• Dr. Brian Abelson

QUAD DOMINANCE – A RECIPE FOR INJURY

Updated: Jun 18


Quadriceps dominance arises when the quadriceps and hip flexors (Iliopsoas) overpower the gluteal and hamstring muscles.


It is incredibility important to maintain balance of flexibility and strength between the Hamstrings and Quadriceps. Ideally the ratio of hamstring to quadriceps strength should be at least 60 percent but, ideally 75%. When these two structures are out of balance, you set yourself up for knee injuries, hamstring strains, gait imbalances, along with a host of other lower extremity injuries.In fact research is showing that this imbalance can increase the incidence of injury by 4.66 times. (1) A hamstrings-quadriceps imbalance can also greatly diminish your athletic performance in any sport from, from running to football/soccer to gymnastics and dance.


Hamstrings Quadriceps Partnership


Your hamstrings are primarily involved in hip extension and knee flexion. In contrast, the quadriceps are mainly involved in hip flexion and knee extension. In other words, they play opposite roles to each other. Depending on the action being performed, when one structure is the agonist (primary mover), the other plays the role of the antagonist (primarily counter-balancing the force generated by the agonist).


For optimum performance, both the agonist and antagonist muscles must be in balance, in both strength and flexibility.


For Example:

  • In Hip Extension: When the hamstrings (agonist) contract to cause hip extension, the quadriceps (antagonists) elongate to support this action.

  • In Hip Flexion: When the quadriceps (agonist) contract to cause hip flexion, the hamstrings (antagonists) elongate to balance this action.

PROBLEMS CAUSED BY THE HAMSTRINGS


With the hamstring–quadriceps inter-relationship, we often find that our patient’s hamstrings are weak and overstretched, while their quadriceps are tight, overactive, and considerably stronger than the hamstrings. The tight quadriceps then act to neurologically inhibit the hamstrings and gluteals, making those structures even weaker.


Anterior Pelvis Syndrome is one of the most common causes of tight, overstretched hamstrings. Ideally, your pelvis should be in a neutral position, not tilted forward or back, and level from side-to-side. The Anterior Pelvis Syndrome occurs when your quadriceps muscles (rectus femoris) tighten up, which pulls the front of the pelvis down, tensions the hamstrings along the back of the leg, and destabilizes the pelvis.


Tight hamstrings often result in limited extension of the knee, as well as increased flexion of the knee. Increased knee flexion causes an increase in dorsiflexion of the ankle, and increased stress on both the Achilles tendon and plantar fascia of the foot. This is why tight hamstring can be a significant factor in causing conditions such as ACL injuries, Achilles Tendinosis, Plantar Fasciitis, and even bunions. (2)


PROBLEMS CAUSED BY THE QUADRICEPS



Many people have tight, restricted, and overactive quadriceps. This is because most people tend to over-use their quadriceps and adductors to perform lower extremity motions such as squats, when they should actually be using their gluteals and hamstrings. This results in the development of muscle imbalances (strong quadriceps and weak hamstrings).


This common muscle imbalances has two effects. Firstly, as the quadriceps become stronger, they neurologically inhibit hamstring activation. Secondly, this inhibition of hamstring activation leads to the development of abnormal motion patterns throughout the entire lower extremity, from the hips, legs, knees, to the ankle and feet.


Note: The more fatigued an athlete is the worse the strength imbalance is between the hamstrings and the quadriceps. Consequently the more susceptible the athlete is to injury. (3,4)



EXERCISES TO RESTORE THE BALANCE

Here is the good news! It doesn’t matter how much of an imbalance between your quadriceps and hamstrings you can take action to correct this problem. You will have to perform a combination of myofascial release exercises and exercises to activate and strengthen you gluteal and hamstring muscles.


The following exercises are ones that we often recommend to our patients who have a hamstrings-quadriceps imbalance.



FLEXIBILITY & MOBILITY


Myofascial Release of the Quadriceps: The quadriceps are often tight, restricted, and overactive. This is because most people tend to over-use their quadriceps and adductors to perform lower extremity motions, when they should actually be using their gluteals and hamstrings. This results in the development of muscle imbalances (strong quadriceps and weak hamstrings).



Releasing The Hamstrings - Foam Roller: Tight hamstrings can result in limited extension of the knee, as well as increased flexion of the knee (in other words, tight hamstrings work to pull the lower part of the leg backwards). This over-flexion has a ripple effect all the way down the kinetic chain, since these restrictions directly cause increased dorsiflexion of the ankle, and increased stress on both the Achilles tendon and plantar fascia of the foot.



Adductors - Myofascial Release With a Ball: When the adductors become short and contracted, they will neurologically inhibit the gluteus medius muscle. This will cause your thigh to move inwards and rotate into an abnormal motion pattern. This abnormal motion pattern will affect both knee and ankle motion patterns, and could lead to problems on the bottom of the foot, such as Plantar Fasciitis.


Myofascial Release of the Gluteal Muscles: The gluteals are made up of three muscles: the gluteus maximus, gluteus medius, and gluteus minimus. These muscles are the antagonists to the iliopsoas muscle group, and need to stay strong and flexible in order to provide stability to the lower extremities. Maintaining this strength and flexibility is a critical factor in resolving numerous injuries and in optimizing sports performance.



STRENGTHENING



Deadlifts (Barbell and Dumbbells) - Great Glute & Hamstring Exercise: Deadlifts are great exercises for strengthening your gluteal and hamstring muscles. They are also excellent for strengthening your core and low back.






5 Ways to Build a Better Butt - Gluteal Strengthening: Five great exercises that will help you build stronger more activated gluteal muscles. Gluteal strength is essential for hip function, avoiding low back pain and preventing lower extremity injuries.





Swiss Ball Hamstring Curls: Swiss Ball hamstring curls are a great way to strengthen your hamstrings. This video provides you with two ways to perform this exercise a beginner and a more advanced exercise.






Pelvic Raises - Beginner to Advanced: Pelvic raises are a great way to activate the muscles of your hips and pelvic floor. This exercise tones and strengthens the muscles of your lower back, abdominals, glutes, and hamstring. This video demonstrates three versions: Beginner, Intermediate, and Advanced. Do NOT attempt the advanced version until you can successfully perform the beginner and intermediate versions with good form.



WHEN EXERCISE IS NOT ENOUGH

In many cases, the combination of exercise is enough to a hamstrings-quadriceps imbalance, but in other cases more help is sometimes needed. When treatment is needed we have found certain soft tissue procedures are required to achieve optimum results.


Below are example of procedures that we often use with our patients to resolve cases of hamstrings-quadriceps imbalances. These procedures are always combined with a functional exercise program.


The Quadriceps Release - Motion Specific Release: The quadriceps are often tight, restricted, and overactive. This is because most people tend to over‐use their quadriceps and adductors to perform lower extremity motions, when they should actually be using their gluteals and hamstrings. This results in the development of muscle imbalances (strong quadriceps and weak hamstrings). (This video will be available June 3/2020)



The Gluteus Maximus Release - Motion Specific Release (MSR): In this video Dr. Abelson demonstrates how to use Motion Specific Release (MSR) to release restrictions in the Gluteus Maximus muscle. Strong, flexible, engaged gluteal muscles are critical to optimum performance and injury prevention.




The Hamstring Release - Motion Specific Release™ (MSR): The hamstring muscles are primarily involved in hip extension and knee flexion, while the quadriceps muscles are primarily involved in hip flexion and knee extension. When running, your hamstrings function as shock absorbers, force generators and stabilizers. Hamstring injuries are a common problem that affects a large number of athletes. (This video will be available Sept 16/2020)



REFERENCES


  1. Croisier, J.L., Ganteaume, S., Binet, J., Genty, M., and Ferret, J.M. Strength imbalances and prevention of hamstring injury in professional soccer players: A prospective study. Am J Sports Med 36: 1469-1475, 2008.

  2. Ahmad, C.S., Clark, A.M., Heilmann, N., Schoeb, J.S., Gardner, T.R., and Levine, W.N. Effect of gender and maturity on quadriceps-to-hamstring strength ratio and anterior cruciate ligament laxity. Am. J. Sports. Med. 34: 370-374, 2006.

  3. de Abreu Camarda, S.R. and Denadai, B.S. Does muscle imbalance affect fatigue after soccer specific intermittent protocol? J. Sci. Med. Sports. 15: 355-360, 2012.

  4. Small, K., McNaughton, L., Greig, M., and Lovell, R. The effects of multidirectional soccer-specific fatigue on markers of hamstring injury risk. J. Sci. Med. Sports. 13: 120-125, 2010.



DR. BRIAN ABELSON DC.

Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.

Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publications which will be available later this year.



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