Quad Sets for Quadriceps Activation

Quadriceps inhibition or the inability to feel/activate your quadriceps after major knee surgeries like ACL reconstruction can be a very frustrating early on in the rehabilitation process. How is it possible that you can’t squeeze your quad?! Luckily for you, we’ll show you our top 7 cues and expert tips to increase your quadriceps activation and get it firing again!

Arthrogenic muscle inhibition is a process in which 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 all mighty quad set.

The quad set is paramount to getting re-gaining quadriceps activation. After an injury (which includes surgery), there is lots of swelling in the knee that accumulates. This swelling leads to a phenomena called arthrogenic muscle inhibition, in which there is an inability to completely contract a muscle despite no injury to the muscle or innervating nerve. To combat this, lots of practice and developing a new “brain-body connection” is required. Follow this foolproof guide to wake your quad back up!

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:

  1. Really focus on squeezing your quad
  2. Sometimes touching the muscle, massaging it, or hitting it can help
  3. Think about moving your kneecap up and into your hip socket
  4. Push your knee down into the towel roll
  5. Lift your heel off the table
  6. Move your shin bone in the shape of a “J” by moving your knee down and your heel up at the same time
  7. Squeeze both quadriceps at the same time Happy quad setting!

Looking for other “foolproof exercise tutorials?” Check out our entire exercise library!

Also, check out this video from our good friend Lenny Macrina who did a critical review on the efficacy of different treatments for treating arthogenic muscle inhibition!

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Arthrogenic muscle inhibition after #ACL reconstruction: a scoping review of the efficacy of interventions Sonnery-Cottet et al BJSM Sept 2018.⠀ .⠀ This paper looked to 'determine whether reported therapeutic interventions for arthrogenic muscle inhibition (AMI) in patients with ACL injuries, following ACL reconstruction, or in laboratory studies of AMI, are effective in improving quadriceps activation failure when compared with standard therapy in control groups.'⠀ .⠀ 780 potential articles were identified. 20 met the inclusion criteria.⠀ .⠀ Using the GRADE approach, there was moderate-quality evidence for the efficacy of cryotherapy in the treatment of AMI.⠀ .⠀ Moderate-quality evidence for the efficacy of exercise in the treatment of AMI.⠀ .⠀ Surprisingly, there was low-quality evidence for the efficacy of NMES, which seems to be pretty accepted treatment but vibration, ultrasound, and TENS also demonstrated low quality evidence.⠀ .⠀ The available evidence does not support taping or bracing in AMI.⠀ .⠀ They mentioned active release or local anesthetics as other modalities that have no affect on quadriceps inhibition.⠀ .⠀ No mention of blood flow restriction training, which would've been interesting. #BFR⠀ .⠀ What do you think? Does this study match what you do in your clinical practice? Tag a friend or coleague who may be interested in this open access paper…thanks!⠀ .⠀ #knee #kneepain #kneesurgery #acl #aclsurgery #ROM #physio #physiotherapist #physiotherapy #physicaltherapy #physicaltherapist #athletictraining #athletictrainer #ATC #PT #teamchampion #dptstudent #lenmacpt

A post shared by Lenny Macrina MSPT, SCS, CSCS (@lenmacpt) on


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