After ACL surgery, your body compensates on quad sets by twisting the hips and lifting them off the table — using body weight instead of the quadriceps to straighten the knee. To fix this, keep your hips square and flat, and focus on activating the quad from its tie-in point at the hip all the way down to the knee. One properly executed rep is worth ten sloppy ones.
Last week, we caught up with a number of pro athletes in a training facility just outside of Dallas.
One of the athletes had been instructed to do quad sets, but was having a difficult time activating the quad — due to a few common compensation patterns that set in after knee surgery.
Quad sets are probably familiar to anyone who has gone through ACL rehab. They're commonly used early on to rebuild the neuromuscular connection to the quadriceps. You sit on a table with your leg extended and contract the quad as hard as you can.
Simple, right?
Your Body Finds Ways To Cheat
Even with an exercise this simple, there are plenty of ways for the body to cheat. And when you cheat, you aren't spending your time rehabbing as efficiently as possible. You aren't getting the most out of every rep.
You're cheating yourself. And you might not even know it.
Most trainers and PTs are busy. They can't always take the time to watch each rep or coach you on how to know when the body is compensating.
As I watched this athlete perform a few reps, I noticed he was getting very little quadriceps activation, and the reps weren't providing much benefit.
Why? Because the body believed it had one task: to straighten the knee. It didn't care — or know — whether it was using the quadriceps or not.
Compensation Pattern #1: Hip Twisting
The first thing I noticed: the athlete's body was twisting the hips to put more body weight into the knee. Rather than straightening the knee with the quadriceps, he was forcing it to straighten with body weight.
I reviewed the anatomy of the quadriceps with him and pointed to each part of the muscle. The quadriceps has tie-in points around the knee and on the front of the hip. If your goal is to fully activate the quad, you need to keep the hip back and focus on activating it all the way up to its closest point at the hip.
Even if it feels like the muscle won't fire, the practice of focusing on a great rep will serve you far better than allowing the body to cheat.
Compensation Pattern #2: Hip Lifting
The athlete tried a few more reps with his hips square. Much better — but still not perfect. The body had figured out another way to cheat.
Now that he was keeping his hips square, he was lifting them off the table and pushing into the knee with his upper body to straighten it. I pointed this out and he corrected quickly.
When You Know What To Watch For, Everything Changes
Armed with the information of how his body was trying to cheat, he was able to resist those temptations. After a few focused attempts, the quadriceps started activating more fully — from the tie-in at the hip all the way down to the knee.
The exercise went from "going through the motions" to truly retraining the quad to activate.
If you can't see what your body is doing wrong, you can't fix it. Compensation patterns after ACL surgery are the brain's way of protecting the knee — but they slow down your recovery. Every rep done with proper form is worth ten sloppy ones.
How Many Reps Are You Wasting?
If I hadn't taken those few minutes with this athlete, how many reps of quad sets would he have performed without knowing how to get the most out of every single one? How far would that have set him back?
Most athletes have no idea whether they're doing everything correctly throughout rehab. They just hope things go smoothly.
When the rehab process takes longer than expected, they get the same canned response: "everyone's different."
Is that really what you want to chalk your recovery up to? Or are you going to make sure you uncover every small detail that helps you get the most out of every minute?
Want To Know What Most Rehab Programs Miss?
Download our free report on the 7 biggest challenges in ACL recovery — and the proven process designed to overcome each one.
Download Free ReportEvery Detail Matters
This is an example of the promise upheld by Accelerate ACL to every athlete we work with. You get a coach who will be with you every step of the way — making sure every minute of the rehab process counts.
Since we work with a limited number of athletes each month, no detail goes unturned throughout the recovery process. The neuromuscular training system we use restores the connection between brain and muscle with precision — the part most rehab programs skip entirely.
At the end of the day, are you going to be 100% certain there was nothing else you could have done to ensure the best recovery possible?
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Always consult your physician or physical therapist before starting or modifying any exercise program, especially after ACL surgery.