An Integrated Approach is Always the Winner

by Terry Malone, PT, EdD, ATC, FAPTA

We greatly appreciate the interrelation of the hip and thigh and that unfortunately the body will avoid using some musculature when allowed to just function (quadriceps avoidance is the common term).

Data now says an integrated approach is required. So we really need to do isolated strengthening – open chain knee extension (sometimes this may be somewhat range specific). Our recommendations are as follows:

1. Perform a terminal extension with what is a maximal load from 30 degrees to full extension.
2. Perform another terminal extension, which will be a much larger load, from 90 degrees to 30 (two sets of 10 repetitions).
3. Integrate the above with isometric wall holds at approximately 30-45 degrees (hold as long as possible, walk around a short time and repeat; do this 3 times daily).
4. Include controlled lunges/squats and/or leg press allowing the full lower chain to be active.

With a meniscus patient, we would use the 90-30 degree open chain and avoid terminal extension.

Remember that an integrated approach has always been the winner!