Exercises should form part of a full medial ligament injury rehabilitation program and will consist of mobility exercises, strengthening exercises, proprioception training and functional or sports specific exercises.
We always recommend seeking professional advice before starting any medial ligament strengthening exercises. See the full rehabilitation program for details of when the exercises below fit into the overall rehabilitation program.
Mobility exercises are done as soon as pain will allow with the objective of maintaining or regaining full joint mobility.
To perform this gentle knee range of motion or ROM exercise the athlete lies on their back on a hard surface. The heel is slowly moved up towards the buttocks, as far as is comfortable. Socks can be worn to ensure that the foot slides. After a minute or so, a further movement may be possible. A towel or strap wrapped around the ankle can be used to help although this should not be forced in the early stages of if there is any pain.
This exercise is extremely important not only to improve the mobility of the injured knee but it will also help maintain the strength of the quadriceps and hamstrings in the early stages of rehabilitation. These movements can also help to decrease the swelling surrounding the knee.
Aim to bend and straighten the knee as far as you comfortably can. This can be done in sitting, standing or lying on your front. Aim for 3 sets of 10-20 repetitions 3 times a day as pain allows. Progress this exercise to holding the leg in place at the end of possible range, both in flexion and extension. This will aid in strengthening the muscles. Further details of strengthening exercises can be found in medial ligament strengthening.
These should begin as soon as pain allows beginning with isometric or static contractions. Follow your physiotherapists or trainers rehabilitation program and if it hurts don't do it!
Static quads contractions
This exercise may be started as soon as pain will allow and can be done on a daily basis. It may even be possible to continue with this exercise if the athlete is in a plaster cast. Contract the quadriceps muscles at the front of the thigh. Hold for 10 seconds. Relax and rest for 3 seconds. Repeat 10 to 20 times. You can also perform this exercise with a rolled up towel or foam roller under the knee as shown. Contraction will cause the foot to lift off the floor as the knee straightens.
Stand with feet shoulder width apart and close to something to hold on to for balance. Lift your heels up as high as possible off the floor. In the early stages, this exercise must be done with both legs at the same time. Slowly lower back to the floor. Aim for 2-3 sets of 15-20 repetitions. Later this exercise can be progressed by moving to single leg calf raises.
Lie on your front and bend the knee up against resistance of ankle weights or a resistance band and gently lower. Remember to keep your hips firmly on the bench and do not allow them to raise up. If they rise up then the weight may be too heavy. Aim for 3 sets of 10 to 20 repetitions initially and as strength improves progress by increasing the resistance to achieve 3 sets of 8 to 10 to failure.
Stand on the uninjured leg only and take the injured leg out to the side as far as possible. Slowly bring it back to the center. Make sure you have something to hold on to. Use a resistance band or ankle weights for increased difficulty. Aim for 3 sets of 10 to 12 reps.
To work the buttocks and hamstrings, the band is wrapped around the ankle and anchored to a table leg. The athlete faces the anchor point and starting with the band just taught, pulls the leg backwards against the band’s resistance. Slowly return to the starting position, maintaining control throughout.
Stand with the feet just wider than shoulder width and back straight. Squat down halfway to horizontal or about 45 degrees and return to standing. Aim for 3 sets of 10 to 20 repetitions during rehabilitation. Progress this exercise by adding weight, increasing the depth of the squat to 90 degrees or near horizontal thighs or moving to single leg squats.
Lunges are a slightly easier version of a squat and are sometimes called split squats. Start with a wide stance. Bend the back knee towards the floor, but don't let it touch. Keep your back upright throughout and don't let the front knee move forwards past the toes. Start with 2 sets of 10 reps with the injured leg in front and then do 2 sets of 10 with the injured leg behind. Gradually increase to 3 sets of 15. To make it harder, you can add either a dumbbell in each hand of a barbell over the shoulders.
There are a number of variations on leg press machines in gyms but they all work in basically the same way. Position yourself on the seat with the feet hip-width apart on the platform. In the starting position there should be approximately a 90 degree angle at the knee. Adjust the seat accordingly.
Push with the legs to straighten the knees (either the seat will move backward or the platform will move forwards). Do not lock the knees but leave a slight bend. Slowly bend the knees back towards the starting position, although do not allow the weights in the stack to touch. This maintains tension on the muscle.
Step ups involve stepping up and down on a step or bench. Try to lead with alternate legs, or do 10 reps with one leg leading and then swap over to do the same on the other leg. Holding weights can increase the difficulty of this exercise.
The athlete lies on their back, knees bent and pushes the hips upwards to work the gluteal muscles and hamstrings. Use both feet on the floor pushing up to begin with. Hold the position briefly and then lower. Begin with 3 sets of 8 reps building to 3 sets of 12 reps then progress the exercise to single leg bridges.
Single leg bridges are done in the same way ensuring you squeeze the gluteal muscles and aim to maintain a straight line from the shoulder on the ground to the knee at the top point of the exercise. Again, begin with 3 x 8 reps and build up.
These involve balance and coordination which is often damaged with knee injury. Standing on one leg with your eyes closed is one way of measuring this.
Balance board exercises
Wobble boards are most commonly used in the rehabilitation of ankle injuries such as ankle sprains, although they should also be used for other lower leg and knee injuries. They can also be used for upper limb injuries, especially the shoulder. This is important in people involved in throwing or similar activities.
These tend to be more advanced sports specific type exercises which bridge the gap between normal rehabilitation and returning to full sports training or playing. Some exercises will depend on the type of sport you play and you should seek professional advice from your coach or physio.
Plyometrics or plyometric exercises are a form of strengthening exercise, incorporating jumping, bounding and hopping movements, which works to increase power in the muscles. Power is used in the vast majority of all sports and so plyometrics can be used to help develop this for most athletes.
Agility exercises involve changing direction, using small hurdles and agility ladders. The aim is to bridge the gap between normal running and getting back to full match fitness.
Returning to sport
This should be done gradually. For example, if you are a footballer then playing just 20 minutes of a game to start with and building up is a good place to start. Going straight back into a full match situation can risk re-injury.