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# Knee Rehabilitation Program
## Post-Meniscectomy + ACL-Deficient Knee
> **Status:** Active program
> **Started:** _______________
> **Last updated:** _______________
---
## Table of Contents
1. [Understanding Your Knee](#understanding-your-knee)
2. [Core Training Principles](#core-training-principles)
3. [Block 1: Foundation (Weeks 1-4)](#block-1-foundation-weeks-1-4)
4. [Block 2: Strength Development (Weeks 5-10)](#block-2-strength-development-weeks-5-10)
5. [Block 3: Performance/Movement (Weeks 11+)](#block-3-performancemovement-weeks-11)
6. [Movement Culture / Ido Portal Style Work](#movement-culture--ido-portal-style-work)
7. [Progression Guidelines](#progression-guidelines)
8. [Weekly Schedule Templates](#weekly-schedule-templates)
9. [Equipment List](#equipment-list)
10. [Tracking & Notes](#tracking--notes)
---
## Understanding Your Knee
### What's Causing the Sounds
| Source | Mechanism |
|--------|-----------|
| **Altered joint mechanics** | Missing meniscal tissue = less cushioning, changed load distribution. Cartilage surfaces contact differently. |
| **ACL deficiency** | Increased anterior tibial translation and rotational instability. Abnormal femur tracking on tibia. |
| **Early degenerative changes** | Meniscectomy + ACL tear accelerates cartilage wear. Sounds reflect cartilage fibrillation. |
| **Synovial fluid changes** | Gas bubbles (cavitation), potentially reduced viscosity. |
| **Scar tissue/adhesions** | Post-surgical tissue snapping over bony prominences. |
### Intermittent Swelling
Lateral or medial swelling that comes and goes = **reactive synovitis**. Joint is intermittently inflamed from mechanical irritation. This is feedback that the knee is being stressed beyond current capacity.
### Why This Program Works
- **Quad strengthening (VMO focus)** — compensates for ACL instability
- **Hamstring strengthening** — acts as dynamic ACL substitute, limits anterior tibial translation
- **Hip abductor/external rotator work** — reduces valgus stress
- **Proprioception training** — retrains neuromuscular control
- **Movement variability** — builds resilient, adaptable tissue
---
## Core Training Principles
### Loading Philosophy
| Principle | Details |
|-----------|---------|
| **Tissue adaptation rates** | Tendons/cartilage: 12-24 weeks. Muscle: 4-8 weeks. Respect the slower tissues. |
| **Progressive overload** | Small, consistent increases. Never rush. |
| **Pain tolerance** | ≤3/10 during exercise is acceptable IF it resolves within 24h |
| **Primary feedback signal** | Swelling. If it increases, reduce volume/intensity. |
### ACL-Deficient Specific Rules
```
⚠️ AVOID: Open-chain knee extension in 0-45° range (max ACL strain zone)
✓ PREFER: Closed-chain exercises (squats, lunges, step-ups)
✓ CRITICAL: Train hamstring co-contraction deliberately
```
### Tempo Notation
Format: **eccentric-pause-concentric** (in seconds)
- `3-1-2` = 3 sec lowering, 1 sec pause, 2 sec lifting
- `5s down` = 5 second eccentric (negative) phase
---
## Block 1: Foundation (Weeks 1-4)
**Focus:** Neuromuscular control, proprioception, basic strength
### Session A — Quad/Stability Focus
| Exercise | Sets × Reps | Tempo | Notes |
|----------|-------------|-------|-------|
| Terminal Knee Extension (band) | 3×15 | 2-1-2 | Safe open-chain for VMO, stay in 0-30° range |
| Wall sit isometric | 3×30-45s | hold | Start at 60° knee flexion |
| Split squat (assisted) | 3×8/leg | 3-1-2 | Hold wall/rack, control descent |
| Single leg stance (eyes closed) | 3×30s/leg | — | Progress to unstable surface |
| Calf raises (bilateral) | 3×15 | 2-1-2 | Full ROM |
**Exercise Descriptions:**
<details>
<summary><strong>Terminal Knee Extension (TKE)</strong></summary>
1. Loop resistance band around fixed point at knee height
2. Step into band so it's behind your knee
3. Stand facing anchor point, knee slightly bent
4. Straighten knee against band resistance
5. Focus on VMO (inner quad) contraction
6. Stay in 0-30° flexion range only
</details>
<details>
<summary><strong>Wall Sit Isometric</strong></summary>
1. Back flat against wall
2. Slide down until knees at ~60° angle
3. Feet shoulder-width apart, weight through heels
4. Hold position, breathe normally
5. Progress by increasing time or decreasing knee angle (toward 90°)
</details>
---
### Session B — Posterior Chain/Hamstring Focus
| Exercise | Sets × Reps | Tempo | Notes |
|----------|-------------|-------|-------|
| Glute bridge | 3×12 | 2-2-2 | Squeeze glutes hard at top |
| Nordic curl negative (assisted) | 3×5 | 5s down | Use band/partner, eccentric only |
| Romanian deadlift (light) | 3×10 | 3-1-2 | Dumbbells, feel hamstrings |
| Side-lying hip abduction | 3×15/side | 2-1-2 | Slight external rotation |
| Prone hip extension | 3×12/leg | 2-1-2 | Keep knee bent 90° |
**Exercise Descriptions:**
<details>
<summary><strong>Nordic Curl Negative (Assisted)</strong></summary>
1. Kneel on pad, ankles secured (partner, strap, or loaded barbell)
2. Hold band attached to high anchor for assistance
3. Keep hips extended (straight line from knees to shoulders)
4. Lower slowly (5+ seconds) toward ground
5. Use arms to push back up (don't use hamstrings concentrically yet)
6. Focus on controlling the descent
</details>
<details>
<summary><strong>Romanian Deadlift (RDL)</strong></summary>
1. Stand with dumbbells at thighs, slight knee bend
2. Hinge at hips, pushing butt back
3. Lower weights along legs until hamstring stretch
4. Keep back flat, chest up
5. Drive hips forward to return
6. Squeeze glutes at top
</details>
---
### Session C — Movement Quality/Proprioception
| Exercise | Sets × Reps | Notes |
|----------|-------------|-------|
| Quadruped rocking | 2×10 | Feel joint movement without load |
| Half-kneeling hip flexor stretch | 2×45s/side | Address common tightness |
| Lateral band walks | 3×12/direction | Mini-band above knees |
| Step-ups (low box, 10-15cm) | 3×8/leg | Control the negative |
| Balance beam walking | 2×10m | Use line on floor or 2×4 |
**Exercise Descriptions:**
<details>
<summary><strong>Quadruped Rocking</strong></summary>
1. On hands and knees
2. Rock hips back toward heels
3. Feel knees moving through flexion range
4. Keep spine neutral
5. No load, just movement exploration
</details>
<details>
<summary><strong>Lateral Band Walks</strong></summary>
1. Mini-band just above knees
2. Quarter squat position
3. Step laterally, maintaining tension
4. Don't let knees cave inward
5. Keep feet parallel, toes forward
</details>
---
### Block 1 Frequency
```
Week structure: A - B - C - A - B (5 sessions)
Rest days as needed between sessions
```
---
## Block 2: Strength Development (Weeks 5-10)
**Focus:** Progressive loading, single-leg strength, hamstring emphasis
### Session A — Squat Pattern
| Exercise | Sets × Reps | Tempo | Notes |
|----------|-------------|-------|-------|
| Goblet squat | 4×8-10 | 3-1-2 | Depth to where form holds |
| Bulgarian split squat | 3×8/leg | 3-1-2 | Rear foot elevated, torso upright |
| Leg press (single leg) | 3×10/leg | 3-1-2 | Foot high on platform = more hamstring |
| Spanish squat (band) | 3×12 | 2-2-2 | Band behind knees, vertical shin |
| Single leg calf raise | 3×12/leg | 2-1-2 | Progress with weight |
**Exercise Descriptions:**
<details>
<summary><strong>Bulgarian Split Squat</strong></summary>
1. Rear foot on bench/box behind you
2. Front foot far enough forward for vertical shin at bottom
3. Lower until rear knee nearly touches ground
4. Keep torso upright, core braced
5. Drive through front heel to rise
6. Control descent (3 seconds)
</details>
<details>
<summary><strong>Spanish Squat</strong></summary>
1. Loop heavy band around squat rack at knee height
2. Step into band, positioned behind knees
3. Walk back to create tension
4. Squat down, band pulls knees forward
5. This allows vertical shins — very patella-friendly
6. Excellent for quad loading with reduced joint stress
</details>
---
### Session B — Hinge Pattern
| Exercise | Sets × Reps | Tempo | Notes |
|----------|-------------|-------|-------|
| Trap bar deadlift | 4×6-8 | 2-1-2 | Or conventional if unavailable |
| Single leg RDL | 3×8/leg | 3-1-2 | Contralateral load |
| Nordic curl (partial) | 4×4-6 | 3-5s down | Increase ROM progressively |
| Seated hamstring curl | 3×10 | 2-1-3 | Slow eccentric |
| Hip thrust (barbell) | 3×10 | 2-2-2 | Full hip extension |
**Exercise Descriptions:**
<details>
<summary><strong>Single Leg RDL</strong></summary>
1. Hold dumbbell/KB in hand opposite to standing leg
2. Slight bend in standing knee
3. Hinge forward, raising rear leg behind
4. Body forms straight line from head to rear foot
5. Feel hamstring stretch on standing leg
6. Return by driving hips forward
</details>
<details>
<summary><strong>Hip Thrust</strong></summary>
1. Upper back on bench, feet flat on floor
2. Barbell across hip crease (use pad)
3. Lower hips toward ground
4. Drive through heels, squeeze glutes at top
5. Full hip extension at top (no hyperextension)
6. Controlled lowering
</details>
---
### Session C — Unilateral/Athletic
| Exercise | Sets × Reps | Notes |
|----------|-------------|-------|
| Step-up (higher box, 30-40cm) | 3×8/leg | No push-off from rear leg |
| Lateral step-down | 3×8/leg | Slow, control valgus |
| Single leg glute bridge | 3×10/leg | Progress with foot elevated |
| Pallof press | 3×10/side | Anti-rotation core |
| Reverse lunge | 3×8/leg | Control deceleration |
**Exercise Descriptions:**
<details>
<summary><strong>Lateral Step-Down</strong></summary>
1. Stand on box/step (20-30cm)
2. Slowly lower opposite foot toward floor
3. Tap heel lightly, return to start
4. Keep knee tracking over toes (no valgus collapse)
5. This is SLOW and controlled — 3-4 seconds down
6. Excellent for VMO and knee stability
</details>
<details>
<summary><strong>Pallof Press</strong></summary>
1. Cable or band at chest height
2. Stand perpendicular to anchor
3. Hold handle at chest
4. Press straight out, resisting rotation
5. Hold 2-3 seconds, return to chest
6. Core stays braced throughout
</details>
---
### Block 2 Frequency
```
4 sessions/week
Example: Mon (A) - Wed (B) - Fri (C) - Sat (A or B)
Add load when hitting rep targets with good form
```
---
## Block 3: Performance/Movement (Weeks 11+)
**Focus:** Power, agility prep, movement complexity
### Session A — Strength Maintenance + Power Introduction
| Exercise | Sets × Reps | Notes |
|----------|-------------|-------|
| Front squat or Zercher squat | 4×5 | Heavier loading |
| Box jump (step down) | 3×5 | Concentric only initially, soft landing |
| Nordic curl (full) | 3×5-6 | Full ROM target |
| Kettlebell swing | 4×12 | Hip power, hamstring ballistic |
| Single leg squat to box | 3×6/leg | Pistol regression |
**Exercise Descriptions:**
<details>
<summary><strong>Box Jump (Step Down)</strong></summary>
1. Choose box height you can land softly on
2. Jump up with both feet
3. Land softly in quarter squat position
4. STEP down (don't jump down) — reduces eccentric stress
5. Reset and repeat
6. Progress height gradually
</details>
<details>
<summary><strong>Kettlebell Swing</strong></summary>
1. Hinge to grip KB between legs
2. Hike KB back like hiking a football
3. Explosively drive hips forward
4. KB floats to chest height from hip power (not arms)
5. Let it fall, hinge to absorb
6. Continuous rhythmic motion
</details>
---
### Session B — Deceleration/Agility Prep
| Exercise | Sets × Reps | Notes |
|----------|-------------|-------|
| Broad jump (stick landing) | 4×4 | Hold landing 3s, no valgus |
| Lateral bound (stick) | 3×5/side | Progress distance gradually |
| Skater squat | 3×6/leg | Counterweight in hands OK |
| Drop landing (low box) | 3×6 | Athletic position, quiet landing |
| Deceleration runs | 4×20m | Jog → stop in 3 steps |
**Exercise Descriptions:**
<details>
<summary><strong>Lateral Bound (Stick)</strong></summary>
1. Stand on one leg
2. Jump laterally to opposite leg
3. Stick the landing — hold 3 full seconds
4. Check: knee over toes, no valgus, quiet landing
5. Progress by increasing distance
6. Critical for ACL-deficient knees — trains lateral stability
</details>
<details>
<summary><strong>Skater Squat</strong></summary>
1. Stand on one leg, other leg behind you
2. Hold counterweight (plate, DB) in front for balance
3. Lower by bending standing knee
4. Rear knee approaches ground (don't touch)
5. Drive through standing leg to rise
6. Pistol squat regression — excellent single leg strength
</details>
---
## Movement Culture / Ido Portal Style Work
### Philosophy
> Movement practice develops attributes often neglected in standard rehab: adaptability, body awareness, ground-based mobility, and movement variability. These qualities build resilient tissue and reduce injury risk.
### Ground Movement Locomotion
**Practice 2-3×/week, 10-15 minute sessions**
| Movement | Description | Focus |
|----------|-------------|-------|
| **Loaded Beast** | Quadruped, knees hover 1-2" off ground. Move forward, backward, lateral. | Core, shoulder stability, hip mobility |
| **Crab Walk** | Supine position, hips up. Walk forward, backward, diagonal. | Hip extension, shoulder mobility |
| **Frogger** | Deep squat → hands forward → jump/step feet to hands → repeat | Hip mobility, squat depth |
| **Shinbox Rotations** | Seated, knees bent 90°. Rotate both legs side to side. | Hip internal/external rotation |
| **Lizard Crawl** | Low crawl, contralateral movement pattern | Full body coordination |
| **QDR (Quadrupedal Movement)** | Ido's system — start with basic positions | Movement complexity |
**Locomotion Descriptions:**
<details>
<summary><strong>Loaded Beast</strong></summary>
1. Start on hands and knees
2. Lift knees 1-2 inches off ground
3. Maintain this hover while moving:
- Forward: opposite hand/foot advance together
- Backward: reverse the pattern
- Lateral: side-step pattern
4. Keep hips low, core braced
5. Breathe normally (don't hold breath)
6. Start with 30 seconds, build to 2+ minutes continuous
</details>
<details>
<summary><strong>Shinbox Rotations (90/90)</strong></summary>
1. Sit on ground, both knees bent at 90°
2. One leg in front (external rotation), one behind (internal rotation)
3. Lift knees and rotate to opposite side
4. Both legs now in mirrored position
5. Smooth, controlled transitions
6. Works hip mobility in all planes
</details>
---
### Squat Mobility / Deep Squat Practice
**Daily practice:**
| Practice | Target | Notes |
|----------|--------|-------|
| **Squat sit accumulation** | 30 min/day total | Break into chunks throughout day |
| **Squat transitions** | 5-10 min session | Deep squat → half-kneeling → tall kneeling → deep squat |
| **Cossack squat progression** | 2-3×10/side | Shift weight side to side, increase ROM gradually |
**Deep Squat Sit Tips:**
```
- Start with assisted (hold doorframe, squat rack)
- Heels down if possible (elevate heels with wedge if needed)
- Work on spreading time throughout day (5 min chunks)
- Read, work on laptop, watch TV in squat position
- Goal: comfortable, unassisted squat for 5+ minutes continuous
```
---
### Balance / Single Leg Flow
| Level | Exercise | Progression |
|-------|----------|-------------|
| 1 | Single leg stand | 30-60s, eyes open |
| 2 | Single leg stand | Eyes closed |
| 3 | Single leg stand | Unstable surface (pillow, balance pad) |
| 4 | Single leg stand | Eyes closed + head turns |
| 5 | Single leg hinge reaches | Touch points around clock face |
| 6 | Single leg squat + rotation | Partial depth with torso rotation |
| 7 | Slackline work | If available — excellent proprioception |
---
### Hanging / Upper Body Integration
> Hanging work decompresses spine, allows lower body recovery while maintaining training stimulus, and builds grip strength.
| Exercise | Time/Reps | Progression |
|----------|-----------|-------------|
| Passive hang | 3×30-60s daily | Just hang, relax shoulders |
| Active hang | 3×15-30s | Engage scapula (pull shoulders down) |
| Scapular pulls | 3×8-10 | Active hang → pull scapula down/together |
| Single arm hang | 3×15-30s/arm | Shift weight to one arm |
| Brachiation | If available | Swing hand to hand on bars |
---
### Movement Flow Sequences
**Beginner Flow (5-10 minutes)**
```
Start in deep squat (30 seconds)
↓
Shinbox rotations (5 each side)
↓
Loaded beast forward (2 meters)
↓
Frogger (3 reps)
↓
Crab walk backward (2 meters)
↓
Cossack squat transitions (5 each side)
↓
Return to deep squat
Repeat 2-3 cycles
Rest 1 minute between cycles
```
**Intermediate Flow (10-15 minutes)**
```
Deep squat (30s)
↓
Shinbox rotations (10 total)
↓
Shinbox → loaded beast transition
↓
Loaded beast travel (3m forward, lateral, backward)
↓
Loaded beast → frogger transition
↓
Frogger (5 reps)
↓
Frogger → crab transition
↓
Crab walk (all directions, 2m each)
↓
Crab → supine roll → prone
↓
Lizard crawl (3m)
↓
Lizard → squat transition
↓
Cossack squats (10 total)
Continuous flow, 2-3 rounds
```
---
## Progression Guidelines
### Strength Work Load Progression
**Week-to-week model:**
```
Week 1: 3×8 @ 20kg (establish baseline)
Week 2: 3×10 @ 20kg (add reps)
Week 3: 3×12 @ 20kg (add reps)
Week 4: 3×8 @ 22.5kg (add load, drop reps)
Week 5: Deload — 2×8 @ 20kg (reduce volume 40-50%)
```
**Guidelines:**
- Add reps first within set (8→10→12)
- Then add load (2.5-5kg) and reset to lower reps
- Target: ~10% volume increase per week maximum
- **Deload:** Every 4th week, reduce volume 40-50%, maintain intensity
### Movement Work Progression
| Dimension | How to Progress |
|-----------|-----------------|
| **Complexity** | Add transitions between movements |
| **Duration** | Extend continuous flow time (5 min → 10 min → 15 min) |
| **Constraint removal** | Less hand support, smaller base of support |
| **Speed** | Slow → controlled → fluid (never rushed) |
### Swelling/Pain Decision Tree
```
┌─ Post-session swelling increased?
│
├── Yes, resolves in 24h
│ └── ✓ Acceptable, monitor closely
│
├── Yes, persists 48h+
│ └── ⚠️ Reduce volume 30%, reassess
│
└── No
└── ✓ Progress as planned
┌─ Pain during exercise?
│
├── 0-3/10, resolves immediately
│ └── ✓ Continue
│
├── 4-6/10 OR lingers hours
│ └── ⚠️ Modify exercise or reduce load
│
└── 7+/10
└── ✗ STOP, reassess in 48h
```
### When to Progress to Next Block
**Block 1 → Block 2:** (after ~4 weeks)
- [ ] Can perform all exercises with good form
- [ ] No increased swelling from sessions
- [ ] Single leg stance 30s+ eyes closed
- [ ] Wall sit 60s at 60° knee flexion
**Block 2 → Block 3:** (after ~6 weeks)
- [ ] Bulgarian split squat bodyweight+20kg, 8 reps
- [ ] Full Nordic curl negative (5 second descent)
- [ ] Single leg RDL with good balance
- [ ] No swelling increase from Block 2 sessions
---
## Weekly Schedule Templates
### Block 1 Template (Weeks 1-4)
| Day | Focus | Duration |
|-----|-------|----------|
| Monday | Session A (Quad/Stability) | 45 min |
| Tuesday | Movement flow + squat sits | 20 min |
| Wednesday | Session B (Posterior Chain) | 45 min |
| Thursday | Rest or light walking | — |
| Friday | Session C (Movement Quality) | 40 min |
| Saturday | Movement flow + hanging | 25 min |
| Sunday | Active recovery (walk, swim) | 30 min |
### Block 2 Template (Weeks 5-10)
| Day | Focus | Duration |
|-----|-------|----------|
| Monday | Session A (Squat Pattern) | 50 min |
| Tuesday | Movement flow (15 min) + hanging | 25 min |
| Wednesday | Session B (Hinge Pattern) | 50 min |
| Thursday | Rest or light activity | — |
| Friday | Session C (Unilateral) | 50 min |
| Saturday | Movement flow (20 min) + squat sits | 35 min |
| Sunday | Active recovery | 30 min |
### Block 3 Template (Weeks 11+)
| Day | Focus | Duration |
|-----|-------|----------|
| Monday | Session A (Strength + Power) | 55 min |
| Tuesday | Movement flow | 20 min |
| Wednesday | Session B (Deceleration/Agility) | 50 min |
| Thursday | Hanging + mobility | 20 min |
| Friday | Session A or B (alternate) | 50 min |
| Saturday | Extended movement flow | 30-40 min |
| Sunday | Active recovery | 30 min |
---
## Equipment List
### Essential (Minimum Setup)
- [ ] Resistance bands (light, medium, heavy loop bands)
- [ ] Mini-band (for lateral walks)
- [ ] Kettlebell (16-24kg depending on current strength)
- [ ] Adjustable dumbbells OR single heavy dumbbell
- [ ] Foam roller
- [ ] Exercise mat
### Recommended Additions
- [ ] Slant board (for Spanish squats, calf work)
- [ ] Nordic curl strap OR setup (doorway anchor, loaded barbell)
- [ ] Pull-up bar (for hanging)
- [ ] Parallettes (for ground flow progressions)
- [ ] Balance pad or Bosu ball
### Nice to Have
- [ ] Slackline
- [ ] Trap bar
- [ ] Cable machine access
- [ ] Plyo box set (various heights)
---
## Tracking & Notes
### Weekly Check-in Template
```
Week #: ___
Dates: ___ to ___
Swelling status (0-10): ___
Pain levels (0-10): ___
Confidence in knee (0-10): ___
Sessions completed: ___/___
Top exercise this week: _______________
Struggled with: _______________
Load progressions made:
- Exercise: ___ → ___
- Exercise: ___ → ___
Notes:
_________________________________
_________________________________
_________________________________
Next week focus:
_________________________________
```
### Exercise Log Template
```
Date: ___________
Session: A / B / C / Movement Flow
| Exercise | Weight | Sets×Reps | RPE | Notes |
|----------|--------|-----------|-----|-------|
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
Post-session:
- Swelling: none / mild / moderate / significant
- Pain: none / during / after / lingering
- Energy: low / moderate / good / great
```
### Long-term Progress Markers
| Milestone | Target Date | Achieved |
|-----------|-------------|----------|
| 30s single leg balance (eyes closed) | Week 4 | [ ] |
| Full Nordic negative (5s) | Week 8 | [ ] |
| Bulgarian split squat BW+20kg | Week 10 | [ ] |
| Box jump (step down) 40cm | Week 12 | [ ] |
| 5 min continuous deep squat | Week 12 | [ ] |
| 10 min continuous movement flow | Week 16 | [ ] |
| Lateral bound + stick landing | Week 14 | [ ] |
| Full pistol squat (or to low box) | Week 20 | [ ] |
---
## Additional Resources
### Recommended Reading/Watching
- Ido Portal's movement culture content
- Knees Over Toes Guy (Ben Patrick) — ATG training
- Dr. Aaron Horschig (Squat University) — squat mechanics
- FRC/Kinstretch — controlled articular rotations
### Professional Support
Consider working with:
- Sports physiotherapist (for technique checks)
- Orthopedic specialist (if instability episodes occur)
- Movement coach (for flow progressions)
---
## Important Notes
```
⚠️ The sounds may reduce somewhat as muscle control improves
and joint loading normalizes, but some crepitus is likely
permanent post-meniscectomy.
Focus on FUNCTION, not noise.
⚠️ If you experience:
- Giving way / instability episodes
- Locking or catching
- Significant swelling increase
- Sharp pain
→ Consult orthopedic specialist before continuing
```
---
*Document version: 1.0*
*Created for post-meniscectomy + ACL-deficient knee rehabilitation*