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Extension: how to estimate it and ways to improve it

Discussion in 'Concerns after knee surgery' started by Josephine, Sep 13, 2017.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    There are very few ways you can improve extension. By far the best tip is to ensure you are walking with the correct gait which is 'heel-toe' and stride and taking a decent step length, not shuffling because you are nervous of tripping. Don't obsess over this, try to make your stride as natural as possible.



    Extension is often more difficult to achieve than flexion and often lags behind but the most important thing to remember is that extension is most often blocked by swelling (=pain) which is best dealt with by managing the swelling and pain. If you attempt these exercises, it's quite possible you will actually increase the swelling and make your extension worse.

    walking heel toe.jpg

    The only thing I would suggest is to rest your heel on a stool so the knee is unsupported but do ensure the stool is not too far away from your knee. Mid calf as in this image is about as much as you should use. NEVER just have your heel on the stool and NEVER apply weights or press on the knee.

    hyper extending.jpg




    1-horz-vert.jpg

    It's actually better not to do any of the numerous exercises you find about the internet as they can make a bad situation worse, much worse.
     
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  2. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    A good way to check extension yourself is like this:

    1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
    2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
    3. slide your hand, palm down, under the back of your knee
    a) if you can get your entire hand under easily, it's probably about +10 degrees
    b) if you can get just your fingers under, it's about +5
    c) if you can get your fingers under but it's a push, it's +0
    d) if you can't get your fingers under at all, it's -5 or more


    Here's a graphic to explain the degrees involved

    knee ROM small.jpg

    Above all, do NOT allow your PT to press on your knee to measure ROM.
    The only measurement that counts is what you can do on your own.
     
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