Knee Pain? TKE (terminal knee extension) & Dorsiflexion screens

Knee pain that lingers at a low hum can be maddening, especially for runners who feel “mostly fine” until mileage adds up. We walk through a simple, trainer friendly screen for terminal knee extension (TKE) that takes minutes and often exposes a tiny side to side gap you can’t afford to ignore. Two to five degrees sounds small, but it can change how the knee loads with every step, rep, and landing.

From there, we lay out a clean decision tree: if TKE is limited, we talk daily practice, smart progressions, and how to apply just enough pressure without turning it into a painful battle. If both knees check out, we pivot to ankle dorsiflexion using the wall test (shoes off) and explain why limited ankle mobility can push stress upstream into the knee, especially in running. You’ll also hear how to approach soft tissue work and foam rolling in a way that actually reduces sensitivity and makes new range of motion “stick.”

Finally, we test what many programs ignore: calf stability and local muscular endurance. We break down the 25 rep single leg calf raise benchmark, what “clean reps” really look like, and how to build a simple weekly calf plan that supports stronger mechanics over time. We also connect the dots anatomically by revisiting the gastrocnemius and why it matters for both the ankle and the knee.

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Transcript

What TKE Reveals About Knee Pain

SPEAKER_00 0:00

In today's video, we're going to take a look at terminal knee extension, also referred to as TKE. Now, this is a very simple screen that you can do as a personal trainer. Client comes in, you assess, you find out they have some knee discomfort. We're eliminating any acute variances, such as swelling, or if it just happened a couple days ago, maybe they heard a pop. That's when you refer out to your team DPT. Most of the time, you're gonna have clients that are gonna come in. Megan's been a runner for numerous years, and her knee just kind of bothers her. It's kind of sitting at like a three or four.

How To Run The TKE Screen

SPEAKER_00 0:32

After I had that good 10-minute conversation during the assessment portion, this is one of the first things I'm going to do. I'm gonna have my client lie in the back, make sure you have a mat. I'm gonna elevate their heels off the ground, and I'm gonna see if I can notice a difference. Two to five degrees. It doesn't sound like a lot, but we've been to lots of seminars, and every single time I've not been defeated, someone has knee pain, and we do this, you will see the difference. Take a look at some of these videos and these images. You will see more of a crevice if it's on a lady's legs, because the pants, if they're sitting down in that optimal five degrees of terminal knee extension, so then the pants will kind of fold over. The one that doesn't have the range of motion, you won't notice those little mountains. So that's the one that we're gonna want to address. Sitting here while you're watching Netflix. I just finished Cobra Kai amazing series, 30-minute episodes. Sit here 30 minutes. A lot of us may not have that time, but you need to do this every single day, a minimum of five minutes. I would challenge you as a trainer, if you do this test and you notice a discrepancy, be selfish. Do this with your clients at the end of a workout. If you want to get more aggressive, you could put a little ankle pad, two pounds, maybe three pounds. It shouldn't be excruciating. At no point should the client feel like, am I gonna hyperextend my knee? It'll be like for the elbow, for example, if you can't get to that end range, we're just giving it some pressure, gravity's pulling it down. That would be the more advanced technique that you

Daily TKE Work And Progressions

SPEAKER_00 2:08

can do. This is my first test. If my client has knee discomfort and both of the knees are fine, then I'm gonna wanna go check out ankle mobility. The whole importance of the discovery process is we're getting into that psychology aspect. If your client's been experiencing knee discomfort for years and you just take them and you do that test right away, or you put them on the wall, you're not listening to them. And that empathy is super, super important. You're gonna have them come to the wall four inches. We have a white line, about the size of an average dude's knuckles. You should be able to get your knee to touch the wall without the calcaneus or the heel coming off. That's why we want to do it without the shoes. Do a couple of those reps. So you do the TKE,

Ankle Dorsiflexion Wall Test Next

SPEAKER_00 2:51

both knees check off, negative. So then we want to go check out ankle dorsiflexion. If they cannot get the knee to touch the wall, studies have shown that if you cannot get to 15 degrees of range of motion with dorsiflexion, you're gonna be more prone to future injuries when it comes to knee, especially with running. So we want to get into that soft tissue, and one of the first things that we're gonna do is foam roll. Now, most clients foam roll like this, back and forth, and it's not truly causing an impression on the nervous system to relax the ankle. That's why we're doing this, to send a message to the brain to calm down so then we can go train in that new range of motion. So, what I prefer to do is have your client get on their stomach, always ask and have them sign consent before any time you touch your client. And then we're gonna get into the lateral side. So you're gonna use both hands, she's super sensitive, and you don't want them to be in that sympathetic state the entire time. I think this is actually a really great example with Megan, because I didn't go super, super hard in the beginning. I've worked with some athletes and I'll go more aggressive. I started out nice and light. Think of it like going to 100 miles per hour. You don't start out at 100, start at five, ten, work your way up, look in the mirror, make sure we're breathing. As they calm down and that discomfort level goes from a six or so, I want it to come down to a three, and then I'll either push a little harder on that same spot, option A, or option B, I'll use a thumbs distance and just go up a little bit to see how that feels.

Smarter Soft Tissue And Mobility Drills

SPEAKER_00 4:16

I had another reaction, so then I'll hold there and we go until we calm down the nervous system. And then we'll do two to three of those rounds, maybe a total of two minutes. If she had limited dorsiflexion on both, I would repeat on this side, and then we would get into some mobility drills. Two of my favorite drills for the the two of my favorite drills for ankle mobility. If they have uh limited ability to get down in that deep squat like Megan does, I would use a pull or a rack and then just rock back and forth. You can also grab a weight as a more advanced technique and just grow and just glide that knee with your heel down over your toe and just go back and forth one to two seconds. If you want to hold a little deeper, five, 15 seconds, do this for about a minute and then repeat on the other side. Your client passes TKE, they pass the ankle mobility

Calf Endurance Stability Test For Runners

SPEAKER_00 5:09

on the wall. Then I'm gonna test stability. We were in Miami a couple weeks ago for a seminar, and we had a student who's experiencing calf discomfort while she hits about mile one or two. And so it stops her from continuing on. I checked her dorsiflexion, it was fine. TKE was fine. So then we did a stability test. You should be able to get to 25 single-legged raises. And studies have shown runners who cannot get to 25, they're more prone to injuries in the future. So I want to check that out. I'm gonna have my client one leg go as high as they can, slightly hold on to the wall. We're not leveraging ourselves. So you're gonna hold that top position, and now she needs to hit this for 25 reps. That's one, two, three. If you don't have a pull, you could use your hand. Ladies, if you have a bun that doesn't count, we want to just go to the top of the head. There's 10. She's starting to struggle already. 15. Not terrible. A lot of your clients are gonna fold right around 10 to 12. 19, she's starting to rock a little bit. She's gonna get to 25. But I would challenge, is that a real clean 25 reps? She's starting to shake a little bit, 24, and 25. So then how did that feel? Is the calf fatigued? Is that exhibiting the same feeling that you have when you go for the run? Most people, especially ladies, we have a lower body day. Do we have a calf day within that? Are we training our calves? Guys always complain about, oh, it's my genetics, I have small calves. Take me through your calf program. I do three sets of 25 on seated calf raises once a week. Train your calves to get stronger since they're more type one. Specifically, the gastroc is a little more type two. Let's give them more of that local muscular endurance by doing three sets of 20 on Monday, three sets of 25 on Wednesday seated. Every single time you train, five days a week, upper, lower, upper lower, incorporate within the accessories single leg calf raises. Don't neglect the anterior side as well. You can do some little duck walks like that. If you want to put a weight on your toe to increase with dorsiflexion, just to train the anterior tip, especially if you do experience medial discomfort, medial tibial stress syndrome. Foam rolling can help with that a lot, but strengthening the gastroc. In my experience, a lot of individuals who have knee or calf pain with running, a lot of times when you strengthen the calf and the stability test, they're gonna be good to go over

Why The Gastroc Matters Most

SPEAKER_00 7:54

time. So remember the muscle that we're targeting here is the gastrocnemius. It's biarticulate, it crosses the knee as well as the ankle. The soleus is the deeper one. For more information and to better understand those 14 muscles as well as the four ligaments of the knee. Watch the anatomy videos and become a lot more competent with the actions. So plantar flexion for the gastrop, but it also flexes the knee.