This is an educational essay designed to help patients who are facing challenges with their knee rehabilitation at home or in an Outpatient PT setting. We want to acknowledge the valuable contributions of Jason Shepherd, BScPT, Injury Prevention Consultant to this article. To find the other articles on Knee Flexion, Knee Extension, Infection and Deep Vein Thrombosis click here: Threats to a Proper Knee Replacement Recovery.

Dr. Erik Dolton, PhD, has spent considerable time studying the condition known as Protective Muscle Guarding. He says, “when the brain senses bony instability or tissue damage in-and-around the knee joint, information is compiled and ‘fast-tracked’ to the brain where a determination is made as to the degree of threat and appropriate response the situation demands.”

Dr. Dalton continues, “Layering the area with protective muscle guarding is a common decision handed down by the cortex. A protective spasm is the brain’s reflex attempt to prevent further damage to injured tissues. By ‘splinting’ the area with a spasm, muscle ‘locking’ effectively reduces painful joint movements. The brain simply acts to protect the body: ‘When in question, lock the muscle.'” Helping patients avoid PT pain is a major concern of Physio Therapists for knee and other surgeries.

Today’s physical therapist will always be confronted with the mysteries of muscle guarding. And this condition must be dealt with quickly as continued guarding inhibits proper knee rehabilitation. A therapist cannot administer effective therapy if a patient’s protective muscle guarding stops the therapy dead in its tracks. And oftentimes, in addition to the brain’s instinctive reflexogenic response to incoming potentially painful movement, there is the natural reaction to consciously protect oneself from danger. Getting past muscle guarding can be the difference between success and failure (and some unpleasant consequences) for your rehabilitation. For more on guarding and “the pain cycle” see the graphic from Nova Active Rehab, and click here.

Notes from Cathedral Chiropractic

Muscle guarding is part of our wonderfully effective self protection mechanisms. However if left untreated it may stop being part of the solution and become part of the problem. As humans we have evolved very effective forms of protection both from injury and from further injury.

At its core, muscle guarding is an effort by the body to defend itself against a perceived threat (whether remembered, anticipated, or actually present). But when no threat is present and the muscle guarding persists, then the behavior has the opposite effect, promoting more problems than it aims to resolve.

Patient: Luis Ortiz, Paramus, New Jersey

Luis found that his response to the administration of physical therapy was to “resist with all his might” in order to “protect himself from pain.” His physical therapy post surgery had completely stalled. “We hit a wall and I became desperate,” said Luis. As much as he respected his physio team he was no longer making progress.

At nine weeks post surgery his condition had not changed and he engaged X10 Therapy to help him catch up on range of motion with the X10 Therapy Machine. His performance on X10 was immediately better than during PT Sessions.

Luis explains his recovery in the video presented below.

After completion of three weeks on the X10 Knee Machine (by week 12 post surgery), including three 30-minute sessions per day utilizing 7 lbs. of pressure modulation, Luis was able to achieve the following:

Luis began using the X10 Knee Therapy Machine in his home 3x per day, 30 minute duration for each session. His quest to avoid PT pain began in earnest. He found that because the X10 machine was under his control, he trusted that it would not hurt him. His brain (both subconscious and conscious) accepted this fact and he was able to relax during therapy. This allowed for real progress to begin again toward his range of motion goal of 130º. In three weeks Luis was able to gain 39º range of motion. He began walking as many as seven miles with less and less of a limp, at first using only one cane (vs. two previously) and then cane free.

The reactions at both Luis’ PT clinic and at his surgeon’s practice (Dr. Deepan Patel) were very positive. Luis was able to avoid a Manipulation Under Anesthesia as his range of motion exceeded the lower limits his surgeon set for MUA. Luis was able to overcome guarding, avoid PT pain, and get back on the path to recovery.

Through the use of the repetitive motion on the X10 Knee machine, motion that is controlled fully by the patient, Luis. was able to achieve relaxation “as control improved.” It was only after Luis “trusted” that the X10 Machine would follow his direction, never move past comfortable range of motion, only advance degree by degree as his leg became relaxed could avoid PT pain, that he began making significant gains. He overcame the guarding which led him to an ultimately successful rehabilitation.