BIOFEEDBACK
Background A 12-year-old female subluxed her left patella while jumping rope at school. There was immediate pain and a localized effusion which resolved with the use of an immobilizer, intermittent ice packs, and rest over a 7-day period. Her pediatrician requested the initiation of quadriceps rehabilitation 2 weeks later after the patient reported no pain and minimal swelling but with a residual stiffness and sensation of weakness in the knee joint. The physical examination was unremarkable except for limited ROM of 10–110 degrees and the inability of the patient to successfully initiate and sustain an isometric contraction of her quadriceps musculature.
Impression Quadriceps inhibition secondary to injury and immobilization.
Treatment Plan In addition to the initiation of therapeutic exercise—static stretching and active-assistive ROM exercise for the knee joint—biofeedback was initiated for the quadriceps mechanism. Using the vastus medialis muscle as the target muscle, the skin was cleansed and electrodes placed in alignment with the fibers of the muscle. A microvolt threshold of detection slightly above the patient’s ability to maximize auditory and visual feedback was chosen. The patient was encouraged to perform isometric quadriceps setting exercises of 6–10 seconds duration attempting to “max out” feedback for the chosen threshold level. The threshold was advanced and the process repeated.
Response Over the course of the initial rehabilitation session, the patient advanced several threshold levels and “reacquired” the ability to initiate and sustain an isometric quadriceps muscle contraction comparable to her uninvolved extremity. She was rapidly transitioned to limited-range dynamic exercise and a functional closed-chain exercise sequence with emphasis on terminal range knee stability. She returned to unrestricted playground activities several weeks later.
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