Knee Flexion Exercises Flexion is one of the basic functions of the knee joint. Although a little flexion is less of an issue than extension, a large deficit in flexion can still have a significant impact on daily life and sports. Generally speaking, flexion flexibility of at least 60° has no effect on normal walking on a flat road; flexion flexibility of at least 90° has no effect on putting on and taking off shoes and socks and jogging; flexion flexibility of at least 110° has no effect on going up and down steps of normal height; flexion flexibility of at least 120° has no effect on squatting. It can be seen that the flexion angle of each level stage, still have different degrees of impact on daily life, in order to minimize its adverse effects, or try to practice flexion function to close to or even reach the normal level. Exercise methods commonly used are as follows: This is a method I personally use: the affected limb is the left leg, for example, sitting in front of the patient, the left arm is placed between the patient’s N fossa below and the treatment bed, playing the role of a fulcrum, the right arm holds the heel and pushes hard medially. Because of the passive deficiency of the rectus femoris, the patient can be made to take a lying or sitting position as needed (simply put: sitting position mainly pulls the periarticular tissues, lying position mainly pulls the rectus femoris), and one’s own arms can also be stretched by the left arm along the axial direction of the femur to the distal end and by the right arm along the axial direction of the tibia to the distal end as needed, so as to reduce the intra-articular pressure during the exercise and to relieve some of the pain. At the same time, the fulcrum of the left arm increases the strength of the advancement. Note! Axial distraction in this direction is generally not performed for 3 months after ACL reconstruction. This approach is mandatory after posterior cruciate ligament reconstruction of the knee. This is another technique that I personally use: with the right leg as the affected limb, for example, the patient lies flat on his back, flexes the hip, places the right and left arms in the position shown, clamps the affected limb in the right axilla and applies downward pressure with the assistance of his own weight, while the left arm can be lifted upward with the right arm as the fulcrum as needed, while the right arm is pushed forward to achieve distal distraction along the femoral axis and distal distraction along the tibial axis, respectively. Caution as above. ? This method is generally applied after the flexion angle exceeds 90°, taking the left side of the affected limb as an example, standing on the affected side of the patient, the right arm holds the distal calf (try to avoid applying force to the distal end of the ankle joint, so as to avoid the formation of excessive plantarflexion of the ankle joint causing injury), the left hand can be padded to the patient’s N fossa as needed, the right arm presses down or the right arm fixes the affected limb in front of the body, the body leans to the left and applies pressure downward with the weight. At this time, the left arm plays the following roles: fix the patient’s position, as a fulcrum to strengthen the downward pressure, as a “wedge” to open the joint gap as much as possible, if the patient feels that the pressure on the N fossa is too large, you can use a soft pillow to replace the palm of the hand in the N fossa as shown in Figure 3b to play a similar role, with the same precautions as above. This is a self-practice flexion function, the patient supine, hip flexion, holding the distal thigh with both hands, or use a cloth belt like a “ribbon” over the shoulder, the length of the belt is adjusted to make the calf basically parallel to the horizontal plane is appropriate, according to the need to place the sandbag at the ankle, fully relaxed, with the calf self-weight and sandbag suspension, generally can do 10-15 minutes each time. 15 minutes each time, of course, the exercise should be fully relaxed to ensure the effect. This is also a self-practice angle method, the specific posture and direction of force need not be introduced too much, this way is suitable for patients with less resistance to joint movement and better flexibility (such as early postoperative patients), the advantage of this action is that the actual angle can be quantified simply by the distance from the heel to the hip, which is more conducive to the flexion exercises according to the normal rehabilitation program. This method is suitable for patients with a knee flexion angle of at least 90°. The patient lies prone, binds an inelastic cloth band around the ankle, and pulls with both hands to achieve hip extension and knee flexion, or if available, places a pulley in front and hangs weights instead of hands, usually for 10-20 minutes each time. When the passive knee flexion angle exceeds 100 degrees, you can try to consolidate the active angle by fixing the bicycle, riding with the body straight, the affected foot firmly fixed on the pedal, and practicing in a very standard posture, the seat height should ensure that the knee flexion angle is both slightly difficult and can be passed through the highest point with a relatively standard posture through efforts, usually following the passive exercise for 10-15 minutes , 1-2 times per day. As the passive angle increases, the seat height can be lowered to achieve a higher active angle while maintaining the riding stance. When the passive angle exceeds 130 degrees, you can try squatting down with the protection of your hands and use your body weight to assist in consolidating the established angle. The exercise requires the weight to be placed on the feet, no more than the toes forward and no more than the heels backward, avoiding excessive back sitting, and usually follows after the passive exercise, 2-5 minutes each time. Therefore the method incorporates the influence of body weight and increased joint pressure, which may aggravate discomfort for patients with N-fossa pain during knee flexion exercises, so be sure to pay attention to gradual progress and not overly forceful exercises. If you have the conditions, you can try to design and manufacture your own pulley pull at home, the mechanical structure of the pulley is shown in the figure, usually this method is suitable for the anterior thigh group of muscles and other soft tissue contracture caused by knee flexion disorder, that is, for patients who feel the pulling pain in front of the knee when flexion exercises, usually with moderate weight, under the premise of full relaxation pulling not less than 15 minutes times. The above are some of the knee flexion functional training methods that I personally use, all of them have the following commonalities: 1, the patient needs to fully cooperate and understand, overcome the psychological tension and muscle (antagonist muscle) tension caused by various reasons, which is the prerequisite to ensure the safety of all exercises. 2. Avoid violence during the exercises to avoid unnecessary additional injuries. 3.If the antagonist muscle cannot be fully relaxed or has high tension before the exercise, you can do the antagonist muscle maximum force isometric resistance 2-3 times at a certain angle, and do it until the antagonist muscle is fatigued, which can inhibit the antagonist muscle tension and appropriate pulling effect, but this method is not suitable for patients who have early injury involving knee extension device. 4. Other precautions and exercise settings can be found in my article “Mobility (ROM) exercises after joint injury”.