Knee Morning PT — Daily ACL Rehab Routine

~15 min · no gym equipment · bands + ball + wall + stair · from Guy's PT protocol (Physyou Sep 7)
This routine is the daily rehab-escalating block from Guy's knee protocol: floor drills, isometrics, and band work done every morning, before/after the heavier gym block. All step/landing drills are 10×3; power items stay 5–6+ reps, quality-first.

⚠️ Read the rules at the bottom before starting. PT assessment at Physyou Sep 7 — bring this page + the ACL referral.
01

Backwards Walking

WARM-UP · DRILL
2 minutes · slow · on an incline if available
The first movement of the day: wakes up knee tracking and VMO without loading the joint.
  1. Walk backwards slowly on flat ground; use a slight incline (e.g. treadmill 3–5%, or a shallow hill) when possible.
  2. Roll through the full foot — heel → midfoot → toe.
  3. Keep the pace controlled; knee should track over the toes, no inward collapse.
  4. Quality over distance — 2 quality minutes beats 10 sloppy ones.
Why: Backwards walking is a rehab staple — it shifts load to the quads/VMO and trains knee extension control through range while being extremely joint-friendly.
02

Wall Sit with Ball Between Knees

ISOMETRIC
30 seconds × 3 · ball between knees and on toes
Isometric quad work that also trains the adductors to keep the knee stable.
  1. Back flat against the wall, feet ~shoulder-width, slide down until thighs are ~parallel.
  2. Squeeze the ball between the knees the whole time — this activates the adductors, which brace the knee.
  3. Keep heels down; push through the whole foot.
  4. Rest 30–45s between holds.
Why: The ball squeeze turns a quad exercise into a knee-stability exercise — adductor co-contraction holds the patella on track.
03

Ball Behind Knee — Straighten Against Wall

ISOMETRIC
5-second hold × 10 each leg
The "new targil" — terminal knee extension training with the ball as feedback.
  1. Stand with the ball pinned between the back of your knee and the wall.
  2. Press the knee BACK into the ball and straighten the leg fully.
  3. Hold 5 seconds with the knee locked out, then relax.
  4. Focus on the VMO (teardrop quad muscle) doing the work — squeeze it at full extension.
Why: Terminal extension is the last bit of range the knee needs to relearn after ACL issues — the ball gives you tactile feedback that full extension actually happened.
04

Elastic Band — Straighten Knee (Alternating)

BAND · VMO
12–15 reps each leg × 2–3
Band-resisted knee extension with a slow, controlled finish — pure VMO targeting.
  1. Anchor a light band around the leg of a chair; loop the other end around your ankle (or behind the knee).
  2. From a seated position, straighten the knee fully against the band resistance.
  3. Pause 1–2 seconds at lockout, squeezing the quad teardrop.
  4. Lower slowly — 3 seconds down. No swinging; the band should be under tension the whole rep.
Why: Band work targets VMO + knee tracking with adjustable, joint-friendly resistance — the exact muscles that keep the kneecap from drifting.
05

Seated Ball Squeeze + Leg Straighten

BAND · ISOMETRIC
8–10 reps · intensify: rubber band around chair leg + own leg
Squeeze + straighten — turns adductor activation into a full-extension movement.
  1. Sit tall, ball between knees, feet planted.
  2. Squeeze the ball (adductors) AND straighten one leg at the same time.
  3. Hold the squeeze at full extension for 2 seconds, then alternate legs.
  4. To intensify: loop a rubber band around the chair leg and your own leg for extra outward resistance.
Why: Co-contraction training — the adductor squeeze while extending teaches the nervous system to stabilize the knee through movement, not just in place.
06

Lying Knee Bends + Straight Leg Lifts (Toes In)

DRILL · FLOOR
Bends 15× · Lifts 12 × 3
The floor pair that starts the day's range-of-motion and glute/quad balance.
  1. Bend: lie on your back, pillow under the knee, bend + straighten slowly — full range, no rush. 15 reps.
  2. Lift: lie on your back, one leg straight, toes pointed IN (not out), lift 6–8 inches off the floor, hold 2s, lower slowly. 12 × 3.
  3. Keep the lower back pressed into the floor — no arching.
  4. The "toes in" position biases the VMO — this is the point, don't skip it.
Why: The toes-in straight-leg raise is the classic VMO isolation move — quad protection after ACL injury starts here, on the floor, before any load.
07

Weightless Deadlift — Wall Touch

DRILL · BALANCE
8–10 reps each side
Heel + hips touching the wall, hinge down, touch the knee — posterior chain without load.
  1. Stand with heels AND hips touching the wall. Left foot forward (as the note prescribes), right foot behind.
  2. Hinge at the hips, bend down until your hand touches the knee.
  3. Drive back up through the glutes to standing. The wall keeps your hips honest — no arching.
  4. Keep the weight in the forward foot's heel.
Why: Rebuilds the hip hinge pattern — the posterior chain takes load off the knee, and the wall cue prevents the hip-extension cheat that hides weak glutes.
08

Step Onto Something — Bend Into Knee

DRILL · LOAD
10 reps each leg · low step
First loaded knee bend of the day — a step-up that respects the range you've earned.
  1. Find a low, stable step (start ~15–20 cm; raise only when pain-free).
  2. Step up, then BEND into the knee under control — sink the hip down and back, knee tracking over the toes.
  3. Push back up through the foot, not the arms.
  4. No knee collapse inward; if the knee wobbles, lower the step.
Why: Graduated loading — the step height is your dial. It rebuilds knee confidence under load without jumping straight to heavy squats.
09

Stair / Landing Triads

STAIRS · 10 × 3
10×3 each · step down · 3-sec lunge · landing
The protocol's money drill: eccentric control down stairs and landing confidence. If knees flare, cut this block — it's the heaviest morning item.
  1. Step down with band: rubber band pulls outward from the leg; step DOWN from a stair slowly (3 sec), resisting the pull. 10 × 3.
  2. 3-second lunge: step forward into a lunge, HOLD the bottom 3 seconds, push back up. 10 × 3 each leg.
  3. Landing on weak foot: step off the stair onto the weak foot, land soft (toe → heel), absorb with the knee bent. 10 × 3.
  4. All three: quality first. If form degrades, stop the block — don't grind through.
Why: ACL rehab lives in eccentric + landing control — the stair triad retrains the knee to decelerate, which is where most re-injuries happen.
10

Finish — Walk It Out

COOLDOWN
2–3 minutes · easy walk
Blood back to the joint, tracking confirmed, day started.
  1. Walk normally, easy pace, 2–3 minutes.
  2. Notice: any pain? any clicking that isn't painless? Rate it 0–10.
  3. If 0–2/10 → the day's plan (gym block / PT) is green-lit. If 3+ → skip the heavy block today, do the morning routine only.
Why: The 0–10 check at the end of the warm-up is your autopilot for whether the heavier gym block (leg curl, leg extension, backwards treadmill, Spanish squats) gets the green light today.

Rules Before You Start

MANDATORY
🚨 Pain rule: never push through joint pain. Sharp pain = stop. Muscle burn = fine. This is rehab, not a hard workout.
🚨 Range rule: never force range. Work the range that's pain-free today; it grows on its own.
✅ Daily rhythm: this block every morning (~15 min). The gym block (leg curl / leg extension / 15-min backwards treadmill / Spanish squats) is separate — heavier, only when the joint is quiet.
✅ Power items (jumps/runs with angles) stay at 5–6+ reps, quality-first, full recovery between sets — from the protocol notes.
🚨 Peptides flagged: the note lists TB-500 / BPC-157. Confirm with your treating ortho/PT before stacking anything — including before the PT-prep week.
✅ Sep 7: bring this page + the ACL referral to Physyou (Yad Halutzim 14, Tel Aviv). PT will tune the routine.