Massage & Bodywork

MAY | JUNE 2015

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If you're a knee-locker and you've ever tried to stop, you probably appreciate how difficult it is to change. Maybe you've observed this tendency in clients and wondered if it was related to some of their aches and pains. Perhaps you've tried to use manual techniques to address the pattern in your clients, only to see them lock their knees when they get up from the table. Are hyperextended knees actually a problem? And if they are, is there anything manual therapy can do about this stubborn habit? In this column, we'll discuss factors involved in knee hyperextension, knee-locking's consequences for the rest of the body, and a multipronged approach to help clients shift this pattern. Referred to in medical literature as "genu recurvatum," locked knees appear to bend backward in standing. A common pattern among ballet dancers (Image 1), gymnasts, and runway models, knee hyperextension creates a straighter profile for the back of the leg. Dancers and gymnasts are often selected for this quality, and many go to great lengths to increase their knee hyperextension, to the point of having trainers sit on their extended legs to further elongate the back line of the leg. Unfortunately, what may be beautiful to the eye can also be difficult to live with. Knees, like the lower back and neck, are designed to have a slight lordotic (or backward- facing) curve (Image 2). Individuals who habitually stand with knee hyperextension that is greater than 5 degrees have more frequent knee pain, as well as poor proprioceptive control of knee extension. 1 Additionally, genu recurvatum is a predictor of ACL injury. 2 Although knee hyperextension may sometimes be a symptom of a serious medical condition such as Osgood-Schlatter disease, 3 it is more often a feature of a genetic predisposition to general joint laxity. Hypermobile joints (e.g., fingers, elbows, and wrists) move beyond the normal range with little effort. Generalized joint laxity occurs in up to one-third of the population, and is at least twice as common in women as men. 4 In a neutrally positioned knee, the head of the tibia supports the femur. In a locked knee, the tibia is slightly posterior to the femur (Image 3), making it impossible to transmit forces efficiently. Instead, there is constant strain on the knee's soft 106 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 5 technique MYOFASCIAL TECHNIQUES Working with Clients' Locked Knees By Bethany Ward and Til Luchau tissues, making them vulnerable to injury. What is more, when the femur and tibia are not stacked, the rest of the body must compensate—often resulting in problems at the ankles, hips, and low back, or even issues in the shoulder girdle and neck. Addressing locked knees is often crucial to creating long- term relief to problems elsewhere in the body. HYPEREXTENSION ASSESSMENT View your client from the side. If her knees are locked, you will notice a reversed or flattened knee curve (Image 2). In this pattern, the head of the fibula is posterior to the lateral malleolus (Image 3). Touch the back of the knee—you'll Hyperextended knees are common among ballet dancers. Notice how the knees appear to bend backward, with the tibia angled in relationship to the line of the femur. 1

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