Phase 3: Strengthen The Complex

Improve muscle and tendon’s ability to produce force and manage load.

1. Start with bilateral tendon strengthening in mid-range tendon positions (neutral/no DF) with slow, tempo controlled movements.
2. Concentrics first, maintaining slow, tempo control.
3. Progress to unilateral strength, maintain mid-range tendon positions (neutral/no DF)
4. Rest to full recovery between sets for optimal strength and safe loading in pain free positions.
5. Strength training on non-consecutive days for ample rest/recovery time

2-3 sets x 15 reps -> 3-4 sets x 8-12 reps with increasing load based on pt response.

Bilateral Exercises -> progression
Squats on total gym -> leg press -> Squats w/ UE assist via hand rail/TRX straps -> free squats
Heel raise on total gym -> on leg press -> in standing w/ UE assist -> free heel raise
Prone hip ext -> bird dog -> deadlift/good mornings

Unilateral exercises
SL squats on total gym -> SL leg press -> SL stand/DL sit
SL heel raise on total gym -> SL heel raise on leg press -> SL heel raise/DL return
Step up w/ UE assist -> step up -> step up w/ row for post chain activation
4 way steamboats on air -> against resistance
SL cone taps -> SL deadlift w/ KB/DB (Flamingos)
Fwd and bwd stepping lunges -> add resistance w/ KB/DB/barbell

Phase 4 – Progress load

1. Progress from concentric to eccentric loading
2. Progress from mid-range to full range tendon position (past neutral into DF)
3. Start with bilateral and progress to unilateral exercises
4. Rest to full recovery b/n sets for optimal recovery/hypertrophy
5. Continue with strength training on non-consecutive days for ample rest/recovery
6. Heavy, slow resistance with controlled tempo
7. Progress from phase 3 increasing sets and decreasing reps with increased resistance

Exercises from phase 3 can carry over with increasing ROM and focusing on eccentric phase of movements. As strength and tolerance improves, can begin to implement explosive concentric phase with controlled eccentric phase.

Additional exercises to consider:
Baps Board w/ weights for progression of foot/ankle control through stance phase
Lunge with high knee -> progress to include heel raise at end of concentric phase
step up row -> progress to include heel raise
KB swing in bilat stance w/ both UEs -> progress to tandem stance w/ 1 UE

Educate patient on importance of compliance of 3-4x/week for proper rest/recovery to allow tissue healing, strength improvement and increased tolerance to load gradually prior to beginning return to run program through phase 5 and 6. Educate pt on the length of the strengthening phase, taking several weeks to months prior to tolerance to running.