Phase 1 is the acute management phase.
The aim is to reduce pain and inflammation and allow the painful area to heal.
Rest is essential at this point. Check the Exit Criteria to see when it is safe to progress to phase 2.
Treatment
To be done daily.
Cold therapy
Apply a cold compression wrap over the painful area of your knee for 20 minutes every 2 hours.
Taping/Bracing
Wear a patella tendon support or use patella taping techniques to help relieve tension on your knee.
It can be worn all the time, but especially if you have to be active.
Anti-inflammatory gel
Apply anti inflammatory gel such as Movelat gel of the affected area.
If you are not sure what is available near you, or appropriate then speak to your pharmacist or doctor.
Apply up to 4 times per day.
Massage
Apply deep tissue massage techniques to the quadriceps muscles.
Stay well away from the painful area just below the knee.
Massage can be applied daily, as long as there is no significant soreness the day after treatment.
Rest
Complete rest from running and jumping activities.
Work on the upper body or other techniques if possible.
Foam roller
Use a foam roller over your quadriceps (front thigh) before stretching. This is a good alternative if massage is not available.
This exercise performs a myofascial release and stretches on the quadriceps muscles at the front of the thigh.
The roller is applied along as full a length of the muscle as possible with more emphasis or weight from the knee upwards, following the direction of blood flow along the muscles.
3 sets for 20 seconds each.
Stretching
To be done daily.
Calf Stretch (straight and bent knee)
Calf stretches should be done with your leg straight to stretch the larger gastrocnemius muscle and bent to target the deeper soleus muscle.
Straight knee:
- Place your hands on the wall and step forward with the foot you are not stretching
- Keep your toes pointed forward and your back heel on the ground and lean into the wall without bending your back knee
- Hold the stretch for 3 sets each for 15 seconds
- Repeat this exercise 3 to 5 times throughout the day
Bent knee:
- Place your hands on the wall and step forward with the foot you are not stretching
- Keep your toes pointed forward and your back heel on the ground and lean into the wall
- Bend the knee and ease in to feel a stretch lower down at the back of your leg
- Hold the stretch for 3 sets each for 15 seconds
- Repeat this exercise 3 to 5 times throughout the day
Glute Stretch
Teaching point:
- On your back cross your right ankle over the left knee
- Grip the thigh of your left leg and pull the knee towards you, lifting your foot off the floor
- Pull the knee further towards you to increase the stretch
- 2 sets and hold for 45 seconds
Hip flexor Stretch
Teaching point:
- Kneel with one knee on the floor and the other foot in front with the knee bent
- Push your hips forward and keep the back upright
- 2 sets and hold for 45 seconds
Quadriceps Stretch
Teaching point:
- Standing quad stretch and hold for 45 seconds
- 2 sets of 4 to 5 times per day
Strengthening/activation
To be done daily.
Clam in flexion with band
Teaching Points:
- Lie on your side with your knees bent and slightly forward so your hips are in flexion
- Raise your knee up in a slow, controlled movement and return to the start position
- If you begin to find this exercise easy then you can increase difficulty with a stronger band
- 3 sets of 8 reps for 30 seconds
VMO activation
Teaching point:
- Keeping the uninvolved knee in place, tighten the involved knee by pushing it into the table
- To position the knee in partial flexion place a towel or roll under the knee
- The knee is straightened (keeping the other knee flexed) and held in full extension
- Hold the position for about 10 seconds and return to the starting position
- Turning your foot outwards helps isolate this muscle more
- 1 set of 10 reps
Note: Contract your quadriceps muscles, ensuring the VMO on the inside of the knee is contracting.
Single leg bridge
Teaching point:
- Lie on your back, knee bent, and push the hips upwards to work the gluteal muscles and hamstrings
- Use one foot on the floor pushing up
- Hold the position briefly and then lower
- 3 sets of 8 reps
Note: Make sure you squeeze the gluteal muscles and aim to maintain a straight line from the shoulder on the ground to the knee at the top point of the exercise.
Single leg calf raise
This a great exercise for working the calf muscle.
Teaching points:
- Hang off a step and lower your heel toward the floor
- Rise up on your toes as far as you can keeping the movement in a comfortable range, and then lower back down
- 3 sets of 12 reps on each side
Move on to phase 2?
Check if you are ready to move on:
Exit criteria
Before you can progress to phase 2 you must:
- Have complete rest for at least 3 days.
- Applied cold therapy for 20 minutes every 2 hours.
- Have no pain to touch.
- Pain-free on standing quad stretch.
- Pain-free going up and down stairs.