Phase 4 is the eccentric loading phase where you can begin to really strengthen your knee and start to return to normal training. Eccentric exercises are those where the muscle is lengthening yet contracting at the same time.
Complete this program when you achieve the Exit Criteria for this phase.
Treatment
Can be done daily.
Foam roller
Use a foam roller for 30 – 60 secs each on your Quads, Hamstrings, and Calf muscles.
This can be done daily.
Massage
If available, a deep tissue massage 2 x per week focussing on the Quads, Hamstrings, Calf muscles, and Plantar fascia under the foot.
This will help keep your muscles in good condition. It is especially important for the Quads.
Activation
Aim to do these 4 times per week.
Crab walk dynamic
Teaching point:
- This exercise should be done dynamically now, up on your toes
- Perform 4 sets of 4 steps each way
Dynamic ice skaters
Teaching Points:
- Place a resistance band around your knees to increase the load on your lateral hip muscles
- Walk forward and backward
- Maintain a good posture by keeping your head and chest up
- 4 sets of 4 steps forward and backwards over 10 metres
Linear ankling drills
Teaching Points:
- Stand with a stiff leg and on your toes
- Move forwards using your ankles to generate the motion
- 2 sets of 10 metres
Lateral ankling drills
Teaching Points:
- Stand with a stiff leg and on your toes
- Move sideways using your ankles to generate the motion
- 2 sets of 5 metres each way
A skip linear
Teaching Points:
- A skip drill is a progression of the marching drill
- It is more dynamic and performed on your toes
- Knee lift is more dynamic and contact time on the ground is reduced
- 2 sets of 10 metres
Strengthening
5 times per week if no reaction 24 hours later.
Decline single leg squat
Teaching points:
The aim of this exercise is to increase the load through the patella tendon.
Studies have shown that single-leg squats at decline angles >15° result in a 40% increase in maximum patellar tendon force.
- The single-leg decline squat is done on a sloping board
- Avoid bending the knee more than 60° as this puts larger forces through the patella
- Wear a backpack to increase load if required
- 3 sets of 15 reps 2 x per day
Eccentric leg press
Teaching point:
- Push up with both legs and lower slowly with one leg
3 sets of 15 reps
Eccentric knee extension
Teaching point:
- This is best done on a leg extension machine at the gym
- 3 sets of 15 reps
Movement control
2 to 4 times per week.
Forward T To Spiderman
Teaching point:
- Balance on one leg and move into the ‘Forward T” position
- Hold your balance for a few seconds before coming into the upright position again
- Then, without dropping your foot to the floor move your leg out sideways into the ‘Spiderman’ position and hold Note: Use a balance board if this is too easy.
A lock at wall
Leaning tower exercise, also known as ‘A’ lock is performed against a wall.
Teaching Points:
- Start by going into a high knee, leaning against a wall
- Take the hip up towards 90 degrees, toes pulled up to the ceiling
- March 3 steps and hold strong on landing
- 4 sets of 6 reps
Carioca
Teaching Points:
- Move sideways with your back leg alternating between going behind and then in front
- 4 sets of 10 metres each way
Lateral Box Jumps
Teaching Points:
- Step sideways over the box, placing both feet on top each time
- Keep light and fast on your toes
- 3 sets of 8 each leg
Running drills
1 to 2 times per week.
Accelerate & decelerate
Teaching point:
- Increase linear speed up to 80-95% of max effort
- Uncontrolled and reactive change of direction drills at speed (80-90% max effort)
- Introduce sub-maximal accelerations/deceleration (build from 70-90%)
- Introduce technical and sport-specific drills.
Note: See your coach for drills specific to your sport if you are not sure.
Complete this program?
Check if you are ready to complete the program:
Exit criteria
To complete this program you should be:
- Pain-free 24 hours after eccentric leg press (at least 2 weeks at 1.5 x bodyweight)
- Pain-free during and 24 hours after maximal sprints and accelerations/decelerations
- Pain-free on change of direction
- Pain-free single leg squat to 90 degrees
However, we recommend you continue with quad stretching exercises and use a foam roller/massage as part of your normal training.
Check regularly to see if your knee is becoming sore by pressing in on the patella tendon.
Apply ice after training and reduce the intensity if you suspect symptoms returning.