Exercises for knee rehabilitation
1. Exercise useful for quadriceps, pelvis and spine coordination
Degree of difficulty
2/5
Starting position: Standing position, legs apart, arms at your sides and feet parallel to one another.
Execution: Flex your knees as much as possible, without losing your balance, as if you wanted to assume a sitting position. Hold the position for a few seconds.
Pay attention: It is important to carry out the exercise keeping gluteal and abdominal muscles contracted.
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2. Leg scissors against resistance, exercise to strengthen quadriceps and psoas muscles
Degree of difficulty
2/5
Starting position: Place an elastic band around your ankles, calves or thighs. Perform the exercise in a supine position on a medical bed, with lower limbs extended and arms at your sides.
Execution: Alternately lift the right limb and the left limb as much as possible against resistance, holding the final position for a few moments and then return to the starting position.
Pay attention: Avoid lifting the pelvis from the medical bed and flexing the leg when lifting the limb.
3. Wall squat exercise
Degree of difficulty
3/5
Starting position: Position yourself with shoulders, trunk and glutes resting on the wall. To facilitate the exercise, place the palms of your hands in contact with the surface of the wall.
Execution: Keeping both the trunk and the spine firmly attached to the wall, slide slowly by gradually flexing the hips and knees. Then slowly return to the starting position.
Pay attention: Avoid detaching the trunk from the wall (movement to be avoided since it would lead to an anterior flexion of the trunk).
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4. Balance exercise
Degree of difficulty
3/5
Starting position: Position yourself laterally to the step, with your left leg flexed and your left foot resting on the step.
Execution: Extend the left leg, bringing the right foot to the same level as the left one, but without resting it on the step. Repeat with the other leg.
Pay attention: Do not use steps that are too high (steps should be about 15/20 cm).
5. Lunges (quadriceps and gluteal muscles strengthening mainly)
Degree of difficulty
3/5
Starting position: Stand on the mat.
Execution: Bring one foot forward and flex the hip and knee. Initially, the flexion of the knee must be minimal to arrive then, in a few seconds, to exceed 90°. The contralateral limb keeps the knee flexed at 90°, resting on the mat. Initially, if you are unstable, a rod can be used to support yourself. As a variant, once you reach the mat, you can slightly move the trunk upwards and downwards for a few seconds.
Pay attention: Keep the trunk in axis.
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6. Squat exercise for hamstrings
Degree of difficulty
2/5
Starting position: Position yourself in an upright position, in front of the back of a chair. Keep your feet shoulders-width apart.
Execution: Flex your knees, avoiding lifting the heels. Try to keep your knees aligned with your toes. Maintain the position. Slowly contract your glutes when extending the knees to return to the starting position.
Pay attention: Avoid flexing your knees excessively or moving your pelvis too low.
7. Quadriceps strengthening exercise
Degree of difficulty
2/5
Starting position: Sitting position on the medical bed or, alternatively, on a chair. Place an elastic band (Theraband) around the patient’s ankle and anchor it to the bed.
Execution: Keeping a knee flexed with the supporting foot on the ground, the patient gradually extends the contralateral knee against the resistance of the elastic band. Maintain the extension position, then return to the starting position.
Pay attention: Avoid extending the trunk posteriorly, unbalancing body weight, to facilitate knee extension.
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8. "Leg-cross" exercise, for quadriceps and hamstrings
Degree of difficulty
1/5
Starting position: Sit on the medical bed, trying to keep the trunk straight, with the legs out, crossed at the ankles in resting position.
Execution: Extend the knee placed below and try, at the same time, to flex the knee that is above. Keep both limbs in an intermediate flexion-extension position. In this way it is possible to activate quadriceps and hamstrings at the same time.
Pay attention: Do not flex or extend the trunk while performing the exercise.
9. Exercise for balance and prevention of falling
Degree of difficulty
2/5
Starting position: Rest your right foot on a step in front of you.
Execution: Climb the step, detaching the left foot from the ground. Repeat with the other leg.
Pay attention: It is important not to use steps that are too high (steps should be about 15/20 cm).
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10. Quadriceps stretching exercise
Degree of difficulty
3/5
Starting position: From the standing position, lift and put one leg on a chair seat. The limb resting on the ground must be at a distance that allows quadriceps muscle elongation of the limb on the chair.
Execution: Keeping your hands crossed on your leg, displace your body weight forward, until you feel a tension sensation in your thigh. If possible, hold the position for a few seconds. Repeat with the other limb.
Pay attention: Avoid lifting the heel of the limb resting on the ground. The limb must remain firm, and it must never be detached from the ground.
11. Open kinetic chain exercise for hamstrings
Degree of difficulty
1/5
Starting position: After attaching weights at the ankle level, position yourself in front of the back of a chair. Grab the back of the chair with both hands for more support during the exercise.
Execution: Flex one knee until it reaches a 90° angle, point at which there is the maximum resistance of the ankle weights. Maintain the position. Elastic bands can be used as alternative to weights. Repeat with the contralateral limb.
Pay attention: Avoid compensation mechanisms, such as bending the hip of the limb with which you perform the exercise. Do not move the trunk forward during knee flexion.
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12. Exercise useful for quadriceps femoris muscle
Degree of difficulty
1/5
Starting position: Sitting position with feet detached from the ground. Grab with your hands the edge of the bed. Place a weight distally at the ankle level (the first time you can perform the exercise even without the ankle weight).
Execution: From the starting position, without changing the spine position, taking advantage of the upper limbs’ contraction, extend the knee against gravity. Keep the knee extended and then slowly return to the starting position.
Pay attention: Avoid spine accessory movements. Avoid excessive arms tension. Avoid returning to the starting position too fast. Avoid using ankle weights with inadequate weight (too light or too heavy). Do not perform the exercise in apnea or with inadequate breathing.
13. Exercise for quadriceps and ankle dorsi-flexors muscles
Degree of difficulty
1/5
Starting position: Supine position with slightly reclined backrest and lumbar support. Place a soft ball under the popliteal fossa of the operated limb, obtaining a knee flexion of about 30°.
Execution: From the initial position, perform a 90° ankle dorsi-flexion and extend the knee by crushing the ball against the bed. Hold the contraction, then slowly return to the starting position.
Pay attention: Avoid to follow accessory movements of the spine. Do not perform accessory hip adduction. Do not perform the exercise in apnea or with inadequate breathing.
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14. Exercise for hip flexor and knee extensor muscles strengthening
Degree of difficulty
1/5
Starting position: Supine decubitus on the medical bed slightly reclined, with the operated limb extended and flexing the contralateral limb at the thigh and knee level.
Execution: Lift the operated limb, flexing the hip, keeping the ankle at 90° and the knee extended (180°) (ankle dorsiflexors and knee extensors isometric contraction). After a few moments, slowly return to the starting position.
Pay attention: Avoid incorrect positioning on the backrest (higher lumbar hyperextension or neck anteposition). Avoid flexing the knee of the raised limb. Avoid performing the exercise in apnea.
15.Exercise for spine erector, shoulder flexors, abdominal, pelvis stabilizers, gluteal, quadriceps and adductors muscles
Degree of difficulty
2/5
Initial position: Seated, with hands extended in front of the trunk, palms in contact and fingers crossed, feet firmly touching the ground, ankle at 90° and knee flexed at 90°. Place a soft ball between your knees, making sure it does not touch the edge of the bed; the soft ball must be actively held in that position for the entire duration of the exercise.
Execution: From the starting position assume a standing position, keeping the hands contact and the ball between your knees. Hold the position, then slowly return to the starting position.
Pay attention: Avoid losing contact with the ball. Avoid accessory movements of the spine, with potential unbalance. Avoid an excessive upper limbs’ elevation, which must not exceed the shoulders height (no over head movements). Avoid excessive distance between the plantar support and the edge of the bed, with the risk of falling backwards. Do not perform the exercise in apnea or with inadequate breathing.
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16. Exercise for trunk stabilizers and anterior and posterior lower limbs muscles strengthening
Degree of difficulty
5/5
Starting position: For this exercise a fit ball is required. Standing, with the dorsal-lumbar spine in contact with the fit-ball, leaning against a wall. Arms are crossed on the chest.
Execution: Perform a squat. If possible, hold the position for 20 seconds.
Pay attention: Keep the spine aligned.
17. Exercise for hip extensor muscles strengthening
Degree of difficulty
1/5
Initial position: Position yourself in an upright position with your feet shoulder-width apart, extended knees and with your hands resting on a stable support (medical bed, wall, chair, table or wall bar).
Execution: Perform extensions f the lower limb.
Pay attention: Avoid hip extra-rotation during the exercise. Avoid bending the trunk forward to counterbalance the extension of the thigh. Tendency to bend the knee instead of extending the hip in case of hip flexor muscles shortness. Avoid excessive lordosis of the lumbar spine, a proper abdominal muscles contraction is needed. Contralateral limb flexion.
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18. Exercise useful to strengthen anti-gravity muscles of the lower limbs
Degree of difficulty
4/5
Starting position: Sitting on the horizontal “leg press” machine, with the spine firmly in contact with the backrest and your feet resting on the platform with extended knees at shoulder-width; the lower limbs are parallel to the floor. The head is in a neutral position with the gaze directed frontally.
Execution: Slowly flex your knees to the maximum allowed level, then push the platform up to the initial position, then perform an isometric contraction and repeat the sequence.
Pay attention: Avoid detaching both the head and the spine from the backrest and headrest, thus overloading neck, spine and pelvis. In case of knee surgery, in the early stages, do not exceed 30° of knee flexion.
19. Quadriceps strengthening exercise
Degree of difficulty
4/5
Initial position: The exercise is carried out on the “leg extension” machine. Sitting with the spine firmly resting on the machine support, the head is in a neutral position with the gaze directed frontally, knees flexed at 90° with the roller pad placed anteriorly to your ankles.
Execution: From the starting position, extend your knees by raising them upwards, so that the lower limbs are parallel to the floor to form a 90° angle with the spine. Hold this position, then return to the starting position and repeat the sequence. During the execution of the exercise, the hands must hold the dumbbells placed laterally to the seat.
Pay attention: Avoid overloading the spine and pelvis, unloading as much as possible the weight on the upper limbs, with the hands grabbing the dumbbells and avoid detaching the spine from the backrest. Perform the exercise slowly. Do not use loads that are inadequate to your abilities.
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20. Knee flexor muscles strengthening exercise
Degree of difficulty
4/5
Starting position: This is a monoarticular movement, characterized by a pure flexion of the knee against resistance, performed through the “standing leg curl” machine. The machine forces you to work alternately first with one limb and then with the other one. Pelvis and thighs are resting on the machine supports, while a pad is fixed behind the ankle. The limb in support has the knee in extension.
Execution: From the starting position, flex the knee at least up to 90°, keeping the pelvis and thighs fixed. Hold this position, then return to the starting position and repeat the sequence.
Pay attention: Avoid making excessively fast movements. Do not detach the pelvis from the support on the machine.
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