Patient Sitting

The Knee Reflex (L2, L3, L4). The patient may be either sitting or lying down as long as the knee is flexed. Briskly tap the patellar tendon just below the patella. Note contraction of the quadriceps with extension at the knee. A hand on the patient's anterior thigh lets you feel this reflex.

Two methods are useful when examining the supine patient. Supporting both knees at once, as shown below on the left, allows you to assess small differences between knee reflexes by repeatedly testing one reflex and then the other. Sometimes, however, supporting both legs is uncomfortable for both the examiner and the patient. You may wish to rest your supporting arm under the patient's leg, as shown below on the right. Some patients find it easier to relax with this method.

The Ankle Reflex (primarily S1). If the patient is sitting, dorsiflex the foot at the ankle. Persuade the patient to relax. Strike the Achilles tendon. Watch and feel for plantar flexion at the ankle. Note also the speed of relaxation after muscular contraction.

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