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How To Strengthen Quads After Knee Surgery

Utilize The Powers Of Electrical Stimulation

Knee Injury Rehab – Strengthening the Quadriceps (Acute Stage) – Ask Dr. Abelson

Neuromuscular electrical stimulation appears to be a promising intervention for use after ACLR. NMES allows for the direct activation of the motor axon, and could allow for the direct recruitment of the inhibited motoneurons. Muscle activation by means of NMES allows for the recruitment of a greater proportion of type II muscle fibers when compared with voluntary contractions of a similar intensity.- Furthermore, although, during voluntary contractions there is a logical order of recruitment beginning with the smallest motor units and progressing to the largest motor units, NMES results in a reversal of the order of motor unit recruitment. The activation of type II motor units are essential to achieve a higher level of quadriceps force production, as well as sufficient power and RFD. As such, their recruitment by means of NMES undoubtedly should aid in the quest to achieve complete recovery of quadriceps strength. A recent meta-analysis reported that use of NMES in addition to standard physical therapy appears to significantly improve quadriceps strength and physical function in the early post-operative period compared to standard physical therapy alone.

Focus On Your Whole Knee

The quadriceps may be the bodys natural knee brace, as the study authors referred to them, but theyre not the only muscles that are critical for good knee function. Equally important are the hamstrings on the back of your thigh and the gluteal muscles of the buttocks. Like the quadriceps, these muscles not only help you sit and rise from a seated position, but they also enable you to complete other everyday activities. These include climbing stairs, lifting heavy objects and getting into and out of your vehicle.

Unfortunately, many people tend to focus on increasing quad strength and flexibility, at the expense of their hamstrings and gluteal muscles, Bungo says. We see that a lot, and that creates a muscle imbalance, which can predispose you to injury. Its important to have that balance.

Several complications can arise from having weakness or poor flexibility in your quads, hamstrings and gluteal muscles. For instance, you might alter your gait to compensate for these deficiencies, and in doing so, you can put stress on other parts of your body, such as your hips and lower back. Plus, poor leg strength can impair your balance and increase your risk of debilitating falls.

Balance is a combination of lower-body strength and your sense of balance, Bungo explains. Knee weakness, and lower-extremity weakness in general, absolutely can increase your fall risk.

Think Beyond The Knee

Typically, early and mid-phase programs focus exclusively on resolving knee mechanics. It is becoming accepted that weakness of core and hip muscles are risk factors in lower extremity injury risk- and in particular ACL injuries., A systematic review by Petersen et al. revealed deficits in hip muscle strength after ACLR. Beyond injury prevention, proximal dysfunction is associated with high risk movement biomechanics and linked to PFP., Strong evidence currently exists that patients with anterior knee pain have deficits in hip abduction, hip extension and external rotation strength. Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFP and should form part of the ACLR rehabilitative program focused on resolving knee extensor strength deficits.

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Exercise #: Stationary Bike And Elliptical Machine

These cardiovascular exercises are especially beneficial because they help strengthen the quadriceps muscles, says Geller. This is particularly important after a knee replacement because the quads are essential to movement and stability in the knee. “These exercises are non-impact, which is safer for your knees than high-impact exercises like running,” says Geller. Bill Bryan, MD, an orthopedic surgeon at Houston Methodist adds that when he tells patients who’ve had a knee replacement to use the stationary bike, he recommends that they push down harder on the pedal with the leg that’s had the knee replacement. “This will maximize the benefits of this exercise,” says Bryan.

The Best Leg Strengthening Exercises After Surgery

Knee Injuries

After surgery to the hip, knee, ankle, or foot, the muscles of the leg often become weak from decreased use during recovery. For this reason, it is important to begin strengthening these muscles once your physician gives you the green light to do so.

Gaining back strength that you have lost after an injury or after surgery is an important step in obtaining full functional mobility and a full recovery.

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What Is Quad Activation Failure

Quad activation failure is the inability to squeeze or tighten your quadriceps. Its not uncommon after major surgeries like an ACL surgery or a total joint replacement but can occur even with arthroscopy.

The frequency is highly variable, but full quad shutdown occurs in less than 5% of post-operative knee patients, said Dr. Farr.

Quad shutdown is caused by neural inhibition which means the nervous system isnt allowing the normal pathways of muscle activation to happen.

After knee surgery, the knee swells up which leads to arthrogenic muscle inhibition, which is having the inability to contract your muscle despite no injury to the muscle or nerve.

In fact,years ago, according to a study, researchers injected saltwater into the knee joint of volunteers,said Dr.Farr. Whenthe volunteershad knee fluid distention , they were unable to fullyactivate their quadriceps.This quadriceps restriction may beamplified with pain, the fear of increasing the pain or even partial weakness from a nerve blockperformed at the time of surgery.

To reverse this after knee surgery, you will need to re-establish a brain-muscle connection and retrain your muscle to contract properly.

Return To Sport And Normal Function

It is possible to get ACL knee strength back in the first year after surgery and to pass return-to-sport criteria and achieve normal function, says Claussen.

Key elements in Shelbourne Knee Center ACL rehab model are:

  • Restoring ROM prior to strengthening
  • Using a contralateral PTG, which provides a predictable return to normal strength in both knees.

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What Not To Do:

  • Do not lock the knees during this exercise. The knees should remain slightly bent.
  • Do not allow any part of the stepping foot to hang off the stool or platform.
  • People who have issues with balance should not perform this exercise.

Muscles involved: Quadriceps, hamstrings, and gluteal muscles.

  • Use two high-backed, stable chairs, placing one on either side of the body with the chair backs next to the arms. Place a hand on the back of each chair for balance.
  • Lift right leg about 12 inches from the ground. All weight should be on the left leg.
  • Slowly bend down a few inches, pushing weight onto the heel of supporting leg.
  • Hold for 35 seconds.
  • Slowly straighten up.
  • There are many different ways to stretch the hamstrings in the back of the legs. One is through traditional toe touching.

    • With the feet close together, slowly bend over at the hips and extend the arms downward. Keep the legs straight but do not lock the knees.
    • Reach the fingers to the top of the toes and hold for 30 seconds.
    • Initially, it may not be possible to reach the toes. In this case, try to get the fingers as close as possible to the toes without causing pain.

    What not to do:

    • Do not use a bouncing motion. Hold the body still.

    Benefits Of Knee Strengthening Exercises

    Wake Up and Strengthen Your Quads After Surgery

    The Arthritis Foundation state that exercise may be the most effective way to treat osteoarthritis without surgery, while the American Academy of Orthopaedic Surgeons note that strong and flexible muscles can keep knees healthy and prevent injury.

    Knee strengthening exercises do not affect the knee joint directly, but they strengthen the muscles surrounding it. Strong muscles in the legs can help provide support for the knees. This support may alleviate pressure and strain on these joints, which can relieve pain and help a person be more active.

    The following exercises can help strengthen the muscles surrounding the knee. If a person experiences pain during these exercises, they should stop doing them and speak to a doctor. Anyone with severe knee pain should consult a doctor before trying to exercise.

    It is best to warm up with light exercise before starting any knee strengthening exercises. Examples of gentle exercise include walking, cycling, and using an elliptical machine, all of which put minimal stress on the knees. This activity will help increase blood flow to the muscles and allow them to be more flexible.

    Muscles involved: Quadriceps and abdominal muscles.

  • Lie down on the floor with the back flat. Use a yoga mat, folded blanket, or exercise mat for comfort on a hard floor.
  • Keep the left leg straight and bend the right leg slightly at the knee, bringing the foot closer to the body.
  • Hold the left leg up for 5 seconds.
  • Repeat two more times with the same leg.
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    Optimally Prepare For Surgery

    Optimally preparing for surgery and resolving deficits in muscle mass and strength would be expected to enhance post-operative function. The research available indicates that prehabilitation results in superior knee function post operatively.- Recent research shows that patients with better pre-operative quadriceps activation demonstrated greater post-operative activation, whilst patients with better pre-operative strength also demonstrated better post-operative strength. There is no consensus on the optimal level of pre-surgery function. Grindem et al. recommended patients should have a LSI of 90% for muscle strength and hop performance prior to ACL reconstruction, which may not be plausible for all patients.

    Sit To Stand Quad Exercises

    Standing up from sitting is a movement we do countless times a day but actually works the quadriceps muscles quite hard.

    These are great functional quadriceps exercises for knee pain for anyone, just choose the level thats right for you. Make sure you use a firm chair for these. The lower the chair, the harder these exercises will work the quads

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    Sitting Supported Knee Bends

    While sitting at your bedside or in a chair with your thigh supported, place your foot behind the heel of your operated knee for support. Slowly bend your knee as far as you can. Hold your knee in this position for 5 to 10 seconds.

    Repeat several times until your leg feels fatigued or until you can completely bend your knee.

    Sitting supported knee bend

    Knee Friendly Quad Exercises That Arent Squats

    The Top 4 Quad Exercises For Your Knee After A Knee ...

    If you have trouble with your knees, give these favorites a try.

    My orthopedist told me that I have one bad knee and one worse knee. Im 27 years old and Ive got double knee replacements in my future if I continue doing the things that I enjoy that should happen around age 40. Im going to get the most out of my knees while I can and hope that over the next 15 years they come up with some amazing knee surgery that is simple, painless, and will get me up and moving again in no time.

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    Open Chain Or Closed Chain Isolated Or Functional

    There is no consensus among the existing published evidence as to whether closed kinetic chain or open kinetic chain exercises should be the intervention of choice following ACLR. There are doubts about safety of OKC exercises, which are arguably unsupported by substantial published evidence. OKC exercises can be useful as they isolate the muscle and limit the involvement of other muscle groups and thus, can ensure higher and more complete activation and fatigue of the target muscle. Some studies have shown that OKC exercises or OKC plus CKC exercises are more effective than CKC exercises alone in improving quadriceps strength after ACL reconstruction, and in patients who are ACL deficient. Others have found no differences in patients quadriceps strength when comparing the two types of exercises., Available clinical research suggests that cautiously incorporating OKC exercises into ACL rehabilitation will improve quadriceps function and the authors advocate the use of both OKC and CKC exercise.

    Lower Extremity Strengthening Exercises

  • Short Arc Quad ContractionsSit on a firm, flat surface with your hands behind you for support. Place a rolled towel on your knee to bend it about six inches. Raise your foot until your knee is straight.
  • Long Arc Quad ContractionsWith the leg dangling off the edge of mat or chair, place a towel roll the under the knee and straighten knee completely. Hold for a count of five, relax for a count of five. Do not add weights to this exercise.
  • Glute SetsPinch your buttocks together as tight as possible. Hold for a count of 5. Relax for a count of five.
  • Ankle and Foot Heel Cord Stretch, StandingFace a wall, standing about two paces away, and place your hands on it. Step forward with one foot. With both heels on the ground, lean your hips toward the wall while keeping the leg in back straight to stretch the calf muscle. Hold for 10 seconds, then relax. Repeat the exercise, but this time keep the back leg slightly bent at the knee. Hold for 10 seconds, relax.
  • Knee and Hip FlexionLie on your back with your legs straight and relaxed. Keep your kneecaps pointed toward the ceiling throughout the exercise. Slide one foot toward your buttocks, bending your knee and hip. Slowly return to the starting position.
  • Hamstring Isometric ContractionsBend the knee slightly. Tighten the muscles on the back of the thigh while digging down and back with the heel. Hold for a count of five, relax for a count of five.
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    Knee Squat With Resistance Tubing

    Step 1: Stand on the middle of the resistance tubing with both feet

    Step 2: Grasp the ends of the tubing at hip level

    Step 3: Slowly lower into a squat position, keeping the back and elbows straight

    Step 4: Hold and slowly return

    Remember to keep your back straight and knees pointing forward. Dont allow your knees to rotate inward or outward

    Optimal Load To Preserve Quadriceps Strength

    Restoring Quadricep Strength 20 Years Post Knee Surgery

    Optimal loading may be defined as the load applied to structures that maximizes physiological adaptation. Additionally, in the context after injury, it can also be considered as the load which minimizes adaptation .

    Achieving optimal loading is challenging. It is essential that in the early periods after surgery, the rehabilitation program incorporates progressive optimal loading to prevent muscle atrophy and strength loss and subsequently facilitate functional recovery. Use of electrical stimulation can support strength preservation, through providing a stimulus to activate the motor units, which may be inhibited due to AMI. The use of electrical stimulation and voluntary isometric contractions can support muscle mass and strength preservation in the early phase. Monitoring pain and joint effusion particularly during the early phases of rehabilitation are important to ensure that the applied training stimulus is not excessive and causing tissue overload. Measurement of pain via the use of the visual analog scale should be taken regularly and recorded. Swelling can be measured with limb girth daily. Measurement of knee circumference at the patella has been shown to have strong intra-tester reliability and good sensitivity to change. Within, the knee, change greater than one centimeter was shown to be clinically significant.

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    What Happens If A Torn Tendon Is Not Repaired

    If left untreated, eventually it can result in other foot and leg problems, such as inflammation and pain in the ligaments in the soles of your foot , tendinitis in other parts of your foot, shin splints, pain in your ankles, knees and hips and, in severe cases, arthritis in your foot.11 2008 .

    Tips To A Speedy And Successful Rehabilitation

    • Apply ice for 10 15 minutes to the operated knee after exercise. Using cold therapy while elevating the leg above your heart helps reduce swelling
    • Beginning 3-4 days after surgery, you can also apply heat under the knee or to the thigh muscle well above the incision for 10-15 minutes before you exercise
    • Short arc quad exercise helps improve strength and range of motion in the knee. Lie on your back with your legs extended and the knee supported by a rolled towel or foam roller. Keeping the knee on the roller, straighten the operated leg at the knee by lifting the heel off the floor. Hold for 5 seconds, then slowly lower the heel back down

    As you recover in the hospital, a physical therapist will most likely teach you exercises to help strengthen your knee. Most often, you can begin these exercises the day after your operation. It is highly recommended you stretch and exercise daily to help avoid complications or dislocation of your new joint.

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    Get Up And Get Moving

    After a knee replacement, the patient is strongly encouraged to get up and move almost as soon as the anesthesia wears off. Early mobility is key to the prevention of blood clots, which is a risk of lower extremity surgery. Getting up and moving is also crucial in reducing swelling, which will hinder range of motion.

    Crab Walk With Loop Band

    The Top 4 Quad Exercises For Your Knee After A Knee ...

    Step 1: Stand with loop band around both thighs, just above the knee

    Tip: Make sure the band is tight enough that you feel some tension when your ankles are slightly separated

    Step 2: With a slight bend in both knees, step sideways to the right with one foot so that youre standing with feet wide apart

    Step 3: Step your other foot to meet the first one, keeping your feet pointing forward the entire time

    Step 4: Continue to walk sideways until youve taken 10 steps, then reverse and walk sideways to the left

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