This is the heavy slow resistance phase.
The aim of phase 3 is to further increase the load through the Achilles tendon and begin to introduce plyometric exercises.
Treatment
Hot & cold therapy
Apply cold therapy after exercises or training.
Do not apply ice directly to the skin but wrap it in a wet tea towel.
Note: A commercially available hot and cold wrap is more convenient and can be used to apply compression as well.
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:
Daily
Pull the foot up as far as it will go (dorsiflexion)
Hold and then point it away from you (plantar flexion) and hold again
The aim is to maintain joint mobility
2 sets for 30 seconds
Massage
If available, deep tissue massage to the calf muscles in particular, as well as quads and hamstrings.
If you do not have access to massage therapy then foam roller exercises are fine.
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
Aim to do these exercises at least once a 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!
Calf stretch bent & straight knee
Teaching points:
- Hold the stretch for 2 sets of 30 seconds with your knee straight and then with your knee bent
- Repeat this exercise 3 times a day
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
Activation
Crab walk with band
Teaching point:
- Place a resistance band around your knees and walk sideways
- This gets the hip muscles firing and fatiguing under bodyweight load
- Make sure they are done pain-free on the knee
- Perform 4 sets of 4 steps on each side with a short rest in between
Side Strikes
Teaching point:
- Try and keep the leg straight
- Knee leg goes quickly and the trail leg goes slowly
- Perform 4 sets of 4 repetitions on each side
Monster walks
Teaching Points:
- Place a resistance band around your knees to increase the load on your lateral hip muscles
- Walk forward and backwards
- Maintain a good posture by keeping your head and chest up
- 4 sets of 4 steps forward and backwards (each way)
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.
High knee march
Teaching Points:
- This is a functional exercise that helps transition to running and more explosive exercises later on
- March forwards on your toes driving your knees high
- 4 sets of 5 metres
High knee march lateral
Teaching Points:
- Perform marching drill sideways, aiming to be on your toes with high knees
- 4 sets for 5 metres
Strengthening
Progress through these exercises 3 times a week.
Single leg calf raise (straight leg)
Teaching points:
- Place the ball of one foot on the edge of the step, keeping your body in an upright position
- Bring your heel up as high as you can
- Then slowly come back down, dropping your heel below the step as far as you feel comfortable
- Perform 3 sets of 12 repetitions with a straight leg
- 3 seconds up, 3 seconds down (6 seconds per repetition) 6-8 repetitions 3 times a week
Single leg calf raises (bent knee)
Teaching points:
- Place the ball of one foot on the edge of the step, keeping your body in an upright position
- With your knee bent bring your heel up as high as you can
- Then slowly come back down, dropping your heel below the step as far as you feel comfortable
- Perform 3 sets of 12 repetitions
- 3 sec up, 3 sec down (6 seconds per rep) 6-8 reps, 3 times a week
Double leg calf raise on leg press
Teaching point:
- Place the balls of your feet on the platform, push and extend your legs
- Flex your ankles while keeping your legs straight and heels in the same position – You should feel a stretch in your calves
- Push through the balls of your feet to extend both ankles, and hold the contraction for a second before releasing
- Aim for (70% max effort)
- 3 sec concentric (up) 3 sec eccentric (down) (6 secs per rep) aim for 6-8 reps, 3 times per week
Squat
Teaching point:
- Start with your feet shoulder-width apart
- Tense your abs
- Sit back – make sure to move your butt backwards, don’t just bend your knees
- Keep your knees in line with your toes
- 3 sets of 8 reps (50% effort)
Note: Look straight ahead and don’t round your back.
Seated calf raise
This is a gentle exercise that will strengthen the soleus muscle which is the smaller muscle lower down.
Teaching points:
- Sit on a chair with your knees bent and lift your heels off the ground as high as possible
- Use a weight/dumbbell over the knee, starting with the foot on the floor
- 3 sec concentric/3 sec eccentric (6 secs per rep) 6-8 reps x 3 per week
Note: This is also an early-stage rehab exercise as it can be done with no weight at all, to begin with, if necessary.
Step down counterbalance squat front
Teaching points:
- Step down using a pole as a counterbalance
- Only drop as far as is comfortable and use a slow, controlled movement at all times
- Perform 3 to 4 sets of 6 to 8 repetitions on each leg
Movement control
Aim to do these exercises 2 to 4 times a week.
Forward T
Teaching Points:
- Stand on one leg with your knee slightly bent
- Lean forwards, open up your arms pulling the non-supporting leg backwards to make the shape of a ‘T’
- Perform 2 sets of 6 repetitions on each leg, holding the T position for 2 or 3 seconds each time
Box jump to inside leg
Teaching Points:
- Jump off a box or step with 2 feet and land on your inside leg
- Maintain end position for a couple of seconds
- 2 sets of 8 reps for each leg
Box jump to outside leg
Teaching Points:
- Jump off the box from 2 feet landing on your outside leg
- Maintain control of the landing
- 2 sets of 8 reps of each leg
Drop jumps from small step (6-8 inches)
Teaching point:
- Step off and land directly into a jump
- Land and hold
- 2 sets of 8 reps
Functional exercises
Aim to do these exercises 2 to 4 times a week.
High knee march linear
This is a functional exercise that helps transition to running and more explosive exercises later on.
Teaching Points:
- March forwards on your toes driving your knees high
- 2 sets of 10 metres
Single leg high knee on a step
Teaching point:
- Drive your knee up into a 90 deg position, lower down and repeat
- 3 sets for 12-15 reps
Running drills
- Aim for 75% speed only when A skip is comfortable.
- Follow return to running program
- Introduce controlled multidirectional movements (50-60% max effort)
- Increase linear speed (60-75%)
- Aim 4-5km
- No sprinting
- Controlled moderate acceleration/deceleration
Running
Try to increase your distance by 1 – 1 .5 km.
Look at running around 4-5 km – If you can’t manage this, then stick to your own level.
Start introducing acceleration and deceleration – Accelerate/maintain/decelerate 20/10/20 – 10/10/10
Add in some change of direction – S-run/curved runs.
Look at getting your pace up to around 75% of your maximum.
Move on to phase 4?
View all.
Exit Criteria
Exit phase 3 when you are able to:
- Run pain-free, and accelerating and decelerating are pain-free
- Hopping should be pain-free
- Single leg heel raise is pain-free
- Calf raises are loaded up to 40-50% of body weight e.g. a 70kg person would be lifting 28kg plus