The quadriceps muscles are a group of four muscles found in the thigh of our legs. Muscles are joined to the bones by a tough tissue called the tendon. The quadriceps tendon joins the quadriceps muscle to the top of the kneecap.
Quadriceps tendonitis is an inflammation of the quadriceps tendon. When the quadriceps contracts, the tension is felt at the tendon which causes the bone to move to the desired position. Excessive use of the quadriceps muscle can increase the tension at the tendon leading to an injury.
Some of the activities that engage the quadriceps muscle are running, jumping, walking, squatting and kicking.
The quadriceps tendon can be felt just above the kneecap.
What Causes Quadriceps Tendonitis?
1. Overuse
This may pertain to athletes. Continuous use of the knee joint in a particular sport like basketball can place a lot of stress on the knee and strain on the quadriceps muscles. Repetitive movement of the knee especially an abrupt movement can lead to an inflamed tendon.
Non- athletes are not left out. If your job involves a lot of standing and walking, it could lead to tendonitis.
2. Not Warming Up Properly
Warming up prepares the muscles for any form of activity especially sports. Not warming up before any form of activity may cause an injury to the tendon as the muscles are not well prepared for the activity.
3. Over-exercising
People tend to feel pain in their knees while exercising. These may be due to an increase in frequency or intensity of exercise and may overload the knee joint which may lead to an inflamed tendon.
4. Muscle Imbalance
For even weight distribution and transmission, there has to be a balance of muscles. The muscles work together to enable us to achieve any posture or movement. If a group of muscles is stronger than their corresponding counterparts, there is a lot of stress on the stronger muscle. If your calf muscles are weak, it places a lot of stress on the quadriceps to keep you standing for a long period of time. This can later lead to overuse of the muscles and tendon and lead to tendonitis.
5. Muscle Weakness
The weakness of the calf muscles or hamstrings can put a lot of pressure on the quadriceps muscle which can lead to quadriceps tendonitis.
6. Limb Length Discrepancy
As the name implies, it is a condition when one limb is longer than the other. Because of their uneven leg length, the quadriceps on one leg may be overworked and lead to the inflammation of the tendon.
7. Foot Deformities
Flat foot is a common foot deformity. This deformity affects the arches of the foot causing them to collapse. The arches of the foot play a major role in weight transmission. A foot with collapsed arches put a lot of pressure on the quadriceps and knee joint which can affect the quadriceps tendon.
8. Inappropriate footwear
One of the functions od the feet is weight transmission. Wearing inappropriate shoes affect the weight transmission and puts a lot of load on the knee. This causes the quadriceps to work harder than normal and in the process lead to a strain at the muscle or tendon.
Symptoms of Quadriceps Tendonitis?
1. Pain while moving the knee joint
The quadriceps extend the knee joint, therefore, injury to its tendon will cause pain while flexing and extending the knee.
2. Tenderness at the knee joint
The quadriceps tendon is usually located just above the kneecap. When injured, pain can be felt when the tendon is touched on the knee joint.
3. Swelling
Tendonitis is an inflammation of a tendon. When a tendon is injured, inflammatory changes take place which causes swelling at the knee.
4. Joint stiffness
There may be joint stiffness early in the morning.
Diagnostic Tests
Doctors usually advise people with pain at the knee to go for an X-ray or MRI as other anatomical structures at the knee joint may mimic symptoms of quadriceps tendonitis. Some of these other conditions are:
- Ligament Sprain
- Kneecap dislocation
- Muscle Strain
- Fracture of the bones that make up the knee joint (thigh bone, shin bone, and kneecap).
How Can It Be Treated?
Medications
Anti-inflammatory drugs like ibuprofen or diclofenac are usually recommended to reduce the inflammatory process at the tendon and in the process, help to relieve pain.
Physiotherapy
After a physiotherapist carries out the necessary assessments on the affected knee, the PRICE treatment regimen is usually carried out at the initial phase. This treatment regimen is usually done for at least 72 hours or until the swelling and pain has reduced.
Depending on the recovery, the physiotherapist will also recommend exercises to strengthen surrounding muscles and the quadriceps as well in order to prevent a re-injury of the tendon and any other complication that may arise from the injury.
PRICE Method
P-Protect
The injured knee needs to be protected from further injury. Supportive devices like crutches or walking frames are recommended to avoid weight-bearing and re-injury of the tendon.
R- Rest
Rest is important. The quadriceps are responsible for many movements and once the tendon is injured, activities need to be placed on hold to allow for healing and prevent re-injury during the healing process.
Knee braces or taping are recommended to keep the knee in place and prevent movement at the joint.
I-Ice
Ice has been shown to reduce swelling and also slow down the inflammatory process in the early stages. Ice packs are used once the injury happens and is stopped when the swelling and tenderness have reduced. After ice, heat packs are usually recommended to increase blood flow and speed up healing.
The ice packs should be done every 3- 4 hours every day for 15-20 minutes.
C-Compression
Tendonitis causes swelling. The use of a compression bandage can help reduce the swelling at the knee joint further.
Elevation
The affected leg is raised to aid the reduction of swelling at the knee joint.
Exercises
At different stages of the healing process, the quadriceps have to be strengthened to prevent muscle weakness. At the initial stage of treatment, static or isometric exercises are advised. As the patient gets better, exercises are added and increased to take the patient back to normal daily function.
Some of these exercises are:
Static Quadriceps contractions
This exercise strengthens the quadriceps without moving the knee joint. This exercise can be done by straightening your leg out in front of you and bending your ankle. This contracts the quadriceps and improves the strength of the muscles.
Wall Sits
This exercise strengthens all the muscles in the body. While standing with your back against the wall, slide down the wall as if you want to sit on an invisible chair. Maintain this sitting posture for as long as you can and relax.
Quadriceps stretches
As the tendon heals, the muscle needs to be stretched to avoid any contracture. Most quadriceps stretches are done in standing. While standing, bend the affected knee to your point of pain with your heel towards your buttocks. Hold for 10 seconds then slowly release.
Hip abduction exercises
Apart from the quadriceps muscles, other muscles need to be strengthened to support the injured tendon. One of these muscles are the hip abductors. These exercises can be done standing or lying.
In lying, assuming the right leg is the affected leg, lie on your left side and raise the right leg towards the ceiling and bring it down. Do this 10 times and repeat on the other leg.
Surgery
Surgery is usually recommended as a last resort and the patient is referred to physiotherapy after the surgery for quick recovery.
How Long Does Healing Take?
If physiotherapy starts on time, it takes at least 4 to 6 weeks for full recovery if it is a minor injury. However, if it is a major injury, it could take more than six weeks to heal. It depends on how soon the injury is noticed and how soon physiotherapy intervention starts.
How To Prevent Quadriceps Tendonitis?
- Wear appropriate shoes
- Warm up before any sporting activity
- Do a lot of muscle strengthening exercises to prevent muscle imbalance and muscle weakness. Also do exercises that target major muscle groups like the hamstrings, calf muscles and the quadriceps.
- Listen to your body. Don’t overwork it.
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