A typical difficulty after knee surgical procedure is quad weak spot which will lead to a knee extension lag. This will have many penalties for future power features and gait coaching, so it’s all the time greatest to handle this rapidly.
Listed here are some methods we use at Champion when somebody has a knee extension lag.
To view extra episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 269: Extension Lag Following Knee Surgical procedure
Pay attention and Subscribe to Podcast
You should use the participant beneath to take heed to the podcast or subscribe. If you’re having fun with the podcast, PLEASE click on right here to go away us a assessment in iTunes, it can actually imply lots to us. THANKS!
Subscribe: Apple Podcasts | Google Podcasts | Spotify | | Extra
Present Notes
Transcript
Pupil:
All proper. So, we acquired Tom from New York asking, “Following a knee surgical procedure, like ACL reconstruction what do you do if a affected person is having a tough time finishing a straight leg elevate with out extension lag? Would performing the train with a brace lock then extension be acceptable?”
Mike Reinold:
Superior. Yeah. Nice query, Tom. Good job, Zach.
Mike Reinold:
Yeah, that’s fairly frequent, proper? That’s undoubtedly one thing we see. That is in all probability a fairly good query as a result of I guess you lots of people see this and it’d be good to simply sort of hear everyone’s recommendations on what we do.
Mike Reinold:
ACL might be one of many extra frequent ones, but it surely actually may be from any knee surgical procedure, that knee extension lag the place they’re attempting to do a straight leg elevate, however they don’t have that quad management to lock out the knee and do it straight. I imply, primarily it’s only a signal that the quadricep power is simply not there. Or it’s simply not lively for that means to raise that leg straight.
Mike Reinold:
So, what will we acquired for recommendations on that? I imply, I feel we had just a few tips up our sleeves with that. However who needs to leap in and supply the primary tip of recommendation for what you do with a lag with a straight leg elevate?
Lenny Macrina:
Is that what the query is? I’m confused by the query.
Mike Reinold:
Are you critical? I can’t inform in case you’re critical.
Lenny Macrina:
It says with out an extension lag? So, in the event that they don’t have an extension, is there one thing else? Am I simply not understanding the query?
Mike Reinold:
No, you’re undoubtedly not understanding the query. What do you do if a affected person is having a tough time finishing a leg elevate with out lag?
Mike Reinold:
Oh.
Lenny Macrina:
So, and not using a lag, meaning the left knee is straight.
Mike Reinold:
So, you’re criticizing Tom for lack of a comma, I imagine? As a result of I feel the remark simply adjustments it. Wow.
Lenny Macrina:
I’ll assume that they’re having a lag as a result of within the query, it says with out an extension lag.
Mike Reinold:
I like this. Grammar police. For this reason, by the way in which, Lenny edits all of our manuscripts, simply so you understand, when we’ve publications.
Mike Reinold:
However let’s simply assume-
Lenny Macrina:
He has a lag?
Mike Reinold:
… the apparent. And we’ll go from that.
Mike Reinold:
What do you do, Len? I do know you will have some nuggets of data right here for us and never simply grammatical critiques. However what do you bought?
Lenny Macrina:
I’m simply ensuring we answered Tom’s query.
Lenny Macrina:
Yeah. I imply, clearly the apparent goes to be utilizing STIM. I’d simply attempt to STIM the quads. Some NMES, not TENS or something like that, however STIM. That may assist to facilitate the quads to contract higher.
Lenny Macrina:
After which, occupied with explanation why this doubtlessly taking place, have they got extreme swelling within the knee joint that might trigger some quad inhibition or extreme quad inhibition? So, we have to get the swelling out.
Lenny Macrina:
Patella mobility. Can they get the patella to lock into the trochlea and be capable of elevate the leg, get the knee straight? That might be one other difficulty.
Lenny Macrina:
You possibly can even attempt to put them in facet mendacity. So, take gravity out and put them in a facet mendacity place and have them do an abduction elevate after which elevate out to the facet, sort of parallel to the ground. Use gravity as not resisting the leg.
Lenny Macrina:
You possibly can put them in a brace. I don’t usually do this trigger not everyone has a brace after an ACL surgical procedure. Not less than what I’ve see, they’d primarily do, however not everyone use a brace, imagine it or not. So, you possibly can’t all the time assume they’ve a brace.
Mike Reinold:
When you’ve got an extension lag too, oftentimes you continue to have that within the brace. I imply, these braces aren’t magically locking you out at zero, too.
Lenny Macrina:
Proper. Yeah.
Mike Reinold:
That is a matter. So, that’s like a band-aid that’s not like a part of the problem.
Lenny Macrina:
Proper.
Lenny Macrina:
And I’d help, too. Some folks want that little further push. I’ll maintain them by their ankle and provides them an help up. And perhaps they do a quad set on the prime and actually have lock-in whereas I’m helping. And I feel that may assist, as effectively.
Lenny Macrina:
And simply doing a ton of quad units. If they will’t get that quad to interact and lock the knee straight, then their homework goes to be STIM with quad units obsessively at residence. They’re doing not simply two units of 10, twice a day. They’re doing all of it day, every single day till one thing provides. And so they’re icing a ton at residence, as effectively.
Lenny Macrina:
These are my massive nuggets for any person without-
Mike Reinold:
Sorry?
Lenny Macrina:
Nothing.
Mike Reinold:
With out the lag.
Mike Reinold:
I like the way you carry up a few massive matters that really don’t have anything to do with the lag, however perhaps they’re making a lag, just like the swelling, the ache, the patellar mobility. Particularly you probably have an ACL with the patellar tendon graft, perhaps it hurts in that space once they can monitor.
Mike Reinold:
So, generally it’s not simply, how will we repair the lag, however what do you need to work on to do away with the lag? I actually like the way you introduced that time up.
Mike Reinold:
What else? What do you do, Dan?
Dan Pope:
I feel it’s simply sort of foolish, however I oftentimes I feel the straight leg elevate may not be coached appropriately. Sometimes, once I consider teaching, I’m considering of teaching a snatch or one thing.
Dan Pope:
However straight leg elevate, most people, their first repetition, you say, kick your leg as straight as you possibly can. First rep truly seems fairly good. They’re struggling. They’re working. Then the subsequent 10 to fifteen, they simply let the knee bend and hold going.
Dan Pope:
One of many issues I love to do is simply put one thing beneath the heel so that each single repetition they’ve relaxed totally. They get the knee into extension or hyperextension as a lot as they will, flex, try to get good quad set, after which elevate up. And reset each single repetition simply because I discover that people don’t carry out their straight leg elevate in a means that’s going to scale back the quad lag. They only carry on going with a bent knee and so they’re in all probability not getting the consequence they need.
Mike Reinold:
Proper. And bear in mind it, I feel you mentioned that effectively the place, generally it’s teaching based mostly. Bear in mind, they’re simply attempting to get from Level A to level B the place it’s simply raise their leg up into the air. Should you don’t instruct them on how, then generally it’s the trail of least resistance.
Mike Reinold:
Your hip flexor is in a great spot. They’re simply going to lift that leg up and so they don’t actually care concerning the place your knee is in. So, that makes it actually, actually essential to actually emphasize, “Hey, contract that quad. Squeeze that quad.” Or what would we are saying in Alabama, we might say, “Mash that quad.”
Lenny Macrina:
Mash that knee straight.
Mike Reinold:
Mash that knee straight, as straight as we are able to, after which raise that leg up.
Mike Reinold:
After which, what I usually do with that teaching cue is, in the event that they begin to lose that or they’re beginning to get drained, we truly, “Whoa, whoa, cease that rep. Let’s begin over and do it once more.”
Mike Reinold:
Bear in mind, it’s as a lot neuromuscular management as it’s a power deficit with that. So, I feel that’s big.
Mike Reinold:
We’ve acquired to get a video on Instagram of you teaching this, too. I wish to see any person like, perhaps they chalk up. Perhaps we’re performing some massive motivation on this.
Dan Pope:
A whistle.
Mike Reinold:
Precisely. However I feel that’s nice.
Lenny Macrina:
I do wish to add yet another factor although, as a result of I’ve seen this a pair instances. If this particular person is having a lag with their leg raises and it’s means out of surgical procedure, one thing uncommon, not just some weeks, like eight weeks, 12 weeks, and so they’re nonetheless struggling?
Lenny Macrina:
You’ve acquired to begin occupied with, have they got a femoral nerve block? And is that affecting them? So, is the nerve that innervates the quad not firing appropriately? Or is it a tourniquet factor? Did they use a tourniquet throughout the surgical procedure? Or did they use a femoral nerve versus an adductor canal block? And that might have an effect on it.
Lenny Macrina:
I’ve seen folks have quad points long-term, like for the remainder of their lives, in the event that they’ve had a femoral nerve block that went loopy and now their nerve just isn’t functioning accurately.
Lenny Macrina:
That’s one other factor too, relying on the place this particular person is of their rehab. A pair weeks out, not stunning. It will possibly occur. However a pair months out, you begin working into different points.
Lenny Macrina:
So, I’d hold that in thoughts, as effectively.
Mike Reinold:
I like that. Yeah. That’s good.
Mike Reinold:
Anyone else have another ideas that Lenny and Dan didn’t cowl? I imply, this can be a fairly simple one.
Mike Reinold:
I feel the one factor I’d add with that is that, perhaps generally, one factor that I’d do is that, Lenny mentioned a whole lot of quad units, quad units, quad units, however I feel generally we are able to do this poorly. Perhaps at residence, they’re doing it on the sofa. So, inherently your butt’s going to sit down into the cushion and also you’re going to be in a flex knee place on the sofa.
Mike Reinold:
You need to actually educate them that, “Hey, you’ve acquired to prop that heel up.” I feel Dan talked about a little bit bit. Prop that hell up.
Mike Reinold:
Generally I love to do a reverse, although. And never everyone has knee extension like recurvatum, like extreme hyperlaxity. However generally I simply need them to do a quad set and begin with their heel on the bottom. After which my cue, my teaching cue, is to raise your heel up off the desk. That means they’re not likely centered on their quad, they’re centered on lifting that heel up. After which, they perceive that appreciation of that lockout mechanism.
Mike Reinold:
I’d say that’s only one different factor to do is perhaps generally change the main target to an exterior focus with what they’re doing with the motion on the heel and never on the hip. I feel generally might have an effect, too.
Mike Reinold:
I feel we nailed it fairly good. I imply, we talked about among the exterior components. Kevin, you wish to add one thing?
Kevin Coughlin:
Yeah. I simply wish to say one piece of apparatus we’ve right here that I’ve discovered tremendous useful for that is M-trigger, the biofeedback.
Kevin Coughlin:
I feel to Dan’s level, generally these folks can do it for one or two repetitions after which they assume they’re contracting as laborious all through the entire set. However generally simply with that visible suggestions to see, that is how laborious it’s essential to be contracting….
Kevin Coughlin:
Among the issues Lenny talked about, if they simply can’t do it, it’s not going to be as useful. However I feel generally, it’s simply them studying that is how laborious I must contract my quad throughout a set of straight leg raises. That visible suggestions may very well be tremendous useful generally.
Lenny Macrina:
That’s a great one. Yeah. Good level.
Mike Reinold:
Yeah. That’s a extremely good level, too, of getting that suggestions and utilizing a biofeedback system, just like the M-trigger. That really is smart. That’s a great level.
Mike Reinold:
I’m glad you mentioned that as a result of with a query like this, generally we miss one or two issues as a result of it’s sort of second nature for what we do. However I feel that’s a terrific level.
Mike Reinold:
However once more, simply to recap rapidly. Be sure to’re addressing the underlying issues that could be inhibiting that. So, assuming it’s not a nerve block difficulty, however swelling, ache, patellar mobility, vary of movement, perhaps they don’t have the complete motion-
Lenny Macrina:
Yeah, precisely. Full extension, yep.
Mike Reinold:
You’ve acquired to nail that down first after which actually work on that quad management. You should use neuromuscular stimulation to assist on the identical time. You may as well use biofeedback to really assist them facilitate that contraction on their very own. And simply actually ensure that we’re teaching and cuing that.
Mike Reinold:
There’s tons of ways in which you are able to do that. However hopefully a few of these ideas will provide help to get that extension lag handed a little bit bit faster for any person post-surgery.
Mike Reinold:
Nice query. Admire it, Tom. That was good please. Sooner or later, be sure you solely submit grammatically right questions or you’ll be-
Lenny Macrina:
Sorry.
Mike Reinold:
I don’t know. Perhaps I simply learn rapidly, however I assumed your query was nice, Tom. However thanks a lot. I admire it. When you’ve got a query like that and aren’t afraid of submitting a grammatical error, please head to Mike Reinold.com. Click on on that podcast hyperlink. And you may submit as many typos as you need.
Mike Reinold:
I can’t wait to see them. And we’ll see you on a future episode. Thanks a lot.
