Personalized Recovery Protocol

Manesh Panjabi

31M  |  Personal Trainer  |  Left Knee  |  MRI: 6 January 2026

Left Knee MRI
3 Active Injuries
Cartilage: Intact
ACL: Structurally Intact
Estimated Recovery: 16-24 weeks
🔴

Lateral Meniscus Tear

Horizontal tear body + posterior horn, meniscal flap, parameniscal cyst 0.9cm

High
🟠

Patellar Tendon Tear

Partial tear ~25% thickness, 0.5x0.7cm, near patellar attachment

Moderate
🟢

ACL Ganglion Cyst

Mucoid changes + ganglion cyst 1.2x0.6cm posterior. Structurally intact.

Stable
Anatomical Map
Your Injury Locations
Patella Lat. Meniscus ACL cyst Pat. Tendon Meniscus Tear Patellar Tendon ACL Ganglion Tap injuries to learn more

Lateral Meniscus

Horizontal tear body + posterior horn

Patellar Tendon

Partial tear ~25% near patellar attachment

ACL Ganglion Cyst

Mucoid changes + 1.2x0.6cm cyst. Structurally intact.

Recovery Roadmap
5-Phase Protocol
You Are Here
Protect
Wk 1-3
Restore
Wk 4-7
Build
Wk 8-13
Load
Wk 14-18
Return
Wk 19-24
1

Protect & Pain Control

Weeks 1-3  |  Foundation of Recovery

▾
Reduce swelling Restore full extension Activate quads Pain < 3/10 at rest
Exercises
🦵
Quad Sets (Isometric)
3 sets x 15 reps x 10-sec hold
Activates VMO without joint compression. Critical after injury to prevent quad atrophy and re-establish neuromuscular control.
▶ Watch Demo
🔄
Heel Slides
3 sets x 20 reps, 2x daily
Restores knee flexion ROM. Gentle joint mobilisation reduces stiffness and promotes synovial fluid circulation to protect cartilage.
▶ Watch Demo
🧊
Straight Leg Raises
3 sets x 15 reps each direction
Strengthens hip flexors and quads without knee flexion load. Protects patellar tendon while maintaining strength.
▶ Watch Demo
💧
RICE Protocol + Compression
Every 2-3 hours, 15-20 min ice
Controls inflammatory cascade. Essential for meniscal cyst and patellar tendon healing. Reduces secondary tissue damage.
What You CAN Do With Clients
🏋️ Coaching Modifications
  • Full upper body programming and coaching -- no restrictions
  • Can demonstrate seated and upper body exercises
  • Supervise and spot clients for all lower body work without personal participation
  • Walk on flat surfaces, climb stairs slowly (one at a time)
  • Can teach breathing, posture, and technique verbally
  • Consider this a period to deepen your coaching eye -- you will spot more when you are not moving
Red Flags - Stop Immediately
⚠ Stop If You Experience
  • Sudden locking of the knee (cannot straighten)
  • Significant increase in swelling within 24 hours of exercise
  • Sharp pain at the front of the knee during quad sets
  • Pain above 4/10 during any exercise
  • Pins and needles or numbness in the leg
Phase 1 Progress Checklist
2

Restore ROM & Neuromuscular Control

Weeks 4-7  |  Mobility + Stability

▾
Full ROM 0-120 degrees Single-leg balance Normal gait Quad strength 70%
Exercises
🧱
Mini Squats (0-45 degrees)
3 sets x 15 reps, slow tempo 3-1-3
Builds quad and glute strength through safe range. Avoids end-range compression on meniscus and patellar tendon strain zone.
▶ Watch Demo
⚖️
Single-Leg Balance Progressions
3 sets x 30-60 sec, eyes open then closed
Restores proprioception and neuromuscular control -- crucial for injury prevention and athletic performance. Start on stable surface, progress to foam.
▶ Watch Demo
🚴
Stationary Cycling (Low Resistance)
20-30 min daily, RPE 3-4/10
Promotes meniscal nutrition through synovial fluid movement. Low-impact cardiovascular work maintains fitness without joint compression stress.
🧘
Hip Strengthening (Clamshells, Glute Bridges)
3 sets x 20 reps each
Hip weakness is often the root cause of knee injury. Strong glutes and hip abductors reduce valgus stress and protect the lateral meniscus on return to activity.
▶ Watch Demo
What You CAN Do With Clients
🏋️ Coaching Modifications
  • Demonstrate upper body and hip-hinge movements without deep knee flexion
  • Can lightly demo deadlifts with straight-leg focus (hip hinge, not squat)
  • Walk around gym at full pace -- normal gait should return this phase
  • Can do standing coaching for extended periods now
  • Light cycling on stationary bike during client rest intervals to maintain fitness
Red Flags - Stop Immediately
⚠ Stop If You Experience
  • Swelling returns significantly after exercise (wait 24h, reassess)
  • Clicking or clunking accompanied by pain (not just painless clicking)
  • Knee gives way during single-leg balance attempts
  • Pain at patellar tendon insertion point above 4/10 during mini squats
Phase 2 Progress Checklist
3

Strength & Load Building

Weeks 8-13  |  Progressive Overload

▾
Quad LSI > 80% Wall sits 90 sec Spanish squats Step-up capacity
Exercises
🏔️
Wall Sits (Isometric Hold)
4 sets x 45-90 sec at 60-90 degrees, 2-3 min rest
Isometric loading at mid-range reduces patellar tendon pain while building quad strength. Proven pain modulation effect for tendinopathy via descending inhibition.
▶ Watch Demo
🇪🇸
Spanish Squats (Belt/Band)
4 sets x 10-15 reps, 3-sec eccentric
Loads the patellar tendon through full ROM with reduced shear. Shifts load to quad-tendon-patellar complex in a safe, controlled manner. Excellent for tendon remodelling.
▶ Watch Demo
🪜
Step-Ups (Eccentric Step-Downs)
3 sets x 12 reps, 5-sec down, 20cm then 30cm step
Eccentric quad loading is the gold standard for patellar tendinopathy. The slow lowering phase maximises tendon stimulus for collagen synthesis and remodelling.
▶ Watch Demo
🏋️
Romanian Deadlift (Bilateral to Split Stance)
3 sets x 10-12 reps, progressing load
Builds posterior chain without excessive knee flexion. Critical for restoring functional strength and hip-dominant movement patterns.
▶ Watch Demo
What You CAN Do With Clients
🏋️ Coaching Modifications
  • Can now demonstrate most exercises -- with good form and zero pain as the test
  • Demo split-stance and single-leg hip hinge movements is now appropriate
  • Can participate in light mobility flows and warm-up circuits with clients
  • Full demonstration of upper body and core exercises without restriction
  • Avoid box jumps, sprinting, and deep heavy squats for demos -- verbal cue instead
Red Flags - Stop Immediately
⚠ Stop If You Experience
  • Patellar tendon pain above 4/10 that persists more than 24 hours after session
  • Swelling that worsens with each training session (not isolated post-session pump)
  • Catching or locking sensation in the knee during loaded movements
  • Loss of motion gained in Phase 2
Phase 3 Progress Checklist
4

Advanced Loading & Power

Weeks 14-18  |  Athletic Conditioning

▾
Single-leg power Quad LSI > 90% Nordic curls Bulgarian split squats
Exercises
🇧🇬
Bulgarian Split Squats
4 sets x 8-10 reps, progress to weighted
High-yield single-leg strength builder with reduced spinal compression vs bilateral squats. Exposes any remaining asymmetry and builds the movement foundation for sport.
▶ Watch Demo
🦅
Nordic Hamstring Curls
3 sets x 5-8 reps, eccentric focus
The most evidence-supported exercise for hamstring injury prevention. Rebuilds hamstring strength and stiffness essential for knee stability and athletic movement.
▶ Watch Demo
📦
Box Step-Ups with Load
4 sets x 10 reps each leg, 40cm box
Functional strength through full range. Mimics stair climbing, lunge patterns, and the demands of client demonstration. Direct carryover to athletic performance.
▶ Watch Demo
🏃
Lateral Band Walks + Lateral Lunges
3 sets x 15 reps each direction
Rebuilds lateral hip and knee stability needed for cutting and directional changes. Directly addresses the lateral meniscus protective musculature.
What You CAN Do With Clients
🏋️ Coaching Modifications
  • Can now participate in most client training sessions at moderate intensity
  • Demo Bulgarian split squats at bodyweight -- stop if patellar tendon flares
  • Can run brief warm-up jogs with clients (straight line, moderate pace)
  • Full demonstration capability except for plyometrics and heavy loaded squats
  • Start incorporating your own Phase 4 work into client session transitions
Red Flags - Stop Immediately
⚠ Stop If You Experience
  • Patellar tendon pain above 4/10 during or after Bulgarian split squats
  • Lateral knee pain that worsens with loading (meniscus flare)
  • Any giving way during single-leg loading
  • Night pain or pain at rest after training sessions
Phase 4 Progress Checklist
5

Return to Full Training

Weeks 19-24  |  Sport-Specific Conditioning

▾
Plyometric clearance Full demo capacity Return to sport criteria Confidence restored
Exercises
📦
Box Jumps (Progressive)
Start 30cm: 4 sets x 5 reps, progress to 50cm+
Plyometric readiness is the final gate before full return to training. Assesses reactive strength, landing mechanics, and tendon energy storage capacity under load.
▶ Watch Demo
⚡
Lateral Bounds and Hop Tests
3 sets x 8 reps each side, compare distance
Single-leg hop tests are validated return-to-sport assessments. Target: affected leg within 90% of unaffected leg. Confirms functional symmetry.
▶ Watch Demo
🏆
Full Training Sessions (Graduated Return)
Week 19-20: 50%, 21-22: 75%, 23-24: 100%
Graduated return prevents recurrence by allowing tissue to adapt to progressive demands. Skipping this phase is the most common reason for re-injury in athletes.
🧠
Psychological Readiness (KOOS/Tampa Scale)
Complete self-assessment tools before full clearance
Fear of re-injury is a major return-to-sport barrier. As a trainer, your confidence in demonstrating movements matters. Complete psychological readiness is part of the criteria.
What You CAN Do With Clients
🏋️ Coaching Modifications
  • Full return to client demonstration capacity if Return-to-Sport criteria are met
  • Can demo box jumps, squats, and cutting movements at client pace
  • Use your recovery experience to become a better coach -- you now understand injury from the inside
  • No restrictions after full clearance by your physio or sports medicine doctor
Red Flags - Stop Immediately
⚠ Stop If You Experience
  • Any recurrence of significant swelling after plyometric sessions
  • Lateral knee pain during or after box jumps (meniscus loading)
  • Patellar tendon pain above 3/10 that does not resolve within 48 hours
  • Loss of trust or confidence in the knee during explosive movements
Phase 5 Progress Checklist
Daily Monitoring
Symptom Tracker

🌡️ Pain Level

3
No Pain Worst Pain

💧 Swelling

✅ Today's Exercises

📊 7-Day Pain Trend

Tap "Save Today's Log" to record each day. Trend shows last 7 days.

Clearance Criteria
Return-to-Sport Scorecard
0%
Ready

Toggle each criterion when achieved

Pain-Free ROM
Full 0-130 degree range without pain
Quad Strength Symmetry
Limb symmetry index above 90%
Single-Leg Hop Test
Affected leg within 90% of unaffected
No Effusion at Rest
No significant swelling 24h post-training
Patellar Tendon NRS < 2
Pain score below 2/10 during loading
Plyometric Clearance
Box jump and lateral bound without pain
Psychological Readiness
Confident in knee; no fear of re-injury
Clinician Clearance
Signed off by physio or sports medicine doctor

🚨 Red Flags: Seek Medical Attention

🔒
Knee Locking

Cannot straighten the knee. May indicate displaced meniscal flap. Seek urgent orthopaedic review.

⚡
Giving Way Episodes

Knee buckles or collapses unexpectedly. Can indicate instability. Stop all loading and contact your doctor.

💧
Sudden Swelling Increase

Rapid balloning of the joint, especially if warm to touch. May signal haemarthrosis or cyst rupture.

🌙
Night Pain

Pain that wakes you from sleep unprompted. Not normal. May indicate serious pathology requiring reassessment.