Quadriceps Tendinopathy: Signs, Symptoms, Treatment, Strengthening, Stretching Exercises

Quadriceps is the muscle located at the anterior region of the thigh. They are four in number. These quadriceps muscles attach superiorly to the pelvis and thigh bone and inferiorly to the kneecap.

Any sort of overuse or damage to the quadriceps tendon inserting into the patella often causes pain and inflammation.

Tendinopathy is a term given to a disease or degeneration of tendons. There may be minute tears in the tendon, which cause pain and inflammation. Any sort of injury to the tendon generally develops gradually often at times because of the repeated overuse. There are many types of tendinopathy conditions like tendonitis or tenosynovitis. The term tendinopathy is given for majority of tendon injuries. The quadriceps muscles go into the superior part of the kneecap. Since the pain usually develops slowly over time, this injury is considered as an overuse type injury rather an injury of sudden onset. Middle aged athletes and athletes involved with weightlifting are more prone to this type of injury due to excessive strain placed on the muscle insertion when they do deep squats.

• Pain above the knee with flexion.
• Tenderness above the kneecap.
• Stiffness after being physical active.
• Feeling of pain at the time of or after any sort of physical exercise.
• Pain when applying pressure at the top of the patella.
• Pain with standing from a squatted position.^[1]

• Rest, Ice, Compression, Elevation is helpful.
• Avoidance of activities that may aggravate the condition.
• Stretching the quadriceps muscles is beneficial.
• Immediate consultation with a sports doctor.
• Anti-inflammatory drugs use useful for reducing pain and inflammation.
• Massage is useful.
• For unrelenting pain, corticosteroid injection can be given.
• Stretching of quadriceps is a very vital part of the rehab program and should be done religiously.^[2]

• Individuals are recommended to seek professional advice before starting any rehab program. The following principles are for information purposes only.
• Aims of Rehabilitation
• Reducing pain and inflammation.
• Improving the fitness of the tendon and quadriceps muscles.
• Strengthening the muscles which are involved.
• Gradual return to full activity or fitness level.
• Rest should be taken from aggravating activities and if the injury is mild, then simply modifying the type of training done is sufficient.
• If the injury is causing pain during training then complete period of rest is required.
• For chronic injuries, continued rest is required whereas for acute injuries, a rest period of about a month is sufficient.
• Ice or cold therapy (not directly to the skin) should be applied in case there is pain upon movement during the acute phase which is usually the first couple of days following the injury.
• After the acute stage has passed, heat may be applied and a heat retainer can be worn.

Patient should begin strengthening exercises as soon as pain allows. If the pain increases the morning after doing strengthening exercises, then the load needs to be reduced.

• These are done by contracting the Quadriceps Muscles in front of the thigh.
• These can be performed either standing or sitting with the knee extended or with a foam roller or rolled up towel under the knee in order to lift the foot off the floor when the quads are contracted.
• The quads can be contracted for 10 seconds and then relaxed for 3 seconds. 10 repetitions should be done.
• Rest can be taken for a minute and this exercise should be repeated up to five times.
• This exercise helps to maintain muscle mass and helps to hasten recovery.
• This exercise should be continued daily until the patient is able to perform the eccentric exercises given below.
• Sports Massage for Quadriceps Tendinopathy.

The patient is required to discuss with his therapist regarding any contraindications before starting sports massage.^[3]

• A lubricant such as massage oil or baby oil for smooth gliding of the hands. Only sufficient amount of lubricant should be used so that there is smooth and controlled movement. Too much of the lubricant results in lack of control.
• A firm, flat surface is required to lie down during the massage.

• There are two aims of sports massage. Firstly, if the massage is directly applied to the tendon itself, it helps in breaking down the adhesions between the tendon and the tendon sheath and speeds up the healing process. The second benefit is massage to the quadriceps muscles helps in improving the fitness and flexibility of the muscles and takes the strain off the tendon.
• Sports massage should not be done during the acute phase of this injury. Acute phase usually lasts for a couple of days following the injury. In cases of severe injuries such as grade 2 and 3 injuries, massage should be avoided for over a week because if there is still bleeding then the heat and massage will increase the bleeding.^[4]

The muscles that need to be stretched are the quadriceps group in front of the thigh. This group is made up of vastus lateralis, vastus medialis, and vastus intermedius. These muscles originate at the thigh and insert into the shin bone via the kneecap along with rectus femoris. The rectus femoris originates from the front of the hip and also inserts via the kneecap.

Flexibility can be tested by performing Thompson’s test.

First the patient should lie down on the back and pull one knee up as high as it can go.

The thigh of the other leg should be horizontal. If it goes up it signifies there may be tight hip flexor muscles.

• The foot of the leg to be stretched should be held and gently pulled up behind. The knees should be kept together and the leg should be pulled up straight and not twisted.
• A stretch can be felt at the front side of the leg. It should not be painful. During the early stages of treatment, the stretches should be held for around 10 seconds. Later when the inflammation calms down, the stretches should be held for around half a minute. This should be repeated 3-5 times and stretched at least thrice a day.
• This stretch can also be done while lying on your front.

• Patient should kneel on one knee with a padded cushion for support, as this stretch puts a lot of pressure on the kneecap when kneeling down, so it is necessary to have adequate padding for support.
• The foot should be pulled up behind. This stretch mostly targets the rectus femoris.
• If pain is felt in the knee when doing this stretch, then this stretch should be avoided. Hold the stretch for 10 seconds initially and then progress to about half a minute. This should be repeated 3-5 times and minimum thrice a day.^[5]

References:

Also Read:

• What Can Cause Quadriceps Tendon Rupture and What are its Symptoms?>
• Quadriceps Tendon Rupture: Exercise, Yoga, Braces, Prognosis, Healing Time
• Quadriceps Tendon Rupture: Treatment, Recovery, Surgery, Diagnosis