Strengthening for Lateral Meniscus Injuries

Early Stage Strengthening Exercises

Static Quadriceps Contractions

This exercise is used to prevent quadriceps muscle degeneration and weakening in the acute stages of injury and/or directly after injury. In this stage weight bearing or more difficult exercises may be either not advised or too difficult. This exercise may be started as soon as pain will allow and can be done on a daily basis.

• Contract the quadriceps muscles at the front of the thigh, keep toes pointed to the ceiling.
• Hold for 10 seconds.
• Relax and rest for 3 seconds.
• Repeat 10 to 20 times.

This can be performed either flat on the floor, or with a foam roller or rolled up towel under the knee.

Static Hamstring Hold

This exercise is used to maintain the strength of the hamstring muscles when other exercises may be too difficult. Again it may be started as soon as pain will allow and can be done on a daily basis.

• Lie on your stomach
• Bend the knee to raise the foot up to about 45 degrees
• Hold for count of 10 and lower slowly .
• Repeat 10 to 20 times.

This can be progressed by increasing the length of hold, as well as using some external force such as a partner to increase the resistance or ankle weights.

 Static Hamstring Contractions

This exercise is more difficult than the one above and also helps in increasing the range of movement in the knee joint. This involves contracting the hamstring muscles without movement - by pushing against a static object. You can do this by attempting to either bend the knee or extend the hip, or both!

• The easiest way of doing this is getting a partner to resist your movement.
• You can also push against a wall, chair or the floor.
• Hold for 10 seconds.
• Relax and rest for 3 seconds.
• Repeat 10 to 20 times.

Mid-Stage Exercises

Straight Leg Raises (SLR)

This exercise is more difficult than the static quadriceps exercise as it involves lifting the entire weight of the leg against gravity. It mainly targets the knee extensors (the quadriceps) but also functions in strengthening the hip flexors (Rectus Femoris and Iliopsoas muscles).

• Position yourself sitting on the floor with both legs straight out in front of you.
• Keeping the knee completely straight, lift the entire leg off the floor > Play video
• Hold for 10 seconds.
• Relax and rest for 3 seconds.
• Repeat 10 to 20 times.

 Knee Extension

This exercise specifically targets the quadriceps muscle group. It may be used relatively early in the rehab process but care should be taken not to overload the injured leg. Always seek professional advice before beginning weight training

• Always start each session with a light warm-up set of repetitions before increasing the weight or resistance.
• Keeping your bottom firmly on the bench, straighten and lower the injured leg in one smooth movement.
• An alternative exercise involves using a resistance band to provide the resistance.
• Tie one end of the band to a table leg or other stable structure

 Leg Curl

Again, this exercise strengthens the hamstring muscles. You can perform this with either ankle weights, a resistance band or a weight machine.

• If using ankle weights or a resistance band, lay on your front.
• Attach the band around your ankle and also around something sturdy, close to the floor behind you.
• Always start resistance band exercises with the band just under tension, if it is slightly slack, shorten the length you are using by tying it shorter.
• Bend the knee, bringing the heel towards your buttocks, as far as you comfortably can.
• Slowly reverse this movement and return to the starting position under control.
• Aim for 3 sets of 10 repetitions initially with light weights/low resistance and gradually increasing.

 Hip Raises (Bridging)

• Lie on your back with your knees bent and feet flat on the floor.
• Lift your hips up off the floor as far as they will go, hold for 3 seconds and lower.
• Repeat 10 to 20 times.

To progress this exercise, increase the length of time that the hips are held up, initially to 5 and then to 10 secs

 Calf Raises

• Raise up and down on the toes on the edge of a step in a smooth movement.
• Aim for 3 sets of 20 repetitions.
• This exercise can be progressed to single leg calf raises as fitness and tolerance increases

Late Stage Exercises

Squatting

This is arguably the best exercise to increase quadriceps muscle strength. Nevertheless, extreme care should be taken with this exercise as it involves large loading of the quadriceps muscles and the knee joint itself

• Squat down half way to horizontal and return to standing.
• Try to sink down through the knees, keeping the back straight and not allowing your knees to move forwards past your toes
• Return to the start position and repeat
• Aim for 3 sets of 10 repetitions during rehabilitation.
• Progress this exercise by adding weight or moving to single leg squats.

Later in the rehabilitation process, squats can be progressed to horizontal (90 degrees flexion at knee and hip)

 Hip Flexor Exercises

• Start with the band tied around your ankle and also something close to the floor.
• Make sure you have something to hold on to.
• Raise the knee up towards the chest, against resistance > Play video
• Slowly return to the start position and repeat.
• Aim for 3 sets of 10 repetitions.

If you do not have rehabilitation band or suitable weights then this exercise can be done without resistance. However in this situation more reps should be added to the rehab program.

 Hip Adduction Exercises

The hip adductors are better known as the groin muscles.

• Attach a resistance band around your ankle and then fasten it to a secure object, to the side of you.
• Start with the leg out to the side, away from the body, with the knee straight.
• Pull the leg across your body as far as comfortable, before slowly returning back to the start position  

Hip Abduction Exercises

The hip abductors are vital components in gait as they allow the hips to support the weight of the body. Thus strengthening exercises for this muscle group is vital to any lower limb rehabilitation program. These can be performed in lying in the acute stage and progressed into standing with a resistance band.

• Tie the band around your ankle and around a sturdy object to the side of you.
• Start with the leg to be worked on the opposite side to the attachment point
• While keeping the leg straight, take leg out to the side as far as comfortable
• Slowly return to the start position.

This exercise can be progressed using elastic bands to increase resistance.

Proprioceptive Exercises

Proprioception can be considered as the body's ability to sense where it is in space. In the event of an injury this mechanism becomes disrupted and proper training is needed to re-educate the muscles to fire at the right time to allow further injury prevention. The most common way to achieve this is to first stand and then walk on an uneven surface. As balance continues to improve proprioceptive exercises can progressed as follows:

• Two footed stand on wobble board -aim to maintain balance for as long as possible
• Progress to one legged (injured side) wobble board exercises
• Practice hopping on the injured leg on an uneven surface
• Gradually increase difficulty by throwing a ball against a wall and catching it while standing on the wobble-board. Aim to challenge yourself by throwing the ball outside your comfortable center of gravity.

 Proprioceptive exercises should be continued even after a return to full fitness to prevent future injury.