The MSing Link – Episode 266

Knee Bending Exercises for MS: Strengthen Hamstrings & Release Tightness

Host: Dr. Gretchen Hawley, PT, DPT, MSCS
Date: January 7, 2026

Episode Overview

This episode addresses one of the most common and challenging symptoms for people living with Multiple Sclerosis (MS): difficulty in bending the knee. Dr. Gretchen Hawley, a physical therapist and MS specialist, explores why this issue arises—specifically highlighting hamstring weakness and quadriceps tightness (spasticity)—and delivers actionable, MS-specific exercises and strategies for assessing and improving knee-bending. The goal is to empower listeners to regain greater function and independence in daily activities by understanding and targeting the root causes.

Key Discussion Points and Insights

1. Why Knee Bending Matters (00:00–03:40)

• Bending the knee is crucial for daily functions: walking, climbing stairs, getting in/out of chairs and cars, and various transfers (bed, shower, etc.).
• Many people with MS struggle here because MS tends to weaken or disrupt coordination in key muscle groups related to knee movement.

Quote:

"Any movement that we do... pretty much any movement requires that we have some degree of bending our knee. ...The issue is often weakness, spasticity, or sometimes both." (A, 00:54–01:37)

2. Root Causes: Weakness vs. Spasticity (03:40–06:12)

• Hamstring Weakness: The hamstrings (back of the thigh) control knee bending; weakness here makes bending hard.
• Quadriceps Spasticity: The quadriceps (front of the thigh) work to straighten the knee; if they’re overly tight or spastic, they resist bending.
• Some people experience both, making assessment and treatment a bit more involved.

Quote:

"If your knee is straight, bending it is going to be very hard because something is making it stay straight, and we actually want the opposite." (A, 04:31)

3. How to Assess What’s Limiting Your Knee Bending (06:13–13:00)

Testing for Hamstring Weakness

• Seated Test:
  Sit in a chair (preferably with a slippery surface underfoot), try to bend your knee by pulling your heel back. If this is very hard, weakness is likely present.
• Other Positions:
  Try in standing (with support if needed) or lying sideways.

Testing for Quadriceps Spasticity

• Assisted Movement:
  Seated, relax your leg while someone else tries to bend your knee. If they can’t move it or feel resistance you’re not intending, this points to spasticity.
• Solo:
  Use a yoga strap to pull your foot towards you in a seated position and assess for resistance.

Memorable Moment:

"If they’re saying something like, 'Dr. Gretchen, stop pushing against me,' and your response is, 'I’m not trying to, it’s just happening,' that is spasticity." (A, 09:50)

4. Exercises for Hamstring Strengthening (13:01–17:48)

• Principle: Any movement that bends the knee activates the hamstrings.
• Positions:
  • Seated: Sit back in the chair, focus on pulling the heel backward. Use a slippery surface to reduce friction.
  • Standing: Use a staggered stance (one foot forward, one back), shift your weight forward, and try to bend the back knee.
  • Side-Lying: Lie on your side and try to bring your heel toward your buttocks.
• Isometric Strengthening: Press heel against chair while attempting to bend the knee, activating muscles without visible movement.

Quote:

"Even if it’s only lifting a centimeter, even if your toes are still touching the ground, but you’re trying to bend your knee... it doesn’t have to lift high, just a little bit.” (A, 16:19)

5. Exercises & Techniques to Release Quadriceps Spasticity (17:49–22:38)

• Stretching:

  • Sit on the edge of a chair or bed, lie back to straighten hips while keeping knees bent for a deep front thigh stretch (hold 3–7 minutes).
  • Standing: In a staggered stance, tuck the butt under and straighten the back leg to stretch the front of the hip and thigh.
  • Seated: Pivot hips and legs wide, rotate torso, tuck hips under, and feel the stretch in the front of the thigh.

• Massage & Release:

  • Use the heels of your palms, knuckles, or assistive devices (jack knobber, Theragun, muscle roller stick) to roll and massage the quadriceps.
  • Foam rolling and manual devices work to reduce tension and spasticity.

Notable Tip:

“A few minutes of releasing the quadriceps before knee bending exercises can make bending much easier.” (A, 22:15)

6. Expected Timelines for Improvement and Neuroplasticity (22:39–24:47)

• Stretching and Releasing: Some experience relief in a day or two, others in several weeks.
• Strengthening: Progress typically takes 6–12 weeks for MS patients, but some may notice a change in just a few days due to improved brain-muscle communication.
• Small Wins Matter: Even a 5-degree improvement in knee flexion can be the difference between managing stairs or not.

Memorable Moment:

“Any movement improvements... really do matter. Don’t feel like you need to make these huge, massive improvements... Any amount can be really, really helpful. You’ve got this. I know that you do.” (A, 25:01)

7. Tailoring Your Approach & Community Support (24:48–26:47)

• Individual needs vary: Reiterate the importance of finding what works for you.
• Missing Link Community: Members can submit questions monthly or use 24/7 Dr. Gretchen AI for tailored guidance.
• Focus on consistency over perfection: Regular practice trumps flawless execution.

Quote:

“Consistency matters more than perfection. ...Even small improvements in knee bending create big functional changes.” (A, 25:21–25:41)

Notable Quotes

• On Spasticity:

  “Spasticity is muscle tightness that restricts, reduces, or prevents movement.” (A, 10:13)

• On Progress:

  “If you do notice improvement sooner... that's likely why that's happening—reminding your brain how your body should be moving and it all clicks.” (A, 24:01)

• Empowerment:

  “You’ve got this. I know that you do...” (A, 25:18)

Important Timestamps

• 00:00–02:41: Introduction, importance of knee bending in daily life
• 03:40–04:40: Two main causes: hamstring weakness and quadriceps spasticity
• 06:13–10:13: How to test for weakness and spasticity
• 13:01–17:48: Hamstring strengthening exercises (seated, standing, isometric)
• 17:49–22:38: Quadriceps stretching and muscle release techniques
• 22:39–24:47: Timelines for improvement, how neuroplasticity works in progress
• 24:48–26:47: Tailoring approach, community resources, mindset encouragement

Summary & Takeaway

Dr. Gretchen breaks down how MS can make knee bending hard, with easy self-assessments to determine your individual barriers—weakness, spasticity, or both. She provides clear, adaptive exercises for each cause, with a huge emphasis on consistency, small gains, and self-compassion. Her engaging style, visual analogies, and practical advice make this a crucial listen for anyone with MS seeking mobility improvements.

Final Message:
Remember, each small step toward better knee bending—be it from building strength or relieving tightness—can unlock real-world gains in independence and daily function. Consistency is key, and perfection isn’t required for progress.

Resources

• For more personalized help or to join The MSing Link community, check show notes for links to Dr. Gretchen’s program and resources.
• Watch the YouTube version for exercise demonstrations if you’re a visual learner.