The aim of phase 2 is to gradually increase the load through your foot.
Treatment
Can be done daily.
Active rest
Relative rest as pain allows. Avoid all jumping and plyometric exercises. You can start running depending on the level of your pain.
Cold therapy
Apply cold therapy at least 3 times a day, and after exercise. 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.
Supports & bracing
Wear a compression ankle support if you feel it helps.
Massage/Foam roller daily
All foam rolling exercises are 3 sets for 20 seconds each.
3) Calf
This exercise massages the calf muscles at the back of the lower leg.
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
2) Hamstring
This foam roller exercise massages and applies myofascial release to the hamstring muscles.
Teaching point:
- Pressure is applied from just above the knee upwards following the direction of blood flow
Mobility & stretching
These exercises should be done daily if pain-free.
Foot stretch
Teaching point:
- Start with your foot pointing up towards you
- Use your hand to pull the foot away from you (toes pointing outwards)
- Add a little pressure with your hands to give the front of the foot a stretch
- 2 sets for 30 seconds
Straight knee calf stretch
Teaching Points:
- 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
- 3 sets for 20 seconds
- One to two times a day
Bent knee calf stretch
Teaching Points:
- 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.
- 3 sets for 20 seconds
- One to two times a day
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 1 to 2 times a day
Activation
These should be done 3 to 4 times a week.
Crab walks 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
Note: If it is painful then try not bending your knee so much, or wait a few days – You may need to go back to phase 1.
Single leg balance exercises
The single-leg balance is a simple ankle proprioception exercise, although various progressions can be added to make it more difficult.
It improves balance and proprioception.
Teaching point:
- The athlete begins by standing on the injured leg only for 30 seconds
- Once this is accomplished the athlete closes their eyes to increase the difficulty
- So the next step is to balance on an unstable surface such as a trampette, wobble board, or half foam roller/mat
- One set for 30 seconds
Double leg bridge with band
This works the gluteal muscles in particular, as well as bringing your core into play.
Teaching point:
- Place a band around your knees to increase the tension on the outside hip muscles as you perform the exercise
- Bridge exercises can be done on the floor, or with feet raised
- 3 sets of 12 reps, with a short rest between sets
Strengthening
Progress through these 3 to 5 times a week as appropriate.
Single leg Plantar flexion
Teaching Points:
- Hold the band, then pull it against a fixed foot
- Keep the foot in neutral and resist the force from the band
- Perform 3 -4 sets of 6-15 second holds, have a short rest, then repeat
Note: Stay within the limits of pain – If it hurts then wait longer before starting this exercise.
Single leg Eversion
Exercises involving eversion and inversion help strengthen the muscles which help to control the ‘rolling’ action at the ankle.
Teaching Points:
- Isometric means there is no movement at the joint throughout the exercise
- For eversion, turn your ankle outwards against resistance
- Hold for 5 – 6 seconds, rest for 3 seconds and repeat initially 4 times (pain-free)
Single leg Dorsiflexion
Teaching Points:
- Wrap a resistance band around the forefoot and anchor it to a fixed point in front of the foot
- Start with the foot pointed away and pull the foot up so the toes point to the ceiling
- 3-4 sets and aim for 6-15 reps
Double leg heel raise (straight knee)
Teaching point:
- Place the balls of your feet on the step and push up onto your tiptoes
- Slowly drop down so that your heels are lower than the step or as far as comfortable
- 3 sets for 8 reps each
Movement control
These exercises should be done 2 to 4 times a week.
Walking high knee march
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 for 30 seconds
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’
- Maintain balance for 4 or 5 seconds and repeat
- Perform 3 sets of 6 repetitions on each leg, holding the T position for 4 or 5 seconds each time
Functional exercises
Aim to do these exercises 4 times a week.
A lock at wall
A lock is performed against a wall.
Teaching point:
- Drive the knee upwards, leaning into the wall
- Take the hip up to 90 degrees
- Keep the toes pulled up towards the ceiling
- Perform 3 sets of 4 repetitions on each leg
Note: Concentrate on technique and once you feel more comfortable you can pick up the speed and do it in bouts of 3.
A marching linear
Teaching point:
- March on your toes with a good high knee lift
- Focus on controlled, accurate technique at a good pace
- Perform 4 sets of 10 metres with a short rest between
Single leg toe taps
Teaching point:
- Stand on a mat, begin by raising your right foot and tapping it forward, to the side, behind you, and to the opposite side
- Then, return your right foot to the mat and repeat with the left side
- 3 sets of 6 reps on each side
Note: your working leg is the one on the mat.
Conditioning exercises
Optional if available?
Aerobic fitness
Breastroke only swimming and very light resistance stationary cycle.
Running
Begin to jog if pain levels allow.
Exit Criteria
Move on to phase 3?
Move onto phase 3 when you can do:
- 3 sets of 10 reps single leg heel raises with no pain after or the following day, and the area is not tender to touch or stretch