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One of my favorite accessory exercises for my lower extremity patients is the sled push & pull.  I picked up this exercise from powerlifting legend Louie Simmons of Westside Barbell.  While Louie uses it for training men and women to Deadlift and Squat world record loads,  I like to use it for my patients rehabbing from lower extremity injuries and surgeries.  The reason this exercise is beneficial is that there is no eccentric phase, which means that there is no soreness associated with the recovery.  Delayed Onset Muscle Soreness (DOMS) is what is felt 1-2 days after a heavy workout, and it comes from the eccentric phase of exercises like squats, deadlifts and lunges.  Louie uses the sled to add volume to his lifters regimen without adding to their post workout soreness, or sometimes after heavy lifting days when his lifters are experiencing a high level of DOMS.

How its done
The Push portion of the exercise is done in a forward trunk lean, hands holding the vertical poles with locked out arms, and a tight core. The patient powerwalks forward with slightly larger than normal strides, landing on the heel and keeping the foot flat through the movement.  The activity should be felt in the gluts and hamstrings, which are often underdeveloped in most people, healthy or injured.

The Pull portion of the exercise is performed by attaching a band or rope to the sled. While holding the band the arms should again be locked out, but this time the entire body is straight with a posterior lean (think waterskiing).  The patient this time walks backward with smaller and quicker than normal steps.  After 10 yards or so there should be a nice burn in the quads.

I called this an accessory exercise because its not a stand alone task and should be additional to your core lower extremity rehab exercise regimen.  Its not going to build superhuman strength but its a great way to add volume and variety to your patients rehab routine.   Additionally, there is minimal vertical knee loading with this exercise, which means that it can be included for patients with knee issues that are irritated by closed chain knee flexion. There are a few variations of body positioning for this exercise and different sleds types can accomplish the same outcomes, but if done as described safety will be optimized.