because i don't tend to stub my toe when walking etc. After a conversation with "ortho man" he suggested my body has compensated for the foot drop by stepping higher. That is exactly what is happening. I don't step real high, but just enough to clear the toe. Since i have strong hip flexors, that is what allows that. (news to me). So, then we checked to see what is causing pain behind the knee (right tendon). He says i don't have enough of a hyperextended knee to warrant any kind of brace at this time. He was in agreement that if at all possible, while healing, try not to support muscles etc. Down the road, if i have plateaued and knee is more painful, then i could try a orthotic. So for now, i just need to keep at it.

  9. #9
    Thanks Mr Coffee, Bringing my heel to my backside while lying on my stomach is really tough for me to do with right leg. You have given me a new exercise to work on.
    Im not sure why Pt told me walking on hyperextended knee wouldn't do long term damage. He's an awesome physio and hes helped me so much. I will be asking him about this next time i see him.

  10. #10
    Quote Originally Posted by mr_coffee
    Bruce,

    My bad leg (the one with the kafo) on it has more push than my good leg. But when i try to walk with just an AFO (by just taking the top piece off) my leg will rotate inward, it doens't hyperextend like it use too from constant stimming of the hamstring. But the inward rotation is what kills me i think, putting stress on ligaments around the knee espeically the vastus lateralis.

    I know your not an ortho guy but u know your stuff. Do you think a proper AFO would prevent this? ALso my foot doens't even stay in the afo, I can feel it coming out of the afo when i take a step and then my kneel will dig into the afo when i take a step. What do you use to keep your foot in the AFO other than the shoe? I have 2 velcro straps.


    i'm going down to state college to live soon so hopefully i can find a good ortho there that can give me other bracing options rather than just saying, well cut this brace down.


    Thanks!

    -Cory
    Cory, I don't know for sure if an afo will work for you. In my case, I don't have the rotational stuff going on that you do. I do think there's a very good chance that a well designed orthosis will help you .. just cutting down a kafo is not going to "cut" it (sorry 'bout that ) .. I just use my shoe to support the lower part of the afo, though if you needed more I'm sure there are ways to make sure you get proper support. Plus the design and shape of the footbed can have a great effect on how the orthosis supports your leg and foot. My afo is hinged at the anlke so that may make it more flexible and compliant. I'm guessing your kafo is not hinged at the ankle.

    Here's an interesting web page, though the language is quite technical and dense. Still I have been able to understand most of what it's saying.

    http://www.oandp.org/jpo/library/1998_02_026.asp

    From your description, I'm guessing you have the potential to develop some type of External Rotary Deformity Recurvatum .. external because your knee is rotated external to your foot. Since I'm not an expert, I don't know what that really means in terms of treatment. But the fact there is a name for it means that people have thought about what can be done about it. I hope when you get to State College you can find someone helpful.

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