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Your guide
What you'll learn
How To Improve Quadriceps Activation!
The quad set is paramount to re-gaining quadriceps activation. After an injury (which includes surgery), there is lot of swelling in the knee that accumulates. This swelling leads to a phenomenon called arthrogenic muscle inhibition, in which there is an inability to completely contract a muscle despite no injury to the muscle or innervating nerve. This quadriceps activation failure is caused by neural inhibition. It's essentially the nervous system not allowing the normal pathways of muscle activation to occur. The best evidence to date (Systematic Review from Sonnery-Cottet 2018) supports the use of therapeutic exercise and icing to improve quadriceps activation. Our favorite exercise to re-teach patients quadriceps activation is the all-mighty quad set. The quad set facilitates lots of quadriceps activation practice and helps with the development of a new “brain-body connection”. Follow this foolproof guide provided in this article to wake your quad back up!
Exercise 01 of 05
Exercise demonstration
7 Tips to Wake Up Your Quad Surgery
Lay on the ground or table and place a rolled-up towel/shirt under your knee. This will act as a lever which will make it easier to activate your quadriceps muscle. Attempt to squeeze your quadriceps muscle using these cues:
- Really focus on squeezing your quad
- Sometimes touching the muscle, massaging it, or hitting it can help
- Think about moving your kneecap up and into your hip socket
- Push your knee down into the towel roll
- Lift your heel off the table
- Move your shin bone in the shape of a “J” by moving your knee down and your heel up at the same time
- Squeeze both quadriceps at the same time Happy quad setting!
Improve Your Quadriceps Activation Following Surgery To Improve Your Knee Extension
In order to not only achieve adequate straightening of your knee, but also keep it, you need a strong quad! This program is for anyone looking to truly [P]Rehab their knee before surgery OR work on regaining their knee extension after a surgery or injury. It’s appropriate for anyone regardless of current fitness level and will build you from the ground up to tolerate the end ranges of knee extension. For more about this program click HERE.
Regaining Knee Extension After Surgery
Other Quadriceps Activation Exercises
Have trouble with the exercise above? Don't worry, below we will show you some other quadriceps activation exercises that are great for building muscle in this area of the body!
Exercise 02 of 05
Exercise demonstration
Straight Leg Raise
View exercise instructions
- HOW: Start by lying on your back. Bend your opposite knee. The first step is to perform a very strong quadricep set by squeezing your thigh as hard as you can. Keeping this constant squeeze, tighten your core muscles and then lift your leg up into the air. Think of making your leg as long and as straight as you can while lifting it. Then slowly lower back down to starting position and repeat.
- FEEL: You should feel an entire contraction of the front thigh muscles and your leg working hard.
- COMPENSATION: You should not be feeling these exercise exclusively in the front of your hip. If you only feel the muscles in the front of your hip working, it means you are not squeezing your thigh hard enough or you're are not squeezing the quads when you are lifting your leg. Maintaining the thigh squeeze is the most important part of this exercise!
LISTEN: HOW TO BEGIN STRENGTH TRAINING
Exercise 03 of 05
Exercise demonstration
Prone Terminal Knee Extension - Hips Down
View exercise instructions
- HOW: Get set-up laying on your stomach with your elbows under your shoulders and hips supported on the ground. On the side, you want to perform the exercise, point your toes towards you and start with your knee on the ground. Begin the exercise by squeezing your quads to fully straighten your knee, hold that position, then return to starting position and repeat.
- FEEL: You will feel your quad muscles working with this exercise along with a calf and hamstring stretch behind your knee.
- COMPENSATION: Focus on getting your knee fully straight while keeping the rest of your body still.
Exercise 04 of 05
Exercise demonstration
Terminal Knee Extension - 3 Way
View exercise instructions
- HOW: Get set-up standing with a band around and above the knee with the band anchored in front of you. You will perform this exercise in 3 different positions: with your feet side by side, with your working leg in front of your other leg, and with your working leg behind your other leg. To perform the exercise, put tension on the band so that it wants to pull your knee forward, let your knee bend and your foot go onto the toes followed by squeezing your quad, pushing your heel into the ground, and pushing your knee back until it is fully straight.
- FEEL: You will feel your quads working with this exercise and maybe even your glutes. You may also feel a stretch behind your knee in the calf and hamstring region when your knee is straight.
- COMPENSATION: Don’t let your butt go back and your hip bend when you straighten your knee. The only thing moving should be your knee going backward!
Exercise 05 of 05
Exercise demonstration
Long Arc Quad - 0 to 90 deg
View exercise instructions
- HOW: Get set-up seated on the edge of a surface with your feet hanging off at a 90˚ angle. Place a band around your ankles. On the side, you want to perform this exercise, kick the leg straight until your knee is fully straight, hold for a moment, then slowly return to starting position and repeat. Your other leg shouldn't move to keep tension on the band.
- FEEL: You will feel your quadriceps, the muscles on top of your thigh working with this exercise.
- COMPENSATION: Do not move the other leg, do not move the rest of your body, limit the motion to your knee
Closing Thoughts
The quadricep muscle often "shuts down" after a surgery or injury. Waking it up with frequent exercise and consistency is crucial for knee extension. If you are in need of some more formal guidance, be sure to check out our Knee Extension Mobility Program that can optimize your quad activation!
Improve Your Quadriceps Activation To Improve Your Knee Extension
Knee extension is not just a recommendation it is needed! Hypothetically, you could walk on a bent knee but this is going to waste energy and ultimately limit your movement endurance. Instead, let's get you moving efficiently by achieving and keeping full knee extension.
About The Author
Michael Lau, PT, DPT, CSCS
[P]rehab Co-Founder & Chief Product Officer
Michael was born and raised in Northern California but now currently resides in Sunny SoCal ever since attending the University of California, Los Angeles as an undergraduate majoring in physiology. After his undergraduate studies, he received his Doctorate in Physical Therapy from cross-town rival the University of Southern California. As a licensed physical therapist with a strong background in strength and conditioning, Michael likes to blend the realms of strength training and rehabilitation to provide prehab, or preventative rehabilitation, to his patients. A common human behavior is to address problems after they become an issue and far often too late, which is a reactionary approach. He believes the key to improved health care is education and awareness. This proactive approach-prehab-can reduce the risk of injuries and pain in the first place. He is a huge proponent of movement education and pain science. Clinically, he has a special interest in ACLR rehab and return to sport for the lower extremity athlete.