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Quadriceps-Tendonitis.Pdf A Patient's Guide to Quadriceps Tendonitis the patella is called the quadriceps mecha- nism. Though we think of it as a single device, the quadriceps mechanism has two separate tendons, the quadriceps tendon on top of the patella and the patellar tendon below the patella. Introduction Alignment or overuse problems of the knee structures can lead to strain, irritation, and/ or injury of the quadriceps muscle and tendon. This produces pain, weakness, and swelling of the knee joint. These problems can affect people of all Tightening up the quadriceps muscles places a ages but the majority of patients with pull on the tendons of the quadriceps mecha- overuse injuries of the knee (and specifi- nism. This action causes the knee to straighten. cally quadriceps tendonitis) are involved in The patella acts like a fulcrum to increase the soccer, volleyball, or running activities. force of the quadriceps muscles. This guide will help you understand The long bones of the femur and the tibia act as level arms, placing force or load on the knee • what parts of the knee are affected joint and surrounding soft tissues. The amount • how doctors diagnose the problem of load can be quite significant. For example, • what treatment options are available the joint reaction forces of the lower extremity (including the knee) are two to three times the Anatomy What is the quadriceps muscle/tendon, and what does it do? The patella (kneecap) is the moveable bone on the front of the knee. This unique bone is wrapped inside a tendon that connects the large muscles on the front of the thigh, the quadriceps muscles, to the lower leg bone. The large quadriceps muscle ends in a tendon that inserts into the tibial tubercle, a bony bump at the top of the tibia (shin bone) just below the patella. The tendon together with A Patient's Guide to Quadriceps Tendonitis body weight during walking and up to five strength of the structure, then injury can occur. times the body weight when running. Repeated microtrauma at the muscle tendon junction may overcome the tendon’s ability to Causes heal itself. Tissue breakdown occurs triggering How does the condition develop? an inflammatory response that leads to tendon- itis and even partial tears. Quadriceps tendonitis occurs most often as a result of stresses placed on the supporting Chronic quadriceps tendonitis is really a structures of the knee. Running, jumping, and problem called tendonosis. Inflammation is not quick starts and stops contribute to this condi- present. Instead, degeneration and/or scarring tion. Overuse injuries from sports activities of the tendon has developed. Chronic tendon is the most common cause but anyone can be injuries are much more common in older affected – even those who do not participate in athletes (30 to 50 years old). sports or recreational activities. Symptoms There are extrinsic (outside) factors that are What does this condition feel like? linked with overuse tendon injuries of the knee. These include inappropriate footwear, training errors (frequency, intensity, duration), and surface or ground (hard surface, cement) being used for the sport or event (such as running). Training errors are summed up by the rule of "toos." This refers to training too much, too far, too fast, or too long. Advancing the training schedule forward too quickly is a major cause of quadriceps tendonitis. Intrinsic (internal) factors such as age, flex- ibility, and joint laxity are also important. Malalignment of the foot, ankle, and leg can play a key role in tendonitis. Flat foot position, tracking abnormalities of the patella, rotation Pain from quadriceps tendonitis is felt in the of the tibia, and a leg length difference can area at the bottom of the thigh, just above the create increased and often uneven load on the patella. The pain is most noticeable when you quadriceps mechanism. Any muscle imbalance move your knee. The more you move your of the lower extremity (from the hip down to knee, the more tenderness develops in the area the toes) can impact the quadriceps muscle and of the tendon attachment above the kneecap. affect the joint. Individuals who are overweight may have added issues with load and muscle There may be swelling in and around the imbalance leading to quadriceps tendonitis. quadriceps tendon. It may be tender or very sensitive to touch. You may feel a sense of Strength of the patellar tendon is in direct warmth or burning pain. The pain can be proportion to the number, size, and orienta- mild or in some cases the pain can be severe tion of the collagen fibers that make up the enough to keep the runner from running or tendon. Overuse is simply a mismatch between other athletes from participating in their sport. load or stress on the tendon and the ability Stiffness of the knee is common when you first of that tendon to distribute the force. If the get up in the morning (or after a long period forces placed on the tendon are greater than the A Patient's Guide to Quadriceps Tendonitis of rest or inactivity), and during and after relative rest and anti-inflammatory medica- exercise. tions, such as aspirin or ibuprofen, especially when the problem is coming from overuse. Diagnosis Acetaminophen (Tylenol®) may be used for How do doctors diagnose this problem? pain control if you can’t take anti-inflamma- tory medications for any reason. Diagnosis begins with a complete history of your knee problem followed by an examina- Relative rest is a term used to describe a tion of the knee, including the patella. There process of rest-to-recovery based on the is usually tenderness with palpation of the severity of symptoms. Pain at rest means strict inflamed tissues at the insertion of the tendon rest and a short time of immobilization in a into the bone. The knee will be assessed for splint or brace is required. When pain is no range of motion, strength, flexibility and joint longer present at rest, then a gradual increase stability. in activity is allowed so long as the resting pain doesn’t come back. The physician will look for intrinsic and extrinsic factors affecting the knee (especially Physical therapy can help in the early stages sudden changes in training habits). Potential by decreasing pain and inflammation. Your problems with lower extremity alignment are physical therapist may use ice massage, identified. The doctor will also check to see electrical stimulation, and ultrasound to if the quadriceps tendon is partially torn or limit pain and control (but not completely ruptured. Weakness of the extensor mechanism prevent) swelling. Some amount of inflam- is a sign of such an injury. matory response is needed for a good healing response. X-rays may be ordered on the initial visit to your doctor. An X-ray can show fractures The therapist will prescribe stretching and or the presence of calcium deposits in the strengthening exercises to correct any muscle quadriceps muscle but X-rays do not show soft imbalances. Eccentric muscle strength training tissue injuries. In these cases, other tests, such helps prevent and treat injuries that occur as ultrasonography or magnetic resonance when high stresses are placed on the tendon imaging (MRI), may be suggested. Ultrasound during closed kinetic chain activities. Eccentric uses sound waves to detect tendon tears. MRIs contractions occur as the contracted muscle use magnetic waves rather than X-rays to show lengthens. Closed kinetic chain activities the soft tissues of the body. This machine means the foot is planted on the floor as the creates pictures that look like slices of the knee bends or straightens. knee. Usually, this test is done to look for Flexibility exercises are often designed for the injuries, such as tears in the quadriceps. This thigh and calf muscles. Specific exercises are test does not require any needles or special dye used to maximize control and strength of the and is painless. quadriceps muscles. You will be shown how to Treatment ease back into jumping or running sports using good training techniques. Off-season strength How do doctors treat the condition? training of the legs, particularly the quadriceps Nonsurgical Treatment muscles is advised. The initial treatment for acute quadriceps Bracing or taping the patella can help you do tendonitis begins by decreasing the inflamma- exercises and activities with less pain. Most tion in the knee. Your physician may suggest braces for patellofemoral problems are made A Patient's Guide to Quadriceps Tendonitis of soft fabric, such as cloth or neoprene. You Avoid the "too" training errors mentioned slide them onto your knee like a sleeve. A earlier. small buttress pads the side of the patella to Surgery keep it lined up within the groove of the femur. An alternative to bracing is to tape the patella Surgery is rarely needed when a wide range of in place. The therapist applies and adjusts the protective measures, relative rest, ice, support, tape over the knee to help realign the patella. and rehab are used. If nonsurgical treatment The idea is that by bracing or taping the knee, fails to improve your condition, then surgery the patella stays in better alignment within may be suggested. Surgery is designed to the femoral groove. This in turn is thought to stimulate healing through revascularization improve the pull of the quadriceps muscle so (restoring blood supply). Weak, damaged that the patella stays lined up in the groove. tissue is removed and the injured tendon is Patients report less pain and improved function repaired. Tissue remodeling through surgery with these forms of treatment. can restore function. Therapists also design special shoe inserts, Arthroscopic procedures can usually be called orthotics, to improve knee alignment done on an outpatient basis.
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