Name: Quad Sets and Progressions
Uploaded: 2023-04-26T01:00:39.000Z
Duration: 8 min 36 s

English captions

https://stream.mux.com/RGqBEf5hqYs8Ww8j5BRkN02XF35n72Vji3gWEzWKqf4A.m3u8

Learn how to properly perform quad sets and progressions in this comprehensive step-by-step instructional video from the Brookbush Institute. This evidence-based video provides expert coaching on setup, positioning, alignment, and technique (including progressions and regressions). Safely enhance quadriceps activation, improve knee stability and control, and support optimal lower-extremity alignment and movement mechanics. Suitable for all fitness levels. Perfect for athletes, fitness enthusiasts, and rehabilitation clients seeking to reduce pain, improve performance, and restore optimal movement mechanics while reducing injury risk.

Introduction to Quadriceps Activation and Progression

Enhancing Range of Motion for Quadriceps

Strength Progression Techniques for Quadriceps

Integrating Quadriceps Activity with Lower Body Movements

Application of Exercises for Various Knee Conditions

Quad Sets and Progressions

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

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Tibialis Anterior Activation on a Table (reinforcing Heel Strike Mechanics):

Place the band over the foot, close to the ankle.

Ask your client or patient to dorsiflex and invert the ankle while flexing the toes.

Note: I prefer a 2:4:2 count (E:I:C) on this exercise to emphasize increasing strength at the new end range achieved with the ankle mobility exercises that preceded this activity.

While performing step 3, you can reinforce "heel strike synergy" by cueing quadriceps activation (locking the knee) and 

 activation (pressing the heel into the table or a towel placed under the heel).

Adjust the resistance so that 12-20 reps may be performed with optimal form.

This exercise may be progressed by using a stronger band

Trying to pull the band up with the whole leg: It is advisable to reinforce quadriceps activation (locking the knee) and 

 activation (pressing the heel into the table or a towel placed under the heel). Try to prevent the individual from using hip flexion and knee flexion to assist in pulling on the band, which may result in reinforcing compensation patterns that include 

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