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Brian Schiff continues his series on functional training, this time focusing on the lateral box step-down, an exercise ideal for increasing VMO strength. Brian remarks, "It is a preferable alternative to the seated knee extension machine as it does not create shear force on the patella-femoral joint."

Execution

Stand with one leg supported on a step with the other leg suspended above the floor. Slowly lower the suspended foot until the heel lightly touches the floor. Pause at the bottom but maintain all the body weight on the stance leg.

Return to the start position. Perform two to three sets of 10 to 15 repetitions with a cadence of 2/1/1.

Application
This exercise is ideal for increasing VMO strength. It is a preferable alternative to the seated knee extension machine as it does not create shear force on the patella-femoral joint. Clients can perform it with or without upper body assistance, depending on their inherent balance and strength capacity.

Additional Notes
Begin with a small step (four to six inches), and advance the height as the client is able to lower further with good control. Any valgus movement (knee caving inward) should be avoided. It is also important to coach them to maintain the knee over the foot, generally avoiding excessive knee-over-toe motion.

If the client lacks strength at the bottom of the range, have him/her stop short of the motion or use mild upper body assistance to complete the eccentric portion of the exercise. Avoid any painful range of motion as this likely indicates irritation on the back of the kneecap.

Brian Schiff, PT, CSCS (www.brianschiff.com) is a licensed physical therapist, respected author and fitness professional. He became a Certified Strength and Conditioning Specialist (CSCS) in 1998. In 2000, he opened his own personal training and sport-specific conditioning facility, Fitness Edge, in Dublin, Ohio. Brian has presented at several professional conferences and seminars on injury prevention and sport-specific training.

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