Knee rehabilitation is not just about doing a few knee exercises. If done properly you can come out the other end a better athlete than you were before injury. Here we explain how to rehab your knee and the types of knee exercises used by elite sports physio Phil Pask.
Is knee rehabilitation the the same for all knee injuries?
No. Obviously the exact protocol, timing and exercises you need will depend on your particular knee injury. We always advise seeking professional advice with your therapist or physio. However, regardless of your injury you will likely progress through a series of phases.
The early stages are more likely to be injury specific, but in later phases, exercises are often similar with more functional or sports specific exercises.
View knee rehabilitation programs for specific injuries:
- ACL rehabilitation program
- MCL rehabilitation program
- Torn meniscus knee rehab
- Patella tendonitis/Jumpers knee
Break knee rehabilitation into phases
Phil breaks our knee rehabilitation programs into 4 phases with a 5th injury ‘mitigation/prevention’ phase. Because every injury is different and every athlete is different our knee rehabilitation programs are criteria based rather than timeline. This means you have to reach specific criteria or milestones rather than a period of time before moving onto the next phase.
This is the acute phase and begins as soon as possible after injury. The main aim here is to reduce pain, swelling and allow your body to heal. Applying the PRICE principles of protection, rest, ice compression and elevation are most important.
Even though you might be injured there are always exercises you can do in phase 1 which will speed up your recovery later and keep you in a training routine.
Seek professional advice and get an accurate diagnosis of your injury. This is not always possible for knee joint injuries if you have a lot of swelling. Your doctor or physio may want to wait until the swelling has gone down so they can perform accurate knee assessment tests.
By the end of phase one you should have minimal swelling and be able to walk virtually pain free.
The aim of phase 2 is to regain normal range of movement in your knee and begin to increase the ability of your knee to take load, but in a controlled environment.
Here we introduce some functional movement patterns using mainly bodyweight, but carefully monitoring your knee to make sure it does not get worse.
The aim of knee rehabilitation in Phase 3 is to prepare your knee to withstand heavier loads through a full range of movement. You will begin to introduce dynamic loading exercises such as hopping, jumping and running up to 50% of maximum speed.
Phase 4 prepares you to return to your normal sport or activity safely to perform at your best with confidence. This confidence will be born out of completing more demanding exercises with heavier loads, unpredictable movements, changes of direction, and agility all performed under pressure and fatigue.
Although you should by now be back to full fitness (perhaps even stronger than before), you should still monitor your knee and integrate knee rehabilitation exercises into your normal training. You cannot ever prevent injury, but you can mitigate the risk.
Types of knee rehabilitation exercises
Knee rehab is not just about doing a few knee exercises. There is so much more you can do whilst you are injured to accelerate your recovery and even become a better athlete than before.
Mobility & stretching
These exercises aim to maintain or regain full range of movement in your knee. If you have a ligament or joint injury or significant joint swelling then your mobility is likely to be restricted.
More on knee mobility exercises.
These exercises are all about keeping muscles firing and working properly, particularly the hip muscles. This is often overlooked with knee rehabilitation. If you have to rest for a period of time then they can ‘go to sleep’ and lose strength, leading to a slower recovery, or poor performance later when you get back to full fitness.
View activation exercises
These form the main part of any knee rehabilitation or strengthening program. They strengthen the quadriceps muscles at the front of the thigh, as well as what we call the posterior chain (hamstrings & gluteal muscles).
Movement control exercises are all about coordination, balance and proprioception. Proprioception is how your body senses where parts of it are in space and is damaged when you are injured. Improving this is important for sports performance and preventing injury.
Functional exercises for knee rehabilitation
These are activity or sports specific exercises and include more complex exercises and agility drills, but in a controlled environment. They bridge the gap between basic knee strengthening exercises and returning to more sports specific training.
These are all about maintaining general fitness as much as possible. In the early stages of rehabilitation this might be arm only swimming or concentrating on your upper body strength in the gym. Later on running progressions involving acceleration runs and intervals are included.
Q Angle of the knee & VMO exercises
The Q angle of the knee is a measurement of the angle between the quadriceps muscles and the patella tendon and provides useful information about the alignment of the knee joint. This is especially relevant with overuse injuries such as Patellofemoral pain, Patella tendonitis or Osgood Schlatter disease.
With many sports injuries affecting the legs, one of the first muscles to waste away is the Vastus medialis muscle on the inside of the thigh. It plays an important part in the position and tracking of the patella or kneecap.
More on VMO rehab