This came up recently in the comment section.
I remember doing quad sets during my recovery, and my knees didn't like them much. So I stopped doing them and got better anyway. Because of my personal experience, I never really looked that closely at quad sets.
Doug Kelsey does so here, though, in "The Ultimate Guide to the Most Misunderstood Exercise for Knee Pain." He makes some interesting observations:
(1) That quad sets are sometimes prescribed for a mistracking patella. And he dashes some cold water on doing quad sets for this reason.
(2) That quad sets are sometimes recommended to strengthen the thigh muscles. But, alas, they're not really great at this, because they generally don't stress the muscle enough.
(3) That quad sets are definitely useful for something else: thickening the synovial fluid that helps cushion impacts in the knee joint and just makes movement easier in general.
For this use, he advises 100 repetitions a day, in sets of 10. Patience is helpful too: beneficial effects probably won't appear for two months.
What is the science behind this? I'm always curious about that. It appears that the seminal study, which Kelsey himself cites, goes back to 2003. The sample size was a bit small (20 subjects, with a total of 28 bad knees), which isn't optimal, but what they found was without a doubt impressive.
The subjects did an isometric exercise that involved keeping their leg straight and raising it. Patients were told to do the exercise 90 times a day. Joint fluid was taken from their knees at the beginning of the trial and after 12 weeks.
What researchers discovered:
Joint fluid viscosity increased from 45.8±7.6 to 59.8±8.6 mPas (P<0.05). In contrast, there were no significant changes between at baseline and after 12 weeks in the patients without any treatment.
A roughly 33% improvement is really good. Note that these aren't exactly quad sets that the patients did, but I have to assume the benefits are similar.
Anyone out there who has a story to share about quad sets, good or bad?
I am doing quad flickers and quad sets at 50% engaging core and glutes as described by Kelsey. The quad flickers helped as I think my quad had been inhibited and was not firing properly. I'm doing the quad sets for the possible synovial fluid effect as you describe. Also knee sliders 10-20mins per day. I'm early into this journey and so am not sure I see an effect as yet. I would have thought walking has a good effect on synovial fluid also.
ReplyDeleteI don't think that you can build quads this way (unless very weak) and not enough to protect the knee but I think it's good if the muscle has been inhibited eg due to swelling. It seems unlikely that you can isolate VMO either as the quads are all innervated by the same nerve.
I think if they don't exacerbate symptoms due to strength or volume then they do no harm and have potential gain.
I originally did too many and symptoms increased but this may have been also as I was doing too much during the rest of the day.
I find your book useful as you say that during your initial months, you were not sure if you were improving or not and it was by month 7 that you knew your plan was working.
Lindsay... What are quad flickers?
DeleteSorry, I missed this. Just watch the quad and contract it really quick- like over a second. When I started this, I was alarmed that I was finding it difficult. It was good to switch on the muscle.
DeleteThanks Lindsay!
DeleteI have done so many quad sets that I shudder at the term "quad sets." I'm pretty sure that just hearing that term makes hives instantly appear on my body. I'd hate to even think how many since a car accident 21 mos ago resulting in a fractured patella, dislocated knee cap, and a lot of cartilage damage. 3 therapists later I still say they just aggravate my knee pain. All 3 have had me do quad sets. I sometimes feel I am in Therapy Hell.
ReplyDeleteI believe that walking and responsibly increasing speed with time will thicken the synovial fluid as well.
ReplyDeleteYes...still on crutches here though.
ReplyDelete