Therapeutic Exercise for the Knee

• ACL Reconstruction Minimum Protection Phase


  Emphasis on eccentric training, advanced neuromuscular balance and agility training, education to prevent re-injury, functional knee brace, return to high-demand activities
• ACL Reconstruction Moderate Protection Phase Criteria to progress

  A sense of pain and joint effusion, full active knee ROM, 75% knee strength, hamstring/quad ration >65%, no evidence of knee instability
• ACL Recontruction Moderate Protection Phase

  Ambulation without assistive device, low intensity end range self strengthening, closed chain exercises, double to single leg progression, open-chain hip extension, abd, and knee extension and flexion, stationary cycling , initiate swimming, treadmill, elliptical, or step, activity specific exercises
• ACL Reconstruction Max Protection Phase Criteria to Progress

  Minimal pain and swelling, full active knee extension, at least 110 flexion, 50-60% quad strength, no excessive joint laxity
• ACL Reconstruction Max Protection Phase Goals and Interventions

  Control pain, swelling and protect healing tissues, 90 flexion and full passive extension, ankle pumps, muscle setting, estim for biofeedback, straight leg raises, hamstring activation, patellar mobs, neuromuscular control/ responses
• Ligament Injury Moderate Protection Phase Goals and Interventions

  Improve joint mobility and cardiopulmonary conditioning, encourage moment, brace if necessary, improve muscle performance with isometrics, improve neuromuscular control, develop activity specific exercises
• McMurray Test

  A test for meniscus tears involving forced hyperextension or max flexion.
• Minimally Invasive Approach TKA


  A surgical approach involving a reduced length of skin incision and no patellar eversion or tibiofemoral dislocation.
• Standard Traditional Approach TKA


  A surgical approach involving incision from the distal femoral shaft running medial of the patella.
• TKA Minimum Protection Phase Return to Function

  Advance as appropriate, progression of balance, advanced functional activities, implement exercises specific to deficits, continue cardiopulmonary conditioning
• TKA Moderate Protection Phase Criteria to Progress

  AROM full knee extension, 110 knee flexion, quads/hamstring and hip muscular strengthen 4/5, minimal to no pain with exercise and ambulation
• TKA Moderate Protection Phase

  Patellar mobilization, increase knee and hip musculature, closed chain strengthening, stationary cycling, increase ROM, proprioceptive training, stabilization and balance exercise, functional mobility exercise, improve cardiopulmonary endurance
• TKA Max Protection Phase Criteria to Progress

  Minimal swelling and pain, well healed incision, independent ADLs and ambulation, full or nearly full active knee extension and 90 degrees knee flexion
• TKA Max Protection Phase

  Pain modulation modalities, compression wraps, ankle pumps, deep breathing, AAROM and AROM strengthening contralateral LE, muscle setting, patellar mobilizations, gait training, flexibility programming, trunk and pelvis stabilization
• Joint Hypomobility Controlled motion and return to function phase

  Educate patient, decrease pain from mechanical pain, increase joint play and ROM, improve muscle performance in supporting muscles
• Joint Hypomobility Protection Phase

  Control pain and protect joint, maintain soft tissue and joint mobility, maintain muscle function and prevent patellar adhesions
• Rheumatoid Arthritis


  A chronic inflammatory disorder affecting many joints, including the knees.
• Post Traumatic Arthritis


  Occurring in response to injury that affects the joint structures
• Osteoarthritis Risk Factors

  Excess weight, joint trauma, developmental deformities, quad weakness, and abnormal tibial rotation
• Saphenous Nerve


  A sensory nerve that innervates the shin along the medial side of the knee.
• Common Fibular Nerve

  Becomes superficial just below the fibular head
• Sciatic Nerve Divides

  Proximal to politeal fossa
• Foot Impairments


  Position and function of foot and ankle affect the stress transmitted to the knee
• Length/ strength imbalances

  Unbalanced forces stress knee structures giving rise to pain during walking or running
• Hip Flexion Contractures

  Inability to extend hip prevents knee from extending just before terminal stance
• Gastroc Controls

  Posterior support to extended knee at loading response or foot flat
• Soleus Controls

  Help limit knee flexion during pre swing
• Hamstrings Control

  Knee extension during terminal swing
• Quads control

  Knee flexion during initial contact and loading reponse, extend knee toward mid stance
• Pes Anserinus


  Providing medial stability to the knee and affecting rotation of the tibia.
• Popliteus Mucles

  Provide posterior capsule support, unlock extended knee
• Peak Extension Torque


  The maximum rotational force produced by the quadriceps during knee extension.
• Patellotibial Ligaments


  Ligaments that combine to stabilize the patella against the superiorly directed pull from the quadriceps muscle.
• Q-Angle


  The angle formed by lines from the ASIS to the midpatella and from the tibial tubercle through the mid-patella.
• Patellofemoral Joint


  The joint between the kneecap and the femur.
• Medial Meniscus


  The cartilage in the knee that is more likely to sustain a tear due to extensive attachments
• Medial Collateral Ligament (MCL)

  Mediolateral stability
• Cruciate Ligaments


  Ligaments in the knee that provide anteroposterior stability.