Knee jerk: L2, L3 L4 roots. Ensure that the patient's leg is relaxed by resting it over examiner's arm or by hanging it over the edge of the bed. Tap the patellar tendon with the hammer and observe quadriceps contraction. Note impairment or exaggeration.

Ankle jerk: SI, S2 roots.

Externally rotate the patient's leg. Hold the foot in slight dorsiflexion. Ensure the foot is relaxed by palpating the tendon of tibialis anterior. If this is taut, then no ankle jerk will be elicited.

Tap the Achilles tendon and watch for calf muscle contraction and plantarflexion.

Reflex enhancement

When reflexes are difficult to elicit, they may be enhanced by asking the patient to clench the teeth or to try to pull clasped hands apart (Jendressik's manoeuvre).

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