Knee Exercises Flashcards
SMR and stretching for anterior thigh
- patellar issues may be due to tightness in the anterior thigh
- band-assisted prone knee flexion: open quads, self-initate PNF using res band, may not target rec fem hip flexion fibres, if uncomfortable in prone then perform in side-lying or standing
- modified Thomas position with band: open hip flexor and knee extensors, lying on elevated surface, band around foot goes under body and over shoulder, pull on the band to bring knee into greater flexion, don’t need to worry about balance, watch for compensation with pelvic tilt
- rolling both or one quads: place foam roller under the quads in a semi-prone position, use hands to walk forward and back to roll the thigh, can add active knee flexion for greater concentration on one spot
SMR and stretching for lateral thigh
- ITB/TFL can have lateral pull causing patellofemoral pain syndrome, loosen to decrease lateral stress on patella
- glute med weakness tend to compensate by over using TFL as main abductor, causing it to be tight
- rolling lateral thigh (ITB/VL): roller under lateral thigh, cross top leg over other leg and use foot to drive the roller up and down the thigh
- rolling TFL: is small, use ball on wall to roll behind ASIS
SMR and stretching for plantarflexors
for limited dorsiflexion or pronation, anterior knee pain may be due to limited DF mobility (compensate with greater knee flexion)
1. seated towel stretch for plantarflexors: towel around ball of foot with extended/knee if possible
2. standing heel press: split stance and press heel into ground into dorsiflexion
3. elevated and banded DF: joint focused exercise with foot elevated and band pulling posteriorly putting pressure on ant translated talus to move it back into mortise to allow better DF movement
3. rolling both sitting with legs out, foam roller under calves, drive forwards and backwards with arms, to roll one cross over one ankle over the other to put more pressure, rotate tibia to target specific spot
lunge stretch
- stretch the hip flexors by going into lunge position, drive knee forward, for greater stretch lift sternum up and arms overhead and contract the glutes
- progress with couch stretch (elevate posterior leg for greater hip extension
- stretch the knee extensors by bring heel of back foot to butt in quad stretch
- watch for compensation with trunk extension and anterior pelvic tilt
SMR and stretching for posterior thigh
open up hamstrings when overactive, limited knee ext, or excessive guarding during acute meniscoligamentous tear
1. SLR: sit with straight, with band over midfoot, lie down and use the band to pull foot to head with the leg extended; progress with active hip flexion; can bias biceps fem with tibial int rot and hip adduction, bias semimembranosus and semitendinosus with tibial ext rot and hip abduction; watch for compensation with knee flex and pelvic post tilt
2. pyramid stance: legs extended, shoulder width apart in split stance, hinge at the hips to stretch the hamstring, support with block and progress with lower block, more challenging since req good balance
3. SMR hamstrings: both or one at a time with ankle crossed
pretzel/figure four/piriformis stretch
- seated: deep gluteal stretch, cross ankle over knee, using hand to support the crossed knee, hinge at the hips
- lying: progression, cross ankle over knee, using hand to support the crossed knee, pull non-crossed leg towards torso, progress with active hip flexion
adductor rockback + gate stretch
- table top pos, extend one leg laterally, rocking butt to heel to stretch adductors
- point heel up to ceiling to target more hamstrings
- gate stretch: add lateral flexion of spine towards ext leg to deepen adductor stretch
resistance: non-weight bearing knee extension
- short arc quadriceps/quad setting: lie supine with foam roller or towel above the knee, push hamstring into roller to extend the knee, higher up the hamstring the greater knee ext ROM, if can lift the leg then they can work through greater ROM or hold ISO at terminal knee extension
- terminal knee extension with band: loop band around pole, foot in the band, step back in split stance with foot with the band behind, only toe in contact with floor, extend knee and drive heel into ground; progress with heavier bands, once able to use heavy band can progress to weight bearing, watch for compensation through heel lifting
- open kinetic chain knee extensions done sitting, simple req little skill, able to isolate knee extensors, weight or force around bottom end of tibia can cause more ant tibia translation full ext to 45 deg before therefore not great for ACL sprain, but non-weight bearing nature good for OA
resistance: weight bearing knee extension
for squats check the working depth since deep knee flexion may be irritating to post horn mensicus and PCL while patella will come into contact with the femur at different points in ROM
1. wall squats: more support, good way to start squatting,
2. BW squat: more complex than wall since req balance, start with box squats for ECC motion, progress with lower box and load
3. split squat: to address asymmetries, progress from BW squat with hip ext, progress using active lunges to train ECC
4. Spanish squat for anterior knee pain since band around knees allows a more upright deep squat position, limiting the need for dorsiflexion which shifts load off the patella to offset pain
5. step up/down, progressing from split squat, req good balance and train unilateral strength with abductor activation, high load on the anterior knee, and req DF ROM, modify height of step
resistance: hamstrings
- ISO heel dig: can do in any position, dig heel into any surface for ISO flex
- hamstring curl: prone, seated, or standing, start unweighted, progress with weights, bands, ankle strap, and machine; not for early PCL since weight on distal tibia pulls it posteriorly but good for OA since non-weight bearing
- nordic hamstring curl is advanced ECC emphasis, good for ACL inj
resistance: hip extension
- glute bridging: supine with 20 deg GH abduction to plant elbows for support, ankles stacked under knees, push through heels to drive the hip up, progress by slightly ext one leg to load the other, single leg only with ankle stacked under knees, single leg only with slight extension; progress with elevation of one end of base to increase working ROM or with load
- hip hinging: can use dowel to guide, against the wall, take one step off the wall, slight bend in knee, keeping spine straight, hinge at hips to roll the dowel down the thigh and bring butt to wall or use dowel as guide for spinal neutrality by putting it behind back, hinging at the hips
- deadlift variations: single leg supported by wall or kickstand, double, and single leg unsupported, progress with load
resistance: hip ext rot and hip abduction
- clamshells: target glute max, side lying, arm out for support, ankles, knees, and hip stacked, pivot off the ankle, small ROM, watch for compensation by rotation of the torso or hip, progress with res band above knee
- side leg raise: side lying, target glute med, ankle, knees, and hips stacked, abduct leg in small ROM, preventing hip motion
- pelvic drop and hike: done on a step or box, more functional glute med exercise: drop the pelvis to lower the heel to the ground, keeping other leg on step straight, use pelvic tilt to bring pelvis back to neutral
- monster walks or taps: target abductors with weight bearing component, easier if band closer to hip
- curtsy squat: puts ECC emphasis of abductor and quads of front leg, not very functional but good challenge
- any single leg weight-bearing exercise will activate abductors and having resistance band loop around thighs will activate both ext rot and abductors as a functional exercise; good for later-stage rehab
balance: lower body
- vary the width of the base of support
- single or double leg, unstable/stable surface, head rotation, and modifying visual input
- progress with weight bearing
