You may start these exercises when you can stand comfortably on your injured leg with your

heel resting on the floor and your full weight evenly distributed on both legs.

Towel stretch: Sit on a hard surface with your injured leg stretched out in front of
you. Loop a towel around your toes and the ball of your foot and pull the towel
toward your body keeping your leg straight. Hold this position for 15 to 30 seconds
and then relax. Repeat 3 times.

When you don't feel much of a stretch using the towel, you can start the following exercises.

Standing calf stretch: Stand facing a wall with your hands on the wall at about eye
level. Keep your injured leg back with your heel on the floor. Keep the other leg
forward with the knee bent. Turn your back foot slightly inward (as if you were
pigeon-toed). Slowly lean into the wall until you feel a stretch in the back of your calf.
Hold the stretch for 15 to 30 seconds. Return to the starting position. Repeat 3 times.
Do this exercise several times each day.

Standing soleus stretch: Stand facing a wall with your hands on the wall at about
chest height. Keep your injured leg back with your heel on the floor. Keep the other
leg forward with the knee bent. Turn your back foot slightly inward (as if you were
pigeon-toed). Bend your back knee slightly and gently lean into the wall until you feel
a stretch in the lower calf of your injured leg. Hold the stretch for 15 to 30 seconds.
Return to the starting position. Repeat 3 times.

Achilles stretch: Stand with the ball of one foot on a stair. Reach for the step below
with your heel until you feel a stretch in the arch of your foot. Hold this position for
15 to 30 seconds and then relax. Repeat 3 times.

Heel raise: Stand behind a chair or counter with both feet flat on the floor. Using the
chair or counter as a support, rise up onto your toes and hold for 5 seconds. Then
slowly lower yourself down without holding onto the support. (It's OK to keep
holding onto the support if you need to.) When this exercise becomes less painful, try
doing this exercise while you are standing on the injured leg only. Repeat 15 times.
Do 2 sets of 15. Rest 30 seconds between sets.

Step-up: Stand with the foot of your injured leg on a support 3 to 5 inches (8 to 13
centimeters) high --like a small step or block of wood. Keep your other foot flat on
the floor. Shift your weight onto the injured leg on the support. Straighten your
injured leg as the other leg comes off the floor. Return to the starting position by
bending your injured leg and slowly lowering your uninjured leg back to the floor. Do
2 sets of 15.

Resisted ankle eversion: Sit with both legs stretched out in front of you, with your
feet about a shoulder's width apart. Tie a loop in one end of elastic tubing. Put the foot
of your injured leg through the loop so that the tubing goes around the arch of that
foot and wraps around the outside of the other foot. Hold onto the other end of the
tubing with your hand to provide tension. Turn the foot of your injured leg up and out.

Make sure you keep your other foot still so that it will allow the tubing to stretch as
you move the foot of your injured leg. Return to the starting position. Do 2 sets of 15.

Balance and reach exercises: Stand next to a chair with your injured leg farther from
the chair. The chair will provide support if you need it. Stand on the foot of your
injured leg and bend your knee slightly. Try to raise the arch of this foot while
keeping your big toe on the floor. Keep your foot in this position.

With the hand that is farther away from the chair, reach forward in front of you by
bending at the waist. Avoid bending your knee any more as you do this. Repeat this 15
times. To make the exercise more challenging, reach farther in front of you. Do 2 sets
of 15.

While keeping your arch raised, reach the hand that is farther away from the chair
across your body toward the chair. The farther you reach, the more challenging the
exercise. Do 2 sets of 15.

If you have access to a wobble board, do the following exercises:

Wobble board exercises

Stand on a wobble board with your feet shoulder-width apart.

Rock the board forwards and backwards 30 times, then side to side 30 times. Hold on
to a chair if you need support.

Rotate the wobble board around so that the edge of the board is in contact with the
floor at all times. Do this 30 times in a clockwise and then a counterclockwise
direction.

Balance on the wobble board for as long as you can without letting the edges touch
the floor. Try to do this for 2 minutes without touching the floor.

Rotate the wobble board in clockwise and counterclockwise circles, but do not let the
edge of the board touch the floor.
When you have mastered the wobble exercises standing on both legs, try repeating
them while standing on just your injured leg. After you are able to do these exercises
on one leg, try to do them with your eyes closed. Make sure you have something
nearby to support you in case you lose your balance.

Developed by RelayHealth.
Published by RelayHealth.
Copyright 2014 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

EXERCISES FOR PAIN BEHIND THE KNEE

Popliteus Tendinitis
with Rehab
Tendonitis is a condition that is characterized by inflammation of a tendon. A tendon is the
soft tissue that connects muscles to the skeletal system allowing for body movements.
Popliteus tendonitis affects the popliteus tendon, which connects the popliteus muscle to the
thigh bone (femur) near the knee. The popliteus muscle helps bend and rotate the knee.
Popliteus tendonitis is often caused by a tendon tear (strain). Strains are classified into three
categories. Grade 1 strains cause pain, but the tendon is not lengthened. Grade 2 strains
include a lengthened ligament due to the ligament being stretched or partially ruptured. With
grade 2 strains there is still function, although the function may be diminished. Grade 3
strains are characterized by a complete tear of the tendon or muscle, and function is usually
impaired.
SYMPTOMS

Pain in the knee, specifically the outer (lateral) and

back (posterior) portions.

Pain that worsens with use of the popliteus muscle

(standing on a slightly bent knee or rotating the knee).

A crackling sound (crepitation) when the tendon is

moved or touched (uncommon, except when tested just
after exercising).

CAUSES
Popliteus tendonitis occurs when damage to the popliteus
tendon elicits an inflammatory (healing) response. Popliteus tendonitis is often an overuse
injury.
RISK INCREASES WITH:

Activities that require extensive running or walking downhill.

Poor strength and flexibility.

Failure to warm-up properly before activity.

Flat feet.

PREVENTION

Warm up and stretch properly before activity.

Allow for adequate recovery between workouts.

Maintain physical fitness:

Strength, flexibility, and endurance.

Cardiovascular fitness.

Learn and implement proper training regimens and sports technique.

Arch supports (orthotics) for individuals with flat feet.

PROGNOSIS
If treated properly, then the symptoms of popliteus tendonitis usually resolve within 6 weeks.
RELATED COMPLICATIONS

Prolonged healing time, if improperly treated or re-injured.

Recurrent symptoms that result in a chronic problem.

TREATMENT
Treatment initially involves the use of ice and medication to help reduce pain and
inflammation. The use of strengthening and stretching exercises may help reduce pain with
activity. These exercises may be performed at home or with referral to a therapist. Many
individuals find that the use of a compression bandage or a knee sleeve helps reduce
symptoms. If you have flat feet, then your caregiver may recommend arch supports. It is
important to learn/modify techniques for running uphill/downhill that do not aggravate your
symptoms. If symptoms persist for greater than 6 months despite conservative (non-surgical)
treatment, then surgery may be recommended to remove the tendon sheath (lining).
MEDICATION

If pain medication is necessary, then nonsteroidal anti-inflammatory medications,

such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen,
are often recommended.

Do not take pain medication within 7 days before surgery.

Prescription pain relievers may be given if deemed necessary by your caregiver. Use
only as directed and only as much as you need.

HEAT AND COLD

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should
be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and
immediately after any activity that aggravates your symptoms. Use ice packs or
massage the area with a piece of ice (ice massage).

Heat treatment may be used prior to performing the stretching and strengthening
activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a
heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

Treatment seems to offer no benefit, or the condition worsens.

Any medications produce adverse side effects.

EXERCISES
RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Popliteus Tendinitis
These exercises may help you when beginning to rehabilitate your injury. Your symptoms
may resolve with or without further involvement from your physician, physical therapist or
athletic trainer. While completing these exercises, remember:

Restoring tissue flexibility helps normal motion to return to the joints. This allows
healthier, less painful movement and activity.

An effective stretch should be held for at least 30 seconds.

A stretch should never be painful. You should only feel a gentle lengthening or release
in the stretched tissue.

STRETCH Gastroc, Standing

Place hands on wall.

Extend right / left leg, keeping the front knee somewhat bent.

Slightly point your toes inward on your back foot.

Keeping your right / left heel on the floor and your knee straight,
shift your weight toward the wall, not allowing your back to arch.

You should feel a gentle stretch in the right / left calf. Hold this position for
__________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.
STRETCH Soleus, Standing

Place hands on wall.

Extend right / left leg, keeping the other knee somewhat bent.

Slightly point your toes inward on your back foot.

Keep your right / left heel on the floor, bend your back knee, and
slightly shift your weight over the back leg so that you feel a
gentle stretch deep in your back calf.

Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.
STRETCH Gastrocsoleus, Standing
Note: This exercise can place a lot of stress on your foot and ankle. Please
complete this exercise only if specifically instructed by your caregiver.

Place the ball of your right / left foot on a step, keeping your other
foot firmly on the same step.

Hold on to the wall or a rail for balance.

Slowly lift your other foot, allowing your body weight to press your heel down over
the edge of the step.

You should feel a stretch in your right / left calf.

Hold this position for __________ seconds.

Repeat this exercise with a slight bend in your right / left knee.

Repeat __________ times. Complete this stretch __________ times per day.
STRETCH - Hamstrings, Standing

Stand or sit and extend your right / left leg, placing your foot on a
chair or foot stool

Keeping a slight arch in your low back and your hips straight
forward.

Lead with your chest and lean forward at the waist until you feel a
gentle stretch in the back of your right / left knee or thigh. (When done correctly, this
exercise requires leaning only a small distance.)

Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.
STRETCH Hamstrings, Supine

Lie on your back. Loop a belt or towel over the ball of

your right / left foot.

Straighten your right / left knee and slowly pull on the

belt to raise your leg. Do not allow the right / left knee
to bend. Keep your opposite leg flat on the floor.

Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold
this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.
STRETCH - Hamstrings, Doorway

Lie on your back with your right / left leg extended and resting
on the wall and the opposite leg flat on the ground through the
door. Initially, position your bottom farther away from the wall
than the illustration shows.

Keep your right / left knee straight. If you feel a stretch behind
your knee or thigh, hold this position for __________ seconds.

If you do not feel a stretch, scoot your bottom closer to the door, and hold
__________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.
STRETCH - Quadriceps, Prone

Lie on your stomach on a firm surface, such as a bed

or padded floor.

Bend your right / left knee and grasp your ankle. If you are unable to reach, your
ankle or pant leg, use a belt around your foot to lengthen your reach.

Gently pull your heel toward your buttocks. Your knee should not slide out to the side.
You should feel a stretch in the front of your thigh and/or knee.

Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.
STRENGTHENING EXERCISES - Popliteus Tendinitis
These exercises may help you when beginning to rehabilitate your injury. They may resolve
your symptoms with or without further involvement from your physician, physical therapist
or athletic trainer. While completing these exercises, remember:

Muscles can gain both the endurance and the strength needed for everyday activities
through controlled exercises.

Complete these exercises as instructed by your physician, physical therapist or athletic

trainer. Progress the resistance and repetitions only as guided.

STRENGTH - Hamstring, Isometrics

Lie on your back on a firm surface.

Bend your right / left knee approximately __________

degrees.

Dig your heel into the surface as if you are trying to pull it toward your buttocks.
Tighten the muscles in the back of your thighs to "dig" as hard as you can without
increasing any pain.

Hold this position for __________ seconds.

Release the tension gradually and allow your muscle to completely relax for
__________ seconds in between each exercise.

Repeat __________ times. Complete this exercise __________ times per day.
STRENGTH - Hamstring, Curls

Lay on your stomach with your legs extended. (If you

lay on a bed, your feet may hang over the edge.)

Tighten the muscles in the back of your thigh to bend

your right / left knee up to 90 degrees. Keep your hips flat on the bed/floor.

Hold this position for __________ seconds.

Slowly lower your leg back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.
OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT
exceed ____________________. Increase in1 lb/0.5 kg increments.

Here are the 5 Stretches to Do Before You Roll Out of Bed:

1) Low Back
Bring both knees to the chest by first raising one and then holding the knee with both hands.
Then raise the other knee. Grasping both knees, pull them down to the chest. Relax.
2) Buttocks

Lying on your back with both knees bent, cross the left leg over the right. Using both hands,
pull your right knee toward your chest. You should feel a stretch in the buttocks on your left
side. Repeat on the opposite side.
3) Pelvic Tilt
Lie on your back with your knees bent, In this relaxed position, the small of your back will
not be touching the bed. Tighten your abdominal muscles so that the small of your back
presses against the bed. Hold for 5 seconds, then relax. Repeat this 3 times and gradually
build to 10 repetitions.
4) Knees to Chest
Lie on your back with both legs straight out. Bring one knee up to your chest and do a pelvic
tilt. Hold for 5 seconds and repeat 5 times. Repeat with the opposite leg.
5) Piriformis Stretch
The piriformis muscle runs through the buttock and can contribute to back and leg pain. To
stretch this muscle, lie on your back and cross one leg over the other; gently pull the knee
toward your chest until you feel a stretch in the buttock. Hold for 30 seconds. Relax. Repeat 3
times.