How To Make Sense Of Knee Joint Special Tests

In part one of this knee joint series we looked at your traditional objective assessment and what tests are available to you.

Of course, we all have an endless amount of tests we can call on…. But how do you make sense of these in the real world?

Today I’ll share with you how we can use testing to truly work for us and how you can implement the 80/20 rule to get the long-lasting you deserve.


The 80/20 rule is a powerful tool we teach throughout the mentorship and return to play programmes. It is designed to focus your time. It’s simple…

We will use 20% of our time focusing on the symptoms and 80% on the finding and treating the true cause of the problem.

Using this rule you can begin to find the true stressors and causes….

Supine vs Prone

Look at the difference in pain experience on knee flexion in supine or prone position. We get a lot of value by looking at the tissues ability to lengthen in prone compared to supine as both positions allow different tissues to lengthen.

Once we compare these positions, we can use clinical reasoning to have clarity and confidence on where we start rather than treating anything and hoping something sticks.


When your patient is in the supine position, knee flexion and overpressure will not require a full lengthening of the majority of quadricep tissue. However, it does mean that the kneecap requires significant lengthening.

If there is a pain experience here then it could mean the knee capsule is holding some kind of protective tone that is contributing toward the pain experience.


When your patient is in a prone position and you perform knee flexion the way their body works is completely different.

Flexion in the prone position requires the quadriceps to lengthen considerably but in this position the stress on the knee joint is considerably different.

If your patient does have restriction throughout flexion in prone then you would suspect that perhaps the vastus lateralis or the quadriceps are carrying a protective tone.

If there was no pain in the supine position but there was prone then it may indicate that you need to influence tissues such as the vastus lateralis, using hands-on or some isometric type movements to target protective tone.


Throughout these tests we are looking to differentiate in pain between prone and supine.

If there is a difference in pain in this testing it can be very valuable in directing you as to where you spend most of your time decreasing protective tone and allowing them to lengthen. Then you need to put forces through the tissues so they can adapt and overcome.

Once again, in supine, if you do have knee pain from overpressure then you would want to consider the knee capsule itself.

If your patient didn’t have knee pain in supine but there was pain with overpressure in the prone position then you know the knee capsule can lengthen effectively but the quads or vastus lateralis may have issues. If we can decrease the protective tone and allow the tissue to lengthen then the knee pain may disappear.

Final Thoughts

It can be an incredibly powerful tool to differentiate between tests. Using this method you can begin to identify the areas in which you believe the patient’s problems may lie. But getting rid of the knee pain is only half of the battle and really only 20% of our focus. We need to understand why these tissues have protective tone in the first place. That is where we can use more advanced assessments and put these together with the rest of the athletes story.

At the mentorship we use a very simple approach just like this to make clinically reasoned decisions to inform our treatment plans. We don’t guess, we use clinical reasoning, which allows us to have the clarity and confidence to know we are on the right track.

Click here for more powerful tools to implement in your private practice.

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