Knee Rehabilitation

Instruction by: Richard Sandor, M.D., Camino Medical Group, Orthopedics Amy Fowlkes, P.T., PRN Rehabilitation Network

Before you begin, there are a few principles to keep in mind: 1. It is important that you do all of the exercises on both legs, even though one knee may give you more trouble. 2. Start with level 1 exercises. Progress to the next level when you can perform the exercise in that level with com fort. Advance levels as comfort permits. 3. Exercise the knee through its available range of motion. 4. When stretching you should feel pulling, not pain. 5. Strengthening exercises may cause a feeling of burning in the muscle that is working. It should not at any time increase knee pain. 6. Perform exercise daily until you achieve a stable program, then go to three times a week. 7. If any single exercise increases your pain, do not do that exercise. If you are having difficulty understanding or performing these exercises or many of the exercises increase your pain, discuss with your physician or physical therapist. LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL 5 LEVEL 6 LEVEL 7 Exercise 1 through 3. Continue these throughout your rehab program. Exercise 4 through 6 Exercise 7 through 8 Exercise 9 through 12 Add exercises 9 and 10 Continue exercises 6 and 8; add 11 and 12 Progress to full activity. If you are having difficulty with this, contact your physician or physical therapist. Activities that may still be difficult at this stage include jumping, deep squats, knee extension machine and running.

This patient handout was produced by the Camino Medical Group Department of Orthopedics for the purpose of better assisting our patients with their recovery. It is important that you follow the directions your physician has prescribed in order to benefit from the rehabilitation process.

LEVEL 1: Stretching

GASTROCNEMIUS
Exercise 1
1. Stand with foot on book or slant. 2. Keep heel on the floor and foot supported. 3. Step forward with opposite foot until you feel a stretch in the calf area. 4. Hold for 30 to 60 seconds. Repeat 3 times.

HAMSTRING
Exercise 2
1. 2. 3. 4. Lie on your back and bring one knee up toward chest. Put your hand behind knee or calf and extend leg toward ceiling. Pull toward chest with slight bend in knee to feel the stretch in the back of your thigh. Hold for 30 to 60 seconds. Repeat 2-3 times.

Knee Rehabilitation

QUADRICEPS

Exercise 3

1. 2. Lie on stomach (on bed or floor). Reach back and pull foot toward buttock to stretch front of thigh. (can use a rope if you are not flexible enough to reach your foot) To take stress off of low back and isolate muscle,
bring opposite foot to floor and move forward.

LEVEL 2: Strenghthening

LEVEL 1: Stretching

Knee flexion (heel slide)

Exercise 4
1. 2. 3. Lie on your back or in a reclined position with leg extended (straight). Slowly bend the knee as you slide your heel toward your buttock. Repeat 2-3 sets of 10-20 repetitions.

3.

4. Focus on keeping the knee in line with the hip. Keep the front of hip pressing down into the floor or bed. 5. You can also try this stretch in standing, but be careful not to arch your back. 6. Hold for 30 to 60 seconds. Repeat 2-3 times.

KNEE EXTENSION
Exercise 5
1. 2. 3. 4. 5. 6. Lie on your back and attempt to push your knee straight. Focus on tightening the muscles in the front of your thigh. When this becomes easy, do the same exercise in standing. Stand with feet shoulder width apart. Let knee bend forward, tighten muscles in thigh and buttock and attempt to straighten leg fully. Repeat 2-3 sets of 10-20 repetitions.

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LEVEL 2: Strenghthening

STRAIGHT LEG RAISE AND

E X T E R N A L R O TAT I O N

Exercise 6

1. 2. 3. 4. Lie on your back with one leg straight and the other bent. Rotate the straight leg outward 20-30 degrees. Squeeze and contract the muscles in your thigh and slowly lift leg 6-8 inches. Repeat 2-3 sets of 10-20 repetitions.

LEVEL 3: Strenghthening
LEVEL 4: Strenghthening

BRIDGE

Exercise 7

1. 2. 3. 4. Lie on your back with both knees bent. Keep knees about a fist width apart. Squeeze the muscles in your buttock area and lift hips up off the table. Repeat 2-3 sets of 10-20 repetitions. To increase the vigor of this exercise, extend one leg while hips are lifted off the table.

LEVEL 3: Strenghthening

HIP ABDUCTION

Exercise 8

1. 2. 3. 4. Lie on your side with straight legs bent at the hip forward 30 to 40 degrees. Tighten abdominal muscles to protect back, and lift and lower top leg. Try to stabilize your back and avoid excessive movement. Repeat 2-3 sets of 10-20 repetitions.

PA RT I A L S Q U AT

Exercise 9

1. 2. 3. 4. 5. Stand with feet hip width apart, using a wall for support if needed. Walk your feet forward, so that when you squat your feet are directly under your knees. Slowly squat down to a 45 or 90 degree angle at the knee. Hold for 10 seconds. Repeat 2- 3 sets 10-20 times. When this becomes easy, you can move away from the wall.

6. You may also increase the hold time up to 1 minute.

Knee Rehabilitation

LEVEL 4: Strenghthening

SINGLE LEG BALANCE

Exercise 10
1. 2. 3. Stand on one leg trying to maintain balance. Focus on tightening the muscles in the front of your thigh and buttock. Extend the standing leg fully.

STEP-UP
Exercise 11
1. 2. To perform step-up, start by facing a 4-6 inch step. Step forward with affected leg, and step back down using the same leg.

3. Repeat 2-3 sets of 10-20 repetitions.

4. Hold for 10 seconds. Repeat 2- 3 sets 10-20 times. 5. To further challenge balance, place opposite knee and hip at 90 degree angle and reach arms overhead.

6. You may also increase the hold time up to 1 minute.

STEP-DOWN
Exercise 12
1. 2. To perform a step-down, use a 2-4 inch step. Place affected leg on the step and slowly lower opposite leg, barely touch and return to start position. Use the muscles in the front of your thigh to control the movement.

3.

4. Repeat 2-3 sets of 10-20 repetitions. (Be careful not to let your knee pass in front of your toes as you lower and bend the affected knee).

Supported in part by an educational grant from Pfizer

CLIN-1046 (1/05))

Last Reviewed: 01/2007