During the mid stage exercises progress to gentle strengthening, gradually increasing the load on the joint and through the recovering tissues. Balance and proprioception training usually begins.
The wall squat exercise is an slightly easier alternative exercise to the squat. By using the wall some of the body weight is supported. The athlete stands with their back against a wall and the feet moved forwards. They perform a squat by sliding the back down the wall and ensuring that the knees do not move forwards past the toes. The squat position can be held for added difficulty, or performed on a single leg only.
- A Swiss ball between the back and the wall can also be used for smooth movement.
Terminal knee extension
This exercise increases the weight-bearing strength of the quadriceps. A resistance band is wrapped around the knee and anchored to a table leg or similar upright object. The athlete starts with the knee slightly bent and body weight on the involved leg. The knee is then straightened backwards, against the resistance of the band. The knee should not be locked straight.
Standing hamstring curl
Standing single leg hamstring curl (leg curl). Start slowly then get faster as your gain in confidence. The athlete stands and flexes the involved knee. Ankle weights can be used to increase difficulty or offer resistance with the hands, or incorporate a resistance band. The athlete may use the hands on to support the body.
Squat with band
The resistance band provides lateral or sideways resistance to add another dimension to the squat exercise. Starting with the feet shoulder width apart, the athlete squats down to no more than a right angle at the knee. The knees should not fall inwards and the back should remain straight throughout. This can be performed with a bar over the shoulders or dumbbells in the hands.
The squat is a great exercise to work most of the leg muscles, especially the quads and glutes. Stand with your feet shoulder width apart and toes pointing straight forwards. Keep the back straight as you initiate movement at your hips. Push your buttocks out behind you and bend your knees. Do not let your knees move in front of your toes or squat deeper than a 90 degree (right angle) at the knee. Start with shallow squats and increase gradually then return to the starting position.
Variations & progressions
- Use a dumbbell in each hand.
- Use a barbell over the shoulders.
Straight leg ball pick up
The straight leg ball pick up strengthens the hamstring muscles in a stretched position. The athlete stands with the heel of the involved leg raised. The uninvolved leg is moved back to provide balance. Ensuring that the back is kept straight the athlete bends to pick up the medicine ball. All motion involves the pelvis moving around the femurs rather than lumbar flexion.
The Plie is a wide squat exercise with the knees pointing outwards. The back should remain straight during the exercise and the pelvis should not til backwards. The athlete stands with the feet turned out. The knees should be bent as if performing a squat, ensuring they do not move forwards past the toes
Knee extension with band
Knee extension exercise (or leg extension) using a resistance band to strengthen the thigh muscles. The athlete sits on the edge of the table (or on a chair) with the knees over the edge. The resistance band is placed around the ankle and anchored under the furthest table/chair leg on the side of the leg being worked on. The athlete lifts the foot upwards to straighten the knee, then returns to the starting position. If pain is felt do not continue with this exercise.
Seated hamstring curl
Seated or supine hamstring curl exercise using a resistance band. The athlete sits with a resistance band around the ankle with both legs straight. A partner holds the band in both hands until it is taut. The partner must not move the band from the starting position. The athlete draws the ankle in towards the buttocks increasing the resistance of the band, then returns to the starting position
This exercise works the hamstring muscles and can be progressed to use weights depending on the state of the injury. Lying on their front with the foot pointing down over the edge of the couch, the athlete fully bends the knee. Provided this is pain free, a resistance band or ankle weight can be used to increase difficulty.
Single leg catch exercises for hamstrings. This starts to strengthen the hamstrings eccentrically or as they lengthen. In a prone position the athlete lifts both legs to a 90 degree angle. Ensuring that the leg and the foot are not turned outwards the athlete drops the leg attempting to stop or 'catch' the lower leg reaching full extension. Alternate the legs.
- The athlete can increase the difficulty of this exercise either by adding ankle weights or speeding up the rate of the leg catch.