Quadriceps function in running betting
However, in recent years, eccentric exercise has been used in rehabilitation to manage a host of conditions. Of note, there is evidence in the literature supporting eccentric exercise for the rehabilitation of tendinopathies, muscle strains, and in anterior cruciate ligament ACL rehabilitation. The purpose of this Clinical Commentary is to discuss the physiologic mechanism of eccentric exercise as well as to review the literature regarding the utilization of eccentric training during rehabilitation.
A secondary purpose of this commentary is to provide the reader with a framework for the implementation of eccentric training during rehabilitation of tendinopathies, muscle strains, and after ACL reconstruction. That being said, the concept of eccentric exercise is not new. To the authors' knowledge, the earliest investigation of eccentric versus concentric exercise was published in However, evidence is mounting to support its use in the treatment of muscle strains, with most of the rehabilitation literature relating to the use of eccentric training in rehabilitation after hamstring injuries.
Finally, eccentric training has been used in recent years as a part of rehabilitation following ACL reconstruction. The purpose of this clinical commentary is to present the physiologic basis for eccentric exercise and to discuss the evidence in support of eccentric exercise in the management of patients recovering from tendinopathies, muscle strains, and ACL reconstructions. Additionally, suggested implementation of eccentric exercise in the management of these conditions will be highlighted.
Although important to the clinician, the causes of these injuries as well as the mechanisms and origins of pain associated with these injuries are beyond the scope of this commentary. Further, other interventions used typically with these conditions such as stretching and modalities will not be discussed.
It is important to note that although the focus of this commentary details the benefits of eccentric training, it is the authors' suggestion that a comprehensive rehabilitation approach include both concentric and eccentric training. It is not the authors' intent to advocate exclusive use of eccentric training, but rather to point out the investigated benefits of and utilization of eccentric exercise as a part of a comprehensive rehabilitation program.
The faster a muscle contracts concentrically, the lower the tension it is able to generate. Thus, more waste products will be generated with concentric work, potentially leading to chemical irritation of nerves and eventually pain.
Abbott et al 5 measured oxygen uptake in subjects during bicycle ergometry. Positive work concentric exercise resulted in more oxygen consumption than negative work. Abbott and others 6 then performed a follow up study examining the relationship between oxygen consumption and work. Oxygen consumption was nearly three times larger at great force and low speed than at small force and high speed.
The above studies show that eccentric exercise results in less oxygen consumption, greater force production, and less energy expenditure than concentric exercise. A low metabolic rate and anaerobic energy generating capacity are needed to carry loads and maintain tension for long periods as is typical of tendons. However, the low metabolic rate results in slow healing after tendon injury. Based on data presented previously on the physiology of eccentric work requiring less oxygen consumption than concentric work, eccentric training may be ideally suited for the rehabilitation of tendinopathies.
In , Alfredson 16 performed, to the authors' knowledge, the first study investigating the effects of eccentric exercise on diseased tendons. The protocol utilized has since been used in most studies on eccentric training. In a prospective study of 15 athletes with chronic achilles tendinosis, three sets of 15 repetitions of bent knee and straight knee calf raises were performed, twice a day, seven days per week over 12 weeks. Athletes were told to work through pain, only ceasing exercise if pain became disabling.
Training load was increased in 5 kg increments with use of a backpack that allowed for the addition of the weight once training with bodyweight was pain free. All fifteen athletes returned to pre-injury levels of activity. Additionally, they had a significant decrease in pain with a significant increase in strength.
Positive changes in tissue structure and mechanical properties as a result of eccentric training have been previously described. Shalabi et al 17 evaluated 25 patients with chronic achilles tendinopathy before and after an eccentric program using the Alfredson et al 16 protocol. Subjects' tendon volume and intratendinous signal were measured via magnetic resonance imaging MRI.
Eccentric training resulted in decreased tendon volume and decreased intratendinous signal, which correlated to improved pain and subjective performance.. Reduction in fluid content within the tendon may suggest increased healthy collagen deposition. Langberg et al 18 found that Type I collagen synthesis increased after eccentric training in a group of twelve soccer players with unilateral achilles tendinosis, offering a possible explanation for the mechanism of tendon healing.
Ohberg et al 19 also found a decrease in tendon thickness and normalized tendon structure measured by ultrasound in most patients, both of which correlated with less pain, in a group of subjects with chronic Achilles tendinosis who were trained using the Alfredson et al 16 eccentric calf protocol.
Mahieu et al 20 found that eccentric training of the plantar flexors resulted in positive changes to the mechanical properties of the plantar flexor muscle-tendon tissue including passive resistive torque, dorsiflexion range of motion, and stiffness. Several authors have conducted studies that support the use of eccentric exercise in the treatment of a variety of tendinopathies. Jonsson and Alfredson 21 studied athletes with jumpers knee patellar tendinopathy who were randomized into either an eccentric or concentric exercise group and treated for 12 weeks.
Subjects in the concentric exercise group had undergone surgery or sclerosing injections. In another study of elite volleyball players with patellar tendinopathy, Young et al 22 found that subjects improved from baseline at 12 weeks and 12 months.
In contrast, Visnes et al 23 found no effect of eccentric training on jumper's knee in volleyball players during the competitive season. The lack of results from eccentric training in this study may be due to the fact that athletes continued to participate in volleyball during the competitive season.
Because rest is often advocated as a component of rehabilitation, failing to cease the aggravating activity may have perpetuated their injury and contributed to the lack of results. These reviews revealed that eccentric exercise may reduce pain and improve strength in patients with lower extremity tendinopathies, but whether it is better than other forms of rehabilitation has yet to be determined.
Therefore, no definitive conclusions can be made regarding whether or not the performance of eccentric exercise alone is superior to concentric-eccentric training or concentric-minimized training. Because the athlete is recovering from injury, the authors of this commentary advise that training load not be determined by a one repetition maximum 1 RM.
Further, some of the exercises are for targeted muscle groups elbow extensors for elbow injury and determining a 1 RM is not practical or advised. The Alfredson et al 16 protocol has been used in previous studies and appears to be a safe, effective method of implementing the eccentric training program for tendinopathies.
Unfortunately, the Alfredson protocol was described for and used in the treatment of achilles tendinopathies and their exact recommendations may not be appropriate for all tendons or regions. Rectus femoris muscle which is one of the quads extends up to the hip joint and helps with bending of the hip joint. These tendons are made up of strong connective tissues which surround the knee bones.
The quads also play a partial role in hip flexion. The patellar ligament tendon connects the quads to the tibia. Majority of the problems related to the leg are due to the overuse of the patellar ligament. Vastus medialis and vastus lateralis attach to the back of the femur with the help of linea aspera.
The majority of the quadriceps muscles are placed vertically downwards whereas the rectus femoris crosses both the knees as well as the hip. This helps in the flexion as well as the extension of the hip joint and knee joint. The location of the quadriceps muscles in the thigh determines their names.
These muscles lie in three different sections namely anterior, medial, and posterior. Rectus femoris which is a straight muscle is placed in the center of the thigh. Vastus lateralis is located on the outside lateral part of the thigh.
In the same way, vastus medialis is placed in the inside part of the thigh and finally, the vastus intermedius is placed between the vastus medialis and vastus lateralis. Injuries associated with the quadriceps Quads are part of the large muscle group which is responsible for various functions including running, walking, climbing stairs, etc.
All these functions generate quite a bit of force and may lead to an injury. Some of the injuries related to the quadriceps are discussed below. Dislocation of the kneecap Tearing of the quadriceps muscles can lead to dislocation of the kneecap.
This type of injury is mainly associated with fall during sports. Surgery is the only way this can be rectified followed by an extensive period of rest. This is next followed by the application of braces and physical therapy exercises to regain strength. The main function of the IT band is associated with abduction, extension, and laterally rotate the hip.
It also contributes to the process of lateral knee stabilization. Torsion of the IT band when it crosses the lateral portion of the kneecap can lead to iliotibial band friction syndrome. People affected with this syndrome may experience weakness or tightness of the quads associated with limitation in walking and running.
Patellofemoral stress syndrome The pain that occurs in the front of the knee and around the patella is due to this syndrome. This syndrome is related to arthritis where the quads stop functioning properly leading to swelling and stiffness in the kneecap.
This is a result of kneecap going out of position. The swelling and stiffness of the knee can also be associated with pain. Paresis and paralysis Problems related to the spinal cord can impact the functioning of the quads. Health conditions such as paralysis and the pinched nerve can lead to weakness in the quads and may result in problems with ambulation. This problem can be resolved when the underlying cause is rectified.
Benefits of healthy quadriceps Since the quads are involved in various functions, there are numerous benefits associated with a healthy quadriceps and these include: Extending and straightening of the knees — Since the knee is one of the most important parts of the leg, it is important to have a healthy knee joint. This is achievable with healthy quads. The positioning of the kneecap is determined with the help of quads. The ligaments connecting the kneecap from the quads protect the knee from getting injured.
Shock absorption — A large amount of friction is produced when you walk or run, this shock is absorbed by the quads and protects the leg from getting injured, particularly the knee joint. The wear and tear, as well as aging and health conditions like osteoarthritis , may cause pressure on the knees.
This pressure is managed by the quads by absorbing them. The quads provide the strength and power for the body to jump off the ground. Since the quads extend from the hip to the knee joint, they also play a role in stabilizing the hips during flexing and extending. They help you to maneuver quickly and change direction while walking or running.
They provide stability to the legs so that you do not fall down when standing, running, or walking. Side effects of quadriceps injuries Loss of function This is considered the biggest side effect of a quadriceps injury. As noted earlier, it is important for the quads to function properly to aid in various other activities.
You may be surprised to know that it is the quads that help you move around in the bed. A simple rolling over or even scooting in the bed requires the help of quads. They also help when standing up from a sitting position, walking up and down the stairs requires your quads to flex and contract appropriately. It is the quads which prevent you from falling when walking or running. It is now quite clear that an injury to the quads can alter various functions.
Knee pains Overuse, arthritis , and loss of cartilage are some of the causes of inflammation in the knee which is associated with pain. The pain may be excruciating depending on the severity of the injury. Severe cartilage damage requires knee replacement to correct the problem.
Patellofemoral joint syndrome This is again associated with pain in the knee which is the result of weak quads. This syndrome can highly limit your ability to exercise, walk up and down the stairs, as well as do squatting. Problems with posture The distribution of strength is altered when the glutes muscle that is present behind the legs become stronger as compared to other muscle. This occurs when people perform weighted squats without strengthening other muscles.
The ankle could experience an increased amount of spraining or twisting when the quads are weak. Contusions A contusion to the quads can occur when the muscle is directly involved in an injury. This type of injury is mainly associated with a sports injury. Contusion of the quads can lead to sharp pain, inflammation, and soreness of the quads.
How do I take care of my quadriceps? Healthy quadriceps relies on three main factors namely strength, flexibility, and balance and proprioception. You need to concentrate on these three aspects to improve the health of the quads. Strength — Exercise involving the hip and knee simultaneously is necessary to strengthen the quads. Since the quads extend from the hip to the knee, both these joints need to be worked upon.
Knees require simple exercises whereas the advanced hip exercises are required for the quads to strengthen and function appropriately. Flexibility — The quads need to be flexible enough to tolerate the wear and tear of the daily lifestyle.
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One is by isolating the quads with exercises that only work them, and the second is by selecting compound exercises that mostly involve the quad. If we frequently have tight quads and want to get them stronger, isolation exercises are great. If we want to get stronger overall and improve our running economy, compound exercises are best. The best quadriceps isolation exercise: Banded quad extension Why it works: this specific exercise has been shown to elicit near maximum quadriceps activity study.
If you know your quads are your weak link, this can be a great exercise to start building strength quickly. The best compound quadriceps exercises 1 — Rear Foot Elevated Split squats Why it works: this muscle strengthens the quads specifically and the legs overall. It also helps us identify and solve strength differences between our two legs.
Strength in all these muscles protects our knee and improves our running economy. You can try these exercises, and even build a custom, quad focused prehab routine in the Recover Athletics app. The Recover App helps runners fix aches and pains and prevent injury. Give the app a try today! Recover athletics is a team of runners, doctors, physical therapists, and entrepreneurs.
Here we will look at the anatomy of each of the quadriceps muscles, how they work, the quadriceps femoris functions and common injuries. Quadriceps Muscles Anatomy The quadriceps muscles group comprises of four muscles: Rectus Femoris: is the most superficial of the quadriceps muscles Vastus Lateralis: is on the outer side of the thigh, Vastus Intermedius: runs down the middle of the thigh and Vastus Medialis: is found on the inner side of the thigh Rectus femoris originates from above the hip, and three vastus muscles each originate from various places on the shaft of the femur, thigh bone The four quadriceps muscles pass down the front of the thigh and then join together near the knee to form the quadriceps tendon aka ligamentum patellae.
The quads tendon flows around the patella kneecap before finally attaching to the tibial tuberosity, by which time it is known as the patellar tendon. The tibial tuberosity is the knobbly bit on the front of the shin bone that you can feel about 1cm below the kneecap. Inserts onto the patella and tibial tuberosity. Vastus Medialis: originates from the intertrochanteric line and the medial side of the femur including the medial intermuscular septum and medial supracondylar line.
It attaches to the medial border of the patella, the tibial tuberosity and the medial condyle of the tibia. Vastus Intermedius: originates from the upper two-thirds of the femur, linea aspera and lateral supracondylar line. It forms the deep aspect of the quadriceps tendon inserting onto the tibial tuberosity.
Vastus Lateralis: originates on the front of the femur from the intertrochanteric line and inferior border of the greater trochanter.
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Vastus Medialis: originates from the intertrochanteric line and the medial side of the femur including the medial intermuscular septum and medial supracondylar line. It attaches to the medial border of the patella, the tibial tuberosity and the medial condyle of the tibia. Vastus Intermedius: originates from the upper two-thirds of the femur, linea aspera and lateral supracondylar line.
It forms the deep aspect of the quadriceps tendon inserting onto the tibial tuberosity. Vastus Lateralis: originates on the front of the femur from the intertrochanteric line and inferior border of the greater trochanter. It inserts onto the lateral margin of the patella and the tibial tuberosity. If you really want to get into the nitty gritty detail of quadriceps anatomy, use the links above to find out more.
Quadriceps Muscles Function The main function of the quadriceps muscles is to straighten the knee. As rectus femoris originates above the hip on the pelvis, it can also independently bend the hip. Here are some examples of what activities rely on quadriceps muscles function: Kicking A Ball: Rectus femoris comes into play when there is a need for combined hip flexion and knee extension Walking: The quadriceps muscles extends the leg as it swings forwards and then stops the knee from bending when the heel strikes the floor Patella Control: Vastus medialis is most active in the final stages of knee extension controlling the movement of the patella Stepping Activities: such as stair climbing Squats: the quads control the downward movement when squatting Standing On One Leg: all four muscles work statically to provide stability Lifting The Leg Off The Bed: Rectus femoris works particularly strongly when raising a straight leg Fun Fact: When simply standing, there is actually very little action in the quadriceps muscles, which is why if someone knocks your knee from behind, the knee suddenly collapses!
Think of your stride like a pendulum clock. Your leg is the pendulum which should move equally in front and behind your body at any speed. When we overstride, the pendulum is swinging more forward than it is backward, as we are not getting the leg behind us while running.
The next time you run, take a video from the side and look at what your pendulum is doing. To fully achieve the pendulum-like motion, we must fully extend the leg behind the body while running. There are a few reasons why a runner might not do this—the first being they might have tight hip flexors. In our culture today, we do a lot of sitting. In fact, the majority of runners need to incorporate a hip flexor stretch into their post-run or rehab routine. The second reason runners are unable to achieve full hip extension is due to a joint or tissue mobility issue with the ankle and big toe.
If we look at the similarities between all of these injuries, we see pain on the front side of the leg. This injury pattern circles back to what we discussed earlier; landing with the leg in front of the body at a high loading rate. If the athlete used efficient recruitment of the glutes, this suboptimal run form would not be evident as fatigue set in. Correcting Inefficient Form The next time you are faced with an athlete who presents with any of the injuries we discussed earlier: forward flexed posture while running, overstriding, form breakdown in races, or an overly arched low back.
Remember to evaluate what is going on at the hips.
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