top of page

Achieving Maximum Knee Flexion Through Manual Therapy and Exercise

Updated: Apr 1

Hands of Person Meditating

A serene morning routine was disrupted. A beloved daily practice is becoming increasingly challenging. Meet Mina, a woman whose unwavering commitment to her morning prayers, a time of peaceful reflection and deep connection, has recently been marred by discomfort and the progressive loss of knee mobility. Mina, like many others, is yearning for a solution. As her desire to regain full knee flexion intensified, exploring effective solutions became paramount. Through Mina's journey, we delve into the world of manual therapy and exercise, examining their role in restoring the grace of movement.

Article Index:



Knee flexion is the act of bending the knee, a movement that decreases the angle between the thigh and lower leg. This motion is fundamental to countless daily activities, from walking and running to sitting and kneeling. In Mina's case, achieving full knee flexion is a matter of physical well-being and an essential component of her spiritual practice. The ability to kneel comfortably each morning to pray is deeply intertwined with her sense of peace and spiritual connection.

Measuring Knee Flexion

The Importance of Maximum Knee Flexion

Maximum knee flexion, the greatest degree of bend a person can achieve in their knee, is critical to optimal function and freedom of movement. Achieving this degree of flexion enables a wide range of activities and positions that many of us take for granted, such as squatting, climbing stairs, and for Mina, kneeling in prayer. A decrease in knee flexion can significantly hamper these activities, impacting quality of life and potentially leading to further musculoskeletal issues.

The Role of Manual Therapy and Exercise in Improving Knee Flexion

Addressing the limitations of knee flexion involves a comprehensive, integrative approach. Manual therapy techniques, such as Motion Specific Release (MSR), Joint Mobilization, and Acupuncture, can play a pivotal role in enhancing mobility and reducing discomfort. These therapies can significantly improve knee flexion when coupled with targeted exercises, enabling individuals like Mina to return to their cherished routines and activities easily. Throughout this article, we will explore these techniques in depth, shedding light on how they work synergistically to optimize knee health.


Understanding Knee Flexion

To appreciate the significance of achieving maximum knee flexion, it's critical to understand the knee joint's complex anatomy and its pivotal role in human locomotion and daily activities.

Hands holding Knee

Anatomy and Function of the Knee Joint

The knee, a hinge joint between the thigh and the lower leg, is one of the human body's most intricate and heavily used joints. Its structure involves an interplay of bones, cartilage, ligaments, muscles, and tendons working cohesively to facilitate a range of movements. Key elements include the femur (thigh bone), tibia (shin bone), and patella (kneecap), with the cartilaginous menisci and crucial ligaments like the ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) providing stability and shock absorption.

Central to our discussion is the hamstring group of muscles and the quadriceps group, both playing a key role in the flexion and extension of the knee. Knee flexion primarily involves the hamstrings at the back of the thigh, contracting to draw the heel up towards the buttocks. Meanwhile, the quadriceps at the front of the thigh engage in knee extension. The delicate balance and interplay of these muscle groups are vital to achieving smooth and pain-free knee movements.

Explanation of the Knee Flexion Range

The knee flexion range is a measurement of the maximum angle that your knee can bend. In healthy individuals, the knee has a flexion range of approximately 120 to 150 degrees, depending on factors such as age, sex, and physical condition. Mina's decreased knee flexion range has hindered her ability to kneel during her morning prayers comfortably.

Implications of Limited Knee Flexion

Limited knee flexion, medically termed as flexion contracture, can significantly impair one's quality of life. Not only does it impact functional tasks such as walking, sitting, or squatting, but it can also compromise seemingly straightforward activities like kneeling for prayer. Moreover, the imbalance it creates can lead to a domino effect on the body's biomechanics, potentially causing undue stress on other joints and leading to further musculoskeletal problems.

In understanding these critical elements of knee flexion, we pave the way towards exploring how manual therapy techniques and targeted exercises can assist in regaining this fundamental movement, empowering individuals like Mina to reclaim their daily routines and physical freedoms.


Manual Therapy Techniques for Enhancing Knee Flexion

With its hands-on techniques, manual therapy forms a cornerstone in our strategy to improve knee flexion. The array of techniques under this umbrella is specifically designed to mobilize joints, alleviate pain, and enhance flexibility, all while promoting healing and well-being. A blend of these techniques, tailored to the unique requirements of each patient, forms the backbone of our treatment plan.

Embracing the Benefits of Motion Specific Release (MSR)

At the heart of our therapeutic approach is Motion Specific Release (MSR), a treatment system that unifies and improves upon the strengths of various musculoskeletal therapies. This broad-based methodology integrates multiple modalities, from osseous procedures to diverse soft tissue modalities, equipping us with a wide-ranging arsenal to effectively combat unique musculoskeletal challenges.

MSR's significance lies in its ability to address the intricate demands of the knee joint, making it a robust tool for improving knee flexion. The technique's holistic approach enables practitioners to adapt treatment to each patient's needs, specifically targeting areas of imbalance or restriction that may be limiting knee flexion. For someone like Mina, MSR could be harnessed to eliminate soft tissue and joint constraints around her knee, aiding in improving movement and minimizing discomfort.

The following video demonstrates some of the common MSR procedures used to address mobility restrictions in patients' knees.

Knee Release Protocol - Motion Specific Release

Dr. Abelson demonstrates an effective knee release protocol using Motion Specific Release (MSR) techniques in the accompanying video. These procedures address the localized area of pain and the broader kinetic chain, contributing to a more comprehensive treatment approach.

Understanding and Utilizing Joint Mobilization

Joint mobilization is another cog in our wheel of manual therapy techniques for boosting knee flexion. It involves passive movement of specific joints using varied degrees of force to enhance range of motion, alleviate joint stiffness, decrease pain, and promote overall function.

In Mina's case, joint mobilization techniques could be applied to focus on her knee joint. These techniques aim to relieve any stiffness or immobilization within the joint, working in synergy with MSR to provide a thorough approach to improving knee flexion.

The following video demonstrates some of the common MSR procedures used to increase knee joint mobility.

Increasing Knee Joint Mobility - Effective Motion Specific Release knee mobility procedures are demonstrated by Dr. Mylonas in this video, which are extremely effective at addressing the body's entire kinetic chain. The femur, tibia, and patella, as well as a large number of muscles and ligaments, make up the complicated structure of the knee joint. Understanding the knee joint's anatomy and biomechanics is important before addressing knee joint mobility.


Acupuncture Image

Integrating Acupuncture

Acupuncture, an ancient Chinese medical practice, incorporates the insertion of fine needles at defined points in the body. Known to relieve pain, decrease inflammation, and foster healing, acupuncture serves as a powerful tool in a multidisciplinary approach to improve knee flexion.

Acupuncture holds a significant place in knee flexion therapy, backed by a wealth of scientific evidence. It alleviates any pain or inflammation that could limit movement, creating a conducive environment for healing and enhanced function.

Specific acupuncture points, such as ST35 (Dubi), Xiyan, SP10 (Xuehai), and GB34 (Yanglingquan), can be targeted to improve knee health and promote flexion. These points are known for their roles in reducing knee pain, improving circulation, and promoting healing in the knee area.

When amalgamated with the power of MSR and joint mobilization techniques, acupuncture forms a comprehensive, integrative approach that can assist Mina in her quest for achieving full knee flexion.


Woman Performing Squat Exercise

Exercise is Critical

Exercise plays an indispensable role in enhancing knee flexion. It helps build muscle strength, increase joint mobility, and improve overall flexibility while alleviating inflammation and reducing pain. A well-rounded exercise regimen can significantly enhance knee flexion when coupled with manual therapy techniques.

Beginners to Advanced

We have curated a spectrum of exercises designed to cater to varying levels of strength and flexibility. From beginners to advanced, each of these exercises aims to improve knee flexion.

Beginner Level: Heel Slides and Seated Knee Flexion Stretch

  • Heel Slides: Lie flat on your back on a firm surface. Slowly bend the knee of your affected leg by sliding your heel towards your buttocks as far as comfortable. Hold for a few seconds, then return to the starting position. Start with 10 repetitions for each leg, performing 2-3 sets. As your comfort and flexibility increase, gradually raise the repetitions up to 20 per set.

  • Seated Knee Flexion Stretch: Sit on the edge of a sturdy chair with your feet flat on the floor. Slowly slide the foot of your affected leg back under the chair as far as possible, then return to the starting position. Start with 10 repetitions for each leg, performing 2-3 sets. As your comfort and flexibility increase, gradually raise the repetitions up to 20 per set.

Intermediate: Prone Knee Bends

  • Prone Knee Bends: This exercise helps increase the knee's range of motion. Lying prone on a flat surface, bend your knee, bringing your heel towards your buttocks. Hold for a few seconds, then slowly straighten your leg back to its original position. Start with 10 repetitions for each leg, performing 2-3 sets. As your comfort and flexibility increase, gradually raise the repetitions up to 20 per set.

Advanced Exercises

Enhanced Assisted Knee Flexion:

  • Preparation: Begin by applying a warm compress or heating pad to the knee area for approximately 15 minutes. The warmth will help increase blood circulation in the area and enhance flexibility, preparing the joint for the exercise.

  • Execution: Sit on a firm surface and loop a towel around the ankle of your affected leg. Using the ends of the towel, gently pull your heel towards your buttock. Bend the knee as far as it is comfortable for you. Hold the position for a few seconds, then slowly release the tension and return to the starting position. Start with 10 repetitions for the affected leg, in 2-3 sets. As comfort and flexibility increase, gradually increase the repetitions to 20 per set.

Enhanced Weighted Step-Ups:

  • Preparation: Wear ankle weights or a weighted vest to add resistance to the exercise. The extra weight will challenge your muscles more, leading to increased strength around the knee joint.

  • Execution: Stand in front of a step or stair. With the added weight in place, step up onto the step or stair using the affected leg, bending the knee in the process. Then, slowly lower yourself back to the ground. Be sure to maintain control throughout the movement to avoid injury. Begin with 10 repetitions for the affected leg, in 2-3 sets. As strength improves and comfort allows, gradually increase repetitions up to 20 per set. The weight added should be challenging but still allow for proper form throughout the exercise.

Enhanced Lunges with Balance Training:

  • Preparation: Place a BOSU ball or a balance disc on the floor. These tools will add a balance component to the exercise, challenging your stability and improving muscle activity throughout the lower limb.

  • Execution: Stand on the BOSU ball or balance disc. Perform a lunge by stepping forward with the affected leg and lowering your body until your knee is bent at a 90-degree angle. Be sure to keep your knee directly above your ankle. Push back up to the starting position, maintaining balance. Repeat the exercise as advised by your healthcare provider. Start with 10 repetitions for the affected leg, in 2-3 sets. As balance and strength improve, gradually increase the repetitions up to 20 per set.

Consistency and Gradual Progress:

Consistency and gradual progression are vital for reaping maximum benefits from these exercises. Start with the beginner exercises and as your strength and flexibility improve, slowly move onto the more advanced exercises. However, always be careful not to overexert yourself as it could lead to injuries. Always consult with a healthcare provider to ensure these exercises are performed safely and correctly.


Woman With Hands Together in Prayer


Mina's path toward reacquiring complete knee flexion was undoubtedly a process that required time, but the outcome was a resounding success. Her treatments and exercises did not turn back time, but they certainly reinstated her function and eradicated her pain.

The recovery regimen entailed a comprehensive approach integrating Motion Specific Release (MSR) methodologies, which incorporate both soft tissue and osseous procedures. Additionally, acupuncture sessions involving electrical stimulation were integrated into her treatment plan. Each technique was crucial in enhancing Mina's mobility and alleviating discomfort. However, it was equally vital that Mina adhered to a meticulous exercise program, transitioning gradually from beginner to more advanced exercises.

With unwavering dedication, Mina successfully reclaimed her knee flexion capacity, allowing her to bend her knee and resume her tranquil morning rituals fully. Now, she can once again kneel in comfort for her daily prayers, an act that for her signifies not just physical health but a profound spiritual satisfaction.

In essence, Mina's journey serves as a beacon of optimism and a testament to the potency of holistic healthcare for individuals grappling with similar difficulties. It validates the potential for complete recovery and reinstatement of a high quality of life. We hope her journey will inspire others facing similar challenges, motivating them to embark on their healing journey with tenacity and hope, knowing that the aim of full functionality is often achievable.



Photo of Dr. Brian Abelson

Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.


MSR Instructor Mike Burton Smiling

Join Us at Motion Specific Release

Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.

Join MSR Pro and start tapping into the power of Motion Specific Release. Have access to:

  • Protocols: Over 250 clinical procedures with detailed video productions.

  • Examination Procedures: Over 70 orthopedic and neurological assessment videos and downloadable PDF examination forms for use in your clinical practice are coming soon.

  • Exercises: You can prescribe hundreds of Functional Exercises Videos to your patients through our downloadable prescription pads.

  • Article Library: Our Article Index Library with over 45+ of the most common MSK conditions we all see in clinical practice. This is a great opportunity to educate your patients on our processes. Each article covers basic condition information, diagnostic procedures, treatment methodologies, timelines, and exercise recommendations. All of this is in an easy-to-prescribe PDF format you can directly send to your patients.

  • Discounts: MSR Pro yearly memberships entitle you to a significant discount on our online and live courses.

Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.



  1. Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews.

  2. Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., Arden, N. K., Bennell, K., Bierma-Zeinstra, S. M. A., ... & McAlindon, T. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage.

  3. Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., ... & Linde, K. (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain.

  4. Magee, D.J. (2014). Orthopedic Physical Assessment. Saunders Elsevier.

  5. Oatis, C. A. (2017). Kinesiology: The Mechanics and Pathomechanics of Human Movement. Lippincott Williams & Wilkins.

  6. Kisner, C., & Colby, L. A. (2017). Therapeutic Exercise: Foundations and Techniques. F.A. Davis. Hoppenfeld, S. (2016). Physical Examination of the Spine and Extremities. Pearson.

  7. Ernst, E., & White, A. (2012). Acupuncture: A scientific appraisal. Butterworth-Heinemann.

  8. Braddom, R. L. (2020). Physical Medicine and Rehabilitation. Saunders Elsevier.

  9. Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications.

  10. Maciocia, G. (2015). The Foundations of Chinese Medicine: A Comprehensive Text. Elsevier Health Sciences.



The content on the MSR website, including articles and embedded videos, serves educational and informational purposes only. It is not a substitute for professional medical advice; only certified MSR practitioners should practice these techniques. By accessing this content, you assume full responsibility for your use of the information, acknowledging that the authors and contributors are not liable for any damages or claims that may arise.

This website does not establish a physician-patient relationship. If you have a medical concern, consult an appropriately licensed healthcare provider. Users under the age of 18 are not permitted to use the site. The MSR website may also feature links to third-party sites; however, we bear no responsibility for the content or practices of these external websites.

By using the MSR website, you agree to indemnify and hold the authors and contributors harmless from any claims, including legal fees, arising from your use of the site or violating these terms. This disclaimer constitutes part of the understanding between you and the website's authors regarding the use of the MSR website. For more information, read the full disclaimer and policies in this website.

Recent Posts

See All


bottom of page