I have a post op knee patient (distal realignment, MPFL reconstructions) who was diagnosed with a posterior tibial vein DVT and has now been on Lovenox for 3 days. She is early post op and so one of our main goals is getting quad activation. I was always taught no estim on these patients with an active DVT. However, I am wondering when folks would consider the use of NMES safe in this situation. I.E. at what point would the clot be stable enough to apply NMES to the quads fairly near the clot site.
I usually consult the below reference b/c I think it is pretty complete. They list it as a contraindication but obviously there has to be a point that one could use the modality I'm just not sure what that point in time is.
Physiotherapy Canad ELECTROPHYSICAL AGENTS Contraindications and Precautions: An Evidence-Based Approach to Clinical Decision Making in Physical Therapy CANADA VOLUME 62 NUMBER 5 SPECIAL ISSUE 2010 ISSN-0300-0508 E-ISSN-1708-8313
Thanks in advance for the input
< Message edited by KBrownPT -- January 26, 2017 12:58:40 PM >
It's really not a good idea if it's contraindicated to use the NMES electrical stimulation for Quad strengthening. There are so many better ways to gain Quad strength, like doing Quad Sets, SAQ's, LAQ's, Straight Leg Raises, Straight Leg Raises with Hip External Rotation, and Quadriceps Isometrics. And those are just Supine and Sitting Therex. Progressing the patient to standing Therex like Wallsquats, Lunges, Deadlifts, and TKE's will completely eliminate the need to do any NMES Electical Stimulation. So, in summary, I would always err on the side of patient safety. And by the time you get the clearance from the Dr., there really won't be any need for it anyway.
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