McKenzie Method for Knee Pain: A Progressive Approach to Total Knee Extension

Knee pain can be a frustrating and limiting condition, affecting everything from walking to athletic performance. Whether you have a diagnosis of a meniscus tear, knee arthritis, patellar tracking disorders or simply idiopathic knee pain, The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is a proven approach for assessing and treating musculoskeletal pain, including knee dysfunction. This method emphasizes patient-driven movement strategies, using a progression of forces to systematically restore knee extension—a key factor in reducing pain and improving function.

In this post, we’ll explore the McKenzie approach to knee assessments, progressing from passive movements to resisted total knee extension exercises using a TheraBand.

Step 1: McKenzie Assessment for Knee Pain

The McKenzie assessment follows a structured process to identify whether knee pain is mechanical in nature, meaning that movement can reduce or centralize the pain.

Key Assessment Components:

1. Baseline Symptoms – Evaluate pain location, intensity, and any restrictions in movement. We can use a functional movement such as step down test or ask the patient if they can do something in the office to produce the pain that brought them in for an assessment. We then use this pain as the baseline symptom.

   
   

2. Repeated Movement Testing – Assess response to repeated knee extension and flexion to determine which movements improve or worsen symptoms.

   
   

3. End-Range Loading – Progressively increase force to determine the knee’s mechanical response.

If knee extension movements improve symptoms, we focus on restoring full end-range knee extension with progressive loading.

Step 2: Progression of Forces in Knee Extension

The McKenzie system follows a gradual force progression, starting with the least amount of external assistance and building up as needed.

1. Passive Knee Extension

   The patient sits with the leg supported.

   The knee is passively straightened, allowing gravity or the therapist to apply gentle overpressure.

   Goal: Achieve full passive knee extension without pain.

   
   

2. Active-Assisted Knee Extension

   The patient begins actively extending the knee while using the hands or a strap for assistance.

   This helps retrain the muscles and joints to reach the full range of motion.

   
   

3. Repeated Active Knee Extensions

   The patient performs repeated seated or standing knee extensions to reinforce the movement.

   If symptoms improve or centralize, this becomes a primary home exercise.

   
   

4. Loaded Knee Extensions with Overpressure

Once the knee can extend fully, overpressure is applied manually or using external resistance (e.g., a rolled towel under the heel in a seated position).

This helps reinforce the end-range extension necessary for pain reduction. The goal is to get to FULL END RANGE.

Step 3: Strengthening with Resistance (TheraBand Total Knee Extensions)

Strengthening with Resistance (TheraBand Total Knee Extensions)

Once full knee extension is achieved, resisted exercises help stabilize the knee and prevent pain recurrence.

TheraBand Total Knee Extension Exercise

1. Setup:

   Anchor a TheraBand behind the knee at a low point (e.g., wrapped around stationary object such as a support beam or railing).

   Stand tall with the affected leg in front, ensuring the band is positioned at the back of the knee.

   
   

2. Execution

   Start with the knee slightly bent.

   Extend the knee fully against the resistance of the band, engaging the quadriceps.

   Hold for 2-3 seconds at full extension, ensuring a strong contraction.

   Slowly return to the starting position and repeat for 10-15 reps.

   
   

3. Progressions

   Increase band resistance as strength improves.

   
   

Why Focus on Full Knee Extension?

Achieving and maintaining full knee extension is crucial for:

✔ Pain relief – Reducing compressive forces on the patellofemoral joint

✔ Optimal biomechanics – Essential for walking, running, and squatting

✔ Injury prevention – Restoring quadriceps activation and joint centration

Final Thoughts

Using the McKenzie Method to assess knee pain and restore total knee extension is a structured, patient-centered approach that can yield long-lasting improvements. By following a progression of forces and integrating TheraBand resistance exercises, patients can regain knee function and reduce pain recurrence.

For individuals dealing with persistent knee pain, a McKenzie-trained clinician can guide them through the assessment and treatment process, ensuring optimal recovery.

Want to explore McKenzie therapy for knee pain? River Forest Health and Wellness offers expert care to help you regain pain-free movement. Contact us today!

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