After any knee surgery, the quadricep muscle group becomes difficult to contract and recruit. These inhibition or impairment is usually secondary to both knee pain and knee swelling. Weakness in the quadriceps can lead to pain, impaired leg function, and prevent a full return to life or sport after knee surgery. Physical Therapists often utilize exercise and electrical stimulation to try to improve the ability the quadriceps to contract, but new research is highlighting the role of manual therapy in restoring quadricep function.
A recent case study of a patient status post ACL reconstruction surgery documented the improvement in quadriceps force production after three commonly used Physical Therapy interventions (Ruggirello et al. 2017). A 23 year old patient began post operative Physical Therapy 2 weeks after ACL surgery. Due to weakness in his quadriceps the Physical Therapist tested the patient's knee strength before and after providing 3 different interventions including knee mobilizations, lumbar manipulation, and electrical stimulation. Exercising alone without additional interventions increased force production the least. Conversely, knee mobilizations followed by lumbar manipulation and electrical stimulation had the greatest improvements in force recruitment. This study adds to the existing literature on the importance of manual therapy in order to improve pain, range of motion, and strength production.