Grade 2 quads, PF problems!!

[physiobob]

Perhaps also a review and followup xray might be useful to check the status of the patella as a whole.It is very surprising that he does not have at least grad 4 post op when he has grade 4 preop. I would suggest this is inhibition due to pain and or psych. factors (conscious or unconscious) and not true weakness. How old is the individual. Are they working at the moment. Are they happy about returning to work asap?

[MrPhysio+]

Hi
Happy New Year to all.
All good advice so far. I agree that muscle inhibition post arthroscopy can be pain / swelling induced. The longer the patient goes without good active control, the more the brain forgets what it is supposed to do. Some patients take longer post arthroscopy to regain control, regardless of their pre surgical strength. A couple of points:
If your taping has not addressed patella tracking to ensure that the vastus medialis is assisted, do so. Muscle stims to the VMO, even if attached to trigger point needles (acupuncture type needles), can help re establish control. Passive assisted knee extension whilst looking at the knee during stims has proved useful to some of my patients. You can also ask the patient to perform three quick knee extensions with the contralateral leg, then try the affected leg. Focus the patients attention on what they can feel. Ultimately, it will be time, despite the frustration of patient and therapist.
If all the above fails, try using an oedema pump, if available, before and after treatment (using a long leg sleeve with the limb elevated.) During the decompression phase, have the patient dorsi/plantarflex the ankle to use the calf as an assist.
Another technique involves passive flexion / extension of the knee with the patient supine, and the therapist holding the lower leg in a figure four leg lock position, and whilst applying traction bending the knee back and forth. Take the knee to the point of discomfort in each direction, and also apply a mild medial or lateral torgue to the joint through range (you need to change grip for the torque effect, doing one side of the knee, and repeating the other side). Difficult to describe. If the patient is not on anti inflammatory medication and can tolerate it, check with the Doctor for supply.
Good luck.
MrPhysio+

[jordan physiotherapist]

I will give you idea
I want to now your opinion ,that is important to me
Use hydrotherapy and active assisted movement
To increase patient strengthening and reduce the pain
I now that too late but I a new member
Thank to all