Full Knee Flexion and Japanese Style Sitting

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Full Knee Flexion

We want every joint in our body to have it's full, normal range of motion and for that range of motion to be pain free. Today we are going to look at the knees and specifically at full knee flexion. One of the easiest ways to look at this is by going into japanese style sitting. Japanese style sitting is when you sit on your shins and your butt goes all the way on to your heels. The feet may or may not be crossed and the big toes can overlap a bit.

If you can easily get into this position and it is comfortable, congrats! You have full pain free knee flexion. If you can't get into this position fully or comfortably, we have some work to do.

How to Work on this

There are three main things I look at when trying to improve full knee flexion. These aren't in any particular order. I first test full knee flexion, try a stretch or mobilization, and then test full knee flexion again. Whichever thing works the best at improving the target skill is the one I spend my time on. This is commonly referred to as the clinical audit process.

The first movement we can look at is big toe dorsiflexion. There is a muscle that goes from the bottom of the big toe all the way up to the middle of the fibula (the smaller bone in your lower leg) called the flexor hallucis longus (FHL). Sometimes and for some people improving their big toe movement can improve full knee flexion. We may be decreasing the tone of the FHL, we may be improving how the nerves in the lower leg are moving, or we may be improving fascial glide. I can't prove which one we are improving and I don't care. If it makes your knee flexion better, I am happy. If it doesn't help, move on.

The second thing we can look at is ankle circles in a "hamstring stretch" position. First, test knee flexion in japanese style sitting, perform 15 circles each direction as described in the video, then retest your sitting. Did it improve?

If we still aren't getting improvement, we can try a mobilization with movement of the knee into internal rotation with some fibular glide. Go into a lunge position and rotate your knee clockwise if it is the left knee or counterclockwise if it's the right knee. If you follow those instructions, you are internally rotating your knee. Do about 10 reps each leg and then retest your sitting.

I do not recommend doing any of these stretches if you have pain with them.

Don't Stretch into a Pinch

A general rule of thumb is to not stretch into a joint that feels pinchy. Typically a joint can feel pinchy when range of motion in the joint itself is lost. Sometimes this can be fixed with a joint mobilization. If it is pinchy to be in japanese style sitting in your knees, I don't recommend trying to stretch through that pinch.

If you are trying to mobilize your big toe and you feel pinching, hang on until next week. I am going to show you a way you can mobilize that big toe yourself to try and improve the motion there.

See you next Monday!

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