Regaining full terminal knee extension is paramount following any knee surgery. The ability to fully extend the knee equal to the other side is usually one of the most important early goals in knee rehab. While there are a ton of knee extension exercises you can do, the most important variable for regaining full terminal knee extension is the amount of volume and time spent working on knee extension. That is undeniably the most important concept to grasp. 3 sets of 1 min of stretches for a total of 3 minutes (out of 1440 minutes in a day aka 0.2% of the day) is just not enough end-range stretching to regain full knee extension! Aim for a total of 10 minutes of knee extension exercises at first, then slowly keep adding the time until you’re spending at least 30 minutes a day working on terminal knee extension.

 

Knee Extension Exercises & Tips

Knee extension exercises, especially after surgery, are not going to be comfortable. If they are comfortable, it probably means you’re not doing them correctly! Regardless of the surgery, there will be joint swelling, or effusion, in the knee that will not only cause more pain and discomfort but also limit the amount of motion available at the knee joint. Furthermore, the muscles around the knee will most likely be tense and guarded, meaning soft tissue work and stretching are also warranted. When working on terminal knee extension during your knee extension exercises, try to hold the position or stretch for as long as possible. That may be a few minutes or just 20 seconds! The goal is to work to that uncomfortable phase, then let your knee bend and relax for a minute or two, and then go right back to the knee extension exercise again. The more time you can spend in that end range stretch the better!

 

Do You Need Guidance On How To Achieve Knee Extension?

knee extension mobility program the prehab guys

This program is for anyone looking to truly [P]Rehab their knee before surgery OR work on regaining their knee extension after a surgery or injury. It’s appropriate for anyone regardless of current fitness level and will build you from the ground up to tolerate the end ranges of knee extension. For more about this program click HERE.

 

Passive Knee Extension Exercises

First, work on regaining full passive knee extension. Passive knee extension is the amount of knee extension/straightening that your knee has if you prop up your foot on a table or chair, letting your knee be suspended in the air.

 

Seated Knee Extension PROM

Sample Knee Extension Overhaul [P]rehab Program Exercise

 

Bang Hangs Knee Extension

Sample Knee Extension Overhaul [P]rehab Program Exercise

 

Active Knee Extension Exercises

It’s extremely important to follow up any passive knee extension exercise with active knee exercise exercises to “lock in” that hopefully newly acquired knee extension range. While the standing terminal knee extension (TKE) is the classic go-to exercise for active knee extension, there are a plethora of other options as well. The key component to every single one of them is to fire your quadriceps muscle and squeeze it as hard as you can. Your goal should be to try to feel a stretch behind the knee. Think of standing tall with each repetition! Below you will find a plethora of our favorite active knee extension exercises, which are all a part of our Knee Extension Overhaul [P]rehab Program that is proven to restore your knee extension!

Standing 3-Way Terminal Knee Extension

Sample Knee Extension Overhaul [P]rehab Program Exercise

 

Prehab Membership The Prehab Guys

The Prehab membership is the anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym! Taking control of your health with exercise & education from the palm of your hand has never been easier. Get access to 50+ programs, 100+ unique workouts, and 3000+ exercises to build your own workout routines. Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab!

 

Sled Pushes

READ: Knee Surgery [P]Rehab Exercises

knee surgery prehab exercises knee extension the prehab guys

 

Retro Walking

Sample Knee Extension Overhaul [P]rehab Program Exercise

 

Quad Sets with a Strap

LISTEN: KNEE EXTENSION AND GETTING BACK TO THE GYM

knee extension after surgery the prehab guys audio experience

 

Cueing for TKE with any closed chain knee exercise (squats, lunge, step-up)

 

Closing Thoughts

Having adequate knee extension is crucial for knee health and function. Moreover, if it is something that is not worked on early after surgery, it becomes very difficult to regain! There are a plethora of options in regards to exercises that are excellent for regaining knee extension, many of which we have exemplified in this article. Find what works best for you, and stick with it! Consistency is key. as you continue to have a better tolerance to these exercises, try to hold positions longer to have better carry over and ultimate improvements in range of motion!

 

Ensure You Gain The Knee Motion You Need!

knee extension mobility program the prehab guys

Knee extension is not just a recommendation it is needed! Hypothetically, you could walk on a bent knee but this is going to waste energy and ultimately limit your movement endurance. Instead, let’s get you moving efficiently by achieving and keeping full knee extension.

 

About The Author

Michael Lau, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Product Officer

Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California. As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients. A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach-prehab-can reduce the risk of injuries and pain in the first place. He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and return to sport for the lower extremity athlete.

 

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

About the author : Michael Lau PT, DPT, CSCS

18 Comments

  1. Rebecca Macijowsky December 16, 2019 at 6:23 am

    I had my left knee replaced in October 2017 & the right in May 2018. I walk every day, & I will admit don’t do enough exercise. My knees feel “tight” some days, would these classes help with that.

    • Michael Lau January 13, 2020 at 7:34 pm

      Yes they would! movement is medicine! Give them a shot and let us know how it goes!

  2. Linda Sumner August 1, 2020 at 3:35 pm

    I’m curious about the step back into a low lunge and then back to 1 legged stance (last video) – why step back at a 45 degree angle? Seems this might twist the front knee and is not a good idea for a “hinge” joint? But am eager to hear your rationale!
    Thank you, these are great videos/tutorials.

    • Michael Lau September 14, 2020 at 5:54 pm

      Totally fine! The movement is primarily in the sagittal plane as the knee joint is a hinge joint. However, there will always be some rotation as the knee moves from extensino to flexion that is normal!

  3. Mert Sarıışık September 18, 2020 at 2:03 pm

    I had acl surgery 2 years ago. At first i regained full symmetrical knee extension. But after 2 months i lost the progress and never get back. Now i have full knee extension on my acl leg but not symmetrical with other leg. Also i have pelvic instability. My right knee is locked in valgus position and feet laterally rotated. I sometimes feel if this position (alignment) limits the extension range. Can it be?

    Also, is it possible to regain symmetrical knee extension back after a long time from the surgery? İ heard that it is not possible to get VMO muscle back if you don’t have symmetrical extension. İs this correct?

    • Michael Lau September 18, 2020 at 4:28 pm

      Hi Mert,

      Yes, it can be possible to regain full symmetrical knee extension even after a long period after surgery – you won’t know until you try! VMO is just a muscle…you have it! Everyone has it. Any active extension exercise will hit it! We have a knee extension prehab program with tons of programming if youre interested in learning more: https://theprehabguys.com/program-knee-extension-overhaul/

  4. Dana Twombly February 17, 2021 at 3:44 pm

    Hi!
    I had an acl avulsion and never gained full extension after surgery. It has now been 5 months since the surgery. Is it too late to get full extension back? I feel like there is something impeding me from being able to lock the knee

    • Sherif Elnaggar February 18, 2021 at 6:39 am

      Hello, thank you for your question! Unfortunately we are not allowed to give medical advice on this platform due to legality. We would advise following up with your healthcare provider or physical therapist who can guide you in-person with your treatment. Each individual will recover from surgeries different, which is ok! Stay consistent with your exercises and stay positive!!! Best of luck!

  5. Mercy June 7, 2021 at 4:56 pm

    Hi! I had 3 of my 4 quads resected/removed in surgery, and only have my rectus lateralis muscle remaining. As a result I lost my knee extension. I’ve been doing physio the last 3 months since surgery but still haven’t regained any sort of knee extension (I can’t lift my leg straight up when laying down or sitting up). Would these exercises help?

    • Sherif Elnaggar June 8, 2021 at 9:47 am

      Hello! Sorry to hear about your surgery, we hope you are recovering well! In regards to your question, we unfortunately are unable to give direct medical advice on this platform due to legality. We would suggest discussing various options for improving knee extension with your physical therapist in-person, as there are many strategies to regain knee extension, it all depends on what each individual can tolerate best. Stay positive and consistent, as stringing together days of consistency focusing on exercising will help with outcomes in the long-term. We wish you the best with recovery!!!

  6. Ismaaeel September 24, 2021 at 7:28 am

    Is regaining TKE a prerequisite to perform isotonic movements?

    • Team [P]Rehab September 26, 2021 at 2:21 pm

      Hello! Fantastic question. Generally speaking after a surgery or major knee injury, the priorities are to regain an active quad set, functional knee range of motion (flexion and extension), reduce swelling, and restore gait. It is beneficial to regain knee extension with an active quad set before moving to more isotonic movements, especially so improper motor control of particular movements is not learned. An example of this would be walking without a straight knee (if knee extension is not regained adequately), which is not the most functional way to walk. Hope this answers your question!

  7. Noam Calvache Ji November 4, 2021 at 7:52 am

    How difficult it is to regain Knee extension if it was not attained right after surgery?

    • Team [P]Rehab November 4, 2021 at 11:18 am

      Hi Noam!! Thank you for your question. Situational dependent, but it can be achieved with the right dosage, consistency, and positive mindset!! If you are looking for a program that can educate you step-by-step in regaining knee extension, we have one for you! The link is here below.

      https://theprehabguys.com/program-knee-extension-mobility-overhaul/

      All The Best,

      Team [P]Rehab

  8. Tim J Driscoll March 1, 2022 at 3:11 pm

    3/2018 Meniscus operation
    2/2021 Knee replacement
    5/2021 reattachment of kneecap which came loose
    6/2021 Kneecap left unattached
    Pain across kneecap going downstairs and very weak. I have been doing weights, leg thrust, leg press, toe raises, and other single leg exercises. Which program would be the best?

  9. Bob Schmitt April 13, 2022 at 6:40 am

    Michael, I am a 70 yr.old male weighing 297lbs.
    I have type 2 diabetes.
    I had a knee revision in December of 2018. Several months after I slipped and came down on that knee. I felt no pain and was able to walk. Several months later, upon rising from my recliner i felt a sharp pain in the knee. The knee turned black and blue and it was painful to walk. The surgeon said that I had broken the bottom half of my patella. I went for therapy but that proved useless. Since then I have had lower back surgery, 2019 October. After the back surgery I developed a buckle in my injured knee and have been trying to correct this problem ever since.
    Is it too late to correct the extensor lag in my knee, which is what I have been told is my problem? I am not very active because it is hard to walk. I have been to several doctors who do not want to get involved with another surgeons work. The surgeon who performed the knee revision has since retired and even he didn’t want to operate to remove the broken patella. Sorry if I’m rambling but I am trying to give you all the info I can. Essentially, am i screwed! Can i have any hope of walking correctly again? I’m tired of sitting around the house. I want to be able to go places and do things. Can you help me? Bob Schmitt 330-519-6183
    jeremiah71351@gmail.com
    Thank you!

    • Team [P]rehab April 13, 2022 at 8:55 am

      Hi Bob!

      Sorry to hear about your recent injuries and the troubles you have been going through. Thank you for reaching out to us regarding the questions you currently have. We would be more than happy to assist you, and we will be reaching out to via email shortly to gain more information from you as well as help guide you in the right direction! We look forward to helping you in anyway that we can

      Best,

      Team [P]rehab

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