Knee Hyperextension Injury Guide
Posted by: Julie Graves | Head Athletic Trainer
Increase Range of Motion
Gradual Return to Play
Ice for 7-10 days 2-3 times per day for 20 minutes the area of pain.
Rest during this time as well.
You can begin heating after that time period as long as there is no residual bruising/swelling 1-3 times per day for 20 minutes with either an electric heating pad or a hot epsom salt bath.
Increase Range of Motion
- For knee flexion (bent knee): Sit on the ground and bend your knee. Slowly pull it towards you and then stop when you have pain. Continue doing this until you reach full flexion without pain.
- For knee extension (straight knee):
- Progression 1: Sit on the ground and let your knee fall to the ground, allowing gravity to do its job.
- Progression 2: Once you are able to straighten your leg with progression 1, roll up a towel and place it under your ankle, allow gravity to do its part so you reach terminal knee extension (full straight knee).
- Progression 3: Once you are able to have terminal knee extension with progression 2, sit on the ground and do a ‘quad set’ (flex your quad so your foot/ankle comes up off the ground) Hold for 3 seconds, repeat this 15-20 times 3x/day.
- Once you have full range of motion, progress so strengthening exercises.
- Hamstring stretch: 3×30” Sit on the ground with your legs straight and try and touch your toes. This should be uncomfortable like any stretch, but not painful. If you don’t feel a stretch this way where it hurts try rotating your leg outward and reach towards the outside of your foot.
- Once pain free with daily activities, you can get on a stationary bike or go on a light jog for about 20 minutes. Do this for a couple of days and as long as there is no soreness/pain you can begin the following exercises.
- Note: The following exercises should be done without pain. Being uncomfortable and fatiguing the muscle is one thing but there’s a difference between that and feeling pain.
- Step 1: Here is the first progression where I want you to start. Slow and controlled with both feet on the towel. Drop your butt after the eccentric motion and bring your feet back. Do 2×10 and you can drop sets/reps in the beginning if needed. Once you feel comfortable and strong with this you can increase sets/reps to 3×12-15.
- Progression 1: Bring one leg up like in this video but I still want this motion to be slow and controlled. Do 2×10 and again can drop sets/reps as needed in the beginning. Do both legs and you can progress to 3×12-15.
- Progression 2: You can use that same video in progression 1 and start doing a double leg quicker motion and then progress to single leg. Remember to always do both legs.
- Progression 3: Nordic Hamstring Fall
Return to Play
Each progression needs to be pain free before going to the next step.
Progression 1: Soccer passing, soccer specific drills
Progression 2: Non-contact practice
Progression 3: Non contact practice and conditioning i.e. sprints
Progression 4 : Full contact practice
- Hyperextension brace is a specific knee brace for hyperextension, however, I don’t think this is necessary as long as you follow all of the above protocols or you still feel slightly unstable when you begin the return to play protocol.
- Compression sleeve here is a recommendation but really any compression sleeve for her knee that fits her will work.
- Always remember to get a good dynamic warm up in before any activity/practice.
- You shouldn’t progress to the next step if you are still experiencing pain.
- Listen to your body, if something hurts modify or stop.