Leg Exercises After Stroke

What usually goes wrong in the leg

Every stroke is different, but a few leg problems turn up again and again. The hip muscles on the weak side don't hold the pelvis level, so the person hitches the hip up or swings the leg out to clear the floor. The knee either gives way when weight goes through it or does the opposite and snaps back into a locked position. The foot drops at the front and catches on the floor, and the toes may curl. Some people have a leg that is floppy; others have one that stiffens into a straight, rigid pattern as soon as they stand.

These patterns decide which exercises help. Strengthening a leg that is already pushing into stiffness can make walking harder, which is why the exercises below are examples of what we commonly use, not a programme to follow as written. Your physiotherapist selects and doses them after assessing the leg, and the overview of home exercise after stroke explains how leg work fits with the rest of the plan.

Passive movements when the leg cannot move yet

In the early days, or after a severe stroke, the leg may not move at all. Passive exercise for stroke patients at this stage is about keeping joints and muscles at their full length until the brain starts sending signals again. A family member moves the leg while the person lies on their back.

For the hip and knee, the helper cradles the weak leg with one hand under the knee and one under the heel, then slowly bends the hip and knee towards the chest and straightens it back down. For the ankle, the leg rests straight, the helper holds the heel in one palm with the forearm along the sole, and leans gently to bring the toes up towards the shin. The hip can also be moved slowly out to the side and back with the leg supported.

Movements are slow and smooth, never bounced or forced. Watch the person's face: grimacing means you have gone too far. If the leg suddenly stiffens, wait a few seconds for it to relax rather than pushing through. Your physiotherapist will show the exact holds on your own bed, because a poor grip can twist the knee.

Early exercises in bed

As some movement returns, the person starts helping. Assisted heel slides are often the first: lying on the back, the person tries to slide the heel up the bed, bending the knee, with the helper guiding as much as needed. Then slowly back down. The aim is a smooth movement without the leg rolling outwards.

Bridging is another early favourite. With both knees bent and feet flat on the bed, the person presses through both heels and lifts the bottom a little off the mattress, holds briefly, then lowers. The helper may need to hold the weak knee so it does not fall outwards. A bridge done with good control builds the hip muscles that later stop the knee buckling and keep the pelvis level when walking.

Knee control exercises in sitting

Sitting on a firm chair with feet flat on the floor, the person slowly straightens the weak knee, holds it straight for a moment, and lowers it under control. The lowering is the important part. Many people can kick the leg up but cannot let it down smoothly, and that same lack of control is what makes the knee wobble in standing.

Another useful one: sliding the weak foot back under the chair as far as it will go, then forward again, keeping the heel on the floor. This is the foot position needed to stand up well. Knee control exercises for stroke patients are rarely about lifting weights. They are about timing and precision, so we often keep the range small and the speed slow.

Standing work at the counter

Once the person can stand with support, most leg work moves to standing, because that is where the leg has to function. A heavy kitchen counter is the usual base, with a helper on the weak side.

• Weight shift: standing with feet hip-width apart, the person slowly moves weight onto the weak leg and back, keeping the knee soft rather than locked.
• Small knee bends: holding the counter, a shallow bend of both knees and back up, watching that the weak knee does not snap backwards at the top.
• Stepping with the stronger leg: stepping forward and back with the good leg so the weak leg has to hold the body's weight.
• Sit-to-stand from a chair of a sensible height, with the weak foot slightly behind the strong one so it takes its share. See the sit-to-stand technique.

These are the building blocks for walking. The guide to walking after a stroke picks up from here, and balance progressions overlap with much of this standing work. For people who cannot yet bear much weight safely, supported standing on the clinic's overhead track allows practice without the fear of falling.

Working on foot drop

When the muscles that lift the front of the foot are weak, the toes catch, especially on uneven floors and the edge of a rug. Exercises focus on two things. First, keeping the calf long, because a tight calf makes everything harder: standing at the counter with the weak foot behind, heel down, knee straight, leaning gently forward until a stretch is felt. Second, trying to switch on the muscles at the front of the shin: sitting with the heel on the floor and trying to lift the toes, even a few millimetres, helped by the hand at first.

Electrical muscle stimulation, which we carry on home visits, can help some people switch these muscles on, and is used alongside active practice rather than instead of it. Many people also benefit from an ankle-foot orthosis that holds the foot up while walking. Whether one is needed, and what type, should be decided after assessment; stroke recovery equipment explains the options.

How leg exercises after stroke progress, and when to stop

Progression follows a rough order: from helper moving the leg, to person helping, to person moving it alone, to doing it in standing, to doing it during a real task. We move up when the current level is controlled and comfortable, not by the calendar. Going backwards for a few days after an illness is normal.

Stop and rest if the person becomes very breathless, dizzy or pale, or if a joint becomes painful. A calf that is suddenly swollen, hot and painful, especially in someone who spends a lot of time in bed, needs a doctor the same day. New sudden weakness, slurred speech or facial droop means calling 112 or 108 for an ambulance straight away.

If the leg is not responding as hoped, physiotherapy for stroke paralysis looks at the reasons in more detail, and the stroke recovery guide sets out what recovery tends to look like over time.

Frequently asked questions