5 Best Exercises to Deal with Quadriceps Tendonitis
Are you experiencing a dull, nagging pain on the front part of your Knee? It could be Quadriceps Tendinitis, an irritation of a thick band of tissue connecting your thigh’s largest muscle group(Quadriceps) to the Knee Cap(Patella). Based on figures from recent research studies, it affects about 2% of Athletes, especially those involved in sports that incorporate high-intensity loading of the lower body i.e. basketball, volleyball, and soccer. This article provides everything you need to know about the condition. We’ll dive into what it is, key causes, signs and symptoms, diagnosis, and treatment options.
Causes of Quadriceps Tendinitis
Overuse
In most cases, Quadriceps Tendinitis sets in as an “overuse injury”. The condition typically develops following activities that involve excessive and repetitive loading of the Quadriceps muscle and tendon over time. At a microscopic level, unchecked repetitive loading in the Tendon causes tiny tears in its fibers, which triggers inflammatory processes responsible for the pain, swelling, tenderness, and related symptoms. If the loading remains unchecked, what started as nothing more than tiny tears may turn into a degenerative process characterized by chronic pain and loss of function.
Direct trauma
Quadriceps Tendinitis isn’t always a result of cumulative injury. Direct injuries like a partial or complete tear caused by direct trauma or excessive loading can set the stage for the condition. Despite interventions like surgical repair and rehabilitation, the tendon may fail to fully heal and restore its structural integrity. This leaves it susceptible to injury and chronic inflammation.
Misalignment
Faulty mechanics in and around the knee joint can cause excessive or imbalanced loading in the Quadriceps Tendon. This may cause microinjuries within its structure, leading to chronic inflammation over time. Misalignment issues in the feet, legs, knees, and pelvis can create abnormal movement patterns which increase tendon loading. Common examples include flat feet, knock Knees, bowlegs, leg-length discrepancy, and pelvic tilting.
Signs and Symptoms
Quadriceps Tendinitis typically starts off with common signs of inflammation in the front Knee area, especially after moderate-intense physical activity involving the lower body.
Pain: A dull ache that worsens over time, and increases with Knee bending.
Swelling
Tenderness
Warmth
In time, what started as an occasional discomfort that worsened with activity is accompanied by Knee joint stiffness. In other words, you find it harder to bend the affected Knee due to stiffness within the joint and the Quadricep muscle. If this sounds familiar, it’s time to see your Physiotherapist or Doctor for a thorough assessment.
Diagnosis
So how do practitioners diagnose Quadriceps Tendinitis?
It all starts with a comprehensive assessment, which looks into the history of your condition and how it’s impacted your physical function through manual clinical tests. At first, the Doctor or physiotherapist asks you a series of questions to understand the behavior of your symptoms in the context of other relevant factors. These include your past injuries or medical conditions, occupation, workout routines, and hobbies. A physical exam, which involves manual orthopedic tests and functional assessment tries to establish the most likely cause of the problem.
Manual clinical tests like the Quadriceps Tendon Loading test, palpation, and other maneuvers can indicate the presence of Tendonitis without the need for further investigative procedures like MRI or CT Scans. These may be recommended in cases where it's unclear despite physical clinical tests, or simply as addiotional confirmatory procedures.
Treating Quadriceps Tendonitis
Most people with Quadriceps tendonitis need conservative treatment to heal, or see significant improvement to get back to what they love to do without much discomfort. The key is to access timely professional treatment that offers both effective pain management and sound strategies to eliminate the causal and aggravating factors.
Physiotherapy
Physiotherapy is a key element of conservative management of Quadriceps Tendonitis, offering a range of techniques aimed at minimizing symptoms, improving muscle function, and eliminating modifiable risk factors. Key treatment approaches include:
Manual Therapy
This involves a wide range of hands-on techniques which improve symptoms, as well as muscle and tendon function. Different forms of massage techniques help with healing by promoting blood circulation to the affected area, aiding with proper reorganization of tendon fibers, and reducing Quadriceps muscle tightness. Joint mobilization techniques may also be used to prevent or reduce stiffness in the Knee joint, which promotes overall function in the long run.
Exercise Therapy
This involves the use of different forms of exercise to reduce symptoms, promote muscle function, and improve joint mechanics. An exercise approach known as Eccentric training has been shown to promote healing and improve overall performance in the affected Quadriceps muscle. However, researchers suggest that it’s best used when incorporated into a program that includes other forms of training like Isometric exercise protocols.
Stretches are also a key part of treatment due to their role in preserving joint mobility and reducing muscle tightness. Based on your symptoms and other relevant factors, the Physiotherapist identifies appropriate stretches for the Quadriceps and all the key muscle groups that work together with your Quads as a unit i.e. Hamstrings, Calves, Glutes, and Core muscles. The type, intensity, and frequency of the stretches depend on the practitioner’s evaluation.
Best Exercises for Quadriceps Tendonitis
Standing Quadriceps Stretch
This is a classic stretch for your Quads and the associated tendon. The move bends the knee while slightly extending the hip joint, which is an optimal position for stretching the muscle.
Stand tall behind a chair.
Bend the affected leg while grabbing the foot to secure it at full knee flexion. You can lean on the chair for extra support.
Gently pull the leg slightly backwards until you feel a gentle stretch on the front portion of your thigh.
Hold for 15-20 seconds, relax, and repeat for 2-3 times/reps.
Lying Hamstring Stretch
This is a simple but effective stretch to zone in on your Hamstrings; the muscles at the back of your thighs which work together with Quads to control the knee joint. These muscles tend to be tight, as a complication of Quadriceps Tendonitis, which translates to compromised function. Therefore, they’ll also need a treat in your exercise program.
Lie down on your back on a mat or floor.
Lift the affected leg straight up until it’s perpendicular to the floor. Reach for the back of the thigh to assist with the lift. You should feel your Hamstrings stretch at the back of the thigh.
Hold the position for 15-20 seconds.
Wall Squat
This is a modified version of the Squat, which is arguably the most effective exercise for your Quads based on overall muscle activation. Leaning on the wall provides extra support, which means lower loading in the affected tendon and Quads, making it great for starters.
Starting Position
Stand tall, about a step away from the wall, with feet at shoulder width apart.
Lean back onto the wall.
The Movement
Bend your knees and slide down the wall until your thighs are level with your knee joints.
Reverse to the starting position.
Repeat, 7-10 reps, 2-3 sets.
Note: If this proves painful, especially close to the bottom position, restrict movement to the pain free range. Your Physiotherapist should be able to modify the exercise based on your needs.
Stiff-legged Deadlift
The Stiff-legged/Romanian Deadlift is one of the most effective exercises for your Hamstrings. Unlike the classic Deadlift, Knees are kept stiff while the upper body moves relative to your legs. This means more activation for your Hamstrings and Glutes.
Starting Position
Stand tall, feet at shoulder-width apart, holding a light Dumbbell in each hand.
The Movement
Bend forward by hinging on your hips. Knees should be kept straight
At the bottom position, Dumbbells should be level or slightly below your knees.
Reverse to the starting position.
Pause and repeat the movement for another set.
Go for 7-10 reps, 2-3 sets.
Once you’ve mastered the movement, you can upgrade the load with heavier Dumbbells or a Barbell if available.
Straight Leg Raises
A simple, light-weight alternative for working your Quads and Hip muscles(Flexors). All you need is space and proper execution.
Starting Position
Lie down on your back on the floor.
The affected leg stays stretched out on the floor while the other one is bent to offer some extra support.
The Movement
Raise the affected leg up to around 45 degrees from the floor.
With control, reverse to the starting position.
Repeat the movement for another rep. Go for 7-10 reps 3-4 sets.
Electrotherapy
This involves the use of various forms of electronic devices to relieve symptoms and promote healing. Again, these are best used in a comprehensive treatment plan that includes exercise and manual therapy. Key examples include:
TENS(Transcutaneous Electrical Nerve Stimulation): Uses low electric currents to alter the transmission of pain signals to the central nervous system. It also helps with pain relief by promoting the release of the body’s natural painkillers (endogenous opioids), which alters pain perception.
Ultrasound: This device generates high-frequency sound waves to the affected tissue, which trigger a range of therapeutic responses. The heat generated by the sound wave’s interaction with affected tissues promotes healing by enhancing blood flow to the area. Sound wave delivery can also be tweaked to interact with the tissues at a microscopic level, enhancing essential healing processes.
Medication
Over-the-counter pain relievers complement other conservative treatment methods. Corticosteroid and Platelet-Rich Plasma(PRP) injections may be used in cases where first-line conservative treatment has failed.
Surgery
Surgical treatment is often the last resort, reserved for cases where all the conservative means have failed, or when there is significant structural damage. Several arthroscopic or open surgical interventions are more effective than conservative management in highly advanced forms of Quadricep Tendonitis. Beyond surgery, physical rehabilitation follows to promote healing and restore physical function.
Dealing with Quadriceps Tendonitis requires careful evaluation or assessment by a healthcare practitioner. This is followed by an individualized treatment plan that addresses key symptoms and underlying causes. Conservative treatment leads the way, especially in the early and intermediate stages of the condition. Medication and Physiotherapy play a key role; offering a variety of treatment options to deal with symptoms and modifiable underlying causes. In advanced cases, surgery offers the last option followed by a comprehensive rehabilitation program aimed at restoring function.
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