Phase 1 – Pain control & activation Week 0–2
- Quadriceps isometrics (VMO focus)10 × 10-sec holds, 2–3 sets
- Straight leg raises (neutral)3 × 10–15 reps (stop if pain rises)
- Hip abductor isometrics3 × 10-sec holds
- StretchingHamstrings, calves, quadriceps (gentle)
🟡 Phase 1 cautions
- Avoid deep knee flexion (painful wall sits, deep squats)
- Break sitting every 20–30 minutes (avoid “movie-sign” pain)
Phase 2 – Strength & alignment Week 2–6
- Mini squats (0–45°)Knee over 2nd toe; slow eccentric
- Step-ups (low step)Controlled pelvis; avoid valgus
- ClamshellsHip ER control; 3 × 12–15
- Core stabilizationPlanks / dead bugs
🟡 Phase 2 cautions
- If pain is 4–5/10 → keep range smaller, reduce depth and volume
- No rapid jump in load (increase only one variable at a time)
Phase 3 – Functional return Week 6–12
- Single-leg squatsMirror feedback; no valgus collapse
- Step-downsSlow eccentric; control alignment
- Dynamic balance drillsStar excursions / balance board
- Low-impact plyometricsOnly if pain ≤2/10 and no next-day swelling
🟡 Phase 3 cautions
- Skip plyometrics if pain ≥ 4/10 or swelling occurs next day
- Return to sport only after good single-leg squat + step-down control
Progression rules
Pain during exercise ≤2/10 and returns to baseline within 24 hours.
If not → regress one phase and reduce load/range.
If not → regress one phase and reduce load/range.
🔴 RED FLAGS — stop rehab & seek urgent review
- True locking/catching or inability to fully extend
- Recurrent patellar dislocation / gross instability episode
- Large swelling/effusion, hot swollen knee, fever
- Night pain, severe constant pain, unexplained weight loss
- New neurovascular symptoms (numbness, cold foot, severe calf pain)
🟡 CAUTIONS — modify and regress if these occur
- Keep pain ≤ 2/10 during rehab; settle within 24 hours
- If symptoms persist > 24 hours → reduce load/range or step back one phase
- Avoid deep squats/downhill running/repeated stairs during flare
- Focus on knee-over-2nd-toe alignment; avoid dynamic valgus
- Wean kinesiotaping once control improves (avoid dependence)
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