Physiotherapy is an integral part of the treatment of most knee conditions.
Some knee conditions resolve completely with the appropriate physiotherapy treatment.
The recovery of other conditions and recovery after surgery is normally hastened with appropriate physiotherapy. Most patients will benefit from an exercise program to improve the function of muscles around the knee, whatever condition affects their knee.
I work with a close team of physiotherapists who have special expertise in the diagnosis, management and physiotherapy treatment of knee conditions including post-operative rehabilitation.
The reason to undertake a programme of exercises for the knee is to improve the strength, stamina and co-ordination of the muscles around the knee, particularly the quadriceps. Better function of these muscles will results in:
- Better shock absorption and thus less pain from arthritic or degenerative conditions.
- Better control of the knee in situations where it may feel insecure or unstable.
- Better co-ordination and integration of the functional elements of the knee for improved performance.
The aim of the exercises are to fatigue the muscle. The muscle will then respond and improve its strength/stamina/co-ordination depending on the way that it was fatigued. If the muscles are not fatigued then the exercise programme will provide less benefit.
Exercise versus activities
There is a major difference between the “activity” of work, sport and domestic duties and an exercise programme designed to improve the function of muscles around the knee.
Exercise programs are designed to improve the function of muscles around the knee without irritating it, so that when activities are performed that might cause aggravation of a knee condition, the knee has more protection from this improved muscle function.
Activities might involve the use of muscles around the knee but these might also cause aggravation of an underlying condition and therefore provide no benefit or even a deterioration in symptoms.
Impact activities, that is, activities that involve the foot leaving and striking the ground/apparatus, put large, jarring forces through the knee and tend to aggravate most underlying knee conditions.
"you can't walk a bad knee better"
Walking is an impact activity and is therefore is not a sensible way of trying to improve most knee conditions, as any improvement of muscle function is likely to be offset by a greater aggravation of the underlying knee condition.
Different knee conditions will respond better to different types of exercises. In general, in addition to impact activities being likely to cause aggravation of the knee condition so can performing exercises in deep flexion.
A physiotherapist can give detailed advice and monitor an exercise programme to ensure that it is as effective as possible.
A simple Exercise Programme
The following diagrams need to add in diagrams are for illustration purposes and include some very basic but very useful exercises.
The straight leg raise, in particular, can help to improve the function of the quadriceps muscles enormously. It is very unlikely to irritate the knee and can be performed almost anywhere!
1. The Straight Leg Raise
- Simple, safe and effective.
- Hold for 10 seconds and then relax.
- Hang a weight over your ankle if it is too easy.
2. The Terminal Extension
- Easy to do, Safe. Good for patella
- Place knee over pillow or rolled up towel then straighten your knee.
- Hold for 10 seconds and then relax
3. Wall Squats
- There is no benefit from doing these for longer than 3 minutes
4. Half Squats
- Not past 90°
- Not past 90°, not for too long, not suitable for those with anterior knee pain
6. Bicycle work
This is one of safest exercises and is very unlikely to cause irritation to the knee.
Start with an exercise bike first at a low speed with low resistance. The speed and resistance can be gradually increased to develop increasingly good muscle function around the knee. It is also great for burning off calories, providing cardiovascular exercise and can be great fun!
Remember to keep the seat high to avoid bending knee too much. It is also a good activity to substitute in the long term for impact activities such as walking, jogging or running as these are impact activities that are liable to irritate the knee in most conditions.
7. In the gym
- Leg Press
Seat back initially, knee bending to 70°
- Hamstring Curl
Take care not to hyperextend the knee.
- Step Machine
Start with small amplitude.
Use it as a warm up and prefatiguing exercise.
Can be aerobic
Repetitions and Progression
The number of repetitions (reps) of a particular exercise is important in order that the muscle develops a training response. In simple terms, it is necessary to exercise the muscle to fatigue in order for it to develop.
You should keep a record of the number of exercises it takes for your muscles to “feel the burn” or feel tired such that the quality of the exercise is reduced.
In general terms, 10 reps is a minimum for any “set” and this should be increased with each day until, say, 20 reps is achieved. When this happens you should add to or increase the resistance applied to the leg.
If any of the exercises hurt significantly then you should obviously cease performing them. If pain persists, you should consult a physiotherapist or make an appointment to see your consultant.
Exercise to Increase flexion (bend) of the knee
- Push against a step
- Pull back under a chair
- Someone else gradually pushing it
- Lying on your front
- Lying or sitting
- Bike - gradually lower the seat
- Be persistent
Exercises to improve extension (straightening) of the knee
- Rest on heel / calf, No knee support
- Tighten thigh to raise heel from ground
- Sit with knee straight and heel on ground
- Try to raise the leg with knee over a pillow
- Really push hard with the thigh muscles
- Someone else pushing down on the knee
Making the Time
It is difficult to allocate time to do these exercises but it is worth trying to make time in your busy schedule to perform them.
Some useful time-finding tips are:-
- Try to have your knee exercises in the back of your mind so that you can do a short set many times during the day, e.g. while sitting in the office, on hold on the telephone; on the steps at home or work; in the lift.
- Set aside 2 periods of 10 - 15 minutes a day specifically for your knee exercises.
- Determine that at other times you will do exercises rather than another activity eg. during TV commercials; at children’s sport; in bed reading.
Some people find it useful to join a gym so that they are then committed to the time and will put in a better effort.
A physiotherapist will be able to give the best detailed advice and monitor your exercise programme to ensure that it is as effective as possible.