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Author Topic: Quad shut down  (Read 2271 times)

Offline clkimbro

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Quad shut down
« on: November 13, 2007, 05:00:37 AM »
My quad shut down about a year ago and I have not been able to activate it.  My doctor at the time had me wearing a brace and I think that is what killed it.  I have been to PT and done all the exercises at home, but nothing seems to be working.  I felt it coming back about a month after my LR but it shut down again.  Iím still doing the leg raises, squats, and exercise bike.  Iíve also tried a muscle stimulator.  My current doctor wants me to start wearing a brace again when I know I will be doing a lot of walking because my kneecap is not tracking properly since my quad is not working.  It has been 4 months since the LR and I am still in significant pain.  What is the best way to get the quad working?  Do I just keep doing the exercises and hope it will come back to life someday?

Offline kathat

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Re: Quad shut down
« Reply #1 on: November 13, 2007, 05:25:18 AM »
Has your PT anything to say on the matter? I would suggest electrical stimulation in combo with exercise. Tanya would be the best one to answer this, as she has finally got her shut down muscle working again. It took a while though, so you'll need to learn patience!
Good luck,
Kathy

Offline tanyap

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Re: Quad shut down
« Reply #2 on: November 13, 2007, 10:24:41 AM »
Hi clkimbro and kathy,
Well what kathy says is true - my VMO shut down completely - for years by the looks of things. My lateral quads also shut down for a while - but they came back quite quickly with PT. But my VMO would not budge. Big hollow in my leg, no amount of straining on my behalf would get it to contract. After a year and a half of PT I went back to OS and he said that he wanted to send me to new PT and start me on an electricalmuscle stimulator machine. He couldnt find a VMO at all. 2 months later I was back with him and this time I had a pea sized VMO that he was only able to find after loads of grunting and straining and trying my hardest to contract. This time he told me he had been concerned that the muscle was paralysed but now that I had a pea sized muscle he was satisfied it wasnt and that it was gonna take a LOT of hard work to bring it back. I was dubious that a muscle could be brought back from the dead like that - here is what he told me:

The brain shuts muscles down if there is trauma or pain. Its muscle inhibition to prevent further injury. In my case many dislocations had repeatedly shut down my VMO. Then the brain does muscle guarding, so even if its switched on the brain gets you to compensate and not use it. These two combined had resulted in total atrophy of my VMO. Most of the nerve fibres had atrophied away so I couldnt send it messages to contract. So - he said that e-stim was needed to help rebuild the neuromuscular pathways - I physically couldnt produce enough of a contraction in the muscle to do this, so the e-stim would force a contraction, the muscle would then send signals back to my brain saying 'this muscle is contracting', my brain would realise there was a muscle there, and it would send down messages saying 'better rebuild nerve fibres to get these messages through'. As well as e-stim (which really doesnt seem to build muscle but it helps with muscle-brain connections), I had a new PT program that concentrated on working VMO out. According to my OS a magical day would come where the amount of nerve fibres in the muscles would reach critical mass and Id wake up one day with a working muscle - he really made it sound like a miracle!!

For the first 3.5 months I was just going through the motions - very frustrating. I was e-stimming twice a day for 20 mins a time and doing 20 mins of exercises 3 times a day and there was still a big hollow and I still couldnt manually contract my VMO. Then one day the magic happened. I woke up one morning and I kept getting a weird sensation in my VMO - like an electric shock, just sudden sharp bursts of pain every few minutes. That went on for half a day. And from that moment onwards Ive been able to contract my VMO - and its visible and I can FEEL it. Its still small and weak as hell compared to the other side but its definitely awake. Im now awaiting the magic day when its firing automatically - actually it may already be doing that but cos its so weak I cant notice it yet (I only had the wake up around beginning of October).

It takes a long time to get muscles firing again if theyve been shut down for a while - thats how it happened with me.
If you want more info on the e-stim I used here is the website I bought it from:

www.kneehab.ie

And my PT exercises were specifically based at getting the VMO working, turning my foot out by 10 degress for SLRs and squats and lunges etc...
Now Ive got a leg that technically all the muscles fire on - but its weak!!! So theres a lot of work to do.

My OS said it would take me 6 months to a year to rehab this leg. That was mid-August. So Ive a long way to go yet.

Hope that helps.
Tanya

1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline ATsoccergirl

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Re: Quad shut down
« Reply #3 on: November 13, 2007, 11:15:59 PM »
I prefer a more funcational approach with my patients. 

First off all, it's physiologically impossible to isolate the VMO as it is nothing more than a small section of the vastus medialis which runs obliquely when compared to the other muscle fibers.  The VMO has the same innervation as the other sections of the quad so a contraction cannot be carried out independantly. 

I have had a lot of sucess combining functional movements with biofeedback.  A functional movement is one in that the mucles are working together in a closed chain situation such as squats, lunges, step ups, etc.  Biofeedback picks up the electrical signals within the mucles and converts it into a visual display or a sound.  This then add objectivity to the exercises and gives the patient feedback on the amount that the muscle is contracting.  It also helps to work not only the injured side, but the healthy side as well. There is a neuromuscluar connection between the two limbs, and the body seeks to maintain balance between the two sides.  For example, if one side is immobilized, the other side can become weaker.  This can work to your advantage, by working the healthy side, you are encourage the injured side to improve.

I'm not a fan of electrical stimulation, as an electrically stimulated contraction is not as good as a naturally produced one and the results don't always translate into better functioning.
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline clkimbro

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Re: Quad shut down
« Reply #4 on: November 14, 2007, 03:35:20 AM »
I appreciate the feedback.  I guess I will stay focused and keep doing the exercises.  I really had no idea it could take this long to get the muscle working.

I went to PT for two months.  The first month I had great improvement but in the second month things started going back to how it was.  I used up all of my PT visits insurance would pay for this year.  I plan on going back next year.

My doctor had me using the e-stim twice a day for 30min.   It made me restless and I was having a hard time focusing on contracting the muscle while the machine was going.  After 10 min I was just ready to rip it off.

Offline tanyap

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Re: Quad shut down
« Reply #5 on: November 14, 2007, 09:55:13 AM »
what atsoccergirl says is true - just to clarify, my VMO had shut down completely but the exercises I am doing now are not meant to isolate the VMO as that is impossible. However, my body always tries to not engage the VMO - only the lateral quads so my PT has carefully adjusted my technique on my exercises to ensure that I have to engage my VMO (along with the rest of the quad set) in order to perform them. Of course visible atrophy of the VMO indicates atrophy of the entire quad set even if it is less visible on the lateral quads.

When I first began with the e-stim I would perform partial leg raises or SLRs each time I felt the electric pulse - so that my brain got trained to make contractions and the electrical impulse simply produced a stronger contraction than I could make myself.

Theres seems to be a divide between whether or not people are a fan of e-stim. Im at a loss as to whether or not I think its useful. I have only really started having any improvement since I started using it - but that was at the same time I started on a new PT program - so who knows which kick started me? Considering the talk my OS gave me Im inclined to think it must have benefits. But perhaps it was the fact that I couldnt produce a contraction in my VMO at all that it was good for me? Im on the fence on it right now - but tending more in the direction of thinking its a good idea.

Atsoccergirl - thanks for the tip about working the healthy side to encourage the bad side to improve - I have noticed when I do my isokinetic tests each month that my good side is improving right along with my bad side - I want to close the gap between them but the good just keeps improving regardless, I hadnt thought about it in that light before you mentioned that.

Im doing all the closed chain exercises you mention - I liek the idea of biofeedback - is there such a thing as personal biofeedback machines or are they only something you see in hospitals or PT practices?




1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline ATsoccergirl

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Re: Quad shut down
« Reply #6 on: November 18, 2007, 06:36:06 PM »
Ask your PT about trying biofeedback there first, and then if you feel it may be helpful your OS should be able to direct you in getting one.  With a presciption from your OS, it should be covered by your insurance to get your own machine.  The machines are small, the ones I use are no bigger than a typically TENS unit. 
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline tanyap

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Re: Quad shut down
« Reply #7 on: November 19, 2007, 09:22:41 AM »
Thanks - Ill do that, am seeing my PT again 3rd of December (I only see her every 6 weeks now for isokinetic testing and in between just work my exercise program myself), so Ill ask her about it.
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Sore knee

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Re: Quad shut down
« Reply #8 on: November 21, 2007, 10:44:05 AM »
Wow loads of good info here. If I can jump in but with more Qs as I am in the same boat asclkimbro as Tanya knows. I had a LR in May and I have never recovered, I had continued swelling and catching / slipping so they operated again in Aug and smoothed down some rough areas on the patella.

We thought that would be the end of it but 3 weeks later the swelling and pain returned. They used biofeedback and it showed that although you could see some muscle movement on contraction of quads the tracing was minimal. They even wondered if the machine was working, so they done it on the other leg and on contraction the tracing shot away up, I had to hold the contraction then let it go and the tracing came doen again. Thus the machine was working - so they said the quads are inhibited. They then put me in a knee brace in the theory if they give the muscles a rest eventually we may be able to kick start them again once inflammation reduces. I just don't know how you know if that has happened as there is still painat night when I take it off and swelling. Interesting to hear all the viewpoints here.
11/5/07 LR right knee and cartilage tidied up
6/8/07 Knee aspiration, steroid injection- more physio
22/8/07 Knee to be scoped for answers
16/5/08 Patella stabilisation for† subluxations
24/6/08 Infection -hospitalised for a week. Debridement surgery
21/11/08 Repeat patella stabilisation performed

Offline mybodyis90mindis5

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Re: Quad shut down
« Reply #9 on: November 21, 2007, 03:52:14 PM »
I had this after my LR.  I had to use the e-stim too, and I did the leg raises like Tanya to get my brain to think about contracting the muscle.  I'm almost a year out, and I still have a really skinny leg, and a normal leg.  But I walk, I hurt, and I have a little tiny muscle.  Disclaimer though, even though I used the e-stim, I HATED EVERY SINGLE SECOND OF IT.  When I started getting feeling in it, it was the most uncomfortable feeling ever.  It takes a long time.  Be patient (even though I'm not) because walking is worth it!  And whenever you feel like the OS isn't doing a good job or fielding your questions or ignoring you, get a second opinion!  Its your body, and you have the rights!