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Most recent trends in knee rehabilitation emphasize immediate motion, immediate weightbearing, early closed kinetic chain exercises, strength exercises, and early return to activity. Effective rehabilitation programs require an understanding of any surgical procedures performed, the structure of the knee, and the nature of the injury.

Strengthening should include both closed and open kinetic chain exercises, as appropriate to the particular needs of the patient. Assessment of patellofemoral alignment in both the static and dynamic modes, patella orientation, and patella tracking is essential to restoring the complete function of the knee and surrounding musculature.

Knee strengthening

Each exercise should be performed in a slow and controlled manner. Resistance may be added by using cuff weights or rubber tubing. Perform 2 or 3 sets of 10–15 repetitions.

Quadriceps setting (quadriceps)

Sitting on the floor with your involved knee out straight, tighten the muscle on the top of your thigh as if trying to push your knee into the floor. Hold for 10 seconds, relax, repeat. This exercise may also be done sitting on the edge of a chair with the heel resting on the floor.

Short arc extension (quadriceps)

Sitting with your involved leg out in front of you and the other leg bent, place a rolled-up towel under the straight knee. Tighten your thigh muscle to extend the lower portion of your leg in a small arc. Keep the back of your knee in contact with the towel. Hold for 10 seconds, then slowly lower. Repeat.

Terminal knee extension (vastus medialis obliquus, quadriceps)

Standing, loop one end of a piece of rubber tubing around an immovable object and the other end around the back of the involved knee. Step back, creating tension in the tubing. Keeping the other leg straight, allow the involved knee to flex slightly, then tighten the thigh muscle to pull the knee back into extension. Hold for 5 seconds, relax, repeat.

Full arc extension (quadriceps)

Sitting on the edge of a table or a high chair with your upper legs supported and your knees bent, slowly straighten your involved knee all the way into full extension. Hold for 5 seconds, then slowly lower.Repeat.

Full arc flexion (hamstrings)

Lying on your stomach, legs out straight, slowly bend your knee as far as possible using the muscles on the back of your thigh. Hold for 5 seconds, slowly lower. Repeat.

Step-up/down (quadriceps, hamstrings, gluteus)

Start with a 5cm (2 in) step progressing to a 15cm (6 in) step. Stand sideways, with the foot of involved leg on the step. Step up using the involved leg, then slowly lower down to the heel (not toes) of the other leg.Raise up again from the heel position and repeat. Be sure to keep the knee lined up over the ankle on the involved side, not too far forwards. Repeat.

Double leg knee bends (quadriceps, hamstrings, gluteus)

Stand with your feet shoulder-width apart. Lean forward slightly and lower your body until your knees are at a 45° angle. Hold for 5–10 seconds, then stand back up, but do not lock your knees all the way straight. To accentuate this exercise, squeeze a rolled-up towel or a ball between your knees. Repeat. This exercise can be made more challenging by going deeper than 45° of knee flexion, but it should remain challenging for the muscles rather than painful to the joint.Closed kinetic chain exercises using a physical therapy ball are useful to stabilize the knee and the rest of the body. Eccentric exercises must be added at the end of such a program.

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