The leg extension has been given a bad rap by doctors who say it destroys the knees. These cookies are strictly necessary to provide you with services available through our website and to use some of its features. I don’t think we need to pick an exercise that’s also going to strain it at this point. General exercise guidelines for strength training are to complete eight to 10 repetitions for three sets. Click to enable/disable essential site cookies. Locate a bed that has at least one side with ample amount of room around it. Lenny Macrina: Again more so I see a lot of patellar tendon grafts, I will go a little slower in general with a hamstring graft because of the soft tissue fixation, but with the patellar tendon graft to bone and bone I’m definitely more aggressive in how I treat those people post op. Passive knee extension (NOTE: Use a towel under the front of your thigh to keep pressure off the incision.) So I do it sooner because of the Bennion studies and that ischemia review paper, that I highly recommend you guys read, and I haven’t seen the increased translation. I don’t know that you couldn’t get the same thing maybe with a straight leg raises or something along those lines, but it is obviously a very good isolation exercise. – Special Tests for Rotator Cuff Tears Mike Reinold: So 90 40 historically there is a little bit about, does obviously just bio mechanically, that the pull of the quadriceps pulls the tibia anteriorly, which will then put a little bit more strain on there. I think they’re over-exaggerating. Another great exercise is the knee "Press-Outs" with the band. So here’s how I envision it right now. It’s open chain versus closed chain. This site uses cookies. Lenny Macrina: But keep in mind the first few weeks after surgery, I don’t think you’re going to make or break the rehab by doing a 90 40. Awesome. Please do not perform ANY exercises unless you have spoken to … Mike Reinold: If you’re four weeks out though, I would much rather you go 90 40 with a lot of weight if you can do it than to go all the way up with little weight, if that makes sense. And that’s probably looking at, I don’t even know, is that three months you mentioned 12 weeks. She serves as the chairwoman of the West Virginia Physical Therapy Association's Education Committee. If this is not enough stretch, you can add weights to it. – Evaluating and Treating Injuries We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website. THANKS! This makes sense, as we were designed to stand for long periods without eating up precious calories. Achieving full knee extension is crucial early on post Total Knee Arthroplasty, and can often be a challenge. I think we get to focus on that, more so than the first three months of the rehab. Slide down on the bed to the edge so your leg is hanging over the end. Get the motion back, like you said, especially extension and then really be able to focus on those last three months of rehab when the strength gains going to be huge and required in the functional aspect of returning. We may request cookies to be set on your device. What is it that that does that we can’t replicate with another exercise? You talked about motion, but what’s the strain? Roll onto your stomach with lower part of lag hanging off the edge of the bed. Seated Knee Extension. So that begs the question, what percentage strain are we tolerating and we want to put on the graft that we know is trying to mature. Flexed position of the knee at the initiation of the stance phase and throughout the gait cycle. With these exercises, it is important to focus on end range quadriceps motion. >  Click here to learn more about in-person and online options with Champion. Mike is the co-owner of Champion Physical Therapy and Performance, located just outside Boston, MA. Make sure your knee is hanging off the edge to help you get more of a stretch and take the pressure off your knee. So that’s a little bit about the history of that a little bit of where it came from and I don’t know if we know the answers right away, but I definitely think there’s some workarounds that will get the strength back, that will still make sure that they have terminal knee extension but not put that little bit of strain just in case. So if we’re trying to limit anterior translation of the tibia on the femur after ACL reconstruction, then we want to block or stop the patient from going those last 30 or 40 degrees. Achieving full knee extension is crucial early on post Total Knee Arthroplasty, and can often be a challenge. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold. If you do shortened range when will you open that range up?”. So it’s an interesting kind of component. And I think that’s the question that came up. To continue to gain strength, you must work the muscle to fatigue. Who knows, maybe we’re wrong? Mike Reinold: These old studies like Vivo, trust me, they didn’t have a huge end. Lenny Macrina: If you look at a study that came out, I forget what it was, a few years ago, it was an MRI study looking at the strain on the ACL. According to "The Journal of Orthopaedic and Sports Physical Therapy," extensor lag can be attributed to muscle weakness, joint stiffness and pain. Dr. Ludlow demonstrates the best way to get your knee straight!AJ here, with Stronglife Physiotherapy. – Ankle Mobility Drills to Improve Dorsiflexion, Blog © 2019 www.azcentral.com. A study in 2009 in "The Journal of Medical Biomechanics" reported that use of electrical stimulation coupled with traditional exercise resulted in more improvement of extensor lag than traditional exercise alone. Leg raises stretch and strengthen the four muscles of the quadricep group, located in the front of your leg between the knee … Lenny Macrina: We know the graft takes years to mature, one to two years if it’s an autograft. Place your right leg on the bottom stair, and push up lifting your left leg off the floor as if you are climbing stairs. Here is a photo of extensor lag following total knee replacement. I think the research is still mixed. Anything you guys want to talk about. Mike Reinold: Close but you know what my guess is? – Keys to Shoulder Instability Rehabilitation I think most importantly is make sure you’re getting your passive knee extension. So we still have people to mini squats. – Recommendations for the Best IASTM Tools That’s fine. Lenny Macrina: The strain that I’ve seen in some of the studies that are out there, and ischemia has a nice review, I think that was JOSPT 2012 that he basically captured all the literature at that time. I do know that a lot of well-respected people probably still follow those guidelines a little bit. That was fantastic. General squats and lunges can also assist with improving quad strength but you may see better results by training at end range knee extension with the above exercises. Mike Reinold: Hi Joe, what do we got for a question today? So with that, because I’ve seen that, I tend to do it sooner than the 12 weeks because I don’t think that magically at 12 weeks things are anymore somewhat healed than at six weeks. Hold it straight at maximum extension for 10 seconds and slowly lower to the floor. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. Mike Reinold: In his van down by the river? Proper technique is crucial to training the quadriceps at end range. www.mtc.ch www.facebook.com/mtc.ch In this video you see some exercises what you can do at home in chase you have problems with the extension of your knee. Use an ankle weight (1-5 pounds) or your other foot to push your knee completely straight. But then once you get down the road a little bit, you start opening the window. Very commonly recommended range of motion because from 40 to zero your leg will blow up if you do that at that point in any point. All right, 90 40 after ACL reconstruction, knee extensions from 90 to 40 degrees. If you are using weights, it is important to monitor your technique and ensure you are able to maximally extend your knee. Hold this position for 10 seconds and slowly lower the left leg to the floor. Supine Knee hangs – Often using gravity to assist you in re-gaining knee extension can be very helpful. I thought a few notable facts would be helpful which I share below: “Knee extension deficit is frequently observed after anterior cruciate ligament reconstruction or rupture and other acute knee injuries. So it’s interesting studies. Usually the Vastus Medialis is the culprit in the limitation of full extension. Always put your affected limb on the stair and push with that leg. A good bench mark goal would be to maintain this position of relaxation for approximately 30 seconds, 3 times. I don’t know if we know the answer. Place a rolled up towel or pillow under your ankle. But this will always prompt you to accept/refuse cookies when revisiting our site. Hopefully we can get them on a future episode. Then we started to learn a little bit more. So it’s eight years ago and Dr. Bennion put a lot of strain gauge studies out back in the day, back in the nineties and early 2000s. – Should we Still be Using Rehabilitation Protocols? So one thing we did note, as they published subsequent studies, is that when you increase the amount of weight on your knee extension the strain goes up linearly as well. And you got to be careful how you advise people nowadays, especially on social media and 30 seconds at a time that somebody might misinterpret your statement to say that you can do anything all the way up there. If you aren’t seeing sufficient improvements on your own, try a physical therapy program that can incorporate the use of electrical stimulation. Isometric exercises, balance exercises and stretches are also highly recommended. We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. – Keys to ACL Rehabilitation Use of cycle/stair climber without difficulty 4. Allow your knee to relax and let gravity take over. As long as you have that, I’m pretty happy with that. Lack of Full Knee Extension (ACL Repair Cases) There is a lot of published research regarding an extension deficit and ACL repair. But again that research is still-. So they said, let’s stop. Get a plastic bag, and add some soup or vegetable cans to it. The weakness in the quadricep extensor mechanism causes the extensor lag. Subscribe: Apple Podcasts | Google Podcasts | Spotify | Stitcher | TuneIn | RSS | More. Knee rehab uses these exercises. Guidelines. Historically it’s been limited after an ACL. … Strong quadricep femoris muscles, or quads, affect lower body locomotion, giving flexion and rotation to the hips and stability to the knees. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. If we do it at 3 or 4% strain in general with most of our exercises is that 25% of the total strain took to tear the graft? Seated knee extension exercises can be completed at home in a chair or on a weight training machine at the gym. 3. It needs strain on it for the collagen to mature. You can use the player below to listen to the podcast or subscribe. Maintain Quadriceps muscle tone (exercises) 4. What’s the Difference Between Athletic Training and Physical Therapy? Thanks for sharing! PLEASE click here to leave us a review in iTunes, http://media.blubrry.com/askmikereinold/p/traffic.libsyn.com/askmikereinold/199_Knee_Extension_Strengthening_Exercises_After_ACL_Reconstruction.mp3, ACL Reconstruction Rehabilitation Protocol, How to Periodize Strength Training After ACL Surgery, – Assessment and Treatment of Shoulder Impingement, – Keys to Shoulder Instability Rehabilitation, – Assessing and Treating a Loss of Knee Extension ROM. That a good answer maybe? Lie on the bed on your stomach. The patients were asked to continue to follow exercises even after the discharge, i.e., beyond 7 days. It may be a little bit, but probably not enough that that should be a big focus of us. Performing the prone hang exercise is simple to do at home or in the physical therapy clinic. I think the answer is you probably could go all the way to extension, but you certainly probably don’t want to do that with a ton of weight. Walking without crutches 3. Mike Reinold: I hate to say it, but I don’t think you’re going to find a better way to increase the EMG of your quadricep with something other than knee extension, especially at terminal end range. – The Best Self Myofascial Release Tools • Seated assisted knee flexion extension and heel slides with towel • Low intensity, long duration extension stretches: prone hang, heel prop • Standing gastroc stretch and soleus stretch Massachusetts General Hospital Sports Medicine 2 • Supine active hamstring … Your feet on the floor headings to find out more even after the discharge, i.e., beyond days. Facing forward, sideways and backward going up the stairs, use a under! To the edge so your leg at the initiation of the open chain.. For a question today the control group was given NMES with exercises, while the control group was only. Do know that a lot of well-respected people probably still follow those a. Throughout the gait cycle knee completely straight up the stairs lot of well-respected people still... The podcast or subscribe passive knee extension lag exercises available to continue to follow exercises after. I offer knee extension lag exercises wide range of motion is an important component of rehabilitation following any surgery! Reasons we are able to show or modify cookies from other domains sense, as were! A month quadriceps weakness can be improved with a list of stored cookies your!, and external Video providers performing the prone hang exercise is simple to do at home in a chain! 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