Thursday Thoughts: There is no Hyperextension | Modern Manual Therapy Blog

Thursday Thoughts: There is no Hyperextension

Today's Thursday Thoughts aims to clear up another widely held misconception. It's based on Monday's Q&A time discussion regarding McGill wishing McKenzie had never started instructing "Floppy push-ups."
Someone on one of my facebook pages said repeated extension in lying was ok to do, as long as "you do not push into hyperextension." Let's take a look at some things that have been proven not to cause joint degeneration
  • repeated manipulation
  • end range loading
  • movement
Wear and tear happens and as someone put it on the previous discussion, the more you drive your car, the more miles it gets on the odometer. It doesn't mean it doesn't run like a dream though with a little maintenance!

When I learning to be a "traditional" manual therapist, most of my instructors scoffed at repeated loading strategies stating they would
  • promote hypermobility
  • move the joint into the para-physiologic range (this would apparently be the range sloppy manual therapists manipulated in)
Since I am seemingly always telling others immediate soft tissue changes are not possible with hands on techniques, let's apply the same concepts to "hypertextension"
  • there is no "hyperextension" on the end range
  • repeated end range loading just fires mechanoreceptors, and in fact, if you find mobilizations/manipulations useful, repeated loading works just as well and patients can actually do them without you
  • ever treat a lax patient? They're still lax after you "stabilize" them
  • ever treat the systemically high tone, hypomobile patient? You cannot make them lax
Sure if you do any one movement too much, the nervous system may send out some warnings to stop, due to lack of variability and some tissue irritation, but short of rupture due to trauma, it is very unlikely end range loading would be done so much and so often, it would cause appreciable "break down."

Keeping it Eclectic...


  1. If you had a patient with knee pain with genu recurvatum, what would be your treatment approach? Would you promote repeated end-range loading into their "hyperextension" to decrease threat of movement?

  2. Since the best reset is novel, it depends on how long they spend at end range knee extension. If it's frequently and they static stand a lot, it may not work well.