Rehabilitation of Quadriceps Tendinopathy

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Quad stretching

An outline rehabilitation program for quadriceps tendinopathy.

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.

Aims of Rehabilitation

  • Decrease pain and inflammation.
  • Improve condition of tendon and quadriceps muscles.
  • Strengthen the muscles involved.
  • Gradual return to full fitness.

Reducing Pain and Inflammation

  • Rest. This may mean simply modifying the type of training done for a less severe injury for example avoiding explosive jumping or plyometric activities.
  • For injuries that cause pain during training then a complete period of rest may be required.
  • If the injury is chronic then a sustained period of rest may be required. For more acute injuries a rest period of 2 to 4 weeks may be sufficient.
  • In the acute stage, if there is pain on movement of the knee joint, usually the first 2 to 4 days, apply ice or cold therapy (not directly to the skin).
  • After the acute stage, apply heat and wear a heat retainer.

Improving Muscle and Tendon Condition

  • It is not enough simply to be pain free. The tendon must be restored as closely as possible to it's original condition. The muscles must also be stretched and restored to optimum condition if re-injury is to be avoided.
  • Stretching the quadriceps muscles is very important to the recovery of this injury.
  • Stretch at least 3 times a day and continue to stretch long after the injury has healed.
  • Stretching can begin as soon as it can be done pain free - usually from day 1. Sports massage techniques can also play a key role in the rehabilitation of this injury. Cross friction massage to the site of pain can improve tendon function. Sports massage applied to the quadriceps muscles will help them stretch more easily, placing less stress on the tendon insertions.

Strengthening Exercises

  • These can be done as soon as they can be performed pain free and without causing delayed symptoms such as pain afterwards or the next day. This may be between 2 and 7 days following injury, depending on severity. It may be longer.
  • Begin with static contractions and when these can be performed comfortably, progress onto dynamic leg extension and squat exercises.
  • More advanced plyometric exercises should be performed later in the rehabilitation plan and prior to returning to competition.
  • Strengthening exercises can be performed on a daily basis initially (usually for the first week or two), especially with the static contraction exercises. As intensity progresses with the dynamic exercises, the athlete may require a rest day in between sessions to allow the muscles to fully recover.

Return to Full Fitness

  • The length of time that is required to return to full fitness will depend on the severity of the injury and whether or not it is a recurrent injury or a first time injury. For a first time injury, recovery may take 2 to 3 months. A longer term chronic, recurring injury may need 4 to 6 months.
  • Gradually return to sports specific training. Again depending on severity this may be days, it may be weeks. Pain should be the guide.
  • Begin with gentle jogging. When the athlete can jog 20 minutes without pain during or after then progress to running and sprinting.
  • An example of a speed session might be 10x50m sprints at 50% effort. Next session perform 10x50m at 75% of full speed and so on.
  • Continue to stretch and perform specific strengthening exercises throughout this phase of rehabilitation.

I am really having trouble shaking this injury off!

  • Rigorously stretch the muscles at least 3 times a day.
  • Cross friction massage to the tendon at the site of pain can be applied on a daily basis. This has proved valuable in recovery of even chronic cases.
  • If the injury does not respond to rehabilitation then seek further professional advice as surgery may be required.
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