Flexion / Extension Exercises: This exercises is extremely important not only to improve the mobility of the injured knee

but it will also help maintain the strength of the quadriceps and hamstrings in the early stages of rehabilitation. These movements can also help to decrease the swelling surrounding the knee. Sit on the edge of a bench or chair. In the early stages it is best to sit on a seat that is high enough to allow the feet not to come in contact with the ground. This makes the exercise easier. Slowly bend (flex) and straighten (extend) the knee within the limits of pain. Aim for 3 sets of 10-20 repetitions 3 times a day as pain allows. Progress this exercise to holding the leg in place at the end of possible range, both in flexion and extension. This will aid in strengthening the muscles. Further details of strengthening exercises can be found in medial meniscus strengthening. Knee Flexion: This exercise mainly targets the hamstring muscles which are the main flexors of the knee. It will also help to stretch the quadriceps at the front of the thigh. Lie face down and flex the injured knee as far as possible. Repeat this exercises 10 times. Hold the knee at the end of range for 5-10 seconds, as exercise becomes easier Repeat 1 to 3 times a day. Heel Slides: This exercise aids in promoting mobility in both the hamstrings and the quadriceps. It also helps to mobilize the hip flexor muscles (iliopsoas and rectus femoris) and the hip joint itself. This movement can be made easier by decreasing the resistance between the foot and floor. Hence, in the early stages of recovery this may be done by wearing a thick sock and sliding the foot along a polished floor as oppose to a carpet. Lie on back, flex one knee with the foot firmly on the ground, as shown. Slide heel up as far as possible. In the early phases of recovery it may only be possible to attain as little as 30 degrees flexion. This range of movement, with repetitions, 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 Light, low resistance exercises such as swimming and light exercise bike training can also aid to increase range of mobility. However these are normally only advised when satisfactory range of movement has been achieved STRETCHES The aim of stretching is to increase the range of movement of a joint by increasing the flexibility of the soft tissue structures that surround it i.e. muscles, ligaments and joint capsule. Stretching exercises are extremely beneficial in rehabilitation but should normally be accompanied by a strengthening program so that instability does not develop around the joint. A number of stretching exercises can be used following injury to the medial meniscus. As always these should only be carried out as pain allows.

Leg Extension using Towel Roll This stretch aids in getting the last few degrees of knee extension in the latter stages of the rehab process. It uses the natural weight of the leg to stretch the structures at the back of the knee Roll a medium sized towel in a ball tie with a ribbon or string so that it keeps its shape Place on a footstool While sitting, rest the heel of the affected leg on the towel so that the leg is as straight as possible If it can be tolerated allow leg to remain straightened Leave for 10-15 minutes. Repeat every hour. Calf Stretches This stretch increases flexibility not only in the calf muscles but also in the hamstrings. Place the injured leg one pace behind the other. Try and keep the knee of the behind leg as straight as possible while bending the front leg A stretch should be felt at the back of the behind leg Hold for 10 seconds and release slowly Repeat 3 times daily OTHER MOBILITY TREATMENTS A number if other methods to increase flexibility can be also used. These can be performed by trained therapists to aid flexibility of the joint. Passive Physiological Movements: This involves a set of movements that follow the body's normal movement pattern. They can be used to regain range of movement and decrease pain . A therapist moves the affected limb through the pain free range and sometimes into the painful range. In doing so he/she can feel the quality of movement and assess where restrictions occur. In addition, gentle graded oscillations at the end of range can be performed to increase the range of mobility. Passive Accessory Movements: This treatment modality involves moving the joint into positions that cannot be attained by muscular contractions. In doing so, the therapist passively stretches certain soft tissue structures that may cause restricted movements. These are normally performed in an oscillatory manner which, as with passive physiological movements, can be graded according to the therapists wishes.