Meniscal Injuries: Phase 4 - Functional Loading
Single leg strength and rotational control are essential components of lower limb rehabilitation and athletic performance. Most sporting movements such as running, cutting, changing direction, and landing occur while weight is transferred through one leg at a time, often with rotational forces acting through the knee and hip. Developing strength, balance, and control in these positions helps improve movement efficiency, reduce compensatory patterns, and build resilience throughout the entire kinetic chain. Training rotational control also helps the body better manage twisting and turning forces, which are common mechanisms involved in knee injuries. By improving stability and coordination in single leg tasks, patients can regain confidence, reduce reinjury risk, and prepare more effectively for the demands of sport and everyday activity.
Following a knee injury, restoring strength alone is not enough to safely return to sport. Ballistics, plyometrics, power training, and rate of force development are all critical in preparing the body for high-speed athletic movements. Sport often requires the ability to rapidly produce and absorb force during sprinting, jumping, landing, and sudden changes of direction. Plyometric and ballistic exercises help retrain the muscles, tendons, and nervous system to react quickly and efficiently under load, improving both performance and injury resilience. Developing power and explosive control also helps bridge the gap between rehabilitation and real sporting demands, ensuring the knee can tolerate fast, unpredictable movements with confidence and control during return to play.
Progress toward:
Single-leg strength
Rotational control
Plyometrics
Ballistics
Dosage
| Exercise | Reps | Sets | Times a week |
|---|---|---|---|
| Step down | 6–10 per leg | 3 | 2–3 |
| Single leg stand ups | 6–10 per leg | 3 | 2–3 |
| Cross over step-up | 8–10 per leg | 3 | 2–3 |
| Curtsie or lateral lunge | 8–10 per leg | 3 | 2–3 |
| Box jumps | 3–5 | 3–5 | 2 |
| Broad jumps | 3–5 | 3–5 | 2 |
| Low level plyometrics | 10–20 contacts | 2–3 | 2 |
| Higher level plyometrics | 5–10 contacts | 3–4 | 2 |
Jumping and plyometric work is quality-dependent. Stop the set as soon as landings become heavy, noisy or the knee starts to drift inwards, and allow full recovery between efforts.
Exercises:
Single-leg squat work: step down
Standing on a step, lower the opposite heel slowly towards the floor and tap lightly before returning. The slow lowering phase is where the control is built, so resist the temptation to drop.
Single-leg squat work: single leg stand ups
From sitting, stand up on one leg and lower back down under control. Progress by lowering the seat height as strength and confidence improve.
Step across the body onto the box rather than straight ahead. The crossing action loads the hip and knee in rotation, which is closer to the demands of turning and cutting.
Stepping behind or out to the side loads the knee sideways and rotationally instead of straight forwards. Keep the working knee tracking over the foot as you lower.
Ballistics
Jump onto the box and land softly with the knees bent and hips back. Step down rather than jumping down, which keeps the landing load manageable while you build power.
Jump forwards for distance and stick the landing without a stumble or extra step. Trains horizontal power production and, just as importantly, the ability to absorb it.
Plyometrics
Low level
An introductory hopping and landing drill performed on the spot with small amplitude. Aim for quiet, springy contacts with the knee staying in line with the foot.
Progresses the previous drill by adding direction or a small amount of travel. Keep contact times short and stop the set if landing quality drops off.
A double leg bounding or hopping progression that builds tolerance to repeated landings. Master this before moving to single leg or higher amplitude work.
Higher level plyometrics
Higher level plyometric drill 1
Greater height, speed or single leg demand than the low level drills. Only progress here once low level landings are controlled, symptom-free and settle quickly.
Higher level plyometric drill 2
Adds lateral or rotational demand, which is where the knee is most vulnerable. Focus on landing balanced and holding the position for a moment before the next repetition.
Higher level plyometric drill 3
The most demanding of the progressions, bringing speed, height and single leg loading together. This is the bridge between rehabilitation and the return to sport drills in Phase 5.
