Phase 1 begins as soon as possible following injury. The aim of phase 1 is to reduce pain and inflammation.
Treatment
To be done daily.
Rest
Complete rest.
No running. Limit walking if possible, and avoid impact.
Cold therapy
Apply cold therapy at least 3 times a day, or every 2 hours for 10 minutes if possible. Do not apply ice directly to the skin, wrap it in a wet tea towel.
Bracing
Wear a heel wedge, especially if you have to be on your feet during the day, as long as you feel it is effective.
Foam Roller
All foam rolling exercises are 3 sets for 20 seconds each.
1) Calf
This exercise massages the calf muscles at the back of the lower leg.
The leg is rolled over the roller along the full length of the muscles from the ankle to just below the knee and back again.
More pressure is applied from the ankle upwards following the direction of blood flow in the muscles.
2) Quadriceps
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) Hamstring
This foam roller exercise massages and applies myofascial release to the hamstring muscles.
Pressure is applied from just above the knee upwards following the direction of blood flow.
Mobility & stretching
Perform the following exercises occasionally throughout the day, every day.
Quadriceps stretching
Teaching points:
- Keep your knees together and gently pull your leg up
- You should feel a stretch at the front of the leg which should not be painful
- Hold onto something for balance if you need to or try holding your ear with the opposite arm
- Hold the stretch for 30 seconds and repeat with a short break in between
- Aim to do this exercise 1-2 times per day
Note: This should be comfortable, don’t force the stretch!
Hamstring stretch
Teaching point:
This is a convenient stretch if the ground is cold or wet.
- Stand on one leg with the other resting on a bench or similar
- Tilt the hips forward to increase the stretch
- Ease into the stretch and hold, as comfortable – don’t force the stretch!
- Perform 2 sets of 30-second holds, gently easing into the stretch
- Repeat 1-2 times a day
Active ankle mobility
The advantage of this exercise is that the damaged ligaments will not be stressed by sideways movement, the calf and shin muscles maintain strength and the pumping motion helps to decrease swelling.
Teaching point:
- Pull the foot up as far as it will go (dorsiflexion)
- Hold for a couple of seconds, and then point it away from you (plantar flexion) and hold again
- The aim is to maintain joint mobility
- Perform 20 repetitions to keep the ankle joint mobile
Note: This should be comfortable, don’t force the stretch!
Activation
These exercises work the hip muscles and can be done daily.
Clam in flexion with band
The clam works the muscles on the outside of the hip.
Teaching point:
- 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
- Make sure your hips do not rotate backwards whilst performing this exercise
- Do 4 sets of 30 seconds with a short break in between
- To be done daily or at least 3 times per week
Clam in extension with band
Teaching points:
- Performing the clam exercise with your knees moved further back as this places your hips into the extension
- This targets the muscles on the outside of the hip in a slightly different way
- It is important to do these exercises on both sides
- Start with the weaker side and do the same number of reps on the strong side
- Make sure your hips do not rotate backwards whilst performing this exercise
- Do 4 sets of 30 seconds with a short break in between
- To be done daily or at least 3 times per week
Double leg bridge with band
Teaching point:
- Raise your hips up and hold for a couple of seconds before lowering
- Do 3 sets of 12 repetitions with a short break in between
- To be done daily or at least 3 times per week
Strengthening
To be done daily.
Single leg calf hold (mid-range)
This exercise is isometric, meaning it does not involve any movement.
Teaching point:
- Stand on the edge of a step and allow all your weight onto one leg
- Perform 5 sets of 15-second holds, gradually building up to 5 sets of 45-second holds
Note: You should be aiming for 70% of your maximum voluntary calf muscle contraction.
Single leg bent knee calf hold
Teaching point:
- Stand on a step with your knee bent
- Hold the position
- Perform 5 sets of 15- second holds, increasing to 5 sets of 45-second holds
- 70% max voluntary contraction
Note: This may feel more difficult than the straight leg hold and works the lower soleus muscle more.
Movement control
These exercises can be done daily.
Gym ball bridge
Double-leg bridge with a ball works the core, glutes, adductor and hamstring muscles.
Teaching point:
- With heels on the ball push the hips upwards maintaining control throughout
- Perform 3 sets of 8 reps
Single leg stand
Teaching point:
- Stand on one leg for 20 seconds and repeat 4 times
Note: If you find this too easy then close your eyes, or use a wobble board or cushion to make it even more difficult.
Conditioning
These are optional exercises to help maintain fitness.
Upper limb strengthening
Work on upper body strengthening.
Swimming
Swim to help maintain fitness.
Move on to phase 2?
Check if you are ready to move on:
Exit Criteria
Move onto phase 2 when normal daily activities including walking and going downstairs are pain-free, and you can do 10 slow-speed double leg heel raises pain-free.