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Thread: Hyperextension

  1. #1

    Hyperextension

    I have hyperextension in my legs. I also have foot drop. Diagnosed with C1/C2 spinal cord injury. Would you know any exercises to use for hyperextension so not to wear out my knee - have had an orthoscopic surgery, don't want a knee replacement. Help

  2. #2
    Senior Member mr_coffee's Avatar
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    I wear un locked kafo on my left leg becuase of hyper-extension issues, after awhile it really kills ur knee's.

    I think i'm going to move to an afo that might also help reduce hyper-extension.

    But exercises, you need to stregthen your hamstrings, so you need to do hamstring curels, where u lift the back of ur heel to your butt. It may sound easy but wow is it tough for me on my good leg even, i can't do it on my bad leg.
    Injured:10-16-04
    C7/C8, T1 incomplete;


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  3. #3
    Hi Fayeboo,
    If you do not have any muscle weakness issues and it is purely a ligamentous problem then a functional knee orthosis could be used. Such as the lineman wear at football games. My preference as a clinician is the Townsend Rebel. It is light weight, off-the-shelf and low profile. Plus I believe the science behind their knee joint is better then some others.

    If you have a drop foot issue and your foot is in a plantarflexed position that can be leading in to your hyperextension as well. In this cas an AFO can be used to prevent the knee hyperextension and also give you a better heel toe contact. The AFO would require a plantarflexion stop.

    If the weakness is just at the knee but the ankle joint is fine and the muscle at the ankle are fine then a stance control KAFO would be approriate. There are ~7+ different stance control knee joints. Some are a lot more low profile then others but are indicated based on the patients clinical presentation.

    Good luck, hope that helps.

  4. #4
    Senior Member mr_coffee's Avatar
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    Orthotic Guy,


    Can an AFO properly prevent hyper-extension?

    My orthotic guy is confused on my case, when I walk, my left leg is constantly flexed, my quad is, making my quad very strong but I have no control over doing hamstring curels with my leg, even though I do have hamstring muscle due to it constantly being contracted when I walk.

    Because I walk without the KAFO being locked, he doesn't understand why I even need an KAFO to begin with but i should be using an afo. My doctor said if I walk with an AFO in the end i'll be screwing my knee's over after awhile of wear and tear. But I can't stand this kafo anymore i've been wearing it for 2+ years now and I feel its keeping me from recovering further.

    I just got a townsend KAFO which blows big time even have 12+ adjustments and 7-8 months later. I don't even wear it, instead I wear my old kafo.

    So i was thinking about asking the ortho to break it down and I can use it as an AFO rather than a KAFO.
    Injured:10-16-04
    C7/C8, T1 incomplete;


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  5. #5
    Mr. Coffee, Sorry to hear about your new KAFO. I like their Knee orthosis, but not a huge fan of their KAFO's. Not to say that other's aren't I just haven't had much luck. I've also had several patients who really love their townsend KAFO's.

    Anyway to answer your questions about wether I think you should be using a KAFO or an AFO. I think that an AFO can do the job in some cases, however not in all. Certainly if you are using a free motion knee joint then it is relatively only limiting the motion in the coronal and transverse planes and only limiting the sagital extension or hyperextension. In other words it is allowing your knee to go through a relatively normal biomechanical pattern and it's limitations may be neccessary to prevent further injury to your knee.

    I also think it is important to note that your physician who has actually has seen you in a clinic has said to you that a KAFO is important for you. Typically physician's do not like to over brace if at all possible and usually under bracing and ignoring of the other joints often occurs. I would stick to his suggestion.

    If you would like tell me some of the issues you are having with your current townsend KAFO and I can try to make some suggestions. Do you still live in CA? They are HQ'ed in Bakersfield,CA I could possibly set up for you to see someone there if you are interested. Is the footplate section laminated or plastic?

  6. #6
    Senior Member mr_coffee's Avatar
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    Orthotic Guy,

    I never lived in CA but I live in PA, and soon i'll be living in NC for a year. So everytime we need an adjustment we have to send it back to CA and wait 3 weeks for it to come back.

    My footplate is plastic now, it use to be laminate. Its also a full footplate, before it was only a half footplate.

    The problems i'm having now is the heel strike is all wrong, and when I walk all the pressure is towards the front of my foot, and its very hard for me to even keep my leg straight because the way the knee joint is.

    If you look at the knee joint, in the bent position, if you go directly down from the knee joint it lands right in the middle of my foot. Normal braces (even my ortho) told me, hm..thats odd. it seems your knee joint is pushed forward then he said, oh yah thats to allow more dorsi flextion to keep your foot from dragging.

    Well the problem is, yah great my foot doesn't drag but I can't straightne my leg, and when i walk its like i'm walking down hill constantly and its painful becuase i'm basically walking on the part right below your toes, like if you were walking on your tippy toes.

    My heel isn't even touching the foot plate and I have a huge strap around my foot but it doesn't stop it. Worse yet everytime I put weight on the kafo, my heel comes down on this edge of the foot plate, tearing into the back of my heel causing massive red marks and thats why I can't wear it.
    Injured:10-16-04
    C7/C8, T1 incomplete;


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  7. #7
    On the KAFO-What is the ankle joint set up like? At reast when it's not on you what position is it in? From there where can you move it? Are there rubber bands on the front or back of the joint? What is static standing like in the KAFO, is your knee bending are you being forced forward/backward? To be honest I'm not exactly sure what you mean by the knee joint position issue, maybe you can try to explain that a little differently.

    On your own Ankle- Is your heel cord tight? Do you have tone? Can you lift your ankle up? Can you push your ankle down?

    Sorry about the mistake, your picture reminded me of a pt. from CA I once saw for something. i think that's why I was confused.

  8. #8
    Senior Member mr_coffee's Avatar
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    Ortho,

    Thanks for the help.

    My other Ortho is trying to build up the heel for me at the moment so i won't have the brace back until friday. If i took pictures it would make more sense.

    The ankle joint is in dorsi flextion, alot. Infact, if i'm sitting on a chair the tip of my foot isn't even touching the ground.

    THe anke joint has no flextion, meaning its stuck in the dorsi position, with no rubberband assist, I tigthen it/losen it with a allen wrentch to put it in more or less dorsi flextion.

    If i try to take it out of that extreme dorsi flextion my foot will not clear the ground and for me to walk, i have to really hip hike and it tires me out quite fast.

    If I'm not wearing the KAFO and I put it in the up right position its at a diagnol.

    for istance instead of it being |_ it look like this /_
    / <-- thats my leg position
    _ <--- thats my foot plate to put it in perspective.

    So when I do a heel strike it really throws my knee forward.

    yes my heel is semi tight, but on my old KAFO I don't walk on my tippy toes. With this new kafo i do. I walk totally on tone on my left leg with planter flextion but again, for some reason with this new kafo it really makes it worse with the old kafo it doesn't kick my foot into planter flextion.

    No i can't lift my ankle up. Yes i can push my ankle down some what on a spasim.

    When I stand with the kafo on, I can't even hardly keep my leg streaight due to it being so slanted, i have to really lean foward with the kafo to keep my leg straight, becuase its like /_
    Injured:10-16-04
    C7/C8, T1 incomplete;


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  9. #9
    Senior Member mikek's Avatar
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    Mr Ortho ??/

    Mr Ortho,
    Very informative !! Can you make a suggestion on this :I have osterporious in my left knee and can't straighten it . Being bent I can't swim with it either. I did consult an orthopedic and he offered no help besides surgery to stretch the ligament. Any advice would be appreciated !!

    Mike

  10. #10
    Mr Coffee- So sometimes you do want a slant on the foot to leg section depending on what neutral is for you, but then you post under the foot, this may be what your orthotist is doing for you now. That being said it sound like you have too much Dorsiflexion in the brace which is naturally leading you to be unable to straighten your knee. The orthtotist needs to reduce the plantarflexion stop. This is easily done by unscrewing the screw in the back of the joint. I would allow some DF range but it should stop at ~5-10 degrees to then assist with heel off during gait.
    Are you tight in you heel cord? Is that why your heel keeps poping out of the back or is it your tone kicking in? or a combination?

    Mike, The real question is what is limiting you from straightening your knee. Is a bone issue or a tissue issue? If you have a bone issue that is limiting it then most likely the only solution is surgical.
    Tissue (ligaments or muscle tightness) issues have the potential to be solved by either static progressive or dynamic stretching orthotic devices. With Osteoperosis you have to be a little cautious about how aggressive this is done, but it's not a contraindication. To have a true long lasting change in degree the joint must remain under a stretch for a minimum of 15 minute sessions. If able to tolerate this or even longer is the reason why many orthotic devices for stretching purposes are used at night or during rest. That being said surgery can also solve those problems,but you must maintain after surgery as to not develope the problem again. I guess I'm conservative by nature but I would think to attempt the orthotic first and if results weren't occuring surgery second, but I'm probably bias.
    An example of a dynamic orthosis could be checked out if you googled ultraflex and a static progressive would be a step lock knee joint, many companies make such a joint such at OTS corp, Becker, Fillauer, etc.

    Good luck, I hope that helps.

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