Thigh Pain
Quadriceps Tendonitis Exercises
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Quadriceps Tendonitis Physiotherapy
A quadriceps tendonitis treatment should start in the acute stages like many other acute injuries. There are several acronyms that you might be familiar with or advised to follow. RICE, PRICE, POLICE. The most up to date is: P.E.A.C.E. & L.O.V.E. (Dubois & Esculier, 2020). In the initial phase: protect, elevate, avoid non-steroidal anti-inflammatories such as ibuprofen, compress and educate the individual about the injury. The next phase is: load, optimism (a positive outlook has been shown to improve outcomes), vascularisation in the form of exercise that doesn’t aggravate the tendon, and exercise that is more specific for the area.
Physiotherapy for quadriceps tendonitis is very effective. Physiotherapists are experts in soft tissue injuries and will be able to educate you about the injury and the best management and treatment plan and rehabilitation exercises for you.
A physiotherapy assessment will look at the whole body, not just the affected knee. Part of the physiotherapy assessment is to understand all of the factors that might have influenced the development of the injury. While quadriceps tendonitis is very common in basketball, a lot of people play basketball and don’t get tendonitis. So understanding the specific contributing factors for your case is important for your recovery and for the prevention of any recurrence in the future.
In addition to education and rehabilitation exercises, physiotherapists can offer different treatments to help promote your recovery. One such treatment is acupuncture or dry needling, which is effective for pain relief and improving function and can aid healing from tendonitis. Acupuncture works by increasing the synthesis of type 1 collagen which is necessary for the repair of tendons, and this type of collagen positively influences the biomechanical properties of a tendon (dos Santos de Almeida et al, 2018).
Rehabilitation exercises are the basis for a successful recovery of tendonitis. Read about Quadriceps tendonitis Exercises.
Quadriceps Tendonitis and Massage
Treatments that physiotherapists can offer include massage and trigger point release. This can be effective for pain relief and can help reduce the strain on a tendon. This can occur if the surrounding muscles are tight. You can also perform massage on yourself. Massage the tissue around the area of pain for 5-10 minutes once or twice daily can be helpful for pain relief. In addition, there are several self-massage pieces of equipment such as massage guns which work by vibration and percussion to relax the muscle.
Trigger points are specifically tight areas within a muscle that can be painful to touch and often refer pain in a regular pattern from the tender point. These points can keep the muscle from being supple as this small portion of the muscle remains switched on a tight.
Quadriceps Tendonitis Taping
The main use of taping during quadriceps tendonitis treatment, is for pain relief via offloading strain from the tendon, in most cases by lifting the patella up the. There are several different options when it comes to offloading the quadriceps tendon with taping. There is poor evidence about the efficacy of taping, but it is a low-cost and safe option, so is often worth trying to see if it offers some pain relief.
Kinesio Taping
Once effective tape technique is with elasticated sports tape, sometimes called Kinesio tape, KT tape, or Rock tape. Using two strips, these are applied to the thigh from about halfway down. One tape applied to the outer part of the thigh and the other to the inner part. The lower ends of the tape wrap around the bottom of the knee cap to finish on the opposite side of the leg on the shin. A stretch is applied to the tape while attaching it to the skin around the knee joint. This produces a recoil of the elasticated tape to lift the patella and offload the tendon. It is best to apply the tape with the leg is relaxed with a slight knee bend, approximately 20º of flexion. Sometimes an additional horizontal strip is applied across the front of the knee also.
Rigid Taping
Another option is using ridged tape, often called zinc oxide tape, which has no elastic property. An anchor strip is applied horizontally across the top of the knee about 3cm above the upper border of the patella. The next two strips are applied one from the inner side of the shin running under the patella and crossing to the outer part of this horizontal strip. The other from the outer side of the shin running under the patella to the inner part of the horizontal strip. These two strips should be applied at the lower end and pulled up to the horizontal strip to slightly crease the skin and provide the desired lift of the patella.
Quadriceps Tendonitis Brace
Knee braces or compressive sleeves can be worn for quadriceps tendonitis. The main function of a brace is to offer more support of the knee joint, and some also offer compression around the joint. Compression can help in two ways. If there is swelling it can help this be reabsorbed and reduce the stagnation of swelling in the area. The second way it can help is by providing greater proprioception of the area. Proprioception is our internal awareness of our body or body part without seeing it, this includes knowing if your knee is bent or straight or if it is rolling in when you walk up the stairs for example.
Injections and medications
In some cases where improvement is poor or progress is slow the addition of other interventions to a rehabilitation program can be effective. A non-invasive quadriceps tendonitis treatment is the use of GTN patches, shockwave therapy is another. GTN patches are glyceryl trinitrate or nitroglycerin patches that can be applied to the skin over the tendon. The compound is absorbed through the skin and reduces pain in the tendon. It is thought that it helps by dilating blood vessels and may stimulate collagen which aids the healing process of the tendon.
Shockwave works potentially works in three different ways: by shocking the nerves and reducing their conduction, therefore reducing perceived pain; affecting specific properties of cells during the recovery process; by breaking down calcium deposits that develop in poorly healed tendons.
More invasive quadriceps tendonitis treatment includes injections, which are effective in some specific cases. There are different forms of injection that can be used. Corticosteroids are used for the anti-inflammatory effect but there is some evidence to show that there can be a negative effect on the structural integrity of the tendon. Therefore, this treatment is often not advised. If it is, there will be a limit to the number and frequency of the injections administered to the tendon.
Surgery
Surgery is kept as a last resort once all other treatments have been tried for an appropriate period of time but with no satisfactory recovery. Traditional surgery includes the removal of diseased portions of the tendon or calcification that can form with tendonitis. A more recent development with surgery is the use of a scraping technique that removes the small nerves that can form with tendonitis. The outcome of this new technique is more positive in terms of pain reduction and a quicker return to sport and activities post-surgery (Masci et al, 2020).
Read more about Quadriceps Tendonitis: Symptoms, Causes and Diagnosis.
Physiotherapy with James McCormack
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.
Can I exercise with quadriceps tendonitis?
This is difficult to answer in a general sense as it is very individual and changes. As a general guide only exercise if it is pain-free or very low pain (1-3/10). Try to find a pattern of how your body responds. Often, a tendon injury may feel ok during exercise but can be more painful after resting or a period of being static. Therefore, it is tricky to know that you are not overdoing it at the moment as you might only find out later in the day, or even the next day.
Does quadriceps tendonitis go away, and what will happen if it is left untreated?
Depending on the cause of the quadriceps tendonitis it may go away on its own with rest. This is more common if there has been a direct impact to the tendon or a sudden overload. Such as an increase in training or an unusual activity has been done. If, however, the tendonitis has gradually developed due to repeated overload over a period of time it is less likely to improve with rest alone. In these cases, active treatment is needed to resolve it. Tendonitis can cause a change in the structure of the tendon. Therefore active quadriceps tendonitis treatment is needed to stimulate specific processes to alter the structure back to what it should be so that it is stronger and more tolerant to load
When should I see a doctor for quadriceps tendonitis?
You should see a doctor for quadriceps tendonitis or if you have severe or constant pain. And if you have tried a reasonable period of 6-8 weeks of physiotherapy and rehabilitation exercise with no effect. At this point, you should be managing your symptoms better and seeing some signs that you are improving. If you do not, then having a review with a consultant or sports doctor is appropriate and they can do further tests such as imaging to ensure the diagnosis is correct. If the diagnosis is correct they may be able to facilitate your progress with additional interventions such as GTN patches, shockwave or injections. Additionally, while it is possible for the pain of tendonitis to be severe, it is possible. If your pain is extremely high and you are struggling to cope, it is important to get further investigations. This is to ensure a correct diagnosis. A doctor can prescribe you medication to help reduce the pain and facilitate you starting a rehab exercise programme.
How long does quadriceps tendonitis take to heal?
With the correct quadriceps tendonitis treatment and management, the healing process should take about 3-4 months to complete. Within this period, while pain may reduce or resolve well before this time but it is useful to remember that the healing process is still underway. Extra caution should be taken with any increases of load to the tendon such as an increase in playing time, for a basketball player. If symptoms persist past this period it will be described as chronic tendonitis. This refers to a different physiological process that occurs in the tissue. It may need to be looked at from a different angle, such as looking if there is some activity that is being continued that is causing the issue to persist.