Manual Muscle Testing of the Knee

Knee Flexion	The patient is prone with legs straight and toes hanging over the edge of the table. The therapist stands next to the test leg. The therapist places one hand on the posterior thigh and the other hand applies resistance at the distal calf or just above the ankle. The resistance is applied in downward direction as the patient actively flexes the knee.
Knee Extension	The patient is short sitting, place a wedge or pad under the distal thigh to maintain the femur in the horizontal position. The therapist stands at the side of the leg being tested. The hand giving resistance is contoured over the anterior surface of the distal leg just above the ankle. Resistance is applied in a downward direction as the patient actively extends the knee.
Knee Flexion with External Rotation	Patient is prone with knee flexed to less than 90 degrees and the leg in external rotation. Therapist stabilizes the thigh with one hand and gives downward and inward resistance at the ankle with the other hand. Patient flexes the knee, maintaining the leg in external rotation.
Knee Flexion with Internal Rotation	Patient is prone with knee flexed to less than 90 degrees and the leg in internal rotation. Therapist stabilizes the thigh with one hand and gives downward and outward resistance at the ankle with the other hand. Patient flexes the knee, maintaining the leg in internal rotation.

Adapted from:

Hislop, Helen J. & Montgomery, Jaqueline with contributor Barbara Connelly.

      Daniels and Worthingham's muscle testing: techniques of manual examination., 6th edition, 1995.