[headline style=”1″ align=”center” headline_tag=”h2″]Introduction to Knee Extension


Knee extension is very important for normal human locomotion, running, squatting, and twisting.

When the knee is injured, operated on, or has OA, knee extension is usually lacking.

When rehabilitating the knee it is vital to increase this motion to normalize biomechanics and optimal movement patterns.

In this post, I am going to disclose several manual and exercise strategies to increase knee extension that I have found to be beneficial to my practice and patients.

[headline style=”1″ align=”center” headline_tag=”h2″]The Biomechanics of Knee Extension


The biomechanics of the tibiofemoral joint differ quite extensively from OKC to CKC. Both have a place in their treatment, but your strategy is going to differ when using OKC to CKC.

When mobilizing on the table, you can do the following glides to increase knee extension:

  1. Anterior glide of tibia
  2. Posterior glide of femur
  3. Unicondylar glide of tibia on femur


In contrast to the table methods, knee extension during gait requires three joints to help extend the knee.

For instance, the subtalar joint needs to supinate during TS, the ankle must have adequate dorsiflexion to slow down the tibia, and the hip must have adequate hip extension, abduction, and internal rotation.

Keep in mind for the screw home mechanism to occur their needs adequate rotation at the tibia and femur. Don’t neglect this in your assessment and treatment to increase functional knee extension.

Here is a sample video of me describing this in detail:

[headline style=”1″ align=”center” headline_tag=”h2″]Knee Extension Strategies


There is a million different ways to work on knee extension. Once you understand the mechanics, you can create your own exercises.

Some ideas that I think about when increasing knee extension is this:

  1. Reactivity of the patient
  2. OKC VS CKC knee extension
  3. Sport or Activity
  4. Bottom up or top down driver

In regards to bottom up or top down, this is the “driver” that creates the motion.

A driver is a subconscious reaction throughout the body. For instance, we get knee extension top down from the swing leg driving the stance leg.

In contrast, if back pedaling in football we get it bottom up. In these instances, your biomechanics change and so should your manual therapy and exercise strategy.

[headline style=”1″ align=”center” headline_tag=”h2″]Manual Therapy Strategies:

Knee Extension


Immediately after surgery or injury, manual therapy is frequently needed to help reduce swelling, pain, and apprehension. No matter what techniques you do, if the knee still has swelling, the knee will never extend. For this reason, always reduce swelling as first priority.

Secondly, manual therapy can be really great to help facilitate normal arthokinematics of the tibia and femur for normal gliding. If immobilized after surgery, the knee joint will need these crucial motions at the joint to move optimally.

Thirdly, although the knee may have normal A/PROM on the table, this doesn’t mean it will translate into function. For this reason, always be working on the hip and ankle/foot complex to get the knee to extend functionally. I have seen a handful of patients that have normal mobility on the table but lack it when walking and etc.






[headline style=”1″ align=”center” headline_tag=”h2″]Exercise Strategies For Knee Extension


Here are just a few exercise strategies that I quickly put together. They are not the end all be all but are some exercises that can increase extension of the knee.



[headline style=”1″ align=”center” headline_tag=”h2″]Conclusion


There are many different strategies and ways to increase knee extension from modalities, manual therapy, and exercise. Regardless of which path you take with your patients, understanding the biomechanics is crucial for your interventions. Give some of these strategies a try and leave a comment below on the outcome.

Have you found any other ways of increasing knee extension?

If so, hit REPLY and leave me a comment on how you are doing it 🙂