The patellar reflex, also called the knee reflex or knee-jerk, is a

stretch reflex The stretch reflex (myotatic reflex), or more accurately "muscle stretch reflex", is a muscle contraction in response to stretching within the muscle. The reflex functions to maintain the muscle at a constant length. The term deep tendon reflex is ...

which tests the L2, L3, and L4 segments of the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...

Mechanism

Striking of the

patellar tendon The patellar tendon is the distal portion of the common tendon of the quadriceps femoris, which is continued from the patella to the tibial tuberosity. It is also sometimes called the patellar ligament as it forms a bone to bone connection when t ...

with a

reflex hammer A reflex hammer is a medical instrument used by practitioners to test deep tendon reflexes. Testing for reflexes is an important part of the neurological physical examination in order to detect abnormalities in the central or peripheral nervous s ...

just below the

patella The patella, also known as the kneecap, is a flat, rounded triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint. The patella is found in many tetrapods, such as m ...

stretches the

muscle spindle Muscle spindles are stretch receptors within the body of a skeletal muscle that primarily detect changes in the length of the muscle. They convey length information to the central nervous system via afferent nerve fibers. This information can be ...

in the

quadriceps muscle The quadriceps femoris muscle (, also called the quadriceps extensor, quadriceps or quads) is a large muscle group that includes the four prevailing muscles on the front of the thigh. It is the sole extensor muscle of the knee, forming a large ...

. This produces a signal which travels back to the spinal cord and synapses (without interneurons) at the level of L3 or L4 in the spinal cord, completely independent of higher centres. From there, an

alpha motor neuron Alpha (α) motor neurons (also called alpha motoneurons), are large, multipolar lower motor neurons of the brainstem and spinal cord. They innervate extrafusal muscle fibers of skeletal muscle and are directly responsible for initiating their con ...

conducts an efferent impulse back to the

quadriceps femoris muscle The quadriceps femoris muscle (, also called the quadriceps extensor, quadriceps or quads) is a large muscle group that includes the four prevailing muscles on the front of the thigh. It is the sole extensor muscle of the knee, forming a large ...

, triggering contraction. This contraction, coordinated with the relaxation of the antagonistic flexor hamstring muscle causes the leg to kick. There is a latency of around 18 ms between stretch of the patellar tendon and the beginning of contraction of the quadriceps femoris muscle. This is a reflex of

proprioception Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...

which helps maintain

posture Posture or posturing may refer to: Medicine * Human position ** Abnormal posturing, in neurotrauma ** Spinal posture ** List of human positions * Posturography Posturography is the technique used to quantify postural control in upright stance in ...

and

balance Balance or balancing may refer to: Common meanings * Balance (ability) in biomechanics * Balance (accounting) * Balance or weighing scale * Balance as in equality or equilibrium Arts and entertainment Film * ''Balance'' (1983 film), a Bulgarian ...

, allowing to keep one's balance with little effort or conscious thought. The patellar reflex is a clinical and classic example of the monosynaptic

reflex arc A reflex arc is a neural pathway that controls a reflex. In vertebrates, most sensory neurons do not pass directly into the brain, but synapse in the spinal cord. This allows for faster reflex actions to occur by activating spinal motor neurons w ...

. There is no

interneuron Interneurons (also called internuncial neurons, relay neurons, association neurons, connector neurons, intermediate neurons or local circuit neurons) are neurons that connect two brain regions, i.e. not direct motor neurons or sensory neurons. I ...

in the pathway leading to contraction of the quadriceps muscle. Instead, the sensory neuron synapses directly on a motor neuron in the spinal cord. However, there ''is'' an inhibitory interneuron used to relax the antagonistic hamstring muscle (

reciprocal innervation René Descartes (1596–1650) was one of the first to conceive a model of reciprocal innervation (in 1626) as the principle that provides for the control of agonist and antagonist muscles. Reciprocal innervation describes skeletal muscles as ...

). This test of a basic automatic reflex may be influenced by the patient consciously inhibiting or exaggerating the response; the doctor may use the

Jendrassik maneuver The Jendrassik maneuver is a medical maneuver wherein the patient clenches the teeth, flexes both sets of fingers into a hook-like form, and interlocks those sets of fingers together. The tendon below the patient's knee is then hit with a refl ...

in order to ensure a more valid reflex test.

Clinical significance

After the tap of a hammer, the leg is normally extended once and comes to rest. The absence or decrease of this reflex is problematic, and known as

Westphal's sign Westphal's sign is the clinical correlate of the absence or decrease of patellar reflex or knee jerk. Patellar reflex or knee jerk is a kind of deep or stretch reflex where an application of a stimulus to the patellar tendon such as strike by a so ...

. This reflex may be diminished or absent in

lower motor neuron lesion A lower motor neuron lesion is a lesion which affects nerve fibers traveling from the lower motor neuron(s) in the anterior horn/anterior grey column of the spinal cord, or in the motor nuclei of the cranial nerves, to the relevant muscle(s). On ...

s and during sleep. On the other hand, multiple oscillation of the leg (pendular reflex) following the tap may be a sign of

cerebellar diseases The cerebellum (Latin for "little brain") is a major feature of the hindbrain of all vertebrates. Although usually smaller than the cerebrum, in some animals such as the mormyrid fishes it may be as large as or even larger. In humans, the cerebel ...

. Exaggerated (brisk) deep tendon reflexes such as this can be found in

upper motor neuron lesion An upper motor neuron lesion (also known as pyramidal insufficiency) Is an injury or abnormality that occurs in the neural pathway above the anterior horn cell of the spinal cord or motor nuclei of the cranial nerves. Conversely, a lower motor ne ...

hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism ...

, anxiety or nervousness. The test itself assesses the nervous tissue between and including the L2 and L4 segments of the spinal cord. The patellar reflex is often tested in

infants An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...

to test the nervous system.

History

Wilhelm Heinrich Erb Wilhelm Heinrich Erb (30 November 1840 – 29 October 1921) was a German neurologist. He was born in Winnweiler, and died in Heidelberg. Academic career In 1864 he received his medical degree from the University of Heidelberg, where for sev ...

(1840–1921) and

Carl Friedrich Westphal Carl may refer to: *Carl, Georgia, city in USA *Carl, West Virginia, an unincorporated community *Carl (name), includes info about the name, variations of the name, and a list of people with the name *Carl², a TV series * "Carl", an episode of tel ...

(1833–1890) simultaneously reported the patellar tendon or knee reflex in 1875. The term ''knee-jerk'' was recorded by Sir Michael Foster in his Textbook of

physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...

in 1877: "Striking the tendon below the patella gives rise to a sudden extension of the leg, known as the knee-jerk."

In popular culture

The term began to be used figuratively from the early 20th century onwards.

O. O. McIntyre Oscar Odd McIntyre (February 18, 1884 – February 14, 1938) was a New York newspaper columnist of the 1920s and 1930s. ''The Washington Post'' once described his column as "the letter from New York read by millions because it never lost the hu ...

, in his New York Day-By-Day column in

The Coshocton Tribune ''Coshocton Tribune'' is a daily newspaper that serves the community of Coshocton, Ohio, United States, and the surrounding Coshocton County. History The ''Coshocton Tribune'' was founded in 1909 by William J. Bahmer, a former teacher. The pap ...

, October 1921, wrote: "Itinerant preacher stemming Broadway on a soap box. And gets only an occasional knee-jerk."

References

Sources