Q&A Time!

What techniques do you use to improve knee extension?

Most knees should have 10 degrees of hyperextension with a firm end feel. I'm always surprised when even seasoned PTs taking my courses or in the beginning of fellowship tell me it should be bony, like the elbow. Here are the techniques I use to improve a stubborn loss of knee extension, as sometimes that last bit of hyperextension or even to neutral are the hardest to get back

IASTM to the:

quadriceps

promoting tissue folding improves knee extension, tissue should not only lengthen, it should contract and restricted tissues have difficulty moving both ways
my analogy to patients is adhesions are like starched clothing, it would neither fold nor stretch

hamstrings

naturally working on the knee flexors would improve knee extension

so many lower quarter issues could use some ITB work, from PFS, ITB friction syndrome, hip capsular patterns, unilateral lumbar derangements, SIJ dysfunction (if you believe in it), lateral femoral cutaneous nerve entrapment, and general loss of knee extension

gastroc/soleus

will improve knee extension as well, concentrating on the proximal lateral aspect, which is often restricted

Functional release to the:

psoas and iliacus

you would be surprised how many clinicians only mash at the knee in femoral posterior glides and tibial anterior glides to improve knee extension, then look at the knee in supine, and it's not extending due to a lack of hip extension! - even happened to me this year!

Mobilization with movement:

contrary what we learn about knee extension requiring tibial external rotation for the screw home mechanism, the mobilization with movement of tibia internal rotation works to improve both flexion and extension
if internal rotation is not working, I try external with open chain, then closed chain

HEP

it's simple progress from open chain repeated knee extension AROM 10 times/hourly to closed chain with light load and light overpressure into end range 10 times/hourly