Is this even “functional?”
We recently posted a split squat isometric hold variation on Instagram showing an athlete crushing a towel with their heel while maintaining a positive shin angle (see image).
The intent behind a task like this is to concentrate force/load into the quadriceps by reducing the contribution from neighboring muscular tissues, specifically the ankle plantar flexors.
We had a couple of therapists ask, “Why aren’t you pushing through the midfoot/forefoot, because this is how we propel during real-world movement?”
To us, using this kind of rationale to guide the use of an exercise/loading intervention during the rehab process involves very little critical thinking.
Should we really just do an exercise because it mimics the positions, joint angles, and muscular activation patterns expressed during real-world movement? For us, NO! This ignores the fact that real-world movement results from the complex interaction between the person (including their muscles & joints), the task, and the environment.
Again, to be clear, our intent with this loading strategy is to concentrate load into the quadriceps to build capacity through those tissues. Our cues to a client would be to crush the heel, simultaneously reach your knee forward, and elevate the back knee from the block/ground. This will light up your quadriceps like you’ve never felt before. If you feel the rear leg doing too much, shorten the stance by bringing the rear knee closer to the front leg.
When might this “functional” argument make sense?
When clients have a specific problem during a specific real-world task, then sometimes it’s important to organize our rehab strategies to mimic those tasks with the intention of improving the client’s tolerance and confidence when engaging with those tasks.
However, this is a very different intention relative to our intention with this post. Building tolerance & confidence with specific tasks does not mean you are building appropriate physiological capacities in the relevant muscular & joint tissues.
So should we not push through the midfoot / forefoot?
Sigward et al. (2021) investigated these compensatory strategies resulting from knee extensor force production deficits following ACL reconstruction and found that shifting load into the ankle plantar flexors (via shifting load into the midfoot/forefoot) was a common strategy used that reduced the demand on the knee extensors. So, how do we reduce this strategy? By concentrating load through the heel.
Does this mean that we want individuals to push through their heels when they walk and run!? Of course NOT!
This simply highlights why it’s extremely important to have a clear intent behind your loading strategies during any kind of rehabilitation plan.
By all means, include variations during these strategies where you shift the load into the midfoot / forefoot, but just be clear on WHY you’re doing it.
What makes a high-quality rehabilitation professional?
One of the most important features for us, is the ability to express superior clinical reasoning skills to guide the implementation of exercise/loading strategies.
Being clear with your intention and having a well-rounded assessment and rehabilitation framework to guide your decision-making is hugely important.
These features, along with equipping yourself with a fantastic array of practical assessment and rehabilitation strategies, makes up a significant amount of what we cover on our Level 1 & Level 2 course for rehabilitation professionals.
If you want to learn more, you know what to do! Online Level 1 & Level 2 going on sale this black friday!
1 . Chan MS, Sigward SM. Center of pressure predicts Intra-limb compensatory patterns that shift demands away from knee extensors during squatting. J Biomech. 2020