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*The perceived lack of co-contraction during long arc quad has been a source of concern for some experts as greater tibiofemoral shear forces could be detrimental to the anterior cruciate ligament.168 However, a study in 2000 indicated that controlled open chain quadriceps exercises six weeks after anterior cruciate ligament reconstruction are more likely to result in a return to sports at pre-injury levels.169 The authors concluded that a combination of open and closed kinetic chain is probably the most beneficial approach. They felt the open kinetic chain exercises were a key factor in restoring quadriceps muscle torque and total muscle function. A later study in 2014 found a more favourable outcome with closed chain exercises, although still reported benefits in the open kinetic chain group without an increase risk in laxity.170 In addition, an interesting finding in two studies is a simultaneous increase in hamstring strength following open chain quadriceps strength training programs.107,173 The mechanisms for this are not currently understood. Further investigation and clarification is required.
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