PHASE 1 (Muscle Balance)

Patellofemoral Pain Syndrome, Patella tendonitis, MCL  injury, ACL injury, LCL injury, Runners knee

Exercises

The aim of phase 1 is to restore normal muscle length, range of motion and introduce postural awareness. The stretches outlined below are an indication of muscle stretches that are advised but do not have to be followed to the letter. Therefore if you have a preferred quad or hip flexor stretch for example, go ahead and use it. The stretches below are aimed to give a new perspective and new ideas on the sometimes stale stretches that we have been performing over the years.

Hip flexor stretch – floor

Lying supine, with knees bent, both feet flat on the floor, the lower back is flat. Bring one leg up towards chest and hold it, while keeping lower back to the floor. The other leg is extended straight out and the gluteals on that side are contracted, while the back of the leg is pushed into the floor. This position is held for 8-10 seconds and repeated 6 times before swapping legs.

Abductor stretch 

Standing with leg to be stretched crossed in behind. Laterally flex away from the stretching leg until a stretch is felt. This position is held for 20-30 seconds, repeating 2-3 times and swapping legs if necessary.

Standing Adductor Stretch 

Standing with one leg straight and the opposite leg bent with legs apart and feet facing forward. Move sideways towards the bent leg until a stretch is felt in the inner thigh of the straight leg. The stretch is held for 20-30seconds and repeated 2-3 times before swapping legs.

ITB stretch 

Lying on your side with lower hip and knee bent, and the pelvis slightly rotated forwards. The top leg is straight and positioned forwards, with the knee turned up slightly.
The top leg is then abducted and then extended, so it is positioned slightly behind the body. The leg is then dropped towards the floor and allowed to hang for 15-20 seconds. The pelvis should not move and the lower back should not be allowed to arch during the movement.

Standing quadraceps stretch 

This well-known stretch can be refined for optimal benefit. Standing in good alignment, holding one ankle. A wall may be used to lean on for balance. Perform a posterior pelvic tilt, while squeezing the gluteals of the stretching leg. This position is held for 20-30 seconds and repeated 2-3 times before swapping. 

Standing hamstrings stretch

Stand in optimal alignment with one leg resting on the couch or a chair straight ahead of you (it is essential that this is at the right height so the spine is held in neutral alignment). The foot should be facing forwards and the hips should be square to the stretching leg. You then perform an anterior tilt of the pelvis (this is a subtle movement that tilts the pelvis beckwards, the couch or chair can be raised if a stretch is not felt). The stretching leg is then slowly rotated from the hip, alternating left to right. The movement is repeated 8 times in each direction before swapping legs.

Assisted supine calf stretch

Lying supine, with a straight leg over the assisting person's knee. The assisting person places one hand on the anterior thigh, just above the knee, and the other hand on the sole of the foot.
The assisting person applies resistance in the direction of dorsiflexion, until a comfortable stretch is felt. The knee should be kept straight throughout. This position is held for 20-30 seconds and repeated 2-3 times before changing legs. You may assist the stretch by actively dorsiflexing (bring toes towards body/bending ankle) the ankle.

 

PHASE 2 Static dynamic and reactive stabilization

1. Reverse curl with Swiss ball

Lie supine with back flat on the floor, head on the ground and hands 3 or 4 inches away from hips. Grip ball with lower leg and try to lift the ball quickly and lower it down slowly. Try not to let the ball rest on the floor. 10 repetitions

2. Hip extension with Swiss ball

Lie supine with legs straight and heels resting on swiss ball, hip width apart. Contract abdominals and perform hip extension by lifting the hips up until a straight line is formed from the knees to the shoulders. Movement should be initiated by contracting gluteal muscles. Return to the start position and do 8-10 repetitions.

3. Controlled kick outs on a bench (1 leg at a time)

Sit on the bench with hands behind you, gripping the edge of the bench so that you are well supported. Bend the knees and kick the legs through smoothly but quickly. Keep heels high and don't point your toes.

3b. Controlled kick outs on a bench (legs together)

PHASE 3 Functional Strength

4. Regular squats

Perform triple flexion of the hip, knee and ankle. Lightly brace abdominals and keep neutral spine. Ensure knees do not over shoot toes. Perform 10-12 repititions.

4b. One legged squats

Perform a regular squat on one leg. Ensure you do not lower yourself down too low and focus on something straight ahead.

5. Lunges

6. Dead Lifts

PHASE 4 Functional Power and Agility

7. One legged hopping on trampoline

7b. One legged squats on trampoline

8. Dynamic jumps onto trampoline

Alternate legs for this exercise and land flat footed.

14. Squat push with medicine ball

Begin movement by squatting down to a point where your thighs are parallel to the floor. Abdominals are braced. Accelerate weight upwards and end position is where arms are extended over head and body is in optimal postural alignment.

15a. Box jumps - two legged jump two legged land

Brace abdominals, flex hips and knees slightly before starting the jump. The landing should be flat footed and once you have landed you should stand upright in good postural alignment looking straight ahead.

15b. Box jumps – two legged jump one legged land

15c. Box jumps – one legged jump two legged land

15d. Box jumps – one legged jump one legged land

16a. Multi Planar hops – Sagittal

Prerequisites – you must be able to perform a two legged static box jump and a single leg balance with good posture, exhibit good core strength and have progressed through the previous phases with out any problem

Contract abdominals and stand on one leg in preparation for the movement. Flex hip and knee slightly, then do an explosive jump forward to land on the opposite leg. Stabilise landing for 3-4 seconds before performing another explosive jump. Perform movement 6-8 times before swapping legs. Use this format for side hops (frontal plane) and turning hops (transverse plane) ideally performing a 90 degree turn.

16b. Multi Planar hops – Frontal

16c. Multi Planar hops – Transverse