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 quads

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 supine depending on the degree of injury. Being seated increases the difficulty.

• Keeping the uninvolved knee in place, the athlete tightens the involved knee pushing it into the table.
• To position the knee in partial flexion the athlete places a towel or roll under the knee.
• The knee is straightened (keeping the other knee flexed) and held in full extension.
• Hold the position for about 5 seconds and return to the starting position.
• This can be further progressed by raising the angle of the knee using a foam roller.

Isometric quad prone

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.
• They then push down on the towel to attempt to straighten the leg and contract the quads.

Isometric hamstring exercises

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.
• The athlete then tries to bend their knee against the therapist’s resistance.
• Start with a gentle contraction and gradually increase force as pain allows.
• The knee should not move.

If a therapist or friend is not available, this can be achieved in a seated position. Sitting on a chair with the knee bent, push the heel back against a chair or table leg or wall.

Sit to stand exercise

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.
• In a slow and controlled manner, the athlete moves from seated to standing and then back to seated as shown.
• Ensure the knees do not fall inwards.

Hip Extension on all fours

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.

• In an all-fours position, the athlete raises one leg behind them, keeping the knee bent and moving the sole of the foot towards the ceiling.
• Once at the top of the movement, they may hold the position briefly before returning slowly to the starting position.