This is the acute phase and begins as soon as possible after injury. The aim of phase 1 is to reduce pain, protect the muscle and allow it to start healing. Work through the following treatment and exercise tasks daily. When you achieve the Exit Criteria move onto phase 2.
Treatment
Do the following treatment methods every day.
Cold therapy
Apply cold and compression for 10 minutes every 2 hours, especially if your injury is recent. If you have a chronic strain then 2 to 3 times per day may be sufficient and you will likely progress through phase 1 relatively quickly.
Taping/bracing
Wear a thigh support or tape, especially if you have to be on your feet. An elastic compression support, or neoprene thigh support is suitable. Some professionals prefer taping if available because you can be a little more targeted with the compression. This supports and protects the muscle and helps reduce any swelling. Use arnica-based cream under the compression but do not massage the area.
Rest
Complete rest from running. However, it is important you do other stretching and strengthening exercises as long as they are not painful.
Stretching
Do not stretch the quadriceps muscles at all during phase 1. However, aim to do stretches for other body areas once or twice a day.
Glute stretch
Teaching point:
- On your back cross your right ankle over the left knee
- Grip the thigh of your left leg and pull the knee towards you, lifting your foot off the floor
- Pull the knee further towards you to increase the stretch
- Hold for 15 seconds
- 3 sets
Hip rockbacks
Teaching point:
- In an all-fours position, feet turned outwards (pointing position)
- Push hips back towards the floor (as far as you feel comfortable)
- Hold for 15 seconds
- 3 sets
Calf Stretch
Teaching point:
- To stretch the big gastrocnemius muscle your back leg must be kept straight
- Stand with the leg to be stretched at the back and hands on a wall at shoulder height
- Bend the front knee and lean forward, keeping the back knee straight and pushing the heel down into the floor
- When you can feel a stretch, hold for 20 to 30 seconds (each side)
- 3 sets for 15 seconds on each side
Hamstring stretch
Teaching point:
- The aim here is to get a little bit of elasticity to the healing tissue, not increase flexibility
- Place your foot on a table or similar and lean into the stretch, keeping your leg straight and chest up
- Take the stretch as far as is comfortable and hold relaxing into the stretch
- Aim to stretch forward from the hip rather than the shoulders
- A gentle stretch should be felt at the back of the leg but it should not be painful
- 3 sets of 15 seconds on each side
Note: This stretch can also be done sitting down.
Hip flexor
Teaching point:
- Kneel with one knee on the floor and the other foot in front with the knee bent
- Push your hips forward and keep the back upright
- 3 sets of 15 seconds on each side
Strengthening
To be done daily.
Isometric quad contractions
Teaching point:
- You can perform this exercise either at home using either a chair or bench
- Hold for 15 seconds
Note: Build up to 30 – 45 second holds
Straight leg raise
Teaching point:
- Lock your knee out and lift it up 6-8 inches off the floor
- Contract the quad muscles and tighten up the kneecap
- 3 sets of 8 reps
IRQ (Inner range quads)
Teaching point:
- This exercise is simply performed by contracting the quadriceps muscles at the front of the thigh
- This exercise can be performed in standing, or in sitting with the knee straight or with a foam roller or rolled-up towel under the knee so that the foot lifts off the floor when you contract the quads
- Contract the quadriceps muscles, making sure the VMO (vastus medialis oblique) on the inside of your knee is contracting
- Hold for 5 seconds, then relax
- 3 sets of 8 reps
Glute band squat
Teaching point:
- Keep feet hip-width apart and the band just above the knees
- Maintain knee position throughout
- go as far as you feel comfortable
- 3 sets of 8 reps (building up to 15 reps)
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 forward so your hips are in flexion
- Raise your knee up in a slow, controlled movement and return to the start position
- 3 sets of 8 reps
Clam in extension with band
Teaching point:
- 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
- 3 sets of 8 reps
Ice skaters
Teaching point:
- These work the hip muscles under load in a slightly different way but moving forwards
- Place a resistance band around your knees to increase the load on your lateral hip muscles
- 3 sets of 5 metres forward and backward
Exit criteria
To move on to phase 2 you must:
- Pain-free on standing quad stretch (standing and prone position)
- Complete rest for at least 3 days
- Apply PRICE principles min 3 x per day for 2-4 days
- Walk pain-free for 15 mins
- Have no pain to touch