Quadriceps Tendon Rupture, Repair and Rehab - Page 116

Wow!! Oregon Bill just made me flash back to miserable post op moments in the latrine lol..The good thing is even at 7 weeks post op I can finnaly see what evryone on this site has been trying to say. Patience plus a good balance of methods used on here will get you up and moving. As I approach 8 weeks Im feeling its time to hit the pool for some lower body stuff and go a little further on my heel slides. Im only at 50 rom but i was just given the green light last week to work on rom.. Im on a mission to kick rom is the butt... One question. Is too much rom without getting that muscle strength back causing some to buckle at the knees sometimes?

Seems to be two schools of thought: either weight bearing from day one but leg straight no ROM, or limited but increasing ROM but no weight bearing for some weeks. 

Maybe these relates to different degrees of damage?

Bikerboyz;

      I am at 7 weeks, my ROM is at 85, I haven't noticed any knee problems, things have breen pretty smooth.  Just a nice good searing pain to get 1 degree back at a time.

Having 85 ROM at 7 weeks is little consolation for having no quad strength.  I just saw my dr yesterday, he says open the brace to 30 and try walking.  I have no idea how I am going to do this, I see myself falling down.  Maybe I can use the 30 to swing my leg forward, then lock it and plant.   Very unsafe and very slow and scary, and 1 mistake its curtains!  I think I will do 30 when I get more confidence in this chicken bone.

Quote:

Originally Posted by OLD RUNNER GUY 

Metalhead: I am 6 months from surgery and my surgical quad and knee still do not look like my good one. I work out every day on it....still cannot land run but it remains puffy tight, and swelled compared to the good side. I have not done much icing after workouts or take any Isoprophen....wonder if that would help.

I find icing helps a lot, along with ibuprofen.

Quote:

Originally Posted by bikerboyz1000 

Wow!! Oregon Bill just made me flash back to miserable post op moments in the latrine lol..The good thing is even at 7 weeks post op I can finnaly see what evryone on this site has been trying to say. Patience plus a good balance of methods used on here will get you up and moving. As I approach 8 weeks Im feeling its time to hit the pool for some lower body stuff and go a little further on my heel slides. Im only at 50 rom but i was just given the green light last week to work on rom.. Im on a mission to kick rom is the butt... One question. Is too much rom without getting that muscle strength back causing some to buckle at the knees sometimes?

I found that I needed ROM before I could really get after quad strength in a big way. I had the buckling problem early on too. What I found is that once we started working proprioception (getting the quads to fire when they're supposed to) the buckling issues lessened. Now I never have that issue. I am five weeks post surgery as of today. One of the best exercises I found for proprioception is one-legged balancing. We are now working on one-legged balancing with the eyes closed. That is a real bugger.

Metalhead

I think with your rom being at 85 you shouldnt have any problem with your brace locked in at 30. Take it slow and see what you think. I had a pretty good day today getting to 55 rom. I actually walked pretty comfortably this morning with my brace set at 70. It wasnt pretty but we keep driving on right?

Tomnorth

seems your moving nicely with rom after only 5 weeks..I know these exercises your talking about and I cant wait to get after it along with others.. Orthos orders are not to challenge the tendon just yet and as much as i would love to try balancing on my repaired leg, I dont think its ready.. Everybody keep working hard and stay in fight!!!

Quote:

Originally Posted by bikerboyz1000 

Metalhead

 

I think with your rom being at 85 you shouldnt have any problem with your brace locked in at 30. Take it slow and see what you think. I had a pretty good day today getting to 55 rom. I actually walked pretty comfortably this morning with my brace set at 70. It wasnt pretty but we keep driving on right?

 

Tomnorth

seems your moving nicely with rom after only 5 weeks..I know these exercises your talking about and I cant wait to get after it along with others.. Orthos orders are not to challenge the tendon just yet and as much as i would love to try balancing on my repaired leg, I dont think its ready.. Everybody keep working hard and stay in fight!!!

I misstated my dates in my original post. I am actually five months post surgery, not five weeks. Sorry for the confusion. I only wish I had been where I am today at five weeks post surgery. ;-)

I misstated my time post surgery in this original post. I am five months post surgery, not five weeks.

since coming on board last week I've read through a lot of the entries. much help and encouaragement. thanks. but one thing I've found different in my case: I've never had any pain. not when my knee gave out, not when I hobbled between two buddies back to the trailhead, not much after surgery. only some soreness and discomfort, but no real stabbing pain like most of you describe. I'm not compalining, mind you, and realize that PT will bring pain with it, but has anyone else had a similar experience?

Wow...I just came from the PT, I am at 95 ROM, 7 weeks out exactly...the PT said time to unlock the brace to30 as per the doctor.  It took about 10 mins walking on a treadmill until I gradually let all my weight down and tried to walk.  My motion is such that I bend my leg as it goes back, swing it forward bent, and lock it and set it down.  This seems to work and it relieves a lot of hip stress and I feels somewhat liberating.  I wouldn't call it walking, because any weight put down on it is with a straight leg.  Man does it help though!

the PT said ok now try to balance on one leg with knee bent.  I am not sure why he had me try to do that, I absolutely cannot right now come close to doing that. I felt as i put my weight down on it it would just fail.  I can do half a leg extension, and as far as a straight leg lift if my leg was 5 pounds less maybe i can do it, i can let it down slowly from a raised postion. 

i guess now I have to gradually strengthen the quad, work on ROM, and try to get more confidence walking.  I am nervous doing this walking with brace open to 30, very freaky.

I also think i am brace dependent, is like a drug, without it i feel like my leg will just collapse, even though it isn't really doing anything locked at 30 (except stop my leg from twisting like a pretzel in case I fall!) 

Originally Posted by OLD RUNNER GUY

Metalhead: I am 6 months from surgery and my surgical quad and knee still do not look like my good one. I work out every day on it....still cannot land run but it remains puffy tight, and swelled compared to the good side. I have not done much icing after workouts or take any Isoprophen....wonder if that would help.

I find icing helps a lot, along with ibuprofen

Thank you TN......should do more icing.....hate to hit the medicine cabinet....but might ask my doc's opinion.    OLD RUNNER GUY

Celebrated 10 weeks post op today with a PT session.  Had ROM 129 which I am really happy with.  My previous PR was 126 last Friday.  To put this in perspective 4 weeks ago I could only do 68 degrees and I didn't know whether to throw up or cry the pain was so bad.  Now I feel tightness at my edge but not pain anymore.  I am getting close to the max for ROM and am going to start doing some yoga soon.

Last Sunday did 20 minutes on cybex machine and then 10 minutes on the erg (rowing machine).  Felt good with both since they a not weight-bearing. On Monday went out for a walk of more than my car to work or the gym trying to find a normal walking gate.  I guess I walked around 3/4 mile and felt okay but tired.  That night I was actually sore like I had run 10 miles.  Clearly this is going to be a long process.

My biggest challenge now is persistent swelling after PT or a long day at work.  I wear a knee sleeve that helps and ice my leg when I get home from work each night but the swelling always comes back. 

To newbies you have to be patient.  If you had a full quad tendon rupture you have had massive tissue damage and it will take time to heal.  Try and avoid your own macho time line for healing and rehab.  Listen to your doctor and the PT.  Hang in there and be persistent.  We are in a healing marathon, not a sprint.

Metalhead,

I suffered a complete avulsion of my left quad a year ago late March training for a powerlifting meet.   I have been a competitive strength athlete since 1985.  

I've recovered well and spent most of it just listening to my body.   I don't believe very many PTs understand this injury.   I'm not slamming the profession - there just isn't much exposure.   So, alot of the protocol they follow has more to do with knee issues.   In its pure form, this isn't a knee injury.   

I encourage you to take complete control and absolutely do not attempt something you are not comfortable with.   I do not believe pain, in our case, is our friend when it comes to recovery.   I know I'm a little fanatical but I've followed many posts a year ago and noticed several re-injuries from pushing recovery.  

Good luck,

Quote:

Originally Posted by bigggfred 
...............

I encourage you to take complete control and absolutely do not attempt something you are not comfortable with.   I do not believe pain, in our case, is our friend when it comes to recovery.   I know I'm a little fanatical but I've followed many posts a year ago and noticed several re-injuries from pushing recovery.  

 

Good luck,

I think I agree.  

I do my stretching to the limit lying down in bed on my side. I bend the leg to the angle as near as I can then just ease off a tiny bit to take off the twinges of pain. Can quite easily go to sleep in that position.  Then when I'm crutching about I swing and bend the leg fairly gently. Other than that just moving about on crutches, in wheelchair, on and off chairs, all add up to gentle leg bending.

Useful tip - getting the bad leg in and out of bed can bend it more than you want to - so just hook it up with your good leg. You can do a big swing, pivoting on your butt. The only difficulty (at first) is in making your bad leg relax whilst the good one does the work.

Quote:

Originally Posted by metalhead39 

Wow...I just came from the PT, I am at 95 ROM, 7 weeks out exactly...the PT said time to unlock the brace to30 as per the doctor.  It took about 10 mins walking on a treadmill until I gradually let all my weight down and tried to walk.  My motion is such that I bend my leg as it goes back, swing it forward bent, and lock it and set it down.  This seems to work and it relieves a lot of hip stress and I feels somewhat liberating.  I wouldn't call it walking, because any weight put down on it is with a straight leg.  Man does it help though!

 

 

the PT said ok now try to balance on one leg with knee bent.  I am not sure why he had me try to do that, I absolutely cannot right now come close to doing that. I felt as i put my weight down on it it would just fail.  I can do half a leg extension, and as far as a straight leg lift if my leg was 5 pounds less maybe i can do it, i can let it down slowly from a raised postion. 

 

i guess now I have to gradually strengthen the quad, work on ROM, and try to get more confidence walking.  I am nervous doing this walking with brace open to 30, very freaky.

 

I also think i am brace dependent, is like a drug, without it i feel like my leg will just collapse, even though it isn't really doing anything locked at 30 (except stop my leg from twisting like a pretzel in case I fall!) 

I walked this way until about a month ago. I am now five months post surgery. I finally had built up enough quad strength to try putting the leg down in a slightly flexed position. It was freaky when I first tried it. I was out for a walk in our neighborhood when I did this. I walked really slow that way, but I kept at it. I find now that it is second nature to walk more normally rather than placing my right leg down in a straightened position. So looking at my own timeline, it was about four months post surgery before I felt comfortable placing my right leg down in this slightly flexed position when walking. The fear of the leg just collapsing underneath you is real, that's for sure. My surgeon is of the ilk that has you take the leg brace off all at once rather than slowly increasing the range of motion. That scared the heck out of me at first. Looking back on it now, I'm glad he did it that way. It really forced me to pay the utmost attention to every step. It also forced me to work the quads harder.

Gratefully I shared your experience of little pain. I'm at 12 weeks since the accident and 10 1/2 wks from surgery. The only pain, was as I awoke from surgery and that was resolved with a shot. I took meds for 24 hrs and then stopped. I'm in PT now doing leg presses, trying to climb a step (very difficult), bike, etc. Based on the other posts and my progress to date, rehab is going to take many more months. Patience is the answer. Thanks to all who posted. The struggles with the brace brought back memories. Today I'm working on the report to my insurance company for reimbursement of expenses. I fell in South Africa and had the surgery there as I was concerned about flying with the injury and possible thrombosis. Had to pay cash up front for everything. Dealing with my US insurance company is providing the pain I didn't experience with the accident. Good luck!

thanks for the feedback. i feel blessed to have been nearly pain free. glad you are progresing, albeit slowly. have appt with docs in two weeks (4 weeks post op) to remove leg cast, check things out, recast (most likely) for another 2 weeks before passive PT begins with yet another cast/brace.

I, too, appreciate all the posts.

ok dudes here is the story.  My PT is talking crazy like doing leg extensions and straight leg raise now at 7 weeks 1 day out. My ROM is around 100 at this point so focus has shifted from not as much ROM to passive quad strengthening.  Giving it all I have I can meekly get my leg off the ground in a straight leg raise, and as far as leg extensions go I can do them halfway, no strength for that yet.

My kneecap feels stressed a bit when doing this, not like its going to retear, but irritates it.  I can almost get around on the stationary bike, I think if I was able to do that going in circles might help me get quad strength.

As tomnorth said I don't see myself putting any weight whatsoever on a bent knee for awhile...I tried it using using my arms for support and it would just collapse.  Thus my walking is going to be stiff legged. 

theoretically with my brace open at 30 it is not really giving any support, but if I take it off to walk stiff legged, I just can't get myself to do it i am too scared.  I put it on and I walk pretty well swinging my leg to and fro until I plant it locked straight by my own motion.   I am not even sure if I wreck that 30 degree protection will work, I feel like I would bust right through the velcro with all of the falling force.

likmetalhead

you have good rom. i would get on that bike asap lol..  as for your knee issues, if you go back through the blog this seems to be pretty popular and from what i can tell it may be due to tracking. from what everybody else have been saying is once you get your quad strength back, the knee finds its natural place and locks in. i have the same thing with my knee but its less and less the more i walk and build some strength back. leg extensions are still a little weird but i can do them until that sensation goes away in my knee. im 3 days ahead of you post op and im still playing catch up to you on my rom lol.. remember, take it slow and if your not comftortable without the brace keep wearing it.. like someone said earlier, im addicted to my brace but i know i have to break the addiction eventually.. ttyl 

Quote:

Originally Posted by metalhead39 

ok dudes here is the story.  My PT is talking crazy like doing leg extensions and straight leg raise now at 7 weeks 1 day out. My ROM is around 100 at this point so focus has shifted from not as much ROM to passive quad strengthening.  Giving it all I have I can meekly get my leg off the ground in a straight leg raise, and as far as leg extensions go I can do them halfway, no strength for that yet.

 

My kneecap feels stressed a bit when doing this, not like its going to retear, but irritates it.  I can almost get around on the stationary bike, I think if I was able to do that going in circles might help me get quad strength.

Are you talking about the leg extension machine? If so, my PT and trainer both said that it is the worst exercise for me. In fact, the head of the PT clinic said that if she had her way she'd pull all leg extension machines out of gyms. They put a tremendous amount of strain on the knee. She said that she sees a lot of patients who injured their knee on a leg extension machine.

Tomnorth,

I heard the same thing about the leg extension machine.  Trainers where I work out also say they would remove the machine if they could.  The machine puts the maximum stress possible at the worst possible place on the leg.  You definitely don't want to use the leg extension machine coming back from a quad tendon rupture.

BTW, I am now at 10 1/2 weeks post op and got 133 degrees ROM today.  That's my new PR.  Otherwise progress is good but seems slow.  I have moments when I am excited about how far I've come and then moments when I realize how far I have to go to be able to run again.  Unfortunately there are no quick fixes.

I have been told the same thing, stay away from leg extension machines!

I accidentally came across this forum when I was at home researching physical therapy for surgically repaired quadriceps tendons.  I had my surgery on January 23, 2012 and am now roughly 15 weeks post-op.  The comments by all of you definitely made my recovery more bearable knowing that there was light at the end of the tunnel.  I felt absolutely useless for the first 6 weeks after surgery and really wondered if I was ever going to "walk" normally again.   Reading about the experiences of others gave me hope.

Now at 15 weeks, I have been fully released to return to work.   I had my last PT session yesterday and owe my recovery to my physical therapist.  He was very knowledgeable about this type of injury and kept me motivated.   My ROM is now 125 degrees and I am now able to climb up and down stairs with little difficulty.  I too was concerned about the occasional "buckling" at the knee, however, this goes away with time.   The balancing exercises seemed to help with this.   I am nowhere near 100%, however, I am able to take extended walks and do aggressive riding on the stationary bike.   I probably will not begin any light jogging until I get to 20 weeks.   Swelling at the knee, lower leg and ankle is still a problem, especially when standing for long periods of time.   I have noticed, however, that this condition has decreased significantly and am now primarily suffering from pitting edema.

Like so many others, slipping on ice was a contributing factor to my injury.  I slipped at the top of icy porch stairs at my house and promptly ended up at the bottom with my right leg being crumpled into a frozen snowbank (snow that had fallen off the porch roof).   I had a complete tear of the quad tendons with surgery 1 week later.  My fault, I was not paying attention and I was in a hurry to get down to the driveway.   I did not turn on the porch light (early evening) and did not see the thin sheet of ice that had formed on the top of the stairs.  This was formed my snow melting off the roof and refreezing on the steps.   We are very diligent in keeping our porch steps clear of snow, however, being in a hurry, failing to turn on the outdoor lights and not checking the condition of the porch steps before using them all contributed to my injury.  Moral of the story: slow down and don't get in a hurry (and stay off of ice, or if unavoidable, please be careful!!).

Those of you are still early in the recovery phase, hang in there!  It does get better.  Following the routine prescribed by your physical therapist but don't overdo it!  It was a reality check for me when I realized that it would quite a long time before I would be able to ski, hike, backpack, jog, etc.  The good news is that I will be able to do these activities again!

I want to personally thank all of you that have shared their experiences and encouragement on this forum.   Sharing our experiences really makes a difference.

Will Run Again: You might be more interested in this than others: I am 6   months .actually 27 weeks from surgery....was seeing my PT about every 3 weeks as a follow up to the endless rehab. On my last visit.....hopefully forever to my PT found that I could do finaaly some light running and interestingly much better barefoot than in my running shoes. Before my injury I had tried some running in the 5 fingers barefoot type shoes. While my PT does not suggest this going to a very light,minimalist type shoe is what I am going to try. I have relatively flat feet but will not go to such a heavier cushioned stability shoe like pre injury. I will start out.....1 minute run....2-3 minute walk and repeat these intervals as I get stronger. Will let you know how I progress. Don't want to rush it as on my first try's had soreness which I will ice. 6 months and while I can bike, weight train, and do elip machines miss my running. To all others behind me in rehab....although it is difficult we can not fight nature...so again patience and persistence is key. Everyone....Make It A Great Day.....ORG....aka....TOM

Week 4+

Bending OK to 60deg. Best if in bed on my side as I can get the bend and relax everything at the same time and stay there indefinitely.

Started touching the floor whilst using crutches, which feels nice, but am avoiding any weight bearing altogether.

Having read earlier posts I'm not going to make any dramatic effort to speed things up - I intend to take it slowly as it will probably be quicker in the end!

Next week to 90 deg and starting to put  partial weight on, which should be OK judging by progress so far.

Back to work OK - paddling about in a wheelchair telling them all what to do. If I had the space I'd wonder about having a kayak on castors, but avoiding any rolling!

Joined the gym - not for the leg but for everything else - I need some heart and lung exercise, having hardly moved a muscle in 4 weeks.

Old Runner Guy,  congratulations on those first running intervals!!!  I know how hard you've worked to get there and how much it means to you.  I am intrigued by the barefoot running issue.  I grew up in FL and as a kid ran barefoot everywhere even on asphalt and concrete!  In high school I often ran cross country races barefoot but was more of a track runner and sprinter.  Wearing running spikes is as close to being barefoot as you can get.  My girlfriend is an elite runner and she just bought a pair of the barefoot mimicking running shoes.  I have friends who train and race in them.  The shoes look like duck's feet but people love them.  Do me a favor and run a few intervals for me this weekend!  Please keep me posted on how the running is progressing.  Do you still get knee swelling?  Any knee discomfort while running or afterwords?

Skip Intro, based on my 10 1/2 weeks experience post op you are spot-on with you progress and approach.  When I was at 4-5 weeks I was only able to reach 68 degrees ROM in one of my first PT sessions and the pain and stress was so bad I almost threw up.  Yesterday I reached 133 degrees with relative ease.  I started weight bearing with the brace at about 4 weeks but was using crutches for the most part.  At six weeks I used the crutches less and less but still the brace.  At eight weeks the surgeon let me lose the brace but I needed crutches for a half week of transition.  I now wear a knee sleeve for support and comfort.  The key is to be steady, persistent, and patient.  You can't rush or fool mother nature!  The greatest risk we have is reinjuring the quad tendon tear so slow and steady wins this race!

Kentucky Derby tomorrow.  Union Rags!!!  I always pick them and am rarely right although I am always convinced of my pick before the race.  Union Rags looks special though.  We'll see tomorrow.

Happy healing to all!!!

Dan

A quick update to document what continues to be a slow but steady return of function.  Quick summary; there are good days and not so good days but the trend is a strong positive.

Current status:

Strength is 55 -70%, ROM 80 - 85%, coordination and agility 50%.  Developing eccentric control is the target for now.  Walking down stairs smoothly and sitting / rising from a chair while using only the injured leg are the challenges I am working right now.  Squats, leg extensions, all kinds of stretches, core, hip and ankle stabilization exercises dominate my daily (5 - 6 days per week) hour in the gym.  I throw it some back and shoulder exercises as well. I have also been cycling, rowing and using a elliptical trainer for about 3 hrs per week of light aerobic work.

There is still a fair bit of puffyness around the knee and visible atrophy in the quads.  Discomfort and stiffness are very much routine after a challenging work out.  I still get woken up by discomfort in my knee just about every night.

I have tried running a couple of times.  My latest effort, last week, was 3 x 1 mile at 8:00 min per mile with 2 min of walking between.  This resulted in significant swelling, stiffness and higher than usual discomfort. This lasted nearly 2 full days post workout.  This was clearly too much.

In addition to rebuilding function in my injured leg I am starting to turn some attention to regaining some general fitness and coordination. This summer I am hoping to start running regularly and resume kiteboarding. I have put on 20# with very little of it being muscle.  The composition of the 20# needs to change or they need to go away.

Background:

49 years old, 170#, 6'3" and very active at time of injury.  Suffered my first complete rupture of the right quad tendon on 8/18/2011 while running down hill.  Tried to stop and pivot, felt and heard a pop and then swelling.  I was 1 mile from home and ended up getting a ride back.  Doctors office that afternoon.  He diagnosed a ruptured quadriceps tendon and referred me to an orthopedic surgeon.  Surgery on 8/23/2011.  Described as text book by the surgeon.  He said it was one of the cleanest and easiest he had done.  Expected a full and relatively rapid (for this type of injury) recovery.  Imobilized for 2 weeks in a brace and then PT to develop ROM and some straight leg exercises to fire the quad begin.  PT is progressing well until 10/28/2011 when I fall down some icy stairs.  I land on my feet, which would normally be good except that in this case it caused the right quadriceps tendon to rupture again.  Repair on 11/2/2011.  This time, the repair is a little bit more complicated and things are not so neat and tidy.  Plus side, the surgeon was able to reuse the holes he drilled in my knee cap. Negative side, he had to remove a lot of scar tissue and damaged tissue.  Recovery will be slower and he cannot assure a good outcome along all dimensions.  Feels that ROM will be particularly hard to recapture.  I am put in a cast for 6 weeks while things heal.

Old Colonial

What a setback you suffered in reinjuring your tendon! Yet you seem to have a good attitude. Inspiring. I've noticed in the posts that some have a natural fear of reinjuring themselves as they work to recover. Being cautious and patient seems to be the way to go, and yet not so much that it prevents a natural way of returning to an active lifestyle. I like your summary, "Good days, bad days; but a strong positive trend." Thanks. 

Old Colonial,  really sorry to hear about your quad surgery do-over.  What a bummer.  What happened to you is what we all fear.  Thanks for sharing your experience.

BTW, did you do the repeat miles on the track or on the roads?  If you are able to run  3 x 8 minute miles after two quad repairs you are doing well.  It sounds like doing repeat miles at this stage in your healing process is too much though.  Why not just do repeat 400's at 8 pace for now.  That way you can find your running gate without overstressing your leg and slowly build up to longer intervals.  I like to run 400, walk 100, and then go again with another 400.  Eventually you can step up to 800's and then do repeat miles.  It just seems that going from double quad surgery to repeat miles is too much for your knee to take right now.

As for me, it will be 11 weeks this coming Tuesday.  I have been outside walking a bit this week trying to find my natural walking gate.  Simply walking is more tiring for me than the stationary bike and cybex machine.  I guess I really do need to walk before I run.

tomnorth;

when I said extensions i am talking about entensions without any machine just me on a chair trying to extend my leg.  Hurts and I can't even do it yet really at 7 1/2 weeks. Yeah the machine is bad, I have been using it for years and years, it could absoutely hurt your knee, but I did it in my 20s mainly when I never got injured...wouldn't play games with it now.   I can do a straight leg lift now for a few reps...my ROM is at 100, seems to be stuck there, have to start cranking and busting through again.  More pain..can't wait. 

Metalhead: I'm relieved that your leg extensions were of the variety you mentioned. I found that once I got to around 110 on ROM, the degrees came back more quickly.