Richard Haynes PTA/CPT - 4/4/2009

Question
I had a total knee replacement the first of Feb and have since had 2 manipulations.  One of my main problems throughout this ordeal is my left Quad's muscle is extremely tight and has been since the surgery. The PT's can't seem to get it to relax.  They massage it everytime and it will loosen up a little but immediately after the session it will tighten up again.  It is very painful and it even bruise's fairly easily.  The doctor tells
me just to work on it to work out the soreness.  At this time I feel there is something else that is causing the Quad's muslce not to relax. Can you give me an amswer on my problem. Thank You for any advice.

Answer
Hi Randy,

You may developed adhesions in the quadriceps in other words scar tissue formation developed.

It sounds as if from my experience that the PTs are attacking the problem as they should. Massage and heat are generally what is given prior to stretching the quadriceps which will in turn promote more knee flexion.

When you say the muscle will not relax I am assuming that it is tight and that you are unable to get functional range of motion from the knee.
Some of this can also be caused by the length of time you went from the knee first giving you signs of pain etc... to the time you had it replaced.

The longer someone goes from a period of pain swelling etc.. to the time its replaced will show in their ability in rehab, range of motion and quadricep mobility.

Unless the surgeon suspected some type of neurological problem as if the quads were in a constant state of contraction, I would, then only suspect adhesions in which the only way really to get them worked out is to heat the quads daily then start an aggressive stretching program.

I suspect that in PT you have been on a stationary bike as well. This piece of equipment is one of the best devices to use after a knee replacement to loosen the quadriceps and promote mobility.


Your situation will take some time to resolve but, if you stay persistant with it and relax the muscle when its being stretched you should see results.

Sincerely
Richard Haynes
Punta Gorda, Florida. 33950