The quadriceps are a group of four muscles found on the anterior thigh. They work together to extend, straighten, the knee, and control knee flexion when you are on your feet. They play an important role in activities such as running, standing up from a chair, climbing stairs, jumping, squatting and kicking.
The quadriceps tendon attaches your quadriceps muscles to your kneecap (patella). It works to straighten your knee, which helps you walk, jump, and climb stairs. If the tendon becomes inflamed, it’s called quadriceps tendinitis or quadriceps tendinopathy. It’s often a result of repetitive movements like jumping or kneeling.
This overuse leads to tiny tears, which cause pain and swelling. The injury often affects athletes, however, any active person can develop quadriceps tendinopathy. The risk is higher if you suddenly increase your physical activity.
Pain is in the front of your knee, just above the kneecap. Usually, the pain is dull and gradually increases over time. The pain may get worse after sitting down for too long or jumping, squatting, and running.
Other symptoms include:
- Reduced range of movement.
Symptoms can be classified into 5 stages:
- Stage 1: Pain only after intense sports activities. No functional impairment.
- Stage 2: Moderate pain during sporting activities. No restriction on performance.
- Stage 3: Pain during sporting activities with slight restriction on performance.
- Stage 4: Pain with severe restriction of sports performance.
- Stage 5: Pain during daily activities. Unable to participate in sports activities.
The most common cause of quadriceps tendinopathy is overuse or repeated actions such as:
- Overload from repeated jumping / running on hard surfaces and sudden increase in physical activity without sufficient recovery time.
- Inefficient walking mechanics.
- Taking part in jumping sports, like volleyball and basketball.
- Exercising without warming up.
Other factors that can increase your risk are:
- Age – as you get older, the tendons become less flexible and more prone to inflammation.
- Weight – excess body weight puts extra stress on the tendons.
- Tightness – tight hamstrings and quad muscles increase pressure on your tendons.
- Chronic disease – such as lupus and diabetes, reduce blood supply to the knee. This weakens the tendons and increases the risk of degeneration from poor healing ability.
- Alignment problems – if your joints or bones aren’t properly aligned, one leg will be placed under more stress. Muscular imbalances can have a similar effect.
Treatment & Management
Most people suffering from quadriceps tendinopathy pain respond well to non-surgical treatment such as:
- Rest: Avoiding activities that bring on your knee pain is vital. In most cases, relative rest is best but in severe cases, complete rest may be necessary using a knee brace or splint.
- Ice: Regularly applying an ice pack to the knee throughout the day for 10-15 minutes can help to reduce inflammation and pain.
- Physiotherapy: your Physiotherapist may use modalities such as massage, acupuncture, electrical stimulation and prescribe exercises.
- Bracing/Taping: Your therapist may tape up your knee to avoid overloading the tendon and prevent pain during day to day activities.
- Orthotics: Shoe orthotics help to address and biomechanical issues that may be contributing to your symptoms such as arch supports.
- Stretching Exercises: Knee stretches to improve the soft tissue flexibility of the calves, hamstrings and quadriceps to reduce excessive tension.
- Strengthening Exercises: Strengthening exercises for the quadriceps muscles to help reduce the strain on the tendon.
- Injections: In more severe cases, your doctor may recommend either corticosteroid or plasma-rich protein (PRP) knee injections for quadriceps tendinopathy that is failing to resolve