Quadriceps Tendonitis (Tendinopathy)

Quadriceps tendinopathy/tendinitis

Quadriceps tendonitis/tendinopathy is inflammation, or more likely degeneration of the tendon of the quadriceps (thigh) muscle at the front of the knee. Specifically, along the top of the patella (kneecap).

Symptoms of quadriceps tendonitis

Quadriceps tendinopathy symptoms develop gradually over time and consist of:

  • Pain along the top edge of your patella (kneecap).
  • You will likely feel discomfort or pain during and after exercise.
  • Often, you have pain simply contracting your quadriceps muscles (front of the thigh) when sitting with your legs our straight.
  • Your knee will feel tender when pressing in (palpating) along the top of the patella.
  • It is likely your knee will feel stiff the day after exercise, especially first thing in the morning.
  • You will probably have pain when standing up from a squat position.

What is quadriceps tendonitis?

Quadriceps tendonitis is inflammation of the tendon of the quadriceps (thigh) muscles at the front of the knee.

Anatomy

Quadriceps muscles

The quadriceps muscle group are the four large muscles at the form of the thigh and consist of the rectus femoris, vastus lateralis, vastus medialis and the vastus intermedius. When they contract the bend (flex) the knee.

The rectus femoris is the largest muscle and also flexes the hip (lifts the thigh) because it originates from the pelvis, crossing both the hip joint and the knee joint (called a biaxial muscle).

The quadriceps muscles join together in a common tendon which attaches to the patella or kneecap, which in turn inserts into the front of the tibia or shin bone.

Tendonitis or tendinopathy?

Tendonitis is inflammation of a tendon (‘itis’ means inflammation). If your injury is fairly recent or acute then it may be inflamed. However, many long term, chronic injuries are more likely to have wear and tear or degeneration. Studies have shown that acute, inflammatory cells are no longer present as they would be in a very recent injury.

The word tendinopathy simply means ‘diseases of the tendon’ and so describes a range of conditions. These include:

  • Quadriceps tendonitis (acute inflammation).
  • Tenosynovitis (inflammation of the sheath surrounding the tendon).
  • Degeneration of the tendon from overuse or ‘wear and tear’.

The term quadriceps tendinopathy is used to cover most tendon injuries.

Treatment of quadriceps tendinopathy

The aim of treatment is to decrease pain and inflammation, and stretch the quadriceps muscles. Then, when your symptoms are under control, gradually increase the load through your tendon as you return to full fitness.

Rest

Rest is very important. This may either mean complete rest, or active rest depending on how severe your symptoms are.

Active rest is often suitable for a less severe injury. It involves modifying the type of training you do. For example, avoid explosive jumping or plyometric activities for a few weeks.

If your knee is painful during training then a complete period of rest may be required. For more recent acute injuries a rest period of 2 to 4 weeks may be sufficient. If you have a long term chronic injury then a sustained period of rest may be required.

Cold therapy & compression

Apply cold therapy or ice if your knee is acutely painful. Ice can be applied for 10 to 15 minutes every hour for the first 24 to 48 hours.

Do not apply ice directly to the skin as it may burn. Use a wet tea towel or better still, a commercially available reusable hot and cold pack.

Later, once any acute inflammation has calmed down, applying heat may be more effective.

Exercises

Quadriceps stretching

Stretching the quadriceps muscles is important and should be done regularly throughout the day. Strengthening exercises, in particular eccentric strengthening may be beneficial, but in the early stages and for acute injuries, rest is the priority.

Your physio can advise on a full treatment and rehabilitation program.

Massage

For particularly chronic tendinopathies, cross friction sports massage techniques can be particularly effective.

Self-massage can be done by applying short, frictions across the tendon along the top of the patella for 5 to 10 minutes.

The aim is to gradually apply firmer frictions to reduce adhesions between the tendon and its surrounding sheath. It is likely you will feel particularly sore spots as thicker areas of the tendon.

Medication

A doctor may prescribe anti-inflammatory medication (e.g. Ibuprofen) in the early acute stages, however, if this injury is a long-term chronic problem then anti-inflammatory medication may not be beneficial and may even hinder recovery.

Always check before you take medication. You should not take Ibuprofen if you have Asthma.

Corticosteroid injections

In persistent cases, a doctor may give a corticosteroid injection. Recovery from chronic quadriceps tendinopathy can take weeks or even months.

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