Quadriceps Tendon Rupture, Repair and Rehab - Page 119

bikerboyz

 

 

You have said it well: the two extremes of rehab are protect the healing, or protect ROM. As you've read in my posts, my Mayo Clinic OS believes in three month healing period. Period. But, after four weeks, with two-piece cast, I began lifting leg at knee by adjustable braces. See him again this Thursday. He wants me at 45 degrees ROM. I will definitely ask him about more PT work, however. I'm guessing that both healing and ROM have to go hand in hand. But the timing is the variable.

Agree. I'm at 7+ weeks and have been very cautiously extending ROM, now at 90 deg. Also extending weight bearing to 50% (keep checking on bathroom scales) and can stand on two feet quite happily, but not walk yet, except on crutches using both feet. Seems to be healing too. Scar looks good and swelling going down.

I've been doing it mainly by just moving about on crutches, trying to live as normally as possible, but without overdoing it. I have to have an occasional  rest with the leg up and out of the splint, but this is getting less frequent.

The only proactive thing I've been doing is pulling my knee up as far as it will go, whilst in bed on my side, and leaving it as long as it is comfortable. I can now sleep with it at 90, but couldn't a week ago.

I tried a first shuffling step this morning, which means 100% weight on the bad leg for just a brief moment. It seemed OK but don't want to push it too fast. Not quite "take up thy bed and walk"!

 

PS tried both feet walking again. The technique seems to be to have both crutches to the ready but off the floor. Then  lean (rock) on to the bad leg with it straight until you can swing you good leg forwards a few inches. Keep both legs straight and just keep rocking from one side to the other and swinging the loose leg. It's a start, even though I look like a very slow clockwork robot!

Edited by skip intro - 5/29/12 at 2:20am

I've changed my mind on the above. Must progress through one crutch to cane first.

Good point on the healing vs ROM in these first crucial weeks.  I am now 2 days shy of 4 weeks Post Op. (Left QTR).  I am probaably at about 50 degress.  My doc wants passive ROM movements, He suggest extendeing or hanging leg off bed.  The one that has helped me, laying the bad leg on an exceris ball while working at desk.  He is very strictt to point out that he does not wnat PT to start unitl 7-8 weeks.  He says if I can be at 90 ROM when I start PT and I am fully healed then the recovery will be much faster.  He is now letting me walk around no crutches with brace open to 60 degress.  Of course there still is the risk of falling or slipping.  The main point he has made and I agree with reading other posts, some passive ROM movements in the frist few weeks prior to PT.  I would be intereted to see what other have experinced that are further along.

Skip Intro

Thats exactly what I did, the transition was scary at first but im so glad I did it when I did. Im 11 weeks post op and i spent 2 to 3 hours in the pool on memorial day. It was the first time Ive gone in the pool and lets just say, as soon as you can get your butts in the pool.. lol

 

Pdub, it looks like your getting the ROM early version. It seems to be the most popular version on this site. I got the total weight bearing, locked out at 0 for a month version. Now im palying catch up on ROM with some hardcore stretching on my knee. Hang in there everybody..

Skip intro

Again, you and I are on about the same time from surgery, 7 1/2 weeks. However, our programs seem to be quite different. At six weeks I was put at 40°. Today I was measured at 95°. For the last week I have given up on the brace totally. Today I walked about a mile and a half at a fairly normal gait. I did take a hiking pole for safety.

I think it helped that I was fully weight-bearing immediately after the surgery. For PT they have me doing range of motion, stability and balance exercises. Today at PT I began some strength exercises too. I am scheduled for the pool this Friday. I'm looking forward to that.

I'm now 14 weeks post op.  Saw surgeon yesterday and he said I'm doing well and call him in two months if I have questions or problems.  Frankly, he did his job on Feb. 21 when I was rushing down back porch steps and went flying, landed on left knee and had complete quad tendon rupture.

 

I have been doing PT since week 5.  I lost the leg brace at week 8.  I can now walk comfortably and am becoming more aggressive in morning walks.  Doing upper body and selected leg exercises at gym.

 

Interesting comments from surgeon yesterday were at 3 months tendon substantially healed but it takes 6 months for tendon to "re-purpose" itself and be totally secure.  He said I can attempt light jogging in another six weeks which would be 5 months post op.  I asked about swelling and he said a year.  In the mean time he said use heat, not ice, because heat promotes circulation and helps dissipate fluids.

 

A word about PT.  If your insurance pays for PT go to a professional.  It's not just the specific exercises, it's the progression.  We are all walking a tightrope of either too much or too little PT.  Do too little and you have a very hard time getting full ROM back.  Do too much and you will slow down the healing process by aggravating the wound.  Really do too much and you could start the whole process over again by re-injuring yourself!

 

Good luck to all and keep on truckin'!  :-)

I had my surgery put off from Monday evening to Tuesday morning. So there was one (fairly short) night of apprehension while I waited. The next, my wife drove to the hospital and by 0800 I was being wheeled to the operating room. Given the choice of "local" or "go to sleep" I chose the latter.

The anesthetic was like faling very slowly backwards down a shaft or well.

I started becoming aware of things around me in the pre-op room. It took a couple of hours of me bouncing in and out of conciousness before I felt we were good enough to go.

Spent the rest of the day at home ... my wife went out to pick up prescriptions. We'd told the OD that I'd prefer to avoid narcotics (if at all possible) so my cocktail is Atavan (4x per day) and Celebrex (2x per day) along with Tylenol for any other pain.

The rupture was a bit larger than he'd originally believed ... but it's all fixed up for now.

Three weeks of total immobilization to start. But the OD knows that my goal is to get in a few more km's on my bike before the end of the season (I have cold-weather riding gear).

As recovery progresses, I'll be sure to contribute my .02.

WILL Run Again: I took your rec and tried a light knee compression brace for my light running. I feel I made a milestone today.....pun intended....I got to about 3/4 mile non-stop...albeit slow....without stopping in my 2 mile run/walk. About a 12-13 minute mile pace but a victory. We take these small personal victories as Milestones !! No real pain during or after just what I would describe as fatigue stiffness but not severe. Again....I am at 7 months. Believe me when you are running your head is down watching every step. I notice my stride is very gradually lengthly. For all the Quadrippers....our rehabs are progressions so look for your own personal milestones. Keep going!!

Old Runner Guy!  Great to hear from you.  Glad the knee sleeve is helping.  I just finished 14 weeks post op and my surgeon said I might try light jogging in 6 weeks which would be 5 months.  Knowing your experience I'm not getting my hopes up though because I don't want to be disappointed if it's six months.  I just want to be healthy again and in the long run a month or two doesn't matter.  In the meantime I walked for 30 minutes this morning pretty aggressively especially on the uphills.  Downhills were a challenge and freaked me out a bit because of overnight rain.  Half way down a steep hill I didn't know if I should continue or turn back.  One slip and .....  I did make it to the bottom without slipping.  As you say, I was conscious of every step!  That was my victory today!

 

It sounds like you're doing great.  I also like to do 100 meters and walk 100 and repeat.  I still think I'm a teenager when I get on the track but my watch says something very different.  Please keep me posted on your running progress! 

 

All the best,

 

Dan

I couldn't have done that. Just too painful and the leg felt really vulnerable - like rubber held together with thin breakable elastic bands. Started 50% weight bearing at 5 weeks which felt plenty soon enough for me!

I find it easy to over-do it. Tuesday I got taken out for a picnic by my daughter. Getting in and out of cars several times. Crutching about. Cruising around on a mobility scooter with my leg up. All no problem and enjoyable. But Wednesday my leg was aching and knee swollen and I felt very tired all day. I don't think it does any harm to push it a bit, but there must be a limit.

Today it feels fine again, so it probably did it some good.

6 MONTHS POST SURGERY

 

Gentlemen & Ladies,

 

new member to the group - came across this blog a week or two ago by accident - found it very insightful - long story short - slipped on empty beer bottle after Steeler / Chiefs game in KC right after Thanksgiving 2011  - thought it was just a bruise but couldn't put any weigh on it or even lift left leg to get into vehicle - followed routine of family doctor, OS visit, MRI , and surgery schedule first week of December 2011 - tore up just about everything all four tendons and quad muscle along with ligament- 59 yrs old - active cycling , handball & racquetball - left leg immobilized 24/7 for 10 weeks with exception of 1 hr PT sessions 3 times a week - about 13 weeks out moved to heated pool activities and since stretching and exercises were repetitive was released by PT to do on my own - aloowed me flexibility to then do PT at my discretion vs. appt times and 6 days a week vs. 3 - started on my own April which would have been approx. 4 months post surgery and have been following routine ever since - they have me using styrofoam noodle to stretch leg out and then to use with both legs to bend and depress up and down to work out knee - also use a wing on ankle to provide resistance in side and front to back exercises on leg - also do squats and lunges and then some squats with noodle under ankle and behind me to stretch quad - usually sore and tired after that - takes about 1-2 hours - they say this warm (94 degrees) water therapy should help healing and strengthening quicker - now 6 months out from surgery and doing some wotk on TTS in the fitess center and pool activities MWF - fitness center activities are just 10-15 minutes on low riding bike - half dozen leg presses at 90 pounds, ellipitcal (about level) 3 - two minute sessions - hamstring streching and half dozen wall squats( down is easy - getting back up is murder) - can go up stairs awkwardly with use of handrail and down the stairs is still difficult although I try to avoid the stair at a time routine - they say no jogging till at least October and to be honest , although I have little patience, I follow the directives fairly close so as not to have to repeat this process - I took off a week around memorial day as I was really feeling sorry for myself due to seemingly slow progress - I do walk about 1/2 to 1 mile with dog every evening before retiring - knee is stiff about 6-8 inches up and down from knee cap - hurts most of time - although when after i get it up on ottoman and straight out , pain decreases for some reason

I started at beginning and read first 100 pages of blog last week - although its not nice to say, i was a little relieved to see others in the same boat as me - guess time will heal about everything - we will see - would appreciate any suggestions from others as to leg strengthening exercises I might be able to add to program as I am going along - I thought I would be back to normal by November 2012 - but I do not see that in the cards at this time  

Grover74

What is your range of motion (ROM) at now? I found that before I was able to make much progress on strength I had to get my ROM up, so I stretched the heck out of my leg three times a day. I am six months post surgery too. You are certainly doing the work, so I'm sure that eventually you'll get to your objectives.

 8 weeks

Just been to the doc. Set splint to free movement. Backwards that is - it's at 0 deg for forwards! 2 more weeks in splint and then physio starts. Should be full ROM and just about 100% weight bearing by then, so it's 'the end of the beginning' and  the start of the strength re-building process

Just over 48 hours post-op ... I still have a bit of a sore throat from where they tubed me. And while I still get the odd woozy moment from the residual anesthetic, my head is - for the most part - clear. Post-op pain hasn't been much of an issue so I'm going to ditch the Atavan ASAP; Tylenol has been doing the trick for me. On the other hand, the Celebrex the OD gave (to control inflammation) has worked wonders on the bit of tendinitis I had in my left knee.

Still no weight-bearing on my "bad" leg - but my wife gives me a hand getting up and down so at least I can rattle around a bit on my crutches.

Unlike Grover74, I haven't read through *every* page of this blog ... so I apologize if this is a repeat:
http://www2.massgeneral.org/sports/protocols/Quadriceps%20and%20Patellar%20tendon%20repair%20rehabilitation.pdf

Ppotz

 awesome link. I was kind of relieved to see a rehab program pretty consistant with mine.

Some ideas in terms of strength work that I have used and suppose have been effective.  I hope it hasn't been just time and walking around that has made my leg stronger and that the stimulus these exercises has provided have been effective.

1. variety is key.  Life will pose all kinds of challenges to your injured leg so the more and varied ways in which you can build strength, coordination and range of motion the better.  My favorites are listed below.
2. Leg extension with ankle pump.  Place a 2 liter bottle on the back side of the knee while you are lying down.  Straighten the leg, tighten the quad muscle and pump the ankle.  First exercise I found really satisfying.  I started with these about 6 weeks post surgery.
3. Assisted squat progression with the TRX.  You can find the video for this series.
4. 1 leg bounce on physio ball.  Sit on physio ball, lift one leg straight out and gently bounce up and down on the ball.
5. Side lunges.  As you get stronger you can make them wider and deeper.
6. Air squats.  There are many flavors of these.  I started with a bench behind me for safety.  Now I am doing some on a Bosu ball as well as the 1 legged version stopping on the bench behind me.
7. Jumping ( small ones! ) up and down on a Bosu Ball.  At some point this will develop into jump squats on the Bosu.
8. Box Jumps.  Jump up onto a box or low wall and step off.  Jump up, jump off, focus on soft landings
9. Step ups onto a low wall or box.  Kind of running in place on and off a knee wall
10. Jumping rope.  When you start off you will favor the injured leg and you can work you way toward symmetry and eventually one legged jump rope.
11. Assorted lunges.  These are great for working the co-contractors in your butt. and building flexibility.  Can add variety my having a resistance band provide some lateral or rotational force.  This will challenge you balance as well as build some strength.
12. Jump lunges.  As you get stronger you can make them deeper and wider
13. walking down stairs with a very slow controlled drop.  Drop, tap your toe, and then return up the stairs.  Drop, tap your heel and then return up the strairs (still working on that one)
14. Jump Squats.  Focus on landing softly, getting a good amount of knee flex and a fast smooth powerful transition to the next jump.
15. Box Row.  This is basically a squat with a 1 arm high elbow row.  20 - 30 # of resistance is plenty.
16. Cycling.  On a wind trainer do some single leg pedaling as well.
17. Concept 2 Rower.  Nice for range of motion and aerobic training.
18. Elliptical trainer set at a high incline.
19. Squat thrust / Burpee .  I am just starting to do these.  They seem to be a total body challenge and force you to connect the strength you are building in your leg with the rest of your body.
20. Kettle bell swings.  Great for co contractors and back.

Six Months From Surgery as of June 1, 2012

 

I thought I would report in at the six months post surgery point.

 

ROM: Pretty much at parity with the good leg (~130 degrees)

Quad Strength: 90% of the good leg (i.e. Cybex leg press machine: Single-legged leg press, 180 pounds, 12 reps, 2 sets vs. 200 pounds for the good leg)

Hamstring Strength: 95% of the good leg (i.e. Leg curl machine: Single-legged leg curls, 8 plates, 12 reps, 2 sets)

Stairs: Going up is pretty easy now...going down still requires some concentration

Walking: I have good days where walking feels like a breeze, but then I have not so good days when it's a bit more of a struggle

Biking: I am able to bike with ease now, although I've been more focused on walking so I've not done any longer distances biking...perhaps this weekend

Swelling: The puffiness around the knee is getting better, although by the end of an active day it will still be a bit puffy and need some icing

Pain: Most times pain is not an issue, but occasionally I will get a "zinger" around the knee that gets my attention...I wonder if others still get this. I had one today during my workout. The sharp pains are associated with the muscles around the knee rather than the quads or the tendon.

Balance: This is getting quite a bit better...I've been working on balance exercises standing on a Bosu Ball. This is a great exercise.

 

That's what I can come up with for now. I've noticed a lot of newbies joining this message board of late. I'm sorry for your injury. I wouldn't wish this on anyone. Hopefully by providing information of our recovery progress we can all learn from each other and get a sense for what's coming. As others have said, this is a long haul. Even though I'm at 90% plus on some measures, I don't think I am functionally at 90% yet. Walking would be consistently easier if I were. But, I know I'll get there, as we all will.

6 weeks post op

 

Visit with OS last thursday. ROM at 60 degrees! More than expected. Doc said interesting thing: after surgery finished but before I left OR they lifted my injured leg at the knee to see what ROM was: 90 degrees. Meaning tendon hadn't contracted too much. Sometimes if surgery is more than a few days after injury tendon doesn't stretch as easily. Prognosis for good ROM.

Will have two-piece cast for two more weeks continuing passive knee lifts; then immoblizer for another 4 weeks (3 months post op). Then PT until...?

Am finding that muscles and joints from other than injured leg are sore. Arthritis, etc., I'm sure. Especially 'good' leg and lower back. But Tylenol helps.

 

Thanks for updates from 6 monthers. Good news.

Week 8 1/2

What I've noticed is an alternating day cycle.

If I do a lot of moving about on one day, the following day my leg hurts and knee is swollen, so I take it easy. It can feel depressing as though no progress is being made. Then the following day it feels a lot better as though things are improving again, which is a relief!

So I'd say - if it hurts take it easy, give it time to recover. Overdo it one day by all means , but take a rest the following day.

PS to the above.

Today I have managed to walk about with one crutch and can now carry a cup of tea from one room to another. I couldn't do this yesterday so this is a big step for me! Actually big steps make it easier, once you have got away from the first nervous shuffling. I must have done a hundred yards or more around the house. My knee is beginning to tingle so perhaps give it a rest now, back to two crutches.

I'm quite pleased with myself - yesterday I felt quite despondent.

Edited by skip intro - 6/4/12 at 7:25am

Skip intro,

Congratulations! It is those little things like carrying a cup of tea that really help you get through day today. My big success came Friday when I was able to do a full revolution on the recumbent stationary bike. I sat there and did another 30 minutes feeling quite proud of myself. Then I did my usual routine of upper body and PT exercises in the weight room. The full revolution on the recumbent bike was a little bit of surprise. That is because there was really no hesitation at the top of the curve. I had expected to feel pain pulling through the last bit, but no real pain just a little tension.
It does seem that you and I have had quite a different experience postsurgery. I didn't feel the wobbling, or else like you would have relied more on the crutches and little weight-bearing. That just goes to prove how different this injury can be from one person to the next. And, the recovery can be from one person to the next. Next you have to try both a cuppa tea and biscuit.

PS Skip intro.

I forgot to add that after all of my good exercise on Friday and some on Saturday by Sunday I was completely wiped out. I went to the pool to do some in pool exercises. But when I got there I just felt so wiped out I decided to take today off. Felt really cruddy all day on Sunday. But, this morning woke up and have felt really good and strong. So that experience is very much like yours of one day really good and the next day feeling really tired. I thought you want to know that I'm experiences in the same as you in that regard.

Good Morning Quadrippers!

 

3 1/2 weeks post op - Thanks to Skip Intro and Active Padre as you're a few weeks ahead of me.

 

After other websearching - found recommendations for ultrasound in combination with heat and ice/cold therapy.  I asked my OD about it and he said most insurance wouldn't pay for it more than 2-3 times a week and if it does most people won't do it, but ideally, 3x a day.

 

I bought a $199 kit from mendmeshop.com.  I've used it for 2 1/2 days so far and there is a noticable softening of the rockhard area on the lateral side of my knee.  it seems to be helping the color and swelling.  It also feels a lot better after heat/usound/ice than just after heat/ice.

 

Friday i'm to get 30 degrees of flex - Christmas in June!

 

Then I hope to start catching up with the pool walkers and stuff you guys that are a little ahead of me are enjoying so much.

 

- TnT

TNT Torpedo....Interesting that you are using ultrasound in combo with heat and ice. I checked out the site you purchased from. After 7 months I still have that knee tightness. Have you used it on the quad at all or just the knee? Can you give me more specific info on your ice/heat ultrasound regiment.?? How actually do you do your routine and how often? I know you are way behind me in rehab....but it all helps !! Good Luck !!

Hi, 

I'm new to this forum, and probably don't qualify because I haven't actually had the misfortune of this nasty accident, ....but my husband has.  He is 6 weeks (nearly) post-op, after a complete tear of his left quad tendon and has been wearing a full leg brace with minimal weightbearing and, like many others, is a fit, active & healthy man (66) but this has knocked his socks off.  He was told by the Dr. to use a frame - not crutches,  but has now started to use the crutches for easier travelling outside the home... although that's not very frequent at the moment!!  :o(

 

Next week (11th June) we visit the Orth Surgeon where hopefully he will give the go-ahead to slowly wean him off the brace and start weightbearing and physio, but I'm dreading that the whole op has been a failure.  The Dr. said the best test will be when he can do a straight leg lift whilst lying down, but surely that can't and won't happen now -  ie before physio!   He hasn't tried because the Dr. said not to for fear of damaging the surgery. 

 

I'm so glad I found this forum  because it has been really helpful and encouraging to read all the progress that is, and has been achieved by other poor victims experiencing the same problem.

 

What is obvious is that everyone recovers at a different level - some faster than other.  Another stand out observation is the difference in post-op procedures - conservative vs straight into physio.  Hard to know what's the best, but I guess we can only be advised by our Dr. at this stage.

 

By the way, he just slipped and missed the bottom step at home (in a hurry!) and straight onto his knee.  So the time lapse between emergency hospital/Xray/Scan/Ultrasound he finally had the op 10 days later - not too bad I guess.

 

Good luck to everyone else and I look forward to reading more success stories. :)

My first test of whether or not things were joined up again was a very tentative deliberate twitch of the kneecap whilst lying down. That was enough to stop me worrying but I'm only just at the lifting a straight leg stage at week 9 so perhaps not to expect too much too soon.

Old Runner Guy,

 

I will be at 16 weeks next Tuesday.  I experimented jogging in place and attempted jogging a few steps while walking tonight.  I made 3 or 4 jogging steps and went back to walking.  When jogging in place I go 30 seconds to maybe a minute at a time.  I clearly have a long way to go.

 

At what stage did you first attempt jogging on land?  How are you doing lately with your comeback?

 

All the best,

 

Dan

Old Runner Guy - I've trying to do the heat/ultrasound/cold three times a day.  heat for 20 minutes, ultrasound 10-15 minutes, mostly around the knee joint, but about 1/3 of the time over the quad muscle area, then ice for 20-30 minutes.  So, I take the heating and ulsound thingy to work and I keep a "pro-ice" wrap around in the freezer at work and at home.  I did notice on the website they offered 60 day money back if it didn't help; so I went for it thinking that if it didn't seem to help, at least I'd know whether it worked or not and would just be out the trouble to send it back.

 

It seems to do better when I do the ice machine (cold water circulating through the pad that goes over the quad tendon and knee) rather than just the wrap around ice pack.  Sometimes it fells real loose after the process and sometimes it just aches less than before.  I don't haul the ice machine back and forth to the office (at least yet), but maybe I should.

 

I see the OD in the morning.  Hoping for 30 degrees and permission to do some pool walking, etc.