Knee Rehabilitation Exercises

Whether you are rehabilitating your knee form after surgery or after an injury, progression of exercises should be slow and pain free

unless otherwise noted.

Stretching exercises should be pushed into slowly and held at the first point of discomfort. Strengthening exercises should be done with

a light enough resistance or weight to complete 3 sets of 20 repetitions. Exercises should never increase pain or swelling, even the next

day.

Stretching or Range of Motion Exercises

1. Hamstring Stretches

2. Quadriceps Stretch

Strengthening Exercises

1. Leg Extension Exercises and Straight Leg Raises

2. Buttock Tucks

3. 1/4 Squats- Progressing from double leg to single leg

4. Step-ups- Forward and Lateral

5. Cardiovascular Exercise- Start on a stationary bike and then progress as tolerated to elliptical or treadmill.

Knee Exercises

*NOTE: Only do one exercise per muscle group on the same day. There are several exercises to choose from for some muscles.

Strengthening Knee Exercises

Warming up with 5 minutes of low-impact aerobics, such as walking or riding a stationary exercise bike, increases blood supply to the

muscles to help prevent injury and stiffness.

Quadriceps Strengthening

Quad Strengthening Contractions:

Sit in chair. Extend legs, heels to floor. Keep knees straight (or as straight as possible if you have arthritis.) Tighten thigh muscles. Hold

for count of 10. Relax for count of 3. Do 10 repetitions. You can do this several times throughout the day. You can build up to 2 or 3

sets of 10 repetitions at a time.

Quad Strengthening Leg lifts:

Lie flat on back. Bend left knee at 90-degree angle, keeping foot flat on floor. Keeping the right leg straight, slowly lift it to the height of

the left knee. Hold for a count of 3. Repeat 10 times. Switch sides. Work up to 10 sets of 10 over several weeks.

Safety Tip:

Leg lifts: Lifting both legs at the same time causes excessive stress on your lower back so

only lift one leg at a time; the opposite leg should be kept slightly bent with foot on floor.

Quad Strengthening Short-Arc Leg Extensions:

Sit or lie on floor. Place a rolled up towel under your thigh for support. Keep you leg straight and raise your foot about six inches off the

floor. Hold for 5 seconds. Slowly lower your foot, bending your knee. Do 10 repetitions. Switch sides.

Quad Strengthening Knee Dips:

Stand with knees slightly flexed. Point your toes straight ahead.

Make sure your kneecaps are also pointed straight ahead.

Lift one leg up and balance on the other leg. Slowly lower yourself up and down ONLY a few inches. Keep the knee of the leg you are

balancing on slightly flexed. Your knees must remain pointing straight forward. Do not let them turn inward. Stand straight, do not lean

you body to one side. Do 10 dips. Switch sides.

If you feel pain in your knees, start with fewer dips.

Quad Strengthening Partial Squats:

Double leg partial squat: Stand. Keep Back Upright. Knees pointing straight ahead - inline with feet and hips. Slowly lower yourself.

Don't bend your knees beyond a 90-degree angle, if 90 degrees is too difficult bend even less.

Safety Tip: Make sure your knees do not extend beyond your toes when doing partial squats. Keeping your weight behind your knees

reduces the pressure on the knee joint during the squat. Bending the knees beyond 90 degrees (a right angle) places excessive strain

on the knee.

Hamstring Strengthening

Hamstring Strengthening Contractions:

Sit in chair, heels on floor. Don't move heels but pull back on them. You will feel tension in you hamstrings. Hold for count of 10. Relax

for count of 3. Do 10 repetitions.

Hamstring Strengthening Curls:

Lie on stomach. Place left foot onto the back of the right heel. Slowly pull your right heel toward your buttocks - resisting with the left

leg. This contracts the hamstrings. Hold for a count of 10. (Keep pressing your left foot and right heel against each other) Hold for a

count of ten and relax for count of 3. Do 10 repetitions.

Walking backwards helps to develop the hamstrings. When walking backwards, your weight is distributed more evenly, resulting in less

strain on your knees.

Other Strengthening Exercises for Knee Stability

Hip Adductors (Inner Thigh) / groin muscle and inner quad muscle (VMO) Strengthening:

Sit in chair, put fist between knees, squeeze together knees. Hold for count of 10. Relax for count of 3. Do 10 repetitions.

Lie on floor on your right side, shoulder and hips aligned. Use your right hand to prop up your head. Place the left hand on floor in front

of you to help balance yourself. Bend left leg and bring it to the floor in front of you. Slowly raise your right leg about 10 inches off the

floor then, hold for a second, then slowly lower leg to ground. Lift 10 times on each side.

Hip Abductors (Outer Thigh) strengthening:

Lie on floor on your right side, shoulder and hips aligned.

Bend right leg (leg on floor) to 90 degrees.

Slowly raise you left leg about 18 inches, hold for a second, then slowly lower leg.

Do 10 repetitions. Repeat on other side.

Glutes Strengthening Backward leg swing:

Hold onto back of chair for support. Swing leg back at a diagonal until you feel your buttocks tighten. Tense muscles as much as you

can and swing leg back a couple more inches. Return leg to floor. Repeat 10 times.

Switch sides.Do 10 repetitions. Repeat on other side.

Balancing Knee Exercises

(helps in knee stability)

Hold onto back of chair or counter top for support. Stand on one leg for one minute. Switch sides.

As your balance improves, use one hand only for support. Next use one finger only for support, then progress to letting go, but keeping

your hands within a couple of inches above chair in case you lose your balance. Do not lean your trunk to one side.

To increase difficulty, shift weight onto the ball of the foot.

Stretching Knee Exercises

No bouncing, slow & controlled fashion, 5-10 minutes aerobics warm up first (e.g. walking, stationary bike) Muscles warmed up are

more responsive to stretches and less likely to tear.

Calf Muscles Stretch:Step back with left, forward with right, lean forward with hips. Do not roll foot out to side. Keep heel flat, foot forward. Bend knees for alternate stretch. Hold 30 - 60 seconds.

Quad Muscle Stretch:

Bring heel to hip with hand. Keep knees together. Do not arch back. Do not leg go to side.

Hold for 30 seconds. Repeat on other side.

Hamstring Stretch:

Standing position

Keep one leg on ground; put one foot on chair with leg straight. Bend forward at the hip. Do not attempt to touch your toes as this will

stretch your back, and the goal of this exercise is to isolate your hamstring muscles in the leg that is being supported by the chair.

Sitting in chair hamstring: Straighten one leg, keeping heel on floor. Lean forward at hips, keeping back straight. Don't try to touch your

toes. Hold for 30 seconds. Repeat on other side.

Iliotibial Band Stretch:

Standing position:

Stand up. Cross right leg behind left leg moving crossing knee beyond the midline of the body. Lean from the hips to the left, the stretch

being felt on your right hip, side of the leg and knee. Hold for 30 seconds. Repeat on other side.

Sitting position: Sit in chair: Bring right foot to outside of left leg, bringing knee towards opposite shoulder so that the knee crosses the

midline of the body. Hold for 30 seconds. Repeat on other side.

Hip Adductors (Inner Thigh) Stretch:

Standing: Step off to the side with the right leg. Then lean away from the leg (bending your left knee)

Sitting position: Sit on floor, spread legs into a v position. Slowly lean forward from your hips, keeping your back straight, until you feel

the stretch. Do not bounce. Then lean towards the right, foot then left foot. Hold each position for 30 seconds.

Hip Abductors (Outer Thigh) Stretch:

Sit on the floor,legs extended in front of you.

Bend right leg and place right foot on floor on outside the left knee.

Twist upper body to right and use left elbow to gently push against outside of right nee until you feel a gentle stretch in the right hips,

buttocks, and lower back.

Hold for 30 seconds. Repeat on other side.

Hip flexors (front of hips) Stretch:

Tightness in these muscles can affect the alignment of the knee bones.

Standing Exercise: Step forward with the right leg, bending right knee. Keep back upright. This stretches the front of the hip on the left

side. Keep left knee slightly bent also.

Hold for 30 seconds. Repeat on other side.

Gluteal Stretch (back of hips / buttocks):

Stand in front of chair, about two feet away from chair. Place left foot on chair, leg bent. Bring your chest towards your knee, keeping

back straight. Hold for 30 seconds. Repeat on other side.

*Of all the above knee exercises, the quadriceps strengthening contraction is probably the easiest, safest and most important exercise you can do to prevent knee pain and injury. Those who have trouble fitting in exercises into their schedule can always do this exercise while watching television.

Knee-Safe Aerobics. Low-impact exercises with minimal risk to the knee joint.

Meniscus tear: Rehabilitation exercises

What do I need to know about a meniscus tear?

A meniscus tear is a common knee joint injury. Meniscus tears commonly occur during sports when the

knee is twisted while it is partially flexed and the foot is firmly planted on the ground, but they are also

common with normal movement in people older than age 40 whose menisci (plural of meniscus) are worn

down. The medial and lateral menisci of the knee are two crescent-moon-shaped disks of tissue

(fibrocartilage) that lie between the ends of the upper leg bone and the lower leg bone that form the knee

joint. The rubbery tissue acts as a shock absorber between the upper and lower leg bones, evenly

distributing the load across the knee.

Symptoms of a meniscus tear depend on the size and location of the tear and whether other knee injuries

occurred along with it. Pain at the inside of the knee can indicate a tear to the medial meniscus, while pain

at the outer side of the affected knee may indicate a tear to the lateral meniscus.

Symptoms of a small tear include pain at the time of injury, with slight swelling over several days. You are able to walk and your pain is minimal, although your pain may get worse when you squat. Your symptoms usually go away within 2 to 3 weeks, although they may recur with bending or twisting.

Symptoms of a moderate tear include pain at the side or in the center of your knee, although you may still be able to walk. The swelling increases over 2 to 3 days, and your knee feels stiff. You may have sharp pain when twisting or squatting. The symptoms may diminish in 1 to 2 weeks, but they may recur with twisting or overuse if untreated. The pain may come and go for several months or a year or more if untreated.

Symptoms of a larger tear include pain, with swelling and stiffness that start right away. Or symptoms can get worse over 2 to 3 days. Your knee may catch, pop, or lock, and you might not be able to straighten your knee. It might also feel "wobbly" or unstable, or give way without warning.

Treatment of a meniscus tear depends upon the size, type, and location of the tear, your age, your health

status and activity level, and when the injury occurred. Treatment options include:

Nonsurgical treatment with rest, ice, compression, elevation, and physical therapy. This may include wearing a temporary knee brace.

Surgical repair to sew the tear together. Surgical removal of the torn section (partial meniscectomy). Total meniscectomy, which removes

the entire meniscus, is generally avoided because of the increased risk for osteoarthritis.

Meniscus tear: Rehabilitation exercises

Why should I do rehabilitation after a meniscus tear?

The goals of rehabilitation are to restore range of motion, strength, and endurance of your knee. A

rehabilitation program usually includes treatment with a physical therapist at a therapy center and home

treatment in your home or at a gym or health club. Your physical therapist will design a program that

guides you through exercises to reach these goals on a schedule that takes into account your health

status, age, and activity expectations. In general, as you see less of your therapist, you do more on your

own.

Recovery from a meniscus tear depends on many factors. If the tear is minor and your symptoms go away,

your doctor may recommend a set of exercises to increase your flexibility and strength.

If you have surgery to repair your meniscus, your surgeon may recommend that you do not move your

knee more than absolutely necessary (immobilization) in the days after surgery. This may be followed by a

period of limited motion before you are able to resume daily activities. Some doctors believe that it helps

to begin a physical therapy and exercise program soon after surgery, while others believe that heavy

stresses, such as running and squats, should be postponed for some months. Physical therapy that is

guided by your doctor and designed for your individual needs is a key part of regaining strength and

flexibility in your leg, as well as helping prevent future degeneration in the knee joint.

Meniscus tear: Rehabilitation exercises

How do I do exercise to heal my meniscus?

For most tears, some simple exercises can help maintain muscle strength in the front of the thigh

(quadriceps), back of the thigh (hamstrings), calf, and hip. All of these areas are important for your overall

leg function while your knee heals after an injury or after surgery. Exercises should only be done on the

advice of your doctor, and only if you feel very minimal or no pain while you perform them at home. The

list below has links to specific exercises with pictures and instructions.

Quad sets

Quad sets help you build and maintain strength in the muscles on top of your thigh. With this action, you are “setting” these quadricep muscles by holding them tight. Do 8 to 12 repetitions several times during the day.

Sit on the floor with your injured leg straight out in front of you. Tighten the muscles on top of your thigh by pressing the back of your knee flat down to the floor. Hold for 10 seconds.

If you feel discomfort under your kneecap, try putting a small towel roll under your knee during this exercise.

Straight leg raises o Straight-leg raise to the front

These straight-leg raises help you strengthen the muscles on top of your thigh and around your hip. Do 8 to 12 repetitions.

Lie on your back with your good knee bent so that your foot rests flat on the floor. Your injured leg should be straight. (During this exercise, your low back should have a normal curve. Your back has a normal curve if you can slip your flat hand in between the floor and the small of your back, with your palm touching the floor and your back touching the back of your hand.)

Tighten the thigh muscles in the injured leg by pressing the back of your knee flat down to the floor. Hold your knee straight.

Keeping the thigh muscles tight, lift your injured leg up so that your heel is about 12 inches off the floor. Hold for 5 seconds, then lower slowly.

o Straight-leg raise to the outside

These straight-leg raises help you strengthen the muscles around your hip. Do 8 to 12 repetitions.

Lie on your side, with your injured leg on top. Tighten the muscles on the front of the thigh of your injured leg to keep your knee straight. Keep your hip and your leg straight in line with the rest of your body, and keep your knee pointing

forward. Don't drop your hip back. Lift your injured leg straight up toward the ceiling, about 12 inches off the ground. Hold for 5

seconds, then slowly lower your leg.

o Straight-leg raise to the back

These straight-leg raises help you strengthen the muscles in your buttocks and in the back of your thigh. Do 8 to 12 repetitions.

Lie on your stomach, and lift your leg straight behind you (toward the ceiling). Lift your toes about 6 inches off the floor, hold for 5 seconds, then lower slowly.

o Straight-leg raise to the inside

These straight-leg raises help you strengthen the muscles of your inner thigh. Do 8 to 12 repetitions.

Lie on the injured side of your body. You can either prop your other (good) leg up on a chair, or you can bend your good knee and put

that foot in front of your injured knee. Don't drop your hip back. Tighten the muscles on the front of your thigh to straighten your injured knee. Keep your kneecap pointing forward, and lift your whole leg up toward the ceiling about 6 inches.

Hold for 5 seconds, then lower slowly.

Hamstring curls

Hamstring curls strengthen the muscles in the back of the thigh. Do 8 to 12 repetitions.

Lie on your stomach with your knees straight. If your kneecap is uncomfortable, roll up a washcloth and put it under your leg just above your kneecap.

Lift the foot of your injured leg by bending the knee so that you bring the foot up toward your buttocks. If this motion hurts, try it without bending your knee quite as far, in order to avoid any painful motion.

You may also want to add a cuff weight to your ankle (not more than 5 pounds), or use soup cans in a plastic bag with the loops around your ankle. With weight, you don't have to lift your leg more than 12 inches to get a hamstring workout.

Heel raises

Heel raises strengthen the calf muscles. Do 8 to 12 repetitions several times during the day.

Stand with your feet a few inches apart, with your hands lightly resting on a counter or chair in front of you.

Slowly raise your heels off the floor while keeping your knees straight. Hold for 3 seconds, then slowly lower your heels to the floor.

Unilateral stance

The unilateral stance will strengthen your stability. This exercise should only be done if you don't have any locking, clicking, or giving way in your injured knee.

Stand in front of a counter or chair with your hands lightly resting on the counter/chair. Shift all of your weight to your injured leg, and stand only on the injured leg. Stand just on that leg for 30 to 60 seconds, then put the other foot down and rest. Repeat 8 to 12

times during the day. As long as there is no pain, you can make this exercise a little harder by slightly bending your

injured knee and standing on just that leg. Hold 30 to 60 seconds. Repeat 5 times.

Heel dig bridging

The heel dig bridging exercise works your hamstrings and the muscles around your hip. Do 8 to 12 repetitions. Do not continue with this exercise if it causes pain.

Lie on your back with both knees bent and your ankles bent so that only your heels are digging into the floor. At this point, your knees should be bent about 90 degrees.

From here, push your heels into the floor, squeeze your buttocks, and lift your hips off the floor until your shoulders, hips, and knees are all in a straight line.

Hold briefly, and then slowly lower your hips back down to the floor.

Shallow standing knee bends

Shallow standing knee bends build strength in the muscles on top of your thigh. This exercise should only be done if you have very minimal pain; if you have no clicking, locking, or giving way in the injured knee; and if it doesn't hurt while you are doing 8 to 12 repetitions.

Stand with your hands lightly resting on a counter or chair in front of you with your feet shoulder-width apart.

Slowly bend your knees so that you squat down just like you were going to sit in a chair. Make sure your knees don't go in front of your toes.

Lower yourself about 6 in. (15 cm). Your heels should remain on or barely off the floor. Rise slowly to a standing position.