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