TKEs aren’t that great for knees

(Last Updated On: June 8, 2020)

TKE = Terminal Knee Extension exercise.

The most fundamental version of the exercise:

Getting fancier:

Adding some bro to it:

More than once, this exercise has made its way around the interwebz as being the holy grail to solving knee pain. Namely by waking up the quadriceps, specifically the VMO (vastus medialis).

I’ve covered the VMO at length in:

–The genesis of patellar tracking and instability issues, and what to do about them.

Long story short, and I think well known to anybody who has played with this exercise, TKEs aren’t usually worth much in the helping-knee-pain arena, certainly not as a main ingredient.

What about being just a good quad exercise? Eh.

The biggest concern with them is the stress they can place on the anterior cruciate ligament (ACL). Notice the alignment of the ACL (anterior view of knee):

From the side:

So the ACL moves from the back of the femur (which is above the knee) to the front of the tibia (which is below the knee). One of its key functions then is to prevent the tibia from anterior translation i.e. don’t let the tibia get pulled too far forward relative to the femur:

If the tibia gets pulled too far forward? That’s one way the ACL can tear:

By placing a band right behind the tibia, we’re having it pull the tibia anteriorly, where the band is trying to stretch the ACL:

-> This is where some people can get into the weeds and start overthinking things. “Well, can stretching the ACL or putting tension on it help strengthen it?”

That’s kind of like asking “Should we practice partially dislocating the shoulder to help prevent future shoulder dislocations?” With certain structures, namely ligaments, practicing stretching the area just makes it more flexible, which, in most of these situations, is undesirable.

The ankle is another example- you don’t want to practice bending your ankle laterally, which is what happens when it gets sprained. You want to practice preventing your ankle from getting bent laterally.

–Flexibility- when more is less

The most extreme example of this idea: you don’t go practicing getting punched in the head to become a better boxer. You practice not getting hit in the head! Also noteworthy is once having a concussion, you become more likely to have another.

After all, the biggest predictor for practically all injuries is having had the injury in the past.

Look, odds are you’re not going to tear your ACL doing TKEs. But do enough of them? Intensely enough? Loosening the ACL is on the table.

If you’re someone recovering from ACL surgery, where the tightness of your new ACL is paramount, then you’re really asking why bother messing with this?

It’s one of those things where the downside isn’t guaranteed but it’s plausible, while the upside -in relation to other options- isn’t there at all. Where we can accomplish anything the TKE can accomplish, without adding that potential strain to the ACL, so we should.

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Alternatives

Change Band Placement

Band above the knee-

This still isn’t great, as now we’re stressing the posterior cruciate ligament (PCL), but that’s a ligament much less likely to cause or be a part of knee issues.

You could also try to place the band exactly in the middle of the knee, so it evenly pulls the top and bottom of the knee. It can just be tough to know if you’re actually pulling that off as intended. For your average person who still has a hard-on for this exercise? I’d probably go this route. For your ACL conscious person who is still insisting on this exercise? I’d put the band above the knee.

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Backward Sled Drag

If that don’t wake your quads up, check your pulse!

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Backward Inclined Treadmill

Add some weight if you want, such as a vest or hold dumbbells or hold a plate at your chest- though I’d try to always keep one hand free so you can grab the treadmill for balance just in case, at least until you’re very confident in your ability.