The following exercises are examples of those that could be used in the rehabilitation of a medial cartilage meniscus injury.
Included are mobility exercises to increase the range of motion at the knee joint, strengthening exercises to build stability and functional exercises which bridge the gap between basic rehabilitation and returning to full sports fitness.
The exercises get progressively more difficult and should always be done pain free. See medial meniscus rehabilitation program for more details of which exercises are suitable for a particular stage of rehabilitation.
In general the patient will start with isometric or static contractions, progress to exercises with resistance bands and finally more functional plyometric exercises before going back to full training.
Mobility or range of motion exercises which can be used in the early stages of a rehab program for a medial cartilage meniscus injury to increase the range of motion at the joint.
Flexion extension exercise
This exercise can be done standing up or sitting down. Simply bend and straighten the knee as far as pain and range of movement will allow. Aim for 3 sets of 10-20 repetitions 3 times a day as pain allows. Increase the difficulty of this exercise by holding the leg still at the end of range, for both in flexion and extension.
Lying on the back, one knee is bent upwards whilst sliding the foot along the ground. Slide the heel up as far as possible towards the buttocks. In the early phases of recovery it may only be possible to bend the knee as little as 30 degrees.
This should increase over time. Repeat 10 to 20 times daily, aiming to increase the range of movement as pain allows. If there is insufficient muscle strength to bend the knee, the exercise may be made easier by using a towel around the ankle to facilitate flexion. This exercise can be made easier by wearing a thick sock and sliding the foot along a polished floor as opposed to carpet.
Exercises should always be done pain free. Isometric exercise scan often begin immediately as there is no movement of the knee joint. As the injury heals and pain allows more dynamic exercises such as squats and lunges can be done.
Isometric hamstring contractions
This exercise will maintain some of the strength in the hamstring muscles. The hamstrings are contracted against the resistance of a partner, held, then relax before repeating. Aim for 10 to 20 repetitions. The exercise should then be repeated for varying amounts of flexion or bend in the knee.
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.
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.
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 legbridges.
Single leg bridges are done in the same way ensuring you squeeze the gluteal muscles and aim to maintain 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.
Stand with the feet just wider than shoulder width and back straight. Squat down half way 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 backwards 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.
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.
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 gape between normal running and getting back to full match fitness. If you are a footballer or soccer player then kicking the ball should be gradually introduced to enable any scar tissue to adjust to the loads.