Manual Muscle Testing: Knee Extension

Original Editor - Claire Knott

Top Contributors - Claire Knott and Wanda van Niekerk  

Muscles Involved:

Patient Positioning

  • Grades 3 to 5 - Patient is in short sitting
  • Grades 0-2 - Patient is in side lying ('gravity minimal' position)

Therapist Position

  • Therapist to kneel beside the patient and stabilise the femur on the test-side
  • If patient is in side lying, therapist to support the lower leg through movement as required.

To Test

  • Patient actively extends the knee
  • For grades 4 to 5 apply resistance through the distal tibia and fibula in a direction opposite to extension.[1]
  • To satisfy grade 5 'normal muscle' performance criteria, the patient must have the ability to move through complete range of motion (active resistance testing) OR maintain an end point range (break testing) against maximum resistance.


  1. Hislop H, Avers D, Brown M. Daniels and Worthingham's muscle Testing-E-Book: Techniques of manual examination and performance testing. Elsevier Health Sciences; 2013 Sep 27