Fixing Hyperextended Knees When Standing

I am a personal trainer. A female client of mine stands with her knees in hyperextension. She has been doing this for a number of years, although I'm not sure how long exactly. As a result, the second posture image in this very short PDF looks very familiar:

http://www.musmed.com.au/hyperextended_knees.pdf

The PDF doesn't show any corrective exercises. Do you know of any exercises that will help to correct/fix knee hyperextension during stance and the effects it causes? Is it a case of fixing the hyperextending knees and the rest will follow? For what it's worth she is also hypermobile.

Also, would this kind of stance lead to pain in the shins like shin splints or compartment syndrome?

Thanks in advance!

Hi Inersha

In my experience hyperextension at the knees is usually coupled with increased lumbar lordosis, anteriorly tilted pelvis and reduced core stability. Correcting the pelvis to a neutral position will make it harder to hyperextend the knees and will improve whole body alignment. A feeling of instability is common when the body is held in this new posture but is overcome the more it is practiced and subsequently as greater control is gained .

People with hypermobility should refrain from taking their joints to the end of their range to reduce the risk of joint damage. The feedback systems within hypermobile joints can be less effective and the overstretching of joint structures may not be fedback to the client making the joint vulnerable to injury.

You cannot reduce the increased range at hypermobile joints but you can strengthen the muscles surrounding the joints to provide stability and to 'brace' the joint and thus increase the control. This means that the person can 'actively' work to maintain the joint in a neutral position and thus avoid over extending.

I would therefore recommend starting with postural correction, pilates based core stability exercises, and general strengthening exercises that do not take the joints beyond 'normal' and that are practiced with the body in alignment and the core 'switched on'.

Yes, hyperextension at the knee may predispose to shin splints as the direction of forces going through the foot and ankle complex are altered due to a more dorsiflexed ankle position. Over-pronation ( rolling in ) of the foot can also add to this.
Are you referring to Acute Compartment syndrome or chronic exertional (CECS)? My experience with this rather limited I'm afraid but I hope I've offered some help with your other quieries.

Okay, disappeared reply. So this time I'm doing short form.

ClaireLouise raises great points.

Also no stretching, foam roller instead, so joints are not overstretched. Bracing can help as your client's ligaments are stretched in the knee, so knowing optimal stop may be difficult for her to get a handle on. Posture correction with mirrors, awesome so the client can see what you are talking about.

Hypermobility can definitely cause a lot of muscular pain and issue. These clients are often in a lot of pain.

No stretching, foam rolling instead, posture awareness, strengthening, bracing, all can be great aids. Also awareness of trigger points and what they are. Recommend: Clair Davies Trigger Point Therapy Workbook.

An often useful exercise is step ups or step throughs over a step. The point of this is to get a repetitive quadriceps contraction without bringing the knee out of a flexed position