Client w/out Rectus Femoris

[Aziz Shobash]

Hi everyone.
just had a quick ? for you.

I have a client who had his rectus femoris removed about 7 yrs ago (cancer). he has a lot of low back, hip and leg pain and he also lost most feeling in his whole right leg.

last time he came in i tried a very light stretch on him (when he was prone i brought his leg up to a 90 degree angle) and he got a cramp in his thigh. he has pt exercises and says he's going to start them again.

has anyone else had a similar situation or any suggestions?
he says he is feeling a difference and he's really excited about it so i want to make sure that i can bring a few new ideas to the table.

thanks in advance

 

[Jesus U]

First off ... wow! I have never thought about someone having to have a muscle completely removed. I'm going to have to sit with that for a while.

I want to make sure I read your post correctly ...
With the client prone, you raised the leg to flex the knee 90 degrees, and he got a cramp in his thigh. Where was the cramp? Quads? Hams? I am assuming Quads ... but I don't like to assume.

Regarding the low back pain and loss of feeling in his right leg, I am curious about the psoas. If he had his rectus femoris removed I can only imagine how much his psoas needs to compensate for hip flexion. And if psoas is tight and pulling his lumbar anteriorly, there may be some nerve involvement giving the loss of sensation. I'd also want to check that TFL and sartorius are well balanced as they both cross the hip joint.


Brian

 

[Dorf1701]

he started to cramp in his quads when his knee was in a 90 degree angle.

sorry it took me so long to respond i haven't been on for awhile.
thanks for the idea's on the psoas and tfl he's coming in tomorrow so i'll see if that helps.

have a great day.

 

[AffessyAdjurf]

Ask your client if he had lymph nodes removed/biopsied/radiated in his groin (my guess is that they were). If so, he may have lymphedema, so suggest that he see his MD immediately! No more massage until lymphedema is ruled out.

If lymph nodes were removed, you as a therapist need to (always and forever) avoid working on that quadrant (entire leg up to waist and midline). Only someone trained in lymphedema protocol and/or manual lymphatic drainage is able to work on this area without causing harm.

If lymph nodes were not removed, and his MD clears him of other pathological issues (such as maybe nerve damage?), I suggest that you proceed gently, as people who have had cancer tend to be super sensitive, no matter how long ago the cancer Dx/Tx was, and it is best to NOT stimulate the sympathetic response in them, especially at or near the cancer site.

Any questions, feel free to email me -
[email protected]

 

[Grandma]

numbness

Cy's comment about lypmhedema is relevant, and you do need to check the history on that. If that possibility is cleared by his history, you're going to need to check the adductors and sartorius to see if there are adhesions bindings or restrictions on the femoral nerve. Also check piriformis and the other deep lateral rotators for sciatic impingement.

Psoas needs to be addressed, but I'm betting that quadratus lumborum is doing much more than its share by lifting the hip high enough to give extra time for the leg to swing through and forward. The best way to work on it is sidelying.