Quadriceps strength and the Reverse Nordic
Health Disclaimer:
These articles are for educative and entertainment purposes only. They are not intended to be a substitute for professional medical advice, diagnosis or treatment. If you have a current injury or are in pain, please seek the advice of your regular health care provider. You are responsible for your own safety and health at all times. Especially, given physical activity is not without risk and can cause harm. By engaging with any content on this website you acknowledge and agree that The Musculoskeletal Clinic is not liable for any direct, indirect, special, consequential, exemplary, or other damages arising therefrom.
Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this web site.
Introduction
The rectus femoris is a commonly injured muscle in athletic populations that involve kicking and sprinting (1,2). Interestingly, in football players this may occur more in pre-season. My thoughts are this may be due to off-season de-training i.e. reduced volume and intensity of sprinting or kicking. Another risk factor is reduced physical muscle length, which can be measured by internal characteristics such as fascicle length, or externally via goniometer (3,4).
How do we either, reduce injury risk or, reduce recurrence? Eccentric training of a muscle has been shown to tick both of these boxes in similarly principled movements such as the Nordic hamstring and the Copenhagen adductor exercises (5–8).
Eccentric training
Why might it be useful to load the rectus femoris muscle eccentrically? There are a couple considerations. One is that it is utilised in movements that require high eccentric loads, like kicking or deceleration (1). Second, it is a multi-joint muscle, i.e. it is a muscle that crosses more than one joint. This creates more movement combinations. Is one end short, while the other lengthens, vice versa, or maybe both are long etc. This could go down a discussion around active and passive insufficiency, a topic covered in previous posts. In essence, in the same moment, a muscle will struggle to shorten or lengthen, at both ends. While it is trainable, the internal structure makes it harder to execute (9,10). Fortunately, the reverse Nordic encourages lengthening at both ends.
Further rationale can be found in the recruitment pattern for the rectus femoris. When utilising a punctum fixation model, the muscle may recruit from bottom-up, or top-down (11). Essentially, during kicking motions, we see a top-down pattern. During deceleration movements we see bottom-up pattern. How do we use this information? If this muscle has been injured then we must cast a wider net and rehab both the skills of kicking and deceleration.
Does the reverse nordic work?
Great rationale! Does the reverse Nordic work?
There are some other studies that have looked at rectus femoris changes after different exercise interventions. Of note, is that after 2 days a week of full or partial squat training, for 10 weeks, there was no change in rectus femoris volume, despite increase in 1 rep max strength (12). However, after 12 weeks of reverse Nordic training, there was increased rectus femoris length, thickness, pennation angle and overall cross-sectional area (2). These characteristics are part of what correlate with the ability to produce force and demonstrate increase muscle length (2,13).
Other training considerations:
Muncie exercise - learn to shorten the rectus femoris at both ends.
2. Sprinting drill - train the acceleration and deceleration properties of the rectus femoris - among other muscles, like the hamstrings.
3. Sissy squat - train eccentric capacity of the rectus femoris while having to stabilise through your ankles.
4. Seiza sitting - improve ankle flexibility for the reverse nordic.
Conclusion
In summary, the rectus femoris is commonly injured during sprinting and kicking. It is not maximally recruited during more day to do movements like squatting. Reverse nordic has been shown to create changes in muscle characteristics and architecture that are favourable to reduced injury risk of the rectus femoris. Other considerations for rehab include returning to maximal kicking and maximal sprinting (acceleration and deceleration) exercises.
References:
1. Mendiguchia J, Alentorn-Geli E, Idoate F, Myer GD. Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med. 2013 Apr 1;47(6):359–66.
2. Alonso-Fernandez D, Fernandez-Rodriguez R, Abalo-Núñez R. Changes in rectus femoris architecture induced by the reverse nordic hamstring exercises. J Sports Med Phys Fitness. 2019 Apr;59(4):640–7.
3. Fousekis K, Tsepis E, Poulmedis P, Athanasopoulos S, Vagenas G. Intrinsic risk factors of non-contact quadriceps and hamstring strains in soccer: a prospective study of 100 professional players. British Journal of Sports Medicine. 2011 Jul 1;45(9):709–14.
4. Witvrouw E, Danneels L, Asselman P, D’Have T, Cambier D. Muscle Flexibility as a Risk Factor for Developing Muscle Injuries in Male Professional Soccer Players: A Prospective Study. Am J Sports Med. 2003 Jan 1;31(1):41–6.
5. Ishøi L, Thorborg K. Copenhagen adduction exercise can increase eccentric strength and mitigate the risk of groin problems: but how much is enough! Br J Sports Med. 2021 Oct 1;55(19):1066–7.
6. Pérez-Gómez J, Villafaina S, Adsuar JC, Carlos-Vivas J, Garcia-Gordillo MÁ, Collado-Mateo D. Copenhagen Adduction Exercise to Increase Eccentric Strength: A Systematic Review and Meta-Analysis. Applied Sciences. 2020 Jan;10(8):2863.
7. Petersen J, Thorborg K, Nielsen MB, Budtz-Jørgensen E, Hölmich P. Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men’s Soccer: A Cluster-Randomized Controlled Trial. Am J Sports Med. 2011 Nov 1;39(11):2296–303.
8. Rudisill SS, Varady NH, Kucharik MP, Eberlin CT, Martin SD. Evidence-Based Hamstring Injury Prevention and Risk Factor Management: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2022 Apr 6;03635465221083998.
9. Gajdosik RL, Hallett JP, Slaughter LL. Passive insufficiency of two-joint shoulder muscles. Clinical Biomechanics. 1994 Nov 1;9(6):377–8.
10. Shapiro J, Kamel B. Passive Muscular Insufficiency: The Etiology of Gastrocnemius Equinus. Clinics in Podiatric Medicine and Surgery. 2020 Jan 1;37(1):61–9.
11. Laßberg C von, Schneid JA, Graf D, Finger F, Rapp W, Stutzig N. Longitudinal sequencing in intramuscular coordination: A new hypothesis of dynamic functions in the human rectus femoris muscle. PLOS ONE. 2017 Aug 17;12(8):e0183204.
12. Kubo K, Ikebukuro T, Yata H. Effects of squat training with different depths on lower limb muscle volumes. Eur J Appl Physiol. 2019 Sep;119(9):1933–42.
13. Lieber RL, Ward SR. Skeletal muscle design to meet functional demands. Philos Trans R Soc Lond B Biol Sci. 2011 May 27;366(1570):1466–76.
Copyright Disclaimer - This article is protected by the Copyright Act 1994. The author controls the copyright of this article. Recognition of the author’s right to be identified as the author will be acknowledged and when relevant the author will be acknowledged as the author. You will obtain the author’s permission before publishing any material from this article. For further information you can reference the Act here: https://www.legislation.govt.nz/act/public/1994/0143/latest/whole.html