What treatment options are available?
Prevention of future injuries through patient education is a key component of our treatment program. This is true whether conservative care or surgical intervention is required. Modification of intrinsic and extrinsic risk factors is essential.
Non-surgical Rehabilitation
At Next Step Physio, the initial treatment for acute quadriceps tendonitis begins by decreasing the inflammation in the knee. Our physiotherapist may suggest relative rest and anti-inflammatory medications, such as aspirin or ibuprofen, especially when the problem is due to overuse. Acetaminophen (Tylenol®) may be used for pain control if you can't take anti-inflammatory medications for any reason.
Relative rest is a term used to describe a process of rest-to-recovery based on the severity of symptoms. If you have pain at rest, strict rest is required and possibly a short time of immobilization in a splint or brace. When pain is no longer present at rest, then a gradual increase in activity is allowed so long as the resting pain doesn't come back.
Physiotherapy can help in the early stages by decreasing pain and inflammation. When you begin your physiotherapy program, we may initially use ice massage, electrical stimulation, and ultrasound to limit pain and control (but not completely prevent) swelling. Some amount of inflammatory response is needed for a good healing response.
Our physiotherapist will prescribe stretching and strengthening exercises to correct any muscle imbalances. Eccentric muscle strength training helps prevent and treat injuries that occur when high stresses are placed on the tendon during closed kinetic chain activities. Eccentric contractions occur as the contracted muscle lengthens. Closed kinetic chain activities means the foot is planted on the floor as the knee bends or straightens.
We often recommend flexibility exercises designed for the thigh and calf muscles. Specific exercises are used to maximize control and strength of the quadriceps muscles. We will show you how to ease back into jumping or running sports using good training techniques. Off-season strength training of the legs, and particularly the quadriceps muscles is advised.
Bracing or taping the patella can help you do exercises and activities with less pain. Most braces for patellofemoral problems are made of soft fabric, such as cloth or neoprene. You slide them onto your knee like a sleeve. A small buttress pads the side of the patella to keep it lined up within the groove of the femur. An alternative to bracing is to tape the patella in place. Our physiotherapist can apply and adjust the tape over the knee to help realign the patella. The idea is that by bracing or taping the knee, the patella stays in better alignment within the femoral groove. This in turn is thought to improve the pull of the quadriceps muscle so that the patella stays lined up in the groove. Patients report less pain and improved function with these forms of treatment.
Our physiotherapists may also recommend special shoe inserts, called orthotics, to improve knee alignment and function of the patella. Proper footwear for your sport is important.
Coaches, trainers, and physiotherapists can work together to design a training program that allows you to continue training without irritating the tendon and surrounding tissues. Remember to warm up and stretch before exercise. Some experts recommend a cool down and stretching after exercise as well. Know your limits and don't overdo it.
Use ice after activity if indicated by pain or swelling. Icing should be limited to no more than 20 minutes to avoid reflex vasodilation (increased circulation to the area to rewarm it causing further swelling). Heat may be used in cases of chronic tendinosis to stimulate blood circulation and promote tissue healing.
Whenever you have to miss exercising for any reason or when training for a specific event, adjust your training schedule accordingly. Avoid the "too" training errors mentioned earlier.
Quadriceps tendonitis is usually self-limiting. That means the condition will resolve with rest, activity modification, and physiotherapy. Recurrence of the problem is common for patients who fail to let the quadriceps tendon recover fully before resuming training or other aggravating activities.
Although recovery time varies among patients, physiotherapy for about four to six weeks is usually recommended. The aim of our treatment is to calm pain and inflammation, to correct muscle imbalances, and to improve the function of the quadriceps mechanism.
With the Next Step Physio rehabilitation program, many patients are able to return to their previous level of activity without recurring symptoms.
Post-surgical Rehabilitation
Many surgeons will have their patients take part in formal physiotherapy after knee surgery for patellofemoral problems. More involved surgeries for patellar realignment or restorative procedures for tendon tissue require a delay before going to therapy. Rehabilitation may be slower to allow the tendon to heal before too much strain can be put on the knee.
When you begin your physiotherapy program, treatments are designed to help control the pain and swelling from the surgery. Our physiotherapist will choose exercises to help improve knee motion and to get the quadriceps muscles toned and active again. Muscle stimulation, using electrodes over the quadriceps muscle, may be needed at first to get the muscle moving again.
As your program evolves, more challenging exercises are chosen to safely advance the knee's strength and function. The key is to get the soft tissues in balance through safe stretching and gradual strengthening.
At Next Step Physio our goal is to help you keep your pain under control, ensure you place only a safe amount of weight on the healing knee, and improve your strength and range of motion. When your recovery is well under way, regular visits to our office will end. Although we will continue to be a resource, you will be in charge of doing your exercises as part of an ongoing home program.
Next Step Physio provides services for physiotherapy in Edmonton.
Intrinsic (internal) factors such as age, flexibility, and joint laxity are also important. Mal-alignment of the foot, ankle, and leg can play a key role in tendonitis. Flat foot position, tracking abnormalities of the patella, rotation of the tibia, and a leg length difference can create increased and often uneven load on the quadriceps mechanism. Any muscle imbalance of the lower extremity (from the hip down to the toes) can impact the quadriceps muscle and affect the joint. Individuals who are overweight may have added issues with load and muscle imbalance leading to quadriceps tendonitis.