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A loss of Knee Extension or Hyperextension is commonly seen following an injury occurring to the multiple ligamentous structures keeping the Knee calm and stable. If, after surgery, there is still a significant loss of motion, and it is becoming clear that recovery is slow and/ or not progressing in a normal manner, it needs to be acknowledged that this can cause serious long-term effects which can only get worse as time moves forward (this is seen as one of the leading causes of Knee Osteoarthritis following ACL Ruptures).
One study by Delaloye et al (referenced below if you would like to read the full piece) describes a process of 3 stages. The first is to identify and observe any inactivation of the Quadriceps muscle. This is typically seen when the Rectus Femoris clearly contracts, whilst the Vastus Medialis does not, and again, if you would like to see an example of this, follow the first link below for pictures.
Once this is identified, the patient can be placed into a prone position (on their front) before asking them to actively and repeatedly Knee Flex up into the clinician’s hands. The repetitiveness and resistance of this exercise will fatigue the Hamstring muscles, and when asked to completely relax down into the bed, the Knee joint should (in theory) have extended further than previously seen. It should be noted that throughout this exercise, the leg should never be forced down into the bed, but rather gently supported, as to not cause any more unnecessary damage.
Once the improvement in Knee Extension has been identified, it is time to ‘re-activate’ the Quadriceps muscles properly without hindering any progress made. To do this, the patient can sit upright again with a roller underneath the impacted Knee, they can then be asked to actively contract the Quadriceps, bringing their heal up and off of the bed. As the knee progresses, the roller can be reduced in height until they are able to successfully contract their Quadriceps whilst relaxing down into a healthy rate of Knee Extension/ Hyperextension.
Alternative methods (as cited by Mike Reinold) are self-stretches and “low-load long-duration stretches”. Both methods are self-explanatory! The self-stretches consist of everyday hamstring stretches which you can do with a roller and your own body weight, simply extend your knee along the floor (so the back of your Knee is against the floor) and place your ankle/foot on top of the roller, from here you can very gently apply pressure just above your Knee to straighten the joint a little bit further.
The second method proposed requires even less work. Positioning the patient in the same position (with their foot still propped up on the roller), find a light piece of equipment which can be balanced, again, just above the Patella, and lay them back. The “Low-load long-duration” stretch should produce significant results from the first session, and it only needs to be held for at least 10minutes!
If you need help with restoring a loss of Knee function or ROM (Range of Motion), please do not hesitate to get in touch!
Dominic
Dominic.sportstherapist@gmail.com
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