8 Ways to Wake Up Your Patient’s Quadriceps After Major Knee Surgery

By dpope2020

January 3, 2025

ACL, acl injury, acl reconstruction, acl rehab, acl surgery, ACL tear, ami, ami knee, arthrogenic muscle inhibition, dan pope, fitness pain free, knee pain, knee pain exercises, knee pain relief, knee pain relief exercises, knee replacement, knee replacement surgery, knee surgery, nmes, physical therapy, post surgery quad recovery, quad, quad atrophy, quadriceps after knee surgery, quadriceps after major knee surgery, quadriceps autogenic muscle inhibition, tens

8 Ways to Wake Up Your Patient’s Quadriceps After Major Knee Surgery

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In today's video we go over: 8 Ways to Wake Up Your Patient’s Quadriceps After Major Knee Surgery

Struggling to get your patients' quadriceps firing after a major knee surgery? Don't worry, I've got you covered! In this video, I'll share 8 effective strategies to help you wake up those quads and get your patients back on track to recovery.

Arthrogenic muscle inhibition (AMI) is a common problem after knee surgery, causing the quadriceps muscles to shut down and become weak. This can significantly hinder recovery and delay functional return. But don't worry, I've got some effective solutions to help you overcome this challenge.

In this video, I'll discuss the following strategies:

  1. Cryotherapy: Applying ice to the injured area can help reduce inflammation and improve muscle function.
  2. Neuromuscular electrical stimulation (NMES): This technique uses electrical currents to stimulate the muscles and promote muscle activation.
  3. TENs: Thought TENs was useless?  Think again
  4. Biofeedback: This technique uses visual or auditory feedback to help patients learn how to contract their muscles properly.
  5. Contralateral limb training: Strengthening the opposite leg can help improve quad function in the injured leg.
  6. Blood flow restriction training: This technique involves using a cuff to restrict blood flow to the working muscles, which can help promote muscle growth and strength.
  7. Vibration therapy: Using a vibrating platform can help improve muscle activation and strength.I'll also provide detailed instructions on how to implement each of these strategies in your practice.
  8. Programming Principles: Choosing the right sets / reps and exercises is crucial for quad rehabilitation. I'll share some of my favorite exercises that are safe and effective.

So if you're a physical therapist who wants to help your patients achieve optimal recovery after a major knee injury, be sure to watch this video.

Timeline:

  • 00:00 - Intro
  • 00:22 - What is Arthrogenic Muscle Inhibition? (AMI)
  • 01:00 - 1) Cryotherapy
  • 01:50 - 2) Neuromuscular Electrical Stimulation (NMES)
  • 09:05 - 3) Transcutaneous Electrical Nerve Stimulation (TENS)
  • 09:35 - 4) Vibration
  • 10:28 - 5) Biofeedback
  • 11:20 - 6) Contralateral Limb Training
  • 12:35 - 7) Blood Flow Restriction Training (BFR)
  • 14:37 - 8) Programming Considerations
  • 15:40 - Practical Take-away 

Wake up quads!!!

- Dan Pope DPT,OCS,CSCS

Show Notes / Relevant Articles:

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Thank you!

Dan Pope DPT, OCS, CSCS

References: 

  1. Hart JM, Kuenze CM, Diduch DR, Ingersoll CD. Quadriceps muscle function after rehabilitation with cryotherapy in patients with anterior cruciate ligament reconstruction. J Athl Train. 2014 Nov-Dec;49(6):733-9. doi: 10.4085/1062-6050-49.3.39. PMID: 25299442; PMCID: PMC4264644.
  2. Hauger AV, Reiman MP, Bjordal JM, Sheets C, Ledbetter L, Goode AP. Neuromuscular electrical stimulation is effective in strengthening the quadriceps muscle after anterior cruciate ligament surgery. Knee Surg Sports Traumatol Arthrosc. 2018 Feb;26(2):399-410. doi: 10.1007/s00167-017-4669-5. Epub 2017 Aug 17. PMID: 28819679.
  3. Conley CEW, Mattacola CG, Jochimsen KN, Dressler EV, Lattermann C, Howard JS. A Comparison of Neuromuscular Electrical Stimulation Parameters for Postoperative Quadriceps Strength in Patients After Knee Surgery: A Systematic Review. Sports Health. 2021 Mar;13(2):116-127. doi: 10.1177/1941738120964817. Epub 2021 Jan 11. PMID: 33428557; PMCID: PMC8167342.
  4. Son SJ, Kim H, Seeley MK, Feland JB, Hopkins JT. Effects of transcutaneous electrical nerve stimulation on quadriceps function in individuals with experimental knee pain. Scand J Med Sci Sports. 2016 Sep;26(9):1080-90. doi: 10.1111/sms.12539. Epub 2015 Sep 8. PMID: 26346597.
  5. Blackburn JT, Pamukoff DN, Sakr M, Vaughan AJ, Berkoff DJ. Whole body and local muscle vibration reduce artificially induced quadriceps arthrogenic inhibition. Arch Phys Med Rehabil. 2014 Nov;95(11):2021-8. doi: 10.1016/j.apmr.2014.07.393. Epub 2014 Jul 30. PMID: 25083559.
  6. Minshull C, Gallacher P, Roberts S, Barnett A, Kuiper JH, Bailey A. Contralateral strength training attenuates muscle performance loss following anterior cruciate ligament (ACL) reconstruction: a randomised-controlled trial. Eur J Appl Physiol. 2021 Dec;121(12):3551-3559. doi: 10.1007/s00421-021-04812-3. Epub 2021 Sep 20. PMID: 34542671.
  7. Charles D, White R, Reyes C, Palmer D. A SYSTEMATIC REVIEW OF THE EFFECTS OF BLOOD FLOW RESTRICTION TRAINING ON QUADRICEPS MUSCLE ATROPHY AND CIRCUMFERENCE POST ACL RECONSTRUCTION. Int J Sports Phys Ther. 2020 Dec;15(6):882-891. doi: 10.26603/ijspt20200882. PMID: 33344004; PMCID: PMC7727417.