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284 | Why Hamstring Co-Activation Might Be Blocking Your Knee Extension · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Robbie Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:00
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:06
  SPEAKER_00: So I got a question this week, and it's actually one that I get this version of this question all the time.
• 1:14
  SPEAKER_00: Get it from athletes who are stuck trying to get their quads to fire, um, stuck trying to get that last little bit of extension back or their early post-op and just can't really get that quad to fire.
• 1:26
  SPEAKER_00: And I get it just as much from the PTs and coaches inside our ACL athlete mentorship or messaging me, emailing me.
• 1:34
  SPEAKER_00: People who are managing this exact scenario with their own ACL athletes and they're hitting the same wall.
• 1:40
  SPEAKER_00: So if you're dealing with this right now, you might be staring at your kneecap, trying to do a quad set.
• 1:47
  SPEAKER_00: You're trying to turn it on, nothing's happening, right?
• 1:51
  SPEAKER_00: Or maybe you're fighting the last few degrees of that knee extension and something keeps kind of grabbing before your quad ever really kicks on, or you get any activation, or maybe you get a little bit of a twitch, but you feel like you're doing something.
• 2:07
  SPEAKER_00: I want you to know, guys, this is not rare.
• 2:10
  SPEAKER_00: You're actually more the majority in this case.
• 2:13
  SPEAKER_00: Most people have a hard time doing this post-op, post-injury, and it's going to be something that a lot of people need to work through.
• 2:22
  SPEAKER_00: And this is not you doing something wrong.
• 2:25
  SPEAKER_00: This is one of the most common blind spots, I would say, in ACL rehab, in particular of getting the quads to activate, getting that knee extension back.
• 2:34
  SPEAKER_00: It's one of the biggest and earliest milestones we're trying to hit.
• 2:38
  SPEAKER_00: And today I want to show you exactly why it happens and some things that you can actually do about it.
• 2:45
  SPEAKER_00: And we're going to talk more in particular about one thing that is about hamstring coactivation that plays into this.
• 2:52
  SPEAKER_00: So here's the thing everybody is staring at the front side of their knee.
• 2:57
  SPEAKER_00: They're looking at their quads, they're looking at their knee.
• 3:00
  SPEAKER_00: Well, of course, because you can't look at the backside as much.
• 3:03
  SPEAKER_00: But with that said, that's where the attention goes.
• 3:06
  SPEAKER_00: Quad activation, knee extensions, quad sets, terminal knee extensions, right?
• 3:11
  SPEAKER_00: That's where all of our focus is, and rightfully so.
• 3:14
  SPEAKER_00: Like we're trying to get the quad, the number one thing that is important in this that coincides with your extension.
• 3:23
  SPEAKER_00: That's the thing we're chasing after ACL reconstruction.
• 3:26
  SPEAKER_00: We're also trying to get the swelling down, the pain, all those things that are really important.
• 3:30
  SPEAKER_00: But I would say knee extension and quad activation are two of the important big rocks post-op post-injury.
• 3:39
  SPEAKER_00: But because we're so locked in on the front side, sometimes we can forget checking the back side.
• 3:44
  SPEAKER_00: The antagonists, the hamstrings specifically.
• 3:48
  SPEAKER_00: Now, the calves also play into this, but I'm gonna mostly focus on the hamstrings here.
• 3:53
  SPEAKER_00: And just for a review, the hamstring muscle group is the thing that extends your hip and also flexes your knee.
• 4:03
  SPEAKER_00: And your calves are going to point your toe down or plant reflexion, and they're also going to help bend your knee too, because we have our gastrognemius that crosses the knee joint that also assists with knee flexion.
• 4:17
  SPEAKER_00: So those two muscles are technically the antagonists to the quadriceps, which is your front thigh muscle.
• 4:25
  SPEAKER_00: And so that's the thing that's important here to understand from an anatomy and a physiology standpoint, because that's going to influence the direction of where we go from here.
• 4:34
  SPEAKER_00: And so the thing is that the hamstrings, they're quietly kind of running the show in the background a little bit, especially post-op.
• 4:42
  SPEAKER_00: And it doesn't always get assessed.
• 4:45
  SPEAKER_00: You might have some stretching in the mix, but it's not necessarily assessed fully in terms of when you're post-op.
• 4:52
  SPEAKER_00: It's kind of on the back burner.
• 4:54
  SPEAKER_00: And nobody's really paying attention to it, especially because the quad is the show for the most part, the knee extension.
• 5:01
  SPEAKER_00: So let's talk especially about why the quad shuts down in the first place.
• 5:06
  SPEAKER_00: And I've talked about this before.
• 5:08
  SPEAKER_00: AMI is a very hot topic in this space, and for good reason.
• 5:12
  SPEAKER_00: That is orthogenic muscle inhibition.
• 5:16
  SPEAKER_00: And this is something that we are learning more and more about.
• 5:19
  SPEAKER_00: We still don't know enough about it, but we are learning more that the ACL injury is more than just a knee injury.
• 5:26
  SPEAKER_00: It is a neurological injury as well.
• 5:29
  SPEAKER_00: Um, your knee doesn't necessarily fully trust itself yet, especially after the injury and especially after the surgery.
• 5:35
  SPEAKER_00: There's swelling, there's trauma, there's pain, there's a new graft after the surgery, typically.
• 5:42
  SPEAKER_00: And your brain, in its own way, decides to protect that joint by turning the volume down on your quads.
• 5:50
  SPEAKER_00: This has a name, as I had shared, and that's the orthogenic muscle inhibition or AMI, right?
• 5:56
  SPEAKER_00: And so it'll just kind of turn down the output of the quads.
• 6:01
  SPEAKER_00: And a lot of times what happens is that the hamstrings actually are the ones who are gonna turn up the volume a little bit.
• 6:07
  SPEAKER_00: It's gonna get a little more protective.
• 6:09
  SPEAKER_00: It's very similar to when someone injures their lower back, it's not like their low back muscles relax.
• 6:16
  SPEAKER_00: They actually tense up, they go to protect that joint.
• 6:19
  SPEAKER_00: Everything gets really tight and stiff.
• 6:21
  SPEAKER_00: Same thing, you hurt your neck.
• 6:23
  SPEAKER_00: It's not like your neck is super loose.
• 6:25
  SPEAKER_00: It's actually gonna be protected if you hurt your neck or you wake up weird, like everything's kind of taut and stiff.
• 6:32
  SPEAKER_00: The same thing here at the knee joint that can happen, right?
• 6:35
  SPEAKER_00: It's it's very similar where the muscles are going to protect because that nervous system is noticing some sort of threat, some sort of discomfort.
• 6:44
  SPEAKER_00: And so this is something that we are still trying to figure out in terms of why the quads shut down so much, especially for AMI.
• 6:52
  SPEAKER_00: And the one thing that's I think really important with this is that we can't just say it's weakness and it's not necessarily a lack of effort, like you're trying, but this is a nervous system-related thing, it's protective, and it's something that is very common with a lot of different injuries, but especially notable for the knee injury and especially for post-ACL reconstruction.
• 7:16
  SPEAKER_00: Now, here's where it gets interesting.
• 7:18
  SPEAKER_00: So I saw a study last month that came out in uh IJSPT, and this is something where I think is helpful from basically showcasing this hamstring coactivation, and it really lines up with the clinical side or anecdotal side.
• 7:36
  SPEAKER_00: So I just want to share some of this study, and I'll make sure to put it in the show notes as well in case you want to check it out.
• 7:41
  SPEAKER_00: But it's a 2026 study from June.
• 7:44
  SPEAKER_00: Researchers looked at 30 men, they had hamstring grafts, which I think is just a little bit of a limitation with this, but just roll with me here.
• 7:54
  SPEAKER_00: They were roughly two weeks out from ACL reconstruction, and they want to see what's happening with the connection between the brain and the muscle early on.
• 8:04
  SPEAKER_00: So they used some EMGs to look at some of the electrical activity of the quads and the hamstrings.
• 8:10
  SPEAKER_00: And so two things showed up when they looked at this.
• 8:14
  SPEAKER_00: First, the the quad shut down, the input to the quad dropped somewhere between 47 to 55 percent compared to a healthy knee.
• 8:25
  SPEAKER_00: That's driven by that same AMI I just mentioned, the nervous system protecting a swollen healing joint by blocking the quad or turning it down.
• 8:37
  SPEAKER_00: Second, and I think this is the part that I think is really interesting, is to stabilize the joint, the brain didn't just shut the quad off and let the hamstring take over.
• 8:49
  SPEAKER_00: Instead, it fired the quad and the hamstrings at the same time.
• 8:53
  SPEAKER_00: So it was a coactivation.
• 8:55
  SPEAKER_00: So the front quad muscle and the hamstrings were both working together, but remember, it was turned down in terms of like how much the output was, in terms of like roughly around 50% for the quads, especially.
• 9:08
  SPEAKER_00: So think of it like your nervous system building a biological splint around your knee, right?
• 9:13
  SPEAKER_00: It locks up the joint on purpose, and that stiffening is exactly what makes early leg straightening so difficult, getting that knee extension back.
• 9:24
  SPEAKER_00: And the thing that probably surprised me the most is that this showed up on both legs.
• 9:29
  SPEAKER_00: Even the leg, the unoperated or uninvolved side, had some stiffening patterns, which I think was very interesting just from a neurological standpoint, just from an input standpoint, but it kind of tells you a little bit of something, right?
• 9:42
  SPEAKER_00: It isn't just a local knee problem, just to that injured or operated side.
• 9:46
  SPEAKER_00: Your brain's entire motor control programming, if you will, is shifting.
• 9:52
  SPEAKER_00: It's it's kind of like a global thing, it's not just on the surgical side.
• 9:56
  SPEAKER_00: And so, what does this actually mean for you right after surgery?
• 10:00
  SPEAKER_00: The issue isn't a structural muscle weakness, right?
• 10:03
  SPEAKER_00: Yes, there is some muscle weakness that's happening, but the thing is that the quad isn't necessarily completely broken, it's not torn, it's not damaged in any way.
• 10:14
  SPEAKER_00: A big part of it is the neurological block.
• 10:17
  SPEAKER_00: And I know a lot of you are like, just give me the answer.
• 10:20
  SPEAKER_00: What will unlock it?
• 10:21
  SPEAKER_00: What will unblock it?
• 10:22
  SPEAKER_00: And I wish we knew it, but we have strategies to help us get there.
• 10:26
  SPEAKER_00: And that that is why we lean into so much of reducing swelling and pain, not trying to rush the process or force this joint into a bunch of painful positions.
• 10:37
  SPEAKER_00: We're using things like NMES and tens and focal cooling, and we're using BFR, we're trying to use eccentrics where we can.
• 10:45
  SPEAKER_00: We're trying to use these things that we know from the literature that can help with AMI and to help re-wake this connection between the brain and the quad muscle before we even start trying to chase like the traditional strength and conditioning that we're after, right?
• 11:02
  SPEAKER_00: And it's one small study, right?
• 11:05
  SPEAKER_00: It's exploratory by design.
• 11:07
  SPEAKER_00: So I'm not saying this is going to move mountains by any means, but it is something that we see very anecdotally that those hamstrings will kick on.
• 11:18
  SPEAKER_00: And I see this all the time.
• 11:20
  SPEAKER_00: I have a particular Instagram video that I did that I'll also tag in the show notes that basically highlights this very clear example.
• 11:31
  SPEAKER_00: And a lot of times what happens is when people are early on, sometimes they have challenges with getting that end-range knee extension and getting the quads active.
• 11:41
  SPEAKER_00: And so if they are on a flat surface, they will sometimes do a quad set and you'll see that activation of the quads, but you will see also the activation of the hamstrings.
• 11:51
  SPEAKER_00: And a lot of times they're just kind of kicking their heel into the surface that they're in.
• 11:56
  SPEAKER_00: And especially if it's not a hard surface, it is a little harder for the person to sense if they're getting full extension and relaxing the hamstrings.
• 12:06
  SPEAKER_00: So that's that heel pop, if you will, where you're really pushing the back of the knee down and getting the heel off the table or the surface.
• 12:13
  SPEAKER_00: What happens is that people will co-contract when they do the quad set because they can't feel everything, especially the quads.
• 12:21
  SPEAKER_00: And so then that hamstring will actively engage with it because that heel is contacting the surface.
• 12:26
  SPEAKER_00: So I like to almost put it off the surface to remove that tactile sensation out of the back of the heel to be able to also feel that lift off the surface a little bit clearer because it can be a little challenging, especially post-op.
• 12:40
  SPEAKER_00: I remember for myself, it was really hard to really get my quads going.
• 12:44
  SPEAKER_00: And I did always feel these like kind of co-contractions, or like I felt my hamstrings fatigue or my glute activating as well.
• 12:52
  SPEAKER_00: And so it's something that is very, very common.
• 12:56
  SPEAKER_00: And people will try their hardest, especially with the quads being shut down, and they will do it and they'll be like, Look, I'm doing it, look, I'm doing it, and they'll see some activation.
• 13:05
  SPEAKER_00: But the thing is, is that if your hamstrings are active, even the slightest bit, it's working against getting extension because it does exactly the opposite of what we want for extension, and it does the opposite of what we want for quad contraction in isolation.
• 13:21
  SPEAKER_00: So that is something that's really important here.
• 13:24
  SPEAKER_00: So even if you're saying, well, a little bit of hamstring activation isn't bad, in this case it is because we're not getting the intent out of it, which is getting full extension, getting full quad activation without that hamstring joining the party.
• 13:39
  SPEAKER_00: So this is a study that helps to just kind of show a little bit of input here.
• 13:43
  SPEAKER_00: Again, some limitations of it.
• 13:45
  SPEAKER_00: They had hamstring graphs, so who knows if that would have influenced a little bit of maybe more quad.
• 15:57
  SPEAKER_00: Who knows if that would have influenced maybe more hamstring activation?
• 16:02
  SPEAKER_00: Who knows if doing different graph types would have shut the quads down even more, like a quad tendon or a patellar tendon, and increase the hamstring activation.
• 16:12
  SPEAKER_00: You know, so I would almost venture to say if they were other graph types, not the hamstrings, that we would even see the results of this heighten even more.
• 16:22
  SPEAKER_00: So this is something for us to just kind of factor into this, especially with a study.
• 16:26
  SPEAKER_00: And there are other studies that show some hamstring activation that is going on, usually through the gate cycle and through other things as well.
• 16:34
  SPEAKER_00: So just something for us to know that there is some data supporting some of the evidence behind this, but anecdotally, and you look across a lot of physical therapists who work with ACLs, and they would also agree that they see a lot of hamstring involvement with people who are trying to get their extension back.
• 16:52
  SPEAKER_00: Now, I don't want you walking away thinking that the hamstrings are the enemy, and that's what you're probably getting at this point.
• 16:59
  SPEAKER_00: It's not that same coactivation, the quad and hamstring firing together, it's useful and it's protective in a lot of contexts.
• 17:08
  SPEAKER_00: We want that.
• 17:10
  SPEAKER_00: It's helpful to stabilize your knee, it plays a role in protecting your graft.
• 17:15
  SPEAKER_00: Co-contraction happens a lot with dynamic activities and sport.
• 17:19
  SPEAKER_00: So we want that.
• 17:20
  SPEAKER_00: The issue isn't that your hamstrings are active, it's the timing, it's the coordination of everything, and it's the input that you're trying to put into, but instead, something else is firing as a compensation.
• 17:33
  SPEAKER_00: So when you're in a rep where you're specifically trying to isolate and wake up your quad, and that splinting pattern starts to show up instead, where the hamstrings are also activating, that's bad timing.
• 17:45
  SPEAKER_00: It's not necessarily a bad muscle like the hamstring here.
• 17:49
  SPEAKER_00: Also, want to be straight with you for a sec.
• 17:52
  SPEAKER_00: This is not the fix for your extension or your quad activation.
• 17:57
  SPEAKER_00: It could be a layer in this, but it's not the thing that's going to solve everything.
• 18:03
  SPEAKER_00: It can be a factor, one factor of many other factors that influence you getting that quad and that extension back.
• 18:11
  SPEAKER_00: And when you're dealing with a stuck quad or stubborn extension deficits, that's a problem worth attacking from every angle available to you.
• 18:21
  SPEAKER_00: We don't throw the kitchen sink at it, but it's not going to hurt to throw in some fatiguing isometric work for your hamstrings to see if it helps us move the needle, especially for struggling extension and quad activation cases.
• 18:34
  SPEAKER_00: This is one of those angles, and I think it's just one that often gets missed because we're looking so much at the front of the knee, the quad, the extension exercises.
• 18:44
  SPEAKER_00: Sometimes it can be helpful to just put some attention towards the hamstrings as well.
• 18:49
  SPEAKER_00: So now let's make this useful.
• 18:51
  SPEAKER_00: What can you actually do?
• 18:54
  SPEAKER_00: First, this needs to be indicated and guided by your own PT.
• 18:59
  SPEAKER_00: So if you're listening to this, you're trying to get your extension back, I understand you probably want to incorporate this in.
• 19:05
  SPEAKER_00: But I would also suggest that if you're working with a really good physical therapist, then this will probably be worked into it if you're having issues.
• 19:14
  SPEAKER_00: But it's also something to consider talking with them just to see.
• 19:18
  SPEAKER_00: But this isn't a replacement for anything you're already doing in your program.
• 19:22
  SPEAKER_00: So make sure you consult your healthcare provider for this.
• 19:25
  SPEAKER_00: Start with an assessment.
• 19:27
  SPEAKER_00: I think this is always important.
• 19:29
  SPEAKER_00: Test, retest, because that's going to help us know did we have some influence here?
• 19:35
  SPEAKER_00: So let's do the assessment, the heel pop tests.
• 19:38
  SPEAKER_00: You lie down on a hard surface, not a bed, not a soft cushion, a hard surface, and you're going to actively hyperextend or do a quad set or heel pop, and you're going to compare your uninvolved side to your involved side.
• 19:56
  SPEAKER_00: That gives you and your PT a starting point.
• 19:59
  SPEAKER_00: This is also just like a very good litmus of like, do you have terminal end range knee extension?
• 20:04
  SPEAKER_00: You sit on the floor, you do your heel pop, the quad set, and see how high does it come off on the uninvolved side, then guess what?
• 20:12
  SPEAKER_00: You get to do it on the involved side and see what is that difference.
• 20:16
  SPEAKER_00: If it's matching, beautiful.
• 20:18
  SPEAKER_00: You don't even need to worry about this.
• 20:20
  SPEAKER_00: If you are someone who is still struggling with extension and there's a difference, then let's keep looking at things.
• 20:26
  SPEAKER_00: Now, if you're already doing what I would say like the main priorities for tackling this knee extension, NMES, which by the way, I just did a full series on 10 ways to improve that, and other episodes on NMES, tens, which is a different kind of pulsating type of frequency for the front of the knee joint, and focal joint cooling.
• 20:52
  SPEAKER_00: So that is where you kind of combine those forces.
• 20:55
  SPEAKER_00: There's research to show that it helps with AMI, blood flow restriction training, isometrics at different angles, looking at terminal knee extensions, and then even potentially doing some eccentrics if we're talking about AMI.
• 21:08
  SPEAKER_00: But if we're talking about quads, waking them up, getting some knee extension into a good place, these are the things that you're going to be tapping into to make sure you're working on things, right?
• 21:21
  SPEAKER_00: You're going to do a closed chain knee extension, you're going to do one that is almost open chain with a strap where you passively pull, activate.
• 21:29
  SPEAKER_00: But the thing is, is that if you're tapping in all these and you're still stuck, this is where we can also bring in the hamstrings to evaluate next.
• 21:36
  SPEAKER_00: And so here's the actual work.
• 21:38
  SPEAKER_00: And I want you to remember the goal is mainly to fatigue.
• 21:42
  SPEAKER_00: It's not to strengthen the hamstrings, although you will still get a byproduct of that.
• 21:47
  SPEAKER_00: It's to fatigue.
• 21:48
  SPEAKER_00: We are trying to tire the hamstrings out just enough that the nervous system lets go of that just protection and eases off the guard.
• 21:57
  SPEAKER_00: Number one is going to be a hamstring heel dig.
• 22:01
  SPEAKER_00: So you can put either a foam roller or something underneath your knee while you're laying flat.
• 22:05
  SPEAKER_00: You also don't have to have anything underneath your knee.
• 22:08
  SPEAKER_00: You could just kind of get your knee into a certain amount of knee flexion, let's say 30 degrees, 60 degrees, 90 degrees.
• 22:14
  SPEAKER_00: And you're going to try and think about trying to pull your heel into that table.
• 22:20
  SPEAKER_00: You're going to dig it into that table as if you're trying to scratch that surface.
• 22:25
  SPEAKER_00: Obviously, the knee is not moving.
• 22:28
  SPEAKER_00: We're just wanting to activate the hamstrings.
• 22:31
  SPEAKER_00: And that is going to be something that you can hold for anywhere from 30 seconds to 45 seconds to 60 seconds.
• 22:39
  SPEAKER_00: Of course, we start even lighter at 10 to 15 seconds and then build your way up, right?
• 22:44
  SPEAKER_00: And this you can do as a single leg, right?
• 22:47
  SPEAKER_00: Just do it on that ACL side, the involved side, and then start to hold these and just gauge the intensity based on how your knee is feeling.
• 22:55
  SPEAKER_00: So that is going to be done for let's say three sets, or if you're going to combine them with these other movements, then you can go for two to three rounds.
• 23:05
  SPEAKER_00: So you'll do this hamstring heel dig, and then you could do a single leg hamstring bridge ISO hold.
• 23:12
  SPEAKER_00: So this might be you laying on the back and you have a bench in front of you, and then you're just going to lift your legs up with your heels digging into that bench, and then you're going to have a bent knee position.
• 23:23
  SPEAKER_00: So then, therefore, you're trying to dig those heels into that bench, and you're trying to fatigue the hamstrings by especially forcing some knee flexion and again trying to do that whole duration of 30 to 60 seconds.
• 23:38
  SPEAKER_00: And then the other thing I think is helpful is to also attack the hamstrings at a different angle.
• 23:43
  SPEAKER_00: So then doing a long lever where your leg is straight.
• 23:46
  SPEAKER_00: So imagine a foam roller against a wall.
• 23:49
  SPEAKER_00: You are having your feet up against the wall, and then you're sit laying down flat on your back.
• 23:55
  SPEAKER_00: And all you're going to do is bridge up onto that foam roller where the back of the Achilles is on that foam roller, and you're just going to bridge up like that and hold that.
• 24:03
  SPEAKER_00: Right.
• 24:04
  SPEAKER_00: That's going to help to do it isometric in a different position, some knee flexion, some hip extended position as well.
• 24:11
  SPEAKER_00: And then we also have an option to do a hamstring calf co-contraction.
• 24:16
  SPEAKER_00: Now I haven't talked a ton about the calf, but as I had shared, the calf can also play a role in that contraction at the knee where it can play into the knee flexion, limiting knee extension.
• 24:27
  SPEAKER_00: So then this co contraction bridge is where you essentially have that foam roller again against the edge of a wall.
• 24:34
  SPEAKER_00: And then you're just going to put the front half of your foot on that foam roller.
• 24:40
  SPEAKER_00: And then you're going to bridge up as high as you can, thinking about how you can get your heel as high as you can, or pointing that toe down and still bridging up with your glute, and your hamstrings and calves will be on fire.
• 24:55
  SPEAKER_00: So this is something that will help to fatigue both.
• 24:58
  SPEAKER_00: Now you don't need all four.
• 25:01
  SPEAKER_00: You can pick one, two, even three of these and run anywhere from two to three rounds for 30 to 60 seconds each, right?
• 25:10
  SPEAKER_00: I would encourage a variety, and especially ones that feel comfortable to the knee where you feel that hamstring is activating, but keep it simple.
• 25:18
  SPEAKER_00: You're not trying to build hamstring strength.
• 25:20
  SPEAKER_00: Again, you're trying to just fatigue it down and tell your nervous system it is safe to ease off of you know the protection here.
• 25:28
  SPEAKER_00: So if your quad won't wake up or you're struggling with knee extension, it could also be a nervous system-related thing that yes, it is reducing input to your quads, but it also might be overdriving your hamstrings.
• 25:44
  SPEAKER_00: So I think in certain situations, this can be a valuable route to tap into more knee extension to get more out of your quads and just see if that is something that is helpful for you in this process, especially if you feel like you're tapping into everything else and it feels like it's not really moving, then this can be something for you to add in.
• 26:06
  SPEAKER_00: Again, if you put this in the mix and you go through a series of these and you get through the rhythm of it, I mean, you might be spending less than five minutes trying to really work on this, especially since the goal is to fatigue the hamstrings.
• 26:19
  SPEAKER_00: You're not trying to rest in between reps.
• 26:21
  SPEAKER_00: You're trying to just get to the next rept and then just be able to get into a good place where you have some activation, but then you fatigue it, the endurance of it, right?
• 26:30
  SPEAKER_00: And then being able to see, okay, did we get any more knee extension?
• 26:34
  SPEAKER_00: So then that's where you pivot back over to the strap-assisted extension work or something to test out your extension, which I would say just like we did the test retest.
• 26:45
  SPEAKER_00: So I want you to do that heel pop test again and see do you get anything more out of your extension?
• 26:50
  SPEAKER_00: Do you get a little bit higher on the heel pop?
• 26:53
  SPEAKER_00: Did it allow your quads to activate a little bit more?
• 26:56
  SPEAKER_00: And this is where I think having a strap to help assist if you're still struggling with extension, so valuable.
• 27:02
  SPEAKER_00: Don't use a band, don't use something stretchy, elastic.
• 27:07
  SPEAKER_00: Use a stiff strap to help you lift up that heel while keeping the back of the knee down on the surface.
• 27:14
  SPEAKER_00: Let that stretch and then also activate with it.
• 27:19
  SPEAKER_00: One of the best ways for you to be able to tap into some knee extension, and I think this is something that we just want to make sure that we don't leave on the table, especially for those of you who might be struggling to get quad activation and some terminal knee extension.
• 27:35
  SPEAKER_00: So I hope that this is helpful, y'all.
• 27:37
  SPEAKER_00: Always want to make things practical, not just like, hey, we have a hamstring activation issue.
• 27:43
  SPEAKER_00: Go figure it out.
• 27:43
  SPEAKER_00: Like, here are some ways for you to put this in play.
• 27:46
  SPEAKER_00: Talk with your PT, you know, give it to your ACL or if you're a PT listening to this, and just see can we get a little bit more out of this?
• 27:54
  SPEAKER_00: And again, it's might not even just be a one-time thing.
• 27:57
  SPEAKER_00: You might have to dose this in daily and multiple times a day and see are we getting some improvement out of this?
• 28:04
  SPEAKER_00: And guess what?
• 28:05
  SPEAKER_00: If it doesn't help, then the juice might not be worth the squeeze.
• 28:08
  SPEAKER_00: But again, we are trying to do everything we can in this process.
• 28:13
  SPEAKER_00: And I just want to share things that are helpful with our athletes, what the research shows, and seeing what we can do to just make sure you have a more effective process.
• 28:22
  SPEAKER_00: So if you need any help, reach out to us.
• 28:24
  SPEAKER_00: We are here to help.
• 28:26
  SPEAKER_00: Until next time, this is your host, Robbie Patel, signing off.