Phase | Goals | Treatment | Progression to next phase |
Acute | - Tendon load reduction (ie, no jumping or running)
- Correct biomechanical errors
- Adapt playing surface
| - Transverse friction massage
- Relative rest from offending activity
- Improve flexibility of quadriceps, hamstrings, IT band, gastrocnemius/soleus complex
- Eccentric quadriceps activity with partial weightbearing performed twice daily
- "Around the world" leg raises
| - Can perform 3 sets of 15 repetitions of eccentric quadriceps activity at full body weight without pain
|
Subacute | - Symmetric lower extremity biomechanics
- Increase strength
- Cardiovascular fitness
| - Upright eccentric decline squat to 60 degrees knee flexion twice daily
- Progress from bilateral to single leg, then to single leg with added weight
- Continue "around the world" leg raises and stretching programs
- Stationary biking or pool jogging at tolerated exertion levels
| - Can perform 3 sets of 15 single-leg decline eccentric squats with 110% body weight (ie, body weight + added weight) without pain
- Conditioning activities performed without pain
|
Functional and sport preparation | - Return to running and jumping
| - Drop squats, 3 sets of 20 reps
- Eccentric step-downs from 4- to 8-inch (10- to 20-cm) heights, 3 sets of 15 reps
- Drop jumps from 4- to 8-inch (10- to 20-cm) heights, 3 sets of 20 reps
- Other sport-specific activities such as shuttle or figure-of-8 runs
| - Can perform drop jump exercises without pain
- Can perform sporting activities at full speed and without symptoms
|