Quadriceps and Patella Tendon Repair Progression (2-6 weeks) | OEP371

This episode focuses on the critical rehabilitation period for quadriceps and patellar tendon repairs from two to six weeks post-surgery. We explore individualized care strategies, precautions, and core exercises to optimize recovery. 
• Importance of individualized rehab strategies 
• Managing precautions during recovery 
• Techniques to regain range of motion 
• Role of blood flow restriction training in rehab 
• Recommended exercises for knee strength and flexibility 
• Strategies for patient monitoring and feedback

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Chapters

• 0:00 Rehabilitation Progression for Quadriceps Tendon Repair
• 9:50 Website Feedback and New eBooks

Transcript

Speaker 1: 0:00

Hello everyone and welcome to episode 371 of the OrthoEvalPal podcast. I'm your host, paul Marquis, and today we're going to be doing part two of our quadriceps and patella tendon repair progression, which is going to be the two to six week time frame. We're going to be talking about some of the precautions we need to pay attention to at this point. We'll go over some weight bearing considerations, range of motion progression, and we'll talk about some of the exercise recommendations and so much more. Now, before we get started, I want to talk about our sponsors. We have Rangemaster, who is known for their shoulder rehab equipment. They offer products from shoulder wands to finger ladders, overhead pulleys to shoulder rehab kits. Rangemaster is your one-stop shop to help with the treatment of frozen shoulders, post-op rotator cuff repairs, total shoulder and reverse total shoulder replacements and so much more. If you'd like to get a free sample of Rangemaster's Blue Ranger pulley system, just email jim at myrangemastercom and add OrthoEvalPal in the subject line. Now we also have MedCorp Professionals. Now I know the folks at MedCorp Professionals personally. They're a locally owned and family operated medical supply company. They carry everything from radial pressure wave units to traction devices, resistance bands to compression garments. Most impressively, though, is their customer service. It's second to none. If you're looking for medical products in your clinic or products for your patients, go to wwwmedcorprocom and if you use the coupon code OEP10, you can get $10 off a Saunders cervical traction unit and if you use code FIRSTTIME10, you can get $10 off your first order at Medcor on other products. Welcome back everyone.

Speaker 1: 1:53

So we're working on part two of our patella or quad tendon repair rehab segment. If you didn't listen to our first episode, which was 370, you may want to go back and do that first. It's just going to make a nice steady progression in regards to how we manage these patients. I talk about some of the precautions and things we have to really be careful with, and then it's going to kind of slide into today's section, which shouldn't take too long because it's similar to our first section, just with a nice steady progression. So now we're at the two to six week post-op period.

Speaker 1: 2:31

Six-week post-op period we need to remember that protocols are guides, okay, so every patient responds differently to surgery or to certain injuries, or maybe there are other complications that happen during the time of this injury, but they may respond a little differently. They may sense pain differently than others. Maybe some are stiffer than others. Some really like to hold on to their swelling and others, you know, really get rid of it quickly. And sometimes we have patients who can start to fire up that quad, which is very difficult after a quad tendon or patella tendon repair. But some of them can fire it on a little bit sooner than others and then others might struggle. So you may need to pivot and adjust and that's okay, all right.

Speaker 1: 3:11

I've always had really good success treating these diagnoses and the key here is to just progress nice and steady. It's better to be a little conservative and to deal with a little bit of stiffness or maybe a little bit of quad shutdown or whatever it might be, than to push too aggressively and re-tear them, because then you're in trouble, then you're into a second surgery, the success rates are not as great after that and it makes it just so much more challenging for the patient. So we need to remember here that we still have these precautions for re-tear. We can't be pushing these folks really aggressively into flexion of the knee. We can't have them actively extending the knee in the open chain or doing things like squatting activities or trying to go up steps. They're still in their brace. So they're still locked into full extension pretty much all the time when they're sleeping, when they're walking. The only time they're not in the brace um or uh, it's unlocked would be in rehab. You know when or when they're doing exercises at home, such as, you know, doing something like a heel slide or something like that. Um, that's the only time you would really unlock or remove the brace, and I typically have people take the brace off. They're usually sick and tired of it. So when they're in the clinic I have them take it off. But I also tell them right up front what they need to be cautious with that they can't just do a straight leg raise without assistance or sit off the edge of the table and let the leg hang off the end, all right. So something you want to think about here is starting to regain this range of motion. Now. Remember we weren't pushing it too much at first. Between that three to six week range we need to start getting up to about 90 degrees of flexion. We shouldn't get it in the third week. It should be something that is very progressive a couple, two, three, four degrees, five degrees maybe every time they come into the clinic.

Speaker 1: 4:58

All right, this is the toughest period in regards to getting range of motion back. The knee is naturally stiff and tight because it's been in full extension and in the brace all the time, but they're also very apprehensive, so they want to fight you. So you're trying to flex them a little bit, um and, and they're trying to kind of push back because they're afraid, um. One thing I do is I have them do a lot of heel slides on their own because again they get that reciprocal inhibition when their hamstrings are contracting, their quads are relaxing. So they can kind of get that naturally and sometimes I'll do a little active, assistive and try to help them a little bit. But it's very tough to get that 90 degrees. And what I have found from my experience is that once we get to that 90 degree mark which should happen, you know, around the five to the six week period you don't want to push on this hard, you want to just let them get it kind of naturally with a little bit of assistance. Once you get to that 90 degree position, it seems like they they go over a hump and then getting past that gets easier. Okay, uh, and so again, we're still not doing any active open chain knee extension. So I like to have these folks do plenty of heel slides.

Speaker 1: 6:10

This is a time frame when you can start using blood flow restriction training. You can do it on both extremities. After the two-week mark we can start it on the affected side where they had the surgery, maybe starting with the BFR on there while they're doing some gravity-assisted extensions, you know, trying to get that knee to zero. Now if they don't have zero, we've got a problem on our hands, because they should have been in this brace locked at zero right from the get-go and there's really nothing like a cyclops lesion or anything like that that could cause them to lose their extension, except for maybe some swelling which would cause them to stay in a flex position. But if they're in their knee extension brace they shouldn't have a problem getting to full extension. But if so, you do need to get them doing some gravity assisted knee extension so they can get to zero without any issues.

Speaker 1: 7:00

Now, straight leg raises. You should be able to have them do straight leg raises in the side lying position, in the prone position, and when I do side lying I take them out of the brace. Now I know many protocols will say leave them in the brace. I've never had an issue with this. When I have them on their side to do that straight leg raise, I have them turn like a quarter, turn forward just a little bit more, so they're more like almost in a more prone position, but they're extending the hip and extending the leg and abducting it at the same time, so the knee can't fall into flexion, it can only fall into extension. So that's how I like to do the straight leg raises. If they're doing it on the side, then I have them roll onto their stomach. They do some prone ones and then they'll also roll on to the affected side and do some adduction. Sometimes I prefer to do adduction in other positions than side lying. I just don't find it to be a very effective way to do it. I might have them do some bolster squeezes or something like that.

Speaker 1: 7:55

Now, if you're going to do some supine straight leg raises, which you should start at about the three you know two to three week period, I would do them with the brace in full extension on the leg and then I start them active, assistively. I go at these really easily, I gauge how much they work and how high we go, and I might start with three sets of five and over the course of three to six weeks, you know, get them doing about three sets of ten independently, with no extra weight on that leg and just developing good leg control. Now again, like I said last time, I love doing ball bridges. I'm not really curling the ball under. I mean, if they're super fit and they're doing fine and they're gaining that range of motion nicely, you might start with some bridges and then hamstring curls at the same time I'm supporting that foot on the ball just to make sure it doesn't slide off. I might have them do some standing heel raises. I'll also put them in the prone position, have them do some active knee flexion to the end range and then I also have them do some upper body ergometry. And if I didn't do some BFR on the legs, I might throw some on the arms at this point and just get, you know, a really nice pump and get some physiologic response and some human growth hormone release to help promote some healing here.

Speaker 1: 9:08

So these folks I might be, you know, seeing them, you know, once to twice a week, just kind of monitoring them a little bit, giving them some home exercises. I want to check on that scar. Maybe I want to do some scar tissue massage and teach them how to do that once the incision is closed and healed up well. Also, you want to make sure that they still have some good patella mobility. Again, you don't want to ream into superior gliding, but good medial lateral motion is important, and you want to start to see that patella start to migrate superiorly with a quad set as they're progressing, and that should come along nicely. So there you have it, folks, Second stage of the rehab for quad and patella tendon rehab.

Speaker 1: 9:50

If you haven't already done so, head over to our new website. Check it out. I'd love to know what you think. Send me any feedback that you would good or bad, or if there's anything you want to see that you might want on there. I had somebody the other day say hey, I just grabbed one of your eBooks wondering if you had an eBook on this particular topic and, as a matter of fact, I'm going to be coming out with some new ones soon and it's going to be fulfilling that need, and so be sure to check it out. Um, hope you all have a great day, be kind to each other and take care.