Quadriceps Tendon Tear/Disruption

with Rehab

The quadriceps muscles are located on the front of the thigh and are responsible for straightening the knee and bending the hip. The quadriceps tendon connects these muscles to the kneecap (patella) and also from the patella to a portion of the shin bone (tibial tubercle). A quadriceps tendon tear or disruption is characterized by a partial or complete tear of the quadriceps tendon between the quadriceps muscles and the patella. Quadriceps tendon tears or disruptions often cause pain above the knee and result in a decrease in function of the quadriceps muscles.

SYMPTOMS

  • A "pop" or tear felt or heard above the patella at the time of injury.

  • Pain, tenderness, inflammation, and/or bruising over the quadriceps tendon.

  • Pain that worsens with use of the quadriceps muscles.

  • Difficulty with common tasks that involve the quadriceps muscle, such as walking.

  • A crackling sound (crepitation) when the tendon is moved or touched.

  • Loss of fullness of the muscle or bulging within the area of muscle with complete rupture.

CAUSES

A strain occurs when a force is placed on the muscle or tendon that is greater than it can withstand. Common mechanisms of injury include:

  • Repetitive strenuous use of the quadriceps muscles. This may be due to an increase in the intensity, frequency, or duration of exercise.

  • Direct trauma to the quadriceps muscles or tendons.

RISK INCREASES WITH:

  • Activities that involve forceful contractions of the quadriceps muscles (jumping or sprinting).

  • Contact sports (soccer or football).

  • Poor strength and flexibility.

  • Failure to warm-up properly before activity.

  • Previous injury to the thigh or knee.

  • Untreated quadriceps tendinitis.

  • Corticosteroid injections into the quadriceps tendon.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment.

PROGNOSIS

If treated properly, then recovery from a quadriceps tendon tear or disruption usually occurs; however the recovery period may b 6 to 9 months.

RELATED COMPLICATIONS

  • Quadriceps muscle weakness.

  • Re-rupture of the tendon after treatment.

  • Prolonged healing time, if improperly treated or re-injured.

  • Risks of surgery: infection, bleeding, nerve damage, or damage to surrounding tissues.

TREATMENT

Initial treatment involves rest from any activities that aggravate the symptoms. Ice, medication, and elevation may be used to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with referral to a therapist. If the tear is complete, then surgery is usually required to repair the tendon, as it cannot heal on its own. After surgery immobilization is required to allow for healing. After immobilization it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the extremity operated upon.

  • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Quadriceps Tendon Tear/Disruption

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Knee Flexion and Extension, Active-Assisted

  • Sit on the edge of a table or chair with your thighs firmly supported. It may be helpful to place a folded towel under the end of your right / left thigh.

  • Flexion (bending) : Place the ankle of your healthy leg on top of the other ankle. Use your healthy leg to gently bend your right / left knee until you feel a mild tension across the top of your knee.

  • Hold for __________ seconds.

  • Extension (straightening): Switch your ankles so your right / left leg is on top. Use your healthy leg to straighten your right / left knee until you feel a mild tension on the backside of your knee.

  • Hold for __________ seconds.

Repeat __________ times. Complete __________ times per day.

RANGE OF MOTION - Knee Flexion, Active

  • Lie on your back with both knees straight. (If this causes back discomfort, bend your opposite knee, placing your foot flat on the floor.)

  • Slowly slide your heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.

  • Hold for __________ seconds. Slowly slide your heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH - Knee Flexion, Supine

  • Lie on the floor with your right / left heel/foot lightly touching the wall (place both feet on the wall if you do not use a door frame).

  • Without using any effort, allow gravity to slide your foot down the wall slowly until you feel a gentle stretch in the front of your right / left knee.

  • Hold this stretch for __________ seconds. Then return the leg to the starting position, using your health leg for help, if needed.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach, your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and/or knee.

Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Quadriceps Tendon Tear/Disruption

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor/mat/bed on which you are lying.

  • Hold the muscle as tight as you can without increasing your pain for __________ seconds.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your knee so that the knee slightly bends.

  • Raise only your lower leg by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in1 lb/0.5 kg increments.

STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working to insure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up or increased dimpling just above the knee. Your thigh may even quiver.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Quadriceps, Step-Ups

  • Use a thick book, step or step stool that is __________ inches tall.

  • Holding a wall or counter for balance only, not support.

  • Slowly step-up with your right / left foot, keeping your knee in line with your hip and foot. Do not allow your knee to bend so far that you cannot see your toes.

  • Slowly unlock your knee and lower yourself to the starting position. Your muscles, not gravity, should lower you.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Quadriceps, Wall Slides

Follow guidelines for form closely. Increased knee pain often results from poorly placed feet or knees.

  • Lean against a smooth wall or door and walk your feet out 18-24 inches. Place your feet hip-width apart.

  • Slowly slide down the wall or door until your knees bend __________ degrees.* Keep your knees over your heels, not your toes, and in line with your hips, not falling to either side.

  • Hold for __________ seconds. Stand up to rest for __________ seconds in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

* Your physician, physical therapist or athletic trainer will alter this angle based on your symptoms and progress.