Can’t bend your knee past 90 degrees without pain?

This blog post contains the best exercises and stretches to reclaim the full amount flexion in the knee.

Exercises to Help The Knee To Bend

STEP 1: Address Swelling
STEP 2: Releases
STEP 3: Joint Mobilization
STEP 4: Patella Mobilization
STEP 5: Contract/Relax Technique
STEP 6: Over Pressures
STEP 7: Stretches
STEP 8: Eccentric Exercises
STEP 9: Knee Flexion Strengthening Exercises
STEP 10: Walking Pattern
STEP 11: Surgery

STEP 1: Address swelling

A significant amount of swelling can limit the total amount of bend available in the knee.

(… which is a very common issue following an injury and/or surgery to the knee.)

Here are 4 quick and simple ways to address the swelling in the knee:

Swelling Massage

Instructions:

• Sit down on a chair.
• Rest your leg on a stool.
• Wrap your hands around the base of your knee.
• Firmly grasp the knee.
• Glide your hands up your leg towards you.
• Perform 30 strokes.

Compression Sock

Wear a compression sock around your knee throughout the day.

This can help reduce the amount of fluid build up in the knee.

(Note: Make sure that the compression sock is not too tight as this can cut off circulation to the rest of your leg.)

Elevation

Rest your leg in am elevated position.

This will use gravity to help minimize the accumulation of swelling in the knee.

Aim for 15-30 minutes per session, 3-5 times per day.

Keep The Leg Moving

General movements of the knee can move the fluid away from the knee.

Here is a simple exercise for you to perform:

Muscle Pump

Instructions:

• Sit down on a chair.
• Bend and Straighten your leg.
• Perform 30 repetitions.
• You can repeat this exercise several times throughout the day.

Apply Ice Pack

Applying ice to the knee regularly can help reduce the amount of swelling in the knee.

Note: Make sure that you do not apply the ice pack directly to skin as this can cause skin irritation.

STEP 2: Releases

Tightness in the structures at the front of the knee can limit the amount of flexion available in the knee joint.

These structures are required to lengthen to allow the knee to bend completely.

These structures include:

Releasing these tight structures can assist with unlocking more movement in the knee.

Thigh Muscles

Instructions:

• Lie down on your stomach.
• Place a foam roller underneath the front of the thigh.
• Apply an appropriate amount of your body weight on top of the foam roller.
• Roll your thigh up/down over the foam roller.
• Make sure to cover the entire thigh region.
• Continue for 1 minute.

Patella Tendon

Instructions:

• Sit down on a chair with your leg in front of you.
• Use your thumbs and apply a firm pressure over the Patella Tendon. (See above)
• Keep your leg completely relaxed.
• Whilst maintaining this pressure, move your thumbs side to side.
• Make sure to cover the entire length of the Patella Tendon.
• Continue for 1 minute.

(Note: Please be careful when using your thumbs as you apply firm pressures.)

Fascial Glide

There is a connective tissue (called Fascia) that envelopes all of the structures in the knee.

If this structure is unable to glide/move properly, this may limit the ability to bend the knee completely.

Try this exercise!

Instructions:

• Sit down on a chair.
• Place your leg in front of you.
• Keep the leg completely relaxed.
• Place your finger tips in the area above your knee cap.
• Apply a pressure with your fingers.
• Proceed to slowly drag your fingers towards you as you slowly bend the knee.
• Aim to feel a pulling sensation underneath your finger tips.
• Repeat 10 times.

Scar Tissue “Release”

Scar tissue will usually form along the incision site following any surgery to the knee.

The potential issue with this is that scar tissue tends to be less flexible.

(Note: I’d suggest you seek guidance from a healthcare professional before attempting this.)

Instructions:

• Sit down on a chair.
• Place your finger tips on top of the incision scar
• Apply a firm pressure.
• Slide your fingers side-to-side (perpendicular to the line of the scar).
• Continue for 1 minute.

STEP 3: Joint Mobilization

Joint mobilizations can loosen up tight joints to help improve the amount of flexion in the knee.

Knee Traction

Instructions:

(You will need assistance from a helper with this exercise.)

• Lie down on the floor on your back.
• Instruct your helper to grasp your ankle firmly.
• Relax your leg completely as your assistant pulls your leg.
• Hold for 30 seconds.

Note: You can also perform this exercise at different degrees of knee flexion.

Knee Joint Mobilization

Instructions:

• Sit down on a chair with your knee bent at 90 degrees.
• Firmly grasp the top of your shin bone with both of your hands.
• Keep your leg completely relaxed.
• Wiggle the shin bone forwards and backwards.
• Repeat 30 times.

Internal Rotation of Tibia

As your knee bends, there should be a degree of internal rotation of the Tibia occurring within the knee joint.

Poor internal rotation of the Tibia may limit one’s ability to fully bend their knee to end range.

Instructions:

• Sit down on a chair.
• Bend your knee as much as possible.
• Keep your leg completely relaxed.
• Wrap your hands around the top part of your shin bone.
• Twist your shin bone inwards.
• Perform 30 repetitions.

Internal Rotation of Tibia (Active)

Instructions:

• Sit down with your hip and knee bent at 90 degrees.
• Keep your knee pointing forwards throughout this exercise.
• Turn your lower leg inwards.
  • (Internal rotation of the Tibia bone)
• Make sure your foot does not lift off the ground.
• Repeat 30 times.

STEP 4: Patella Mobilization

There are multiple layers of soft tissue (muscle, tendon, fascia) that directly attach onto the knee cap.

Collectively – these tissues can pull the knee cap out of the ideal alignment.

If you experience a sharp pain around the front of the knee when you bend your leg, it is possible that your knee cap (Patella) is grinding against the bony surface of the leg bone (Femur).

The following Patella mobilizations will help stretch these tight layers.

(Note: Do not attempt this by yourself if you have a history of Patella Dislocations.)

Glides

Instructions:

• Sit with your leg relaxed in front of you.
• Use your thumb and index finger to firmly glide the patella in the following directions:
  • Up/Down
  • Side to Side
  • Diagonally
• Repeat 20 glides in each direction.

Tilts

Instructions:

• Sit with your leg relaxed in front of you.
• Use your thumb and index finger to firmly tilt the patella in the following directions:
  • Up/Down
  • Side to Side
  • Diagonally
• Repeat 20 tilts in each direction.

STEP 5: Contract-Relax Technique

This technique will help relax the tight structures (such as the muscles/tendons/fascia) that may be limiting the amount of bend in the knee.

Instructions:

• Sit down on high chair where your legs are able to dangle freely in the air.
• Bend your knee as far as possible.
• Place the foot of the other leg on top of the ankle.
• Use the foot at the top to push your knee into more bend.
• Apply as much pressure as you are able to comfortably tolerate.
• Hold for 30 seconds.
• Whilst keeping the foot at the top still, attempt to push the foot at the bottom against the back of the foot on top as hard as you comfortably can.
• Hold this contraction for 30 seconds.
• Relax your leg as you use the top leg to push your knee into more bend.
• Hold this for 30 seconds.
• Repeat for 2-3 cycles.

Note: DO NOT PUSH INTO PAIN!

STEP 6: Overpressures

The following exercises work best the longer you maintain the overpressure.

Apply as much pressure as you can safely tolerate for as long as you can.

Knee Flexion (on Chair)

Instructions:

• Sit on a high chair.
• Bend your knee as far as possible.
• Place your foot (from the other leg) on top of the ankle.
• Use the leg at the top to push your knee into more flexion.
• Apply as much pressure as you are able to comfortably tolerate.
• Hold for at least 1-5 minutes.

Knee Flexion (Prone)

Instructions:

• Wrap a band around your ankle.
• Hold the other end of the band in your hand.
• Lie down on your stomach.
• Bend your knee.
• Pull on the band to encourage the knee to bend as far as possible.
• Apply as much pressure as you are able to comfortably tolerate.
• Hold for at least 1-5 minutes.

Wall Lunge

Instructions:

• Place your foot onto a step.
• Have both of your hands supported onto a wall that is in front of you.
• For the leg on the step, keep the knee in line with your toes throughout this exercise.
• Apply as much of your bodyweight onto the leg that is on the step.
• Move your knee forwards as much as possible.
• Perform 20 repetitions.

Body Weight Overpressure

Instructions:

• Sit down on a chair.
• Have your feet flat on the floor.
• Place your hands on either side of the chair.
• Lift your hips off the chair.
• Lower your body as far as your knees will comfortably allow.
• Hold for at least 5 minutes.

Note: Be careful with this exercise if you have shoulder issues as it requires you to support your body weight on your arms.

STEP 7: Stretches

Once you are able to completely bend your knee, your leg will be able to adopt the position required to stretch the following thigh muscles more effectively.

Quadriceps

Instructions:

• Stand up right.
• Hold onto something for balance.
• Pull your ankle towards your buttocks.
• Stay up right and keep your knees in line with each other.
• Tuck your tailbone and drive your hips slightly forward.
• Aim to feel a stretch at the front of your thigh.
• Hold for 30 seconds.

Want more stretches for tightness in the thigh?

See Post: Quadriceps Stretches

Rectus Femoris

Instructions:

• Assume a kneeling lunge position in front of a couch.
  • Place a pillow underneath the knee. (If required)
• Completely bend the knee of the back leg and rest the top of the ankle on the couch.
• Keep your pelvis facing forwards throughout the stretch.
• Tilt your pelvis backwards.
• Push the hips forwards.
• Lunge forwards.
• Aim to feel a stretch at the front of your thigh.
• Hold for 30 seconds.

For more stretches to this muscle:

See Post: Rectus Femoris Stretch

Tensor Fasciae Latae

Instructions:

• Assume the forward lunge position.
• Keep your feet in line with each other.
• Proceed to lunge forward.
• Tuck your tail bone underneath you.
• Lean your hips towards the side of the back leg.
• Aim to feel a stretch in the front/outer side of your hip.
• Hold for 30 seconds.

For more TFL stretches:

See Post: Tensor Fasciae Latae Stretches

STEP 8: Eccentric Exercises

These exercises will help lengthen and strengthen the tight thigh muscles.

Controlled Squat Descends

Instructions:

• Hold onto a stationary object that is in front of you.
• Place your feet shoulder-width apart.
• Keep the knees in line with your toes throughout this exercise.
• Lean backwards so that your entire body weight is relying on your arms.
• Place most of your body weight onto your heels.
• Drive your hips backwards as you squat down as low as possible.
• Stand up to return to the starting position.
• Perform 20 repetitions.
• Progression:
  • Gradually reduce the amount of support being provided by your arms.
  • Squat deeper

Controlled Step Downs

Instructions:

• Hold onto a hand rail for support.
• Slowly step down with your good leg.
  • (The knee that you are targeting is the one that stays on the step.)
• Return to the starting position.
• Perform 20 repetitions.
• Progression:
  • Move slower.
  • Reduce hand rail support.
  • Use a higher step.

STEP 9: Knee Flexion Strengthening Exercises

The next step is to encourage strength and control in the muscles responsible for bending your knee.

Knee Flexion in Prone

Instructions:

• Lie down on your stomach.
• Bend your knee.
• Aim to feel a firm contraction at the back of the thigh.
• Hold for 5 seconds.
• Repeat 20 times.

Knee Flexion in Standing

Instructions:

• Stand up right.
• Hold onto something for balance.
• Keep your knees together throughout this exercise.
• Bend your knee as much as possible.
• Aim to feel a firm contraction in the back of the thigh muscle.
• Hold for 5 seconds.
• Repeat 20 times.

Heel Slide

Instructions:

• Sit down on a chair.
• Apply a downward pressure towards the ground with your foot.
• Drag your foot on the floor towards you.
• Aim to feel a firm contraction in the back of the thigh muscle.
• Perform 20 repetitions.

For more exercises to strengthen the muscles that are involved with bending the knee:

See Post: Hamstring Strengthening Exercises

STEP 10: Address your walking pattern

… Are you walking on the ball of your foot with the knee in a bent position? (See above)

This is commonly seen in people who are limping while they walk.

Over time – the body can get used to walking this way.

STEP 11: Surgical Intervention

If you have persisted with the suggested exercises for at least 3-6 months and have seen no improvement in your ability to bend your knee, you may need to consider getting a review with a specialist.

Here are a few things the Specialist might consider:

Manipulation Under Anesthesia

This procedure is where the Specialist will forcefully bend your knee multiple times whilst you are under the effects of anesthesia.

This will help mobilize any adhesions that may preventing your knee to bend completely.

(This procedure is occasionally performed after a Total Knee Replacement.)

Knee Surgery

If you have structural damage to your knee that is affecting the movement in your knee, you may need surgical intervention.

Nerve Impingement

The L5 nerve supplies the hamstring muscle and signals the knee to bend.

If your L5 nerve is compressed in your lower back, this will limit the strength of this muscle to bring the knee into a flexed position.

If this relates to you – Consider getting a review with a Neurosurgeon to address this issue.

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Conclusion

Reclaiming the full range of flexion in the knee is important as it allows for the normal function of the knee joint.

If you can’t bend your knee (especially past 90 degrees), the suggested exercises mentioned in this blog post will help you get back the full mobility of your knee.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek medical guidance before attempting any exercise and/or implementing any recommendation. For more information: Medical Disclaimer.