Extensor Tendonitis Phase 1

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. Avoid impact.

Cold & compression

Apply cold therapy at least 3 times daily, or every 2 hours for 10 minutes. 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.

Foam roller

This exercise massages the calf muscles at the back of the lower leg and can be done daily. It is a good idea to make it part of your normal training routine/warm-up.

Teaching point:

  • 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
  • 3 sets of 20 seconds for each leg

Note: If you are lucky enough to have access to a massage therapist then get a deep tissue massage once or twice a week.

Mobility & stretching

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

This is a convenient stretch if the ground is cold or wet.

Teaching point:

  • Stand on one leg with the other resting on a bench or similar
  • Tilt the hips forwards 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 a couple of 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

Activation

Clam in flexion with band

The clam exercise 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 for 30 seconds with a short break in between
  • This exercise can 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 places your hips into extension This targets the muscles on the outside of the hip in a slightly different way.

  • 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 for 30 seconds with a short break in between
  • This exercise can be done daily or at least 3 times per week
  • It is important to do these exercises on both sides

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
  • This exercise can be done daily or at least 3 times per week

Strengthening

To be done daily.

Mid-range hold

This exercise is isometric, meaning it does not involve any movement. Use a band or manual resistance.

Teaching point:

  • 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.

Outer range hold

This exercise is isometric, meaning it does not involve any movement.

Teaching point:

  • Hold your foot still as your partner pulls the resistance band
  • 5 sets for a 15-second hold with a gradual build-up to 5 sets for a 45-second hold
  • 70% max voluntary contraction

Inversion holds

Teaching Points:

  • Apply tension to the band and resist this movement with your foot, which should not move
  • Hold for 15 seconds, repeat 5 times, with a gradual build-up to 5 times for 45 seconds
  • Once daily
  • 70% max voluntary contraction

Note: Ensure pain-free and no movement.

Eversion holds

Teaching Points:

  • Apply tension to the band and resist this movement with your foot, which should not move
  • Hold for 15 seconds, with a gradual build-up to 5 sets for 45s
  • Repeat 4 times
  • Once daily
  • 70% max voluntary contraction

Note: Ensure pain-free and no movement.

Movement control

Can be done daily.

Gym ball bridge

Teaching point:

  • With heels on the ball push the hips upwards maintaining control throughout
  • Perform 3 sets of 8 reps on a gym ball if you have one

Note: If you don’t have a gym ball, place your legs on a chair or bench.

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

Optional to help maintain fitness.

Upper limb strengthening

Work on upper body strengthening.

Exit criteria

Move on to phase 2?

Move onto phase 2 when normal daily activities including walking and going down stairs are pain-free and you can do 10 slow-speed double leg heel raises pain-free.

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