What is Knee Hyperextension after a Stroke?

Knee hyperextension is a common problem after a stroke.  Knee hyperextension is when the knee goes beyond a straight position. Yeah, not exactly natural looking or feeling. ?

vector image of knee hyperextension

Knee hyperextension (recurvatum) usually happens in the involved leg.  It is the most obvious when full body weight is placed on the leg (stance phase). For instance, when swinging the uninvolved leg during walking.

vector image of stance and swing phase.

This can create hip pain, back pain, and of course knee pain.  When the knee extends unnaturally during stance, it can also make it impossible to bend the knee to swing the leg through (swing phase). This might cause you to swing your leg out to the side to clear the ground.

vector image of knee hyperextension

What causes knee hyperextension after a stroke?

Knee hyperextension is caused by poor control in the muscles around the knee.  This can happen due to under-active hamstring muscles (muscles that bend the knee) or overactive quadriceps muscles (muscles that straighten the knee).

What are the best exercises to help decrease knee hyperextension after a stroke?

So, the focus of the exercises is two-fold. One is to relearn how to bend the knee by teaching the brain how to “turn off” the overactive quadriceps.  The second part of the exercise focus is to retrain the muscles that bend the knee.

The final part of the training will be relearning how to stand. The focus of standing will include learning how to engage the quadriceps enough to support your body weight, without going into hyperextension.

If you have made it this far, I am sure you really want to know “the how”.  So let’s get right to it…..

How to strengthen weak muscles around the knee to stop knee hyperextension after a stroke?

As I stated, part of preventing knee hyperextension is to retrain the muscles that bend the knee. Heel slides are an excellent activity for this. To perform a heel slide, you want to lay on your back.  Next, try and bend the knee by pressing your heel down into the mat (or whatever surface you are on 🙂 )

Heel slides:

knee hyperextension exercise one

Modified Heel Slide:

If you are unable to bend your knee with it flat on the bed/mat, here is a modification.


Next you want to try and straighten the leg in standing without hyperextension. Now, this might take a TON of practice so be patient. The main thing to focus on is maintaining a “crouched” position with both knees bent.

Step one

Shift your body weight to the involved leg

Step two

Try and step the uninvolved leg forward while maintaining a slight bend in the involved knee.

standing exercise for knee hyperextension



Other articles you may be interested in: 

Pontine Stroke: Everything you need to know

Pontine Stroke: Everything you need to know

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Full video the hamstring strengthening and standing progression