After a meniscus tear, it's important to strengthen the quadriceps to reverse muscle atrophy, reduce the risk of another injury, and minimize the progression of osteoarthritis.

Why do the quadriceps get weak leading to impairments in knee function?

Disuse Atrophy

Meniscus tears are often treated surgically with a meniscus repair or partial meniscectomy. Meniscus repairs usually require more time to heal and your surgeon may give you weight-bearing precautions after surgery.

If you are non-weight bearing, then disuse atrophy of the quadriceps can set in very quickly. Atrophy occurs when there is a loss or thinning of muscle. This usually happens due to a lack of muscle stimulation. Basically, you don't use your quadriceps enough so they get weak.

Arthrogenic Inhibition

If you had a partial meniscectomy, you are usually able to weight bear right away after surgery which may minimize the impact of disuse atrophy; however, you may still be dealing with arthrogenic inhibition. This occurs when you lose the ability to voluntarily contract your quadriceps.

Compensations in your brain-muscle pathways result in the inability to fully contract the quadriceps following the injury. After your meniscus tear or surgery, you may still be fighting against this arthrogenic inhibition. If you have difficulty contracting your quadriceps after surgery, your Physical Therapy may use neuromuscular electrical stimulation to help recruit the motor units responsible for quadriceps contraction.

What can you do to activate and strengthen the quadriceps?

Regardless of whether you had a meniscus repair, meniscectomy, or opted to avoid surgery, studies recommend that you need to strengthen the quadriceps with progressive resistance exercises to reduce pain and improve knee function.

Initially, you should start with basic quadriceps activation exercises to increase motor unit recruitment of the quadriceps and restore your full range of motion. These exercises include short arc quads, long arc quads, quad sets, and straight leg raises. In the video above, I explain the short arc quads (supine knee extension) and long arc quads (sitting extension with a band).

Next, these exercises should be progressed using ankle weights or a resistance band. In a physical therapy clinical setting, we'll typically use 1-10 lb ankle weights until the desired range of motion and strength is achieved during the beginning to intermediate stages of recovery.

In a gym setting, you can perform seated resisted knee extensions. Adding resistance with seated knee extensions will also increase compression on the patellofemoral joint so make sure you give yourself 1-2 weeks to adapt to a new increase in resistance. If you have severe patellofemoral arthritis, seated knee extensions probably won't be the best exercise for you.

All the exercises mentioned so far are open chain exercises. Once you are clear for full weight bearing, you should begin closed chain strengthening like partial wall sits or partial squats. These exercises should be progressed slowly and you should constantly assess your response to them after completing them.

For example, after completing 3x30 second wall sits to 60 degrees of knee flexion, you should assess your knee symptoms on a scale of 0-10 (0=no pain, 10=worse pain imaginable). If your pain increased more than 2 points during the exercise or 1 hour to 24 hours after doing them, then you should limit your range of motion the next day or lower the reps and sets. If the exercise continues to increase pain levels by more than 2 points, then you should temporarily stop the exercise and choose another exercise that feels better until you are ready to try it again in 2-3 weeks.

It's very common for the knee to get aggravated when trying to progress the difficulty with quadriceps strength training. If pain levels increase, then complete gentle range of motion exercises like heel slides, long arc quads, or riding a bike for 1-2 days until the symptoms subside. If the knee gets aggravated then acute inflammation is usually involved. This acute inflammation should subside in 2-3 days.

Supplement for better recovery

Chronic inflammation is likely involved after surgery and attempting to promote a healthy inflammation response through diet and supplementation can help you.

Many of my clients have benefited from taking a high-dose curcumin extract like Active Atoms to promote a healthy inflammation response. Curcumin extract will help with both acute and chronic inflammation. It is shown to be as effective as Ibuprofen and Diclofenac for managing knee pain associated with osteoarthritis. There are many studies about the benefits of Curcumin Extract for knee pain including several systematic reviews.

So if you have excessive inflammation, use diet and exercise to reduce inflammation. NSAIDs may help in the short term, but curcumin extract is a better long-term solution. In addition, you'll get many other health benefits since inflammation is linked to most diseases.

Consider taking a high-dose curcumin extract like Active Atoms to promote a healthy inflammation response and support your meniscus tear recovery. Lately, I've been opening up the capsule and adding the turmeric extract to a mixture of two tablespoons of olive oil, one tablespoon of honey, and freshly squeezed lemon juice from half a lemon. This drink (or shot) is delicious and so healthy! Olive oil increases the absorption of turmeric and provides you with healthy fats. This is also one of my favorite cold remedies to boost my immune system.

For more information about the potential benefits/risk of Curcumin Extract for Meniscus Tears, watch this video:

References

1) Hunnicutt, J., Xerogeanes, J., Tsai, L., Sprague, P., Newsome, M., Slone, H. and Lyle, M., 2022. Terminal knee extension deficit and female sex predict poorer quadriceps strength following ACL reconstruction using all-soft tissue quadriceps tendon autografts.

2) Nuccio, S., Del Vecchio, A., Casolo, A., Labanca, L., Rocchi, J., Felici, F., Macaluso, A., Mariani, P., Falla, D., Farina, D. and Sbriccoli, P., 2022. Deficit in knee extension strength following anterior cruciate ligament reconstruction is explained by a reduced neural drive to the vasti muscles.

About Dr. Marc Robinson, PT, DPT, Cert. MDT