Meniscal Injuries: Phase 3 - Advanced Strength Training and Return to Activity
Strength training should be tailored to avoid excessive joint stress while still improving strength and function.
Modifications may include:
Avoiding extreme knee flexion angles initially
Gradual loading progression
Monitoring fatigue and pain response
Avoiding high-impact activities early in recovery
Individualising exercise selection
Long-term exercise is strongly encouraged to maintain mobility, bone health, muscle strength, and overall wellbeing.
Goals
Maximise strength
Improve higher-level function
Return to recreational activity
Maintain long-term joint health
Progressive Strength Training
A structured strengthening program may include:
Leg press/squat (modified depth)
Deadlift variations
Step-up/down control exercises
Functional carrying tasks
Advanced balance exercises
| Exercise | Reps | Sets | Times a week |
|---|---|---|---|
| Leg press | 6–10 | 3–4 | 2–3 |
| Back box squat | 6–10 | 3–4 | 2–3 |
| Hex deadlift | 6–10 | 3–4 | 2–3 |
| Romanian deadlift (RDL) | 8–10 | 3 | 2–3 |
| Dumbbell split squat | 8–10 per leg | 3 | 2–3 |
| Barbell reverse split lunge | 6–8 per leg | 3 | 2–3 |
| Single leg, leg press | 8–10 per leg | 3 | 2–3 |
| Step ups | 8–10 per leg | 3 | 2–3 |
| Lunges | 8–10 per leg | 3 | 2–3 |
| Split squat | 8–10 per leg | 3 | 2–3 |
| Hip thrusts | 8–12 | 3 | 2–3 |
Leg press
Press through the whole foot with the back supported, controlling the descent. Depth is set to what the knee tolerates, so load can be increased without pushing into deep flexion.
Back box squat
A barbell squat to a box, which fixes depth and keeps every repetition consistent. Sit back onto the box under control, pause briefly, then drive up.
Hex deadlift
Standing inside the trap bar allows a more upright torso and a slightly more knee-driven lift than a barbell deadlift. A useful way to load both hips and knees heavily.
RDL
Hinge from the hips with the bar tracking close to the legs and the back held long. Lower until you feel a stretch through the hamstrings, then drive the hips forward.
Dumbbell split squat
In a split stance, lower the back knee straight down while keeping the torso tall. Loads one leg at a time without the balance demand of a full single leg exercise.
Barbell Reverse split lunge
Step backwards into the lunge, lower under control, then drive back to standing. Stepping back is usually kinder on the knee than lunging forwards.
Single leg, leg press
Pressing one leg at a time exposes any side-to-side difference in strength and lets the injured side be loaded specifically. Keep the knee tracking in line with the foot.
Step ups
Now performed with added load and a higher box. Drive through the leading leg and control the lowering phase without letting the knee collapse inwards.
Lunges
A loaded lunge pattern that builds strength through a longer range and challenges balance. Keep the front shin controlled and the trunk upright.
Leg press
Press through the whole foot with the back supported, controlling the descent. Depth is set to what the knee tolerates, so load can be increased without pushing into deep flexion.
Split squat
A static split stance squat with the feet staying in place throughout. Lower straight down and drive up through the front leg, keeping the hips square.
Hex deadlift
Standing inside the trap bar allows a more upright torso and a slightly more knee-driven lift than a barbell deadlift. A useful way to load both hips and knees heavily.
Romanian deadlift
Hinge from the hips with the bar tracking close to the legs and the back held long. Lower until you feel a stretch through the hamstrings, then drive the hips forward.
Hip thrusts
With the upper back on a bench, drive the hips up until the body is level, squeezing the glutes at the top. Builds hip strength with very little demand on the knee
