An EPL Physio’s Eccentric Exercises for Anterior Thigh Injuries

Anterior thigh injuries are common in sports that involve sprinting and kicking, placing significant demands on the quadriceps, particularly the rectus femoris.

Successful rehabilitation requires more than simply restoring strength; athletes must tolerate the high-speed eccentric demands of deceleration, sprinting, and kicking. In his Practical, English Premier League physiotherapist Adam Johnson outlines how he progresses his athletes through rehabilitation. This blog provides a taste of some eccentric exercises he uses in his rehab.

If you want to know exactly how an EPL physio manages anterior thigh injuries, watch Adam’s full Practical HERE. With Practicals, you can be a fly on the wall and see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster. Learn more HERE.

Start with the right assessment and diagnosis

Before prescribing exercises, it’s essential to ensure the diagnosis is correct. Management strategies should always be grounded in your clinical assessment and the structures involved in the injury.

Adam emphasises revisiting the assessment and considering the injury classification; using the British Athletics muscle injury classification system (A, B, or C). This helps determine whether the injury is myofascial, involves the muscle belly, or includes intramuscular tendon involvement. The classification also informs expectations around rehabilitation timelines and reinjury risk, helping guide how cautiously loading should be progressed.

Equally important is understanding the sporting demands. An athlete who is a sprinter will place different stresses on the quadriceps compared to a football player who frequently kicks. The mechanism of injury, position played, and sporting requirements should all influence your rehabilitation approach.

With that foundation established, you can apply Adam’s progressive exercise prescription principles confidently.

Knee-dominant eccentrics

Following isometrics, early eccentric work often focuses on knee-dominant loading. This approach can be useful initially because it places less strain on the proximal rectus femoris, which is most commonly involved in anterior thigh injuries.

Adam describes how knee-dominant eccentrics can help athletes develop the ability to absorb load through the knee while controlling deceleration. This is particularly important as athletes return to tasks such as running or landing.

From a rehabilitation perspective, these exercises expose the quadriceps to meaningful eccentric load while still allowing clinicians to carefully monitor symptoms and movement quality. They also provide an opportunity to observe how comfortably the athlete tolerates increasing knee flexion angles under load.

A key coaching point is ensuring the movement remains genuinely knee-dominant. Athletes should avoid compensating by extending through the trunk or leaning backward, as this reduces the eccentric demand on the quadriceps.

These movements form an important bridge between early rehabilitation loading and the higher demands of sport, see Adam demonstrate three great exercises he uses with his athletes in this video from his Practical:

Progressing to hip-dominant eccentrics

Once athletes tolerate knee-dominant loading well, they can progress to hip-dominant eccentric exercises.

Adam notes that hip-dominant eccentrics are more difficult to achieve than knee-dominant ones. The knee naturally allows large ranges of motion which makes eccentric loading relatively straightforward. Achieving meaningful eccentric loading at the hip requires more deliberate positioning and control.

These exercises place the rectus femoris under tension across both joints and challenge its ability to control hip extension while the limb transitions toward flexion. This type of loading becomes particularly important when preparing athletes for the demands of sprinting and kicking.

Because of this, hip-dominant exercises often represent a meaningful progression in rehabilitation, requiring greater control and load tolerance from the athlete. See Adam demonstrate some eccentric, hip-dominant exercises he uses in this clip from his Practical:

An important note

Quadriceps eccentrics are only one part of rehabilitation. Adam emphasises the importance of strengthening complementary musculature such as the gluteals, adductors, and calf muscles to ensure the load is adequately distributed and to reduce the athlete’s risk of reinjury.

Developing strength across these muscle groups can help support efficient force production and absorption during high-speed running and kicking tasks.

Wrapping up

Given the nature of anterior thigh injury mechanisms, eccentric exercises are an essential part of rehab, but it also means their introduction and progression need to be considered thoughtfully.

Starting with knee-dominant exercises allows clinicians to introduce deceleration safely, while hip-dominant eccentrics provide a logical progression as athletes regain tolerance to load, and these exercises are appropriate to prescribe to any patient, not just elite athletes.

In his full Practical, Adam Johnson demonstrates many more progressions and clinical reasoning strategies he uses with his athletes, if you’re interested in expanding your rehabilitation toolbox for anterior thigh injuries, watch the full Practical here.