Phase 1 begins as soon as possible following injury. The aim of phase 1 is to reduce pain and inflammation. Work through the treatment and exercises in phase 1. Only move onto phase 2 when you have achieved the Exit Criteria for this phase.
Treatment
To be done daily.
Rest
- Complete rest
- No running or jumping at this stage… Be patient!
- Limit walking if possible and avoid deep knee bends
- Maintain fitness by arm-only swimming or use the time to work on your upper body as well as your rehab exercises
Note: Depending on how bad or how long you have had your injury you may progress quickly or need complete rest for a few days or more.
Check the Exit Criteria for phase 1 before moving on to the next phase.
Cold therapy & compression
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 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.
Bracing & taping
Wear a Patella strap or patella taping, especially if you have to be on your feet during the day. Continue to tape/brace as long as you feel it is effective.
Foam Roller
Use a foam roller on your Quadriceps, Hamstrings, Iliotibial band, and Calf muscles. This can be done daily and is a good idea to make it part of your normal training routine/warm-up.
Stretching & mobility
Throughout the day, every day.
Patellofemoral mobes
Teaching point:
- Gently push from side to side
- Glide from top to bottom
- 3 sets of 30 seconds in all directions once a day
Note: This will help to keep your patellofemoral joint mobile with correct patella tracking.
Quadricep stretch
Teaching points:
This stretch is especially important for Patella tendonitis.
- 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 a couple of times a day
Active ankle mobility
Teaching point:
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.
- Pull the foot up as far as it will go (dorsiflexion)
- Hold for a couple of seconds, and then point it away from you (plantarflexion) and hold again
- The aim is to maintain joint mobility
- Perform 20 repetitions to keep the ankle joint mobile
Activation
To be done daily.
Clam in flexion with band
Teaching point:
The clam works the muscles on the outside of the hip.
- Lie on your side with your knees bent and slightly forwards so your hips are in flexion
- Raise your knee up in a slow, controlled movement and return to the start position
- Making sure your hips do not rotate backward whilst performing this exercise
- Do 4 sets of 30 seconds with a short break in between
Note: 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. 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 backward whilst performing this exercise
- Do 4 sets of 30 seconds with a short break in between
- This exercise can 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
- This exercise can be done daily or at least 3 times per week
Strengthening
To be done daily.
Calf holds
Teaching point:
This exercise is isometric, meaning it does not involve any movement.
- 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 seconds
Note: You should be aiming for 70% of your maximum voluntary calf muscle contraction.
Bent knee calf holds
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 seconds
- 70% max voluntary contraction
Note: This may feel more difficult than the straight leg hold and works the lower soleus muscle more.
Movement control
Can be done daily.
Gym ball bridge
Teaching point:
Double-leg gym ball bridge exercises work the core, glutes, and hamstring muscles.
- 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.
Move on to phase 2?
Exit criteria
Move onto phase 2 when:
- Normal daily activities including walking and stairs (down) are pain-free.
- You can do 10 double-leg squats pain-free.