Muscle Testing: Knee Flexion + Extension

Muscle testing
Knee flexion + extension

Knee flexion
Muscles
Biceps femoris
Semitendinosus
Semimembranosus
Range
0 to 135 degree
Grade 5 (Normal), Grade 4 (Good),
and Grade 3 (Fair)
HAMSTRING MUSCLES IN AGGREGATE
Position of Patient: Prone with limbs straight.
Test may be started in about 45 ° of knee flexion.
Position of Therapist : Standing next to limb to
be tested. Hand giving resistance is contoured
around the posterior surface of the leg just above
the ankle .Resistance is applied in the direction
of knee extension for Grades 5 and 4.
The other hand is placed over the hamstring
tendons on the posterior thigh
Test: Patient flexes knee while
maintaining leg in neutral rotation.
Instructions to Patient: "Bend your
knee. Hold it! Don't let me straighten it."
MEDIAL HAMSTRING TEST
(SEMITENDINOSUS AND
SEMIMEMBRANOSUS)
Position of Patient : Prone with knee flexed

to less than 90° . Leg in internal rotation (toes
pointing toward midline).
Position of Therapist : Hand giving
resistance grasps the leg at the ankle.
Resistance is applied in an oblique direction
(down and out) toward knee extension .
Test: Patient flexes knee, maintaining the
lower leg in internal rotation (heel toward
examiner, toes pointing toward midline).
LATERAL HAMSTRING TEST (BICEPS FEMORIS)
Position of Patient: Prone with knee

flexed to less than 90° . Leg is in external
rotation (toes pointing laterally).
Position of Therapist : Therapist resists
knee flexion the ankle using a downward
and inward force
Test: Patient flexes knee, maintaining leg
in external rotation (heel away from
examiner, toes pointing toward examiner)
Grading the Hamstring Muscles (Grades 5 to 3 )
Grade 5 (Normal) for All Three Tests:

Resistance will be maximal, and the end
knee flexion position (approximately 90° )
cannot be broken.
Grade 4 (Good) for All Three Tests: End
knee flexion position is held against strong
to moderate resistance.
Grade 3 (Fair) for All Three Tests: Holds
end range position but tolerates no resistance
Grade 2 (Poor)
Position of Patient: Side-lying with test limb (up-

permost limb) supported by examiner. Lower limb
flexed for stability.
Position of Therapist : Standing behind patient at knee
level. One arm is used to cradle thigh, providing hand
support at medial side of knee. Other hand supports the
leg at the ankle just above the malleolus
Test: Patient flexes knee through available range of
motion.
Instructions to Patient: "Bend your knee."
Grading
Grade 2 (Poor): Completes available range of motion
Grade 1 (Trace) and Grade 0 (Zero)
Position of Patient: Prone. Limbs are

straight Knee is partially flexed and
supported at ankle by examiner.
Position of Therapist : Standing next to test
limb at knee level. One hand supports the
flexed limb at the ankle. The opposite hand
palpates both the medial and the lateral
hamstring tendons just above the posterior
knee.
Test: Patient attempts to flex knee.
Instruction s to Patient : "Try to bend
your knee."
Grading
Grade 1 (Trace): Tendons become
prominent, but no visible movement
occurs.
Grade 0 (Zero): No palpable contraction
of the muscles; tendons do not stand out.
Muscle testing
Knee extension
KNE E EXTENSION
Muscles
Quadriceps femoris
1. Rectus femoris
2. Vastus intermedius
3. Vastus lateralis
4. Vastus medialis longus
Range
135 to 0 degree
Position of Patient:
Short sitting. Place wedge or pad under the distal thigh to
maintain the femur in the horizontal position. may replace the
padding under the thigh with his or her hand Hands rest on
the table on either side of the body for stability, or may grasp
the table edge. The patient should be allowed to lean
backward to relieve hamstring muscle tension.
Do not allow the patient to hyperextend the knee because this
may lock it into position.
Position of Therapist : Standing at side of limb to be tested.
The hand giving resistance is contoured over the anterior
surface of the distal leg just above the ankle. For Grades 5
and 4, resistance is applied in a downward direction in the
direction of knee flexion.
Test: Patient extends knee through
available range of motion but not beyond
0° .
Instruction s to Patient : "Straighten
your knee. Hold it! Don' t let me bend it."
Grading
Grade 5 (Normal): Holds end position

against maximal resistance.
Grade 4 (Good): Holds end position
against strong to moderate resistance.
Grade 3 (Fair): Completes available
range and holds the position without
resistance
Grade 2 (Poor)
Position of Patient: Side-lying with test limb

upper-most. Lowermost limb may be flexed for
stability. Limb to be tested is held in about 90 °
of knee flexion. The hip should be in full
extension.
Position of Therapist : Standing behind patient
at knee level. One arm cradles the test limb
around the thigh with the hand supporting the
underside of the knee. The other hand holds the
leg just above the malleolus.
Test: Patient extends knee through the
available range of motion. The therapist
supporting the limb provides neither
assistance nor resistance to the patient's
voluntary movement. This is part of the
art of muscle testing that must be
acquired.
Instructions to Patient: "Straighten your
knee."
Grading
Grade 2 (Poor): Completes available

range of motion.
Grade 1 (Trace) and Grade 0 (Zero)
Position o f Patient : Supine.

Position of Therapist : Standing next to
limb to be tested at knee level. Hand used
for palpation should be on the quadriceps
tendon just above the knee with the
tendon "held " gently between the thumb
and fingers.
Test : Patient attempts to extend knee.
Instruction s to Patient : "Push the back
of your knee down into the table." OR
"Tighten your kneecap".
Grading
Grade 1 (Trace): Contractile activity can

be palpated in muscle through the tendon.
No joint movement occurs.
Grade 0 (Zero): No palpable contractile
activity.

Muscle Testing: Knee Flexion + Extension

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Muscle testing

Knee flexion + extension

Position of Patient : Prone with knee flexed

Position of Patient: Prone with knee

Grade 5 (Normal) for All Three Tests:

Position of Patient: Side-lying with test limb (up-

Position of Patient: Prone. Limbs are

Grade 5 (Normal): Holds end position

Position of Patient: Side-lying with test limb

Grade 2 (Poor): Completes available

Position o f Patient : Supine.

Grade 1 (Trace): Contractile activity can

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