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Quadriceps Tendinopathy

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Introduction

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.

Information Video

Signs & Symptoms

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:

  • Stiffness, especially in the morning.
  • Reduced range of movement.
  • Swelling.
  • Tenderness.
  • Weakness.
  • Poor mobility.

 

Symptoms can be classified into 5 stages:

  • Stage 0: No pain.
  • 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.

Causes

The most common cause of quadriceps tendinopathy is overuse or repeated actions such as:

 

  • Sports.
  • Overload from repeated jumping / running on hard surfaces and sudden increase in physical activity without sufficient recovery time.
  • Poor posture.
  • 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.

Assessment & Diagnosis

Your Physiotherapist will take a detailed history of your symptoms and will then perform a thorough clinical examination to provide a fast and accurate diagnosis. Having a timely diagnosis ensures the most effective treatment can be implemented without delay. Your Physiotherapist will ask about the activities important to you so they can understand your limitations and work with you to create personal goals and tailor your treatment.

Self-Management

Most people suffering from quadriceps tendinopathy pain respond well to non-surgical treatment. Your Physiotherapist will educate you on your condition and suggest useful adjuncts that you can use at home to support healing and symptom resolution. Relative rest will be encouraged and your Physio will advise that you avoid activities that bring on your knee pain. To effectively treat this condition, the tendon must be subjected to a focused load to stimulate cell remodelling whilst also implementing rest days so that the adaptations can take place without repetitive irritation. Your Physio will usually recommend performing your exercises on an every other day basis and will advise that you monitor your symptoms closely. Regular re-assessment will make sure you are making progress and will allow for any adjustments to be made to your plan.

 

Your clinician may also recommend using ice applied regularly to the knee throughout the day for 10-15 minutes can help to reduce inflammation and pain. To further reduce symptoms, you may also be provided with advice on non-steroidal anti-inflammatory medication to help reduce pain and inflammation.

Physiotherapy

Your Physiotherapist will provide you with a bespoke and progressive home exercise plan that will help stimulate healing and increase the structural resilience of the affected tendon. As you improve, your exercise plan will be adjusted to support optimal adaptation and cellular remodelling, helping you to return to your normal level of activity. We offer ongoing support so that you can prevent re-occurrence.

 

Your Physiotherapist may use modalities such as manual therapy techniques and acupuncture to reduce your pain, promote healing and restore function. and prescribe exercises. Your therapist may also tape up your knee using specific methods to help avoid overloading the tendon and prevent pain exacerbation during day to day activities.

Escalation of Treatment

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

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