Quadriceps Tendon Pain

If you’ve ever experienced any kind of leg pain, you will know how excruciatingly annoying it can be. After all, we rely on  our legs to perform eventhe simplest of tasks, and when they start to ache, the world around us can become a bit depressing. In this article, uadriceps tendon pain, that occurs just above the kneecap, will be discussed. Also covered are causes, symptoms, risk factors, diagnosis, and the operative and non-operative treatment management options. 

What is quadriceps tendon pain?

To better understand this issue, we  need to delve into human anatomy. Although this might feel a bit complicated, understanding the organisation of muscles and bones in your leg can help. 

In medical terms, the kneecap is known as the patella. This bone connects the large muscles in the front of the thigh, known as  the quadriceps, to the lower leg bone. The quadriceps end in a tendon, which in turn inserts into a bony bump at the top of the shin bone,just belowthe kneecap. The mechanism of action of the quadriceps muscles requires the use of two separate tendons: one located on top of the kneecap (quadriceps tendon) and the other below the kneecap (patellar tendon).¹

uadriceps tendon pain occurs as a result of putting undue stress on the knee, in turn, on the two tendons. But in what ways do we put pressure on the knee, and is it only external factors? Let’s find out!

Causes of quadriceps tendon pain

As you might have guessed from the anatomy of the knee and tendons, putting undue stress or pressure on the structures supporting the knee can be harmful and painful, leading to quadriceps tendon pain. There are extrinsic (external) and intrinsic (internal) factors that may cause this:

• Extrinsic (external) factors 

This usually involves the use of unsuitable footwear and overtraining (in terms of frequency, duration, and intensity). The issue is also usually seen in those who particpate in extensive ground or surface sports,such as running. Additionally, if you’re following a training schedule but attempt to advance too rapidly, your quadriceps might bear the brunt of it, leading to wear and tear.² 

• Intrinsic (internal) factors

Intrinsic factors such as age, flexibility, and joint mobility can affect the proper functioning of quadricep-supporting structures. Abnormalities in foot structures, such as misalignment of the foot, ankle, or leg, or issues such as flat feet and leg length differences, can lead to tendonitis. In addition, obesity and muscular issues in the lower extremities due to disease or otherwise can also cause problems in the quadriceps tendons.²

Risk factors for quadriceps tendon pain 

There are various risk factors that can contribute to getting quadriceps tendonitis, including:³

• Obesity
• Diabetes
• People who playground/surface-based sports such as volleyball or soccer
• Rheumatoid Arthritis
• Leukemia
• Gout
• Chronic Renal Failure 

Symptoms of quadriceps tendon pain

Symptoms usually include pain in the bottom thigh area, just above the kneecap, whichworsens with knee movement. Other key signs may include:³

• Swelling near the tendon
• Sensitive to the touch
• Burning, irritation, or warmth in the affected area
• Knee stiffness early in the morning or upon waking up

Diagnosis of quadriceps tendon pain

• Medical History

Diagnosis of quadriceps tendon pain usually begins with the healthcare practitioner taking a full history of the patient’s knee problems.

• Physical Exam

The next step involves assessing the  range of motion, flexibility, movement, and strength of the knee. The physician may also look for scars or swelling and check for ruptured tendons. All of this will be done while keeping in mind the extrinsic factors that may affect knee movement.³ 

• Imaging tests (X-rays and MRI scan)

X-rays are beneficial in showing fractures or the presence of calcium deposits, but to rule out soft tissue injuries, the physician may order Magnetic Resonance Imaging (MRI) or an ultrasound. Notably, all of these procedures are completely painless.¹

Treatment options

Non-surgical treatment

RICE

RICE refers to Rest, Ice, Compression, and Elevation. This is usually the first-line treatment in acute cases, especially if it is a mild case. The treatment essentially involves resting, applying ice or cold therapy, bandaging, and elevating the affected area to relax the affected muscles.⁴

Physiotherapy

When RICE treatment is not sufficient, a physiotherapist can be the next step. Physiotherapy may involve electrical invigoration, ultrasound, and exercise programs for joint and soft tissue mobilisation and stabilisation.⁴ 

Quadriceps tendonitis exercises

Exercises for most types of tendonitis are simply used to get the patient back to usual levels of mobility and can range from light stretches to the use of resistance bands for increasing affected muscle and core strength. Some examples of these exercises include straight leg raise, hamstring curl, prone quadriceps stretch, and supine hamstring stretch.⁵

Quadriceps tendonitis taping and bracing

Tapes and braces essentially work by properly aligning the kneecap, and supporting the distribution of  force on the quadriceps tendon. Physiotherapists typically advise patients on which braces to use and how to wear them. However, it’s important to note that before using braces, patients may benefit from taping to determine if the pain decreases and to give them a general idea of how the mechanism works. It would then be a wise investment to get a brace.⁶

Orthotics

Structural and functional imbalances in your legs can cause issues in the knees, hips, ankles, and other areas of the lower limbs, which can lead to  falls, ankle sprains, and foot pain occurring frequently. Orthotics involves the use of insoles, braces, splints, calipers, footwear, and other devices to address these biomechanical issues.^7,8

Anti-inflammatory medications

If the muscle is overused, doctors may prescribe ibuprofen to reduce  inflammation. If the patient tolerates anti-inflammatories, medications such as acetaminophen may be used.¹ 

Surgical treatment

Open surgery

Surgery is usually the last resort and  performed in the most severe cases. Open surgery requires the surgeon to reattach the torn tendon to the patella. The surgeon will drill small holes into the patella to firmly secure the tendon to the bone and restore its normal position and function.⁹

Arthroscopic surgery

Arthroscopic surgery is a minimally invasive surgical procedure used for diagnosing knee problems. The surgeon will make a small incision above the knee and insert a camera called an arthroscopeto view the knee and surrounding structures. If further surgical treatment is required, tiny instruments will be inserted through other incisions to carry out the treatment. This type of surgery is less invasive than open surgery and allows for a quicker recovery time.¹⁰

Percutaneous ultrasonic tendon debridement (PUT)

This procedure assists faster and natural healing of the tendon by the body. The procedure involves inserting a needle under ultrasound guidance to pierce the damaged parts of the tendon. Since tendons have limited blood supply, repeatedly piercing the damaged area is thought to trigger the body’s natural healing response by mimicking a new injury that requires immediate repair.¹¹

After surgery

While open surgery takes around 4 months to heal, arthroscopic surgery and PUT take a relatively shorter time to heal (around 6 to 8 weeks). Nonetheless, it is important to take your physician's post-op advice.

Outcomes

All of the above surgical procedures have a very positive outlook and the majority of the patients make full recovery. It is however crucial to avoid high-impact activities during the recovery period.^9,10,11

Summary

Quadriceps tendonitisrefers to  pain that occurs around the kneecap area. It usually occurs due to the overuse of  muscles and tendons that surround the kneecap. This can occur if one excessively partakes in surface sports or overtrains too much. However, there are a variety of other risk factors. Diagnosis usually involves a Medical History check, imaging, and a physical exam. Treatments are usually non-surgical unless it is a very severe case.  If you are experiencing pain or discomfort in your knees or the surrounding areas, it is best to see  your physician, as this will ensure that you recover faster.