February 18, 2025 • 16 mins
The podcast episode focuses on the first two weeks following quadriceps and patella tendon repairs, providing essential strategies for managing recovery. Emphasis is placed on avoiding complications, proper bracing techniques, and establishing patient confidence during the rehabilitation process.
• Discusses the importance of early management in recovery
• Highlights strategies for controlling swelling and promoting circulation
• Explains the necessity of using a dial brace locked in full extension
• Offers guidelines on maintaining limited range of motion
• Provides exercise recommendations to activate muscles and aid recovery
• Addresses pain management and appropriate modalities
• Stresses the importance of building patient confidence post-surgery
• Previews future discussions on rehabilitation progress and strategies
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello everyone and welcome to episode 370 of the
OrthoEvalPal podcast.
I'm your host, paul Marquis PT,and today we're going to be
talking about quadriceps andpatella tendon repairs.
We're going to be talking aboutthe progression of this from
zero to two weeks after surgery.
We're going to talk about sometips to avoid complications
early on after a quad tendon orpatella tendon repair.
(00:22):
We'll be talking about bracingand crutch use.
We'll discuss some precautionssoon after surgery.
We'll even give you someexercise and modality
recommendations and so much more.
But before we get started today,I'd like to mention our
sponsors.
First of all we haveRangemaster.
Rangemaster is known for theirshoulder rehab equipment.
They offer products fromshoulder wands to finger ladders
(00:42):
, overhead pulleys to shoulderrehab kits.
Rangemaster is your one-stopshop to help with the treatment
of frozen shoulders, post-oprotator cuff repairs, total
shoulder and reverse totalshoulder replacements and so
much more.
If you'd like to get a freesample of Rangemaster's Blue
Ranger pulley system, just emailjim at myrangemastercom and add
(01:02):
OrthoEvalPal in the subjectline.
We also have MedCorpProfessionals.
Now, I know the folks atMedCorp Professionals personally
.
They're a great bunch of folksand locally owned, family
operated medical supply company.
They carry everything fromradial pressure wave units,
which I have and use on aregular basis, to traction
devices, resistance bands, tocompression garments you name it
(01:24):
.
They have it.
Most impressively, though, istheir customer service.
It's second to none.
If you're looking for medicalproducts for your clinic or
products for your patients, goto wwwmedcorprocom, and if you
use coupon code OEP10, you canget $10 off a Saunders cervical
traction unit, and you can alsouse the code FIRSTTIME10 if
(01:47):
you're a first-time purchaser ontheir website and get $10 off
your first order.
Now, welcome back everyone.
So, as usual, I get this lightbulb moment for a podcast topic
which just snowballs into morethan you know.
Enough content, for you knowmore than one episode, and so
I'm going to break this topic upinto two, maybe three episodes,
(02:10):
just so that I don't overwhelmyou with a bunch of content that
is just kind of confusing.
We're just going to give youzero to two weeks after a quad
tendon or patella tendonreconstruction, and we're going
to just talk about how we wouldmanage that.
And you know, as I was workingwith this patient of mine who
(02:30):
had a patella tendon repair, Istarted thinking about all of
the things that could go wronghere after surgery, and I'll be
the first to admit that treatingtendon repairs probably makes
me a little more nervous thananything else out there, and I
have seen tons of these andluckily I'm batting a thousand
in the last 33 years never had are-rupture under my care.
(02:51):
But I also am maybe a littlemore conservative.
When I see these patients Ireally step back and say to
myself, okay, what could I do,or what could the patient do to
cause some sort of acomplication here?
All right, so if you thinkabout that actually you could
think about this every singletime you see a patient what
(03:12):
would I do today that could makethis patient worse?
And then you clear all of thatstuff and that opens up the
field for whatever else you wantto do and can do in a safe
environment.
Okay, so if you look at it thisway, your approach is going to
be much more targeted, much morestrategic.
And then you need to rememberyou just can't treat these
(03:35):
patients who have tendon repairslike a, you know, a total knee
replacement or a total shoulderreplacement.
You have these soft tissuesthat are repaired that you don't
want to tear off.
You don't want to, you know,upset the surgeon who did this
surgery and put all this workinto repairing these tendons.
So it's important that you lookat your anatomy, you understand
(03:56):
it well.
You need to remember that thepatella tendon and quad tendons
take up a huge amount of load.
All right, it's a large musclegroup, a very large tendon group
.
And I also want you to thinkabout and go back to you know
your college days when you werestudying this.
Remember selective tissuetension.
All right, passive knee flexionand hip extension are going to
(04:19):
stretch that extensor mechanism,ok.
And.
And active knee extension andhip flexion are going to shorten
the quad tendon and patellatendon.
So remember that when you areworking on your patient,
remember that at the time framesthat they're in, it's important
that we get these patients insoon after surgery, like three
to four days, so that we canstart to prevent DVT, get the
(04:44):
calf activated a little bit, getsome elevation, get some edema
control, start to get the quadto turn on a little bit and get
all the surrounding musclesactivated.
So let's just start talkingabout bracing and crutches first
of all.
So these folks usually thatcome out of surgery and they
have a dial brace on it's lockedinto full extension.
(05:05):
We use a dial brace because wewant to, at some point in the
future, allow a little bit ofrange of motion on a progressive
basis, you know, week by week.
So you want something that isadjustable but lockable.
All right, because at first youwant this brace to be locked
out into full extension.
They need to have a long bracefor good leverage.
(05:26):
Short braces don't really do agood job at preventing flexion
of the knee.
You want these people to besleeping with this brace on.
Okay, because at night it'scommon for us to flex the knees,
maybe even kick a little bitwhen we're, when we're dreaming
or sleeping, and so andsometimes you might get up in
the middle of the night notthink about it and flex that
(05:46):
knee, and so we really want thatbrace to be locked out.
They would need to be sleepingwith it and whenever they are
walking they're using crutches,they're to be weight bearing as
tolerated.
If the brace is locked out intofull extension and you're
driving your weight through thefemur, through the tibia, and
the knee is not flexingwhatsoever, you really can walk
with that knee in this extendedposition.
(06:07):
You can put full weight bearingon it.
You know right away pretty much, but we recommend weight
bearing is tolerated justbecause at first they're going
to be a little uncomfortable.
So that brace is on at alltimes while they're using
crutches.
It's locked into extensionwhile they're using the crutches
, all right.
So we're also going to see a lotof swelling in this patient.
So we want to teach them how toproperly elevate the leg.
That's important.
(06:28):
I like to do a lot of anklepumps when that leg is elevated.
If they need some ice, you know, for pain control, then they
can ice while they have it inthat elevated position because
they have this brace on, itneeds to be pretty tight.
They're also going to have alot of lack of movement.
So you need to remember,because they have this lack of
movement, they're in pain, theyjust had surgery, they're at
(06:50):
high risk of DVT.
So I have these folks do lotsof ankle pumps, okay, and so
that's very important.
Now let's talk about range ofmotion.
They really shouldn't be movingthis knee past 25 to 30 degrees
of flexion in the first coupleof weeks.
When I get these patients going,I first ask them can you do a
(07:14):
heel slide?
I want you to pull your heeltoward your butt.
Okay, that's how I like them totry to imagine doing this.
I don't want them to flex thehip, to pull the knee toward
their face in order to get it toslide.
I like them to really activatethat hamstring because, number
one, you're not getting anaggressive, passive stretch to
(07:36):
the quad.
When they're doing this they'regoing to be a little
uncomfortable, but when you'reactively using the
hamstringstring you'reinhibiting the quadricep even
more so the quad is going torelax a little bit more and have
less pull on on the repair.
So I like them to just try todo an active heel slide.
See how they do now.
If they've got zero degrees ofextent or flexion and they just
(07:58):
can't activate it, they can'tpull it up, then the way I like
to try to get flexion is not tograb them at the ankle and push
the knee into flexion.
I like to take my hand and putit under the popliteal space and
I like to raise the knee up inthe middle, and so therefore,
the heel will naturally slidetoward the bottom.
They really relax well.
(08:19):
The other thing that it does isit prevents the over
compression of the posteriorfemur and tibia from getting
compressed together, so it kindof spreads it apart a little bit
.
Patients tolerate this reallywell.
So this is how I like to startwith just light, passive range
of motion.
I go from zero to 20, 25, 30degrees of flexion, really nice
(08:42):
and easy.
I don't want a tremendousamount of tension in that
patella tendon and it should benice and comfortable.
Okay, now I, you know, want tomake sure and emphasize that you
do not let the patient hangthat leg off the edge of a
plinth.
You don't want to be doingaggressive passive range of
motion.
I'm telling you right now, thishas to be very light.
(09:03):
You need to gain the confidenceof the patient so that later on
, as you start to advance thepatient, they have confidence in
you, that they can number onedo what they're going to do and
that they're being well guided.
They have to be very dependenton therapy at this stage of the
game because they really don'tknow what that leg will do, how
well it will hold up, and theycan't just work through it, like
(09:24):
some people will work throughthe pain after a total knee
replacement and, and that's okay, we want them to do that, but
not in this situation.
So it's not always more pain.
Um, you know, no pain, no gain.
It's sometimes no pain, allgain.
So we want this to be nice andgradual.
I might take these people.
If they are really having a lotof capsular stiffness, I may
(09:48):
put a little roll under thatknee at 10 degrees of flexion
and just get a very gentlestretch and I might put a little
heat over the quad.
Maybe I'm avoiding thatincision if it's still kind of,
you know, not well healed.
But I may just put it on thequad just to get it to relax a
little bit and slowly work themup into passive flexion.
But again, I pull up fromunderneath the knee.
(10:11):
Let's talk about some exercises.
Well, I like to do ankle pumps.
If that leg is in fullextension at the knee then you
can do resisted ankle pumps.
I like to do TheraPen to startoff with.
We want to get this quadstarting to turn on because
obviously it's going to beinhibited.
We just had patient, just hadsurgery.
There's some swelling, there'ssome pain, there's going to be
(10:32):
some quad shutdown.
So very sub-maximal quadricepisometrics.
I leave them at full extension.
If they're there, that's great.
I just talked to them aboutlightly turning it on.
You might just see a quivergoing on there.
We'll jump into some glute sets.
I'll do some patellamobilization, especially
medially and laterally.
(10:52):
But I am not going to jam onthis into superior glides
because obviously that's goingto be stretching a patella
tendon repair.
If they had a quadricep repairthey're going to tolerate this a
lot better.
Okay, so then you can go intosome superior gliding, but it
depends on if they've had apatella tendon repair or a
quadricep tendon repair.
(11:13):
Um, I love to do bald bridgesearly on.
I will take that leg, I'll keepit in full extension, I'll grab
them under the ankle, I'll liftit up in the air, bring them up
into kind of, like you know, 45or 50 degrees of a straight leg
raised position.
I'm completely passivelyextending the knee.
They tolerate this very well.
I'll place that ankle on a balland they'll take the other foot
(11:35):
, put the other ankle on a balland I will hold their leg on the
ball so it doesn't roll off.
And I will have them knock outthree sets of 10 or three sets
of 15 ball bridges and they haveto keep the legs straight.
They're activating the glutes,the back extensors, the
hamstrings and, as a result, thequads are not getting a big
stretch on them and they'returning off.
(11:56):
They tolerate this really well.
When they're done, you take theleg and you put it back on the
table from here I might put themon onto an upper body ergometer
.
While their brace is in fullextension, the leg is rested,
I'll put them on the UBE.
I'll throw some BFR on theirarms right away so that we can
get this nice physiologicresponse.
(12:18):
We're going to have humangrowth hormone release and that
will promote healingsystemically and be very helpful
.
I do not do BFR on the surgicallower extremity until two weeks
have gone by.
We will talk about that in thenext episode and how we do that.
Now.
Let's say the patient's in alot of discomfort.
Well, we could do somemodalities.
(12:39):
You can use ice to control painand I like to do interfercial
current if they're having a lotof discomfort right around the
knee.
But absolutely no NMES orRussian stimulation to the
quadricep musculature for eithera quad tendon or a patella
tendon repair.
You do not want that muscleyanking on that repair.
(13:00):
All right, you can run the riskof re-rupturing those tendons
and your patient will beabsolutely miserable and never
come back to therapy.
So you are not to use NMES onthose patients within the first
two weeks of physical therapy.
I also like to teach patientshow to properly elevate their
(13:20):
leg.
This may take some assistancewith somebody at home.
How to properly elevate theirleg.
This may take some assistancewith somebody at home.
If they are to do an attemptedstraight leg raise, active,
assistively, maybe they shouldhave their brace.
They need to have the brace on,locked out into full extension,
okay, but really they're nottrying to do that until the two
to six week mark and that's withactive assistance.
So if somebody can take thatleg and get it elevated for them
(13:42):
above their heart, that's great.
So Lots of stuff in the firsttwo weeks.
What I really want you to getout of this is how do you not
hurt the patient or harm thepatient?
I should say A lot of patientsyou know have a little hurt
while you're working with them,but you really don't want to
harm them.
And so building confidence inthat first week is very
(14:03):
important, because they'relooking to you for guidance and
they need to have thatconfidence in you.
So building that confidence up,getting them where they need to
be, to that 25 to 30 degrees ofknee flexion in the first two
weeks is more than enough.
They need to be in their brace,they need to be using their
crutches.
They need to be watching outfor icy surfaces, slippery
surfaces, so they don't theydon't fall down, and then you
(14:27):
give them some good guidance.
You're not gonna be doing a tonof stuff with them, but getting
them started in the rightdirection with a lot of
education is super important.
So I'm going to stop there fortoday, for week zero to two.
Next episode we're going todiscuss a progression from the
two-week to the six-week mark.
We'll talk about how we moveforward with that patient who's
(14:48):
had a patella tendon or quadtendon repair.
I'd love to get your feedbackon this type of content, okay,
giving some real specifictreatment advice.
I think that there are a lot ofpeople out there on social
media who show you a bunch ofstuff.
If you watch Instagram oryou're on Facebook or TikTok or
(15:09):
whatever it might be, they havea million exercises to improve
your knee range of motion.
Well, we need to be verycautious here, okay, and we need
to be very strategic when wetreat these types of patients.
So I need you to kind of takethose types of social media
examples with a grain of salt.
They're applicable in certainsituations, but not all
(15:31):
situations.
So I want you I hope that'swhat you got from this episode
today is how to preventcomplications when you see these
types of tendon repairs.
So if you do want to give mefeedback on this type of content
, just go to the show notes andgo to send us a text.
You click on that.
You can send me a text.
I don't I can't respond to it,but I can certainly bring it up
(15:53):
in a future episode and Iactually get a lot of my content
ideas this way.
So please, even if it's to sayhello, I'd love to hear where
you're from and what type ofcontent you're listening to,
what type of content you like tolisten to.
And it can be as simple as Ilike to have you know actual
treatment techniques you know inthe podcast, or patient
(16:14):
presentations, whatever it mightbe.
I'd love to hear from you.
If you can't text it to me,send me an email.
I'd be more than happy toanswer you by email also.
Also, don't forget to jump overto Apple podcast.
Leave us a rating and review.
I really appreciate thefeedback helps me make OEP
better for you and so that youhave better content to consume.
(16:36):
So hope you all have a greatday, be kind to each other and
take care.
Hello everyone and welcome to episode 370 of the
OrthoEvalPal podcast.
I'm your host, paul Marquis PT,and today we're going to be
talking about quadriceps andpatella tendon repairs.
We're going to be talking aboutthe progression of this from
zero to two weeks after surgery.
We're going to talk about sometips to avoid complications
early on after a quad tendon orpatella tendon repair.
(00:22):
We'll be talking about bracingand crutch use.
We'll discuss some precautionssoon after surgery.
We'll even give you someexercise and modality
recommendations and so much more.
But before we get started today,I'd like to mention our
sponsors.
First of all we haveRangemaster.
Rangemaster is known for theirshoulder rehab equipment.
They offer products fromshoulder wands to finger ladders
(00:42):
, overhead pulleys to shoulderrehab kits.
Rangemaster is your one-stopshop to help with the treatment
of frozen shoulders, post-oprotator cuff repairs, total
shoulder and reverse totalshoulder replacements and so
much more.
If you'd like to get a freesample of Rangemaster's Blue
Ranger pulley system, just emailjim at myrangemastercom and add
(01:02):
OrthoEvalPal in the subjectline.
We also have MedCorpProfessionals.
Now, I know the folks atMedCorp Professionals personally
.
They're a great bunch of folksand locally owned, family
operated medical supply company.
They carry everything fromradial pressure wave units,
which I have and use on aregular basis, to traction
devices, resistance bands, tocompression garments you name it
(01:24):
.
They have it.
Most impressively, though, istheir customer service.
It's second to none.
If you're looking for medicalproducts for your clinic or
products for your patients, goto wwwmedcorprocom, and if you
use coupon code OEP10, you canget $10 off a Saunders cervical
traction unit, and you can alsouse the code FIRSTTIME10 if
(01:47):
you're a first-time purchaser ontheir website and get $10 off
your first order.
Now, welcome back everyone.
So, as usual, I get this lightbulb moment for a podcast topic
which just snowballs into morethan you know.
Enough content, for you knowmore than one episode, and so
I'm going to break this topic upinto two, maybe three episodes,
(02:10):
just so that I don't overwhelmyou with a bunch of content that
is just kind of confusing.
We're just going to give youzero to two weeks after a quad
tendon or patella tendonreconstruction, and we're going
to just talk about how we wouldmanage that.
And you know, as I was workingwith this patient of mine who
(02:30):
had a patella tendon repair, Istarted thinking about all of
the things that could go wronghere after surgery, and I'll be
the first to admit that treatingtendon repairs probably makes
me a little more nervous thananything else out there, and I
have seen tons of these andluckily I'm batting a thousand
in the last 33 years never had are-rupture under my care.
(02:51):
But I also am maybe a littlemore conservative.
When I see these patients Ireally step back and say to
myself, okay, what could I do,or what could the patient do to
cause some sort of acomplication here?
All right, so if you thinkabout that actually you could
think about this every singletime you see a patient what
(03:12):
would I do today that could makethis patient worse?
And then you clear all of thatstuff and that opens up the
field for whatever else you wantto do and can do in a safe
environment.
Okay, so if you look at it thisway, your approach is going to
be much more targeted, much morestrategic.
And then you need to rememberyou just can't treat these
(03:35):
patients who have tendon repairslike a, you know, a total knee
replacement or a total shoulderreplacement.
You have these soft tissuesthat are repaired that you don't
want to tear off.
You don't want to, you know,upset the surgeon who did this
surgery and put all this workinto repairing these tendons.
So it's important that you lookat your anatomy, you understand
(03:56):
it well.
You need to remember that thepatella tendon and quad tendons
take up a huge amount of load.
All right, it's a large musclegroup, a very large tendon group
.
And I also want you to thinkabout and go back to you know
your college days when you werestudying this.
Remember selective tissuetension.
All right, passive knee flexionand hip extension are going to
(04:19):
stretch that extensor mechanism,ok.
And.
And active knee extension andhip flexion are going to shorten
the quad tendon and patellatendon.
So remember that when you areworking on your patient,
remember that at the time framesthat they're in, it's important
that we get these patients insoon after surgery, like three
to four days, so that we canstart to prevent DVT, get the
(04:44):
calf activated a little bit, getsome elevation, get some edema
control, start to get the quadto turn on a little bit and get
all the surrounding musclesactivated.
So let's just start talkingabout bracing and crutches first
of all.
So these folks usually thatcome out of surgery and they
have a dial brace on it's lockedinto full extension.
(05:05):
We use a dial brace because wewant to, at some point in the
future, allow a little bit ofrange of motion on a progressive
basis, you know, week by week.
So you want something that isadjustable but lockable.
All right, because at first youwant this brace to be locked
out into full extension.
They need to have a long bracefor good leverage.
(05:26):
Short braces don't really do agood job at preventing flexion
of the knee.
You want these people to besleeping with this brace on.
Okay, because at night it'scommon for us to flex the knees,
maybe even kick a little bitwhen we're, when we're dreaming
or sleeping, and so andsometimes you might get up in
the middle of the night notthink about it and flex that
(05:46):
knee, and so we really want thatbrace to be locked out.
They would need to be sleepingwith it and whenever they are
walking they're using crutches,they're to be weight bearing as
tolerated.
If the brace is locked out intofull extension and you're
driving your weight through thefemur, through the tibia, and
the knee is not flexingwhatsoever, you really can walk
with that knee in this extendedposition.
(06:07):
You can put full weight bearingon it.
You know right away pretty much, but we recommend weight
bearing is tolerated justbecause at first they're going
to be a little uncomfortable.
So that brace is on at alltimes while they're using
crutches.
It's locked into extensionwhile they're using the crutches
, all right.
So we're also going to see a lotof swelling in this patient.
So we want to teach them how toproperly elevate the leg.
That's important.
(06:28):
I like to do a lot of anklepumps when that leg is elevated.
If they need some ice, you know, for pain control, then they
can ice while they have it inthat elevated position because
they have this brace on, itneeds to be pretty tight.
They're also going to have alot of lack of movement.
So you need to remember,because they have this lack of
movement, they're in pain, theyjust had surgery, they're at
(06:50):
high risk of DVT.
So I have these folks do lotsof ankle pumps, okay, and so
that's very important.
Now let's talk about range ofmotion.
They really shouldn't be movingthis knee past 25 to 30 degrees
of flexion in the first coupleof weeks.
When I get these patients going,I first ask them can you do a
(07:14):
heel slide?
I want you to pull your heeltoward your butt.
Okay, that's how I like them totry to imagine doing this.
I don't want them to flex thehip, to pull the knee toward
their face in order to get it toslide.
I like them to really activatethat hamstring because, number
one, you're not getting anaggressive, passive stretch to
(07:36):
the quad.
When they're doing this they'regoing to be a little
uncomfortable, but when you'reactively using the
hamstringstring you'reinhibiting the quadricep even
more so the quad is going torelax a little bit more and have
less pull on on the repair.
So I like them to just try todo an active heel slide.
See how they do now.
If they've got zero degrees ofextent or flexion and they just
(07:58):
can't activate it, they can'tpull it up, then the way I like
to try to get flexion is not tograb them at the ankle and push
the knee into flexion.
I like to take my hand and putit under the popliteal space and
I like to raise the knee up inthe middle, and so therefore,
the heel will naturally slidetoward the bottom.
They really relax well.
(08:19):
The other thing that it does isit prevents the over
compression of the posteriorfemur and tibia from getting
compressed together, so it kindof spreads it apart a little bit
.
Patients tolerate this reallywell.
So this is how I like to startwith just light, passive range
of motion.
I go from zero to 20, 25, 30degrees of flexion, really nice
(08:42):
and easy.
I don't want a tremendousamount of tension in that
patella tendon and it should benice and comfortable.
Okay, now I, you know, want tomake sure and emphasize that you
do not let the patient hangthat leg off the edge of a
plinth.
You don't want to be doingaggressive passive range of
motion.
I'm telling you right now, thishas to be very light.
(09:03):
You need to gain the confidenceof the patient so that later on
, as you start to advance thepatient, they have confidence in
you, that they can number onedo what they're going to do and
that they're being well guided.
They have to be very dependenton therapy at this stage of the
game because they really don'tknow what that leg will do, how
well it will hold up, and theycan't just work through it, like
(09:24):
some people will work throughthe pain after a total knee
replacement and, and that's okay, we want them to do that, but
not in this situation.
So it's not always more pain.
Um, you know, no pain, no gain.
It's sometimes no pain, allgain.
So we want this to be nice andgradual.
I might take these people.
If they are really having a lotof capsular stiffness, I may
(09:48):
put a little roll under thatknee at 10 degrees of flexion
and just get a very gentlestretch and I might put a little
heat over the quad.
Maybe I'm avoiding thatincision if it's still kind of,
you know, not well healed.
But I may just put it on thequad just to get it to relax a
little bit and slowly work themup into passive flexion.
But again, I pull up fromunderneath the knee.
(10:11):
Let's talk about some exercises.
Well, I like to do ankle pumps.
If that leg is in fullextension at the knee then you
can do resisted ankle pumps.
I like to do TheraPen to startoff with.
We want to get this quadstarting to turn on because
obviously it's going to beinhibited.
We just had patient, just hadsurgery.
There's some swelling, there'ssome pain, there's going to be
(10:32):
some quad shutdown.
So very sub-maximal quadricepisometrics.
I leave them at full extension.
If they're there, that's great.
I just talked to them aboutlightly turning it on.
You might just see a quivergoing on there.
We'll jump into some glute sets.
I'll do some patellamobilization, especially
medially and laterally.
(10:52):
But I am not going to jam onthis into superior glides
because obviously that's goingto be stretching a patella
tendon repair.
If they had a quadricep repairthey're going to tolerate this a
lot better.
Okay, so then you can go intosome superior gliding, but it
depends on if they've had apatella tendon repair or a
quadricep tendon repair.
(11:13):
Um, I love to do bald bridgesearly on.
I will take that leg, I'll keepit in full extension, I'll grab
them under the ankle, I'll liftit up in the air, bring them up
into kind of, like you know, 45or 50 degrees of a straight leg
raised position.
I'm completely passivelyextending the knee.
They tolerate this very well.
I'll place that ankle on a balland they'll take the other foot
(11:35):
, put the other ankle on a balland I will hold their leg on the
ball so it doesn't roll off.
And I will have them knock outthree sets of 10 or three sets
of 15 ball bridges and they haveto keep the legs straight.
They're activating the glutes,the back extensors, the
hamstrings and, as a result, thequads are not getting a big
stretch on them and they'returning off.
(11:56):
They tolerate this really well.
When they're done, you take theleg and you put it back on the
table from here I might put themon onto an upper body ergometer
.
While their brace is in fullextension, the leg is rested,
I'll put them on the UBE.
I'll throw some BFR on theirarms right away so that we can
get this nice physiologicresponse.
(12:18):
We're going to have humangrowth hormone release and that
will promote healingsystemically and be very helpful
.
I do not do BFR on the surgicallower extremity until two weeks
have gone by.
We will talk about that in thenext episode and how we do that.
Now.
Let's say the patient's in alot of discomfort.
Well, we could do somemodalities.
(12:39):
You can use ice to control painand I like to do interfercial
current if they're having a lotof discomfort right around the
knee.
But absolutely no NMES orRussian stimulation to the
quadricep musculature for eithera quad tendon or a patella
tendon repair.
You do not want that muscleyanking on that repair.
(13:00):
All right, you can run the riskof re-rupturing those tendons
and your patient will beabsolutely miserable and never
come back to therapy.
So you are not to use NMES onthose patients within the first
two weeks of physical therapy.
I also like to teach patientshow to properly elevate their
(13:20):
leg.
This may take some assistancewith somebody at home.
How to properly elevate theirleg.
This may take some assistancewith somebody at home.
If they are to do an attemptedstraight leg raise, active,
assistively, maybe they shouldhave their brace.
They need to have the brace on,locked out into full extension,
okay, but really they're nottrying to do that until the two
to six week mark and that's withactive assistance.
So if somebody can take thatleg and get it elevated for them
(13:42):
above their heart, that's great.
So Lots of stuff in the firsttwo weeks.
What I really want you to getout of this is how do you not
hurt the patient or harm thepatient?
I should say A lot of patientsyou know have a little hurt
while you're working with them,but you really don't want to
harm them.
And so building confidence inthat first week is very
(14:03):
important, because they'relooking to you for guidance and
they need to have thatconfidence in you.
So building that confidence up,getting them where they need to
be, to that 25 to 30 degrees ofknee flexion in the first two
weeks is more than enough.
They need to be in their brace,they need to be using their
crutches.
They need to be watching outfor icy surfaces, slippery
surfaces, so they don't theydon't fall down, and then you
(14:27):
give them some good guidance.
You're not gonna be doing a tonof stuff with them, but getting
them started in the rightdirection with a lot of
education is super important.
So I'm going to stop there fortoday, for week zero to two.
Next episode we're going todiscuss a progression from the
two-week to the six-week mark.
We'll talk about how we moveforward with that patient who's
(14:48):
had a patella tendon or quadtendon repair.
I'd love to get your feedbackon this type of content, okay,
giving some real specifictreatment advice.
I think that there are a lot ofpeople out there on social
media who show you a bunch ofstuff.
If you watch Instagram oryou're on Facebook or TikTok or
(15:09):
whatever it might be, they havea million exercises to improve
your knee range of motion.
Well, we need to be verycautious here, okay, and we need
to be very strategic when wetreat these types of patients.
So I need you to kind of takethose types of social media
examples with a grain of salt.
They're applicable in certainsituations, but not all
(15:31):
situations.
So I want you I hope that'swhat you got from this episode
today is how to preventcomplications when you see these
types of tendon repairs.
So if you do want to give mefeedback on this type of content
, just go to the show notes andgo to send us a text.
You click on that.
You can send me a text.
I don't I can't respond to it,but I can certainly bring it up
(15:53):
in a future episode and Iactually get a lot of my content
ideas this way.
So please, even if it's to sayhello, I'd love to hear where
you're from and what type ofcontent you're listening to,
what type of content you like tolisten to.
And it can be as simple as Ilike to have you know actual
treatment techniques you know inthe podcast, or patient
(16:14):
presentations, whatever it mightbe.
I'd love to hear from you.
If you can't text it to me,send me an email.
I'd be more than happy toanswer you by email also.
Also, don't forget to jump overto Apple podcast.
Leave us a rating and review.
I really appreciate thefeedback helps me make OEP
better for you and so that youhave better content to consume.
(16:36):
So hope you all have a greatday, be kind to each other and
take care.
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