Terminal Knee Extension Exercises

Can’t straighten your knee completely? This blog post contains the best exercises to help reclaim the full amount of extension in the knee.

What is Terminal Knee extension?

Terminal knee extension refers to the end range of movement as the knee is completely straightened.

(Note: It is normal to have approximately 5 degrees of hyper-extension occurring in the knee joint.)

Why is it important to have Terminal Knee extension?

Terminal knee extension is a normal movement of the knee.

Limitations in knee extension is likely to negatively affect how the body moves (especially whilst walking) which may eventually lead to issues.

Why is it limited?

Generally speaking – knee extension is reduced following injury or surgery (eg. ACL repair, Total Knee Replacement, Meniscus repair) to the knee.

It can also be influenced by the way one walks.

Exercises to improve Knee Extension

1. Releases

If the muscles which are located behind the knee are tight, this can limit the amount of knee extension available in the joint.

Muscles located behind the knee:

• Popliteus
• Hamstring (Lower)
• Gastrocnemius (Upper)

Releasing any tightness in these muscles may help increase the amount of extension in the knee.

a) Hamstring

Instructions:

• Sit down on the floor with your leg straightened in front of you.
• Place a foam roller underneath the back of your thigh.
• Apply an appropriate amount of your body weight on top of the foam roller.
• Make sure to cover the entire length of the Hamstring.
• Continue for 1 minute.

b) Gastrocnemius

Instructions:

• Sit down on the floor with your leg straight in front of you.
• Place the back of the calf muscle on top of a foam roller.
• Place your other leg on top of this leg.
• Keep the leg that is in contact with the foam roller completely relaxed.
• Apply a downward pressure with the top leg.
• Rotate your bottom leg inwards/outwards to cover as much area as possible.
• Make sure to cover the entire length of the calf region.
• Continue for 1 minute.

c) Popliteus

Target area:

Instructions:

• Sit down on the floor.
• Place the back of your knee on top of a foam roller.
• Place your hand slightly above the knee cap.
• Apply a downward pressure.
• Move your knee from side to side the cover the entire area behind the knee.
• Continue for 1 minute.

Note: If you experience tingling and/or numbness in your leg whilst performing this release, you are likely pressing on a nerve. You will need to reduce the amount of pressure being applied.

2. Fascial Glide

Fascia is a connective tissue that interconnects all the structures in the body.

If this layer of connective tissue around the knee is not able to move/stretch/glide properly, this can limit the amount of knee extension.

Try these 2 techniques:

a) Back of Thigh

Instructions:

• Sit down on a chair.
• Start with your knee in a fully bent position.
• Place your finger tips underneath the back of your knee.
• Apply a firm pressure into the skin.
• Slowly glide your fingers up the back of your thigh as you progressively straighten your knee.
• Feel a firm pulling sensation at the back of your thigh.
• Perform 3-5 repetitions.

b) Back of Calf

Instructions:

• Sit down on a chair with your knees in a bent position.
• Place the tip of your thumbs on the upper portion of your calf muscle.
• Apply a firm pressure into the skin.
• Slow glide your thumbs downwards as you straighten your legs as you stand up.
• Feel the firm pulling sensation at the back of the calf.
• Perform 3-5 repetitions.

3. Joint Mobilization

Performing joint mobilizations can help reduce any tightness in the knee joint.

a) 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.
• Repeat 3 times.

b) 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.
• Shift the shin bone forwards and backwards.
• Repeat 30 times.

c) External Rotation of Tibia

The tibia (shin bone) will need to externally rotate relative to the femur (upper leg bone) as the leg straightens out.

Here is a technique that can help encourage this movement.

Instructions:

• Sit down on the edge of a chair.
• Straighten your leg out in front of you.
• Keep your leg relaxed throughout this exercise.
• Keep your knee pointing forwards at all times.
• Wrap both hands around the upper shin bone.
• Twist the shin bone outwards as you try to straighten your leg further.
• Repeat 30 times.

4. 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.

a) Knee Extension (with foam roller under ankle)

Instructions:

• Lie down on the floor.
• Place a foam roller underneath your ankle.
• Push your knee downwards as far as it will go.
• Relax your leg.
• Allow gravity to passively stretch your leg into extension.
• Hold for at least 10 minutes.

Note: If you would like to increase the stretch, you can place a heavy sack on top of the knee.

b) Prone Extension

Instructions:

• Lie facing downwards on the floor.
• Place the foam roller underneath the lower thigh region.
• Relax your leg into a straightened position.
• Allow gravity to stretch your leg.
• Hold for at least 10 minutes.
• Progression: Apply a weight to your ankle.

c) Knee Extension Exercise (Sitting)

Instructions:

• Sit down on a chair.
• Straighten your leg with your heel in contact with the floor.
• Relax your leg.
• Place your hands above the knee.
• Lean your torso forwards and apply a firm downward pressure.
• Make sure that you are able to tolerate the amount of pressure being applied.
• Hold for at least 5 minutes.

5. Stretches To Help Increase Knee Extension

Stretching can help reduce the tightness in the muscles that may be limiting the ability to completely straighten the knee.

a) Hamstring

Instructions:

• Place your foot onto a step.
• Straighten this leg.
• Keep your foot pointing forwards.
• Bend forward by hinging at the hips.
• Aim to feel a stretch in the back of your thigh.
• Hold for 30 seconds.
• Drive your heel firmly into the step for 30 seconds.
  • Aim to feel a contraction in the muscles at the back of the knee.
• Relax your leg.
• Move further into the stretch by leaning your torso forwards.
• Hold for 30 seconds.

See post: 9 Different Hamstring Stretches

b) Gastrocnemius

Instructions:

• Sit down on the floor with your leg straightened in front of you.
• Loop a towel around the forefoot.
• Keep your knee completely straight by pushing the knee downwards.
• Pull the towel with your hands.
• Aim to feel a stretch in the back of the calf.
• Hold for 30 seconds.

See post: 7 Gastrocnemius Stretches

6. Knee Extension Strengthening Exercises

How do I strengthen my knee extension?

Try out these exercises! They target the Quadriceps muscle group.

The following exercises have been arranged in ordered from least to most difficult.

Note: You may need to focus on the easier exercises before progressing to the more difficult ones.

a) Push Knee Down

Instructions:

• Lie down on the floor.
• Place a foam roller underneath your ankle.
• Push your knee downwards as hard as you can comfortably tolerate.
• Aim to feel a firm contraction in the thigh muscle.
• Hold for 5 seconds.
• Repeat 20 times.

b) Knee Extension over Foam Roller

Instructions:

• Lie down on the floor.
• Place a foam roller underneath your knee.
• Push your knee downwards onto the foam roller.
• Whilst keeping pressure onto the foam roller, straighten your leg as much as possible.
• Aim to feel a firm contraction in the thigh muscle.
• Hold for 5 seconds.
• Repeat 20 times.

c) Straight Leg Raise

Instructions:

• Lie down on the floor.
• Keep your knee completely locked straight throughout this exercise.
• Aim to feel a firm contraction in the thigh muscle.
• Lift your leg.
• Perform 20 repetitions.

d) Planks

Instructions:

• Assume the plank position. (See Above)
• Lock your knees straight.
• Aim to feel a firm contraction in the thigh muscle.
• Hold for 30 seconds.

7. Weight bearing exercises

The following knee extension exercises are more challenging than the previous exercises as they require you to load your body weight onto your knee.

a) Walking Backwards Against Resistance

• Tie a thick resistance band onto something in front of you.
• Hold the other end of the band with your hands.
• Walk backwards as far as the resistance band will allow you.
  • Focus on straightening your legs as you push your foot into the ground.
• Return to the starting position once the band has reached its maximum length.
• Perform 20 repetitions.

b) Knee Extension Against Resistance Band

Instructions:

• Wrap a resistance band around the back of your knee.
• Anchor the other end of the resistance band in front of you at knee height.
• Step backwards to create a firm amount of tension onto the band.
• Hold onto something for balance.
• Raise your other leg in the air.
• Straighten your leg against the resistance of the band.
• Aim to feel a contraction in the thigh muscle.
• Hold for 5 seconds.
• Repeat 20 times.

c) Step Up

Instructions:

• Place your foot onto a step.
• Shift your body weight onto the foot.
• Without using momentum, step up onto the step.
• Straighten your leg completely.
• Feel the contraction in your thigh muscles.
• Repeat 20 times.
• (If required – You can hold onto something for balance.)

d) Standing Knee Extension Exercise

Instructions:

• Hold onto something for balance.
• Stand on one leg.
• Perform a mini squat.
• Make sure to straighten your leg completely at the top of the movement.
• Perform 30 repetitions.

8. Patello-Femoral pain syndrome

If you experience pain in the front of your knee (underneath the knee cap) when you try to straighten your knee, you may be experiencing Patello-Femoral Pain Syndrome.

This refers to the knee cap grinding/rubbing onto the bone that is directly behind it.

Try this exercise to help loosen up the knee cap.

Knee Cap 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.

Note: You will likely benefit from seeing a healthcare professional to treat this knee problem directly.

9. Address your walking pattern

Are you walking with your knee bent and pushing through the balls of your feet?

This is commonly seen in people whilst using walking aids such as crutches.

Over time – the body can get used to walking this way… even after ditching the crutches!

Since the knee is constantly in a bent position whilst walking, it can eventually make the structures in the knee very tight.

This can make it very difficult to straighten the knee.

Aim: When you walk, the heel should come in contact with the ground first. To make this possible, the knee is required to adopt a straightened position.

10. Address your sitting

When sitting – the knee is kept in a bent position.

… This is not inherently a bad thing!

However – if you are in this position for significant amount of time, the knee can get accustomed to being in a flexed position.

Over time – the knee structures can become tight which can make it difficult to completely extend the knee.

Aim: Don’t sit all day! Try to take multiple breaks from sitting as often as you can.

Alternatively – You can also consider sitting with your knee in an extended position.

11. Surgical Intervention

If you have persisted with the suggested exercises for at least 6-12 weeks and have seen no improvement in your ability to straighten your knee, you may need to consider getting a review with a specialist.

Here are the main options they might discuss with you:

a) Manipulation under Anesthesia

This technique is usually performed following a Total Knee Replacement.

It involves the Orthopedic surgeon forcefully moving the knee joint to its full range of motion whilst the patient is under anesthesia.

The aim of this is to address tight structures, scar tissue and/or adhesions that might be limiting full knee extension.

b) Knee Surgery

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

Common knee surgeries include: ACL Reconstruction, Total Knee Replacement, Meniscus Debridement

c) Nerve Impingement

The L3 nerve supplies the thigh muscle and signals the knee to straighten.

If your L3 nerve is compressed in your lower back, this can limit the strength of the quadricep muscles and result in a decreased ability to extend the knee.

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Conclusion

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

The suggested knee extension exercises mentioned in this blog post will help you achieve this.

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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. For more information: Medical Disclaimer.