Phase 2 is the isotonic phase. The aim is to increase the load through your knee gradually. As you improve you should increase the speed of the downwards phase of the knee-strengthening exercises.
Each rehab/training session should comprise:
- Warm-up
- Stretching
- Strengthening exercises (so mild discomfort is felt on the last set)
- Ice/cold therapy afterwards for 15 minutes
Only move on to phase 3 when you have achieved the Exit Criteria (see below) for this phase.
Rest/offload
Complete rest is not always essential. Avoid all jumping and plyometric exercises completely. Anything else you do should depend on your level of pain:
- If pain is >7/10 then continue complete rest for min 2 weeks
- If pain is 4-7/10 then reduce distance/duration by 50%
- If pain is <3/10 reduce distance/duration by 30%
- If you reduce the running volume by 50-30% and there is no reaction 24 hours later it is fine to continue to run at a steady pace with no hard accelerations/decelerations.
Cold therapy
Apply cold therapy 3 times a day and after any rehab exercises. This can be an ice massage where you rub a frozen plastic cup of water over the area or a cold therapy compression wrap.
Massage/foam roller
Use a Foam roller over your quadriceps (front thigh), hamstrings, and calf muscles, Or if available a deep tissue sports massage. This can be done daily and is a good idea to make it part of your normal training routine/warm-up.
Stretching & Mobility
To be done daily.
Quadricep stretch
Teaching point:
This stretch is especially important for Patella tendonitis.
- Hold the stretch for 30 seconds and repeat with a short break in between
- This should be comfortable, don’t force the stretch
- Aim to do this exercise 1-2 times per 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 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 once or twice a day
Activation
3 to 4 times a week.
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
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
Teaching point:
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.
- 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 of 30 seconds
Double leg bridge with band
Teaching point:
- This works the gluteal muscles in particular, as well as bringing your core into play
- 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
3 to 5 times a week.
Straight leg calf raise
Teaching points:
- Hang off a step and lower your heel toward the floor
- Rise up on your toes as far as you can keeping the movement in a comfortable range, and then lower back down
- Start Bodyweight, and gradually add load with dumbbells
- Start with 3 sets of 8 to 10 repetitions using both legs through a comfortable range of motion
- Progress to single-leg calf raises if you have no reaction within 24 hours layer
Bent knee calf raise
Teaching point:
- Start with 3 sets of 8 to 10 repetitions using both legs bent at the knee
- Progress to single leg bent knee calf raises if you have no reaction 24 hours later
Isometric leg press
Teaching point:
This is the most important strengthening exercise in this phase. Isometric exercises mean no movement – Just hold the weight.
DO NOT GO PAST 90 DEGREES OF KNEE BEND
- Use a leg press machine if possible, or hold a bent knee position on the edge of a step
- Start with 3 sets of 15-second holds and build up to 6 sets of 45-second holds
- Aim for up to 70% of the maximum weight you can normally press
- Do one leg at a time
- Start with the weaker/injured leg and do the same on your stronger leg
Movement control
2 to 4 times per week.
Forward T
Teaching point:
- Stand on one leg with your knee slightly bent
- Lean forwards, open up your arms pulling the non-supporting leg backward to make the shape of a ‘T’
- Maintain balance for 4 or 5 seconds and repeat
- Perform 3 sets of 4 repetitions.
Functional
4 times per 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
- Concentrate on technique and doing the exercise as quickly/sharply as comfortable
A March 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
A march lateral
Teaching point:
- A march laterally or sideways
- Concentrate on accurate technique with a good fast knee lift
- Perform 4 sets of 5m in each direction
Conditioning
Optional if available.
Running
You can begin straight line running (no agility drills) at 50% or your maximum speed.
Aim for 3 to 4km in distance but make sure you don’t run in pain, or have soreness the following day.
If you do then reduce the distance or time you run for.
No sprinting or hard acceleration/deceleration.
Max speed sprints.
Swim/Pool exercises
If you have access to a swimming pool then you can perform mobility exercises in the water. A great way to maintain fitness is to run in deep water with a buoyancy aid worn around your waist/chest. Or swimming, but avoid leg kicks, especially Breastroke if this is painful during, after, or the next day.
Move on to phase 3?
Check if you are ready to move on.
Exit criteria
Move onto phase 3 when you can do:
- 3 sets of 10 reps single leg squat.
- 3 hops with no pain after or the following day.