Subject: Mass General Knee strengthening program


175 Cambridge Street 

Boston, MA  02114 



Strength Training for the Knee 


This handout is to help you rebuild the strength of the muscles surrounding the knee after 

injury.  It is intended as a guideline to help you organize a structured approach to 

strengthening the knee. 


Precautions When Exercising 

• Avoid pain at the patellar tendon  

• Avoid pain and/or crepitus (grinding) at the patella (kneecap) 

• Build up resistance and repetitions gradually 

• Perform exercises slowly, avoiding quick direction change and impact loading 

• Exercise frequency should be 2 to 3 times a week for strength building 

• Be consistent and regular with the exercise schedule 


Before Staring Your Workout 

• Warm-up prior to exercising by stationary cycling, elliptical machine or treadmill 

walking uphill 

• You are “warmed – up” when you have started sweating 

• Gently stretch all muscle groups next (see attachment for recommended stretches) 

• Do exercises involving multiple muscle groups first and individual muscle groups 


• Do aerobic workouts after strength workouts 

• Cool-down by stretching after exercise 


Progressive Resistance Exercise (PRE) Principle 

• To build muscle strength and size, the amount of resistance used must be 

gradually increased 

• The exercises should be specific to the target muscles 

• The amount of resistance should be measurable and gradually increased over a 

longer period of time 

• To avoid excess overload and injury, the weight or resistance must be gradually 

increased in increments of 5 to 10 % 

• Resistance can be increased gradually every 10 to 14 days when following a 

regular and consistent program 

• Adequate rest and muscle recovery between workout is necessary to maximize the 

benefit of the exercise 

• If the PRE principle is followed too strictly, the weights potentially will go higher 

and higher 

• At a certain point, the joints and muscles will become overloaded and injury will 


• This eventuality can be avoided by refraining from using excessive weight during 

strength training 



175 Cambridge Street 

Boston, MA  02114 




Basic Knee Strengthening Program 


Emphasis is to build muscle strength using BOTH legs. Progress according to the PRE 



Frequency: 2 to 3 times per week, 3 sets of 10-15 repetitions 


Basic Program Exercises (see illustrations at the back of the handout) 

Leg Press 

Hamstring Curl 

Knee Extension Machine  

Wall Slides (hold dumbbells for resistance) 

Roman Chair (hold dumbbells for resistance) 

Chair Squat 

Calf Raises 

Hip Abductor/Adductor machine 

Step Up/Down (see attachment for progression) 


If you do not have access to gym equipment, the following exercises can be substituted 

using ankle weights (see illustrations and instructions attached): 

Straight leg raise 

Short-arc lift 

Side lying abduction 

Standing hamstring curl 

Toe raises 



In General, the Basic Knee Strengthening Program is good for most people who are 

active recreationally, but who do not participate in running and jumping sports.  For 

people who will participate in running and jumping sports, the following Advanced Knee 

Strengthening Program can be used to develop a higher level of knee strength. 




175 Cambridge Street 

Boston, MA  02114 



Advanced Knee Strengthening Program 


Emphasis is to continue to build muscle strength using both legs and progress to 

Advanced Exercises using the Single leg. These exercises are integrated with the 

exercises from the Basic Knee Strengthening Program. 


Frequency: 2 to 3 Times per week, 3 sets of 10 repetitions 


The following single leg drills are integrated into the workout on a rotating basis: 

Step Up/Down 

Single Leg Wall Slide 

Single Leg Squat (see attachment for progression of single leg drills) 


When starting the new single leg drills, start with 3 sets of 5, and add one repetition per 

set, per workout until you can do 3 sets of 10.  When 3 sets of 10 are easy and pain free, 

then you can hold dumbbells to increase resistance and strength. 


So that the Advanced Knee Strengthening Program would be as follows: 

Leg Press 

Hamstring Curl 

Knee Extension Machine  

Wall Slides (hold dumbbells for resistance) 

Roman Chair 

Chair Squat (hold dumbbells for resistance or barbells) 

Calf Raises 

Step up/down 

Alternate workouts with single leg wall slide and single leg squat 



Knee extension machine (quadriceps extensions): while providing effective exercise for 

the quadriceps muscles, this exercise places high levels of stress on the kneecap joint. 

Please use caution and stop using this machine if you are experiencing any pain, clicking 

or grinding in the knee.  


Roman Chair: to avoid injury, proper technique with good abdominal and low back 

control is very important with this exercise.  Do not perform this exercise if you have a 

history of low back injury or are experiencing any low back pain.  


The following exercises can cause injury and should be performed with caution: 

Stairmaster or stair climber machines 


Squats beyond 90 degrees of knee flexion 

High impact and plyometric exercises 


If you have any questions regarding the exercise program, or would like to set up 

an appointment with a physical therapist, call 617-643-9999. 



175 Cambridge Street 

Boston, MA  02114 









Leg Press                                                   Hamstring Curl                          Knee extension 


Abductor-Adductor                                        Calf Raise                             Roman chair 


















Straight leg lift                                        short arc lift                     standing hamstring curl 










Side leg lift                                   toe raises                             calf stretch 









Quadriceps stretch         hamstring stretch                                                           ITB stretch                              




175 Cambridge Street 

Boston, MA  02114 



Instructions for Single Leg Exercises 



Step Up-Down Exercise 

Place one foot on the step. Maintain balance, if necessary, by holding 

onto the wall or chair. Standing sideways to the step, slowly step up onto 

the step and slowly straighten the knee using the quadriceps muscles. 

Slowly lower the opposite foot to touch the floor.  Do not land on the floor, 

just touch gently and repeat the step up. 


Start with a step of 3 inches in height. Start with 3 sets of 5 repetitions. Add 

one repetition per set, per workout, until you can do 3 sets of 10. If pain free, 

progress the height of step. Repeat progression at new step height, starting with 3 sets of 5 repetitions 


To avoid overstressing the kneecap, limit exercise to step height no greater than the height of a 

normal stair (8-9inches).  At this point, you can begin to add the single leg wall slide exercise.  The 

strength workouts should be practiced 3 times a week (every other day). 


Single Leg Wall Slide Exercise 

Stand on the single leg with your back and buttocks touching a wall.  Place the foot 

about 6 inches from the wall.  Slowly lower your body by bending the knee and slide 

down the wall until the knee is flexed about 45 degrees (illustration).  Pause five 

seconds and then slowly slide back up to the upright starting position.  Keep the 

hips level and be sure you are using your knee muscles to perform the exercise. 


Start with 3 sets of 5 repetitions. Add one repetition per set, per workout, until you 

can do 3 sets of 10.  At this point, you can begin to add the single leg squat exercise.   


The strength workouts should continue every other day at the most, with more time 

between workouts if the knee gets sore after a session.  Continue doing the step-up 

exercise each workout.  Alternate the workouts between the single leg wall slide and 

the single leg squat.  


Single Leg Squat Exercise 

Stand on one leg and lower your buttocks toward the chair. Slowly return to the 

standing and starting position.  Remember to keep your head over your feet and 

bend at the waist as you descend.  You do not have to squat all the way to the chair, 

instead, try to stay in a comfortable range of motion where there is no knee pain.  

As you gain strength, try to do the exercise without holding on to anything. 


Start with 3 sets of 5 repetitions. Add one repetition per set, per workout until you 

can do 3 sets of 10.  


After working up to the point where you can do 3 sets of ten of all three drills, you can hold 

dumbbells to add resistance.  Start with 3 pounds in each hand and add 1 to 2 pounds a week until 

you reach 10 pounds in each hand. When you return to sports or recreational activities, decrease the 

strength workouts to 2 times a week and do 1 set of 10 of each of the three drills only, as a 

maintenance workout.