The aim of knee rehabilitation is to restore normal range of movement in the joint, strengthen the surrounding muscles and restore proprioception (co-ordination) of the joint.
Initially, isometric or static exercises are done, progressing to dynamic strengthing which involves movement. Finally, functional and sports specific exercises return you back to full fitness.
On this page:
- Rehab for specific injuries
- Q angle and VMO rehab
- Knee exercises
Specific Knee Injury Rehabilitation
Q Angle & VMO Rehabilitation
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.
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.
Read more on VMO rehab and the Q angle of the knee.
Knee Mobility Exercises
Knee mobility exercises are done as soon as possible after injury, but only if the pain will allow. The aim is to restore range of motion without putting any damaged tissues under stress. The exact exercises and how quickly you progress through will depend on the type and severity of the injury.
Active mobility exercises are where the athlete physically attempts to move the joint through a range of motion are often the first step. Passive knee mobility exercises are when a therapist mobilizes the knee without any effort from the athlete. Assisted mobility exercises use a resistance band or strap to help increase range of motion.
This is a knee mobility exercise to increase the range of knee flexion or bend at the joint. It is suitable for early stage rehabilitation after more severe injuries and surgery where the range of movement of the joint is limited.
This exercise helps to increase the range of knee flexion available at the joint. The athlete uses the other leg to gently push back on the lower leg, increasing knee flexion as far as possible.
This exercise is used to increase knee flexion. Sometimes after a knee or thigh injury or after surgery in this area, it is not possible to fully bend the knee. The position is held for a few minutes as long as it isn’t painful.
This exercise is used to help regain full knee extension. Often after a severe knee injury or after surgery, it is not possible to fully straighten the knee. Gravity will help encourage extension.
Early stage knee strengthening exercises
These exercises are done as soon as pain allows. In some cases, within a day or so of injury after the acute stage.
Isometric quad exercises aim to strengthen the quads by contracting the muscle, with no, or very little movement of the knee joint. The athlete can be sitting or lying down, depending on the degree of injury.
This exercise strengthens the quads at the front of the thigh. It is for the very early stages of a knee injury or quad strain. To begin strengthening the quad muscles at the front of the thigh the athlete lies on their front with a rolled up towel under the ankle so the knee is very slightly bent.
Static or isometric hamstring exercises can be used in the early stages of rehabilitation for a knee injury, or a hamstring strain to help prevent muscle wasting. The athlete lies on their front with the knee slightly bent and the therapist grasps around the back of the ankle.
Hip extension exercises such as this work the glute muscles (buttocks) and the hamstrings at the back of the thigh. This is an early stage exercise as no weight is added, only gravity is used as resistance.
This is a simple exercise that works the quadriceps in the early stages of rehabilitation after a knee injury. It is also helpful for the elderly to maintain quad strength. The athlete sits with the knees bent and feet directly under the knees.
Mid-Stage knee exercises
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 a slightly easier alternative exercise to the squat. By using the wall some of the body weight is supported. The squat position can be held for added difficulty, or performed on a single leg only.
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.
Standing single leg hamstring curl (leg curl). Start slowly then get faster as you 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.
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 forward. Keep the back straight as you initiate movement at your hips. Push your buttocks out behind you and bend your knees.
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 backward. The athlete stands with the feet turned out. The knees should be bent as if performing a squat, ensuring they do not move forward past the toes
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.
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.
Advanced knee exercises
Late stage or advanced knee exercises are more functional and sports specific. The aim is to restore full strength and mobility to the joint and return the athlete to full training and competition.
A ball can be used with a lunge to help with balance and to add extra weight. The athlete stands with the injured leg a wide stance in front of the other. The athlete holds a medicine ball close to the chest With the weight shifted onto the front leg, the back knee is slowly bent and dropped down towards the floor. This exercise works the Glutes, Quads, and Hamstrings.
This exercise is ideal for not only strengthening the muscles of the lower extremity but also for burning calories! The athlete stands with the injured leg a wide stance in front of the other. With the weight shifted onto the front leg, the back knee is slowly bent and dropped down towards the floor. The lunge position may be held to increase difficulty. Walking lunges are a more advanced version of the lunge.
By raising the uninvolved leg on a step the athlete adds more weight to the leg being worked on. The athlete stands with the injured leg a wide stance in front of the other. The uninvolved leg is raised on a step with weight on the toes. With the weight shifted onto the front leg, the back knee is slowly bent and dropped down towards the floor.
By using a medicine ball in the lateral lunge (side lunge) the athlete is able to add weight to the exercise as well as using it to aid balance. The athlete steps to the side keeping the toes forwards and the feet flat. Whilst keeping the involved leg straight, squat through the hip of the involved leg ensuring that the knee is in line with the foot.
Eccentric squat knee exercises target the hamstrings, glutes, and quads. The athlete raises the heels using half a foam roller. Keeping the back straight the athlete lowers themselves down slowly. The athlete returns to the starting position then repeats. To increase the level of difficulty the athlete can lower the body closer to heels. This exercise can also be executed on one leg.
The Norwegian hamstring curl (or Nordic curl) requires either a partner or gym equipment to lock the lower legs securely. This is a very advanced exercise isolating hamstring muscles. A partner anchors the athlete’s calves. A straight line must be maintained from knee to shoulder.