Injury: Quadriceps Tendinopathy
Background: The quadriceps muscles are a group of four muscles that are located in the front of the upper leg and are usually referred to as the thigh muscles. The muscles come together to form one large tendon as they travel to the knee, called the quadriceps tendon. The quadriceps tendon connects to the upper part of the knee cap and is the primary extensor of the knee. With overuse to the quadriceps muscle in sports, one can develop irritation and inflammation of the tendon, called quadriceps tendonitis. Over time, typically within 1 to 3 months, if the tendonitis persists, the tissue can undergo changes that cause the tendon to develop a more chronic pain. The underlying changes to the tendon do not usually have definitive inflammation, and so the name changes to tendinopathy, rather than tendonitis.
Evaluation: Athlete will usually have no notable swelling of the knee. Tenderness is typically seen with deep pressure directly over the quadriceps tendon (pictured below). Pain may also be reported at the quadriceps tendon with extension of the knee against resistance, as well as with exercises like lunges or squats.
Treatment: In general, quadriceps tendinopathy can be difficult to treat, because it has developed over a prolonged period and there is actual structural change to the tissue, rather than just inflammation, as in tendonitis. Relative rest, stretching and icing is a good first step when in pain. However, soft tissue stimulatory techniques, such as ASTYM, Graston or Dry Needling, may be necessary for resolution of the pain.
Return: Many athletes will attempt to play through the pain initially, as the pain may occur only with certain aspects of sport or physical activity. However, over time the pain may progress to limit the ability to participate. Specific time for return to play can be difficult, because the athlete may need to fail typical conservative measures before more aggressive measures are taken. A general recommendation would be gradual return to sports after 4 to 6 weeks of physical therapy that includes a soft tissue stimulatory technique.
Sports Considerations: The underlying process of this condition does play a role in pain management. Due to tendinopathy implying chronic changes to the tendon rather than inflammation, anti-inflammatory medications may not be the best choice. Also, when being treated with soft tissue stimulatory techniques, it may be counter productive to use anti-inflammatory medications, as they may dampen the body's appropriate healing response to the treatment.
