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The Effect of the Quadriceps Muscle on Sports Performance and Injury

Prevention: Biomechanical Perspective

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Tuijin Jishu/Journal of Propulsion Technology
ISSN: 1001-4055
Vol. 45 No. 4 (2024)
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The Effect of the Quadriceps Muscle on

Sports Performance and Injury Prevention:
Biomechanical Perspective
Mohammad Ahsan1, Abdullah Alzahrani2
1
Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal
University, Dammam, Saudi Arabia.
Department of Rehabilitation Sciences, College of Applied Sciences, Shaqra University, Shaqra, Saudi Arabia.

Abstract:- This narrative review aims to explore the significance of the quadriceps muscle in various athletic
activities and its association with injury susceptibility. Understanding the role of this muscle group can provide
valuable insights for athletes, coaches, and healthcare professionals in optimizing performance and preventing
injuries. The quadriceps muscle is particularly important for activities that require explosive movements, such as
sprinting and jumping. Strong and well-developed quadriceps muscles contribute to increased speed, acceleration,
and vertical jump height. Athletes who possess greater quadriceps strength and power have a competitive
advantage in sports that demand these attributes. While the quadriceps muscle is crucial for sports performance,
it is also susceptible to various injuries. Quadriceps strains are common among athletes, especially those involved
in sports that involve rapid changes in direction or sudden accelerations. Weakness or imbalances within the
quadriceps muscle can lead to increased injury risk, as other muscles may compensate and overload certain areas.
Additionally, inadequate warm-up, improper training techniques, and overuse can further increase the likelihood
of quadriceps-related injuries. To minimize the risk of quadriceps injuries, athletes should focus on strengthening
and conditioning this muscle group through targeted exercises. Incorporating exercises such as squats, lunges, leg
presses, and plyometrics can enhance quadriceps strength and power while improving overall performance.
Adequate warm-up routines, proper technique, and gradual progression in training intensity are also essential in
preventing injuries. This narrative review provides a comprehensive analysis of the role of the quadriceps muscle
in sports performance and injury risk. The strengths of this review lie in its interdisciplinary approach, critical
evaluation of the literature, and synthesis of information in a narrative format. The recommendations provided by
the authors have important implications for athletes, coaches, and sports medicine professionals. Further research
is needed to optimize training strategies and reduce injury risk associated with quadriceps weakness.

Keywords: Force Production1, Change of Direction2, Muscle Strains3, Patellar Tendinopathy4, ACL Injury5,
Strengthening Exercises6, Biomechanical Analysis7, Rest and Recovery8.

1. Introduction
The quadriceps muscle group plays a crucial role in sports performance and injury risks. In this narrative review,
we will explore the functions of the quadriceps muscles, their contribution to sports performance, and the
associated injury risks. The quadriceps femoris includes the rectus femoris, vastus lateralis, vastus medialis, and
vastus intermedius. The principal role of the quadriceps is to facilitate the extension of the knee joint, which is
essential for running, jumping, kicking, and squatting. The role of the quadriceps muscle in sports performance
and injury risk is multifaceted, encompassing strength, endurance, neuromuscular control, and injury prevention.
Several studies have shed light on different aspects of the quadriceps muscle in sports performance and injury
risk. Lamberti et al. revealed that the implementation of low-intensity endurance-resistance training resulted in
enhanced mobility and muscle power among individuals who had experienced chronic stroke [1]. This finding
suggests that targeted training interventions can enhance lower limb function, which may apply to athletes aiming
to improve their performance or recover from injuries involving the quadriceps muscles. A prospective cohort

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study by Beischer et al. investigated young athletes who returned to sport after anterior cruciate ligament (ACL)
reconstruction [2]. The findings of the study indicated that engaging in knee-strenuous sports nine months
following ACL reconstruction surgery was linked to a much higher likelihood of experiencing a second ACL
injury, with the risk of occurrence being about seven times greater. This highlights the importance of adequate
rehabilitation before returning to high-stress activities involving the quadriceps muscles. Tottori et al.'s research
demonstrated a correlation between quadriceps femoris muscle volume (MV) and sprint performance in
preadolescent sprinters [3]. This finding emphasizes the significance of muscular morphology on athletic
performance at a young age, suggesting potential implications for training strategies to optimize sprinting ability
through specific adaptations within the quadriceps muscles. Hedayatpour et al. explored sex-specific adaptations
of quadriceps activity following fatiguing contractions [4], revealing differences between men and women related
to fatigue-induced changes in activation patterns during sustained contractions involving the quadriceps muscles.
Mason et al.'s Cochrane review assessed various rehabilitation strategies for hamstring injuries, including those
affecting the proximal rectus femoris tendon origin, primarily with hip flexion movements rather than knee
extension actions [5].
The literature reviewed provides comprehensive insights into various aspects related to the role of quadriceps
muscles in sports performance and injury risk across different populations, including stroke survivors, young
athletes recovering from ACL reconstruction surgery, preadolescent sprinters, elite football players with
myoaponeurotic injuries, as well as non-injured athletes undergoing specialized training regimens targeting their
lower limb musculature. These studies collectively emphasize how factors such as strength imbalances within
individual leg compartments like hamstrings versus quads or left-right asymmetries can influence both athletic
prowess as well as susceptibility towards future risks such as recurrent soft tissue damage or impaired functional
capacity post-injury recovery phases.
2. SPORTS PERFORMANCE:
The quadriceps muscles play a crucial role in sports performance. Athletes who participate in sports that require
explosive power in the lower body, such as basketball, soccer, and track and field, often focus on strengthening
their quadriceps muscles through exercises such as squats, lunges, and leg presses. However, it is important to
balance quadriceps training with exercises that strengthen other muscle groups and improve overall mobility and
flexibility to prevent injury and optimize sports performance. Quadriceps muscles may help in sports performance
by below mention reason.
2.1 Force Production
The quadriceps muscles generate significant force during activities requiring explosive lower limb movements.
This force production is crucial for sprinting, jumping, and kicking. Numerous research have been conducted to
examine the impact of various interventions on the enhancement of quadriceps muscle strength and hypertrophy.
The study undertaken by Maniar et al. [6] involved a systematic review aimed at providing a comprehensive
summary of the existing evidence pertaining to the association between muscular force and ACL loading. They
found that the quadriceps can increase the load on the ACL by inducing anterior shear forces at the tibia during
activities such as landing and jumping when the knee is extended. Additionally, hamstring activation was shown
to oppose ACL loading by generating posterior tibial shear force when the knee is flexed greater than ~20° to 30°
[6]. Schoenfeld et al. compared resistance training with short rest intervals to training with long rest intervals in
young resistance-trained men [7]. They found that longer rest periods promoted greater muscle strength and
hypertrophy increases compared to shorter rest periods. Toth et al. [8] demonstrated that early neuromuscular
electrical stimulation (NMES) use reduced skeletal muscle fiber atrophy in certain fiber types and preserved
contractility in others. This study provides cellular-level evidence supporting the beneficial modification of
skeletal muscle maladaptations following ACL reconstruction through early NMES use. Pearcey et al.
investigated the efficacy of foam rolling as a recovery strategy following a rigorous exercise routine. The
researchers evaluated many performance indicators, including pressure-pain threshold, sprint time, change-of-
direction speed, power, and dynamic strength-endurance [9]. Their results showed substantial improvements in
delayed-onset muscle soreness (DOMS) measures while enhancing muscle performance recovery following foam

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rolling exercises. Kassiano's systematic review concluded from the available literature that full ROM performed
initially elicits greater force production response than pROM performed towards end range motion [10]. DeLang
et al. [11] focused on female adolescent soccer players' performance during lateral vertical jumps relative to limb
dominance using force generation contribution measures. Despite symmetrical jump height outputs, they found
significant differences in force generation contribution between dominant and non-dominant limbs during specific
phases of the jump task.
Figure 1. Illustration the role of quadriceps muscle in sports performance.

2.2 Muscle Hypertrophy and Cross-Sectional Area (CSA):

Quadriceps muscle hypertrophy and CSA can play an important role in sports performance, particularly in
activities that require lower body strength and power. Research has shown that increasing quadriceps muscle
hypertrophy and CSA can improve sprinting, jumping, and other explosive movements. This is because larger
muscle size and CSA allow greater force production and power output. In addition to improving sports
performance, increasing quadriceps muscle hypertrophy and CSA can help reduce the risk of injury. Stronger
muscles can better absorb shock and impact, reducing the likelihood of strains, sprains, or other injuries. Seynnes
et al. conducted a high-intensity resistance training program. They found significant increases in quadriceps
muscle cross-sectional area (CSA) after only three weeks of training, with architectural changes preceding gains
in muscle CSA [13]. This suggests hypertrophy contributes to strength gains earlier than previously reported [13].
Cheon et al. conducted a comparison between open kinetic chain exercise (OKCE) and closed kinetic chain
exercise (CKCE) in order to assess the impact on quadriceps muscle thickness in a sample of healthy adults. The
results revealed distinct enhancements in muscle thickness that were contingent upon the specific type of exercise
executed [13]. Duarte et al. conducted a randomised clinical trial pilot study involving whey isolate
supplementation combined with resistance training in young, healthy adults. They observed increased muscle
thickness related to whey protein intake but no effect on muscle strength gains [14]. Neves et al. conducted a
within-subject design over a period of nine weeks to examine the impact of different frequencies of resistance
training on maximal dynamic strength performance and muscle hypertrophy in persons who were already trained.
They found similar increases in maximal dynamic strength and quadriceps femoris CSA regardless of the
frequency of resistance training sessions per week [15]. Lai et al., Hebisz and Hebisz also demonstrated positive

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effects from lower limb resistance exercises, such as increased muscle strength and physical fitness among pre-
frail elderly patients through randomised controlled trials involving lower limb resistance exercises over twelve
weeks [16,17]. Ema et al., Earp et al., Azevedo et al., and Santos et al. studied different aspects related to specific
components or responses associated with the quadriceps femoris muscles during various types of exercises such
as eccentric versus concentric contraction-focused resistance training, isometric knee extension torque;
hypertrophy; taping conditions; neuromuscular fatigue during treadmill running; sex-specific adaptations induced
by RT; alterations in leg extensor biomechanical properties due to ageing or mechanical loading respectively [18-
21]. Kojić F. et al. studied upper-body bicep curl vs lower-body squat training response between sexes, showing
similar adaptations regarding hypertrophy/strength/contractile properties induced by RT without specific sex-
related differences for upper/lower body muscles. Bergstrom HC shown that there is a continuous decline in
muscle strength in the triceps surae and quadriceps femoris muscles in humans as they age. This decline is
accompanied by a drop in tendon stiffness and elastic modulus. However, despite these changes, the
mechanosensitivity of these muscles remains intact [22]. Dafkin C. et al. demonstrated relationships between
EMG amplitude/movement latency, indicating close links between kinematic measurements/EMG measures
reflecting actual movement assessed via kinematics [23]. McCrum C. et al. showed composite patterns indicating
neuromuscular fatigue during exhaustive treadmill runs within severe intensity zones SIZ1/SIZ2, suggesting
initial morphological/functional changes following RT are similar for males/females without any specific sex
adaptations for upper/lower body muscles [24]. To increase quadriceps muscle hypertrophy and CSA, athletes
can engage in resistance training exercises that target the quadriceps muscles, such as squats, lunges, leg presses,
and step-ups. It is important to gradually increase the intensity and volume of these exercises over time to avoid
injury and ensure continued progress. It is also important to note that individual factors such as genetics, training
history, and nutrition can influence muscle hypertrophy and CSA. Therefore, it is recommended to work with a
qualified strength and conditioning coach or sports scientist to develop a personalized training program that
considers individual needs and goals.
2.3 Jumping and Landing:
The quadriceps muscles play a vital role in vertical jumping by extending the knee joint and generating power to
propel the body upwards. During jumping, the quadriceps muscles generate the initial force needed to propel the
body off the ground. As the quadriceps contract concentrically, they extend the knee joint, allowing for the
explosive extension of the legs and the upward movement of the body. In addition to generating force, the
quadriceps muscles also contribute to stabilizing the knee joint during the landing phase. When landing from a
jump, the quadriceps muscles work eccentrically to control the descent and absorb the impact forces. This
eccentric contraction helps to decelerate the body and protect the joints from excessive stress. The role of the
quadriceps muscle in jumping and landing has been extensively studied with ACL loading and lower extremity
stability. Porrati-Paladino et al. [25] investigated plyometric and eccentric exercises' effectiveness in improving
lower limb stability in female soccer players. They found that eccentric exercises alone or combined with
plyometric exercises improved lower limb stability without affecting jump height. Jankaew et al. [26] explored
how hamstring stiffness influences lower limb muscle recruitment during jumping manoeuvres using surface
electromyography (EMG) and ground reaction force (GRF) measurements during different types of vertical
jumps. de Britto et al. [27] investigated the pre-landing myoelectric activity of the hamstrings and quadriceps
muscles in male and female athletes. The researchers gathered electromyography (EMG) data from recreational
athletes who performed bilateral drop jumps from two distinct heights. Ortiz & Olson [28] also contributed
valuable insights into various aspects related to quadriceps muscle function during jumping tasks, including its
impact on ACL injury risk assessment, neuromuscular activation patterns, fatigue effects on knee joint stability,
dynamic knee valgus tendencies post-ACL reconstruction surgery, internal joint forces during dance landings
influencing axial forces among others. Based on these findings, both quadriceps and hamstrings play critical roles
in maintaining lower extremity stability during jumping tasks while minimizing excessive loads on structures such
as ACLs. Proper landing techniques are essential for minimizing the risk of injury during jumping and landing
activities. The quadriceps muscles play a key role in maintaining proper knee alignment and controlling the
landing forces. Strong and well-conditioned quadriceps muscles can help improve landing mechanics, reduce the

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risk of knee injuries such as ACL tears, and enhance overall jump performance. To enhance jumping and landing
abilities, athletes can incorporate exercises that target the quadriceps muscles, such as squats, lunges, and
plyometric drills, into their training programs. Focusing on proper form, gradually increasing intensity and
volume, and allowing for adequate rest and recovery is important to optimize performance and minimize the risk
of overuse injuries.
3. INJURY RISK: The quadriceps muscles are commonly used during physical activities such as running,
jumping, and squatting, which can put them at risk for injury if not properly conditioned or if overused. These
may include…
Figure 2. Illustration the role of quadriceps muscle in injury risk

3.1 Muscle Strains:

Quadriceps muscle strains frequently occur in athletic activities characterized by repetitive kicking and sprinting,
with a specific prevalence shown in the sport of football. Pietsch and Pizzari conducted a systematic review to
identify risk factors for quadriceps muscle strain injury in sports [32]. The results of their study indicated that
prior quadriceps injury, recent hamstring injury, the leg used for kicking, and participation in competitive matches
were the most significant risk factors for subsequent quadriceps muscle injury. This comprehensive analysis
provides high-level evidence supporting the association between these factors and quadriceps strain injuries.
Mendiguchia et al. provided a clinically relevant review of rectus femoris muscle injuries in football [33].
Although their paper did not directly focus on specific risk factors or mechanisms related to quad strains as Pietsch
and Pizzari's work did, it offered valuable insights into the mechanism of rectus femoris injury. Understanding
these mechanisms is crucial as the rectus femoris is one of the four muscles that make up the quadriceps group;
therefore, its injuries may be indicative of broader issues within the quad muscles. Ekstrand et al. (34) aimed to
examine and evaluate the occurrences and characteristics of injuries among female and male elite football teams
playing on artificial turf and natural grass surfaces. While the primary objective of their study did not directly
revolve on quadriceps strains, the researchers discovered that male individuals had a lower likelihood of
experiencing quadriceps strains during match play on artificial turf in comparison to grass fields. In their study,
Roe et al. conducted an investigation spanning eight years to ascertain the occurrence, characteristics, and impact
of time-loss injuries among elite Gaelic football players [35]. Their data revealed that "quadricep strain" accounted
for approximately 5% of all time-loss lower-limb related clinical entities sustained by elite Gaelic football players
during match-play activities over this period. Overall, these studies collectively provide substantial evidence
regarding various intrinsic (e.g., previous history of quad injury), extrinsic (e.g., competitive match play),

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mechanical (e.g., posture deviations), environmental (e.g., playing surface), or other contributing factors
associated with increased risk or occurrence rates for quad strains across different sports settings.
3.2 Patellar Tendinopathy:
Also known as jumper's knee, this injury involves the degeneration of the patellar tendon. Activities that involve
repetitive jumping or explosive quadriceps contractions can lead to overuse and subsequent tendon damage. The
risk of patellar tendinopathy in athletes has been a subject of interest due to its impact on athletic performance
and potential long-term consequences. Mersmann and colleagues [36] did a longitudinal study with the aim of
examining the progression of morphological and mechanical characteristics of muscle and tendon in adolescent
volleyball athletes over a two-year period spanning from mid-adolescence to late adolescence. The researchers
discovered that in the later stages of adolescence, there was a significant increase in the size of the patellar tendon,
resulting in enhanced mechanical strength in conjunction with the functional and morphological growth of the
muscle. They found an unfavorable relationship between muscular strength and tendon loading capacity during
mid-adolescence may be mitigated by this adaptive mechanism, which has the potential to affect athletic
performance and the risk of injury [36]. Slane et al. [37] examined the heterogeneity in healthy patellar tendons
among various age groups and genders. This investigation utilized ultrasound speckle tracking to analyze the
tendons during passive knee extension. The results of their study demonstrated a notable lack of uniformity in the
progression from superficial to deep layers, with no discernible impact of age. However, there was a statistically
significant difference in non-uniformity between males and females, with males exhibiting a greater degree of
non-uniformity.
Interestingly, their results contrasted with previous findings on Achilles tendons, suggesting that factors other
than fascicle sliding might dominate non-uniformity in patellar tendons [37]. Mersmann et al.'s study provides
valuable insights into how adaptive processes may influence tendon injury risk by compensating for unfavorable
muscle-tendon relations during growth [36]. However, it primarily focused on elite volleyball athletes, limiting
generalizability to other sports or populations. Slane et al.'s work sheds light on gender differences in patellar
tendon non-uniformity but acknowledges that further studies are needed to elucidate links between non-uniformity
and injury [37]. Both studies provide important contributions but have limitations, such as small sample sizes
(Mersmann et al.: n=18; Slane et al.: n=50), which could affect the generalizability of their findings.
3.3 Patellofemoral Pain Syndrome:
This condition is characterized by pain around the patella (kneecap) and is often associated with mal tracking or
abnormal contact between the patella and the femur. Quadriceps weakness or imbalances can contribute to altered
patellar mechanics and increase the risk of this syndrome. Giles et al., through their double-blind, randomised trial
investigating quadriceps strengthening with blood flow restriction (BFR), reported significant reductions in pain
with daily living at eight weeks among people with patellofemoral pain syndrome receiving BFR therapy
compared to standard care [38]. Baellow et al. [39] investigate differences in lower extremity electromyography,
kinematics, and kinetics during a drop-vertical jump (DVJ) and lower extremity isometric strength among women
with and without patellofemoral pain (PFP). The researchers discovered that women diagnosed with PFP
demonstrated modified muscle activation, kinematics, and kinetics while doing the DVJ in comparison to women
without any musculoskeletal issues. The results indicated that there was an elevation in the normalized muscle
activity of the vastus medialis among individuals in the PFP group during the landing phase of the DV) task.
Conversely, the PFP group exhibited a reduction in muscle activation specifically in the gluteus maximus and
biceps femoris. This finding suggests that there is a change in the way motor units are activated in the hip and
thigh muscles in individuals with PFP [39]. Moreover, women with PFP completed the DVJ with greater hip
internal-rotation moment and had decreased knee-flexion excursion compared to healthy women. Additionally,
they took less time to reach peak trunk flexion and lateral flexion during the DVJ [39]. These alterations suggest
changes in biomechanics associated with an increased risk of injury. The study provides valuable insights into
how altered lower extremity biomechanics may contribute to injury risk among individuals with PFP. However,
it is important to note that this evidence is derived from a single cross-sectional study involving a relatively small
sample size (15 healthy women and 15 women with PFP). While cross-sectional studies are useful for generating

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hypotheses, they have limitations regarding establishing causal relationships or generalizing findings to broader
populations due to their observational nature [39]. The findings suggest that individuals with PFP exhibit distinct
patterns of muscle activation and kinematic changes during dynamic movements such as jumping. However, due
to limitations inherent in cross-sectional studies, such as sample size constraints and the inability to establish
causality, further research utilizing longitudinal designs or randomized controlled trials is warranted to confirm
these observations.
3.4 Anterior Cruciate Ligament (ACL) Injury:
The quadriceps muscles play a role in protecting the ACL by providing dynamic stability to the knee joint.
Weakness or imbalance in the quadriceps can lead to altered forces on the ACL, increasing the risk of ACL tears,
especially during activities involving sudden changes in direction or landing from jumps. Alentorn-Geli et al.
examine the impact of mechanical and contractile characteristics of thigh muscles on the susceptibility of male
soccer players to ACL injuries [40]. The authors utilised tensiomyography (TMG) to assess the neuromuscular
characteristics of the quadriceps and hamstring muscles in individuals with confirmed ACL tears compared to a
control group. The findings of the study revealed that various indices related to transverse mechanical stiffness
(TMG) exhibited higher values in the non-injured side of individuals with ACL injuries in comparison to the
control group. Notably, statistically significant disparities were detected, notably in the muscles of vastus lateralis,
rectus femoris, and biceps femoris. The researchers arrived at the conclusion that the presence of resistance to
fatigue and muscle stiffness within the hamstring muscles could potentially serve as risk factors for ACL injury.
At the same time, an imbalance between the quadriceps and hamstrings might also contribute to ACL injury risk
among male soccer players. While this study provides valuable insights into potential neuromuscular risk factors
for ACL injury, it is important to evaluate its limitations critically. Firstly, the sample size is relatively small, with
40 ACL-injured individuals and 38 controls. Although statistical significance was reported for certain TMG
parameters, larger sample sizes are generally preferred to enhance statistical power and generalizability [40].
Furthermore, although TMG provides objective measurements of muscle contractile properties, it is essential to
consider other contributing factors to ACL injury risk, such as biomechanics during sports activities, previous
injury history, training intensity, and playing surface characteristics [40]. These confounding variables were not
fully addressed in the study by Alentorn-Geli et al., raising questions about the comprehensive assessment of
neuromuscular risk factors solely based on TMG parameters. In addition, while the study focused on male soccer
players specifically, it is crucial to recognise that different sports may impose distinct demands on lower limb
musculature due to variations in movement patterns and physical loads. Therefore, extrapolating these findings
directly to athletes from other sports or female athletes should be approached with caution until further research
confirms their applicability across diverse athletic populations. While Alentorn-Geli et al.'s investigation sheds
light on potential neuromuscular risk factors for ACL injury among male soccer players using TMG assessments,
critical appraisal reveals limitations related to sample size considerations, confounding variables not fully
accounted for, and generalizability across diverse athletic populations. Future studies should aim for larger sample
sizes with comprehensive consideration of various contributing factors towards ACL injury risk.
4. PREVENTION AND REHABILITATION: To minimize the risk of quadriceps-related injuries and optimize
sports performance, it is essential to implement preventive measures and rehabilitation strategies. These may
include…

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Figure 3. Illustration the role of quadriceps muscle in injury risk

4.1 Strengthening Exercises:

Quadriceps muscle strength is a critical factor in various musculoskeletal conditions such as ACL reconstruction,
patellofemoral pain, knee osteoarthritis, and resistance training programs. In a study conducted by Schoenfeld et
al., it was found that longer interset rest intervals were associated with significant improvements in muscle
strength and hypertrophy among a group of resistance-trained males [41]. The study conducted by Hauger et al.
demonstrated the efficacy of neuromuscular electrical stimulation in enhancing quadriceps muscle strength
following ACL surgery [42]. Additionally, Plotkin et al.'s study demonstrated that both load progression strategies
(increasing load or repetitions) are viable for enhancing muscular adaptations over an 8-week training cycle [43].
Furthermore, Coratella et al. [44] examined the distinct muscle recruitment patterns exhibited by bodybuilders
during various squat variations. Kubo et al. examine the impact of squat training at varying depths on the muscle
volumes of the lower limbs [45]. In a similar vein, Barbalho et al. investigated the differences between resistance-
training programs including back squats and hip thrusts in women who were already well-trained [46]. According
to the findings of Morton SK's study, it was observed that meticulously designed full-range resistance training
regimens have the potential to enhance flexibility, similar to the conventional static stretching regimens commonly
used in conditioning programs [47]. The study conducted by Schwanbeck SR indicated that both free weights and
machines yielded comparable enhancements in muscle mass and strength [48]. Delgado J's comparison between
back squat, Romanian deadlift (RDL), and barbell hip thrust (BHT) exercises demonstrated how RDL was equally
effective as BHT for isolating the hip extensors [49]. Overall, these studies collectively provide evidence
supporting various methods for improving quadriceps muscle function across diverse patient populations,
including athletes undergoing ACL reconstruction or individuals with neurological conditions.
4.2 Flexibility and Mobility Training:
Adequate flexibility and mobility of the quadriceps muscles and surrounding structures can help prevent strains
and improve movement efficiency. Quadriceps muscles play a crucial role in knee function, flexibility, and
mobility. Several studies have investigated the impact of various interventions on quadriceps muscle flexibility
and strength. The findings of a randomized controlled trial indicated that the implementation of dynamic
hamstring stretching in conjunction with strengthening activities yielded superior results in terms of muscle
activation time and clinical outcomes when compared to static hamstring stretching [50]. Nevertheless, a separate

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study that compared static and dynamic quadriceps stretching exercises did not see any significant differences in
quadriceps flexibility, strength, muscle activation time, or patient-reported outcomes among those with inflexible
quadriceps [51]. Resistance training has been shown to affect flexibility as well as strength compared to static
stretching regimens [52]. A randomized controlled trial evaluated the effect of stretching and progressive
resistance exercise on both range of motion and muscular strength. The study implemented a program that
incorporated passive stretching and progressive resistance exercise, specifically focusing on the lower limbs, over
a period of several weeks. Subsequently, maintenance sessions were conducted. The findings indicated that there
were no statistically significant increases observed in the passive popliteal angle and muscle strength [53]. While
some studies suggest positive effects of certain interventions, such as dynamic hamstring stretching or resistance
training, on flexibility and mobility related to quadriceps muscles, others demonstrate conflicting results. This
highlights the complexity involved in understanding the impact of different interventions on quadriceps muscles'
flexibility. In conclusion, while there is evidence supporting certain interventions, such as dynamic hamstring
stretching or resistance training for improving flexibility related to quadriceps muscles, conflicting results exist
within the literature. Further research is needed to establish clear guidelines regarding effective strategies for
enhancing flexibility specifically related to quadriceps muscles.
4.3 Proper Warm-up and Cool-down:
A thorough warm-up routine that includes dynamic stretching and activation exercises prepares the quadriceps
muscles for intense activity. Cooling down with static stretching and gentle movements helps prevent post-
exercise muscle tightness. The warm-up and cool-down exercises play significant roles in muscle function,
soreness, stiffness, blood flow, and recovery after exercise. Olsen et al. conducted a randomized controlled trial
to examine the impact of warm-up and cool-down exercises on delayed onset muscle soreness (DOMS) in various
regions of the rectus femoris muscle after doing leg resistance exercises [54]. The researchers discovered that
engaging in aerobic warm-up exercises before resistance exercise may effectively mitigate muscular soreness in
the central muscle regions, but not in the distal muscle regions. Nevertheless, it fails to mitigate the decline in
muscular strength. Chwała et al. evaluated the impact of vibration treatment on the rate of muscle regeneration
following physical exertion, utilizing shear-wave elastography as the assessment method [55]. The findings of the
study demonstrated that the use of vibration treatment following exercise resulted in a notable reduction in post-
exercise muscle stiffness, hence establishing it as a more efficacious restitution technique compared to passive
resting. The study conducted by Marshall et al. [56] investigated the effects of a soccer-specific active warm-up
followed by a rest period on muscle temperature, electrically evoked muscle contractile characteristics, and
voluntary power. The researchers discovered that the warm-up specifically designed for soccer activities resulted
in a 3.2°C increase in muscle temperature. This increase was accompanied by simultaneous enhancements in the
voluntary rate of torque generation. Teixeira-Salmela et al., as well as Sharp et al., focused on evaluating the
impact or improvement resulting from programs consisting primarily of a combination of warm-ups or cool-downs
along with other exercises such as aerobic exercises or isokinetic strengthening, respectively [57,58]. In
conclusion, evidence suggests that proper warm-up exercises may help prevent DOMS in certain regions but
might not completely prevent the loss of muscle force. In contrast, cool-down activities like foam rolling can
acutely reduce SBP without any additional benefit when combined with strength training activities alone.
4.4. Technique and Biomechanical Analysis:
Analyzing movement patterns and biomechanics can identify faulty mechanics and address movement
dysfunctions that may contribute to injury risk. The quadriceps muscle group has four distinct muscles, namely
the vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris. These muscles play a crucial role in
various movement patterns and exhibit specific biomechanics. Several studies have investigated altered movement
patterns and muscular activity during different tasks, such as single-leg squats, double-leg squats, stair ascent,
crouch gait evaluation, chasse steps in table tennis players, regular and counterbalanced squats, side-cutting after
ACL reconstruction, sit-to-stand transfers post-KA (knee arthroplasty), perturbation training post-ACL rupture
surgery, proprioception after electrocoagulation of the femoral insertion of the ACL, and experimental quadriceps
muscle pain during walking. The study conducted by Christensen et al. [59] examined the relationship between

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preoperative quadriceps weakness and postoperative aberrant movement patterns in individuals undergoing total
knee arthroplasty (TKA) and engaging in high-demand mobility activities. The researchers discovered a positive
correlation between higher preoperative quadriceps strength and improved postoperative function. Ravera et al.
conducted an assessment of the changes in force-energy rate of various muscles during crouch gait. They
employed musculoskeletal models informed by electromyography (EMG) data, together with analytical methods,
to examine the specific contribution of each muscle to the gait pattern. The findings of their study demonstrated
a higher level of energy expenditure per unit of time in children exhibiting crouch gait as opposed to those with
unimpaired gait. The study conducted by Kabacinski et al. [61] examined the knee strength ratios of female
athletes competing at a high level. The researchers utilized isokinetic strength testing at various speeds to assess
the strength of the hamstrings and quadriceps muscles. Additionally, isometric strength testing was employed to
evaluate the knee extensor muscles. The significance of the bilateral strength deficit and muscle balance between
the hamstrings and quadriceps in relation to sport-specific motions was emphasized. In their study, Thoma et al.
[62] investigated the correlation between quadriceps femoris strength and sagittal-plane knee biomechanics during
stair climbing in persons with articular cartilage defects (ACDs). The researchers employed three-dimensional
motion analysis to assess kinematics, along with ground response force measurements. The quadriceps muscles
have a moment arm that allows them to exert torque around the knee joint. The length and angle of this moment
arm change throughout the range of motion, affecting the force production capabilities of the quadriceps.
Additionally, the patellar tendon, which is an extension of the quadriceps muscles, provides leverage and increases
the mechanical advantage for knee extension. Understanding the movement patterns and biomechanics of the
quadriceps muscles is essential for optimizing training, rehabilitating injuries, and enhancing athletic
performance. Incorporating exercises that target the quadriceps, such as squats, leg presses, and lunges, can help
strengthen these muscles and improve their functional capabilities. Additionally, maintaining proper form and
alignment during movement patterns involving the quadriceps is crucial for minimizing the risk of injury and
maximizing performance.
4.5. Rest and Recovery:
Sufficient rest and recovery periods between training sessions or competitions are crucial for the health and
performance of the quadriceps muscles. Adequate rest and recovery allow the muscles to repair and rebuild after
exercise-induced damage, reduce inflammation, and optimise performance for future training sessions. The effect
of rest and recovery on quadriceps performance is a topic that has been investigated through various studies.
Schoenfeld et al. conducted a study [63] comparing short rest intervals (1 minute) with long rest intervals (3
minutes) in resistance-trained men performing resistance training programs. The researchers discovered that
extended periods of rest were associated with more substantial enhancements in both muscular strength and
hypertrophy compared to shorter rest periods, providing evidence supporting the importance of rest intervals in
promoting muscular adaptations. In a similar context, Evangelista et al. [64] compared split workout routines with
full-body workout routines on measures of muscle strength and hypertrophy. No statistically significant
differences were observed between the two cohorts, indicating that engaging in weight training either twice or
four times per week yielded comparable outcomes in terms of neuromuscular adaptation, provided that the weekly
set volume was equalised. Eymir et al.'s randomized controlled trial [65] demonstrated that progressive muscle
relaxation combined with standard physiotherapy led to better pain relief, increased quadriceps strength, and
reduced kinesiophobia during hospitalization following total knee arthroplasty. Longo et al.'s study [66],
comparing long versus short resting intervals during high-intensity resistance training while equalizing volume
load, the study findings suggest that prioritizing the maintenance of high loads is crucial for promoting strength
gains, but a bigger volume load is primarily responsible for inducing hypertrophy, regardless of the duration of
rest intervals between sets. To optimize rest and recovery for the quadriceps muscles, athletes can incorporate
strategies such as foam rolling, stretching, massage therapy, and adequate sleep into their training programs.
Additionally, it is important to allow for adequate rest periods between training sessions and to avoid overtraining
or excessive fatigue.

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5. Limitations:
While narrative reviews provide valuable insights into specific topics, it is crucial to recognize their limitations.
The narrative review on the role of the quadriceps muscle in sports performance and injury risk highlights several
limitations, including scope and selection bias; This review focuses primarily on quadriceps muscle performance
and injury risk in sports. This topic is crucial, however other factors may affect sports performance and injury
risk. Limiting the scope risks missing important information that could improve comprehension. Lack of
systematic methodology; Instead of following a strict methodology, narrative review relies on the author's
subjective interpretation of the material. Subjectivity can prejudice evidence and distort it. Absence of quality
assessment: Without a thorough examination of study design, sample size, and statistical analysis, finding's
reliability and validity are difficult to determine. Thus, narrative reviews may yield weaker conclusions than more
rigorous methods. Publication bias: Since nonsignificant or negative research are less likely to be published,
relying on published studies can bias outcomes. This bias may overestimate the quadriceps muscle's effect on
sports performance and injury risk. Narrative review findings may be limited by study populations, methodology,
and outcome measures. Limited generalizability: It is difficult to derive meaningful findings that can be applied
across populations or sports disciplines without a methodical approach to heterogeneity. Researchers and readers
should consider these limitations when interpreting the findings and seek additional evidence from other sources
to establish a more comprehensive understanding of the topic.
6. Strength:
Its detailed literature analysis and interpretation make this narrative review stand out. The researchers reviewed
various databases and studies from aspects of sports performance, injury risk, and prevention and rehabilitation.
Interdisciplinary approaches help understand the topic and analyze the results more deeply. The narrative
framework of this review helps combine material from multiple sources. The narrative approach helps the authors
highlight key research themes and patterns that may not be apparent in a traditional systematic review or meta-
analysis. This approach enhances the depth and richness to the overall quality. The way authors critically evaluate
the methodology and research quality in their analysis is impressive. By considering the limitations and potential
sources of bias in the literature, the authors have provided a more balanced and accurate assessment of the existing
evidence.
7. Recommendations:
The authors propose numerous significant recommendations for athletes, coaches, and sports health specialists
based on their findings. Authors stress quadriceps strength for athletic performance first. Force production, muscle
hypertrophy and cross-sectional area, jump and landing, and change of direction depend on the quadriceps muscle.
Thus, athletes should train quadriceps-specifically. Second, quadriceps strength affects injury risk. Authors claim
that weak quadriceps muscles increase the likelihood of muscle strains, patellar tendinopathy, patellofemoral pain
syndrome and ACL injury. Thus, injury prevention programs should incorporate quadriceps-building exercises
like squats and lunges. Finally, more study is needed to determine the best quadriceps strength and injury
prevention training methods. The authors recommend studying the impact of strengthening exercises, flexibility
and mobility training, proper warm-up and cool-down, technique and biomechanical analysis, and rest and
recovery on quadriceps strength and sports performance.
8. Conclusion:
The role of the quadriceps muscle in sports performance and injury risk has been extensively studied. This
narrative review was conducted to summarize the current understanding of quadriceps muscle's importance in
sports. The quadriceps muscle is responsible for extending the knee joint and plays a crucial role in activities such
as running, jumping, and kicking. It is also essential in maintaining balance and stability during sports
performance. The review found that strengthening the quadriceps muscle can improve sports performance and
reduce the risk of injury. However, overuse or improper use of the quadriceps muscle can lead to injury,
particularly in high-impact sports. Coaches and athletes should be aware of the importance of the quadriceps

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muscle in sports performance and take steps to prevent injury through proper training and conditioning. Further
research is needed to fully understand the role of the quadriceps muscle in sports performance and injury risk.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.

Acknowledgments: The authors would like to thank the Deanship of Scientific Research at Shaqra
University for supporting this work.
Conflicts of Interest: The authors declare no conflict of interest
References
[1] Lamberti N, Straudi S, Malagoni AM, et al. Effects of low-intensity endurance and resistance training on
mobility in chronic stroke survivors: a pilot randomized controlled study. Eur J Phys Rehabil Med.
2017;53(2):228-239.
[2] Beischer S, Gustavsson L, Senorski EH, et al. Young Athletes Who Return to Sport Before 9 Months After
Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay
Return [published correction appears in J Orthop Sports Phys Ther. 2020 Jul;50(7):411]. J Orthop Sports
Phys Ther. 2020;50(2):83-90.
[3] Tottori N, Suga T, Isaka T, Fujita S. Knee Extensor Morphology and Sprint Performance in Preadolescent
Sprinters. Res Q Exerc Sport. 2022;93(4):781-787.
[4] Hedayatpour N, Mohammed Sediq Rashid D, Izanloo Z, Seylaneh H, Falla D. Men and women show
different adaptations of quadriceps activity following fatiguing contractions: An explanation for the
increased incidence of sports-related knee injuries in women?. J Electromyogr Kinesiol. 2021;58:102552.
[5] Mason DL, Dickens VA, Vail A. Rehabilitation for hamstring injuries. Cochrane Database Syst Rev.
2012;12:CD004575. Published 2012 Dec 12.
[6] Maniar N, Cole MH, Bryant AL, Opar DA. Muscle Force Contributions to Anterior Cruciate Ligament
Loading. Sports Med. 2022;52(8):1737-1750.
[7] Schoenfeld BJ, Pope ZK, Benik FM, et al. Longer Interset Rest Periods Enhance Muscle Strength and
Hypertrophy in Resistance-Trained Men. J Strength Cond Res. 2016;30(7):1805-1812.
[8] Toth MJ, Tourville TW, Voigt TB, et al. Utility of Neuromuscular Electrical Stimulation to Preserve
Quadriceps Muscle Fiber Size and Contractility After Anterior Cruciate Ligament Injuries and
Reconstruction: A Randomized, Sham-Controlled, Blinded Trial. Am J Sports Med. 2020;48(10):2429-
2437.
[9] Pearcey GE, Bradbury-Squires DJ, Kawamoto JE, Drinkwater EJ, Behm DG, Button DC. Foam rolling for
delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train.
2015;50(1):5-13.
[10] Kassiano W, Costa B, Nunes JP, Ribeiro AS, Schoenfeld BJ, Cyrino ES. Which ROMs Lead to Rome? A
Systematic Review of the Effects of Range of Motion on Muscle Hypertrophy. J Strength Cond Res.
2023;37(5):1135-1144.
[11] DeLang MD, Hannon JP, Goto S, Bothwell JM, Garrison JC. Female Adolescent Soccer Players Utilise
Different Neuromuscular Strategies Between Limbs During the Propulsion Phase of a Lateral Vertical
Jump. Int J Sports Phys Ther. 2021;16(3):695-703.
[12] Seynnes OR, de Boer M, Narici MV. Early skeletal muscle hypertrophy and architectural changes in
response to high-intensity resistance training. J Appl Physiol (1985). 2007;102(1):368-373.
[13] Cheon S, Lee JH, Jun HP, An YW, Chang E. Acute Effects of Open Kinetic Chain Exercise Versus Those
of Closed Kinetic Chain Exercise on Quadriceps Muscle Thickness in Healthy Adults. Int J Environ Res
Public Health. 2020;17(13):4669.

543
 Tuijin Jishu/Journal of Propulsion Technology
ISSN: 1001-4055
Vol. 45 No. 4 (2024)
__________________________________________________________________________________
[14] Duarte NM, Cruz AL, Silva DC, Cruz GM. Intake of whey isolate supplement and muscle mass gains in
young healthy adults when combined with resistance training: a blinded randomised clinical trial (pilot
study). J Sports Med Phys Fitness. 2020;60(1):75-84.
[15] Neves RP, Vechin FC, Teixeira EL, et al. Effect of different training frequencies on maximal strength
performance and muscle hypertrophy in trained individuals-a within-subject design. PLoS One.
2022;17(10):e0276154.
[16] Lai X, Bo L, Zhu H, et al. Effects of lower limb resistance exercise on muscle strength, physical fitness,
and metabolism in pre-frail elderly patients: a randomised controlled trial. BMC Geriatr. 2021;21(1):447.
[17] Hebisz P, Hebisz R. The Effect of Polarised Training (SIT, HIIT, and ET) on Muscle Thickness and
Anaerobic Power in Trained Cyclists. Int J Environ Res Public Health. 2021;18(12):6547.
[18] Ema R, Sakaguchi M, Akagi R, Kawakami Y. Unique activation of the quadriceps femoris during single-
and multi-joint exercises. Eur J Appl Physiol. 2016;116(5):1031-1041.
[19] Earp JE, Newton RU, Cormie P, Blazevich AJ. Inhomogeneous Quadriceps Femoris Hypertrophy in
Response to Strength and Power Training. Med Sci Sports Exerc. 2015;47(11):2389-2397.
[20] Azevedo PHSM, Oliveira MGD, Schoenfeld BJ. Effect of different eccentric tempos on hypertrophy and
strength of the lower limbs. Biol Sport. 2022;39(2):443-449.
[21] Santos R, Valamatos MJ, Mil-Homens P, Armada-da-Silva PAS. Muscle thickness and echo-intensity
changes of the quadriceps femoris muscle during a strength training program. Radiography (Lond).
2018;24(4):e75-e84.
[22] Kojić F, Mandić D, Ilić V. Resistance training induces similar adaptations of upper and lower-body
muscles between sexes. Sci Rep. 2021;11(1):23449.
[23] Dafkin C, Green A, Kerr S, McKinon W. The patellar reflex: does activity of quadriceps femoris muscles
reflect leg movement?. Neurol Res. 2012;34(6):623-626.
[24] McCrum C, Leow P, Epro G, König M, Meijer K, Karamanidis K. Alterations in Leg Extensor Muscle-
Tendon Unit Biomechanical Properties With Ageing and Mechanical Loading. Front Physiol. 2018;9:150.
[25] Porrati-Paladino G, Cuesta-Barriuso R. Effectiveness of Plyometric and Eccentric Exercise for Jumping
and Stability in Female Soccer Players-A Single-Blind, Randomized Controlled Pilot Study. Int J Environ
Res Public Health. 2021;18(1):294.
[26] Jankaew A, Jan YK, Hwang IS, Kuo LC, Lin CF. Hamstring Muscle Stiffness Affects Lower Extremity
Muscle Recruitment and Landing Forces during Double-Legs Vertical Jump [published online ahead of
print, 2023 Jun 5]. Sports Biomech. 2023;1-19.
[27] de Britto MA, Carpes FP, Koutras G, Pappas E. Quadriceps and hamstrings prelanding myoelectric
activity during landing from different heights among male and female athletes. J Electromyogr Kinesiol.
2014;24(4):508-512.
[28] Ortiz A, Olson SL, Etnyre B, Trudelle-Jackson EE, Bartlett W, Venegas-Rios HL. Fatigue effects on knee
joint stability during two jump tasks in women. J Strength Cond Res. 2010;24(4):1019-1027.
[29] Coratella G, Beato M, Schena F. Correlation between quadriceps and hamstrings inter-limb strength
asymmetry with change of direction and sprint in U21 elite soccer-players. Hum Mov Sci. 2018;59:81-87.
[30] Serpell BG, Ball NB, Scarvell JM, Buttfield A, Smith PN. Muscle pre-activation strategies play a role in
modulating Kvert for change of direction manoeuvres: an observational study. J Electromyogr Kinesiol.
2014;24(5):704-710.
[31] Alentorn-Geli E, Myer GD, Silvers HJ, et al. Prevention of non-contact anterior cruciate ligament injuries
in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol
Arthrosc. 2009;17(7):705-729.
[32] Pietsch S, Pizzari T. Risk Factors for Quadriceps Muscle Strain Injuries in Sport: A Systematic Review. J
Orthop Sports Phys Ther. 2022;52(6):389-400.
[33] Mendiguchia J, Alentorn-Geli E, Idoate F, Myer GD. Rectus femoris muscle injuries in football: a
clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med.
2013;47(6):359-366.

544
 Tuijin Jishu/Journal of Propulsion Technology
ISSN: 1001-4055
Vol. 45 No. 4 (2024)
__________________________________________________________________________________
[34] Ekstrand J, Hägglund M, Fuller CW. Comparison of injuries sustained on artificial turf and grass by male
and female elite football players. Scand J Med Sci Sports. 2011;21(6):824-832.
[35] Roe M, Murphy JC, Gissane C, Blake C. Time to get our four priorities right: an 8-year prospective
investigation of 1326 player seasons to identify the frequency, nature, and burden of time-loss injuries in
elite Gaelic football. PeerJ. 2018;6:e4895.
[36] Mersmann F, Bohm S, Schroll A, Boeth H, Duda GN, Arampatzis A. Muscle and tendon adaptation in
adolescent athletes: A longitudinal study. Scand J Med Sci Sports. 2017;27(1):75-82.
[37] Slane LC, Dandois F, Bogaerts S, Vandenneucker H, Scheys L. Non-uniformity in the healthy patellar
tendon is greater in males and similar in different age groups. J Biomech. 2018;80:16-22.
[38] Giles L, Webster KE, McClelland J, Cook JL. Quadriceps strengthening with and without blood flow
restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med.
2017;51(23):1688-1694.
[39] Baellow A, Glaviano NR, Hertel J, Saliba SA. Lower extremity biomechanics during a drop-vertical jump
and muscle strength in women with patellofemoral pain. J Athl Train. 2020;55(6):615-622.
[40] Alentorn-Geli E, Alvarez-Diaz P, Ramon S, et al. Assessment of neuromuscular risk factors for anterior
cruciate ligament injury through tensiomyography in male soccer players. Knee Surg Sports Traumatol
Arthrosc. 2015;23(9):2508-2513.
[41] Schoenfeld BJ, Pope ZK, Benik FM, et al. Longer Interset Rest Periods Enhance Muscle Strength and
Hypertrophy in Resistance-Trained Men. J Strength Cond Res. 2016;30(7):1805-1812.
[42] Hauger AV, Reiman MP, Bjordal JM, Sheets C, Ledbetter L, Goode AP. Neuromuscular electrical
stimulation is effective in strengthening the quadriceps muscle after anterior cruciate ligament surgery.
Knee Surg Sports Traumatol Arthrosc. 2018;26(2):399-410.
[43] Plotkin D, Coleman M, Van Every D, et al. Progressive overload without progressing load? The effects of
load or repetition progression on muscular adaptations. PeerJ. 2022;10:e14142.
[44] Coratella G, Tornatore G, Caccavale F, Longo S, Esposito F, Cè E. The Activation of Gluteal, Thigh, and
Lower Back Muscles in Different Squat Variations Performed by Competitive Bodybuilders: Implications
for Resistance Training. Int J Environ Res Public Health. 2021;18(2):772.
[45] Kubo K, Ikebukuro T, Yata H. Effects of squat training with different depths on lower limb muscle
volumes. Eur J Appl Physiol. 2019;119(9):1933-1942.
[46] Barbalho M, Coswig V, Souza D, Serrão JC, Hebling Campos M, Gentil P. Back Squat vs. Hip Thrust
Resistance-training Programs in Well-trained Women. Int J Sports Med. 2020;41(5):306-311.
[47] Morton SK, Whitehead JR, Brinkert RH, Caine DJ. Resistance training vs. static stretching: effects on
flexibility and strength. J Strength Cond Res. 2011;25(12):3391-3398.
[48] Schwanbeck SR, Cornish SM, Barss T, Chilibeck PD. Effects of Training With Free Weights Versus
Machines on Muscle Mass, Strength, Free Testosterone, and Free Cortisol Levels. J Strength Cond Res.
2020;34(7):1851-1859.
[49] Delgado J, Drinkwater EJ, Banyard HG, Haff GG, Nosaka K. Comparison Between Back Squat,
Romanian Deadlift, and Barbell Hip Thrust for Leg and Hip Muscle Activities During Hip Extension. J
Strength Cond Res. 2019;33(10):2595-2601.
[50] Lee JH, Jang KM, Kim E, Rhim HC, Kim HD. Effects of Static and Dynamic Stretching With
Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A
Randomized Controlled Trial. Sports Health. 2021;13(1):49-56.
[51] Lin WC, Lee CL, Chang NJ. Acute Effects of Dynamic Stretching Followed by Vibration Foam Rolling
on Sports Performance of Badminton Athletes. J Sports Sci Med. 2020;19(2):420-428.
[52] Morton SK, Whitehead JR, Brinkert RH, Caine DJ. Resistance training vs. static stretching: effects on
flexibility and strength. J Strength Cond Res. 2011;25(12):3391-3398.
[53] Lee JH, Jang KM, Kim E, Rhim HC, Kim HD. Static and Dynamic Quadriceps Stretching Exercises in
Patients With Patellofemoral Pain: A Randomized Controlled Trial. Sports Health. 2021;13(5):482-489.

545
 Tuijin Jishu/Journal of Propulsion Technology
ISSN: 1001-4055
Vol. 45 No. 4 (2024)
__________________________________________________________________________________
[54] Olsen O, Sjøhaug M, van Beekvelt M, Mork PJ. The effect of warm-up and cool-down exercise on
delayed onset muscle soreness in the quadriceps muscle: a randomised controlled trial. J Hum Kinet.
2012;35:59-68.
[55] Chwała W, Pogwizd P. Effects of vibration and passive resting on muscle stiffness and restitution after
submaximal exercise analysed by elastography. Acta Bioeng Biomech. 2021;23(2):3-11.
[56] Marshall PW, Cross R, Lovell R. Passive heating following the prematch warm-up in soccer: examining
the time-course of changes in muscle temperature and contractile function. Physiol Rep.
2015;3(12):e12635.
[57] Teixeira-Salmela LF, Olney SJ, Nadeau S, Brouwer B. Muscle strengthening and physical conditioning to
reduce impairment and disability in chronic stroke survivors. Arch Phys Med Rehabil. 1999;80(10):1211-
1218.
[58] Sharp SA, Brouwer BJ. Isokinetic strength training of the hemiparetic knee: effects on function and
spasticity. Arch Phys Med Rehabil. 1997;78(11):1231-1236.
[59] Christensen JC, Mizner RL, Bo Foreman K, LaStayo PC, Peters CL, Pelt CE. Preoperative quadriceps
weakness preferentially predicts postoperative aberrant movement patterns during high-demand mobility
following total knee arthroplasty. Knee. 2019;26(1):79-87.
[60] Ravera EP, Crespo MJ, Rozumalski A. Individual muscle force-energy rate is altered during crouch gait: A
neuro-musculoskeletal evaluation. J Biomech. 2022;139:111141.
[61] Kabacinski J, Murawa M, Mackala K, Dworak LB. Knee strength ratios in competitive female athletes.
PLoS One. 2018;13(1):e0191077.
[62] Thoma LM, Flanigan DC, Chaudhari AM, Siston RA, Best TM, Schmitt LC. Quadriceps femoris strength
and sagittal-plane knee biomechanics during stair ascent in individuals with articular cartilage defects in
the knee. J Sport Rehabil. 2014;23(3):259-269.
[63] Schoenfeld BJ, Pope ZK, Benik FM, et al. Longer Interset Rest Periods Enhance Muscle Strength and
Hypertrophy in Resistance-Trained Men. J Strength Cond Res. 2016;30(7):1805-1812.
[64] Evangelista AL, Braz TV, La Scala Teixeira CV, et al. Split or full-body workout routine: which is best to
increase muscle strength and hypertrophy?. Einstein (Sao Paulo). 2021;19:eAO5781.
[65] Eymir M, Unver B, Karatosun V. Relaxation exercise therapy improves pain, muscle strength, and
kinesiophobia following total knee arthroplasty in the short term: a randomised controlled trial. Knee Surg
Sports Traumatol Arthrosc. 2022;30(8):2776-2785.
[66] Longo AR, Silva-Batista C, Pedroso K, et al. Volume Load Rather Than Resting Interval Influences Muscle
Hypertrophy During High-Intensity Resistance Training. J Strength Cond Res. 2022;36(6):1554-1559

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