Chapter 21 · Knee
Knee Instability protocol
Indexed — full page in progressSource: Rehab Science · Ch 21 · PDF pp. 835–867📖 Rehab ScienceBuild my programme →
AMBER — get assessed before starting rehab
Screen for red flags before starting any protocol (safety check). Progress by symptoms and function, not by the calendar: > 3/10 pain → start phase 1; < 3/10 → phase 2 (PDF p. 205).Follow this programme to treat
- Knee that feels like it’s going to give out or buckle
- Meniscus tear (limited knee range of motion with catching/locking, instability, and pain when standing and twisting on the injured leg)
- Ligament tear (ACL, PCL, MCL, LCL)
- Kneecap dislocation
Conditions in this protocol
- Meniscus tear PDF p. 836
- Knee ligament tear (ACL PDF p. 840
- Kneecap (patellar) dislocation PDF p. 846
Questions the book answers
- When should I consider surgery? p. 837
- What are the different types of surgical interventions for meniscus injuries? p. 839
- How much instability is acceptable? p. 842
- When should I seek medical attention? p. 843
- How do doctors determine the location and grade of the injury? p. 843
- Should I get surgery? p. 844
- What type of surgery is typically performed, and how long is the recovery? p. 845
Good for
- Alleviating knee pain
- Improving knee stability and neuromuscular control
- Warm-up for phase 2 and 3 exercises
Guidelines
- Perform every day
- Do 3 sets of 10–15 reps unless otherwise noted
- Tools: stretch strap, foam roller
- Add phase 2 when range of motion is greater than 90 degrees (see finish position in heel slide exercise)
Exercises
Good for
- Reducing knee pain
- Improving knee stability and neuromuscular control
- Early knee and hip strengthening
- Warm-up for phase 3 exercises
Guidelines
- Perform 3 or 4 days a week
- Do 3 sets of 10–15 reps unless otherwise noted
- Tools: resistance loop, physio (exercise) ball, plyo box, dumbbells
- Add phase 3 once you have full knee range of motion and can do the exercises without pain or instability
Exercises
diagram pending
Banded squat
PDF p. 852 · instructions pending
diagram pending
Knee extension
PDF p. 853 · instructions pending
diagram pending
Single-leg bridge
PDF p. 854 · instructions pending
diagram pending
Ball hamstring curl
PDF p. 855 · instructions pending
diagram pending
Step-up
PDF p. 856 · instructions pending
diagram pending
Split squat
PDF p. 857 · instructions pending
Good for
- Increasing knee and leg strength
- Preventing knee pain and injury
Guidelines
- Perform 3 or 4 days a week for 8–12 weeks, or until you have regained stability
- Do 3 sets of 10–15 reps unless otherwise noted
- Push sets to fatigue
- Tools: resistance loop, bench, dumbbell, plyo box
Exercises
diagram pending
Standing banded hydrant
PDF p. 859 · instructions pending
diagram pending
Bulgarian split squat
PDF p. 860 · instructions pending
diagram pending
Single-leg deadlift
PDF p. 861 · instructions pending
diagram pending
Lateral step-down
PDF p. 862 · instructions pending
diagram pending
Clock
PDF p. 863 · instructions pending
diagram pending
Skater squat
PDF p. 864 · instructions pending
diagram pending
Single-leg hamstring curl
PDF p. 865 · instructions pending
diagram pending
Tiptoe walk
PDF p. 866 · instructions pending
diagram pending
Bilateral jump to unilateral landing
PDF p. 867 · instructions pending
Source: Rehab Science · Ch 21 · PDF pp. 835–846· 13 original research citationsshow sources ▾
Also cited by the book on these pages:
- [Ch 21·7] Horga LM, Hirschmann AC, Henckel J, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020;49(7):1099-1107. find original ↗
- [Ch 21·8] Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359(11):1108-1115. find original ↗
- [Ch 21·9] Wells ME, Scanaliato JP, Dunn JC, Garcia EJ. Meniscal injuries: mechanism and classification. Sports Med Arthrosc Rev. 2021;29(3):154-157. find original ↗
- [Ch 21·10] Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus. Orthop Traumatol Surg Res. 2017;103(8S):S237-S244. find original ↗
- [Ch 21·11] Chirichella PS, Jow S, Iacono S, Wey HE, Malanga GA. Treatment of knee meniscus pathology: rehabilitation, surgery, and orthobiologics. PM R. 2019;11(3):292-308. find original ↗
- [Ch 21·13] Drobnič M, Ercin E, Gamelas J, et al. Treatment options for the symptomatic post-meniscectomy knee. Knee Surg Sports Traumatol Arthrosc. 2019;27(6):1817-1824. find original ↗
- [Ch 21·14] Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE. Mechanisms, prediction, and prevention of ACL injuries: cut risk with three sharpened and validated tools. J Orthop Res. 2016;34(11):1843-1855. find original ↗
- [Ch 21·16] Boden BP, Sheehan FT, Torg JS, Hewett TE. Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J Am Acad Orthop Surg. 2010;18(9):520-527. find original ↗
- [Ch 21·17] van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016;50(24):1506-1515. find original ↗
- [Ch 21·18] Kaplan Y. Identifying individuals with an anterior cruciate ligament-deficient knee as copers and noncopers: a narrative literature review. J Orthop Sports Phys Ther. 2011;41(10):758-766. find original ↗
- [Ch 21·19] Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2010;40(11):705-721. find original ↗
- [Ch 21·20] Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-808. find original ↗
- [Ch 21·21] Smith TO, Song F, Donell ST, Hing CB. Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2011;19(6):988-998. find original ↗
Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.