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by Lewis G. Maharam, M.D., FACSM
Time for a Quad Job 1. Sit up on a desk or high surface, stick your leg out straight, drop it about 6" and support it with a chair or stool. 2. Fill a gym bag or duffel with weights, books, soup cans, whatever, and strap it to the lower leg. 3. Lift only the last 6" (about 30 degrees) to full extension, hold for three seconds, then come slowly back down. Do 5 sets of 10 reps each day, with just enough weight that you get to 5 or 6 on that fifth set, and have to stop. Can't get there? Take out some weight. Can do all 10? Add some weight.
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But orthotics alone won't do it. You need your other ally, the medial quad, the muscle in the front of your thigh that's supposed to hold the kneecap in the center of the groove. The stronger it is, the better it can do its job. But there's a rub: Leg extensions usually used to strengthen the quads also pull the kneecap back down into the groove and grind it up some more. No good. But the terminal extension exercises (in the box), which limit the motion to the last six inches of extension, don't. Do them daily until the pain disappears, then twice weekly. Both legs, please. They're a matched pair, and what's already happened on one side is a good bet for the other some day.