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Main Menu Testing Knee Internal / External Rotation

Internal / External Rotation


Internal external rotation of the knee is often said to be important in the knee. The popliteus and hamstrings muscles play a significant role in rotating the knee (internally) to aid unlocking of the knee joint from full extension and locking the knee into extension.

It should be noted that this position stretches the ligaments at t the rear of the knee and can impinge the meniscus (cartilages) in the posterior horns. This could be preferable in some patient populations but in most cases could lead to injury. Care should be exercised if using this test.

 Supine Lying position:

In this position there is the increased innate thoracic and pelvic stability (little rotation occurs) but the angle of the knee has to be considered with the knee at 90 degrees results tend to be higher than the other most popular angle 45 degrees.



Lying: in the lying position stabilisation usually involves holding the bed handles. Most manufacturers supply a thigh / calf stabiliser. Use the pelvic strap.


The footplate supplied with the machine should fully stabilise the foot it is likely the foot will pull to dorsi flexion during the test so care should be used to full tighten any straps

Axis of rotation:

The axis of rotation goes from the machine and extends through the center of the calcaneous (see below). To check the alignment simply rotate the foot and ensure the knee does not lift from the stabiliser.


Anatomical zero:

Foot points to roof.

Range of motion:

Large individual variations exist in the amount of movement. The ROM should be between 30-50 degrees internal rotation and 20-40 degrees external rotation. 

Gravity correction:

The effects of gravity are negligible in this position in fact some manufacturers use a counter balance rather than instrumented correction.


Speeds tend to be lower in internal external rotation of the knee with multiples of 30 being common. However, any speed from 30-240 degrees/second could be considered representative of the speed of subtalar movement during walking/running. A mid range speed for ordinary subjects is 45 degrees per second which will offer good results.

Generally it is accepted that speeds of 30 degrees/second and multiples of this should be used.



TEST Protocol General Patients Athletes Research
Contraction Cycle  con/con con/con 





Speed/s  30-60  30  30-180  30-180
Trial Repetitions  0  0  3
Repetitions  10 10   10  5
Sets  3  4  up to 9
Rest  20-30 20-30   20-30  20
Feedback  nil nil  nil  nil 


Exercise Protocol General Patients Athletes
Contraction Cycle con/con con/con con/ecc
Speed/s 30-60 30 30-180
Trial Repetitions 0 0 0
Repetitions 10 10 14
Sets 6 6 up to 12
Rest 30-60 30-60 30
Feedback bar bar bar



In the knee it is normal to look at the ratio between the right and left sides there should be a 0-10% difference between the sides. Anything beyond this would indicate a muscle imbalance which would be best corrected.

Eccentric results are generally 30% higher than concentric within the same muscle.

Concentric/concentric: internal/external rotation ratio should show a external rotation dominance of 10 percent.

Peak torque occurs in the internal rotators at 20 degrees and in the external rotators at 2 degrees (Hester & Falkel 1984).

Normative values:

All values Pt ftlbs



Non Dominant




Non Dominant


Ostering et al. (1980) knee angle M 18-35
30 deg sec 90 89.7 102.7 101.3 111.4
30 deg sec 45 78.1 77.4 83.2 81.0
Hester & Falkel (1984) 90 M 18-35
30 28 24.7 28.2 25.6
60 25.4 22.8 25.6 24.1
120 20 18.5 20.1 19.2
180 16.2 15.1 16.9 15.5
PTBW ftlbs









30 14 15 16 16
60 13 14 15 15
120 11 11 11 11
180 9 9 9 10


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