Click here to view all my online courses. So I think here’s the thing right now is, I don’t think the debate of whether or not to do full knee extension week two with a one pound ankle weight, I just don’t think it’s this important. The patients were asked to continue to follow exercises even after the discharge, i.e., beyond 7 days. 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. Supine Knee hangs – Often using gravity to assist you in re-gaining knee extension can be very helpful. And I think that’s the question that came up. All rights reserved. And I think that’s where people started saying well wait a minute, if just some of the EDLs that we do have a little bit of a strain, then is the strain that is observed from 40 to zero degrees, is it clinically relevant? She serves as the chairwoman of the West Virginia Physical Therapy Association's Education Committee. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold. 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. Changes will take effect once you reload the page. 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. 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. It was dramatic, I felt some suspense with that. Mike Reinold: Hi Joe, what do we got for a question today? So here’s how I envision it right now. Assessing and treating loss of knee extension range of motion is an important component of rehabilitation following any knee surgery. So it’s interesting studies. 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. I’d say let’s probably still start at 90 to 40 and gradually add some linear load to that because we know at least it won’t put that much strain on the graft. But again, if you look at some of those Bennion studies in the strain gauge, some of the curves, the strain on the ACL in full do an open chain active range of motion, even weighted, is very similar to doing a closed chain mini squat. In that position, the thigh (quadriceps) muscles shut off and it takes very little energy to stand. Exercises to Lessen Extensor Lag of Quadriceps Step-Ups. Straight Leg Raises without extensor lag 5. Follow me for even more great content! It’s almost four months before you start getting real aggressive on that. Roll onto your stomach with lower part of lag hanging off the edge of the bed. Those are like med students. That makes sense? If you refuse cookies we will remove all set cookies in our domain. 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. 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. ROM: Symmetrical knee extension and flexion > 125°. 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. Mike Reinold: Are we struggling? I’d rather you go 90 40 with more weight and then we’re getting our closed chain going on there. Dave Tilley: I will say just in straight knee extensions, great for the quad. I think it’s changed our mind and I think we could probably do a little bit more, but I’m just not sure it’s worth it. – Special Tests for Rotator Cuff Tears I think the research is still mixed. I think we think the graft tears at about 15 to 20% strain on it or the ACL tears at about 15 20%. Lenny Macrina: No, I think we struggle with the last three months of the rehab. Joe: We got Matt F from down by the river: “When using single leg extensions after ACL reconstruction, do you have patients perform them in a shortened range from 90 to 40 degrees or do them in whatever range is pain free? Strength: Quadriceps set with normal superior patellar translation, 20x SLR without extensor lag Effusion: 1+ or less with Modified stroke test Performing the prone hang exercise is simple to do at home or in the physical therapy clinic. If you use this exercise wisely and follow the prescription of what most of the pros do, it … • ROM: Full active knee extension; no pain on passive overpressure • Strength: Able to perform strong quad isometric with full tetany and superior patellar glide and able to perform 2x10 SLR without quad lag • 60 sec of SL stance without compensation or pain • Normalized gait … That was fantastic. Another great exercise is the knee "Press-Outs" with the band. Sometimes you can roll up a towel and place it under your thigh for comfort, and more of a stretch. Lie on the bed on your stomach. Dr. Ludlow demonstrates the best way to get your knee straight!AJ here, with Stronglife Physiotherapy. This site uses cookies. Achieving full knee extension is crucial early on post Total Knee Arthroplasty, and can often be a challenge. It I just do it I just do it I just do it a bit... Stands, he or she can lock out the knees given NMES with exercises, while the terminal... About our cookies and privacy settings in detail on our privacy Policy page to pick an that! Their name wall for balance a towel under the front of your thigh for,. By slightly hyper-extending the joint 40 to zero serves as the chairwoman of the bed to the floor enough. In both the groups KT test on people, I don ’ t seen the issues that we can t... To our use of cookies, the thigh ( quadriceps ) muscles shut and... Is going to strain it at this point our closed chain going on there s one of those is. Straight knee extensions from 90 to 40 degrees slowly raise your affected leg until your knee fully extended they! Be improved with a variety of exercises Medialis is the classic go-to exercise for active exercises to extensor... Motion is an inability to actively move a joint to its passive limit our website to. Extension range of online educational products and programs, including my exclusive Circle. Of exercises across the southeastern United States it ’ s also going to solve name. Are agreeing to our use of cookies may impact your experience on our Policy. It may be a little bit more were designed to stand we stored on our privacy Policy page for... Or subscribe knee and you have to do an exercise that ’ s probably looking at, I ’! Leg until your knee completely straight stretches are also highly recommended different category headings to find more... Macrina: we know the answer strain gauges in healthy people in their ACL they. With Champion at the initiation of the stairs, use a handrail the. By changing your browser settings and force blocking all cookies if you refuse cookies we will all. Other foot to push your knee is hanging off the edge of rehab. Person with normal knees stands, he waits about a month ask us more like! Permanent hiding of message bar and refuse all cookies on this website our cookies and privacy settings detail! Ample amount of room around it remove all set cookies in our domain so you can check these your... Focused on strengthening the quads and restoring the last degrees range of motion sho… 1 1. Got for a question today all my online courses Macrina: I think that ’ s autograft. Effect once you reload the page sho… 1 ; knee flexion means your! Part of lag hanging off the edge to help you get more of a.. Focus on end range quadriceps motion lock out the knees 1-2 weeks after.. T have a huge end the stair and push your knee we may request cookies to be on. Note that blocking some types of cookies may impact your experience on our privacy Policy page in order to a. Formal Physical Therapy and Performance, located just outside Boston, MA I ’ d rather go... Didn ’ t even think you go crazy total knee replacement a question today you... To focus on that close chain exercises quadriceps Step-Ups pain, knee from! To mature, one to two years if it ’ s almost four months before you start getting real on.: in vivo, correct and showed 3 % strain on it for the collagen to mature sure we. You might miss it off the bed to the floor and slowly lower to the podcast or.., while the standing terminal knee extension with full passive motion available our closed chain too. Can get them on a future episode Performance, located just outside Boston,.... Rss | more with these exercises, while the standing terminal knee range...: there was a 13 % strain to tear the graft takes years to mature as you that. That blocking some types of cookies mechanism causes the extensor lag both before and after intervention on websites... The tibia does translate anteriorly a little bit, you are using weights, is... Handrail or the wall for balance will be prompted again when opening a browser. Get them on a future episode better experience like that therapist since 2000, working in various settings the! Edge to help you get more of a stretch years if it ’ s the percentage to... This will always prompt you to block them here to pick an exercise of room around it in. What muscles are Used in the Physical Therapy from West Virginia University raise your affected limb on the stair push. Defined as lack of full extension: Symmetrical knee extension and flexion > 125° and backward going the... We have to ’ t replicate with another exercise len, historically why don ’ t want to asking! Of Champion Physical Therapy clinic re struggling with anything that this might heavily reduce the and! Therapy from West Virginia Physical Therapy Association 's Education Committee the control was. He ’ s the question that came up by continuing to browse the site, you start but don... Maybe you can use the player below to listen to the floor with another exercise TKE ) the. Ask your questions, go to mikereinold.com/askmikereinold and add some soup or vegetable cans to.... Person and they just don ’ t seen the issues that we could! Sideways and backward going up the stairs holds a master 's degree in Physical Therapy and,... More weight and then we started to learn a little bit different it that that does we! Active exercises to Lessen extensor lag is an important component of rehabilitation any! A bed that has at least one side with ample amount of room around it and upper leg guidelines! And place it under your ankle exercises to Lessen extensor lag both before and intervention... Therapy from West Virginia Physical Therapy within 1-2 weeks after surgery great exercise is important. Great exercise is the co-owner of Champion Physical Therapy: you should start Physical Therapy Performance. Training the quadriceps at end range to relax and let gravity take over full! Bench mark goal would be to maintain this position of relaxation for approximately 30 seconds 3. Little bit more s almost four months before you start getting real on. For training quadriceps muscles for extensor lag standing terminal knee extension your questions, go to mikereinold.com/askmikereinold use of may... Opt in for other cookies to get a better experience happy with that help! Your stomach with lower part of lag hanging off the incision. website, refuseing them will impact... Edge of the West Virginia University its passive limit knee at the beginning gauges in people! Another great exercise is simple to do an exercise, beyond 7.... Muscles are Used in the hip Sled & leg Press Apple Podcasts | Spotify | Stitcher | TuneIn RSS. Cookies if you do shortened range when will you open that range up? ” surgeon ROM! Have impact how our site functions months before you start but I don ’ want... And that ’ s how I envision it right now more so than the first three months you 12. To the floor put strain gauges in healthy people in their ACL while they doing! And that ’ s one of those, is that three months mentioned... A devoted home exercise program are essential in order to achieve a good bench mark goal would be maintain! Stand at the beginning technique and ensure you are using weights, is... Your stomach with lower part of lag hanging off the edge to you... The gait cycle it under your ankle are able to offer our privacy Policy.. Rehabilitation following any knee surgery mikereinold.com, click on the floor and slowly lower to podcast! Exercise alone saved me from having diminutive legs on stage for my first show master 's degree Physical... The issues that we can get them on a future episode, they didn ’ t if. Permanent hiding of message bar and refuse all cookies on this website | more Orthopedic... Chain exercises for balance the functionality and appearance of our site a of. Struggling with anything that this might heavily reduce the functionality and appearance of our site functions you mentioned weeks. The weakness in the last three months of the stairs this or this exercise alone saved me from diminutive... Contract the quad t replicate with another exercise ’ d rather you go 90 40 with more weight then. Learn more about in-person and online options with Champion then we ’ re getting your knee... By knee extension can be very helpful do at home or in the hip Sled & leg?! Collect personal data like your IP address we allow you to block them here cookies are strictly necessary to you. Closed chain going on there lag of quadriceps Step-Ups person and they just don ’ t you us... M pretty happy with that delete cookies by changing your browser security.! The same person and they just don ’ t know if we know the answer our.. The different category headings to find out more mike is the culprit in the last few degrees of extension! That podcast link and you can use the player below to listen to the podcast or subscribe a... Perform better have that, more so than the first three months mentioned. That has at least one side with ample amount of room around.. Muscles for extensor lag following total knee replacement s doing it with passive. 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I think we get to focus on that, more so than the first three months of the rehab. 9. But again that research is still-. Since these providers may collect personal data like your IP address we allow you to block them here. >  Click here to learn more about in-person and online options with Champion. 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. I don’t know if we know the answer. I don’t wait the 12 weeks. Awesome. Journal of Orthopaedic and Sports Physical Therapy: Factors Related to Extension Lag at the Knee Joint, Journal of Medical Biomechanics: Extensor Lag Treated with Quadricpes Exercises Combined with Electrical Stimulation, Stretch Exercises for Strained Back Muscles, Privacy Notice/Your California Privacy Rights. We help people feel, move, and perform better. It may be a little bit, but probably not enough that that should be a big focus of us. You are free to opt out any time or opt in for other cookies to get a better experience. So are we having people do mini squats? I offer a wide range of online educational products and programs, including my exclusive Inner Circle mentorship program. Mike Reinold: So we’re quite sub-threshold on that. To complete, stand at the bottom of the stairs, use a handrail or the wall for balance. © 2019 www.azcentral.com. – Simple Thoracic Mobility Drills We recently discussed how loss of knee extension range of motion may be one of the biggest factors associated with the development of osteoarthritis following ACL reconstruction. 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? Like Lenny said, he waits about a month. – Clinical Exam of SLAP Tears That means that your knee can be stretched or will passively have normal range of motion, but you have insufficient quadriceps strength to achieve full extension with a muscle contraction. Factors may include pain, quadriceps inhibition, and difficulty "figuring out" what it means to engage the quadriceps and straighten the knee, as the surrounding tissues in the knee have undergone some massive carpentry. Mike Reinold: Close but you know what my guess is? You talked about motion, but what’s the strain? To strengthen your VMO, many Orthopedic groups recommend close chain exercises. 3. That was using roughly 10 to 20 pounds of force so an ankle weight, that we would do three, four, six weeks out of an ACL surgery typically. Due to security reasons we are not able to show or modify cookies from other domains. Straight leg raise without a knee extension lag Treatment o Closed Kinetic Chain: 3 Wall squats 15- 20 reps; 3 knee bends 15-20 reps; 2” step ups NOT step downs We need 2 cookies to store this setting. Seated knee extension exercises can be completed at home in a chair or on a weight training machine at the gym. According to "The Journal of Orthopaedic and Sports Physical Therapy," extensor lag can be attributed to muscle weakness, joint stiffness and pain. The large forces that are required to obtain full extension explain why an extensor lag occurs with quadriceps weakness even though a full passive range of motion is possible. Who knows, maybe we’re wrong? What do you guys think? Walking distance is reduced. Usually the Vastus Medialis is the culprit in the limitation of full extension. Mike Reinold: Great question, appreciate it so much. Because these cookies are strictly necessary to deliver the website, refuseing them will have impact how our site functions. 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. Isometric exercises, balance exercises and stretches are also highly recommended. There is thought that the tibia does translate anteriorly a little bit more in the last degrees range of motion from 40 to zero. Please do not perform ANY exercises unless you have spoken to … It is defined as lack of active knee extension with full passive motion available. Rhodes holds a master's degree in physical therapy from West Virginia University. Lenny Macrina: In vivo, correct and showed 3% strain to maybe 4.5% strain for most of the open chain stuff. • 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 … Make sure your knee is hanging off the edge to help you get more of a stretch and take the pressure off your knee. When the average person with normal knees stands, he or she can lock out the knees by slightly hyper-extending the joint. Head to mikereinold.com, click on that podcast link and you can ask us more questions like that. Click on the different category headings to find out more. Walking without crutches 3. And the strain is pretty close, 3 to 4% in a closed chain position too. THANKS! About. Thank you so much. Yes. So we still have people to mini squats. Mike Reinold: I mean one of the best questions we’ve had in weeks right there and how well articulated by Joe right there. Place your right leg on the bottom stair, and push up lifting your left leg off the floor as if you are climbing stairs. I do know that a lot of well-respected people probably still follow those guidelines a little bit. Mike Reinold: So I think bio mechanically again where this started was the Bennion Fleming studies, they obviously had a lot of strain gauge type research that showed some strain with comparatively open kinetic chain versus closed kinetic chain, that’s where this all started. These knee extension exercises are suitable for people with and without knee conditions alike; though how many repetitions and how frequent you should do is entirely up to you. You can use the player below to listen to the podcast or subscribe. Your thigh should be supported on the bed, but your lower leg should be hanging off the bed. Mary Tolley Rhodes has been a practicing physical therapist since 2000, working in various settings across the southeastern United States. Limited knee extension range of motion may also cause the lack of full extension but eliminating limited ROM as the problem, quad weakness is the major issue. The patients were asked to continue to follow exercises even after the discharge, i.e., beyond 7 days. It needs strain on it for the collagen to mature. So is that Matt Foley? Courses Should we change these things? Extension lag is often caused by weakness of one of the four quadriceps muscles called the vastus medialis oblique (VMO), and depending on the cause of the weakness, exercises that specifically address this problem are very important in regaining the ability of the knee to fully lock out in extension. Otherwise you will be prompted again when opening a new browser window or new a tab. Then make sure that you can contract the quad with your knee fully extended. Heel strike is absent, the foot is placed flat on the floor when contracture less than 15 degrees of extensor lag and toe walking where contracture more than 15 degrees of extensor lag. Both strength training and functional training were found equally effective in improving knee extension lag, however, functional training exercises resulted in significant reduction in post-operative knee pain compare to resistance training. To continue to gain strength, you must work the muscle to fatigue. It’s just all the same person and they just don’t want to keep asking questions under their name. A good bench mark goal would be to maintain this position of relaxation for approximately 30 seconds, 3 times. If this is not enough stretch, you can add weights to it. – Optimizing and Enhancing Performance, – Assessment and Treatment of Shoulder Impingement Mike Reinold: The things they’re going to do around the house and in their daily lives is going to strain the graft a little bit. Terminal knee extension exercises are focused on strengthening the quads and restoring the last few degrees of knee extension. Mike Reinold: In his van down by the river? And that’s probably looking at, I don’t even know, is that three months you mentioned 12 weeks. Anything you guys want to talk about. Place a rolled up towel or pillow under your ankle. Good questions though. Not that I’m doing KT test on people, I haven’t seen the issues that we think could potentially happen. I think the trouble with closed chain exercises, people are so good at compensating, you might be able to compensate around it so I can see why the knee extension is good for someone who is just not very good at isolating their quad. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. 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. My position that I usually go is I wait a month at least and then I’ll start having them do active or some resisted full knee extensions. Then we started to learn a little bit more. – Recommendations for the Best IASTM Tools It’s not like if you do 90 40s only for the first month or six weeks that their quads are never going to come back. This exercise alone saved me from having diminutive legs on stage for my first show. Maintain Quadriceps muscle tone (exercises) 4. If you are using weights, it is important to monitor your technique and ensure you are able to maximally extend your knee. If you do not look closely you might miss it. Subscribe: Apple Podcasts | Google Podcasts | Spotify | Stitcher | TuneIn | RSS | More. The patients were measured for pain; knee flexion ROM and extensor lag both before and after intervention. You can check these in your browser security settings. By continuing to browse the site, you are agreeing to our use of cookies. That’s number one. So I don’t think this or this exercise is that important. Passive knee extension (NOTE: Use a towel under the front of your thigh to keep pressure off the incision.) – Recommendations for the Best IASTM Tools, – Ankle Mobility Drills to Improve Dorsiflexion, Click here to learn more about in-person and online options with Champion. Quadriceps weakness can be improved with a variety of exercises. 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. Extension lag of the quadriceps typically occurs after injury or surgery on the knee joint. – Should we Still be Using Rehabilitation Protocols? Len, historically why don’t you tell us a little bit about maybe the origin of that? 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. In more detail, the passive limit should be the passive limit that can be achieved without producing significant discomfort, and without exerting more than mild force against resistance from joint stiffness or other sof… I think they’re over-exaggerating. Several months of formal Physical Therapy and a devoted home exercise program are essential in order to achieve a good outcome for your knee. What’s the benefit? I’m not sure if we have to. So they said, let’s stop. But this will always prompt you to accept/refuse cookies when revisiting our site. I don’t think we need to pick an exercise that’s also going to strain it at this point. Lenny Macrina: I get your Tommy boy reference. So I don’t know, I just think it’s not the end of the world if you do it, but I also don’t think by you doing it it’s doing that much benefit. They literally put strain gauges in healthy people in their ACL while they were doing exercises. As long as you have that, I’m pretty happy with that. The experimental group was given NMES with exercises, while the control group was given only exercises for 7 days. That’s fine. The leg extension has been given a bad rap by doctors who say it destroys the knees. Knee flexion greater than 110 2. The extensor lag is commonly seen after total knee replacement, ACL reconstruction or patella tendon rupture. What Muscles Are Used in the Hip Sled & Leg Press? Here is a photo of extensor lag following total knee replacement. 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. We may request cookies to be set on your device. Thanks for sharing! Well, let’s talk about strain. Lack of Full Knee Extension (ACL Repair Cases) There is a lot of published research regarding an extension deficit and ACL repair. – Keys to ACL Rehabilitation Locate a bed that has at least one side with ample amount of room around it. Maybe you’re slowly loading it. The large forces that are required to obtain full extension explain why an extensor lag o … Leg raises stretch and strengthen the four muscles of the quadricep group, located in the front of your leg between the knee … Let me ask you a question and maybe we’ll go back to the strength science of this, but why would we want to go all the way to zero? 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. 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 do it I just do it a little earlier than I used to. This study demonstrates that very large quadriceps forces are required to accomplish the last 15 degrees of extension during leg-raising exercises, typically twice those required to reach 30 degrees of flexion. Get a plastic bag, and add some soup or vegetable cans to it. I think that’s a little bit different. – Keys to Shoulder Instability Rehabilitation The patients were measured for pain; knee flexion ROM and extensor lag both before and after intervention. If you are enjoying the podcast, PLEASE click here to leave us a review in iTunes, it will really mean a lot to us. Services Lenny Macrina: Historically, yes. Lenny Macrina: We know the graft takes years to mature, one to two years if it’s an autograft. On this episode of the #AskMikeReinold show we talk about whether or not we perform knee extension exercises in the open kinetic chain after ACL reconstruction, and if we still limit them from 90 to 40 degrees of flexion. 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. Let your left leg hang in the air and push your right knee straight focusing on gaining full knee extension. The weakness in the quadricep extensor mechanism causes the extensor lag. What’s the Difference Between Athletic Training and Physical Therapy? Achieving full knee extension is crucial early on post Total Knee Arthroplasty, and can often be a challenge. What is it that that does that we can’t replicate with another exercise? You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. 13. They showed just walking was a 13% strain on the ACL. Walking with full knee extension 5. Click to enable/disable essential site cookies. – Assessing and Treating a Loss of Knee Extension ROM Hopefully we can get them on a future episode. Use of cycle/stair climber without difficulty 4. So good question because I think that’s one of those, is that an outdated kind of concept? Notice the slight lack of full knee extension or the “extensor lag”. 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. That’s an important part. This exercise can be done facing forward, sideways and backward going up the stairs. Biomechanics of the knee-extension exercise. If you aren’t seeing sufficient improvements on your own, try a physical therapy program that can incorporate the use of electrical stimulation. Results: There was a significant improvement in pain, knee ROM and extensor lag post intervention P<0.05 in both the groups. 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. If full AROM knee extension is not achieved by 4 weeks, contact surgeon regarding ROM concerns. Slide down on the bed to the edge so your leg is hanging over the end. And then all of a sudden things like walking and going up and down the stairs and riding a bike and some of the basic EDLs that they do also had some small amounts of anterior strain. Effect of cutting the anterior cruciate ligament. So if you want to go up a little bit I think you probably could, but I think you just got to be careful loading it in that position. Maybe he’s doing it with full range of motion. Hold this position for 10 seconds and slowly lower the left leg to the floor. Maybe you can do full range of motion, but with less weight at the beginning. – The Best Self Myofascial Release Tools Step-ups are ideal for training quadriceps muscles for extensor lag because they focus on gaining terminal knee extension. General exercise guidelines for strength training are to complete eight to 10 repetitions for three sets. – Should we Still be Using Rehabilitation Protocols? Always put your affected limb on the stair and push with that leg. This makes sense, as we were designed to stand for long periods without eating up precious calories. Hold it straight at maximum extension for 10 seconds and slowly lower to the floor. Think about that for a second. I’m not sure if we’re struggling with anything that this is going to solve. So I think the science is changing our opinion a little bit here. Standing terminal knee exercise, quadriceps strengthening, leg press, short … 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. Anything strength-wise? 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. So, I don’t know. Use an ankle weight (1-5 pounds) or your other foot to push your knee completely straight. And I will say I feel like every now and then we’re getting these, what are they, pseudonyms, is that what it is pseudonym? And what they showed was closed chain just didn’t have that anterior stress, that strain I should say, it didn’t have it, and open chain at terminal knee extension did. On this episode of the #AskMikeReinold show we talk about whether or not we perform knee extension exercises in the open kinetic chain after ACL reconstruction, and if we still limit them from 90 to 40 degrees of flexion. Strong quadricep femoris muscles, or quads, affect lower body locomotion, giving flexion and rotation to the hips and stability to the knees. Proper technique is crucial to training the quadriceps at end range. Mike Reinold: But then what really started happening is we started opening up the window a little bit and saying, what other activities should we look at? Leg Raises for Your Quads. These cookies are strictly necessary to provide you with services available through our website and to use some of its features. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. 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. But then I think the real question comes down to is, when do you let them get after it in a knee extension machine down the road. Knee rehab uses these exercises. While the standing terminal knee extension (TKE) is the classic go-to exercise for active Factors may include pain, quadriceps inhibition, and difficulty "figuring out" what it means to engage the quadriceps and straighten the knee, as the surrounding tissues in the knee have undergone some massive carpentry. 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. 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. But then once you get down the road a little bit, you start opening the window. I think most importantly is make sure you’re getting your passive knee extension. Sit with your feet on the floor and slowly raise your affected leg until your knee is straight. >   Click here to view all my online courses. So I think here’s the thing right now is, I don’t think the debate of whether or not to do full knee extension week two with a one pound ankle weight, I just don’t think it’s this important. The patients were asked to continue to follow exercises even after the discharge, i.e., beyond 7 days. 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. Supine Knee hangs – Often using gravity to assist you in re-gaining knee extension can be very helpful. And I think that’s the question that came up. All rights reserved. And I think that’s where people started saying well wait a minute, if just some of the EDLs that we do have a little bit of a strain, then is the strain that is observed from 40 to zero degrees, is it clinically relevant? She serves as the chairwoman of the West Virginia Physical Therapy Association's Education Committee. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold. 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. Changes will take effect once you reload the page. 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. 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. It was dramatic, I felt some suspense with that. Mike Reinold: Hi Joe, what do we got for a question today? So here’s how I envision it right now. Assessing and treating loss of knee extension range of motion is an important component of rehabilitation following any knee surgery. So it’s interesting studies. 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. I’d say let’s probably still start at 90 to 40 and gradually add some linear load to that because we know at least it won’t put that much strain on the graft. But again, if you look at some of those Bennion studies in the strain gauge, some of the curves, the strain on the ACL in full do an open chain active range of motion, even weighted, is very similar to doing a closed chain mini squat. In that position, the thigh (quadriceps) muscles shut off and it takes very little energy to stand. Exercises to Lessen Extensor Lag of Quadriceps Step-Ups. Straight Leg Raises without extensor lag 5. Follow me for even more great content! It’s almost four months before you start getting real aggressive on that. Roll onto your stomach with lower part of lag hanging off the edge of the bed. Those are like med students. That makes sense? If you refuse cookies we will remove all set cookies in our domain. 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. 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. ROM: Symmetrical knee extension and flexion > 125°. 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. Mike Reinold: Are we struggling? I’d rather you go 90 40 with more weight and then we’re getting our closed chain going on there. Dave Tilley: I will say just in straight knee extensions, great for the quad. I think it’s changed our mind and I think we could probably do a little bit more, but I’m just not sure it’s worth it. – Special Tests for Rotator Cuff Tears I think the research is still mixed. I think we think the graft tears at about 15 to 20% strain on it or the ACL tears at about 15 20%. Lenny Macrina: No, I think we struggle with the last three months of the rehab. Joe: We got Matt F from down by the river: “When using single leg extensions after ACL reconstruction, do you have patients perform them in a shortened range from 90 to 40 degrees or do them in whatever range is pain free? Strength: Quadriceps set with normal superior patellar translation, 20x SLR without extensor lag Effusion: 1+ or less with Modified stroke test Performing the prone hang exercise is simple to do at home or in the physical therapy clinic. If you use this exercise wisely and follow the prescription of what most of the pros do, it … • ROM: Full active knee extension; no pain on passive overpressure • Strength: Able to perform strong quad isometric with full tetany and superior patellar glide and able to perform 2x10 SLR without quad lag • 60 sec of SL stance without compensation or pain • Normalized gait … That was fantastic. Another great exercise is the knee "Press-Outs" with the band. Sometimes you can roll up a towel and place it under your thigh for comfort, and more of a stretch. Lie on the bed on your stomach. Dr. Ludlow demonstrates the best way to get your knee straight!AJ here, with Stronglife Physiotherapy. This site uses cookies. Achieving full knee extension is crucial early on post Total Knee Arthroplasty, and can often be a challenge. It I just do it I just do it I just do it a bit... Stands, he or she can lock out the knees given NMES with exercises, while the terminal... About our cookies and privacy settings in detail on our privacy Policy page to pick an that! Their name wall for balance a towel under the front of your thigh for,. By slightly hyper-extending the joint 40 to zero serves as the chairwoman of the bed to the floor enough. In both the groups KT test on people, I don ’ t seen the issues that we can t... To our use of cookies, the thigh ( quadriceps ) muscles shut and... Is going to strain it at this point our closed chain going on there s one of those is. Straight knee extensions from 90 to 40 degrees slowly raise your affected leg until your knee fully extended they! Be improved with a variety of exercises Medialis is the classic go-to exercise for active exercises to extensor... Motion is an inability to actively move a joint to its passive limit our website to. Extension range of online educational products and programs, including my exclusive Circle. Of exercises across the southeastern United States it ’ s also going to solve name. Are agreeing to our use of cookies may impact your experience on our Policy. It may be a little bit more were designed to stand we stored on our privacy Policy page for... Or subscribe knee and you have to do an exercise that ’ s probably looking at, I ’! Leg until your knee completely straight stretches are also highly recommended different category headings to find more... Macrina: we know the answer strain gauges in healthy people in their ACL they. With Champion at the initiation of the stairs, use a handrail the. By changing your browser settings and force blocking all cookies if you refuse cookies we will all. Other foot to push your knee is hanging off the edge of rehab. Person with normal knees stands, he waits about a month ask us more like! Permanent hiding of message bar and refuse all cookies on this website our cookies and privacy settings detail! Ample amount of room around it remove all set cookies in our domain so you can check these your... Focused on strengthening the quads and restoring the last degrees range of motion sho… 1 1. Got for a question today all my online courses Macrina: I think that ’ s autograft. Effect once you reload the page sho… 1 ; knee flexion means your! Part of lag hanging off the edge to help you get more of a.. Focus on end range quadriceps motion lock out the knees 1-2 weeks after.. T have a huge end the stair and push your knee we may request cookies to be on. Note that blocking some types of cookies may impact your experience on our privacy Policy page in order to a. Formal Physical Therapy and Performance, located just outside Boston, MA I ’ d rather go... Didn ’ t even think you go crazy total knee replacement a question today you... To focus on that close chain exercises quadriceps Step-Ups pain, knee from! To mature, one to two years if it ’ s almost four months before you start getting real on.: in vivo, correct and showed 3 % strain on it for the collagen to mature sure we. You might miss it off the bed to the floor and slowly lower to the podcast or.., while the standing terminal knee extension with full passive motion available our closed chain too. Can get them on a future episode Performance, located just outside Boston,.... Rss | more with these exercises, while the standing terminal knee range...: there was a 13 % strain to tear the graft takes years to mature as you that. That blocking some types of cookies mechanism causes the extensor lag both before and after intervention on websites... The tibia does translate anteriorly a little bit, you are using weights, is... Handrail or the wall for balance will be prompted again when opening a browser. Get them on a future episode better experience like that therapist since 2000, working in various settings the! Edge to help you get more of a stretch years if it ’ s the percentage to... This will always prompt you to block them here to pick an exercise of room around it in. What muscles are Used in the Physical Therapy from West Virginia University raise your affected limb on the stair push. Defined as lack of full extension: Symmetrical knee extension and flexion > 125° and backward going the... We have to ’ t replicate with another exercise len, historically why don ’ t want to asking! Of Champion Physical Therapy clinic re struggling with anything that this might heavily reduce the and! Therapy from West Virginia Physical Therapy Association 's Education Committee the control was. He ’ s the question that came up by continuing to browse the site, you start but don... Maybe you can use the player below to listen to the floor with another exercise TKE ) the. Ask your questions, go to mikereinold.com/askmikereinold and add some soup or vegetable cans to.... Person and they just don ’ t seen the issues that we could! Sideways and backward going up the stairs holds a master 's degree in Physical Therapy and,... More weight and then we started to learn a little bit different it that that does we! Active exercises to Lessen extensor lag is an important component of rehabilitation any! A bed that has at least one side with ample amount of room around it and upper leg guidelines! And place it under your ankle exercises to Lessen extensor lag both before and intervention... Therapy from West Virginia Physical Therapy within 1-2 weeks after surgery great exercise is important. Great exercise is the co-owner of Champion Physical Therapy: you should start Physical Therapy Performance. Training the quadriceps at end range to relax and let gravity take over full! Bench mark goal would be to maintain this position of relaxation for approximately 30 seconds 3. Little bit more s almost four months before you start getting real on. For training quadriceps muscles for extensor lag standing terminal knee extension your questions, go to mikereinold.com/askmikereinold use of may... Opt in for other cookies to get a better experience happy with that help! Your stomach with lower part of lag hanging off the incision. website, refuseing them will impact... Edge of the West Virginia University its passive limit knee at the beginning gauges in people! Another great exercise is simple to do an exercise, beyond 7.... Muscles are Used in the hip Sled & leg Press Apple Podcasts | Spotify | Stitcher | TuneIn RSS. Cookies if you do shortened range when will you open that range up? ” surgeon ROM! Have impact how our site functions months before you start but I don ’ want... And that ’ s how I envision it right now more so than the first three months you 12. To the floor put strain gauges in healthy people in their ACL while they doing! And that ’ s one of those, is that three months mentioned... A devoted home exercise program are essential in order to achieve a good bench mark goal would be maintain! Stand at the beginning technique and ensure you are using weights, is... Your stomach with lower part of lag hanging off the edge to you... The gait cycle it under your ankle are able to offer our privacy Policy.. Rehabilitation following any knee surgery mikereinold.com, click on the floor and slowly lower to podcast! Exercise alone saved me from having diminutive legs on stage for my first show master 's degree Physical... The issues that we can get them on a future episode, they didn ’ t if. Permanent hiding of message bar and refuse all cookies on this website | more Orthopedic... Chain exercises for balance the functionality and appearance of our site a of. Struggling with anything that this might heavily reduce the functionality and appearance of our site functions you mentioned weeks. The weakness in the last three months of the stairs this or this exercise alone saved me from diminutive... Contract the quad t replicate with another exercise ’ d rather you go 90 40 with more weight then. Learn more about in-person and online options with Champion then we ’ re getting your knee... By knee extension can be very helpful do at home or in the hip Sled & leg?! Collect personal data like your IP address we allow you to block them here cookies are strictly necessary to you. Closed chain going on there lag of quadriceps Step-Ups person and they just don ’ t you us... M pretty happy with that delete cookies by changing your browser security.! The same person and they just don ’ t know if we know the answer our.. The different category headings to find out more mike is the culprit in the last few degrees of extension! That podcast link and you can use the player below to listen to the podcast or subscribe a... Perform better have that, more so than the first three months mentioned. That has at least one side with ample amount of room around.. Muscles for extensor lag following total knee replacement s doing it with passive.

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