Quad Responsiveness. Clinic Hack.

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.

A pitfall of patient-centered communication

I’ve come back from physician visits without a clear idea of what my physician thinks. I think I’ve found a problem, and I believe it’s communication. 

The push to be patient-centered and take all patient preferences in to account has morphed in to a wishy-washy communication style which boils down to the clinician saying “Well, whatever works for you. What do you want to do?” This, in turn leads to conversations at home with spouses and friends of “I don’t know, I wanted my doctor’s professional opinion and they told me I could do what I want. They gave me options but not direction”

The Three Question Test for Exercise Implementation

3 question test

One of the first tasks given to students on clinical rotation is to come up with an exercise flowsheet, or plan, for a patient they have just evaluated. This seems pretty standard in the outpatient orthopedic setting for students.

This task is often hard enough for many students. They work through it and I question their decisions and ask why they picked a certain movement. It’s harder than it sounds to predict how things will go and what they should work on. I always let them work on this independently at first, then we discuss their thought processes.

I’ve started using a Three Question Test for each item on the flowsheet. I’m not sure this originated with me, as I have been mentored by many and have picked up ideas from lots of smart folks. But here is the current question sequence:

Recent Videos on Pain and the Brain

I’ve have a handful of “Go-To” videos I share with people when I want to get them up to speed on pain science topics. Recently there have been a few more videos surfacing, and I wanted to place them here in a post for you, in-case you want some updated material, or new concepts.