The return to play process for an athlete is far from cut and dry, but one thing, at least for us with our doctors, that is near top of the list for requirements is the return or equaling out of the quad girth after any sort of knee repair. I’m very fortunate to have doctors who are willing to discuss what they are looking for, why they deem it important, and even how they feel I should prioritize each (this could be its own post), and this one is almost always the one they talk about the most. We love to jump the gun and go to start working on “functional skills” but if the doctor won’t clear the athlete because you prescribed what you think is most important because you know better, well the athlete’s still going to be sitting next to you on the bench. Throughout my tenure I’ve tried a whole vast array of methods to try to help the athletes “regain the girth” so that the doctors would feel more confident releasing them for more activity sooner. Hypertrophy really isn’t tricky though right? It comes down to 1 thing really, time under tension, and these three methods of programming have provided me the best success without needing toys.

• The Tempo Method (also called Oxidative Method)- This was discussed by Dr. Viktor Seluynaov at The Seminar in 2013. It’s very similar (if not identical) to an old body building method of keeping constant tension on the muscle. To perform this method, you move at a 2 second count down followed by a 2 second count up for 10 reps, so each set last 40 seconds (I’ve also done this in the 1×20 format, have an athlete doing so now and it seems to be going well). Throughout the set you don’t bottom out and you don’t lock out, so you keep constant tension on the muscles. I’m going to be blunt with you, these are awful. They hurt, but there is zero doubt in my mind that they work. With athlete’s recovering from a knee repair we will typically use Zercher or Goblet to start, and may move to front squats, typically all with the heels elevated to try to hammer that quad a bit more. We will also do these with RFESS, but instead of the full 40 seconds between legs we will go 20 and switch so they go on the minute (also doing this with 1×20 right now and seems to be progressing nicely).
• Eccentric Drop Sets- I don’t know what to call these, and this name made sense so that’s where I’m starting. If anyone knows what they’re called or has a better name let me know. To execute these, we do 1-3 sets of 10 reps. The first rep the athlete takes a 10 second count to lower the weight, 2nd rep 9, 3rd rep 8…10th rep 1 (but controlled). Lots of time under tension eccentrically here. We do these both single leg for leg extensions and calf raises, or 2 up 1 down (meaning concentrically move with both legs, eccentrical control with one. Super challenging but a ton of time under tension without the necessity of a heavy load torqueing on the knee.
• 100 Reps in 3 Sets or Less- Back in the day we used to have a staff training group that was run by one of my predecessors Jim Roney. Above and beyond everything the workouts were fun and great for comradery within the department, but on top of that Tank taught me a ton through training, and this was a common place in our workouts. Him being a big “West Side” guy (if there’s such a thing) at the time he talked about there’s three ways to get stronger, lift a heavier weight, lift the weight faster, lift it more times. Which we all know today as the max effort, dynamic effort, and repetition effort methods. In the repetition effort method, he would “ask” us to accrue a ton of volume, and this was one of his favorites. It’s tedious, it hurts, but its sure works. This is might be the simplest way to increase time under tension, do the movement more times! We have programmed Spanish Squats here a lot, and in the past we have done things like SB Leg Curls and SB Bridges with it, BW Box Squats, and Band Good Mornings. I think they can all fit.

These are three simple methods to increase time under tension to help improve that “girth growth” that your doctors are after so you can get into the “fun stuff” and get them back to training/practice. Obviously, this isn’t the only thing I’d do in these situations, you should be helping build other qualities along with this hypertrophy so that the player is prepared to get into the more “advanced” rehab to come, but don’t skip this, because at the end of the day, skipping this step is going to not slow down their progress, but if they doctor so chooses, halt it completely.