0:00 This is Brent, coming at you with yet another activation video. In this video 0:03 we're going to do a very common exercise, but unfortunately it's not commonly 0:07 progressed, and you and I both know that unless you progress an exercise, you 0:13 will not continue to see adaptations. So, I'm going to have my friend, Yvette, come 0:17 out, and she's going to help me demonstrate various ways of progressing 0:21 the quad set. Now, the quad set is a very simple exercise, and I know some of you 0:26 who have never seen like a post-surgical knee, are probably going to 0:29 look at this exercise and go, "uhh?", but keep it in the back of your mind. One day you 0:34 will get somebody who has had a chronic history of knee pain, who has had knee 0:38 surgeries, and this exercise will become very handy. All the quad set is, you're 0:44 trying to get them to maximally fire their quad, by locking out their knee, or 0:48 squeezing it into the table. Alright, so let's see that Yvette. Squeeze your 0:52 quad, good, push your knee down on the table. If, for some reason, they're having 0:56 a hard time visualizing this, or they're not quite getting it, or they can't 1:00 quite seem to get their quad to fire, using a towel under the knee that they 1:06 can then squish, definitely helps. So I just want you to squish this towel. How 1:12 does that feel? Does that make it a little bit more of a stronger contraction? Okay, good 1:17 deal. So, from here, we can go in a few different directions, and I'm basically 1:22 to talk about three different ways to progress the quad set. We have a range of 1:26 motion, we have strength, and we have integration. So let's start with range of 1:31 motion, because you will get the individual who's shy of full extension. 1:36 For them, what you're going to do is, you're going to start with a larger 1:39 towel under the knee, so at least they have something to squeeze into, even 1:45 short of terminal extension, and they can start working on that quad activity. So, 1:48 go ahead and squeeze this towel. And then, what you'll do is progressively use 1:52 smaller, and smaller towels, or you could even just go, like, let's say, unroll the 1:57 towel one layer at a time, as their range of motion gets 2:02 better and better. From there, once they get all the way back down to the table, 2:07 you can then, for the last few degrees of extension, actually place the towel under 2:13 their ankle. Now there's space under here, so 2:17 that when they fire their quad, it's almost pushing them into hyper extension, 2:20 but since these individuals don't have terminal extension, they'll get to 2:24 progress all the way through to the very end. So that's our range of motion 2:29 progression. All our range of motion progression is, is using various height 2:35 towels, at first the knee, and then the ankle. Once we get back all of our range 2:42 of motion, maybe we want to start thinking towards getting some of our 2:46 quads strength back. Well, that's easy enough, we're just going to throw a half 2:51 foam roll underneath the knee so that we can get a little bit of range here, and 2:57 work on terminal extension. For resistance, I'm just going to use an 3:01 ankle weight. So, Yvette, go ahead and extend your knee, hold, we're going to 3:09 hold for two to four seconds, do 12 to 20 repetitions, just like we have with all 3:13 of our activation exercises. I think you can see, very easily, you could 3:17 progress by increasing the weight of the ankle weight, there's a couple other ways 3:22 to progress as well though. We could one, take this away, and use a full foam roll. 3:32 Now, instead of getting that last 5 to 10 degrees, maybe here we have 3:36 the last 10 to 20 degrees of extension. So that's going to make it a 3:40 little tougher, make them use a little bit more of that end range. You 3:46 might also want to think about where you're placing the ankle weight on the 3:50 tibia. Now, of course, if you place it up here, I know some of you are already 3:55 thinking towards your lever lengths. This is a shorter lever, so they should be 3:59 able to do more weight, and this should be harder. But there is one other thing I 4:02 want you to think about, there are different things happening at the knee 4:06 with those two positions. If I'm here, I have more of an anterior to posterior 4:12 shear force, and if I am here, I have more of a curvilinear force. I generally find 4:18 that people who have very touchy knees, or extension is really painful, using a 4:24 proximal load, even with the load up a lot higher, tends to be a lot easier on 4:29 their knee, and you'll get a lot more done without pain. Alright, so here's the 4:34 beginning of our strength progression, so now you guys have the range of motion 4:37 progression with the towel, you have the strength progression here, but we're 4:42 still not done. We still have to find a way to integrate quad activity, and 4:46 terminal extension, with our lower body synergies, and this is where I love 4:52 to geek out, so I'm going to show you some cool little tricks you can 4:55 use here. 5:02 I'm going to take away this foam roll, and all I'm going to do is, I've tied a 5:08 resistance band around the table leg here, I'm going to flip it over Yvette's 5:13 foot. Now I'm in position to add this terminal knee extension, this quad set, to 5:21 my tibialis anterior activation. You can think about that from a functional 5:26 standpoint on how important that would be during heel strike and gate. So if I 5:31 dorsifelx with toes curled, I squeeze the quad. Believe it or not, just the way 5:37 the knee is set up, right, just the way this whole system is set up, resistance here, 5:42 is actually making it harder here too. If she's extending, she has to extend this 5:47 whole fixed system, and as weight increases here, this also becomes harder. 5:54 So let's try that one more time, just to show them how we go. Usually I do this in 5:57 a stepwise motion from bottom to top, so I'm going to have our curl her toes, 6:02 dorsiflex and invert, squeeze your quad. I'm not done yet though. I'm going to have 6:08 Yvette go ahead and drop back onto her elbows, and this time I'm going to ask 6:13 her to curl her toes, dorsiflex, squeeze her quad, and then press her 6:20 whole leg into the table, really trying to get a good glute contraction. I 6:24 can even use my one of my favorite queues, which is squeeze your 6:27 glutes together like you're holding a dollar bill. Alright, let's go ahead and 6:31 start that all over. So, toes curled, foot up, quads tight, glutes tight. If they're 6:38 having a little hard time with a glute tight, give them something to squeeze. 6:42 Just like you did for the range of motion progression, I'd go ahead and put 6:46 a towel underneath their ankle, and now its toes down, foot up and in, quad tight, 6:53 and now she has something to squeeze with her glute, she can try to squeeze 6:57 her whole leg back down to the table that I've now created a little gap with, 7:00 with this towel. So there you go, don't stop with quad sets, quad sets are 7:07 just the beginning. Work on that terminal knee extension, those last few degrees 7:11 can make a huge difference. Work on strengthening and make sure you 7:15 have strength through that full end range. Make sure you're thinking about 7:19 integrating that terminal extension, and that quad activity, back into the 7:24 synergies of the lower body. And then, from here, there're a couple other 7:28 videos you might look at. I have a gluteus medius progressions, video where 7:33 I create an activation circuit where I almost use this identical exercise to 7:39 create posterior glide of the femoral head and acetabulum, hoping to reduce the 7:46 activity of the TFL, and increase gluteus medius activation. You can also check out 7:52 my VMO activation video, where I use something called a TKE, or total knee 7:56 extension, which is basically quad strengthening in a closed chain. So there 8:01 you go, whether you're working with a post-surgical knee, whether you're working 8:05 with that older individual with cranky knees, whether you're working with that 8:10 athlete who's kind of had that chronic runner's knee, you know lateral knee, 8:15 patellar tendonitis type knee pain symptoms, these exercises, integrated into 8:22 their warm-up activity before they start their higher intensity activity, can make 8:26 a huge difference over the long run. I hope you enjoy the video. Thank you 8:29 Yvette.
