Quadriceps Tendonitis Treatment
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Quadriceps tendonitis is a painful condition felt at the front of the knee. Learn more about Quadriceps Tendonitis: Symptoms, Causes and Diagnosis. Strengthening exercises are a key component of rehabilitation to fix quadriceps tendonitis or tendinopathy. There are two main parts to the rehabilitation that we will cover, pain-relieving and strengthening exercises. It is important to pay attention to both to get on top of symptoms and reduce the healing time as much as possible, to fix the issue and prevent it from recurring.
Isometric exercises, which are static contractions of the muscle, can be an effective way to get pain relief with a tendonitis. This has been shown to be effective in several studies on the patella and Achilles tendons. While the patella tendon is a different portion of the tendon of the quadriceps muscle it is possible to get a similar effect with the quadriceps portion with static exercises. And this has been found to be true anecdotally. Research with a group of volleyball players with patella tendinopathy showed a significant pain reduction after a single session of exercise. 5 sets of 45second isometric contractions at 70% maximum voluntary contraction produced a staggering reduction of pain from an average of 7/10 to 0/10. This pain relief was sustained for at least 45minutes after the session (Rio et al, 2015).
A good way to relax the muscle is using a foam roller or massage gun. This firm pressure or percussive action can reduce the tone in a muscle temporarily, which for some people reduces symptoms temporarily also. The bottom line is to try and see how your body reacts.
This contraction can be done either on a knee extension machine, using a resistance band or wall to push against, or using a leg press or squat position. The knee needs to be held against the resistance for 45seconds in a mid bend position. A short break of a few minutes is taken then the process is repeated 4-5 times. The difficulty with this exercise is finding the optimal load that will produce this analgesic effect. If the resistance is too low it will not be effective and if it is too high it may aggravate symptoms. It is therefore advised to start below the estimated level of tolerance and increase the resistance gradually over several sessions until the optimum resistance is found.
There has been a change in the selection of rehabilitation protocols in the past few years for tendonitis or tendinopathy in general. Research has shown a better effect of heavy and slow resistance training in both eccentric and concentric directions as compared to eccentric exercises alone. Previously there has been a trend of using eccentric exercises and avoiding the concentric phase.
With an eccentric exercise, a muscle works as it lengthens, think of the lowering movement of the biceps curl. With a concentric exercise, the muscle works as it shortens, think of the upward movement of a biceps curl.
As quadriceps tendonitis is a less common area of tendonitis, other areas have been researched more. We can consider this information in relation to the quadriceps tendon. Most similar is the patella tendon for which much research has been done. A review of this research compared three treatment options for patella tendonitis: corticosteroid injections, eccentric exercise, and heavy slow resistance. The conclusions were that short and long outcomes with the heavy slow resistance protocols were better for both patient satisfaction and pathological improvement, as compared to the other groups (Kongsgaard et al, 2009).
In practical terms, this rehab protocol entails 3 strengthening sessions per week. Using 4 sets of slow repetitions of leg press, hack squat and squat exercises. These all start with lower weights, of 15 repetitions max and gradually lower over 12 weeks to 6 repetitions max weights. This is heavy strength training and is therefore not appropriate for everyone. For a healthy and fit population, this is extremely effective.
Tendonitis is caused by an overload of the tendon. Therefore, the tendon mostly needs relative rest and reconditioning. Therefore stretching does not play an essential role in recovery. However, any additional load, even that from the muscle being tight can exacerbate the issue and may increase pain. Anecdotally some people find stretching gives them pain relief. On the other hand, it can also aggravate pain for others.
Read more about Quadriceps Tendonitis Treatment.
Stretching can be more helpful in preventing tendon injuries. In particular ballistic stretching before activity. With healthy non-injured tendons, static and ballistic stretching can increase tendon elasticity and have a positive effect on passive resisted torque and tendon stiffness. These are elements that improve the function of tendons and reduce their chance of injury (Witvrouw et al, 2007).
This is not medical advice and we recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. He offers Online Physiotherapy Appointments for £45.
How long does it take to heal?
The healing time of a tendon is around 3-4 months. Physiologically this is the time it needs under healthy conditions with the right stimulation that the tendon needs to fix. Recovery will take longer if conditions are not ideal, such as if there are frequent aggravations or flair-ups by overdoing it. Therefore it may feel frustrating but it is important to be patient for follow the gradual recovery process. Small incremental increases will produce a steady improvement. Larger jumps in weight, load or volume will risk a flair-up.
Can I exercise with quadriceps tendonitis?
You should avoid any exercise that causes an increase in pain in the tendon for more than 1-2 hours after the activity. These activities that cause aggravation for this prolonged period are not tolerated by the tendon and are not going to have the desired effect of stimulating the correct recovery.