Table 2 Strengthening exercise protocol, with instructions and progressions where applicable. Reprinted from: Hinman RS, Kimp AJ, Campbell PK, Russell T, Foster NE, Kasza J, Harris A, Bennell KL: Technology versus tradition: a non-inferiority trial comparing video to face-to-face consultations with a physiotherapist for people with knee osteoarthritis. Protocol for the PEAK randomised controlled trial. BMC Musculoskelet Disord 2020, 21(1):522 [45]
Home exercise protocol | |||
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Maximum of 6 exercises (with progression as appropriate) performed three times a week - 2 knee extensor strengthening exercises - 1 hip abductor strengthening exercise - 1 hamstring strengthening exercise - 1 calf strengthening exercise - 1 other exercise as appropriate from the list (optional) Dosage Determined on an individual basis by the physiotherapist | |||
1. Quads strengthening (aim to include two exercises) | |||
 Knee extension | Non weight-bearing | Q1. Seated knee extension (with resistance) with 5 s hold | Progression: Increase with theraband resistance – red through to black |
Non weight-bearing | Q2. Inner range quads over roll (with resistance) with 5 s hold | Instruction: Put a rolled up towel under your arthritis knee. Keep the knee cap and toes pointing toward the roof. Keeping the back of the knee in contact with the towel, push the back of your knee down into the towel and straighten your arthritis leg | |
 Sit-to-stand | Weight-bearing | Q3. Sit to stand (without using hands) | Progression: lower chair height, hover above the seat without touching down (3 s hold), add resistance band around knees and push outwards keeping knees over toes |
Weight-bearing | Q4. Sit to stand with more weight on involved knee | Instruction: Take more weight by either a) placing uninvolved further forward b) shift both feet sideways so study leg is midline | |
 Steps | Weight-bearing | Q5. Step-ups | Progression: Increase step height |
Weight-bearing | Q6. Forward touchdowns from a step | Progression: Increase step height, don’t touch floor | |
Weight-bearing | Q7. Step-ups with weight | Instruction: Hold 2 kg of weight either a) against chest, b) in each hand, c) in one hand while holding for balance, or d) in backpack Progression: Increase step height, increase weight | |
Weight-bearing | Q8. Forward touchdowns from a step with weight | Instruction: Hold 2 kg of weight either a) against chest, b) in each hand, c) in one hand while holding for balance, or d) in backpack Progression: Increase step height, increase weight | |
 Wall squats | Weight-bearing | Q9. Partial wall squats for 5 s hold | Progression: more weight on study side |
Weight-bearing | Q10. Split leg wall squats for 5 s hold | Instruction: Step feet away from wall (about 30 cm) and move non-involved leg a further 15 cm away from the wall. | |
 Controlled squats | Weight-bearing | Q11. Controlled partial squat with 5 s hold |  |
 Leg Sliding | Weight-bearing | Q12. Forward and backward sliding of non-study leg | Instruction: Keep weight on study leg. Concentrate on keeping knee positioned over the foot |
Weight-bearing | Q13. Forward and backward sliding of non-study leg with resistance band pulling study leg laterally | Instruction: Place loop of elastic band around involved knee and leg of a table to provide a pull outwards on knee that you must resist by keeping knee in line with foot. Progression: Increase with theraband resistance – red through to black | |
Weight-bearing | Q16. Sideways sliding of uninvolved leg | Instruction: Keep weight on study leg. Concentrate on keeping knee positioned over the foot | |
Weight-bearing | Q17. Sideways sliding of uninvolved leg with resistance band pulling study leg laterally | Instruction: Place loop of elastic band around study leg and leg of a table to provide a pull outwards on knee that you must resist by keeping knee in line with foot. Progression: Increase with theraband resistance – red through to black | |
 Step to single leg balance | Weight-bearing | Q14. Step with study leg to about 30° knee flexion for single leg balance | Instruction: Take a step forwards with study leg, keeping knee bent to about 30° knee flexion. Allow uninvolved leg to lift off and practice balancing as long as you can |
Weight-bearing | Q15. Step with study leg to about 30° knee flexion for single leg balance with arm movements | Instruction: Take a step forwards with involved knee, keeping knee bent to about 30° knee flexion. Allow uninvolved leg to lift off and practice balancing as long as you can, while raising arms out to side and above head in an arc. | |
2. Hip abductor strengthening (1 exercise) | |||
 Standing hip abduction | Weight-bearing | HA1. Side leg raises in standing with 5 s hold | Progression: Increase theraband resistance – red through to black, add another 5 s halfway |
 Side stepping | Weight-bearing | HA2. Crab walk with resistance band | Progression: Increase theraband resistance – red through to black |
 Standing hip abduction | Weight bearing | HA3. Wall push standing on study leg for 20 s | Progression: Hold weight in hand, increase the hold time |
Weight bearing | HA4. Wall push standing on study leg positioned up to 45° knee flexion |  | |
3. Hamstring strengthening (1 exercise) | |||
 Bridging | Weight-bearing | HG1. Bridge with 5 s hold |  |
Weight-bearing | HG2. Split leg bridge with 5 s hold | Instruction: Place feet hip-width apart, then move study leg slightly closer toward your bottom and slightly in towards centre | |
Weight-bearing | HG3. Single-leg bridge on study leg with 5 s hold | Version A: Lift bottom. Keeping hips level, lift uninvolved leg off the floor/bed. Hold for 5 s. Slowly lower uninvolved leg back to the floor. Then slowly lower bottom back to floor. Version B: Lift uninvolved knee off floor/bed. Lift bottom and take all weight through study leg. Hold for 5 s. Slowly lower your bottom back to floor/bed. | |
 Standing knee flexion | Non weight-bearing | HG4. Hamstring curls -Standing over bench knee flexion with 5 s hold |  |
Non weight-bearing | HG5. Hamstring curls -Standing over bench knee flexion with 5 s hold against resistance band | Instruction: Place one end of an elastic band securely around ankle of study knee. Place the other end of elastic around your opposite foot so you are standing on it. | |
 Seated knee flexion | Non weight-bearing | HG6. Seated knee flexion | Instruction: Place one end of an elastic band securely around a stable object (e.g. a heavy table leg). Loop the other end around the ankle of your study leg. Keeping your opposite foot on the floor, pull against the elastic band and bend your knee more. Progression: Increase with theraband resistance – red through to black |
 Standing hip extension | Non weight-bearing | HG7. Hip extension with knee bent (90°) - standing over bench with 5 s hold |  |
Non weight-bearing | HG8. Hip extension with knee straight - standing over bench with 5 s hold |  | |
Non weight-bearing | HG9. Hip extension with knee straight with resistance band - standing over bench with 5 s hold | Instruction: Place one end of an elastic band securely around ankle of study knee. Place the other end of elastic around your opposite foot so you are standing on it. | |
4. Calf strengthening (1 exercise) | |||
 Standing plantar-flexion | Weight-bearing | C1. Double heel raises with 5 s hold |  |
Weight-bearing | C2. Single heel raises with 5 s hold |  | |
Weight-bearing | C3. Double heel raises with 5 s hold over edge of step |  | |
Weight-bearing | C4. Double heel raises with 5 s hold over edge of step |  | |
5. Balance exercises | |||
 Tandem stance | Weight- bearing | B1. Maintain balance in tandem stance | Progression: remove hand support, slowly raise arms in the air, eyes closed |
 Natural stance | Weight- bearing | B2. Maintain balance whilst tapping opposite foot forwards & backwards |  |
 Single leg stance | Weight- bearing | B3. Maintain balance in single leg stance | Progression: Increase hold time, slowly raise arms up and down, eyes closed |