personal-stuff/training/knee-rehab-program.md

Knee Rehabilitation Program

Post-Meniscectomy + ACL-Deficient Knee

Status: Active program
Started: _______________
Last updated: _______________

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Table of Contents

1. Understanding Your Knee
2. Core Training Principles
3. Block 1: Foundation (Weeks 1-4)
4. Block 2: Strength Development (Weeks 5-10)
5. Block 3: Performance/Movement (Weeks 11+)
6. Movement Culture / Ido Portal Style Work
7. Progression Guidelines
8. Weekly Schedule Templates
9. Equipment List
10. Tracking & Notes

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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

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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

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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:

Terminal Knee Extension (TKE)

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

Wall Sit Isometric

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°)

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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:

Nordic Curl Negative (Assisted)

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

Romanian Deadlift (RDL)

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

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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:

Quadruped Rocking

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

Lateral Band Walks

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

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Block 1 Frequency

Week structure: A - B - C - A - B (5 sessions)
Rest days as needed between sessions

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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:

Bulgarian Split Squat

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)

Spanish Squat

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

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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:

Single Leg RDL

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

Hip Thrust

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

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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:

Lateral Step-Down

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

Pallof Press

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

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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

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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:

Box Jump (Step Down)

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

Kettlebell Swing

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

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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:

Lateral Bound (Stick)

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

Skater Squat

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

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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:

Loaded Beast

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

Shinbox Rotations (90/90)

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

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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

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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

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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

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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

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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

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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

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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)

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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	[ ]

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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)

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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

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Document version: 1.0 Created for post-meniscectomy + ACL-deficient knee rehabilitation