In the first three parts of this series, we explored how performing exercises that your foot-ankle complex, hamstrings, and adductors can make your lower body more resilient. In the final installment of this series, let’s swing the spotlight onto the front and top of your legs and explore some ways to improve durability in this area by spending just a few minutes each week on it.
A complaint that the majority of my clients share is that they feel excessive tightness in their anterior hip. It usually bothers them when they need to bring their knees toward their chest, such as when running, stepping, or jumping, but sometimes shows up during other athletic and everyday activities. While on the surface this seems like a mobility issue (and sometimes it is), more often than not the cause is that they’re not regularly loading their hip flexors like the iliacus and psoas or targeting the larger quad muscles and the tendons that attach to them.
Among those who play speed/power sports, this issue can manifest itself in ligament sprains and tendon tears around the knee and in acute quad muscle strains. In endurance sports, the loads are lower but more persistent, and athletes often have chronic issues in their mid-to-high quad area. In an attempt to alleviate stiffness and soreness in this part of their legs, I often see clients stretching constantly. While this provides some immediate relief and I’m for them becoming more mobile, over-stretching plus under-loading can exacerbate the issue.
Preparing Your Pistons
The piston action of running – and especially sprinting, where the knee lift is higher – requires you to pull one knee up as your other leg extends and pushes away from the floor. This is very taxing on the muscles and connective tissues of the upper leg, particularly on the front side. To help athletes better prepare their lower body for the rigors of running fast, I often have them lie on the ground, put a mini-band around their feet, and mimic the piston action in what I call a “sprinter exercise.” Then we progress to a long sit position, which you start as if you were sitting at a picnic with your legs out in front of you. Then you lift one leg up and over a small obstacle like a yoga block to recreate the running motion.
Doing slow mountain climbers and certain plank variations is also useful. Getting into and maintaining a tall plank asks a lot of your quads and hip flexors as you try to prevent yourself from tipping over. There’s evidence to show that a reverse Nordic extension – which at TD Athletes Edge we call a fallback – helps improve the durability of the quads and the supporting structures that surround the knee. The starting position is the same as the Nordic hamstring curl that we detailed in part three of this series but you fall the other way instead, like Neo dodging bullets in The Matrix. A research team from the University of Vigo in Spain discovered that this exercise increased the durability of participants’ rectus femoris – one of the quad muscles – by increasing its thickness and fascial length over the course of a 12-week training program.1
Another method for emphasizing the quads is to perform a squat variation whereby you lift your heels up, which emphasizes the muscles and tissues on the front of your upper legs. You can mix up performing isometric, concentric, and eccentric exercises in all these patterns.
Safeguarding Your Quad and Patellar Tendons
As you move down the thighs, the quads turn into quad tendons and then envelope the patella (kneecap) and becomes the patellar tendon, attaching to the tibial tuberosity - that bump below your knee. attach on the tibial tuberosity – that bump below your knee. Basketball and volleyball players, triple jumpers, and other athletes whose sports involve a lot of leaping often experience chronic pain at this insertion point. To try and mitigate it, they sometimes wear a strap or band that offers compression. Stretching, icing and resting are other common tactics. Yet although these provide relief while they’re playing or practicing their activity, it’s a Band-Aid measure.
They’d get better results from proactively loading and strengthening their quad tendons. Sadly, they often shy away from such isolation work as they’re worried that the demands of their sport are already too much for this painful area and that zeroing in on it while in the gym will merely make the issue worse. This isn’t the case, and they’d become more durable by simply performing a few isolation exercises a couple of times a week in addition to their normal lower body routine. The goal is to get the tendons back to being springy, not letting them go soggy from too little loading and too much stretching. A study released via The American Journal of Sports Medicine concluded that slow, heavy resistance training is the best way to treat and prevent tendinopathy of the patellar tendon.2
An exercise we call “the kneeler” is a great place to start loading the patellar and quad tendons. It’s also a good example of why the assertion that you should never bring your knee over your toes is merely a myth. While this might be valid for heavy lunges and some other compound, high-load exercises, there are plenty of scenarios in sports when your knees might need to go beyond your toes, if only for a few seconds. If you don’t ever get into this position in a controlled environment like the gym, it’s unlikely you’ll be able to do it safely during a game or scrimmage. Joints and connective tissues need to express their full ranges of motion if they’re to stay durable.
Getting your knees over your toes is not going to blow up your joints. If we took this reductive way of thinking too far, we’d have to start crossing off a huge list of so-called “bad” exercises and be left with very few “good” ones. All this would do is create a mindset of exclusion, fear, and fragility. The only way for your body to remain resilient is if you use it to the full extent of its capabilities on a regular basis. And a solid starting point for this when it comes to giving your knee different looks is to expose yourself to some isolated exercises in which your knee will briefly come over your toes.
Here are some examples of this kind of movement and others that will make your hip flexors, quads, and quad and patellar tendons more durable:
1. Mini-Band Floor Long Sprinter w/ 3s Iso
2. Mini-Band Incline Tall Plank w/ Sprinter
3. Mini-Band Slider Tall Plank w/ Alt. Sprinter
4. Seated Quad Lift w/ Hover
5. Hands Supported Kneeler
6. TRX Tall Kneel Fallback
7. Heels Elevated Wall Sit
Taking Aim at the ITB
Another part of the lower body that athletes often have issues with but infrequently work on is the Iliotibial band. The ITB runs from your pelvis along the outside of your thigh to your knee. It’s a kind of hinterland between your quads and hamstrings and excessive tightness in either or both can feed into the ITB getting stiff and sore. Yet just like with pain in the tibial tuberosity, a more common cause of ITB issues is a lack of mechanical loading. While the quads and hamstrings on the outside seam are often powerful from sporting activities and compound exercises like squats and deadlifts, they don’t see enough dedicated action to handle the load demands of what you do outside the gym. As a result, you can be left with a painful chronic condition that might seem like it’s never going to abate.
The good news is that just like with the other muscles and connective tissues mentioned earlier, performing a few sets of ITB-centric exercises a couple of times a week could work wonders. This was demonstrated by a study published in the Journal of Orthopaedic Surgery and Research, which concluded that runners who performed ITB strengthening exercises recovered better than those who simply stretched or did regular workouts.3 Instead of just foam rolling this area – which feels good at the time but is unlikely to resolve your ITB issues – you’d do well to focus on loading this outer edge of your upper legs from several different directions. This can be achieved with exercises that involve you moving through the transverse and rotational planes.
This is backed up by substantial evidence, including findings released in The BMJ (British Medical Journal).4 Researchers found that after a year, patients suffering from ITB syndrome who frequently targeted the area with exercise and were educated about their condition saw more improvements than those who received corticosteroid injections.
A curtsy lunge is one of my favorite ITB movements. You can also add some resistance to side-to-side exercises. Anything that forces the muscles and tissues around the lateral hip to engage and become more tolerant of load is going to be beneficial here. Lateral walks and side planks can help you better manage the acute load of sprinting fast and the chronic load of running slow over longer distances.
Adding glute-specific movements like loaded bridges and hip thrusts might also be beneficial. A group of exercise scientists compared one group that did such exercises for 12 weeks with another that performed phony ones that didn’t require glute activation. They found that the first group reduced their lateral hip pain, which many people attribute to ITB syndrome.5 The BMJ study mentioned earlier supported this notion, stating that lateral hip pain is often pinned on the IT band even though gluteal tendinopathy is to blame. The takeaway? Mix in the exercises below into one, two, or three workouts a week, along with some that emphasize the outside of your glutes:
1. Mini-Band Sidelying Straight Leg Lift
2. Mini-Band Side Plank w/ Straight Leg Lift
3. Ancore Side Plank w/ Row
4. DB Goblet Curtsy Lunge
5. Planted Curtsy Step-Down w/ Knee Drive
6. Mini-Band High Lateral Walk
Read the full Bulletproofing Your Lower Body series:
Miss part 1? Click HERE to catch up
Miss part 2? Click HERE to catch up
Miss part 3? Click HERE to catch up
1. Diego Alonso-Fernandez, Rosana Fernandez-Rodriguez, and Rocío Abalo-Núñez, “Changes in Rectus Femoris Architecture Induced by the Reverse Nordic Hamstring Exercises,” The Journal of Sports Medicine and Physical Fitness, April 2019, available online at https://pubmed.ncbi.nlm.nih.gov/30293403/.
2. Mads Kongsgaard et al, “Fibril Morphology and Tendon Mechanical Properties in Patellar Tendinopathy: Effects of Heavy Slow Resistance Training,” The American Journal of Sports Medicine, February 12, 2010, available online at https://journals.sagepub.com/doi/10.1177/0363546509350915.
3. Janine McKay et al, “Iliotibial Band Syndrome Rehabilitation in Female Runners: A Pilot Randomized Study,” Journal of Orthopaedic Surgery and Research, May 24, 2020, available online at https://josr-online.biomedcentral.com/articles/10.1186/s13018-020-01713-7.
4. Rebecca Mellor et al, “Education Plus Exercise Versus Corticosteroid Injection Use Versus a Wait and See Approach on Global Outcome and Pain from Gluteal Tendinopathy: Prospective, Single Blinded, Randomised Clinical Trial,” The BMJ, May 2, 2018, available online at https://www.bmj.com/content/361/bmj.k1662.
5. Charlotte Ganderton et al, “Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial,” Journal of Women’s Health, June 27, 2018, available online at https://pubmed.ncbi.nlm.nih.gov/29715073/.
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Tim DiFrancesco, PT, DPT spent 6 seasons as the Head Strength & Conditioning Coach of the Los Angeles Lakers and is the founder of TD Athletes Edge. He is nationally renowned for his evidence-based and scientific approach to fitness, training, nutrition, and recovery for athletes and fitness enthusiasts.