Knee and Ankle Exercises, Phase 4: Return to Activity

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Knee and Ankle Exercises, Phase 4: Return to Activity

KA-4 · Version 1.0, October 2026

Phase 4 is the final phase. It brings the earlier work together with full squats, lunges, single-leg calf strength, and a walking and stairs drill that practices everyday movement. Start after your provider checks your progress from the previous phase. If you are our patient, your provider will show you any new exercise.

How often: Daily for one phase. Each session takes about 10 minutes. Sessions per day are listed with each exercise.

What "no pain" means: Each exercise should NOT cause sharp pain. A small stretch is okay. If something hurts, stop. Try a smaller motion. If it still hurts, skip that one and tell your provider.

Do not use these exercises if:

• You may have a broken bone in your knee, leg, or ankle. Wait until your provider checks your scans and says it is safe.
• You have any of the warning signs in the red flags list.
• Your knee or ankle clicks, locks, catches, or gives way under you, and your provider has NOT yet cleared you with imaging.
• You have sudden swelling in the knee or ankle, especially within 24 to 48 hours of a new injury. Wait for provider clearance.
• You have calf pain with redness, warmth, or swelling. This can be a blood clot (DVT). Stop everything and seek immediate medical care.
• You cannot put weight on the leg without sharp pain or buckling. Wait for provider clearance before starting.

1. Bodyweight Squat

Dose: 1 time a day, 12 reps
You need: A chair or counter for safety (optional)

How to do it

1. Stand tall with feet hip-width to shoulder-width apart, toes slightly turned out.
2. Push your hips backward and bend your knees at the same time. Like sitting down into an invisible chair.
3. Lower as far as you can while keeping your heels flat, knees tracking over toes, and back straight. Stop at thigh-parallel or sooner if needed.
4. Press through both heels. Squeeze the buttocks and stand back up.
5. Do 12 reps. Move with control.

Too hard? Try this: Hold a chair in front of you for balance. Or only squat halfway down. Or do them to a chair like the mini-squat in Phase 2.

Too easy? Try this: Hold a light weight at your chest. Or pause 2 seconds at the bottom. Or take 3 seconds to lower.

2. Forward Lunges

Dose: 1 time a day, 8 reps each leg
You need: A wall or counter for balance (optional)

How to do it

1. Stand tall with feet hip-width apart. Take a comfortable step forward with one leg (about 2 feet).
2. Slowly lower yourself by bending BOTH knees. The back knee should drop toward the floor (do NOT touch it).
3. Stop when the front thigh is about parallel to the floor. The front knee stays over the ankle (NOT way past the toes).
4. Press through the front heel to push yourself back up to standing.
5. Step the front foot back to start. Do 8 reps on this side. Switch.

Too hard? Try this: Hold a wall or counter on one side for balance. Or only go halfway down. Or do reverse lunges (step BACKWARD instead of forward) for less knee load.

Too easy? Try this: Hold a light weight in each hand. Or pause 2 seconds at the bottom. Or step further forward.

3. Single-Leg Heel Raises

Dose: 1 time a day, 10 reps each side
You need: A wall or counter for balance

How to do it

1. Stand on one leg, with fingertips lightly on a wall or counter for balance only.
2. Slowly press up onto the ball of the foot. Lift as high as you can.
3. Hold 2 seconds at the top.
4. Slowly lower back to the floor with control.
5. Do 10 reps. Switch sides.

Too hard? Try this: Use both hands on the wall. Or do 5 reps. Or keep the other foot lightly touching the floor (instead of fully lifted) for some support.

Too easy? Try this: Take fingers off the wall. Or stand on the edge of a step so the heel can drop below the toes (deeper range).

4. Functional Gait and Stairs Drill

Dose: 1 time a day, 2 to 3 minutes total
You need: A flat path to walk on; a set of stairs; a chair or your car

How to do it

1. Walking (60 seconds): Walk slowly and tall. Hips level, no limp. Push off through the toes of the back leg with each step. Pay attention.
2. Stairs up (30 seconds): Climb stairs slowly, one step at a time. Press through the heel of the stepping-up foot. Do NOT collapse the knee inward.
3. Stairs down (30 seconds): Slowly step down, one stair at a time. Keep the knee tracking over the toe. Use the calf to control the descent.
4. Car drill (30 seconds): Practice getting in and out of a chair or your car. Use a hip hinge to lower into the seat. Use your legs to stand up. Swing the leg in and out as one unit.
5. Notice where your form falls apart. That is what you keep working on after the program ends.

Too hard? Try this: Skip the stairs portion if stairs are still uncomfortable. Just do the walking and chair work.

Too easy? Try this: Add light hand weights for the walking portion. Or do the stairs two at a time (only if cleared and comfortable).