Dr Ian M Davison
MBBS (Hons), FRCS, FRACS, FAOrthA
ORTHOPAEDIC SURGEON
Ian M Davison Pty Ltd ABN 93002 954 663
Hip and Knee Replacement Surgery
Arthroscopic Knee Surgery
General Orthopaedic Limb Surgery
QUADRICEPS EXERCISES
The quadriceps (quads) are the four muscles that make up the bulk of flesh on the front of
the thigh. Their contraction causes the knee to straighten, and controls the movement of
the kneecap. They are especially active in cycling, running, climbing, jumping and
kicking.
Almost any acute knee injury is associated with some degree of quads wasting. This
occurs remarkably quickly and may be evident as early as four days after injury. The
weakness that is associated with quads wasting may result in pain under the kneecap, a
knee that tires easily, or even a tendency for the knee to give way. Only an obsessive
daily commitment to a quadriceps strengthening exercise program can restore bulk
and strength to this muscle: even then, the wasting which occurs in one week may take
months to build up again.
Exercises which straighten the bent knee against resistance exercise the quads, but put a
lot of pressure across the kneecap, and may make symptoms of knee pain worse. For this
reason cycling, squats, jumping, climbing and kicking are not recommended exercises to
build up wasted quads. The best exercise program is one of graduated static resisted
exercises, performed with the knee very slightly bent. They are graduated because they
are increased on a daily basis; static, because there is only very limited movement in the
knee in performing the exercises; resisted, because they are performed with weights
against gravity. These exercises can be performed without the need for special
equipment, time off work, supervision, instruction or expense.
They are done in the following way:
Take a 2 litre plastic milk container, and fill it with 2 litres (2kg) of water. Thread a
belt through the handle of the bottle, and close the belt to make a loop. Lie flat on a
bed or bench with your ankles hanging over the bottom end, place a rolled towel
under your knee and thread your foot through the loop so that the bottle of water
hands freely from your ankle. Lie back with your head on a pillow and your hands
folded under your head, and with the foot twisted outwards and away from the other
foot. Now straighten the knee by contracting the quads, without lifting the knee from
the rolled towel. This should cause the ankle to rise slightly from the end of the bed,
together with the belt and bottle of water. Count off 10 seconds slowly, then lower
the ankle to the bed and rest for 5 seconds before repeating the exercise. Start by
doing 20 such exercises in the morning, and a further 20 in the evening. This should
take no longer than 5 minutes per session.


Graduate the daily level of exercise by gradually adding more weight with a second
bottle of water, to which a small amount of water (say 300mls or 300 grams) is added
each day until you can no longer comfortably lift the weight. Then, instead, increase
the number of exercises performed at each session, or lengthen the amount of time for
each successive lift.
Finally, calculate and record the amount of work you have done each day by the
formula:
Work = sessions x weight x exercises x seconds

For example, a 10 second lift performed 20 times lifting 2kg for 2 sessions every day
represents 10 x 20 x 2 x 2 = 800. The result may be charted to demonstrate that you
are working harder each day, and the chart compared with your clinical improvement.
Finally, remember: no amount of surgery or medicine can build up muscle. It is your
responsibility alone. Furthermore, what takes only a week to waste away, may take
months of hard work to build up again. DON’T DELAY.