Quadriceps Tendon Rupture, Repair and Rehab - Page 163

Hey Eric, I've been following here for awhile, just never got around to posting until now. As far as the crab cakes go, well just another thing I don't eat (No seafood). The best way to explain my eating habits is to picture a typical 5 year old let loose in a food court located in a mall and tell them that can have anything they want, that would be me. I am now 52 and have never been to a restaurant that did have carry out. But on the bright side I don't smoke of drink, so at least I have that going for me.
 

I did A LOT of these, but my PT was much better looking. If you don't have someone to assist you just get a belt or something and tie it around your ankle to pull it back gently. Did you get any kind of OK to do stuff without the brace? As long as your lying on a safe level surface you could do it.

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Eric, thanks for that. I do now recall those. Doc just said I could go to 30. A little surprised I didn't have more of a stretch. Perhaps I should have started a week ago. Anyway.... It's a marathon and not a race....

Got a feeling you'll make it a 10K. You have some cheerleaders this time.

@Scoobs, @Eric308,

 

To shed some light on safe ROM at weekly progression is this:

 

To break down why some OS's take each path for your healing.

 

Aggessive ROM could be given to you out of complete ignorance from your OS. It could also mean that you have no pre-existing condition of tendonitis or tendonopathic conditions. The surgery performed was to ONLY fix the Quad Tendon in either a rupture of mostly torn condition.

 

Moderate ROM is the typical path to follow

Aggressive ROM – full brace locked at zero until 6 to 8 weeks

0-2 weeks - Up to and no greater than 30 degrees flexion (30 Degrees PROM = PASSIVE RANGE OF MOTION)

2-4 weeks - Up to and no greater than 60 degrees flexion (60 Degrees PROM = PASSIVE RANGE OF MOTION)

4-6 weeks - Up to and no greater than 90 degrees flexion (90 Degrees PROM = PASSIVE RANGE OF MOTION)

6 weeks and beyond – Up to FULL PROM

 

Moderate ROM – full brace locked at zero until 8 to 10 weeks

0-2 weeks - Up to and no greater than 25 degrees flexion (25 Degrees PROM = PASSIVE RANGE OF MOTION)

2-4 weeks - Up to and no greater than 50 degrees flexion (50 Degrees PROM = PASSIVE RANGE OF MOTION)

4-6 weeks - Up to and no greater than 75 degrees flexion (75 Degrees PROM = PASSIVE RANGE OF MOTION)

6-8 weeks - Up to and no greater than 100 degrees flexion (100 Degrees PROM = PASSIVE RANGE OF MOTION)

8 weeks and beyond – Up to FULL PROM

 

Conservative ROM – full brace locked at zero until 10 to 12 weeks

0-2 weeks - Up to and no greater than 20 degrees flexion (25 Degrees PROM = PASSIVE RANGE OF MOTION)

2-4 weeks - Up to and no greater than 40 degrees flexion (50 Degrees PROM = PASSIVE RANGE OF MOTION)

4-6 weeks - Up to and no greater than 60 degrees flexion (75 Degrees PROM = PASSIVE RANGE OF MOTION)

6-8 weeks - Up to and no greater than 80 degrees flexion (100 Degrees PROM = PASSIVE RANGE OF MOTION)

8-10 weeks - Up to and no greater than 100 degrees flexion (100 Degrees PROM = PASSIVE RANGE OF MOTION)

10 weeks and beyond – Up to FULL PROM

 

 

Tip of the day - Early ROM is good. That means beginning week 2 Post OP is when it is safe to begin PASSIVE ROM movements. An example would be to place a pillow under your knee with the assistance of someone else making sure your leg does not go past 30 degrees. Now is the time to buy yourself a "goniometer." This measures your degree of flexion (ROM)

 

About ME:  Saw my OS Yesterday. I was only 6 days post op. She took off the steri strips and incision opened up in multiple places. What a freakin bloody mess. It was easily rectified by putting new steri strips on though. I guess these should be done at the 10 day or later point in time. I am on the Aggressive ROM route for the left leg now.

 

FYI - Website is coming soon. I will be asking you all to participate in some of the content going into the site. I simply want the most accurate information for folks like us to be able to go to for reference.

Clicked submit before checking things:

 

Conservative ROM should be this:

 

Conservative ROM – full brace locked at zero until 10 to 12 weeks

0-2 weeks - Up to and no greater than 20 degrees flexion (20 Degrees PROM = PASSIVE RANGE OF MOTION)

2-4 weeks - Up to and no greater than 40 degrees flexion (40 Degrees PROM = PASSIVE RANGE OF MOTION)

4-6 weeks - Up to and no greater than 60 degrees flexion (60 Degrees PROM = PASSIVE RANGE OF MOTION)

6-8 weeks - Up to and no greater than 80 degrees flexion (80 Degrees PROM = PASSIVE RANGE OF MOTION)

8-10 weeks - Up to and no greater than 100 degrees flexion (100 Degrees PROM = PASSIVE RANGE OF MOTION)

10 weeks and beyond – Up to FULL PROM

@NJPete...Thanks for all the good breakdown. The only deviation I see in my protocol was that it shows 90 PROM (max) no earlier than three weeks post. That's about exactly when I hit it, and it was very easy with the PT's assistance. I never went beyond the 90 until after six weeks and was locked at ZERO until then as well.

   Glad to hear you are progressing well. I had those steri strips as well and my OS just left them on and they finally degraded in the shower and fell off. You have to really squint to even see my scar. Question...when you say Passive Range of Motion does that mean that someone is always assisting you? I was doing all those heel slides and other ROM exercises after about six weeks by myself.

(AROM)

@BillInMaryland, for your diet. I totally understand you did what you had to do to survive. I used to do the same thing when I knew I would not be around a variety of food that was pleasurable enough for my taste buds. That is what we do as humans. Find food, stock pile it, and eat it over time. Food was typically few are far between. 

 

One question people will ask is --- How does my diet pertain to my healing?

 

The answer is this. Our body already does an amazing job at healing. We can't tell it to do a better job than it does. The ONLY thing we can control is the environment in which we provide nutrients for our body --- called eating. The cleaner we eat, the better our body (ANY HUMAN BODY NO MATTER WHO YOU ARE OR WHERE YOU ARE FROM) will function. The main function we are concerned with is the healing function. We WANT our tendon tissue to heal to the patella. We WANT there to be a complete and concrete bond  between tendon and bone. We WANT the muscle tissue to be able to rebuild. After all, our body has given us so much. When things start to fail in our body or break down, there is only one answer...OUR DIET is the key.

 

E.G. If you had a new engine installed in your car or truck, would you do your first oil change with used oil that had some metal and sand or debris in it? Of course not. If you did, the engine would not last as long as you would like. The same thing goes for our body.

 

The reason tendons break in the first place are really caused by two main reasons

 

1. Trauma

2. Poor Diet

 

There used to be a 3rd, but I eliminated it. The third one was pharmaceutical medications like statins. Etc. If you are on them, your diet could be better.

 

Doctors all over the world are finallly realizing most of our ailments, diseases and disorders are caused by diets. The Mayo Clinic even has thier own health book.

 

Anyway, hope this helps.

There are two types of ROM Exercises - Active and Passive

Active is when you do with your own muscles and passive is when someone else does it. I stress passive because that is a typical prescription given by a doc. Heel slides are techically active movements. The UW guide has us doing heel slides at phase 2 (2 weeks). Most of our ROM should be done by someone else BUT, and I stress BUT, can be done with the assistance of ourselves. A passive ROM could simply be hanging your leg off the bed with your brace locked at 30 degrees and you slowly letting is drop into the 30 or close to it positiion.

 

I should make a better chart for when to switch between passive and active ROM. The cautious approach is always passive though.

Gotcha, and according to my PT there is also AAROM (active assisted), like when she gave me a strap to help pull my leg back in the heel slide. I guess that would apply to any ROM exercise when you use some sort of outside apparatus. Wow, just came across this...what a total bummer. Go to Post #630

 

http://www.epicski.com/t/66016/quadriceps-tendon-rupture-repair-and-rehab/600#post_948618

Edited by Eric308 - 5/17/13 at 11:28am

That is exactly correct Eric. You have also become an expert in your field and a valuable player in this forum.

 

Here is some additional information about R.I.C.E.- First TWO Weeks are critical

 

1. R = REST - This goes without saying much. The first two weeks are mission critical in the playbook for QTR healing. The less you do, the better your outcome will be.

 

2. I = ICE - Getting a cold surface temperature to your skin of about 55 to 60 degrees is critical. You will want to do this 30 minutes on and 30 minutes off. Ice Compression Therapy has changed quite a bit and they've recently discovered combining the comrpession and icing at the same time reduces healing time tremendously.

 

3. C = Compression - Most of the time we can get the compression from the Ice Compression Therapy machines like and aircast, hyperice or others to acheieve this. When not icing, typically during sleeping, you should be compressing with something. I recommend the tubigrip compression sock. They are about 8 to 10 dollars when purchased. Your OS will typically carry them. They are better than ACE where they apply an even compression and more comfortable than the old Ted Hose.

 

4. E = Elevation - You must elevate above the knee and not at the knee. Your knee should be above your heart and your foot should be above your knee.

 

If you can make it past the first two weeks doing great therapy including your diet and sleep, you will be in good shape for the rest of your healing time.

A couple things to add about compression therapy. The old icing method is outdated. If Atheletes are using devices like Game Ready w/knee wrap, then we can at least use devices like a cryocuff by aircast or something along those lines.

 

How much did the Game Ready cost to rent? My doctor recommended it (ACL-R). I have some phone calls out and seeing if covered with insurance, but thought I'd post here.

I called Game Ready today and they told me it would be about $60/day. The units new cost about $2,660 plus the knee wrap of 380, plus a bag to carry it all @ $170 bring your grand total to $3,210 plus tax I guess. Most prescriptions are 14 to 24 days. Most people use them for right after surgery for 14 to 21 days then every time after PT. Renting could be costly but may be the only option for reimbursement.

 

They told me Ice Compression Therapy devices are typcially "Out of Network" their billing code goes under miscellaneous - durable medical equipment. Call your Insurance up and see what, if any they cover. There is NO better machine out there. The aircast does a good job, but is a different type of therapy compared to the Game Ready. Game Ready turns on and off, has a better cooling chamber, has a better means of applying the appropriate compression and has higher standards for delivering everything.

Hi guys, I am at 11 weeks and the past week has been awesome, my range of movement has increased tremendously.  I am allowed to walk with out brace but when ever doing something should put it back on.  I can go up and down, yes down steps.   I can not make a revolution on an exercise bike, just use for stretching.  Question is I can use an elliptical machine, should I?  Did for about a minute going very easy and I could feel knee becoming hot so I stop.  Any opinions, I will see PT on Thurs but if I can't do any harm would like to start getting back into shape,  thanks guys, Doug

 

NJ Pete, thanks so much for the information. I went back and forth between Aetna and Game Ready late in the afternoon. I'm coming close to my out-of-pocket maximum this year on insurance, but, unfortunately, since this is out-of-network I'd be starting on a whole new deductible. I was fortunate enough to have my mom's CryoCuff right after my initial injury. It's one of the automatic ones (not just the gravity feed model) and I hardly had any swelling. I know the Game Ready's compression is much better, but I'm just going to have to go with that one. Thanks again!

@doughaas.......im at 7 and a half weeks postop. i did eliptical for 15 minutes on level 1. i held on tight to railings in front and did not use arm motion bars. u should do fine on it. i also use that arm rotation machine as cardio. something is better than nothing. i tried to do bike today and no way i can do a revolution. i got up from military bench today and thought it was bolted down. it wasn't and leg jerked and it immediately hobbled me. im good now though. gots to b more careful!

NJ Pete - great info as always. Must get me one of those goniometers. I just achieved an instantaneous additional 15 degrees ROM as I was misinterpreting the way the hinge on the brace worked feel heaps better now knowing that I am comfortably at 30 degrees, and not stuck at 15 ! Tomorrow , I will open the brace and see if I can get to 45 degrees. Be stoked with that. Question... So at 3 weeks, is it ok to do start straight leg lifts ?

i have noticed that my patella is not smooth like my other one. noticed an indentation now in my middle of the patella? anyone feel the difference in the patella after qtr. and after i ice using the chyrocuff, my whole knee area looks wierd. and i remember doing leg lifts after 3 weeks, while lying in bed.

Hey Poli, the patella would probably look different to the other one early on due to the nature of the repair. Looking at my 9 year post RQT knee and I think it still looks slightly different to a "bought" one.... But you would have to really study it to tell the difference ( scar aside of course ). Not sure about the "roughness" you refer to though. I was reading some where recently that they rough up the patella as well as drill the holes when repairing. Wonder if it is this you are feeling

Hey poli: I am 19 weeks post, and the appearance fo my L knee is somewhat different as well.  And the dent you speak of, I have a ridge of sorts that I could characterize as a dent.  Its there on my other knee, but not nearly as pronounced.  My PT syas it normal, and will diminish.  She also says not to expect the appearance to be identical to the un-injured side, although in time the differences will be more subtle.

They do rough up the superior aspect of the patella with a burr, to make a healing bed for the tendon to re-attach.  Also, if the OS uses the Krakow repair technique, 3 drill holes are made from superior to inferior, to feed non-absorbale suture material through, to fasten the tendon back in place.  In my case, the OS then re-inforced the repair with more suturing of the tendon to the tissues overlying the patells, which explains the ridge "or bump" I feel on the patella, (absent on the un-injured side".

Hey DougHaas....great to hear you're doing better. About that exercise bike. I'm 12 weeks post and have been riding one for a few weeks with complete revolutions. Try moving the seat up a notch, a hole, a number or whatever. I started on an old Schwinn Aerodyne at my gym with 6 holes showing on the adjustment. First 100 revs were tough, but soon became stretched and pain free. The height of the seat effects the angle of the knee bend or ROM. The higher, the less bend. I'm at 5 holes now and I don't even feel initial pain anymore. They say you need about a 105 minimum to ride a bike. Hey, great job on those stairs. Also, my PT told me no elliptical at this point, fwiw. Cheers, Eric

@Scoobs....Great news. I was thinking something must be awry with your ROM readings. At first I thought it was just a Southern Hemisphere miscalculation. Kind of like your toilet deal down there. Re: leg lifts...my OS yelled at me at a check-up three weeks post. I gave him the old, "watch this, Doc", and he said I shouldn't be doing that until after six weeks. However, I was OK to do hip abductors and prone abductors. Basically just leg lifts on your side and belly. Just be sure to fire and lock that quad as tightly as possible for best results. Keep up the good work, dude.

@NJPete and others thanks for the advice. I wish I had been with it enough to get back on and read it. You were spot on. The first 6-8 hours after surgery seem to lull you into a false sense of security that its really not that bad must be some post op IV meds. Just now surfacing from the first 72 hours and it really is that bad.

The itching from the pain meds started in the middle of night 2 and it was brutal, followed the next day by the gastro effects of them. Now middle of the forth day I am off the meds and through the worst of it. The only lingering side effect is some weakness/numbness in my hands which seems to be improving. I'm icing regularly with iceman and doing ace wrap for compression. Swelling looks pretty well controlled, ready to get through the next week and two my first PO appointment. Really looking forward to starting rehab, can't stand the 'R' in RICE.

My biggest problem right now is sleeping, I'm a side sleeper and being on my back all night is killing me. Wake up early with lots of low back pain. I'm thinking of putting my foam/metal leg immobilizer back on at night that I got from the ED. I was able to pull off sleeping on my side with that, no hinges to get in the way. Any other tricks to sleeping with this brace?

Also had trouble sleeping with that thing. Are you talking like the hinges dig in to the side of your knee joint? I stuck some 2" foam padding between the hinge and the knee joint. Worked good. However, I don't see a problem with the ED immobilizer as long as it's straight and secure. I had no option like that. My OS told me I could take it off at night at week 6 post surgery. Also, I got used to sleeping with it on my side after awhile.

Hi all - Tom, I'm a side sleeper too but didn't have the issues you are having so I'm thinking it is the kind of brace you have. I was able to lie easily enough on my side the first night I got home - was very thankful for that actually! I did use a pillow for the first few nights but got tired of that and just resorted to finding the best spot I could. You'll be in the brace for a bit yet, but you will get used to it and to sleeping soundly with it. I think pretty much all of us have a problem with the 'R' of the RICE method!! But rest you must especially in the first couple of weeks. Getting a good strong repair is crucial to how things take in that initial post op period.

Great to hear you are doing well Doug! At 11 weeks you are ready to get cracking at strengthening exercises. Your knee's going to send all sorts of weird signals and get pretty sore, but your repair should be strong enough to handle what you can throw at it. I started my PT at week 12 and have been using the elliptical machine and bike for cardio the past 4 weeks. Bike seat is up a notch and I'm on a higher resitance level while the ellip machine has been great for really working the leg and building that strength. A hot knee could just be from some stimulation in the joint that has been passive for a while. As long as you think your repair remains firm, keep on going.

My gym work this week rocked! The lateral scar tissue has broken up a bit and I am kneeling again! I've upped resistance on the bike and with that and the leg extensions with 24lbs on the machine, the muscle is starting to come back to the quads. Walking on and off boxes (up and down) with ease now. Really focused on that extension when you step down and have released the tightness enough to be handling that without pain or concern now. Still leg pressing 120lb but that goes up tomorrow. Cardio is slowly coming too. Nice to get some deep breathing in the lungs again! Keep up the rehab!! Cheers

Tom5208- I decided to ditch wearing the articulated brace in bed and wear the padded rigid one I was given to start with instead- it was certainly much more comfortable, allowed me to get a reasonable nights sleep and didn't adversely affect my regaining normal ROM. Once I had regained more than about 110 degrees on the articulated one during the day I didn't bother wearing a brace at night.

Hey catinthehat...good advice and what I thought as well. Thought you might like to know I'm going to a local dance recital tomorrow and the theme is "Cat In The Hat". I'll be thinking of you.