Quadriceps Tendon Rupture, Repair and Rehab - Page 122

Hi everyone!

 

I hope its been a good couple of weeks for everyone.  Its 8 weeks postop.

 

The heat/ultrasound/iceOrcold is working pretty well for pain and swelling.

 

The routine I've been on (all to increase blood flow because of the no blood supply to tendon thing):

day 1 - stretching, quadsets, ad/ab/lying hip flex, toe raises, lying bridges on ball, leg swings to front and to sides, pool walking

day 2 - upper body cardio - pushups (bad leg lying on good leg), pull ups, dips and crunches, circuit-training like - it's been years since I've done this many pushups and so I've been building up to reps I've not done since my 20's.  four sets of the above with some stretching during the rests.  pool walking

day 3 - upper body balancing (light wt - goal of 20 reps for two sets) - barbell shrugs, dumbell shrugs, wrist curls forward, wrist curls reverse, incline dumbell curls, reverse curls, 1 arm mil press, lateral raises, bent over lateral raises, close grip bench press, triceps kickback, overhead dumbell pullover, close grip lat pulldown, dumbell bench press, incline flye

 

At 4 weeks post op, he let me unlock the brace and set me at 45 degrees before leaving the office.  He limited me to 90 degrees until 8 weeks.  I'll see where I'm allowed to go to tomorrow for the next 4 weeks.  

 

Questions:

1) there was a post that I can't seem to find about someone who had a routine about getting up at 5, doing PT, heat, massage, maybe ultrasound and etc. through out the day.l;  I'd like to find that and take it to my doctor.

2) how aggressive is the strengthening program when other OD's have allowed strengthening of the quads.  So far, I'm only allowed to contract the quads to the point of just moving the knee cap.  No, real tension on the muscle so far - so I'm still becoming less and less of a man as my muscles atrophy away.  What have the rest of you that are further along been doing to recover your speed and strength.

3) Anyone know what a re-tear feels like?  I've had the sharp pains across the kneecap, but my doctor says that is normal.

 

Thanks in advance for all your help.

 

One tip for the flexibility from the PTherapist - I wasn't holding the stretches for varying periods of time.  He recommends some for 1-2 seconds, some for 10 seconds and some for 45-60 seconds.  It lets the proprioceptors (sp) in the muscles get used to the tension and quit tensing the muscle, lets it stretch further. 

 

I've got to hit the pool before they close early today.

That's some routine! 

Week 12+.

I've done nothing at all in the way of physio or deliberate exercise, other than  trying to be as normally mobile as possible. I'm walking OK, sometimes with a stick. Up and down stairs is fine, slowly and carefully. Every day is slightly better, but some days I need to take it easier and keep my leg up. Not pain as such, more just feeling weak and feeble if I've overdone it the day before.

Re-tear fears - I've had the occasional pain in the knee cap but I think this is par for the course. Judging from this forum re-tearing doesn't seem to be a risk from normal activity - unless you fall again etc. 

 

Starting physio this week. Not planned this way - 2 weeks late - the reference got lost in the post!

 

So I'm making reasonable progress I think, but looking forwards to seeing if this can be speeded up.

 

I'm 67 and was fit and active cyclist/walker before all this.100 mile bike or 20 mile walk no prob, I get the impression that mid 60s seems to be the age for it. Is the previous level of exercise an indirect cause? A lot of posters here some to be active types!

In my case the direct cause was just a little slip in the snow down three steps. Nothing much at all.

This is exactly what happened to me, I slipped on "black ice" on the top of my stairs and fell down 4 steps landing in snow and ice.  This is all it took.  My injury occured last January and this has to be one of the worse experiences I have had. 

 

I also was active hiking, cycling, running, etc. before this injury (I am 56 years old).  I was lucky to have an exceptional physical therapist who understood this injury and was able to keep me motivated and in a "positive" mindset.  Almost 6 months later, I am able to walk OK, however, I still have issues going downhill (does not feel natural) and can feel some pain in my knee after extending climbing.   I still experience swelling of the knee and leg at the end of the day, however, I am off of Ibuprofen now.  I see my orthopedic surgeon for my last visit this week.  I have been reluctant to start running again or cycling on a road bike.  This may change later this summer.

 

Physical therapy is the primary contributing factor to a steady recovery (in addition to time).  Hope all goes well with your PT.

I too experienced sharp pains in the knee area (especially on the interior side of my right knee) up till around 12-14 weeks.  I was worried that I was trying to do too much too early so I backed off on some of my exercises.  I just went on a 2.5 mile hike with a 1,400 ft elevation gain and did not experience any sharp pains, just a general feeling of "weakness" in the knee/leg area.  I am hoping this will resolve itself as I slowly build up my leg muscles again.

 

Another interesting observation is that I started to experience "knee pain" in my left (uninjured knee), especially when going down stairs.  I believe that this was because I was favoring my left knee.  This seems to have somewhat resovled itself with time and with exercise.   

Just had my two year anniversary since the injury (total rupture of quads, patella and collateral)

 

Some observations for long term rehab. Measure the size of your calf and quad and compare it to the good side. When the medicos discharged me I still had a significant size difference and it took some serious work to get them the same size. It really made a difference when the injured leg got the same bulk as the other.

 

I have found that my injured leg just isn't as quick as my good leg. In stride advance there is a imperceptible lag. This does not seem to be a problem in day to day training. (Whilst I may have the same size bulk in the injured leg I am starting to think that its just not as strong)

 

But lately I have been doing cross country mountain running and my good knee has flared up. The OT has told me that it is overcompensating for the lag in the bad leg.I am going to try over training my injured sides glutes, calf and quads to see if that can fix up the issue.  

 

The OT and surgeon seems to think that the injury has compromised the structure to such and extent that I might not be able to get it back to parity with the other leg ..... [pessimists the lot of them, I can do without their negativity].

 

Additional OT assessment has also shown that some of the range of movement angles for whole of limb are within end of range limits but compromised compared to the other limb. For example lateral flexion from injured lower limb is 12 degrees less than the good limb.  Its fixable but if you don't know about it then it will go untreated. Get a good medical team behind you and ask the hard questions.

 

Just be aware that insurers and doctors  are quick to make a call that you are cured but what they really mean is that you are functional but not yet back to where you were before you were injured.  Make sure to benchmark and manage your own long term rehab program.

 

It concerns me that in the long term, if you do not recover complete use of the limb, then there will be a knock on effect that will lead to other problems.

 

I would be interested to hear from any one who is 5 or so years out and hear if they had any follow on problems from the injury.

Skip Intro

 

Going in for 12 week OS appt this afternoon. Like you have not had PT work as yet. However, have adjustable brace and get around pretty well with walker or crutches. In my small kitchen or bath I can move from counter to counter without help.

ROM at 75 degrees. Doing knee lifts and massaging of area around knee to soften scar tissue, and moving the kneecap left and right.

Will be 69 in August; have been active cycling for years, mt and road. And hiker (accident happened hiking in The Wave area along the Utah/Arizona border in April.) Anxious to get bak to biking especially. Will hear what doc has to say this afternoon. Keep up your posts; we're at about the same stage.

Padre

10 days post op.Meet with OS and he has me doing heel slides (approx 30 degrees) no immobilizer

 

and leg  lifts with immobilizer  on tight. Off the Norco and on to Advil and Celebrex.

 

Has anyone found a light weight (mesh) immobilizer the neoprene is really hot.

Any upper body workouts that work with the immobilizer.

 

Next appointment not for four weeks so I have a lot of work to do.

 

                                                               Thanks for your help.

 

                                                                All The Best

Hi everyone

 

Quick question. At my 6 week post-op, I'll be going from full leg cast to adjustable hinged brace. Will I be able to walk without crutches at this point?

I got off the crutches in stages over several weeks.

First just touching the floor gently with the bad foot at about 6 weeks.

Firming up on that.

Then aiming for 50% weight bearing by trying the feel of it progressively on the bathroom scales, still with 2 crutches.

When confident at 50% going to one crutch some of the time. There's a bit of technique here http://www.youtube.com/watch?v=EO7JyA_8dZM

As that improved having careful goes with no crutches.

Now (wk 12) no crutches for several weeks but use a stick if I feel like it. On the offside same as one crutch technique.

But at every stage reverting back to one or two crutches if I felt the need - you can't speed things up much!

Not used the wheelchair for a long time. Sold on the mobility scooter - back to ebay from whence it came. Lost £50 on the deal but worth it, much cheaper than hiring and was really useful up to about week 8.

Back from 10 week OS visit. 75 degrees ROM. Full weight-bearing with aid of crutches. Still use adjustable brace. Reminded of danger of falling and re-rupturing tendon. It happens when we try to do too much, too fast. Need 3 months for full healing and enough ROM to insure that if I fall I won't reinjure leg.

 

Received a couple new exercises to do: 1) sit on edge of hard-surface so legs can dangle freely. Put good leg on top of injured leg and press down as tolerated but before severe pain. Leave in this position until uncomfortable. Repeat hourly. 2) sitting on floor or couch or bed with leg extended, slowly fire muscles to press back of knee to surface. Repeat until uncomfortable. Continue moving kneecap side to side and massage area around kneecap to soften scar tissue.

 

Walking, standing, etc., as tolerated, but with brace at zero degrees and aid of walker or crutches. Able to get around pretty well. But get tired easily. And some knee soreness and swelling. But feel like I'm making good progress. Slow but sure.

 

Next appointment at 3 months. If ROM 90 degrees plus will begin more agressive therapy working with PT.

 

 

Active Padre

Update 9 months post op Been back to work (construction) since June, everything pretty much back to normal. I have been walking on the treadmill and even did some time at 6 mph. I'm continuing Pt at home with lots of stretching Rom is around 140 I dont think I will ever get it to touch my butt still trying though.

 

It still feels stiff going down stairs, but the last few days thats been feeling better. Dont let this injury get you down you will have a full recovery. I am thinking about doing a triathlon in august that would be 10 months after surgery.
 

Hey all, I hope everyone is doing well! Today will 10 weeks post op.

 

I saw my orthopedic surgeon 2 weeks ago and he says I am recovering well. He says that I may only need another few weeks of PT but I feel like I have a long way to go. He suggested that I stop wearing my brace in controlled areas (mostly around the house or at work) but that I must wear it outside the house for another 3-4 weeks. I have been walking around without a brace at PT for a few weeks now, but doing this at home was very scary. My knee felt shaky and seemed like it was going to hyper extend. It was tough a couple of days but after two weeks my knee feels much stronger. I still use the cane without my brace just in case.

 

My range of motion is coming back slowly, I am at 116 degrees now. I have been doing some stretching exercises which seemed to help. PT has been awesome, I can see my progress after every session.

 

I would like to purchase a smaller light weight brace (currently I have a full length bledsoe brace) to give me support when I do leave around the house. Does anyone have any recommendations?

Do you need the cane when walking in a brace? I'm trying to figure out if I'll be able to walk without a crutch/cane when I get out of my cast (and into a brace) in 2 weeks (when I'll be at 6 weeks post-op). What do you think?

 

And does PT hurt? I'm scared!

 

I think it will depend on how your knee feels. The brace, crutches and cane have been great for support but with the help of your PT you will slowly remove these items until your leg is back to normal. Right now with the brace on I don't need to use a cane but I have it in hand when I am going out somewhere just in case. I rather be safe than sorry. When I first started PT (3 weeks post-op) I needed both crutches for stability. While I was walking I would feel as if my knee was going to give out. As my knee became stronger I started to use one crutch, and then to a cane (5-6 weeks post op).

 

PT hasn't been painful for me but I am usually sore after each session. I was also scared, but the physical therapist hasn't made me do anything that I wasn't 100% comfortable with. Communicate with your therapist and provide feedback. If something doesn't feel right (if you are sore, tired or in pain) you need to let your therapist know so they can adjust your therapy. They want to help you get better without having you re-injured. Good luck!

 I just wanted to first say great job on all your accomplishments rather big or small. This injury is not a race but you will be granted small victories every now and then so use them for momentum and move forward.

chicadivertida- i went straight off of feeling when getting off of crutches and cane. I lost the cane at 10 weeks and although shaky at first, walking got easier everyday.. I went to 1 crutch at 6 weeks, cane at 8 weeks, nothing at 10.. Keep in mind I was allowed weight bearing right after surgery but I was locked at 0 degrees for a month in a hinged brace. As for PT, by the time you get to it, you will be more than ready to take on whatever they have to give. My PT pushes me hard but she also is very concerned that Im not in any pain. Discomfort is fine though lol.

 

So that you can compare, Im 16 weeks post op and Im at 110 rom. rom is coming slow but it has consistently come at 5 to 7 degrees a week and Im fine with that. I started PT at week 12, walking in the pool at week 10, walking on land and treadmill at week 8 very slow. PT consist of 1 hour of butt kicking lol. squats with thera ball against the wall, leg presses both legs and injured leg, leg curls, one leg balance on sponge, step ups fwd and backwards and side to side, walk with band around waist with bungee cord attached to wall fwd backward side to side, walk around PT room while seated in a low stool using legs to propel you. stretch, massage. Im still doing quad sets at home and stretching 2 to 3 times a day.

 

Victories include, walking upstairs easily, walking downstairs more confident, getting into and out of cars normally, less swelling during long days, easier to get legs moving when sitting for a long time, less clicking in knee, walking for miles at a fast pace for cardio, elliptical for miles, sit in movie theaters without standing and stretching lol. Im sure there's more.

 

Needs improvement- walking with complete normal gait, walking downstairs, more rom, quad weakness, quad stamina at the end of a long day gets weak. still cant run but i can feel it getting close.

 

New guys and gals, let the tendon heal before you do too much. You will be at week 12 before you know it working hard at PT.  Good Luck to everyone..

Quote:

 

 

 

 

12+ weeks

Yes you can't hurry it up much, but physio helps. I've just started and feel the benefit already. She's given me some simple exercises, not painful but they are hard work! Slow squat for 20 seconds, repeat 30 times a day, as far as you can go with back straight etc. Lift each leg to 90 deg knee bend for 20 seconds 20 times a day. Each of these with chair back to hold on to if necessary. No bouncing - keep movements slow and steady!  Then squeeze a football between the knees 20 times a day. Then leg straightening on the bed by pressing back of knee down onto a rolled up towel. Doesn't sound much but I'm beginning to feel as though I've just run a marathon.

I've also borrowed  bike turbo trainer (Cycletrack Tracx) - a great pleasure getting back on the bike even though I'm only pedalling in the living room. She advises keeping off the road for a bit longer in case of emergency stops etc. but I can watch Le Tour instead.

Greetings,

  2 weeks post-op ..ice machine 20 minutes per hour...Advil and Celebrex for pain...heel sliders

and leg lifts every few hours...walking on both legs with crutches (not very far).

 Sleep is very difficult ...Really Need Help with any ideas on how to get some sleep.

 Thank you in advance,

                                                                        All The Best

                                                                            Calhiker

Omg I know exactly what you're going through. Sleep is so awkward in the cast! Have you tried an over the counter sleep aid? Usually if I take a few doxylamine succinate on an empty stomach, it helps me get to sleep (http://www.amazon.com/Kirkland-Signature-Doxylamine-Succinate-192-Count/dp/B0045XGE9E/ref=sr_1_1?ie=UTF8&qid=1341676668&sr=8-1&keywords=doxylamine+succinate).
 

I tried Tylenol PM for helping to sleep. It worked but made me groggy in the morning.

While I had my cast on I'd try to lie as still as I could while falling asleep. And use some simple relaxation techniques to quiet my body, beginning with toes and working up to nose.

But what really helped me sleep was finally getting cast off. But...

 

A. Padre

Calhiker,

 

Sleeping is difficult with a cast or brace on. It is important to keep the brace on 24-7. My PT told me a story about a patient who took his brace off at night because he was very uncomfortable. He had a nightmare and started thrashing around and reinsured the leg.

 

Back to your question. I had my doctor write me a script for Ambien. Worked wonders for me and while I would wake up a lot, I would fall back asleep pretty quickly. I also had a number of different pillow combinations to get comfortable. You need quality sleep to help the healing process.

 

 I am at week 14 and am making progress. My leg has been slow to come around as I also did some damage to the cartilage in my accident. That will be a separate op in a month or so. My range is about 120. I am walking pretty well and walked down stairs normally for the first time this week. I had been doing the one step at a time technique. It was a real leap of faith doing that and it was more mental than physical.

 

I still go to PT and do limited pilates with a private instructor. I have been pool walking in a current pool which is a great exercise.

 

Be patient and get some good books and a Netflix account if you don't have one.

Dear Chic..A.Padre...Funko,

   Thank you all very much for your response. Some great ideas and

good guidelines. I do take off the brace for the ice machine but I won't

even think about taking it off at night.

                                                          All The Best

                                                          Calhiker

Greetings

  Has anyone had any experience with Electrical Muscle Stimulation (EMS),

if so what did you think of it. Thank You.

                                                 All The Best

                                                   Calhiker           

I am 8 months from surgery and here are some observations and updates:

----Start with some negatives.....despite extensive rehab I still walk with a gimp and experience some weakness in quad and knee....although I have had full range of motion for several months. My passion is running and racing and I am thinking at least my racing days may be over. I can ....what I call shamble....not quite stride running or even fast walking but a short stride like shamble with an uneven gait. I have had it evaluated by other runners and it is stiff legged yet despite all the rehab work. I can go 3 miles of shambling....but being a former marathoner.....36 full marathons in my past it is not running. I have found and strongly suggest to the Quadrippers who are close to land running or striding or shambling to try the barefoot running flats. I use the 5 Finger brand. I was using them for short runs before my surgery and the reason I suggest them is that you will adapt to a more normal even run and not rely on cushioned shoes that form your foot to the cushion. We are really starting over completely and while I was still in PT my therapist noticed I was stronger barefoot than in shoes....albeit with the limp gait. If you decide to try this route do it with very short durations.....but you will not be able to do any distance anyway so it might be worth a try.

----Now for some positives....despite my running frustrations I am fairly strong. I am able to squat about 175 lbs on a Smith machine at the Health Club. I am getting stronger on my bike. Today I had my greatest achievement post op. I did a 50 mile bike ride on a very hilly course in about 3 !/2 hours in an organized event called the Tour of Saints in central Minnesota on country roads in 86 degree heat and humidity. I can't tell you how great this felt finishing...it almost brought tears to my 65 year old body. The first thing I remembered after finishing was the first 3 weeks I spent when I got on a stationary bike in rehab and was doing  half revolutions for t3 weeks. Then after 3 weeks....the great feeling of doing one complete revolution and now to do 50 miles on land.....only you yourself can appreciate the journey we have come on from this horrible injury. About 2 hours after I finished I went to my health club and did about 10-12 minutes of strides in the pool. I can tell you the knee and quad on the bike felt great.....some expected swelling after but no pain or fatigue like in running. So....to all....keep working and enjoy like you never have enjoyed before even your little accomplishments as they will get better. I know it is important to me to express somewhat here.....becuse despite all your family and friends these are only milestones we truly understand. Everyone...keep going and be patient there is light at the end of our tunnels.....OLD RUNNING GUY !!

I have done the Tour of the Saints. And am encouraged by your accomplishment. It really is all relative, isn't it? Marathons may have had their day; but now? Maybe charity rides or more recreational pursuits. I'm at 10+ weeks. Making progress every day. Walk without aid around the house. Extending ROM to nearly 90 after exercising a while. I, too, hope to get swimming and water therapy into my schedule soon. And, hopefully in a couple months, back to some easy biking.

Keep up the reports.

 

a Padre

Today was my 6-week post-op visit to the Orthopedic surgeon. My right has been locked straight in the brace continuously for the past 4 weeks - except at night for the past week when I've been taking it off for sleeping (heat wave/no air conditioning) ... and of course when I take a shower ... and sometimes when I hobble very short distances around our place. OK "nearly" continuously.

He poked and prodded the quad tendon area and asked me about any pain ("only when you poke me there doc"); but I've been very fortunate and haven't had any pain. Even the doctor's pressing on the tendon was not much more than the feeling of somewhat uncomfortable pressure.

My legs were up on the examination table and he asked me to bend my knee ... I did as far as I was comfortable and he asked me to hold it until he measured with his protractor. I’m not sure what his reading was ... but he seemed satisfied and promptly set my brace for 50 degrees range of motion. Then he told me to add 10 degrees every week until I come back to see him in 6 more weeks - at which time he wants to see me at 110 degrees ROM.
 
No physiotherapy yet. But, he did say that I could start driving again.

ORG

 

Glad to hear about your positive accomplishments, but sorry that you are still not running like you want to run.

 

Update: I am 5 months from the surgery. The knee is still swollen and tight but I can play golf (with a cart) and generally walk OK as long as I wear a compression brace. I would not feel comfortable without the brace. I regularly use an ultrasound machine and an EMS. My ROM is just about as good as the other knee but again the knee feels tight and sore most of the time if I don't have the brace on the knee. I rehab mostly on my own at this time because I found that PT had become very repetitive. I love to carry my golf bag and walk when I play but don't see this as a real possibility any time soon. I see the OS in two days and am anxious to see what he says about the constant swelling and discomfort. On the good side, I have played up to 36 holes a day without any real loss of distance and my balance is getting a lot better.   I do not feel that I could run at this time or risk riding a bike outside just yet.

 

Has anyone had the same experience that I have had in that the knee feels decent as long as I wear a compression brace and weak and sore if I don't? Also. has anyone had cortisone injected in the knee at about 5 months to alleviate swelling. OS said that he might do that when I see him this week.

I've been reading a lot of the treads about tightness around the knee, my husband complains about the same thing. He had his quad tear repaired 2nd May.

 

Although I didn't have a Quad tear but I have had 20% of my left meniscus removed and there is still a tear in the lateral meniscus, I also experienced the same tightness for many months - I guess all operations effects the muscles in one way or another.  I did a lot of physio building the quad & other muscle up again but couldn't relieve the tightness above the knee.... until I had acupuncture.  What a difference that made.  The physio (who also did the acupuncture) hit it on the head, so to speak, after the 3rd session and found just the right place to fling those needles in. She put them in the outer calf muscle, stuffed if I know how that would have any effect on the knee, but obviously it all connects somehow.  Since then it's just gone away and I can now do a quad stretch equal to the good leg, and more importantly there is no more tightness. 

 

My husband wears a support stocking over his knee when he is walking/swimming in the pool, and also wears it generally around the place.  It is not 'babying' the knee by wearing it, in fact it helps with the swelling and healing, not to mention the feeling of support it offers. 

Has anyone else experienced neck/shoulder/back pain from crutch/walker use?