hey so in today's video what I want to
talk about is terminal knee extensions
so this is a common exercise that a lot
of people use to get the VMO and to
drive knee extension so if you just do a
few so this is the kind of traditional
way of doing it or people are pushing
back and again they're squeezing their
their quad. Now, I've got a little bit of
an issue with that because I think
that's driving a very bad pattern that I
actually spend the vast majority of my
time trying to get people to avoid, okay
so if you look at osteoarthritis
it's kind of patients, a lot of people
with knee pain a lot of people a lot of
lower limb issues and I'll go into this
a lot and I spend a lot of time the
first hour of my return-to-play
course is actually spent telling people
why we should avoid this and I've got
plenty of other videos on that if you
want to learn more with that but to make
a long story short as that foot hits the
floor what we wanna discourage is
actually, the knee snapping back because
there's a lot of disadvantages to the knee
snap and back okay so when the knee
snaps back the knee joints doing work
obviously but what it then does is it
puts the glutes at a disadvantage so
we're putting the glute max essentially
into a passive hip extension so if the
knees snapping back early then it's very
very hard for the glute to actually do
work so I spend a lot of time both with
you know athletes, professional athletes
but also here in the clinic actually
helping people to subconsciously delay
knee extension because if we delay knee
extension then the hip can actually do
work, okay now don't misunderstand me
there's nothing wrong with knee
extension but what I when I want knee
extension is just like gait okay so as
I'm running or walking
I want the hip to do a lot of work okay
you and the articular muscle want that hip
to do a lot of work and then I want the
knee to extend okay so I I'm okay with
the knee extending but I want the knee
to extend about here whereas I think a
lot of people even a very bad stimulus
to the brain there's a lack of
coordination happening with this
exercise where you're just basically
trying to pump the VMO, I'm a little
bit skeptical if I'm honest about the
carryover to an exercise like that so a
better
option in my opinion that I would use
with an athlete or with a patient is as
that foot hits the floor okay I want to
be pushing through the foot okay as I
come true and then I want the knee to
extend here okay so an option that we
would do is, Shanes just gonna step
forward with his left leg but the big
thing that I'm cueing Shane here is I
want his knee extension to be driven
from the floor and the foot okay
because that's what's gonna have to
happen subconsciously in real life in
the vast majority of tasks that people
do so as you pass through here Shane and
I want good intent imagine you're
squashing an orange through that mid foot and
forefoot as you come true and what's
gonna happen is Shane's naturally gonna
get the knee extension to happen without
consciously having to to do the movement
okay when we talk about using this
exercise for ACLs it doesn't quite make
sense to me okay because the ACL is
heavily reliant on especially the medial
hamstrings okay so in this movement here
we're essentially getting the quads to
do a lot of work the hamstrings are
doing very very little when we go back
to this exercise but pushing through the
mid-foot and forefoot we're getting a
lot of proximal gastro, distal
hamstring to resist knee extension to
allow the hip to do work when the hips
done work then the quad can finish the
movement okay so I think that's a very
very important differentiation so Shane is
still gonna feel a lot of quad but the
intent is through the foot all the time so
we can still drive the knee extension we can
still get the quad to fire okay but
better still we're getting the quad to
fire while the hip does work while the
hamstring and gastro are also doing work
okay so if you know anything but my
approach it's a very coordinated
approach I think it's a step before
strength okay but most importantly in a
very simplistic view all I want,  is I want
everything to do its job I'm not big
into isolating muscles I want everything
to be able to do its job in three planes
of motion and tolerate load, tolerate the
bodyweight and I think this exercise is
a much better choice that's going to
a lot of those boxes from a coordinator
point of view and I just feel obviously
it's very hard to prove this but I feel
the carryover is much much better we use
this and we've got a lot of progressions
to go from this position so the key
coaching cues here is, as Shane
goes he needs a lot of good intent from
that mid-foot the more intent he has
from the midfoot and forefoot the longer
he's gonna delay knee extension but
there's a nice co-contraction at the
knee so the quad is still firing all the
quad muscles are still firing but
they're firing with the hamstring and
with the gastro to keep that knee nice
and safe if I have a patient that's
walking and we get this knee snapping
back like you see with a lot of OA
patients the knee joints doing a lot of
work we produce force at the quads
lot of force going down into that knee
joint without the hamstring and the
gastro helping okay whereas we do it
this way where we have got good
intent through the foot, the midfoot and
forefoot then we're also getting the
hamstring and gastro to be active while
we're still getting good stimulus from
the quad okay it's a very simple change
okay but we're getting everything
working rather than trying to isolate
something that I personally feel it's a
very very bad pattern that I spend a lot
of time the vast majority of my time
with lower limb injuries, is I
actually spend the vast majority of my
time trying to get people moving away
from that and you see this a lot with a
lot of exercise when people are doing
all these fast exercises the knee snaps
back if the knee snaps back then the hip
is gonna find it very very hard to do
work if we can delay knee extension then
we're putting a hip in the best possible
lenth tension relationship to actually do
work and then the knee can can finish
the movement okay so it's just something
to consider okay it's a small change
that in my opinion is gonna have a
massive impact in your clinical practice
so you can still get what you want
we're just making a small change by
looking at the physiology by looking at
movement by looking at how the brain
works look at how the brain interacts
with the spinal cord and the peripheral
tissues and I just think the value in
this exercise it's a lot greater than
just doing terminal knee extensions so
give it a try see what you think
let me know in the comments and as I
said I'd be more than happy to answer
any questions
you
