Quad Strengthening Protocal

A Patient Guide to Quadriceps Strengthening

Colin Walker FRCS- Orthopaedic knee surgeon

Frank Gilroy MCSP- Consultant Physiotherapy advisor

Laura Clarke- Student Physiotherapist

Anatomy of the Quadriceps

The Quadriceps Femoris is comprised of 4 muscles extending the knee; Rectus Femoris, Vastus Lateralis, Vastus Intermedius, Vastus Medialis – which can be seen in the picture below.
These knee extensors are crucial in the act of walking, jumping running and squatting with Vastus Medialis stabilizing the patella.

1. Rectus Femoris

2. Vastus Lateralis

3. Vastus Intermedius

4. Vastus Medialis

Common Reasons for Quad Weakness

• Rupture of Rectus Femoris
• Quadriceps Tendonitis
• Meniscal Tear

Patellofemoral Pain Syndrome
• Improper Footwear
• Training Errors/Techniques
• Patellar Malalignment
• Stresses Upon Knee Structures

• Total Knee Arthroplasty (TKA)
• Total Hip Replacement
• Knee Reconstruction
• Knee Arthroscopies
• Cartilage Removals/Repairs

Physiotherapy and Prevention

It is important that the muscles in your thigh stay strong in order for them to:
• Prevent Injuries
• Allow good movement
• Carry out everyday tasks e.g walking, stairs, running, jumping

Before strengthening, your leg must move freely in order to build up to full power. Simple stretches which are to be carried out before completing the strengthening exercises can be found in this handout.



Initial Rehab (0-48 hours)

If there has been a specific trauma to the quadriceps, the primary goal is to control pain and reduce inflammation. PRICE should be carried out

PROTECTION: Prevent further injury, cease activity/sport

REST: Key to preventing strain on injured area. Without rest the healing process can be harmed

ICE: Reduces inflammatory response + decreases pain. Apply for 20 minutes using a towel to prevent ice burn/irritation to skin

COMPRESSION: Reduces swelling as a result of inflammatory process. Use an elastic bandage to allow expansion of muscles however must be a snug fit.

ELEVATION: Decreases swelling by increasing venous return pf blood resulting in less oedema and pain.

Basic Stretches

Stretches are essential after any form of exercise and should be carried out in order to prevent injury and tightness. Hold each stretch for around 30 seconds and repeat 3 times. It is important not to force stretches into pain.
Aim to complete the following stretches 2-3 times per day, 5 days per week.

1.Quad Stretch

Increase stretch by pulling knee further behind










2. Calf Stretch

Increase stretch by pulling further forward

3. Soleus Stretch

Increase stretch by bending back knee more










4. Hamstring Stretch

Increase stretch by leaning further forward

Quadriceps Strengthening Drill

1. Straight Leg Raise

Phase 1:
-Long sitting
-Lift affected leg straight off bed
-Keep foot pointed towards ceiling

Phase 2:
-Attach Theraband
-Carry out exercise as above

Phase 3:
-Light ankle weight (2kg)
-Carry out Exercise as above

Do until leg is tired
4 per day  5 per week

2. Straight Leg Raise

Phase 1:
-Long sitting
-Lift affected leg straight off bed
-Keep foot pointed outwards

Phase 2:
-Attach Theraband
-Carry out exercise as above

Phase 3:
-Light ankle weight (2kg)
-Carry out Exercise as above

 Do until leg is tired
4 per day  5 per week

3.Inner Range Quads

Phase 1:
-Long sitting
-Rolled up towel/foam roller under knee so leg is slightly flexed
-Lift affected leg straight off bed
-Keep foot pointed towards ceiling

Phase 2:
-Attach Theraband
-Carry out exercise as above

Phase 3:
-Light ankle weight (2kg)
-Carry out Exercise as above

 Do until leg is tired
4 per day  5 per week

A video demonstrating each of the exercises above can be found by clicking on the following link: https://www.youtube.com/watch?v=5WnFQwcWQZo 

Your physiotherapist will give you a piece of stretchy band known as a Theraband to place around your ankles in order to create some resistance whilst carrying out the exercises which make the muscles work a little harder. They come in a variety of strengths dependant on the colour starting with:

Yellow > Red > Green > Blue > Black


FITT Principles and Evidence Base

These include:

Frequency – How often the exercise is completed

Intensity – How hard the participant is working (gravity/theraband/weights)

Time –How long the session lasts and finally

Type– What exercise is being executed

(Waehner, 2014).

Having read the literature, resistance strength training has proved beneficial in adults if they are exercising 3-5 times per week (Murlasits, 2012). The study showed that 3 days per week sessions compared to that of the once weekly classes were superior and lead to physiological adaptions; however it must be noted that these were only in the short term. This highlighted that there can be a threshold of strengthening within the adult population.

3 studies; Bolton et al (2012), Basat et al (2013) and Stolzenberg et al (2013) showed that resistive training had significant increases in the results and average reps within each of the studies methods sections were around 12-15 for each exercise.


American Academy of Orthopedic Surgeons. 2015, Patellofemoral Pain Syndrome, [ONLINE] Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00680 [Accessed 4th June 2014]

Aveyard, H. & Sharp, P. 2009, A beginner’s guide to evidence based practice in health and social care professions, Open University Press, GB.

Basat, H., Esmaeilzadeh, S., Eskiyurt, N. 2013, “The Effects of Strengthening and High Impact Exercises on Bone Metabolism and Quality of Life in Postmenopausal Women: A Randomised Controlled Trial.” Journal of Back and Musculoskeletal Rehabilitation, pp. 427- 435.

Blood-Smyth, J. 2015, Strengthening the front thigh muscles, [ONLINE] Available at: http://www.thephysiotherapysite.co.uk/physiotherapy/physiotherapists/articles/168/stren gthening-the-front-thigh-muscles [Accessed 4th June 2015]

Bolton, K.L., Egerton, T., Wark, J., Wee, E., Matthews, B., Kelly, A., et al. 2012, “Effect of Exercise on Bone Density and Falls Risk Factors in Post-Menopausal Women with Osteopenia: A Randomised Controlled Trial.” Journal of Science and Medicine in Sport, pp. 102-109.

Kochen, B. 2015, Weakness in Quadriceps [ONLINE], Available at: http://www.livestrong.com/article/500830-weakness-in-the-quadriceps/ [Accessed 4th June 2015]

Murlasits, Z., Reed, R., Wells, K. 2012, “Effect of Resistance Training Frequency on Physiological Adaptions in Older Adults” Journal of Exercise Science and Fitness, pp28-32

Stolzenberg,N., Belavy, D.L., Beller, G., Armbrecht, G., Semler, J., Felsenberg, D. 2013, “Bone Strength and Density via pQCT in Post-menopausal Osteopenic women after 9 Months Resistive Exercise With Whole Body Vibration of Proprioceptive Exercise.” Centre for Osteology and Metabolic Diseases, pp.66-76.

Waehner, P., 2014. The F.I.I.T Principle. [online] Available from: http://exercise.about.com/od/weightloss/g/FITTprinciple.htm [Accessed 7th April 2015]