Knees Over Toes?

Think about a lot of things we do day in and day out. Going up and down stairs. Squatting to pick something off the ground. Running and stopping to change direction. All of these movements requires the ability for your knee to pass over your foot in order to perform these tasks. The inability to do this motion, especially if you have lingering discomfort can pose a problem. We’re going to discuss why this position is crucial in knee rehab in general, but more importantly in ACL rehabilitation.

The Significance

When progressing through ACL rehabilitation, you need to start training in different knee positions. The introduction of knees over toes is an important movement pattern to train if you have the range of motion, strength and enough time has elapsed. The knee should be prepared for ALL movement. Being able to train movements through a full range of motion available improves outcomes and increases confidence. This prepares you for the next stages in ACL rehabilitation but more importantly prepares you for life.

When can this training start?

Typically around the 4-6 week mark or it will depend on surgeon preference. A client needs to check certain boxes in order to start training knees over toes. Strength is key, you need to demonstrate adequate quadriceps control and hamstring strength to allow for this type of loading. If someone can walk without compensation and perform single leg strengthening without pain we are comfortable with loading knees over toes. This does not mean we are advocating squatting 500 pounds with your knees over toes. But, starting out with slow, controlled and supported movements in this position should be a part of your rehab program.  Something as simple as weight shifting with your knees over your toes counts as training!

How does this help me during rehabilitation?

This movement pattern will help improve your strength as well as help with pain in the front of your knee. Being able to load your knee in a safe manner in deep angles of bending will strengthen your muscles. This will allow return to running with less apprehension and possibly reduce some discomfort in the knee. This will also help with confidence in returning to sport. Sports happen in all planes of movement and requires automatic reactions to be successful. Therefore, the knee must be strong in all positions to have success and build confidence upon returning to sport. Here is an option for a knee dominant split squat, make sure you talk with your rehabilitation specialist to make sure you have met the criteria to try this!


Clinicians will shy away from deep knee bending training because it is not included in a protocol. We believe that if someone has met the criteria based on time elapsed, strength and range of motion then this is a safe way to train. The process should start slowly and gradually exposing the athlete to these positions without issues. Once more time has elapsed, they can transition to more dynamic movements to prepare the body for sport. The important part to remember is that training has to be comprehensive and well laid out for the athlete. It has to be customized to them in order for them to know it’s going to be successful. If you have any questions please send us a message below.