The muscles that surround the knee, particularly the quadriceps and the hamstrings of the thigh, atrophy readily after a knee injury. Reconditioning of the knee must begin as early as possible. Immobilization of the knee requires that the muscles be exercised almost immediately after an injury occurs if atrophy and contractures are to be prevented. If the knee joint is immobilized, one should engage in isometric or static muscle contractions and graduate to straight leg raises, from both the sitting position with hip flexion and from lying on the back. Toe raises can also be executed to exercise the gastrocnemius (calf) muscle. Active bending of the knee should be avoided until initial pain and soreness have diminished somewhat. A gradual program of leg swinging in the pain free range combined with static stretching of the hamstrings can commence following removal from immobilization. A program of progressive resistance exercises is usually not begun until pain is minimal and healing has begun. These exercises should include:

1)Leg Extensions

With resistance applied at the ankle, slowly begin from a flexed leg position to straighten the leg and then back again. After completing that set, point the toe out as far as possible and begin again. Then point the toes in as far as possible to complete.

2)Leg Curls

With resistance applied to the ankle and lying face down, begin in a straight leg position and slowly bring the heel to the buttock and then down again. You should also attempt sets of this exercise with toes pointed in and toes pointed out.

3)Toe Raises

Standing on a raised surface with the balls of the foot, letting the heels hang over for a complete stretch, slowly bring all the weight straight up on to the toes and then down again for complete stretch. Again, you should also complete sets of this exercise with toes pointed in and toes pointed out.

Such exercises should be performed in sets of ten, working toward an ultimate program of three sets of ten, two or three times daily. When the knee has been reconditioned to the point at which strength and flexibility are adequate for activity, light jogging graduated to running at half speed may commence for further strengthening.

Dr. Kenneth Simpson photo