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Quadriceps Tendonitis

With the knee being involved in every weight-bearing movement we make, quadriceps tendonitis can often take over people’s lives. In this article, we outline what the condition is, and the fastest way to heal it.

What is Quadriceps tendonitis?

The quadriceps tendon is the larger tendon just above the kneecap. It is a soft tissue structure, a common tendon connecting the four muscles in front of the thigh: The quadriceps Femoris, the vast medialis, vastus lateralis, and vastus intermedias. The quadriceps tendon attaches to the top of the kneecap (patella) which then attaches to the shin bone via the patellar tendon. This whole complex is called the quadriceps mechanism which helps perform an extension of the knee. It also helps you walk, jump, and climb stairs by straightening your knee. So, when a tendon becomes inflamed, it is classed as quadriceps tendonitis or quadriceps tendinopathy. Quadriceps tendonitis is also spelled as quadriceps tendinitis.

Quadriceps tendonitis is different from Patellar tendonitis(patellar tendinopathy). Patellar tendonitis is an inflammation of the patellar tendon that connects the kneecap (patella) to the shinbone (tibia).

Symptoms of quadriceps tendonitis

Quadriceps tendinitis or Quadriceps tendinopathy can cause pain in the front of the patella and at the bottom of the thigh.  Typically, the pain is dull and progressively worsens with time.

Sitting for too long, jumping, jogging or squatting may exacerbate the knee pain.

In some individuals, pain may subside during movement and return when movement ceases.

Other symptoms of quadriceps tendonitis include

  • Knee pain during and after exercise which is located just above the kneecap.
  • Tenderness when you touch the top edge of the knee cap.
  • Burning sensation in the area.
  • Stiffness the next day after exercise.
  • Knee pain standing up from a squat position.

Causes of quadriceps tendinopathy

Tendons often become inflamed as a result they have to over-work or absorb too much shock from weight-bearing activities.

Overuse injury

The most common causes of overuse injuries are repetitive activities such as running and squatting. They can put a lot of repetitive stress through the knee joints and can cause a number of different overuse injuries, including quadriceps tendinopathy. When these quadriceps muscles start to tire, the tendon has to work harder which can cause symptoms of swelling or inflammation. Typically, your body attempts to repair these tiny tears. However, if you continue to repeat the same movement, more tears will form.

Alignment problems

If your joints or bones are misaligned, one leg will be exposed to increased strain, causing quadriceps tendinitis. For example, misalignment of the pelvis can cause a leg length difference which results in more bodyweight being distributed on one leg more than the other. With the average individual performing 6000-10,000 steps a day, many of the structures in the leg bearing weight can become inflamed, including the quadriceps tendon. Additionally, muscular imbalances can lead to quadriceps tendinitis.

Direct blow

A direct blow from a fall or a sports injury can cause the tendon to become inflamed.

Muscle weakness

If the quadriceps muscles are weak, then they aren’t able to absorb shock very well. Some of this shock then gets transferred into the tendon which can lead to injury or small tears over time. Also, if the hamstring muscles are weak then it causes muscular imbalances and overuse of the quadriceps.

Quadriceps tendonitis Risk factors

  • Previous injuries such as quadriceps muscle tears or jumper’s knee.
  • A lack of stretching of the large muscles of the leg before and after physical activity.
  • Muscle imbalances or weakness. The most common imbalance is caused by weakness of the vastus medialis muscle.

Other factors that contribute to your increased risk of having quadriceps tendinitis include

Age. The tendons lose their flexibility and become more susceptible to inflammation as we age.

Weight. Extra weight places additional stress on the tendons.

Tense muscles: Tight quads and increases pressure on your tendons.

Chronic illness: some disorders, such as diabetes and lupus, diminish the knee’s blood flow. This increases the risk of tendinitis by weakening the tendons.

Furthermore, the athletes, such as basketball and volleyball players are at more risk of having this injury. However, anyone who is physically active can acquire quadriceps tendinitis. It means that if you suddenly increase your physical activity, the risk increases.

 

Diagnosing quadriceps tendinitis

Your doctor will conduct different tests to diagnose quadriceps tendonitis. This may include:

Physical examination: A physical therapy practitioner or a medical doctor will first perform a physical exam of the knee joint and quadriceps tendon. He/she carefully evaluates your knee and the surrounding areas at your first appointment.  They’ll check for swelling,  pain, and tenderness.

Medical history. This helps your doctor determine what might have caused the damage.

Imaging testing: If the doctor suspects that there may be a tear he/she will advise an ultrasound scan or MRI scan. If a partial tear has been identified then Prolozone Therapy can be done to help the tendon to heal. If a full tendon rupture is identified then quadriceps tendonitis surgery such as arthroscopy is required to rewarm up. An x-ray scan is not useful for this condition.

Nonsurgical treatment options for quadriceps tendonitis

RICE

The RICE method is the early treatment option for quadriceps tendinopathy. This therapy includes:

Complete rest. To protect the injured area, movements that overwork the knees must be restricted. Your kneecap  may need to be stabilized with a brace.

Ice. A cold compress or ice helps relieve swelling and other symptoms.

Compression. A compression bandage can help in reducing edema.

Elevation. Placing your damaged knee on a higher surface will further reduce swelling.

Prolotherapy

The quad tendon has a poor blood supply, which is why it can struggle to heal on its own. It is the oxygen and nutrients in our blood that help to heal these structures.

Prolotherapy involves the injection of oxygen and nutrients into these structures to provide a direct supply of what is needed to heal them and provide pain relief.

As the therapy is helping to treat the root cause of the problem, it is deemed to be a permanent fix. For more information about this treatment alongside video testimonials, please click on the image below:

Physiotherapy

In the early stages of quadriceps tendinopathy, physical therapy aims to decrease inflammation and pain. Additionally, a physical therapist at a sports medicine clinic will prescribe a rehabilitation program that will involve strengthening exercises for the quadriceps muscle. The exercises will help to take some of the force away from the tendon during walking and sports activities. More advanced practitioners at sports medicine clinics may use electrical stimulation to enhance the effects of the exercises as part of the treatment plan. Other treatments at sports medicine clinics may include the use of taping on the muscle to provide additional support. A physical therapist may also perform massage therapy to improve circulation and relieve pain.

Medication 

Non-steroidal anti-inflammatory medication (NSAIDs) such as ibuprofen can help to reduce inflammation, although they will not fix tendinitis. It is advised only to take them as a last resort due to the side effects that they can have.

Other treatment options

Injections for quadriceps tendinitis are invasive procedures that include an element of risk and unpredictability. Injections can help in severe cases of quad discomfort above the knee, but they should be performed only after noninvasive treatments such as shockwave therapy and physical therapy treatment have been used.

There are several injectable treatment alternatives. Cortisone injections are occasionally hazardous and should be avoided. It is believed that needle tenotomy stimulates inflammation and promotes recovery. Some physicians use platelet-rich plasma to support healing. It is important to mention here, that PRP treatment for tennis elbow is supported by some evidence, the same cannot be said for quad tendinitis.

Quadriceps tendon surgical repair: The majority of quadriceps tendinitis patients do not require surgical procedures. However, if nonsurgical therapies fail or your injury is serious, you may require surgical treatment.

A surgeon will remove the damaged portion of your tendon during a surgical procedure.  Surgical treatment options include

Open surgery: During open surgery, a single, big incision is made.

Arthroscopic surgery: It involves the use of tiny incisions, a miniature video camera, and miniature surgical instruments. It is less invasive than traditional surgical procedures.

Percutaneous ultrasonic tendon debridement: It uses ultrasonic energy to remove damaged tissue over an injured area.

Prevention tips for relieving quadriceps tendinitis

  • It is important to warm up and stretch the leg muscles before and after physical activity.
  • If you are a keen runner, then regular massage of the quadriceps will help to take some pressure off both the quadriceps tendon and the patella tendon. Massage of the hamstring will also help to support the overall functioning of the knee joint.
  • Perform regular strengthening exercises for the large muscles of the leg to ensure that they can support the knee effectively. Ensure that you warm up before performing any explosive strength work. A physical therapist can help to provide advice on the right type of exercises if you are unsure. You can visit your nearby sports medicine clinic to get guidance.
  • If you have unstable ankles then this can cause overuse of the knee and the quadriceps tendon. Orthotics in your shoes can help to stabilize the ankles in order to prevent tendon injuries and other knee problems. If you are unsure about which orthotics to choose then a physiotherapist at a sports medicine clinic will be able to make a recommendation.
  • Activity modification – if you perform a repetitive sporting or occupational activity then it is advised to modify it until the quadriceps tendinitis injury has been healed. Additionally, avoid activities that may cause pain such as climbing stairs to allow your quadriceps tendon injury to fully recover.
  • For people with a history of knee pain or tendinitis, it is wise to wear a splint or neoprene brace during repetitive weight-bearing activities, especially athletes. It can also help to keep the kneecap in the correct alignment.
  • Orthotic devices are foot-supporting shoe inserts. They aid in the treatment of tendinitis by relieving pressure on the knee tendons. Your doctor may recommend a custom-made or store-bought orthotic foot insert based on your symptoms.
  • For individuals that don’t like wearing splints or braces then another option can be Kinesio taping.

Recovery  and prognosis

Recovery from quadriceps tendinitis depends on numerous factors, including  age, the severity of the injury,  health status, and  treatment strategy

Mild tendinitis typically improves in a few weeks when treated non-surgically. You can now gradually resume physical activities.

However, if you’ve had the injury for a time, it may take between 6 and 12 weeks to recover.

If you require surgery, you may need six to nine months to recover. In case of surgery, you must avoid weight-bearing activities for the first six weeks. As your mobility improves, you can gradually begin strength training. After seven months, you should be able to gradually return to sports activities.

Frequently asked questions

Does quadriceps tendonitis require surgery?

Quadriceps tendonitis does not require surgery. Arthroscopy is only recommended if there has been a complete tendon tear.

Will a knee brace help quadriceps tendonitis?

Yes, a brace covering the knee joint can help to stabiles the kneecap if someone is suffering from quadriceps tendonitis.

Does quadriceps tendonitis go away?

The condition can go away with the right treatment and advice from a trained practitioner.

Can you walk with quad tendonitis?

It is okay to walk with quad tendonitis if it is not causing you pain. If you attempt to walk through any pain then the limping postures can start to cause pain in other areas of the body such as the hip and lower back.

Can a quadriceps tendon tear heal itself?

It is hard for a quadriceps tendon tear to heal itself as it has a poor blood supply and is under constant strain from an individual’s body weight during weight-bearing activities.

 

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