Neuromuscular and

strengthening exercise
therapy for young adults
with a meniscal tear

1
 Neuromuscular and strengthening exercise therapy for young adults with a meniscal tear

This exercise therapy program contains exercises for you to perform twice weekly for 12 weeks with your
physical therapist. The exercise therapy program aims at reducing your pain and improve your muscle
strength and function.

On the next page, we ask you to register your pain before and after each exercise session.

The program includes:

Warm up on a stationary bike (5min)

Exercises focusing on knee control and stability (8 exercises with different levels of difficulty)

Exercises focusing on improving muscle strength (4 exercises)

Furthermore, two exercises are included that can be used to reduce swelling and increase range of motion
intended to be used in the first weeks (if needed).

Your physical therapist will help you adjust the program to your needs. You can expect a small increase in
soreness/pain in your muscles or knee during and after the exercises, especially during/after the first
couple of exercise sessions. As more exercise sessions are completed you will experience less pain and an
ability to perform the exercises at a higher level of difficulty.

If needed, your physical therapist will help you reduce or increase the level of difficulty of the individual
exercises than those described in the program. Your physical therapist will make notes in the program of
how this new level of difficulty should be performed.

The exercise program is organized with description of the different exercise levels on one side, while the
other side is used to register level, number of sets and number of repetitions for each exercise. This allows
you and your physical therapist to keep track of your progression during the 12 weeks.

Rest and ice are important to reduce pain and swelling

You might experience swelling and pain after your knee injury. The swelling and pain may continue for
several weeks, but will eventually decrease, if you remember to include periods of activity and rest during
your day. Resting the knee is also important after the exercise sessions. When you rest your knee you can
put your lower leg on some pillows or similar, so that the knee is as extended as possible and elevated
above the level of your heart.

If needed a bag of ice, frozen vegetables or similar can be placed on your knee for up to 20 min. at a time
up to five times a day. It is important to put a towel between the ice bag and the knee to avoid frost-bites.
You can continue to use ice bags as long as you experience swelling of your knee and after performing the
exercise program.

2
Registration of knee pain

Before and after each exercise session during the 12 weeks, we ask you to answer the question below
concerning your knee pain. In the box next to the specific exercise session you are supposed to note the
number between 0 and 10, which corresponds to your knee pain right before and after the exercise session.
0 corresponds to “no pain” and 10 corresponds to ”worst pain possible”.

How much pain do you have in your knee right now?

0 1 2 3 4 5 6 7 8 9 10
No pain worst pain possible

Pain before the session (0-10) Pain after session (0-10)

1. session
Week 1
2. session
1. session
Week 2
2. session
1. session
Week 3
2. session
1. session
Week 4
2. session
1. session
Week 5
2. session
1. session
Week 6
2. session
1. session
Week 7
2. session
1. session
Week 8
2. session
1. session
Week 9
2. session
1. session
Week 10
2. session
1. session
Week 11
2. session
1. session
Week 12
2. session
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 Warm up

The warm up consists of 5 min. of biking on a stationary bike.

Resistance is set on an individual level and can be increased
during the 5min. In the first couple of weeks the resistance
should be set to zero, while it is supposed to be increased
over time.

Exercises that can be used if you experience swelling of your knee or reduced range of motion
The two exercises below are only intended to be used as long as the knee is very swollen or has
a reduced range of motion.

Sit or lay down on your back with both of your legs extended as much as possible and the heel
of the injured leg on a carpet tile or cloth that can slide on the floor. Bend your knee as much as
possible.
10 sets x 5 repetitions
At every fifth repetition the knee is kept in the bent position for 30s.

Sit or lay on your back with a small ball or bolster under your knee. Contract your quadriceps
muscle and push the back of your knee downwards to compress the ball, so that the knee is
extended and the heel lifts from the floor. Lower it slowly to the floor and repeat.

3 sets x 10 repetitions.

4
Exercises focusing on knee joint control and stability

Each of the exercises in this part of the program are performed in 2-3 sets of 10-15 repetitions
with rest corresponding to the duration of one set between each set and exercise unless
otherwise stated. To increase the level of difficulty over time several levels of difficulty are
shown for each exercise. You are only supposed to perform the individual exercise at one level
during one exercise session. By advice from your physical therapist you can increase the level
of difficulty by changing the number of repetitions and the direction and speed of the
movement, by increasing the load and/or changing the base of support. The exercises are
performed with both the injured and non-injured leg, even though focus is on the injured leg.
Some of the exercises are performed in front of a mirror to increase the visual feedback from
the movement. It is important that the hip, knee and foot are aligned in all exercises as shown
in the pictures below.

GO NO GO

5
 Knee bends

Level (put a circle) Number of sets Number of reps.

1. session 1 2 3 4
Week 1
2. session 1 2 3 4
1. session 1 2 3 4
Week 2
2. session 1 2 3 4
1. session 1 2 3 4
Week 3
2. session 1 2 3 4
1. session 1 2 3 4
Week 4
2. session 1 2 3 4
1. session 1 2 3 4
Week 5
2. session 1 2 3 4
1. session 1 2 3 4
Week 6
2. session 1 2 3 4
1. session 1 2 3 4
Week 7
2. session 1 2 3 4
1. session 1 2 3 4
Week 8
2. session 1 2 3 4
1. session 1 2 3 4
Week 9
2. session 1 2 3 4
1. session 1 2 3 4
Week 10
2. session 1 2 3 4
1. session 1 2 3 4
Week 11
2. session 1 2 3 4
1. session 1 2 3 4
Week 12
2. session 1 2 3 4

6
Exercise 1: Knee bends
Level 1
Place a chair behind you. Stand with your back straight and with your feet shoulder width apart. Raise your
arms in front of your chest. Bend your hips and knees and lower yourself to your bottom touches the edge
of the chair, or as far as you can lower yourself so that you are still able to stand up in a controlled
movement. Stand up straight again. Keep your back straight and look straight ahead.

Level 2
The same starting position as in level 1, but without the chair. Bend your hips and knee until a knee flexion
of approx. 90 degrees and stand up straight again. Keep your back straight and look straight ahead.
Alternatively, the squat position can be maintained for a couple of seconds before standing up straight
again.

Level 3
Turn the BOSU ball around with the flat side up. Stand on the BOSU ball with your feet shoulder width apart.
Raise your arms in front of your chest. Bend your hips and knees to the knees are flexed approx. 90 degrees
and stand up straight again.

Level 4
Stand with all of your weight on one leg and the other leg on a sliding surface. Slide backwards and
forwards with the foot on the sliding surface while the weight bearing leg is flexed and extended. Repeat
with the other leg. The exercise can be made more challenging by doing level 1 on one leg.

7
 Pelvic lift

Level (put a circle) Number of sets Number of reps.

1. session 1 2 3
Week 1
2. session 1 2 3
1. session 1 2 3
Week 2
2. session 1 2 3
1. session 1 2 3
Week 3
2. session 1 2 3
1. session 1 2 3
Week 4
2. session 1 2 3
1. session 1 2 3
Week 5
2. session 1 2 3
1. session 1 2 3
Week 6
2. session 1 2 3
1. session 1 2 3
Week 7
2. session 1 2 3
1. session 1 2 3
Week 8
2. session 1 2 3
1. session 1 2 3
Week 9
2. session 1 2 3
1. session 1 2 3
Week 10
2. session 1 2 3
1. session 1 2 3
Week 11
2. session 1 2 3
1. session 1 2 3
Week 12
2. session 1 2 3

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Exercise 2: Pelvic lift
Level 1
Lay on your back with both legs on the ball and your arms along your sides. Contract your gluteus muscles
and lift your pelvic and lower back from the floor so the body is fully extended. Hold the position for 3-5s.
and rest for a couple of seconds before the next repetition.

Level 2
Lay on your back with both legs on the ball and your arms along your sides. Find the neutral position of
your back and pelvis, contract your core muscles, lift your pelvis up and roll the ball towards your bottom
until you only rest on your shoulders. Go back to the starting position.

Level 3
Lay on your back with one leg on the ball, the other leg elevated and your arms along your sides. Contract
your gluteus and hamstring muscles and lift your pelvic and lower back from the floor so the body is fully
extended. Hold the position for 3-5s. and rest for a couple of seconds before the next repetition.

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 The plank

Level (put a circle) Number of sets Number of reps.

1. session 1 2 3
Week 1
2. session 1 2 3
1. session 1 2 3
Week 2
2. session 1 2 3
1. session 1 2 3
Week 3
2. session 1 2 3
1. session 1 2 3
Week 4
2. session 1 2 3
1. session 1 2 3
Week 5
2. session 1 2 3
1. session 1 2 3
Week 6
2. session 1 2 3
1. session 1 2 3
Week 7
2. session 1 2 3
1. session 1 2 3
Week 8
2. session 1 2 3
1. session 1 2 3
Week 9
2. session 1 2 3
1. session 1 2 3
Week 10
2. session 1 2 3
1. session 1 2 3
Week 11
2. session 1 2 3
1. session 1 2 3
Week 12
2. session 1 2 3

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Exercise 3: The plank
Level 1
Rest on the tip of your toes and your elbows and find the neutral position of your back and pelvis. In this
position, contract your core muscles and hold the position for 30-60s. Repeat the exercise three times.

Level 2
Rest on the tip of your toes and your elbows and find the neutral position of your back and pelvis. In this
position, contract your core muscles and lift one leg at a time, so you are only resting on one leg.

Level 3
Rest on the tip of your toes and your elbows and find the neutral position of your back and pelvis. In this
position, contract your core muscles and lift one leg at a time thereby stretching the rubber band.

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 Side plank

Level (put a circle) Number of sets Number of reps.

1. session 1 2
Week 1
2. session 1 2
1. session 1 2
Week 2
2. session 1 2
1. session 1 2
Week 3
2. session 1 2
1. session 1 2
Week 4
2. session 1 2
1. session 1 2
Week 5
2. session 1 2
1. session 1 2
Week 6
2. session 1 2
1. session 1 2
Week 7
2. session 1 2
1. session 1 2
Week 8
2. session 1 2
1. session 1 2
Week 9
2. session 1 2
1. session 1 2
Week 10
2. session 1 2
1. session 1 2
Week 11
2. session 1 2
1. session 1 2
Week 12
2. session 1 2

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Exercise 4: side plank
Level 1
Lay on your side with support from one elbow. Find the neutral position of your back and pelvis. Contract
your core muscles and lift your pelvis until your body is aligned. Hold it for 30s. and rest for a couple of
seconds before the next repetition. Repeat 3 times to each side.

Level 2
Lay on your side with support from one elbow. Find the neutral position of your back and pelvis. Contract
your core muscles and lift your pelvis until your body is aligned. Lift your upper leg up towards the ceiling,
and lower it slowly again before you lower your pelvis down to the floor again.

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 Stair climbing

Level (put a circle) Number of sets Number of reps.

1. session 1 2 3 4 5 6
Week 1
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 2
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 3
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 4
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 5
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 6
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 7
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 8
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 9
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 10
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 11
2. session 1 2 3 4 5 6
1. session 1 2 3 4 5 6
Week 12
2. session 1 2 3 4 5 6

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Exercise 5: Stair climbing
Level 1
Step up and down on a step-board controlling the
movement. Repeat with the opposite leg.
Level 3
Step up, and then down in front of the step-board,
step backwards up and then down from the step-
board to reach your starting position again. Repeat
with the opposite leg.
Level 5
Jump over the step-board and land on the floor in a
controlled way. Turn around and repeat the jump other
way around. Knee control and stability is important
during the exercise. Repeat with the opposite leg.
Level 2
Step up, and then down in front of the step-board, turn
around and repeat the other way. Repeat with the opposite
leg.
Level 4
Jump up on the step-board in front of you, landing with
3/4 of the feet on the step-board. Jump down again to
reach your starting position. Try to extend your body
fully after jumping from the step-board and to jump up
on the step-board again shortly after landing on the
floor. Repeat with the opposite leg.
Level 6
Stand on one leg and jump up on the step-board
stabilizing the landing. Extend the hip and assume a
standing position. Try to extend your body fully after
jumping from the step-board and to jump up on the
step-board again shortly after landing on the floor.
Repeat with the opposite leg.
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 Outer thigh

Level (put a circle) Number of sets Number of reps.

1. session 1 2 3
Week 1
2. session 1 2 3
1. session 1 2 3
Week 2
2. session 1 2 3
1. session 1 2 3
Week 3
2. session 1 2 3
1. session 1 2 3
Week 4
2. session 1 2 3
1. session 1 2 3
Week 5
2. session 1 2 3
1. session 1 2 3
Week 6
2. session 1 2 3
1. session 1 2 3
Week 7
2. session 1 2 3
1. session 1 2 3
Week 8
2. session 1 2 3
1. session 1 2 3
Week 9
2. session 1 2 3
1. session 1 2 3
Week 10
2. session 1 2 3
1. session 1 2 3
Week 11
2. session 1 2 3
1. session 1 2 3
Week 12
2. session 1 2 3

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Exercise 6: Outer thigh
Level 1
Tighten the exercise band around your ankles. Move one of your legs diagonally backwards and outwards with your
toes pointing forward. Return slowly to your starting position and repeat. Keep your upper body steady trough the
movement. Focus on stabilizing the standing leg, keeping your hip, knee and foot aligned. Repeat with the other leg.

Level 2
Stand on one leg at a balance cushion or pad with the exercise band around your ankles. Maintain your balance and move
your leg diagonally backwards and outwards. Keep your knees nearly extended, controlling the movement. Repeat with
the other leg.

Level 3
Turn the BOSU ball around with the flat side up. Stand on one leg on the BOSU ball with the exercise band around your
ankles. Maintain your balance and move your leg diagonally backwards and outwards. Keep your knees nearly extended,
controlling the movement. Repeat with the other leg.

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 Inner thigh

Level (put a circle) Number of sets Number of reps.

1. session 1 2 3 4
Week 1
2. session 1 2 3 4
1. session 1 2 3 4
Week 2
2. session 1 2 3 4
1. session 1 2 3 4
Week 3
2. session 1 2 3 4
1. session 1 2 3 4
Week 4
2. session 1 2 3 4
1. session 1 2 3 4
Week 5
2. session 1 2 3 4
1. session 1 2 3 4
Week 6
2. session 1 2 3 4
1. session 1 2 3 4
Week 7
2. session 1 2 3 4
1. session 1 2 3 4
Week 8
2. session 1 2 3 4
1. session 1 2 3 4
Week 9
2. session 1 2 3 4
1. session 1 2 3 4
Week 10
2. session 1 2 3 4
1. session 1 2 3 4
Week 11
2. session 1 2 3 4
1. session 1 2 3 4
Week 12
2. session 1 2 3 4

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Exercise 7: Inner thigh

Level 1
Tighten the exercise band to a stall bar or similar and
your ankle on the active leg. Stand with your side to the
stall bar and use it for support to keep the balance, if
needed. In the starting position the active leg is moved a
bit towards the stall bar, from which it is moved inwards,
in front of the standing leg. Repeat with the other leg.
Level 2
Tighten the exercise band to a stall bar or similar and
your ankle on the active leg. Stand on one leg on a
balance cushion or pad with your side to the stall bar and
use it as support to keep the balance, if needed. In the
starting position the active leg is moved a bit towards the
stall bar, from which it is moved inwards, in front of the
standing leg. Repeat with the other leg.

Level 3
Lay on your side on an exercise mat using the elbow as support as in the side plank exercise. Put your upper leg on a
chair at the level of the knee (if needed with a pillow under the knee) and keep your lower leg elevated just below the
seat of the chair. Lift your body from the floor by pressing the upper leg against the seat of the chair. Move the lower
leg down to the floor and up again to the chair. Repeat with the other leg.

Level 4
Lay on your side on an exercise mat with the elbow as support as in the side plank. Put your upper leg on a chair at the
level of the foot and keep your lower leg elevated just below the seat of the chair. Lift your body from the floor by
pressing the upper leg against the seat of the chair. Move the lower leg down to the floor and up again to the chair.
Repeat with the other leg.

19
 Slide-exercise sideways and sideway lunge

Level (put a circle) Number of sets Number of reps.

1. session 1 2 3 4 5
Week 1
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 2
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 3
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 4
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 5
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 6
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 7
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 8
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 9
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 10
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 11
2. session 1 2 3 4 5
1. session 1 2 3 4 5
Week 12
2. session 1 2 3 4 5

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Exercise 8: Slide-exercise sideways and sideway lunge

Level 1
Stand with one foot on a carpet tile or cloth that can
slide on the floor. Move the foot to the side in a sliding
movement while bending and stretching in the opposite
knee. Repeat with the other leg.
Niveau 2
Stand with one foot on a carpet tile or cloth that can slide on the
floor and the other foot on a balance cushion or pad. Move the foot
to the side in a sliding movement while bending and stretching in
the opposite knee. Repeat with the other leg.

Level 3
Stand with your feet shoulder width apart. Perform a
sideway lunge controlling and stopping the movement
gradually when the foot touches the floor. In the end
position the active leg is flexed and the standing leg is
nearly fully extended. Extend the active leg and return to
the starting position. Repeat with the other leg.
Level 4
Stand with your feet shoulder width apart with the
exercise band stretched between your legs. Perform
small jumps to one side stretching and loosening the
exercise band by abducting and adducting your legs.
Repeat to the other side.

Level 5
Stand on one leg next to a distance of approx. 20cm. marked with a cord or similar. Jump across the 20cm. and land in
a controlled way on the opposite side of the cord and jump back to your starting position. Do 30-60 jumps. Repeat
with the other leg.

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 One-legged leg press

Kilos on the
Number of sets Number of reps.
injured leg

1. session
Week 1
2. session
1. session
Week 2
2. session
1. session
Week 3
2. session
1. session
Week 4
2. session
1. session
Week 5
2. session
1. session
Week 6
2. session
1. session
Week 7
2. session
1. session
Week 8
2. session
1. session
Week 9
2. session
1. session
Week 10
2. session
1. session
Week 11
2. session
1. session
Week 12
2. session

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Exercises focusing on improving muscle strength
Each of the exercises in this part of the program are performed in sets of 2-3 with 8-15 repetitions with rest
corresponding to the duration of one set between each set and exercise. Start off with 2 sets of 15
repetitions. During the next weeks you and your physical therapist will increase the level of difficulty by
increasing the resistance (i.e. weights) and changing the sets and repetitions to 3 x 12, 3x 10 and finally 3 x
8. The level of resistance is increased using the +2 principle, i.e. when you are able to perform two
additional repetitions in the last set more weight is added and fewer repetitions per set are performed (e.g.
when you are able to perform 17 repetitions in the second set). Although, the primary focus is on the
injured leg, the exercises are performed with both the injured and non-injured leg. If the knee is very
swollen and has a reduced range of motion, the strengthening exercises can be postponed for 1-2 weeks.

Exercise 9: One-legged leg press

Put one foot on the platform. Ensure that the angle of the knee is approx. 90 degrees. Contract your core
muscles and extend the leg by pushing the platform. Stop the movement when the leg is nearly fully
extended to avoid overstretching your knee. Lower the leg slowly in a controlled way. Repeat with the
other leg.

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 One-legged knee extension

Kilos on the
Number of sets Number of reps.
injured leg
1. session
Week 1
2. session
1. session
Week 2
2. session
1. session
Week 3
2. session
1. session
Week 4
2. session
1. session
Week 5
2. session
1. session
Week 6
2. session
1. session
Week 7
2. session
1. session
Week 8
2. session
1. session
Week 9
2. session
1. session
Week 10
2. session
1. session
Week 11
2. session
1. session
Week 12
2. session

24
Exercise 10: One-legged knee extension
Ensure that your lower back is supported. Sit with your knees flexed (approx. 120 degrees angle) and the
pad of the lever just above your ankle. Extend one leg fully by pushing the lever. Repeat with the other leg.

25
 One-legged knee flexion

Kilos on the
Number of sets Number of reps.
injured leg
1. session
Week 1
2. session
1. session
Week 2
2. session
1. session
Week 3
2. session
1. session
Week 4
2. session
1. session
Week 5
2. session
1. session
Week 6
2. session
1. session
Week 7
2. session
1. session
Week 8
2. session
1. session
Week 9
2. session
1. session
Week 10
2. session
1. session
Week 11
2. session
1. session
Week 12
2. session

26
Exercise 11: One-legged knee flexion
Lay on your stomach with your legs stretched and your knees just off the edge of the seat with the pad of
the lever at a level just above your ankles. Position your upper body by grasping the handles. Flex one knee
as far as you can by pushing the lever and lower it slowly in a controlled way back to the starting position.
Avoid lifting the pelvis from the seat. Repeat with the other leg.

27
 Kettlebell swings

Kilos Number of sets Number of reps.

1. session
Week 1
2. session
1. session
Week 2
2. session
1. session
Week 3
2. session
1. session
Week 4
2. session
1. session
Week 5
2. session
1. session
Week 6
2. session
1. session
Week 7
2. session
1. session
Week 8
2. session
1. session
Week 9
2. session
1. session
Week 10
2. session
1. session
Week 11
2. session
1. session
Week 12
2. session

28
Exercise 12: Kettlebell swings
Not all will be able to do this exercise, so discuss with your physical therapist whether you are ready to
start the exercise. Stand with your weight on your heels. Ensure that your shoulders, hips, knes and ankles
are aligned. Extend your arms and give the Kettlebell a push. When the Kettlebell returns towards your
body, move your hips backwards wit approx. 15 degrees flexed knees. Bend your upper body forwards with
a straight back. When you are in the desired end position, start the lift by pushing the hips forward and let
the upper body find a vertical position returning to the starting position. Keep your head in a natural
position throughout the lift (neck/jaw angle of approx. 90 degrees).

29
 Your own notes

30
This exercise program was made by the DREAM study group in collaboration with Photo/AV at Aalborg University Hospital
and physical therapists at Arkadens Fysioterapi, Aalborg, Denmark.

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December 2016
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