Quadriceps Tendon Rupture, Repair and Rehab - Page 123

I am almost 10 weeks Post Op.  Just got to 90 ROM and a full revolution on the stationary bike.  Started PT at 7 weeks Post Op and was at 55 ROM.  A few things I can suggest, the Elpitical machine only requires about 65-75 ROM and is good to get the knee moving.  I just discoverd this a week ago and PT did not mention it to me.  I only started with 20 minutes, 5 min Fwd, 5 min back etc.  Secondly, the basic everyday wall slide for stretching and ROM and lastly steps ups on a stair.  I am starting to go upstairs normally, albeit slowly.  However, can not even begin to go down normally; does anybody have suggestions on what exercises or work is needed to go downstairs? How long did it take to go downstairs, Thx.

PDub: Interesting about the eliptical machine. This was my favorite machine before my accident. I'm at 8wks+1day. Had my 2nd PT session today. At 103 ROM but could not get a full revolution on the stationary bike. Have not been to the gym since my accident. I'm excited about the eliptical machine and am going tomorrow. This site is so great as you get info that isn't given elsewhere. Anyone else tried the eliptical machine?

When my brace was locked straight I would sometimes get an ache in the outer portion of my back - on the side where I was using the cane.

A friend told me that the cane is a bit long ... causing me to pass the weight on the cane up through my bent elbow and into my back.

That bit of insight was a tad late ... since I'm now only using the cane for a bit of balance and not heavy-duty support.

But it probably wouldn't hurt to have the lengths of your support devices evaluated by someone knowledgeable.

Dear Idaho Guy - 

 

I am 65 years old and a 43 year skier all over the West as a recreational racer and off piste steeps/backcountry skier.  I suffered a complete left quad rupture on 2/15/2012 and I can't point to a terrific ski accident as the cause - darn!  In truth despite many spectacular falls I never suffered severe injury.  But, I fell down the stairs for the cause of my injury.  The treatment was surgical repair by David S. Gazzaniga, M.D. in Newport Beach, CA.  He studied at the Steadman-Hawkins clinic at Eagle, CO and was the team surgeon for the NY Jets and US Tennis Open.  So, you probably know the drill.  He was great.  He prescribed physical therapy, naturally.  I am 20 weeks post op and worked on the PT three times per week at ProSport Physical Therapy at Newport Beach.  My ROM with the left knee was 130 degrees this morning.  My right knee gets to 150 degrees.  I have no limp.  I now have muscle tone and am starting to rebuild the quadriceps muscles.  I followed directions and refused to succumb to the temptation of overworking on the therapy.  It hurts like a very stiff muscle pull and has to be "warmed up" every day.  I still have not run, but plan to shortly.  They say I'll be back on slope this next season.  Oh, I forgot to say, I am a tournament tennis player on the national level.  They say I'll be able to play again.  So, the moral to this story is to follow doctor's orders and don't rush the rehab.  Patience will have a reward - I hope!

Chic,

 I agree with PPOTZ concerning having a professional check your

crutch setup.The PA in my doctors office took one look at me

and reset everything,no problems with neck or back pain since.

                                                                   All The Best,

                                                                     Calhiker

hey Biggfred! Awesome to hear your accomplishments! Those numbers are damn good, esp considering your injury. I hear ya about the squats and the mental thing. I am kind of glad i didn't do mine lifting. I did it with a suplex takedown and I won't try that again. thankfully there are like hundreds of other takedowns, I just can't get my mind around repeating the movement that tore my quad. I have tried just about everything conventional med has to offer to rehab the intact tendon. If you don't have pain there u may not need to worry. For years I would have a burning pain on the proximal top of my patella where the quad tendon inserts. This is what basically ended my heavy squatting days. if I sit in a chair for hours I will get this pain, the repaired tendon is cured, its the other one that still gets the pain. they call that the "theater sign" and its indicative of tendonosis, which is microtears of the tendon which have for some reason not healed....possibly due to my chronic use of NSAIDS for DOMS(delayed onset muscle soreness) from my bodybuidling days. Since the drug was OTC I guess I took its chronic use lightly. I will be starting prolotherapy and PRP (Platlett rich plasma) injections later this month. It is my last hope for a cure. Otherwise my OS said either give up jiu jitsu and heavy weights or just wait for it to tear and will fix it. Not a whole lot of literature on these treatments, but im desperate. I want to train balls to the wall again and start tearing it up on the mat. I agree with u man if I can heal my unrepaired quad I think I will exell...hell I have been training in constant pain for close to a year now! I can't imagine how easy it would be if I had my old strong quads back! i'll let u know how it goes!

Just a little update. I am coming up on 13 weeks post surgery. Yesterday, I did a 9 mile moderately tough mountain bike ride that took a couple of hours. Lots of getting off go over tough rocky areas. Getting on was the only part that caused a little pain. I expected a little post ride swelling but there wasn't much.
I've been trying to alternate mountain bike rides and Gym work every other day. I'm now doing 150 pound leg press leg. And, 75 pound single leg. My PT added a 90 pound press involving pushing out with both legs and then slowly moving back with just the injured leg. That last exercise is good and demanding on the muscles.
Walking is fairly normal. Going up and down stairs only hurts when I put a lot of pressure on the ball of the foot. PT has me standing sideways on the stairs with the injured leg on the up stairs side. Stepping up causes the most pain I now experience. Pain is on the medial side of the patella.
So, all In all I'm really happy with where I'm at this point for a 69-year-old guy. PT says I can try running when I can leg press my weight (200).

brew22\

 

I alternate between the eliptical and treadmill. my rom is 105 and i still cant get a full revolution on the bike without cheating. the eliptical is great for cardio as long as your not in any pain.

 

pdub

 

my pt has me step up and off of a box the size of about 2 steps. the challange is quad control on the way down. this has dramaticaly improved my going down stairs ability. if your stepping down with the injured leg dont forget to bend it if your able to. my injured leg totally forgot how to walk with the bend witch led to the akward buckle. once i started to bend my knee while walking the buckle stopped. the funny thing is that buckle was my knee telling me it was ready to walk properly lol. good luck to everybody..

Hi fellow Qrippers,

 

Last Monday had approx 8 week post-op.  Doc said it looked great, have about 110 degrees ROM, still swollen significantly, but seriously smaller as each week goes by.

 

Okay'd to swim, straight leg quadsets, no brace if on level terrain, after two more weeks, can do straight leg quadsets lifting leg off floor/table.  Continuing daily heat, ultrasound, cold/ice and 2-3 other times a day cold/ice.  Swam a mile Sunday, dida little over 3/4 mile today (only had 30 min. in pool before a class started).  Feels okay, sometimes aches, sometimes the sharp stabbing (mild) pain around the kneecap.  

 

Doc said no strengthening until 12 weeks post-op, but do something to get a sweat (blood flow) every day.

 

Anyone care to share their strengthening program?

Little bit of info I learned today. I am 81/2 months from surgery and have said many times in previous posts that although I can bike and do strength work I still can not run without a hitch in my stride and with no speed at all. I went back to my surgeon this week complaining of this and showed him that my surgical quad is still 1 to 11/2 inch smaller in circumfrence than my other good quad and my knee is about 1 inch bigger on my surgical side than the normal side leg. He said this is all normal but still ordered a MRI to see if any further damage. I got the MRI and talked to the radiologist right after the MRI. I was able to get to talk to him because my daughter works at the Image Center as a technician. Usually you never see these doctors as they pass on their info to your physican/surgeon.. He told me I had no mensicuss damage but had patella tears in the knee. This concerned me as I thought I had maybe done too much or too fast rehab that could result in more surgery. I started researching patella partial tears and saw the only sure cure is surgery and started freaking. Two days later my surgeon got back to me after seeing the MRI and said everything was fine....no further or new damage. I asked him about patella tendon tear and he said this is all part of the quad rupture experience. When attaching the quad tendon to your kneecap(patella) and drilling the three holes to attach the tendon partial small tears in the patella tendon will occur and is all part of the post operative healing process. He said I can continue running and that with proper work and rehab the legs should come back to normal size....but it could take 1 year at least. My personal experience is that running comes last in rehab and probably never as good as before surgery. This is really 2 injuries in one....the quad rupture and the knee patella with its tears. It is all related and heals at its own pace. Interesting !!

It was interesting to read the string of emails about the quadriceps tendon rupture.  I am 66 years old and ruptured mine in February 2012.  I was walking down some steps to my car after an exercise class.  The pain was very severe.  I had the surgery 4 days later and began my recovery.  By the end of this June I was out of the brace and functioning reasonably well.  I went on vacation at the end of June to the Galapagos Islands in Ecuador with my wife, children, and grandchildren.  

 

The first day of the trip we were touring Quito before flying to the islands the next morning.  During lunch at a local restaurant, I went to the bathroom.  Upon leaving the restroom, I stepped on a 2" high step.  Apparently my knee buckled at the same time I hit the step and my quadriceps tendon completely ruptured again.  Needless to say, I was devastated.  Once I got over the initial shock, I took action.  We built a homemade splint so that I could get back to the van.  I asked our tour guide to find a medical supply shop where I could buy a brace and crutches.  He knew exactly where to go.  Once I got the brace on I became somewhat mobile with my crutches.  The next decision was to get on the boat for a week or come home.  I called my surgeon and he said a week would not make that much difference in the re-repair.  I decided to tough it out and stay with my family.  With a significant degree of difficulty, I was mobile enough to participate in a few of the activities during our 7 day tour of the Galapagos Islands.  Going to the bathroom in the middle of the night on a 48 passenger ship, the Eclipse, that was swaying with the seas was certainly a challenge.  The good news is that I made it through this ordeal.  We returned to the good old USA on Sunday, July 8, 2012 and I was in surgery on Tuesday, July 10th.  

 

Apparently my tendon had deteriorated significantly since my original surgery in February.  My doctor reinforced my tendon with 2 achilles tendons from cadaveras.   Thank God people are willing to donate body parts when they leave this earth.  The recovery will be much longer than the original rupture.  At some point, I will be in a cast for 6-8 weeks and then into a brace.  I will start physical therapy somewhere down the road.  My wife is definitely a candidate for sainthood.  My goal is to play 18 holes of golf before the end on 2012. 

 

The moral to this story is do not rupture your quadriceps tendon a second time.  In retrospect, I wish I had worn my brace during my vacation.

Yes, I have used the elliptical quite a bit. I used it quite a bit before my injury too. I find it is really easy on the knee but gives a good quad exercise along with cardio. Don't be surprised if the fatigue factor hits you earlier than you might expect though. I used to go 30 minutes at a pace of 145 strides per minute with resistance about 2/3rds of the way up. I haven't gotten back to that level yet. The best I've done is around 25 minutes with resistance down a touch and strides at around 140. When the fatigue hits it is usually the muscles surrounding the knee that feel it first. But it is true that you can start getting a good cardio workout in earlier on the elliptical than you could on a stationary bike.

Wow. This is scary. I think I'll stay in my brace for at least 6 months so this doesn't happen to me.

Hang in runners. I'm a bit over 2 years out from my second quad rupture--2005, 2010. I'd only done 27 marathons (4 Bostons) and had pretty much hung up the long ones. I was pretty much back to full distances if not full speed within 8 months of my 9-2005 R rupture. I was able to do a 5 mile uphill (1700' climb) in July after my 3-2010 left quad repair at a very slow pace but my left knee has never been quite right downhill at any speed. MRI last year showed the quad repair was fine but a severe patella tendonosis with effusion (fluid) that probably accounts for the feeling that the leg isn't going to come down quite right. Never the less if my back wasn't shot I think 10 miles or less would be doable. Knee hurts, but things always hurt when you're a marathoner.

 I'll post again after my next spinal nerve root radiofrequency ablation next month.

I just got out of my cast after 6 weeks. My doc put me in a brace finally. I'm still not able to walk without crutches. My thigh muscle is miniscule. My leg is extremely swollen...I would say my ankle is the size of a lemon and my knee is as big as a grapefruit. My doc wants me to be able to bend my knee to 45 degrees in 10 days. I'm kind of scared this won't be possible. I'm also not sure how I'll be able to walk again in the foreseeable future...my leg feels like spaghetti :-( Any tips?
 

Chic,

 4 weeks post surgery so very little background

in PT but for swelling the Donjoy Iceman cold water

system is great and has made a big difference for me.

Your insurance very well might cover the cost and most

Home Health Care Services have the machine.

                                                 All The Best

                                                  Calhiker

Chica

I'm at 90 days post op today. First had full leg cast for four weeks; then hinged cast for four weeks. Now in adjustable brace. Rule of thumb for ROM: one degree per day post op. So, keep doing heel slides and slow but sure the ROM will come. I'm just getting to 90 degrees now. Also, remember the three months needed for secure healing of tendon to kneecap. Then more agressive PT and muscle rebuilding. My 69th birthday is next month. Hope to walk on my own by then, perhaps with cane help.

Enjoy being cast free!!!

Padre

Chica

Cant imagine being locked out in a cast for 6 weeks. I will say that I was locked out for 4 weeks and was allowed to move my brace to 30 after 4wks. during that time I did what quad sets I was able to do. Make sure you pump those ankles and tighten the quads as much as possible. If your allowed to weight bear do it as much as safely possible. I had the wobbles real bad but focused every time I stood up and tried not to. My approach was fight for your quality of life back. My PA told me that I will never be the same person I was before the injury. Wrong answer! lol.. Don't get discouraged about the size of your leg because that just comes with the territory. Big weeks are coming for you. I think week 8, 10, 12, were big improvement weeks.You have a lot to look forward too. Keep working!!!

Steve.....

Week 13+ 

I'd say just take your time it'll come. My main ROM exercise was to pull my leg up as far as I could comfortably, whilst lying on my side in bed. Then leaving it there as long as I could.

 I started walking by just touching the floor with the bad foot whilst using crutches - no weight bearing at all at first. Just slow progress.

Swelling goes down if I put my foot up high when lying on the sofa.

 

Have finished with the apparatus now but take a stick if walking far i.e. more than say 1/2 mile which is about my limit.

What's really helped is having my bike on a turbo trainer and doing a lot of short walm-ups - working up and down the gears 30 secs on each, until feeling tired. It's the only heart/lung exercise I've been able to do

Steve,

 

Agree completely with your comment about weeks 8, 10, 12 being big improvement times. My 2nd cast came off at 8 weeks. Began daily improvements in ROM after 10 weeks, now, at 12 weeks, still have adjustable brace but get around to do most things I used to do: work, cook, walk short distances, get out, etc. Past 90 degrees ROM. Doc appt July 25 for PT assessment and workout schedule.

Having a lot to look forward to is good motivation. Hang in there everyone. And thanks again to those who are further advanced. You give us all hope.

 

Padre

Greetings,

   4 weeks post op. Will start PT in two weeks.

Can anyone give me some guidelines as to the frequency

of PT and what qualities you looked for in a therapist.

Just went to a hinged brace that makes driving possible,

my wife is thrilled.

                                  Thanks for the help,

                                     Calhiker

Cal hiker

 

So jealous you're driving. What angle is your brace set to? Mine is at 45 degrees but I haven't attempted driving yet.
 

Chic,

  60 degrees but I can get in and out of the car at 45 degrees.

                                                             All The Best,

                                                               Calhiker

Good to hear of your progress. I'm two yrs out also. Good knee causing some problems/pain. I'm gearing up for a half in Sept. and hope it all works out. It's so good to run again.  Keep posting and good luck.

Previous post to Auscoach

Calhiker and other drivers

 

Anyone know what the law says about driving with leg brace? Do you need doc permission? Insurance waver? I know I can drive with brace and have done so. But only short distances on local roads.I don't know what I'd be able to do in an emergency at high speed. It might be a good addition to this thread for a lawyer to weigh in on this topic.

Padre

At 6.5 weeks and down to one crutch! Small victories :-)
 

 good job chica.. :)

3 months check up:

 

Surgeon satisfied with healing of tendon and ROM (95 degrees). Can take off adjustable brace to walk except in crowds or over uneven ground. Use cane if needed and/or for security. Have PT appointment tomorrow to begin muscle-building and toning, and to do gait training. OK to do whatever I can tolerate as to work, play, exercise, but nothing that would twist knee or demand sudden movements. Suggested stationary cycling, swimming, walking, eliptical machine, etc., Cautious on stairs.

 

Feels great to finally be able to drive and get around as I'm used to, at least to a limited extent.

 

Thanks for the encouragement, and am passing it on. Healing takes time. But it comes.

 

Padre

7 weeks post injury / 6 weeks post surgery -

Met with my Ortho surgeon, today (my birthday) and received good news, really good news, and really really good news!

Good news-I no longer have to sleep in my brace; Really good news-I no longer have to wear my brace in the house (we have a really small house with no stairs); Really really good news-I get to start PT!  Ortho surgeon was quite pleased with my x-rays and with my ability to hold up my leg when he lifted it out straight.  Now, I didn't hold it up very long, but holding it at all was a HUGE improvement, as I'm sure this group can appreciate. And there was no pain, which was a great relief. 

 

Still have to wear my brace when "out and about", especially on our property which is rocky and uneven...., but I'm just fine with that.  Don't plan to be doing much hiking, yet, anyway.  Feeling really good about recovery and ultimate regaining of strength.  I'm not an athlete or extreme sport person - I just want to regain my normal'ish life and be able to be up and outside with my family, my grandkids, and enjoy my five pet cows. That's beginning to look like an attainable goal....