Conditioning: Phase 4

The following is the final of four phases that will guide you from Runner’s Knee injury toward healthy running. From here, you should be ready to return to full, healthy running.

Duration: 2 Weeks
Goal: Plyometrics and Eccentric Loading
Frequency of Exercises: Daily, 2-3 days per week
Warm Up: For at least 5 minutes before activity (e.g. Pre-Run Warm up)

Bulgarian Split Squats: 3 x 10 reps (slowly, 3 second down, 3 second up). In a split squat stance with your back leg supported on a chair, come straight down then back up. You can use a pole or chair to support your balance. Add weight if it is too easy. Purpose: increase demand on hamstring.
Jump Squats: (on box first, then on ground) 3 x 8-10 reps. With your legs shoulder width apart, bend down by bringing hips back and knees bent, and then come back up. As you land, try to make the landing quiet, which indicates shock absorption. If it’s too loud, then you are not landing with enough knee and hip bend flexion. Do this one at a time at first before progressing to intervals over time (e.g. sets of 3, 4, etc.).
Hamstring Curls (With Ball): 3 x 12 reps. Lying on your back, lift your hips with your heels on the ball. Keeping your hips up in the air, bring the ball away from you, slowly come back, and then repeat. Keep your hips up in the air throughout. If that is too easy, try it with one leg at a time. Purpose: increase strength in the hamstring and improve resilience to load.

Step Ups: (Fast) 3 x 10 reps each leg. On a step, bring affected leg up on step and step up, and then back down. Do as many reps as possible until 30 seconds or fatigue. Alternate with the other side. Purpose: increase load on the hamstring.
Single Leg Balance (Running Man): 3 x 30 seconds. Stand with both hands on your hips with your feet directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Bend the standing leg slightly, and go through a running motion with the other side by bringing the leg backward and forward. Purpose: improve balance and stability.
Front Plank: 3 x 30 seconds or until fatigue. On your elbows and knees, bring your knees off the ground and hold. Try to keep your body level throughout this exercises by keeping your hips level and engaging your abdominals and glutes. Keep your elbow below your shoulders and push up to engage your scapular muscles. Purpose: strengthen core and glutes for running form stability.

Stretching:
- Kneeling Hip Flexor Stretch: In the kneeling position with arms supported on the wall, engage your abdominals by doing a posterior pelvic tilt (i.e. low back is flattened with a limited curve). This posterior tilt will stretch the hip flexor muscles and decrease strain on the hamstring. Engage your glutes on your kneeling side and keep your body as a unit until you feel a stretch in the front of your hip. You may increase your stretch by leaning away from the side. Purpose: decrease anterior tilt to decrease strain on hamstring.
- Kneeling Hamstring Stretch: 10 sec holds x 10 reps. In the kneeling position, bring your affected foot forward until you feel a pull in your hamstring. Next, bring your hips back while keeping your core neutral. You should feel a stretch in the hamstring. Hold for 10 seconds then relax.
Run/Walk Progression.

TO GRADUATE FROM PHASE 4

Pain is minimal and manageable, and you are continuing to progress with running while implementing exercises from previous phases as needed or desired to maintain form.

Principles of Hamstring Strain: A Review

CAUSE – abrupt overload of the muscle/tendon, usually with an explosive activity like sprinting
NEED – offload hamstring and reduce pain
PLAN – avoid overstretching the hamstring as it recovers (2-3 weeks), massage to decrease muscle scar tissue, and progressively load the tissue to improve strength

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