Ortho Eval Pal: Optimizing Orthopedic Evaluations and Management Skills
Be inspired by Paul and his experience with evaluating and treating orthopedic injuries. Learn about everything orthopedic from plantar fasciitis to cervical spine pain, how to communicate with specialists better, optimizing your evaluations and so much more!
Ortho Eval Pal: Optimizing Orthopedic Evaluations and Management Skills
Quadriceps and Patella Tendon Repair Progression (6-12 weeks) | OEP372
Discover the essential steps for recovering from quadriceps and patella tendon surgery within the pivotal 6 to 12-week mark. We focus on the importance of actively working towards range-of-motion improvement while engaging in tailored exercises to enhance strength and stability.
• Discusses the importance of early rehabilitation steps post-surgery
• Highlights targeted exercises to enhance range of motion and strength
• Emphasizes the significance of confidence building during recovery
• Explores the role of blood flow restriction training in rehab and much more!
(Video) Knee flexion stretching. See arm position. Gentle stretching
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Hello everyone and welcome to episode 372 of the OrthoEvalPal podcast. I'm your host, paul Marquis, and today we're going to be talking about quadriceps and patella tendon repair, the progression from 6 to 12 weeks after surgery. So we're going to be talking about some of the precautions still at this stage. We'll be going over some brace modification, range of motion progressions and exercise recommendations and so much more. But before we get started, I'd like to mention 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. We also have MedCorp Professionals. Now, I know the folks at MedCorp Professionals personally. They are a locally owned, family-operated medical supply company. They carry everything from radial pressure wave units to traction devices, tens, electrodes you name it resistance bands, compression garments. They have a ton of rehab equipment. Most impressively, though, is their customer service. It's second to none If you're looking for medical products for your clinic or products for your patients? Go to wwwmedcorprocom and if you use coupon code OEP10, you can get $10 off a Saunders cervical traction unit and code FIRSTTIME10 and get $10 off your first order at Medcor on any other product. Welcome back everyone.
Speaker 1:Okay, so this is part three of our patella and or quad tendon repair rehab segment. Now, if you haven't listened to our first two episodes, which are 370 and episode 371, you probably want to go back and do that in order, just so that you're kind of up to where we are now. Now we're at the six to 12 week post-op period. We're moving right along Now. We're starting to gain some range of motion. The strength is going to start coming along.
Speaker 1:We're going to work on some gait here in this section. Now we really want to try to start improving this gait pattern, because we've been locked out into full extension for quite a while and this can turn into kind of a sense of insecurity when you get to this point, because we now start to unlock this brace for gait. So we go from zero to 40 degrees. Allow them to flex a little bit so that when they're walking in the terminal stance phase of gait. They can flex that knee a little bit, start to get more of a natural gait going. So if they're uncomfortable with that, you could go back to using a crutch on the opposite side and just slowly work on this weight bearing at zero degrees. Then have them, you know, kind of flex a little bit and see if they can kind of accept a little bit of load. But you really want to get that motion at the back side. So your hamstrings are pulling the knee into flexion a little bit when you're bringing that heel up in the terminal stance phase of gait and then you swing it through and just kind of work on that.
Speaker 1:You want to slowly increase that range of motion up to about 70 degrees while weight bearing. You know, by the time you get to that 12-week mark, all right, that's important. Now, as far as range of motion goes, we want to continue to increase that range of motion. I like to do it actively and have it. Have them gain it naturally. They just have more confidence in themselves that they'll stop when you need them to.
Speaker 1:Some people will come out and they'll be very, very stiff and so you may need to help them a little bit. A little active assist deflection won't hurt a thing. Again, if you want to see how I like to increase range of motion and deflection, I can show you how I manually do it. I'll add a video in the links today in the show notes, so that you can see where I like to put my elbow and my hand underneath that knee and let the knee basically fall over my hand slowly in deflection and then you slowly work on, you know, gaining, that You're at. You know 100 degrees, you want to get to that, 105, 110, you're slowly building up so that you know, by the time you get to weeks 10, 11 year or 12, you're getting up to about 130 degrees quite comfortably. All right, so now let's talk about exercises.
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Speaker 1:We are going to start with some weight shifting exercises and I like to do this with about 10 degrees of knee flexion bilaterally. Maybe I'll get them on two Erex pads which are quite stable when you're on with both feet. Some people still use these wee balance boards. I love them because you can keep your knees almost in full extension and really get you know this side to side motion. The base is very unstable, like I would never go into a single legged, you know Erex or um, you know, can do ball type of thing where you're where you're really working the proprioception hard. I would not be doing that at this stage. Really, this proprioception is happening. You know, with both feet on the floor. I like a side to side teeter board. It's one plane, um, fairly easy to work with. You can get some hand support, some you know those stable ski poles or your hands could be on something to give yourself some support just to start to work that very, very light proprioception okay, and that helps to increase that weight bearing.
Speaker 1:You start them at, you know 5 to 10 degrees of knee flexion and you progress to 15 degrees, 20 degrees while they're in this little kind of mini squat working on balance. Now, as far as closed kinetic chain squatting, we have a shuttle cardiovascular trainer. That's how I like to start them. Because they're flat on their backs. You can start with less than body weight. You can go with about, you know, 15 to 20 pounds of pressure. If you want to start with that, I start with a double-legged press, probably about 0 to 40 degrees. I may put the heel a little bit ahead of the center of gravity. Okay, because if you're on your back and your feet are a little higher on the pad, you're going to engage the glutes and hamstrings a little bit more. When you start to drop that heel closer to your center of gravity, you're going to start using the quads and become a little more quad dominant. So I start with the heels up, bring them down and start to, you know, slowly engage those quads with really lightweight. I really track their amount of weight and their reps and slowly build that up over the next, you know, several weeks till we get to about the 12 week period.
Speaker 1:I may start them with some mini light lunges, like not true walking lunges, but I'll have a hand, each hand on a chair on each side of them and they'll just do a little simulated light lunge and then switch legs and go to the opposite side. You need to remember that the hardest part about doing a lunge after you've had any surgery on your quad tendon or patella tendon is when that leg is behind you. Because you now have this, you know, passive insufficiency issue, where the quads getting stretched a little bit, the knee is flexing back there while you're going down into that lunge and you get this nice big pull. So you got to be careful there. I I'm actually more cautious about that part of the lunge than when their leg is out in front of them, because they're engaging their glutes, their hamstrings and a little bit of their quads. So they're getting a little help to do that. They're just not getting this big passive stretch. So be cautious with that.
Speaker 1:Um, next, we want to get into, you know, a good quad set. So sometimes throwing on a little bio feedback to get a better quad set is important. Before getting into your straight leg raises. So they should be able to turn that quad on really well and then start with some straight leg raises without the brace. Now, okay, so we start to wean out of the brace. Some of these folks are going to have a little difficulty with this. So they may need some active assistance. You might need to, you know, especially on the takeoff. After that you know they're hitting. You know the straight leg raises and all other positions.
Speaker 1:I like to get them on a bike at this point. If they have a comfortable 110 degrees not a lot of stress you can generally get them on a regular bike. Some bikes have a little longer crank arm on it so you may have to get to 115 degrees before you can get around comfortably. If they can't do that and you still want them to bike, we have a bike that has a modified pedal on it so we can decrease that stroke. So at about 90 degrees of knee flexion they can start biking. Um, I like to teach them how to do it active, assistively. So the good leg is helping a little bit.
Speaker 1:At first the other one's along for the ride, or the affected leg is along for the ride. Then they start to kind of engage a little bit more, then get to a 50-50. And then we start to just lengthen that pedal crank a little bit more so they get a little bit more range of motion each time they get on, and this is very encouraging when people can get on a bike. There's this sense of accomplishment that they really like, and so I like to get them in there, you know, after that six week mark, just to kind of get their cardio going a little bit, along with that upper body bike to, you know, get some blood flow going. Also, I like to do some lateral band walking. You can be, you can do these with full knee extension. Um, some people, you know, around that 10 to 12 week mark, will start to feel a little more comfortable and may get into just like a, an isometric squatted position at about 10 degrees and do this. That is perfectly fine, nothing wrong with that.
Speaker 1:We do this a lot. Start with a light band and just build yourself up Then a lot of these. You know, we'll continue with blood flow restriction training. If we're just having a hard time getting a good pump or getting some good cardio, we might put some BFR on them and, you know, increase those reps a little bit with lighter, no weight at all. And also do BFR on the contralateral side, on the infected limb. Maybe throw someone on the arms at this stage and continue to work the arms a little bit and get that human growth hormone release and promote some healing. And, you know, disuse atrophy in that quad area. So again at this point, folks, we are still not doing forceful knee extension. We're not kicking soccer balls, we're not doing any eccentric loading, we're not doing any jumping or plyometrics.
Speaker 1:This is difficult tissue to heal and can take a long time.
Speaker 1:You don't want to mess these up.
Speaker 1:I've never seen one messed up, so I can't tell you what that looks like.
Speaker 1:But you don't want to mess these up. I've never seen one messed up, so I can't tell you what that looks like. But you don't want to go there because the repair on a patella tendon or a quad tendon a second time just isn't that great. The integrity is just not as good, the patient's going to be much more apprehensive and the recovery just take forever. So I'd rather the patient be a little on the tight side and we'd be a little bit more conservative, just to get some great healing there and then later on into the next section. That we're going to talk about is 12 weeks on is how to, you know, start to build that strength a little bit better and start to develop some confidence and decrease that sense of kinesiophobia as they get closer to you know, getting back into sports or higher level activities. So there you have it, folks Patellar tendon, quad tendon repair rehab up to 12 weeks. I hope you enjoyed today's episode. Be kind to each other and take care.