The SPECIALIST'S OFFICE => Bone breaks around the knee => Topic started by: mjeffrey on November 04, 2015, 08:58:27 PM

Title: Ideas/Tips for getting back ROM and Quads
Post by: mjeffrey on November 04, 2015, 08:58:27 PM
Hi Everyone.

Thought I'd start a thread with ideas/links for working on ROM. Seems to be an issue for most of us and maybe putting them all together would help people. The more ideas the better, I'm sure there is no definitive answer, what works for one person may not work for another.

Here's my list:

Sag Exercise with weight
This was my favourite and its easy to do while resting in front of TV. You'll need weights of some sort to attach to your ankle. Lie on your back and put your thigh in the air, a bit like this: ( Place the weight on the ankle and let it slowly sag under the weight. Let it stretch for a while, rest and restart. Start light and gradually increase the weight (or move it closer to the ankle for more leverage). I used a divers weight belt for this but ankle weight or other things would work as well.
I liked it because it was gentle and the force was consistent (the PT was sometimes too hard and I think the expectation of pain caused the muscles to resist). Progress was easy to monitor as well. Another option is lying wall slides (

CPM machine
While not normally something to help your ROM, I used it like this to good effect after my MUA.
details here. ( You'll need to rent one, they are pretty expensive to buy.

Stationary bike
Once you are more advanced and can make a full revolution, a stationary bike (you'll need around 100 degrees) is a really good investment (I rented one). Put the seat up to the highest setting (add a cushion if necessary) and gradually reduce it over the weeks.

Heel slides
See here ( Many people recommend these but I didn't find them useful.

Patella Mobilisations
I did these as well. They are meant to help break down adhesions. I don't know if they work but Dr Frank Noyes recommends them and that was good enough for me: ( (

please add with you own experiences, recommendations.

Title: Re: Ideas/Tips for getting back ROM
Post by: Madyakker on November 16, 2015, 07:04:37 PM
Yep I would agree with all of those and the sag exercise is particularly helpful if you are struggling with extension.
Title: Re: Ideas/Tips for getting back ROM
Post by: morgana on December 26, 2015, 03:33:03 AM
Mark - once again, great topic for a Sticky Thread!

My favorite was sitting in a chair, ankles crossed (good over bad) and gently pulling the bad ankle towards the chair.
Title: Re: Ideas/Tips for getting back ROM
Post by: Madyakker on January 25, 2016, 10:26:05 PM
Hi, I found ROM exercises in warm water helpful. I think the warm water helped my muscles relax and stop them trying to subconsciously protect my knee all of the time.
Hope this helps.
Title: Re: Ideas/Tips for getting back ROM
Post by: beefrank on March 08, 2016, 06:28:47 AM
I agree with morgana that the topic should be given more exposure, especially for those just starting their long road to recovery. Perhaps the title of this thread could also be expanded to “Ideas/Tips for getting back ROM and quads”.
There is a close relationship between quads and ROM. Loss of quad muscle mass is a condition nearly all fellow sufferers experience as a result of the muscles’ enforced inactivity. Muscle loss not only manifests as shrinking quads, but also shortening of muscle fibres, which affects ROM. The latter is exacerbated by having the knee immobilised in extension to protect the repairing patella, but in this position the quad muscle fibres are held in a shortened state.

An article at summarises a paper that observed that strength loss arising from muscle loss can occur faster than muscle mass loss, and also provides an explanation of how an associated process results in muscles “forgetting” how to function correctly. This is a condition many fellow sufferers experience.

I knew about loss of muscle mass and strength in relatively inactive people because of injury or occupation (the problem is well known in astronauts) but only recently came across figures that quantified this loss at 1 – 3% per day. Apparently loss of muscle mass can commence after just four hours of inactivity, and some people can lose almost all muscle mass in about a month! Ageing is another cause of loss of muscle mass, and the seniors amongst us will confirm that this loss is accompanied by a shrinkage in muscle length (try touching your toes in the way you used to in your more youthful days).
Most OS appear to advise to aim for about 15 degrees increase in ROM per week, with the aim of achieving 90 degrees at six weeks. From personal experience, increasing ROM was limited by patella pain and swelling felt behind the knee, but I did achieve the OS’s target at six weeks. Even now, ROM in the affected leg is about five degrees less than the good leg and  still appears to be restricted by swelling felt around the knee and not quads being stretched.

At six weeks, my priority turned to arresting the loss of, and improving, quad muscle condition, and ROM progress was generally only monitored. Addressing quad condition I found to be far more difficult than achieving good ROM, and I still do. The reported 1 - 3%  per day loss rate is unfortunately not reversed at the same rate with exercise, even with intense exercise. The road to recovery is slow. Furthermore, fellow sufferers have to contend with knee pain (in my case I now know was caused mainly by hardware in the patella), which places an upper limit on exercises that can be tolerated, and with muscles that have partially or completely “forgotten” how to function correctly. In one study (( functional performance in the affected legs of subjects had not returned to normal after several years.

I tried a TENS machine in the early days to stimulate the quads, but did not get on well with it. Sparking between the electrodes and skin was often painful, but this was probably because I paid insufficient attention to ensuring a good connection. If I’d have known then what I know now, I would have persisted with the machine as a way of exercising the quads in order to prevent muscle atrophy. The TENS machine recommended by Mark is possibly the most effective way of arresting the early, very rapid loss of quad condition, and perhaps should be promoted more by OS as a method for retaining quad mass and helping loss of ROM.

This brings me to the final point. Stresses applied to the patella during PT (, for example while doing ROM exercises) speed up and strengthen the repair process, such that hardware holding the patella together can probably be removed six months earlier than if not doing PT. Medical studies though have shown that injuries affecting one half of the body can increase reliance on the limb on the opposite side. This preferential favouring of the unaffected side can bring about compensating physiological changes, including habits, that sub-consciously or instinctively interfere with the recovery process of the affected side. In my case, over three months post hardware removal and elimination of all knee pains, I still unthinkingly favour my good leg, for example when lifting heavy objects or climbing or descending stairs. This clearly means that the unaffected leg is being exercised more.

I’m working at kicking these habits, but the earlier learned response to pain when stressing the knee has become instinctive and is proving hard to kick.
Title: Re: Ideas/Tips for getting back ROM and Quads
Post by: mjeffrey on October 28, 2016, 06:14:54 PM
Title: Re: Ideas/Tips for getting back ROM and Quads
Post by: charlottekatt on October 30, 2016, 02:30:23 AM
2 years out (yes, I'm still hanging out reading)....What probably helped me with ROM the most was sitting on the floor (tile floor) and doing assisted (more like forced... towel wrapped around ankle) heel slides with my daily goal to move the line 1 inch.  Yes, it hurt like you know what... yes, there were days the line didn't move.   But it was progress I could see. 

Second thing that helped was borrowing a bicycle training stand so I could pedal at home.  Getting on/off the bike was a bit harrowing (involved a milk crate)...not something I would have told my doc or my PT about. the time since, everything's pretty well back to normal.  Hardware is still in place and isn't causing any problems.  Can do stuff like climb ladders properly... get up from couches without using hands, run up stairs if I have to.