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Letters to the Editor to:

Scientific Articles:
Ryan L. Mizner, Stephanie C. Petterson, Jennifer E. Stevens, Krista Vandenborne, and Lynn Snyder-Mackler
Early Quadriceps Strength Loss After Total Knee Arthroplasty. The Contributions of Muscle Atrophy and Failure of Voluntary Muscle Activation
J Bone Joint Surg Am 2005; 87: 1047-1053 [Abstract] [Full text] [PDF]
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[Read Letter to the Editor] Activating the Quadriceps after Total Knee Replacement
Jerrold Gorski   (24 May 2005)

Activating the Quadriceps after Total Knee Replacement 24 May 2005
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Jerrold Gorski,
Physician
Winthrop University Hospital

Send letter to journal:
Re: Activating the Quadriceps after Total Knee Replacement

JgorskiMD{at}hotmail.com Jerrold Gorski

To the Editor:

I read “Early Quadriceps Strength Loss After Total Knee Arthroplasty”, (JBJS,87A,1047-1053), hoping to find relevent clinical application. Identifying failure of voluntary muscle activation, the authors may have inadvertently provided a scientific rationale for an empirically effective post op technique that my patients describe as cruel, albeit while laughing.

It is my routine to tickle the ipsilateral foot post op TKR, usually eliciting a robust quadriceps contraction, some pain and usually a laugh. If done artfully, patients accept this treatment, as it literally “jumpstarts” recovery of the quadriceps. It works well but only in those who are ticklish. Many family members eagerly take part with this treatment. Patients are motivated to avoid the tickle technique by doing the quad contraction on their own, and moving the leg to avoid the noxious irritant. Counterintuitively, pain avoidance and “very rapid mobilization” can be beneficially combined to improve voluntary and involuntary quadriceps muscle activation.

Might I suggest study of this technique as a clinical application suitable for the authors continuing research?

Respectfully, Jerrold Gorski MD