Extensor Tendonitis Phase 4

This is the eccentric loading phase.

Mobility & Stretching

To be done daily.

Foam roller

Use a Foam roller over your calf muscles (front thigh), hamstrings, and quadriceps

3 times for 30-60 seconds.

Massage

If available get a deep tissue sports massage for your legs twice a week, In particular, the calf muscles and hamstrings.

If not then use a foam roller.

Activation

Aim to do these 4 times per week.

Crab walks

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 3 for 5 metres on each side with a short rest in between

sidestrikes

Teaching point:

  • Try and keep the leg straight
  • Knee leg goes quickly, trail leg goes slowly
  • Perform 3 sets for 5 metres

Monster walks (dynamic)

Teaching Points:

  • Monster walk exercises using a band at the knees are performed more dynamically on your toes
  • 3 sets for 5 metres

Walking calf raise

Teaching Points:

  • Walk slowly across the floor
  • Start with a heel strike and once you get to the forefoot push-off, come up onto the toes
  • Swing the other leg forward and heel strike with the next foot to continue
  • Make sure you do this slowly and under complete control
  • 3 sets of 15 metres

Note: Heel-toe walking is a great exercise for the ankle and calf muscles. It will strengthen all muscles of the lower leg, as well as help, improve proprioception or balance.

Tip toe walking

Teaching point:

  • With your heels pointed inwards walk forward slowly, keeping your heels slightly off the floor
  • Do the same exercise going back but with your heels outwards
  • 3 sets for 15 metres each way

A skip linear

Teaching point:

  • Linear ( straight line)
  • A Marching drill now progresses into a skipping drill making it more dynamic
  • Skip with a dynamic knee lift and a dynamic reaction off the floor
  • 2 sets of 10 metres

A skip lateral

Teaching point:

  • Lateral (sideways) out and back
  • A Marching drill now progresses into a skipping drill making it more dynamic
  • Skip with a dynamic knee lift and a dynamic reaction off the floor
  • 2 sets of 10 metres

Mini pistol squat

Teaching point:

  • Bending at the knee, begin to squat down on one leg, extending your non-working leg out in front of your body
  • Lower yourself down and repeat
  • 2 sets of 10 reps

Strengthening

3 – 5 times per week if no reaction 24 hours later.

Resisted dorsiflexion

Use a stronger resistance band or better still use cable machines at your local gym.

Teaching Point:

  • A resistance band is wrapped around the forefoot and anchored to a fixed point in front of the foot
  • Start with the foot pointed away and dorsiflex or pull the foot up so the toes point to the ceiling
  • 3 sets for 15 reps

Eccentric kettlebell lowers

Teaching point:

  • Lift the kettlebell with your foot, then lower your foot so your toes are pointing down
  • Drop the kettlebell to the floor, take your foot out and repeat
  • 3 sets of 12 reps

High knee march with band

Teaching point:

  • Place the band around the arches of both feet
  • Drive the knees up as fast as possible, keeping the foot dorsiflexed (foot is lifted upwards) throughout
  • 3 sets of 15 reps

Eccentric resisted dorsiflexion

Teaching point:

  • A Physio or partner pulls down on the foot as the patient resists the movement
  • 3 sets of 12 reps

Movement control

Can be done daily.

Forward T on a balance board

Teaching point:

  • On a balance/wobble board 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

A lock at wall

A lock is performed against a wall – quick feet.

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 4 sets of 6 repetitions on each leg

Carioca

Teaching Points:

  • Move sideways with your back leg alternating between going behind and then in front
  • 4 sets of 10 metres each way

Crossover box jumps

Teaching point:

  • Keep light on your feet
  • Hold the position briefly at either side
  • 3 sets of 8 on each side

Standing hops

Teaching point:

  • Hop up and down on your standing leg
  • Control the landing
  • 2 sets of 8 reps

Single leg drop jumps

Teaching point:

  • Start on the step and hop off
  • Land and hold for a couple of seconds and repeat
  • Control the landing
  • 2 sets for 8 reps

Triple hop on mat

Teaching point:

  • Hop on a single leg three times, without losing balance and landing firmly
  • 4 sets for 6 reps

Running

  • Aim 5-6km plus
  • Introduce change of direction drills.
  • Introduce sub-maximal accelerations/deceleration (build from 70-90%)
  • Increase linear speed up to sprint 75%-85% max effort
  • Build up gradually
  • Alternate days only – monitor for reaction – must return to the baseline level of discomfort after 24 hours

Move on to phase 5?

Exit criteria

To move on to phase 5:

  • Daily activites should be pain free still
  • Running should be pain-free
  • All exercises are pain-free
  • You are pain-free 24hrs post exercise
  • Your foot is pain-free to touch
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