The aim of phase 3 is to increase quadriceps muscle strength and endurance.
Treatment
To be done as required.
Hot & Cold Therapy
Apply heat before training & ice after as required – 10 to 15 min at a time.
Taping & support
Use Kinesiology tape for running sessions if available.
Massage
Arnica/movelat as required. Consider deeper techniques including friction. More time between sessions may be needed as you go deeper. If the muscle is sore the following day, then wait a day. Can be done daily.
Stretching
Aim to do these once or twice a day.
Gluteal 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
- 3 sets and hold for 15 seconds
Calf Stretch
Teaching Points:
- Calf stretches should be done with your leg straight to stretch the larger gastrocnemius muscle and bent to target the deeper soleus muscle
- 3 sets of 15 secs, 1 x per day
Adductor swings
Teaching point:
- Swing the leg out sideways, making sure you rotate your leg so your toes point upwards as your leg swings upwards
- 3 sets of 15 secs, 1 x per day
Note: Dynamic adductor swings must be done within a pain-free range of motion.
Quad stretch
Teaching point:
- Hold the foot of the leg to be stretched and gently pull up behind
- Aim to keep the knees together and pull the leg up straight not twisted
- A stretch should be felt at the front of the leg – It should not be painful!
- 3 sets of 15 secs, 1 x per day
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 and hold for 15 seconds
Hamstring swings
Teaching point:
- The affected leg is the one swinging
- Swing forwards and backward, keeping the knee straight
- Take it as far as you feel comfortable, keeping it smooth and rhythmical
- 3 sets of 15 seconds
Strengthening
Aim to do these once or twice a day.
Double leg squat with weight
Teaching point:
- Add weight to make it more difficult by holding a dumbbell or using a free weights bar
- 3 x 12 reps daily
Reverse Nordic
Teaching point:
- Lean backwards as far as you can, then push your legs/shins into the ground to return to starting position and repeat
- 3 sets of 3 reps
Knee extension
This is best done on a machine in the gym but you can use a resistance band at home.
3 x 12 reps each leg.
Reverse lunge
Teaching point:
- Bend your back leg so your back knee will nearly touch the ground, and your front knee so your thigh is about parallel to the ground
- Your front leg is the one that will be working
- 3 sets of 12 reps
Step up
3 x 12 reps (weighted – start 8kg)
Leg press
3 sets of 12 reps (if available)
Calf raises (optional)
Teaching Points:
- Ideally, these should be performed in a gym using a Squat (Smith’s) machine so you can increase the load on the muscles
- 3 sets of 12 reps
Soleus raises (optional)
Teaching Points:
- Calf raise exercise with knees bent places more load on the soleus muscle lower down
- Aim to do these exercises 4 times a week
- 3 sets of 12 seconds
Clam in extension with band (optional)
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
Clam in flexion with band (optional)
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
Step up (optional)
Teaching point:
- Step up controlling the final part of knee extension (when it is nearly straight)
- Perform 3 sets of 12 repetitions with a short rest between
Note: Add weight using dumbbells to make it more difficult if you need to?
Functional
4 times per week.
Quick feet and hold
Teaching point:
- Aim for fast feet then hold
- 3 sets of 8 reps
March 3 steps and hold
Teaching point:
- Start standing on right leg, march 3 steps and hold strong on landing repeat
- 3 sets of 8 reps
Superman
Teaching Points:
- 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
- 3 sets – 6 reps for each leg
Cardiovascular fitness
3 x / week maximum.
Start jogging
Stage one:
- Run for 3 minutes at 50% pace
- Walk for 1 minute
- Repeat this 4 times
- 3 times a week (maximum)
Note: Give yourself a day to make sure there is no reaction, ie, your quad isn’t sore -You should be pain-free whilst running.
Stage two:
You can now increase the amount of running by decreasing the amount of rest time
- Run for 4 minutes
- Walk for 30 seconds
- Repeat this 4 times
- 3 times a week (maximum)
- Alternate days
Note: Running should always be pain-free.
Exit criteria
Are you ready to move on to phase 4?
Move onto phase 4 when:
- Pain-free through all exercises
- Pain-free single-leg squat
- No pain when jogging or 24 hours after
- No pain to touch
- You have 70-80% strength injured compared to the good side