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Knee Rehabilitation Terry Malone, Turner A Blackburn and Lynn A Wallace PHYS THER. 1980; 60:1602-1610.

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that the knee joint will not have to be aspirated.ten. The rehabilitation is begun as rapidly as disorders range from contusion to surgical reconstruc. high-resistance program has its benefits. This preliminary diagnosis assists theraeach year. the success 1602 Chronic knee instabilities often require reconstruction.apta. are based on clinical experience and issue on evaluation. MS success depends on discipline. to the hospital and back to the home again. at least the extremity will be better able to withstand surgery. BLACKBURN. Exercises can be used to decrease physical therapy practitioner rather than the athletic the effusion or hemarthrosis in the knee and thus trainer. Our knee rehabilitation programs are also based on the belief that if knee surgery is performed. inasmuch as our practices are primarily pists in designing and implementing the rehabilitation oriented toward orthopedic sports medicine. a low-repetition. a vigorous rehabilitation program must be undertaken with the goal of rebuilding the strength of the involved extremity as well as the entire body. Our programs are designed to be done at home and Physical Therapy. In a healthy knee. Swelling and discomfort commonly result. We believe that the critical factor in the success of an exercise program is to avoid causing swelling and discomfort while having the patient work to his maximum exercise tolerance. designed to deal with pathological conditions. but their and LYNN A. These procedures are normally more difficult and complex than acute injury repairs. but in many knee disorders the supporting structures or articular surfaces often cannot safely handle the high resistance. are based on high repetition and relatively low resistance.evaluate the knee as outlined in the article in this grams. Knee musculature cannot be expected to approach normal strength without such a disciplined program. Key Words: Exercise Therapy. A preliminary diwork with many types of knee disorders. Surgery. to use equipment available to the patient. The chronically involved knee will benefit from an exercise program to the extent that the problem may be diminished through increased strength or flexibility. The extremity must regain range of motion and function. should it be performed. The exercise programs vary depending on the problem and the condition of the patient. We have tried to the knee joint may not allow the surgeon to make a emphasize general rehabilitation rather than specific definitive diagnosis immediately so that he can do the strength training because this article is directed to the surgery if necessary. PHYSICAL THERAPY Downloaded from http://ptjournal. GENERAL GUIDELINES Our rehabilitation programs. This article also describes the use of appli. Ken Knight's DAPRE also appears to build strength quickly.possible. The knee program. This principle applies to programs not only for the athlete but for the nonathlete. knee programs have the potential of helping the TURNER A. our programs are designed to carry over from the home Although many knee rehabilitation programs exist.3 But in our hands.of that surgery is dependent upon a disciplined exercise program. Ofances often integrated into a comprehensive rehabil. is done tion. The true test of rehabilitation is whether the patient can return to the same level of function he had before the injury. these programs have irritated many of the knee problems. After surgery for acute or chronic problems. exercises will decrease the swelling enough so itation program. Swelling in various periods of rehabilitation. Also. The DeLorme1 and Oxford2 techniques are excellent for building strength in normal knees. there are few laboratory-controlled studies comparing Before designing a knee program. Dr. It takes perseverance to succeed. Following this principle minimizes the stress placed upon the knee. Many TERRY MALONE. This article presents rehabilitation base for successfully designing and implementing an programs we have found from clinical experience to adequate rehabilitation program. we carefully the efficacy of these particular programs. This evaluation provides a data empirical data. early because after 10 days the torn ligamentous Our programs are presented here in order of the structures become very difficult to repair. inasmuch as many of our patients live out-of-town. 2013 Knee Rehabilitation . therefore. patient reach the goal of normal strength. WALLACE. Even if the problem is not negated. In our clinics agnosis is made as soon as possible after an acute we treat several hundred patients with knee problems knee injury. Knee. MEd.allow the knee to be examined more effectively.org/ by guest on August 15. The debilitation of the body during and after major knee surgery and the subsequent decrease in physical activity point to the necessity of providing complete cardiovascular and physical rehabilitation. MS. Most pro.

The therapist must make certain that the patient does not substitute with the gluteus medius. 4. Most patients should be able to reach 10 lb (4. whether the disorder is an extensor mechanism problem.Fig. The exercises of choice. bicycle riding can be encouraged if the activity does not create swelling or discomfort. a meniscal problem. The following progressive programs started during the acute injury period are for conservative (nonsurgical) treatment or for preoperative treatment for various disorders. Terminal extension exercise through a short arc of motion. Fig. he may perform a minimum terminal extension exercise to encourage contraction. 3. patellofemoral crepitation. gluteus maximus. Quadriceps femoris muscle setting. Straight leg raises should be done three times a day.apta. If the patient has difficulty contracting the quadriceps femoris muscle. 1).3 kg) so as not to inflame the damaged structure further. Extensor Mechanism Injuries The extensor mechanism injuries dictate that care be taken to avoid irritating the structures involved. Fig. is to start on a quadriceps femoris setting program throughout the day (Fig. If tolerated by the patient. This will encourage full extension and will "squeeze" the knee effusion. 1. 1603 Downloaded from http://ptjournal. 3.5 kg). ACUTE INJURY During the acute injury period. 2013 . These patients should be given several months to work on this program. Terminal extension exercise combined with straight-leg-raise exercise. and any type of degenerative joint disease Volume 60 / Number 12. straight-leg-raising exercises. Resistance should be very low (less than 5 lb or 2. the patient is in some type of immobilizer. In certain instances. The usual modalities for pain and swelling may also be used. Osgood-Schlatter's disease.8 kg). Resistance for straight-leg-raising exercises is kept to an upper limit of 15 lb (6. The patient can perform minimum terminal extensions along with the straight leg raises (Figs. Straight-leg-raising exercise. 2). or hamstring muscles when trying to do the quadriceps femoris exercise. December 1980 should be treated with quadriceps femoris setting exercises. these exercises should be done out of the supporting wrap (Fig.org/ by guest on August 15. or supportive wrap. or a ligamentous problem. helping to speed its absorption. cast. The seat on the bicycle should be raised Fig. The hamstring stretching is useful in preventing overcompression of the patella against the underlying bony surface. Such problems as subluxing patella. inflamed plica. This quadriceps femoris program can be continued until further evaluation by the physician and initiation of a progressive program. 2. 4). Exercises that involve flexion-to-extension motions or heavy resistance may aggravate these types of injuries. and hamstring stretching.

Knee extension exercise as described in the techniques of exercise. Fig. Depending on the condition of the Fig. Fig. Hamstring stretching. 2013 . 9. straight leg raises. short-arc (terminal extension) or straight-leg-raise exercises should be substituted. The patient should begin with about 15 minutes of riding and increase to one hour. Running is often discouraged for those patients with these types of knee problems because the biomechanical forces of running put great stress upon the extensor mechanism. Ligamentous Injuries Chronic ligamentous injuries will respond to quadriceps femoris setting. Meniscal Injuries Patients with meniscal injuries do flexion-to-extension exercises to strengthen the quadriceps femoris mechanism (Fig. Hip extension strengthening as described in the techniques of exercise. Fig. If full-arc exercises cause pain. quadriceps femoris setting. and hamstring stretching. Vertical tears of the menisci do not heal. Hip adduction strengthening as described in the techniques of exercise. the gears of the bicycle should be adjusted so that a steady pace may be maintained. 7.org/ by guest on August 15. increases in strength and flexibility may allow the individual to avoid surgery. In the nonathletic individual.apta. but increased strength and flexibility around the knee may allow the athlete to continue participating in sports until the appropriate surgical procedure is performed. On an outdoor bicycle. Hip Abduction strengthening as described in the techniques of exercise. 8. Fig. PHYSICAL THERAPY 1604 Downloaded from http://ptjournal. If the bike is the stationary type. Fig. 6-10).5 mph (20 kph). If the initial evaluation reveals weaknesses in the hip muscles or other areas. Hip flexion strengthening as described in the techniques of exercise. 10. Often individuals with horizontal cleavage tears of their menisci remain asymptomatic. Hamstring exercise as described in the techniques of exercise. and bicycling should be included in the program. 5). 5. 6. the resistance should be kept low and the patient should ride at a steady pace of about 12.high enough so that the knee comes to full extension at the bottom of the pedal stroke. This will minimize irritation of the patellofemoral joint. appropriate rehabilitation exercises should be initiated (Figs.

2013 . pushing the heel into the therapist's hand. The patient begins quadriceps raises daily over the next three weeks. Patients may also use a rocking chair in much the same fashion. An elastic wrap tied to the foot and strapped to the back rung of the chair provides the patient a means of independently assisting himself at home. If there is a combined anteromedial and anterolateral instability. Supervision is necessary to ensure that inflammation is controlled and not exacerbated. Patients who have meniscectomies are started on POSTOPERATIVE PERIOD much the same program. full-arc exercise may tend to cause subluxation of the tibia anteriorly and increase the instability. It may be necessary to delay another day there is full range of motion and no swelling. anterolateral. increased according to the patient's tolerance.apta. rocking forward over the stabilized foot. the rehabilitation program and flexion exercises are begun about 10 days after begins the day of surgery. The next day. Flexion to extension is started within a patient should be doing two to three sets of 5 leg day or two of the surgery and bicycling within the raises by the time of discharge (about seven days). Posterolateral instabilities should be exercised in an arc lacking 10 degrees of full extension. Progressive resistance can be tient. such as tendinitis. These exercises may be painful and it is gery) and will go home to progress to about eight sets best to begin gently. The much earlier. started on a much more vigorous exercise program straight-leg-raise exercises are progressed slowly. antiinflammatory agents. quadriceps femoris setting is They are used when there is a full range of motion begun (5 to 10 repetitions per hour). The patient can use any type of assistance forflexion. are seen by clinicians during the acute injury period. then plant the foot into theflooras he moves forward over the planted foot. An under-the-table rope and pulley may also be used to stimulate the hamstring muscles. Depending ance is seldom added to this exercise. along with the with very little swelling or discomfort in or about the ankle-circumduction program. The patient begins straight-leg-raise exThis activates the hamstrings and inhibits the quad. The patient uses no Volume 60 / Number 12. The patient is encouraged surgery. With a proximal or distal extensor reconstruc. Flexion-to-extension exercises are included in benefits in the lower extremity and to prevent phle. week. Hamstring on the extent of surgery. The first few treatments should of 10 straight leg raises daily. Resist. bitis. because full extension allows the tibia to rotate externally against the posterolateral part of the capsule. Many common problems. and supervised exercise. be active before adding the assistive routines. progression. the quadriceps femoris setstretching is also added during this period. The patient is normally allowed six weeks from surgery to reach 90 degrees offlexion. Bicycling is also indicated for these problems. Patients who have had chronic ligamentous instability for several years will show weaknesses in the hamstring and hip musculature.ercises but may only be doing two to three sets of 5 riceps femoris muscles. An active-assistive program of flexion is to do ankle circumduction to promote circulatory used. Judicious use of patellar mobilization techniques may be helpful in increasing range of motion. begun by having the patient sit and attempt to flex and posterolateral surgeries require an especially slow the knee.joint. thus allowing an increase in straight leg raises upon discharge (10 days after surthe flexion. Hamstring stretching exercises tion or a plica excision. The patient should be advised to increase repetitions Knees with ligamentous repair are immobilized for gradually until performing about eight sets of 10 leg at least six weeks.org/ by guest on August 15.One method is to have the patient sit and slide the foot as far as possible. bursitis.short period of time. but they are allowed to begin straight-leg-raise exercises at day one and progThe postoperative period treatment regimen for the ress to about eight sets of 10 repetitions in a very various types of surgical repairs depends on the pa. This program is done according to patient good exercise technique. The very after extensor mechanism surgeries. Bicycle riding is begun once tolerance. many surgeons will perform manipulation under anesthesia. The exercise is femoris setting and ankle range of motion at day one. Individuals with arthroscopic meniscectomies are Inasmuch as the extensor mechanism is involved. These conditions are often of the "inflammation type" and respond to rest.added at this point. A knee-flexion program (as outlined above) is begun immediately after the manipulation to maintain the increased range.Gait is nonweight bearing with crutches. Resistance is kept low but is raised as the walking and weight bearing to tolerance with patient becomes able to handle the resistance with crutches. ting exercises are usually much easier to perform in Active and active-assistive flexion programs are a flexion cast than out of the cast because the patient begun one week after plica excision and three weeks can use the cast to resist the contraction.If he does not attain this goal.flexion-to-extensionexercises can be instituted. Active flexion is complicated combined anteromedial.treatment programs for patients with meniscectomies. December 1980 1605 Downloaded from http://ptjournal. if the patient feels quite uncomfortable after surgery. and contusions. The patient may begin knee.

Exercises include an attempted straight leg raise with minimum terminal extension and active flexion. 13. along with the chair routines as described earlier. The resistance is kept very low for the quadriceps femoris muscle exercises—no more than 5 lb (2. Hip flexor stretching as de. These patients progress much more rapidly after the cast is removed and must be carefully monitored at that time. Patients with meniscectomies can progress with their programs rather quickly and begin bicycling within the month and progress to 12. After six to eight weeks of immobilization. the knee will swell and progress will be slow. The patient is taught the appropriate exercises as dictated by the surgical procedure. Bicycle riding is begun as soon as range of motion is full and inflammation is at a minimum.5 miles (20 km) a day. cises as described in the techniques of exercise. The gait training should include tightening of the quadriceps mechanism during weight bearing. 6). which allows controlled range of motion.org/ by guest on August 15. because 1606 it stretches the surgical reconstruction. The patient remains nonweight bearing with crutches for the next three to four weeks. and straight leg raises are used. Fig. Three weeks after surgery. No passive extension should be done. resistance doing these exercises. until touch-down and partial weight bearing can be begun. flexion to extension. Sprinting is the activity of choice because it minimizes the repetitive compressive trauma upon the knee joint. 14. We have found that too much quadriceps femoris muscle activity can cause the tibia to become subluxed anteriorly and stretch the repaired tissues. Adductor stretching as described in the techniques of exercise. For anteromedial instabilities. It is important to remember that ligamentous reorganization is an extensive process occurring much less rapidly than muscular strengthening. Quadriceps femoris stretching as described in the techniques of exercise. Hamstring stretching exerscribed in the techniques of exercise. an under-the-table rope and pulley is used for gaining knee flexion and strengthening. At two weeks after mobilization. (Right) Fig.Fig. It may take longer to rehabilitate extensor mechanism problems than other disorders. Stair running is an excellent activity to increase the strength of the quadriceps femoris mechanism. This cast is applied about 10 days after surgery and allows "protected" motion. knee extension exercises can be added. Fig. Running activities can be begun at this point. 2013 . 11. Active-assistive flexion is used to gain knee flexion. INTERMEDIATE POSTOPERATIVE PERIOD As patients with extensor mechanism problems obtain their full range of motion after surgery. Some surgeons apply a hinge cast. 12. individuals undergoing ligamentous repairs or reconPHYSICAL THERAPY Downloaded from http://ptjournal. standing hamstring exercises are performed (Fig. If flexion-to-extension activities are attempted with these patients.3 kg) for the first month.5-6.apta. Therefore. hip exercises in the cast can be added to ensure that the entire lower extremity is involved in the maintenance program. the cast is removed and an active range-of-motion program is begun. It is very important that the knee come into extension slowly and under active quadriceps femoris mechanism power.Fig. they progress in their straight-leg-raise exercise program toward 10 to 15 lb (4. For posterolateral repairs.8 kg). Abductor stretching as described in the techniques of exercise. terminal extension. 15. As the necessary range of motion is obtained.

11-15). aspects demanded by the sport. These cricent level of normal on their Cybex®* isokinetic teria must be met before an individual can safely dynamometer evaluation of the quadriceps femoris return to competitive athletics.of activity at half-speed.7 The inclusion of balance return to athletics stresses the functional and specific activities such as one-leg standing. Thus running and agility drills begin only to surgery. the patient must lower extremity and adequate maturation of the re.apta. muscle and are riding the bicycle 12. Inc. The isokinetic dynamometer is used to measure the These bouts of exercise are performed at 5-rpm incre. A eight patterns. Patients with extensor mechanism must be incorporated to enhance functional performWest Point Program demonstrates this problems must work at high speeds of contraction (20 ance. commonly used protocol consists of 30-sec bouts of and Z running. To start flexion-to-extension All functional activities should be done with the same exercises before then will only invite further trauma ease and confidence that the patient possessed prior to the knee. nism takes much longer to rehabilitate than does the hip and hamstring musculature.org/ by guest on August 15. surfaces to regenerate. The 6 rpm or higher). and stair The distances are gradually increased to one mile. advanced activities are begun with physician KNEE APPLIANCES approval.4 m) of walking with 100 yd ligamentous repair must wait a year or longer to allow (91. The use of the "step up" is an important During this time the patient should be running withfunctional activity for rehabilitation. Motivated patients comparison. ADVANCED POSTOPERATIVE PERIOD An often-neglected component of performance is balance. Once these can be performed. Once the reconstruction "firms up. When patients who have had a endurance activities. weight shifting. 10). This seems to be easier on bilities should do limited-arc exercises and must work the knee joint than is the continuous pounding of at slow speeds at first to avoid damaging the recon. the exercise should be the jogging in this program should begin sprint-types discontinued.2 km) without a limp paired or reconstructed ligamentous tissues.equal to those performed before surgery. December 1980 Downloaded from http://ptjournal. This portion of the paper gives a basic introVolume 60 / Number 12. 9. Bay Shore. ance. Also. Ligamentous sprains involve the disruption Advanced rehabilitation for the patient who will of capsular nerve endings. climbing. it will take at least six months for the knee opposite side in strength and flexibility (Figs. first at half-speed and then progressing full flexion much earlier. All running times should be meniscectomy or ligamentous repair reach a 75 per. exercise with 30-seconds of rest between each bout. 2013 1607 . line backer and defensive back drills. the patient Isokinetic exercise may be used in either a complete can begin running and cutting. If flexion-to-extension exercise of the vividly. Before starting to run. continue with straight leg raises and bicycling.5 miles (20 km) a day. Those who have had and tilt board exercises is necessary if an individual extensor mechanism repair and plica excisions must is to attain his preinjury level of fitness. But the many patients who cannot tolerate knee causes any irritation.be able to walk two miles (3. If there Rehabilitation is not complete until each muscle of has been any type of shaving of the patellofemoral the lower extremity is equal to or greater than the surfaces.strength of both lower extremities for a right-to-left ments from 10 rpm to 50 rpm. 100 Spence St.structions should not be allowed to resume competiThe following is an example of a progressive runtive athletics before adequate rehabilitation of the ning program. quadriceps quarter of a mile in a straight line without problems. the individual can begin months to regain full extension but normally regained 40-yd dashes. an athlete returning to competition following alternates 100 yd (91. femoris muscle strengthening. bicycling.patients shows that the quadriceps femoris mechaated. Stair climbing can be included in this work struction. NY 11706.4 m) of jogging until he completes a quarter of a reorganization and maturation of the substituted mile during the first bout of exercise. Other functional activities may include figureshould increase their speed and range of motion. 5 Gen. Many patients treated in physical therapy for knee problems can benefit from a supportive knee appli* Lumex. agility activities or limited arc. to full speed. The patient structure. Patients who out a limp and without increased swelling.4. Patients with combined rotatory insta. He then erally. Once the have undergone ligamentous repairs may require six mile can be run fairly easily." they out.and without having an increase in swelling. The status of the patient's cardiovascular after sufficient strength has been attained and tissue system must be superb if he is to participate in repair has occurred.jogging. Our experience with different types of may work at longer bouts at higher speeds as toler. Patients who have ligamentous repairs must progresses according to tolerance until he can jog a work on their hip exercises (Figs.

a Lenox Hill Brace may be fabricated to compensate for knee hyperextension. PO Box 1. MD. 17. Appliance selection should be based on the following considerations: 1) there must be a definite need. 2) a knee appliance will replace a conscientiously pursued strength/power maintenance program. McLean. and 5) the cost must be affordable. Linden Blvd at Brookdale Plaza. Our treatment programs are based on what has been successful for our patients in our clinics. the markings are transferred for a second time onto the positive mold. Commercially fabricated devices include stock models such as a Levine strap. such as the Palumbo Patellar Stabilization Brace ‡ (Fig. † † Lenox Hill Brace Shop. 3) the particular device chosen must meet the established need. * * Pro Orthopedic Devices. King of Prussia. Palumbo Patellar Stabilzation Brace used to prevent the lateral dislocation of the patella. Fig. varus/valgus. 17). M. 2) to compensate for decreased internal stabilization with an increased external stabilization system. The patient is then casted. 2013 . will last indefinitely if properly fitted and cared for. For example. or rotational instabilities. Department of Orthopaedic Surgery. Custom-made orthoses have been available for the past several years and. Palumbo. 2) the appliance must not be used in a way that might injure the patient. 8206 Leesburg Pike. Clinic fabrication includes use of such appliances as a modified Levine strap† and a felt lateral-patellar stabilizer and use of tape. for example. M. the patella. NY 10021. Our treatment decisions have been based on empirical ‡ P. MD. These orthoses. and cartilage braces. that 1) a knee appliance will replace a thorough rehabilitation program. and 3) to change the biomechanics of the knee (such as to pull a patella alta inferiorly or to increase the space between the patella and the femur). or rotational instabilities. dynamic patellar stabilization braces. Commercially fabricated custom orthoses include those designed to prevent the lateral dislocation of † Jack Levine. Inc. with the markings ultimately being transferred to the wet plaster. The various types of appliances can be categorized by method of fabrication. which include the Lenox Hill Derotation Brace®†† (Fig. although expensive. 16). duction to the selection and fabrication of these devices and should not be considered as a complete guide to the topic. varus/valgus. 1608 PHYSICAL THERAPY Downloaded from http://ptjournal. The Pro Dr. The medical and lay communities have many misconceptions about knee appliances. Brooklyn.Fig. Brookdale Hospital Medical Center. The purposes of knee appliances are as follows: 1) to protect the surgical procedure during healing of tissues. Brace used to alleviate discomfort of patellar tendinitis.apta. Fig. PA 19406. NY 11212. 4) the appliance must look reasonably attractive and feel comfortable to the patient. 100 E 77 St.org/ by guest on August 15. 18. M. Director. provide maximum protection for the patient's knee. Pro-devices. New York. as well as those designed to alleviate the discomfort of patellar tendinitis such as the Pro Dr. The Lenox Hill Derotation Brace requires the clinician to mark anatomical landmarks with a water-soluble pen on a stockinette that the patient is wearing. Brace** (Fig. 18) and the Iowa Brace. 16. VA 22180. The orthotist then fabricates the brace over the positive mold to accommodate both for knee size and type of instability. Inc. When the plaster cast (negative mold) is filled with plaster. and 3) a knee appliance is always needed after an injury. The reasons for using these appliances are the need for additional support for the knee joint and the attempt to save money over the cost of custom-fabricated devices. The Lenox Hill Derotation Brace to compensate for knee hype rextension.

After a two-count rest. This short-arc quadriceps femoris exercise allows exercise through a range of motion. He flexes his hip toward his chest at about a 45-degree angle. Clinical research must now be done to verify our theories and procedures. he can raise the entire leg up to a 45degree angle of the hip and continue the straight-leg-raise technique (Figs. Hamstring Exercise: The patient stands with the anterior part of the thigh pressed against a wall or table to block hip flexion. and lowers it to the floor. 1). Eight sets of 10 are allowed. He holds the leg there for a count of two and then lowers it to the floor and relaxes it for a count of two." (This means that if the patient sits with the legs dangling and weights attached. Resistance is added and progressed according to the patient's tolerance (Fig. The quadriceps femoris muscle must be contracted and the knee held in full extension before the leg is lifted. This is an easy way to estimate how much weight to use on these exercises. Rehabilitation must degenerate into function! APPENDIX Techniques of Exercise The following exercises represent our routine techniques that are adapted according to each patient's response. usually with the knee in full extension. The emphasis of rehabilitation must be dictated by the demands the individual places upon the knee. causing the patella to track proximally and the leg to be straightened as much as possible.org/ by guest on August 15. The terminal kneeextension exercise can be used with the straight-leg-raise exercise. Resistance is added in much the same way as with the straight leg raise (Fig. This basic information regarding knee appliances and the type of problems they may alleviate is to serve only as an introduction. Resistance can be added as necessary. feet resting on the floor. This encourages the patient to work harder on extending the knee and on using more motor fibers of the quadriceps femoris muscle. Here. the contraction should be held for a full six-second count. Quadriceps Femoris Setting Exercise: Quadriceps femoris setting is an isometric contraction of the quadriceps femoris mechanism. The knee should be at full extension throughout the lift. 4). Hip Flexion Exercise: The patient sits on a firm surface. as if there were no weight at the ankle at all. The patient does eight sets of 10 lifts with a 30-second to 1-minute rest between each set of 10. The critical factor in each exercise program is for the therapist to avoid causing the patient swelling or discomfort while having him work to his maximum exercise tolerance. the support beneath the knee is just enough so that when the patient contracts the quadriceps femoris muscle as tightly as possible. SUMMARY Knee rehabilitation is nearly as complex as the knee itself. holds it for two counts.) The patient extends his knee. Knee Extension Exercise: This exercise is done from 90 degrees of flexion to the fullest amount of extension. We hope that it will stimulate the physical therapy clinician to become more interested in evaluating patients who might benefit from these devices and consult with their physicians regarding their possible use. The patient performs 50 of these exercises an hour during every waking hour (Fig. rather than on controlled laboratory study. Rehabilitation must not be of a cookbook nature but rather individualized to fit the needs of the patient. The general and specific programs and exercises presented are to be used eclectically. the heel will clear the exercise surface by less than an inch. the exercise is repeated. he should do minimal terminal extension exercises. Because this is an isometric exercise. 2013 . The patient begins with a weight that he can lift easily. He flexes the knee to its fullest position.data. 5). He holds it there for two counts and then lowers it for a two-count rest. When the patient has the knee extended to its fullest amount. with the uninvolved leg flexed to 90 degrees and foot planted flat next to the involved knee. yet that makes him tired after eight sets of 10 lifts. 6). Straight-Leg-Raising Exercise: The patient is positioned supine. and then flexes back to 90 degrees with the foot resting on the floor. The weight is increased according to the patient's tolerance (Fig. December 1980 1609 Downloaded from http://ptjournal. Ankle weights provide progressive resistance. The clinician Volume 60 / Number 12. Straight leg raises are done three different times a day. Terminal Extension Exercise: If support is placed beneath the popliteal fossa during straight leg raises. 2). The individual does four to eight sets of 10 lifts three different times a day. The knee must remain in the same amount of extension on the last lift as it did on the first. This exercise is done in four sets of 10 repetitions three different times a day. perhaps on his elbows. The exercise should be done with the foot resting on the floor or stool and is termed "bottomed out. He contracts the involved quadriceps femoris muscle and then lifts the leg up to 45 degrees. 3. the ligaments of the knee could be stretched through the pull of gravity. a terminal knee extension exercise can be added to the program.apta. Fifty of these exercises are done three different times a day. When the patient is having trouble gaining full knee extension. The patient contracts the quadriceps femoris muscle. pauses for a count of two.

7). 1980 4. on his contralateral side with his contralateral knee flexed to 90 degrees for stability. Resistance can be added at the ankle. holding for a six-second count. Br J Phys Med 14:29-32. and then repeats. Hip Adduction Exercise: The easiest way to strengthen the hip adductor muscle is by an isometric exercise. He actively pulls his knees toward the floor and holds for 10 counts. then releases.org/ by guest on August 15. An alternate exercise program for the hip abductor muscles can be done isometrically. He holds for 10 counts. He slowly leans forward—no bouncing is allowed. Five minutes of stretching is preferred (Fig. Torvic PJ: Biomechanics of anterior cruciate ligament failure: An analysis of strain-rate sensitivity and mechanisms of failure in primates.can add resistance by placing a barbell plate weight on the knee and holding it with the contralateral hand. This is repeated 25 times three different times a day. Hip Flexor Stretch: The patient lies supine. Four sets of 10 repetitions are done and progressive resistance added as necessary (Fig. DeLorme TL: Restoration of muscle power by heavy resistance exercise. Noyes FR. J Bone Joint Surg [Am] 56:236. 1976 7. while the ipsilateral hand grasps the front of the sitting surface to prevent the patient's leaning backward (Fig. Abductor Stretching: The patient lies on his side with his bottom leg flexed forward so that his top leg with knee flexed can touch floor. J Sports Med 3:288. A belt is strapped just proximal to the knees and the patient abducts the thigh against the belt. Hanham IF: The etiology and prevention of functional instability of the foot. then releases. Five minutes of stretching is preferred (Fig. This should be done 25 times. 1974 6. 13). J Bone Joint Surg 27:645-667. 1951 3. 2013 . holding for a six-second count and then relaxing. lowers his leg. Am J Sports Med 7:336-337. 14). 9). 11). sitting. Grood ES: Strength of the interior cruciate ligament in humans and rhesus: Age and species-related changes. Hip Extension Exercise: The patient positions himself over a firm table or bed. rests for two counts. 8). Yamamoto SK. DeLucas JL. then releases. Four sets of 10 repetitions are performed three times a day with 30-second to 1-minute rests between each set. in relation to his affected knee. et al: Functional rehabilitation of the knee: A preliminary study. He may do this supine. From the prone position he extends his hip on the involved side with the knee in full extension to the normal amount of extension at the hip. 10). Five minutes of stretching is preferred (Fig. Five minutes of stretching is preferred (Fig. Hip Abduction Exercise: The patient lies. Five minutes of stretching is preferred (Fig. The patient places a basketball or a soccer-type ball between his knees and then squeezes the ball. Dean MRE. Knight KL: Knee rehabilitation by the daily adjustable progressive resistance exercise techniques. J Bone Joint Surg [Br] 47:678-685. REFERENCES 1. He holds this position for 10 counts and then releases. three different times a day. J Bone Joint Surg [Am] 58:1074. 15). or standing (Fig. Adductor Stretching: The patient sits with soles of his feet together and slides them toward the buttocks. He holds this position for two counts. Freeman MAR. Feagin JA. Hartman CW. then releases. He holds for 10 counts. with the edge of the surface at the hip joint line. 1976 5.apta. He pulls one knee to his chest and extends the opposite leg as hard as possible. Hamstring Stretch: The patient assumes a long-sitting position with one leg off the exercise surface. 1965 1610 PHYSICAL THERAPY Downloaded from http://ptjournal. 12). 1945 2. He performs a quadriceps femoris setting exercise and then lifts the leg in the frontal plane of the body. Zinovieff AN: Heavy resistance exercise: The Oxford techniques. He holds for 10 counts. The individual must not flex his hip during this exercise or rotate his trunk posteriorly (Fig. Quadriceps Femoris Stretching: The patient lies prone and pulls his heel toward his buttock. Noyes FR.

1980.org/content/60/12/1602#otherarticles Subscription Information http://ptjournal.Knee Rehabilitation Terry Malone. 2013 . Cited by This article has been cited by 4 HighWire-hosted articles: http://ptjournal. Turner A Blackburn and Lynn A Wallace PHYS THER.xhtml Information for Authors http://ptjournal.apta.org/site/misc/ifora. 60:1602-1610.xhtml Downloaded from http://ptjournal.apta.org/site/misc/terms.apta.org/subscriptions/ Permissions and Reprints http://ptjournal.org/ by guest on August 15.apta.apta.