Early knee exercises - introduction
Link: https://youtu.be/2iB8pcKzJgo
Introduction: video transcript
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Hi there.
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My name is Chris
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and I'm one of the physiotherapists here at Addenbrooke's Hospital.
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In this video series, we are going to go through some early knee exercises.
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You may have been directed here by a consultant
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or physiotherapist following a recent knee injury.
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This could have been a twisting injury that may have caused a ligament sprain
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or some irritation of the cartilage in the knee, otherwise known as the meniscus.
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Depending on the severity of the injury,
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you may have been given crutches to help with your walking.
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As the pain improves and provided you need feels stable.
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You can stop using the crutches
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under the guidance of your physiotherapist or consultant if needed.
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This may only be a few days or could be a few weeks
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as of course, all injuries are different.
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It's important to understand that the large majority of these injuries
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get better with time and a good rehabilitation program.
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With only very few small numbers requiring surgical intervention.
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In all
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cases, the first part of the process is to go through a course of physiotherapy
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as a large majority of people recover by doing this.
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In the very few cases where time and physiotherapy has not allowed someone
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to make a full recovery, this may be where they are referred for a scan
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and seen by an orthopedic consultant.
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Following a knee injury, it is important to keep the knee
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moving as pain allows, to prevent the joint becoming too stiff.
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It is also important to start a strengthening exercise program
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to allow you to maintain and regain quad,
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hamstring, glute and calf muscle strength.
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As you progress, look to return to your normal activities as pain allows,
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such as gradually increasing your walking and returning to activities like cycling.
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The timeframe of recovery varies considerably
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depending on the severity of the injury and the individual’s journey.
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Some people return to full function within 3 to 6 weeks.
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For others, it can take 2 to 3 months and for some cartilage related injuries,
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it is not unusual for these to take a little longer,
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with people still improving up to six months after the injury.
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Whatever stage of recovery you are at, there is always scope
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for an exercise program to improve your situation.
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We are breaking the exercises down into phases.
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Start with the easier exercises and as you improve,
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progress to the more challenging ones.
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It is worth noting that research supports a criteria based progression
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through the phases rather than a strict time based progression.
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This means that you may be able to progress to the next phase
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a little earlier than the weeks stated, or it may take a little longer.
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Progress when you feel ready and as pain allows.
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If you are unsure about any of the exercises in the videos
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or have any questions, please consult your physiotherapist.
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I hope these videos are helpful.
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Thanks for watching.
Early knee exercises - phase 1
Link: https://youtu.be/AmpUL3sOz5g
Video transcript: phase 1
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Welcome back.
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Here, we’re going to go through some early knee exercises in phase one.
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We have classed phase one as the first two weeks following the injury.
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As I mentioned in the previous video, research supports
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a criteria based progression, through the phases
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rather than a strict time based progression.
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This means that you may be able to progress to the next phase
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a little earlier than the week stated, or that it may take a little longer.
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Progress when you feel ready and as the pain allows.
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As for how often and how many,
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this will vary from person to person and depend on your stage of recovery.
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In the early stages, we often recommend doing the exercise
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as little and often, perhaps 6 to 12
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repetitions, 3 to 4 times a day.
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As you progress, aim to increase
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the numbers gradually as pain allows.
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Aim to progress to 8 to 15 repetitions,
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2 to 3 sets in that little session, 4 to 5 times a week.
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As you
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improve, you should aim to do enough reps and sets to get to the point
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where your muscles feel fatigued.
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The first exercise is active
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or active assisted knee range of motion.
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Here we are going to use a towel or the rope of a dressing gown
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to bend and straighten the knee.
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Aim to straighten the knee as much as you can to ensure you regain
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full extension,
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as pain allows.
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As you are able, progress to not using the towel.
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The next exercise
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is the static quads exercise.
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In a long sitting position, either on the bed or on a sofa, it's fine.
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Tighten up your thigh muscles to fully straighten the knee,
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hold the contraction for 5 to 8 seconds and
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then relax.
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Then we have the inner range quads exercise.
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Roll up a pillow or a towel and place under the knee.
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So it is in a little flexion.
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Straighten the knee to lift the ankle up,
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hold in this position for 5 to 8 seconds
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and lower.
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The next exercise is the straight leg raise.
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Fully straighten your knee by tightening your thigh muscles
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like in the static quads exercise, then lift your leg off
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the bed and lower.
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We then have sitting knee extension.
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In a sitting position fully straighten the knee,
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hold for 5 to 8 seconds
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and lower.
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That’s the end of this Phase one video.
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These exercises can also be found on the physiotherapy section
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of the Addenbrooke's website under patient information leaflets
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where you can click on early knee exercises.
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Thanks for watching, see you at phase two.
Early knee exercises - phase 2
Link: https://youtu.be/rywp-fN_fsQ
Video transcript: phase 2
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Hi.
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Welcome back.
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These are the exercises for phase two,
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which may be approximately
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2 to 6 weeks following the injury,
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as previously mentioned though,
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it might be
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that you are able to progress
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to some of these exercises
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a little earlier,
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or it may take a little longer, for you
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to manage something.
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Progress when you feel ready
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and as your knee stability
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and pain improves and allows.
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With regards to numbers at this stage
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you should be looking to progress
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from little and often
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to doing a more structured program,
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where you aim
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to progress to 8-15 repetitions, 2
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to 3 sets, around 4 to 5 times a week.
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As you improve,
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you should aim to do enough
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repetitions and sets to get to the point
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where your muscles feel fatigued.
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Gradually increase in numbers
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as pain allows.
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Low level discomfort that settles quickly
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following the exercise
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is absolutely fine,
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provided your direction of travel
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is improvement
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rather than having more difficulty.
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The first exercise is ‘sit to stand’.
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From a sitting position, stand up,
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then sit down again.
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You can vary the difficulty
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by changing the height of the seat.
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This exercise can also be made easier
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by moving the injured leg
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slightly forwards
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before standing, or harder
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by moving it slightly back
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to bias a certain leg.
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The next exercise is a squat.
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This can be done in a variety
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of different ways.
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You may want to start with your back
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against the wall
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for a little more support.
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Feet away from the wall, around
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shoulder width
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apart, bend and straighten the knees.
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Start with a smaller squat
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and gradually increase the depth as able.
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As you progress,
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move on to a squat away from the wall.
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Again, feet roughly shoulder width apart,
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you can have your feet facing forwards
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or slightly out
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whichever you find more comfortable.
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Simply bend and straighten the knees.
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Start with
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small squats
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and gradually progress the depth.
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If there is some
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cartilage-related irritation
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from the injury,
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then a deeper squat would irritate this,
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so we tend to advise against really deep
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squats beyond 90 degrees
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for this type of injury at this stage.
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Moving on to heel raises.
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Holding onto the wall
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or supportive surface,
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come up onto your toes
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and lower back down, progression
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would be moving onto one leg.
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The next exercise is the bridge.
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Working on hip
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strength is also important
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in the recovery of a knee injury.
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Either on the floor
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or on the bed, lie
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on your back
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with knees bent,
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feet about shoulder width apart.
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Lift your bottom off the bed
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as high as you are able and lower.
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To progress, lift one leg into the air,
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then lift the bottom of the bed
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to perform a single leg bridge.
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Moving on to the lunge,
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place the leg you're working on
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in front of the other leg,
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holding onto a supporting surface
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or the wall as needed, bend
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and straighten the front knee
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to perform a lunge.
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The back heel can come off the ground.
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Start with a small lunge,
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and gradually progress the depth.
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As you
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progress,
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you could move onto a stepping lunge.
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Start with feet together.
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Step forward to perform a lunge, then
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bring the foot back
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up to the starting position.
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The next exercise is single leg stand.
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Following a knee injury,
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there is usually
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a reduction in our balance.
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It is therefore important
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to include balance exercises
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into the rehabilitation program.
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This exercise involves
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simply standing on one leg,
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start at a supportive surface as needed,
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aiming to gradually increase the time
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you can stand on one leg.
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This exercise
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can be made more challenging
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by closing your eyes
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or by standing on an unstable surface,
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such as a cushion, a wobble cushion,
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or a balance board.
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The final exercise
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in this video is a single leg dip,
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standing on one leg,
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holding on to the wall
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or a supportive surface,
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bend and straighten the knee.
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Start with a smaller bend
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and gradually increase as able.
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That's all of the exercises
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in this early knee
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exercise, phase two video.
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The progression
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of some of these exercises,
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such as the squat
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and the lunge, would be to start
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adding weight using dumbbells, a barbell,
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kettle bells, or simply a backpack.
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If you're unsure about
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any of the exercises in these videos
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or have any questions,
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please consult your physiotherapist.
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I hope these videos have been helpful
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and you now have more confidence
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in your rehabilitation program,
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and are getting back to full function.
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All the best, cheers!