Getting the quadriceps functioning again after surgery is a serious task. Effusion and pain inhibition “shut down” the quad and atrophy can set in very quickly.
You will be loading the quad, both in open and closed chain and I must recommend that you spend time under tension to stress the muscle tissue and develop strength. Progressive overload, with respect to tissue healing timelines, is paramount.
Once a base level of strength is developed, and the patient can clearly generate force, the next thing to progress is speed, or quad responsiveness. I hesitate to call it “Rate of Force Development” because I’m not taking any force curve data with this method, but it does work speed and reaction time and the nice triphasic neuromotor pattern needed to start and stop a motion.
Adding speed is appropriate during “Phase 4” rehab in this criteria based ACLr protocol from Hospital for Special Surgery (great resource).
Let’s use the banded LAQ as an example. Here I’m using a Stretch Band (which are an epic way to challenge patients above a typical theraband) in a protected range in this post ACLr patient.
Video 1: Slow, controlled, time under tension, limited ROM.
Video 2: Quick movement, responsive, start-stop control (triphasic action).
Note: *in the video I hold my hand out so that YOU can see my fingers. In the clinic, keep it behind your back to the patient must react to the sound only.*
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Many patients have difficulty with this right away, but they learn how to make this quick, hard, fast motion within a number of reps and it feels real good to get this reaction time back up towards prior level.
Short n sweet.