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Quadriceps Tendon Rupture, Repair and Rehab - Page 19

post #541 of 10808
Originally Posted by Connie P View Post
Helmut-Yes, the walker is nice I sure didn't want to learn crutches in recovery I really like having 5 feet on the ground instead of three. Espacially now! As far as swelling.....my whole leg is still swollen. My foot as well. I think it's partly due to the immobilizer. That doesn't let me sit too comfy ever, then all the weight of my leg is on my heel...then that get's to hurting.

May I ask how many of you are able to sleep on your sides?? Does this do anything to the knee??
Can't sleep ther for long but this is how I do it. Give yourself lots of room to have your leg lay in front of you straight out. Then put pillows under the entire length of the leg. That way you foot is supported as well as you upper thigh. You may need help from partner to get rolled over.
Sometimes I just put the blankets betwen my leg and just lay on side with legs stacked on top of each other too. Hope that helps. Takes a bit of trial and error but it is worht it.
post #542 of 10808
Thread Starter 

NMES questions

Hello gang:

Managed to do a 100-mile supported bike ride this past Sunday. Was actually with the second-fastest group (composed primarily of older guys - the younger, super-fast guys were all in front of us in another group) for the first 60 miles. I even did a couple of pretty stiff hills. But then, ran into a five-mile long hill, and my group dropped me - I think primarily because I could not "bear down" for a long time with my QTR knee. I ended up doing the last 40 miles on my own in stiff, buffeting winds - ended up being a REALLY hard day - still felt pretty good, but disappointed that I couldn't hold onto the wheels of guys whose wheels I should be able to stay latched onto. So, I believe I need some more strength - my program isn't getting me there as quickly as I want to be - I want to be able to ski this winter, and I am somewhat concerned about that right now. My QTR leg is still both smaller and substantially weaker than my non-QTR leg. I know people like Sinrider and the weightlifters on this thread are freaks of nature and seem to be performing at their previous levels - that is where I want to be too! BADLY!!!

I have a very good friend who is a PT and went to a conference this weekend in Portland, OR. She discussed QTRs with one of the speakers there and he suggested Neuro-muscular electrical stimulation (NMES) in conjunction with exercise (primarily lifting weights). My friend is willing to help me come up with a program that incorporates NMES into it. My question to all of you is whether anybody has any experience with NMES, and what that experience might be. I'm really interested in hearing about it, so please reply if you have.

Otherwise, I am still progressing, sure but slow. I am so glad to see the rest of you doing well - Connie, CalQuadPop, Helmut, Boxing, DudeinMD, etc. Keep after it!

post #543 of 10808

14 Weeks Post

IDG - I just read your post and feel the need to share again. Seems to me I remember you writing about an incident you had at rehab some time ago. You were afraid the repair had been damaged.

I wrote about slipping on my porch on day 19, completely collapsing the repaired knee, feeling a ripping sensation and more pain than the original incident. My OS saw me about a week later after the swelling had gone down and we both felt that I should try to resume rehab and see how it goes.

8 weeks after the fall (11 weeks total) I had to throw in the towel. I had been working like a crazyman trying to get it to function properly, and I just seemed to be going backwards. An MRI proved what my body had been telling me all along. Most of the repair had failed. Had the surgery again 3 weeks ago and after a couple of really down weeks, I'm feeling dangerously good again.

It's everything I can do to keep from doing too much. I've been back on the eliptical again 7 of the last 8 days. Gaining flexability every day (I'm at about 70*), working the rest of my body hard in the weight room. I still believe that sinrider's approach to this is my best chance to regain full strength and ROM. I also believe that had I not taken that spill at the 3 week point, I would be running by now.

Sinrider used to write about being in the "no fall zone." That's what I'm doing different this time. Caution in dangerous situations, aggressive in my rehab.

If I can say something positive, I found the second time around (surgery) to be a lot easier. Maybe just knowing what to expect. Only needed the pain meds the 1st 24 hours. Less swelling, even the scar looks better.

BTW, I have a NMES but have been told that it would only benefit me if the quad was having trouble firing at all. So I've kept it out of my routine for now. Here's hoping you can join the "freaks of nature" and perform to your expectations. Your 100-mile bike ride sounds pretty close.

post #544 of 10808

25 Weeks

Hey -

After 2 weeks back at work at the power company, I've worked about 4 days around 24 hours straight and my legs have held up. I haven't been able to get to the gym much to work them.

While I was off work, I was able to work and strengthen them every day, but now I'm missing too much workout time and I'm feeling more weakness in the quads. I'm totally happy with the recovery so far, but I have to work them hard every day or they will regress.

IDG - I believe we will both be as good or better than before. My legs are smaller and weaker too, but these were some bad injuries and it just takes time to get all our strength back. Thanks again...

Tiger bait
post #545 of 10808

20 Weeks

Willthethrill: Sorry to hear of your setback. You're due for some good luck. I wish you all the best.

I had PT session #12 today. ROM is measuring 135 degrees. The first exercise was jumping on a mini-trampoline, starting in a squat position, jumping up, and then landing back in a squat position. I did two sets of 10 jumps. On the third set I experienced "injury pain" when starting in the squat position, so I bailed out and did 10 minutes of "cool down" on the stationary bike. I think I will delete this exercise from my rehabilitation program. Next up I did six sets of 10 reps on the Hammer Strength "individual leg" leg press machine. I started at 20 lbs and worked up to 70 lbs. I felt like I could go heavier, but better safe than sorry. I finished off the session with 10 minutes cool-down on the stationary bike.

One thing I notice when I do squat exercises is I feel a "click" or "pop" part-way through the range of motion. It's not painful but it is definitely noticeable. I wonder if this is muscle, tendon, or scar tissue moving across the repair location sutures or drill-holes. Hopefully this will go away when I build additional muscle mass.
post #546 of 10808

11 weeks post op

Hello everyone
pt#21 tue. Doct gave me some strength exercises, leg still weak,rom at 103.

California quad pop-seems like our injuries happened very close together.Mine was may 17,had my surg. the day after you got injured and start pt 10 days after that. 2x/week for the first 2 weeks and 3x/week after that.start with quad squeeze and heel slides. start week 2 at 30rom.,gaining 8-10 degrees per week until I reached 60-65,after that have been kind of slow,I think.Stop using the crutches at week 4, walking with the brace at 30 degrees.Couple of weeks ago I took brace off and start walking with the cane ,just in case.Now I,m trying not to use the cane inside the house.When I go out I wear the brace at 90 degrees because my knee buckles.I started doing some half squats on the total gym with the brace on at 70 degrees about 3 weeks ago, no pain .Knee still sore after pt sessions.You asked me if I had holes drilled on my knee,yes I did,6 of them.I had a complete rupture,the tendon snap from the patella doing heavy weigth lifting(squats).The OS told me that when he open my knee he found a real mess in there.I use to compete in weigth lifting 20 years ago and I found out the hard way that I,m not that young anymore,oh well!!!,hard headed.Seems like you are having a lot of progress,good for you!!,keep working hard,and thanks for your words. To everyone else outhere good luck and wishing you a full recovery.

Don jp
post #547 of 10808
Greetings All!

2 days ago, Aug 12, I was 9 mo post surgery. I tell everyone who asks I feel I can do anything I want but still have some tightness across the front of the repaired knee. When riding my new bike (IDG-100 miles! Wow!) I sometimes experience pain/fatigue in the 2 quad muscles on either side of the knee which I attribute to re-gaining the strength.

Connie: put me down for "medium rare" ! I had difficulty getting comfortable as well and had to change positions frequently. I mentioned I slept on the couch for 3 wks due to the fact that I was up so often to alleviate pain/discomfort. It tended to dissapate after the first couple of weeks. I am a side sleeper, and that was the most difficult part. I really couldn't very well, not at all first 2 weeks, but the pillows/blankets mentioned earlier helped.

Helmut: My surgery was on a Monday and the following Thurs suddenly had major foot swelling. Dr said "elevate". When I had my stitches out at 2 wks I asked the PA if he was concerned about the amount of swelling. He said no, you have to elevate! I said I am and then he took my leg and bent it straight up and said "this is elevation". I must admit it scaredthe "h" out of me when he did that. But after I elevated more, so the leg was at least above my head. The swelling disappeared as quickly as it came, maybe 3.5 weeks?

IDG: I had e-stim during my first, oh 10 PT sessions. After that, no. I agree I think it is to gain that early quad firing experience and to begin to build some strength. I was shocked when a friend pointed out to me how skinny my leg was compared to the healthy one. I would say it was about 6 mo before I felt I was gaining mass in the injured leg, and that is about where you are I think. I still had a hitch in my running at that point and the heavy pool work helped both mass and the hitch.

Will: OMG! Sorry for your reinjury! Hope things are getting better now!

Keep Pluggin' !

post #548 of 10808

Surgery May 21 -- 12 weeks post op -- 47 year old runner

Hi all,

I came across Idaho Guy's original post a couple of months ago, and was relieved to see that another over 40 man who believed himself to be an athlete could get this injury. Didn't realize that there was such a rich community of fellow QTRs out there, and sort of wish I'd been reading and posting throughout my rehab. Will give my story and hope it will be helpful to others in the fellowship of blown quads.

I've been a fairly serious masters runner, have averaged running 1500 miles a year for 20 years, and keep a running journal going back to 1987. Ran a 2:44 marathon back in 1992, then got married, had kids, gained some weight, and generally slacked off. In 2004 I made a big push to get back in shape, lost 25 lbs, and ran Chicago in 2:57 at age 42, and was semi-proud of myself. Have kept in shape since then, and run a regional trail race called "The Dipsea" every June in Marin County, CA.

I was 2/3 of the way through my training ramp for 2008, and feeling very good about my training, doing 30-35 miles a week of high quality, including hill repeats, long trail runs on Sundays, no leg problems at all. On May 16th I was at our little swimming club and decided to go off the diving board. The first couple of dives were fine, bu the 3rd time my right leg came down slightly wrong and I felt my right leg just explode when the board compressed. Very sickening feeling, as all can relate to.

Made it home and had a friend who's an OS come to our house the next day, and he immediately said "dude, you blew out your quad tendon, that's bad." But he's an upbeat guy, and added "it could be worse, could have been your ACL." I asked who he would go to if he had this injury, and my friend referred me to a prominent OS in our area who's the chief of sports medicine at a big university hospital. He's highly qualified, and was very clear and the diagnosis. He did the surgery on May 21, 5 days post-injury. I had a nasty full rupture, with a lot of additional tissue tearing down both sides of my knee, but not issues with ACL or meniscus. Instead of drilling my patealla they used bio absorbable surgical implants in my patella and sewed everything back together. Post-surgical pain was awful for about the first 48 hours, did lots of percocet and used a little ice water circulating machine that helped keep it cool. But it really, really hurt a lot.

Was in a brace locked straight for four weeks, which sucked. Couldn't drive since it was my right leg. Started PT 3 weeks after surgery, twice a week. The were worried that I wouold over do it on the PT, so most of the time it's been a struggle for them to keep me from being too aggressive in my rehab. Overall PT has been good but I think more of my recovery has been do to just using my leg pretty aggressively.

The knee stayed swollen for about the first 8 weeks, but functionality started coming back at about 3 weeks. Went to 50 ROM, then 80, 89, last time I went it was 125. At this point I can bring my heel up to within about 3-4" on my butt cheek, and am not too worried about getting the full flex.

My PT guy has focused more on getting me to be able to fire my quads and straighten my leg completely. I was at -2 degrees last time I went, so it gets completely straight, but that main inner quad muscle is still much smaller than my uninjured leg.

As they gave me more degrees of motion on my brace I started to do weight bearing at about 4 weeks. First with crutches, then I'd take a 10 steps without crutches, 10 steps with light weight bearing, and 10 with no weight bearing, and so on. I was very systematic about trying to layer in more activity. My Dr. and PT have been really happy with the results so far, but it's still a negotiation to let me do more activity. I started riding my bike at 7 weeks, first time was about a mile, and the leg felt tight, but have gradually ramped it up.

We went up to a family camp in the Sierras near Tahoe 9 1/2 weeks post surgey, and I had originally been really worried about getting around, but it ended up not being a problem. I rowed, hiked and swam every day, and didn't have any pain. A couple of times after a big day the leg was slightly swollen by the timeI went to bed, but it cooled off over night. I included a lot of climibing and decents and it help up just fine, but I only did a 2 hour hike, not a 6 hour. I also didn't run or water ski. Activity was fine but if I just stand in one place for a couple of hours it gets stiff and tight.

I've been riding my bike to work (about 30 minutes) for 2 weeks and it seems to be very good therapy. Have started running again but on very limited and intermittent terms. Will walk a mile to warm up, then jog the strights and walk the turns, and keep moving for about an hour. Then I go the the fitness center and do sit ups, push ups, etc. I can do most exercises but there are a few that remind me that my leg is still weak. I can comfortably do leg extensions with 50 lbs on my left leg, but only 25 on my right. I am really focused on trying to build up the strength on my right leg through walking, biking, and in general moving around as much as I can. I don't limp and look normal (albeit slow) when I jog, but I did notice a tiny bit of swelling the day after my last run/walk. I made it up to two laps without walking, will try to go to 3 laps next time.

I do have that big muscular looking bump over the quad, it's an oval and is centered over the 3" incision. Wish it would go away but from this forum it sounds like that will be there for awhile. I guess it will gradually get a little smaller but never go away.

I was encouraged to do early motion by an abstract of a study I found on the Web, here it is for those of you who are interested:


I think that Dr.'s don't see that many of this type of injury they want to "baby" the repair, which makes sense, but then the fact that the leg is immobilized for so long ends up delaying the recovery. I've tried to take a middle ground of generally listening to my OS and PT guy, and have consistently pushed ahead of what they wanted -- but only by a little. One area I was pretty relaxed about was the ROM. From everything I've read, the ROM will come back over time, and there's no need to go through these excruciating PT sessions where they try to push through the pain. I have very good ROM now, and it's come back on its own based on simply using my leg a lot. Maybe I've been a wuss but I've been very deliberate about trying to avoid overdoing it and having my leg swell up and set my rehab back a couple of weeks. I'm not trying out for the Olympics, just want to get as close to 100% back asis humanely possible.

My plan is to run a mile without stopping by 14-15 weeks out, and then combinine running, cycling and gym workouts to build back the strength. I have a 5K I plan to run with one of my daughters at Thanksgiving, and at this point that looks like it shouldn't be a problem.

My biggest concern is that I'll have continued weakness in the quad. I read one study where even several years after surgery the injured quad was 20-30% weaker than the other one. My plan is to gradually increase my fitness and then exercise the heck out of it starting at about 20 weeks, basiclaly to do all that I can without having it swell up.

So, that's my story. Since I injured myself in May, I'm about on schedule with CalQuad Pop and Don JP, so I'm interested to hear how they're doing and what's working for them. I felt old and pathetic after I got hurt, so it's encouraging both to hear that there are quite a few 40-50 year olds who were in very good shape who still got hit by this injury. Getting old isn't for sissies!

Like for all ofthe folks on this board, this is a huge setback for me, but I want to do everything humanely possible to get my active lifestyle back, including long trail runs on weekends. I'm especially interested in any thoughts for the folks who are 3-6 months farther along on how well they have been able to ramp up to something resembling their previous level of activity, and any tips they have.

For people who are recently injured, my advice is to be go for early weight bearing and motion, but not be crazy about it. I have been very incremental and systematic in my approach to recovery, and it seems to have been working well so far. More than anything, pay attention to your own body, and listen to what it is telling you. My leg isn't fully recovered, but it is starting to feel like it belongs to my body again and is a functioning part of the whole, which is really encouraging.

That's all I've got, and it's probably more than people want to hear, but it feels good to lay it all out there. Good luck to you all.


p.s. TIger Girl, I'd love to connect with your friend who had a double QTR from a diving board accident. I'm still amazed that's how I hurt myself.
post #549 of 10808
Hi Paul

Sounds like you had very good success in short order. I am 44 and also felt like I was a 20 year old athelete. Although I tore mine on a motorcycle crash the mechanism of injury is the same. My OS told me that at my age and activity level injuries like this are common especially if your sport is high impact like hockey in my case or running in yours. It seems that the tendon and ligament tissue does stiffen and degrade with age and therefore cannot take sudden impacts any longer. This is also proven out with a biceps rupture I sustained 4 years ago.

The article you provided is interesting but it does not mention the age of the 50 cases nor mechanism of injury. I do agree that the sooner you can move the better you are going to be within reason. I think the real risk to early rom and weight bearing is the possiblity of accidental reinjury at a very vulnerable time.

Please don't think i am being negative but in my case I have good reason. My initial injury was a slight tear but due to an over zealous PT the injury turned into an 80% tear then required surgery. I had no indication that the tear had gotten worse other than strange swelling. There was no extra pain to indicate a problem. So I my case I believe that staying off it for the 4-6 weeks as indicated is a prudent plan.

That being said there was one person here that ditched crutches and brace 2 weeks in and had good results. However, there was also one that had a reinjury after only 3 weeks post op I think.
post #550 of 10808

I think rehab is like porridge for Goldilock's and the Three Bears -- not too hot, not too cold, just right in the middle. It's not always easy to find the balance between babying the injured leg and abusing it, but that's what we all have to discover for ourselves.

I got the full copy of the report from the lead author and most of the accidents were slips or falls where the person's foot came down wrong. Few were from big crashes like yours -- from what I can tell most of these injuries happen in ways that are sudden and very surprising to the person who got injured. If I had been 36 instead of 46 going off that diving board, I'm highly confident this wouldn't have been an issue.

It's a bummer that your over aggressive PT injured your slight tear to the point you needed surgery. I'm very cautious about any PT where it feels like they're pushing past what my leg can stand. Especially on ROM, my leg has clearly let me know what the limit was, and fortunately my PT didn't try to push me farther than was prudent.

I'm far enough out I don't think I have much danger or reinjuring it, but I want to avoid swelling and pain from hitting it too hard. Good luck with your slow and steady approach.
post #551 of 10808
Hey Everyone,

I have been away for quite some time and trying to catch up on all your posts. My initial injury was April 5, not quite 5 months ago. I was released from PT a few days ago with ROM up to 136. I am still going 3 times a week on my own to keep ROM up and continue to build strength. My knee has varying degrees of pain, soreness, etc from time to time. Have developed a "popping" sensation on the outside of the knee cap which occurs about 50% of the time when I walk. It doesn't hurt, but is annoying. Possible scar tissue maybe, I don't know.

Knee was buckling alot, but that has gotten better, although it still buckles once in awhile. Hope that eventually goes away. Have a tendancy to walk stiff legged once in awhile and am trying to be concious not to do that. Next OS visit is Sep 8. He may do an MRI to check things out, especially the "popping" thing going on. Later.
post #552 of 10808

Better Luck fir WillTheThrill

Originally Posted by willthethrill View Post
Had the surgery again 3 weeks ago and after a couple of really down weeks, I'm feeling dangerously good again.

Your luck absolutely has to improve. I hope everything goes smooth from here on out.

post #553 of 10808

6 weeks post-op

I see the OS tomorrow. I am working my butt off trying to get to 90 ROM plus. The OS let me do my own PT the last couple of weeks. I had no idea what everyone meant when they said the knee was stiff. I have to constantly check the damaged leg with my other leg to make sure I am working everything the right way. It seems like it will never bend correctly again, but everyone here gives me hope that it will.

I can extend the leg out straight, but I have a lot of pain below the patella. I did not damage it there to my knowledge, so I am not sure why it is so painful in that spot.

Thanks again to all for this forum.

post #554 of 10808

12 weeks post surgery -- ran 1 mile

Hi all,

After 90 days without running, and 84 days post surgery, I took the plunge yesterday and ran one mile. It wasn't fast, but I didn't stop, and the leg held together just fine. As a precaution I iced it last night while watching the Olympics but didn't experience any pain or swelling. To those of you who are still anxious if you'll ever trust your leg again, it will come, just be patient.

As far as ROM, the bending will come, that takes time as well. Me knee had clear and firm limits to the ROM, but it has improved steadily. My PT guy and others I've talked to focus more on getting the knee to flatten out completely and the quad muscles to fire. In addition to the tendon damage, the quad muscles take a huge hit from this injury, and they take a lot of extra attention to start to work again.

post #555 of 10808
Hi all. Well the brace comes off on Monday and I was wondering what to expect after that. I am nervous thinking that the new lack of support is start a whole new round of pain. What have you experiences been?
post #556 of 10808

15 Days after Surgery

Hello All! Today I had my staples removed. It's 2 weeks since my surgery. I'm not sure what the deal is with my doctor. He basically just took a quick glance at my knee and asked his assistant to remove the staples. She removed the staples, reapplied my ace bandage(rather tight) and my immobilizer(rather tight also). The OS looks at me and says stay off of your leg for 4 more weeks. I was like, are you serious? He says that it takes 6 weeks for the the tendon to heal and that I can't put weight on it until after 4 more weeks. Needless to say, I went into instant depression. I can't imagine sitting on the couch for 4 more weeks. WOW!!!! No work or anything. Other than going to the restroom, etc., stay off of it.

After seeing most your posts, seems like most of you were starting your PT after your staples came out. He did give me another prescription for Oxycodone. Other than pain from the stitches being removed, I'm not in any pain right now. Not sure how long that will last though.

After hearing about Will and others having to have the surgery again, I'm afraid to do anything other than sit on the couch. Right now, I'm not sure how I'm going to manage 4 more weeks of sitting. Have any of you had to stay off of your leg for 6 straight weeks. If so, WHAT DID YOU DO for 6 weeks? Also, do you guys keep your ace bandage and immobilizer on really tight. It's so uncomfortable. I'm sitting here wondering how I can do this..... Needless to say, my staple removal day has turned UGLY. Oh well, Any advice would be greatly appreciated.

Thanks for all the great information so far guys. Keep it up. Have a great weekend guys!!!
post #557 of 10808

Dude....I'm right behind you....

Today, is my 8th day post-op...I get my staples out Monday. I already know that I get to put my ace back on and my immobilizer and wait another 6 weeks.....with no weight bearing. PT hasn't even been mentioned....

As I understand it it will take that long for the tendon to grow back and re-attach itself well enough that when we finally do get to stand up...it'll hold.

Honestly Dude, I don't want to feel the pain of this injury ever again....I would much rather have 10 babies than to go thru what we have all been through...anytime!! I mean that....I've had 4....I'd still do 10.

6 Weeks is a long time...I'm either sitting in my recliner, sitting in my wheelchair (with one leg extended), or walking to the other end of the house with my walker. I sometimes feel as tho' my butt bones are gonna poke thru hubbies boxer shorts...(I wear them because they're easier to get down over the immobilizer) I hate TV and simply don't watch it. My flower garden that was so beautiful is full of new weeds-my garden that was huge is looking alot like my flowers...Hubby cooks all the time now - Does all the laundry - helps hold my leg when I need to use the bathroom (because I can't bend it nor hold it out straight on my own). My house is not as tidy as I'd like it to be. Dude, we're in the same boat!

One thing I am doing is beginning a Recovery Journal at wordpress.com
That's just to keep family and friends up on my recovery. I can upload pics and it's something only I can do....I'm also doing a Bible study, that I've been wanting to do for a couple of months...other than that, I sit.

Now, about your immobilizer and ace....Like I said, I have the immobilizer and an ace wrap too.....I get to open my staples to room air as often as I wish just as long as I DON'T BEND my leg. I never get up or sleep with it off. If your immobilizer is too tight and you didn't have any major bleeding with the staples coming out AND you can absolutely keep your leg straight, then I would loosen the immobilizer...If your toes are more darker than pink or you feel as tho your foot is going to go to sleep, then loosen it, if your foot is throbbing and hot, then loosen it. Keep your leg elevated and then snug it up some before going to sleep or getting up. Let me say, that's what I'd do.....

Even with staples, I keep mine more loose than too snug....just for comfort measures. My leg still hurts...and swells badly when I get up, but I just can't sit all the time....

We chose this forum because other like us have been where we are...they are better and some are so much more healed than you and I. I couldn't run a mile if my life depended on it....I'd be dead for sure.

I know 6 weeks is a long time and I am not looking forward to it at all, but it is what it is....
I'm sorry, I don't have any great advice...just hang tuff..we'll get there!
post #558 of 10808

105 degrees ROM today

Wow, this place sure is busy recently.

I saw my Dr. on Tuesday 8/12/08. He was very pleased with my progress and wrote me another Rx for 4 more weeks of PT (3x/week).
He had me extend my leg out and he could see that I could bend it pretty far back on the table. Since he did the surgery 6/5/08, he knows how bad things were in there. He said the quad kind of shredded before the tendon ripped. He said sometimes when that happens, bone fragments can be attached to the tendon/muscle. That is all he said. He is a man of few words (bue he really knows his stuff and also teaches). I really don't need him to elaborate on the repair as I can feel it for myself! (my tendon ripped up higher, so I don't have holes drilling in the kneecap).


I read an article online. It was a New York Times article from 3/15/97 "Months of Therapy Will Accompany Healing" by Lawrence K. Altman. The article was about President Bill Clinton's quad rupture.
http://query.nytimes.com/gst/fullpag...C0A9619582 60

Anyway, in the article, a doctor that did not perform the surgery, Dr. Victor Frankel, at Hospital for Joint Diseases in New York City, said that "the surgical repair is about 15% of the recovery and that 85% is from the healing and rehabilitation".

That was an interesting fact! Notice that surgery isn't even half the battle, only 15%! The rest is healing and physical therapy. So, while some of you are losing patience in the immobilizer--that is a big part of the recovery process right there.

In various articles I found online, Bill Clinton tore his right quad tendon. According to Clinton, "Literally, my quadriceps shredded, and hung on only by 10%...they drilled three holes in my knee." (He had surgery only 14 hours after the accident, but then he was the President.)

According to Clinton's doctor, Dr. David P. Adkison, "More than 50% of Mr. Clinton's tendon was torn, and the tear was in a pattern that was more complex than usual." Such tendons usually tear horizontally. But Mr. Clinton's tear began "fairly high in his thigh, headed down toward his kneecap and then split and sort of delaminated the tendon and then came around to the inside of his knee."

Clinton had an epidural for the surgery and for 2 days later so he would not be knocked out and also so he wouldn't have to take any pain pills that would affect his decision making (guess he didn't want Gore to be in charge for even a few hours). Clinton's surgery was about 2 hours.

(reference the link above, as this info is from that same article.)

Oh, the interesting thing about Clinton's quad rupture. My doctor said that while Clinton was president some bill was being proposed by some health care companies to reduce physical therapy treatment. Well, after going what he went through, Clinton said he couldn't possibly sign such a bill. He had his therapist with him all the time and knew he wouldn't be walking if it weren't for physical therapy!

Ok, back to my progress. I was 103 rom last week, so to only be 105 rom this week seems like slow progress to me.

It must be an optical illusion, but it always looks to me at home while I'm doing my heel slides that my leg is coming up really high. I thought for sure I would pass 105 rom today. Well, that just shows me I have a lot of work cut out for this weekend. This is why one can never get comfortable.

Stationary bike - moved from #4 to #3, which is normal for my leg length. We had it on #4 which was just a bit high for my leg length but allowed me to do a complete pedal all the way around. I was able to easily pedal at #3. I'm doing 10 minutes smoothly as of today between 65 and 70 rpm.

Treadmill - I'm doing 10 minutes on that. I started at 1 last week and gradually moved up to 2 by today (no incline). I am holding on to the handrails. I seem to move really smooth on the treadmill, but not as smooth just walking on regular ground.

Steps - still have one riser under the Fonda step. I need to find out if we should move it to 2 risers (which is about the normal height of my stairs at home and most stairs). I can feel more strength in my leg. I didn't even have to hold onto the handrails while I did my up and down step (leading with my injured leg). However, I did have my hands just above the handrails in case I needed them. On the side-to-side step leading with injured leg, I only had one hand lightly on the handrail, but not grasping the hand rail. I think I will try that exercise next week with my hand just hovering about the hand rail. I have steps at home--so plenty of time to practice steps at a higher level.

Walking between handrails - I'm able to walk with more confidence and take larger and smoother steps. However, this is after a good warmup on the bike and my other exercises. When I wake up in the morning at home and first get out of bed, I'm kind of doing a bit of a zombie shuffle. Guess it will take time to walk normal all the time.

Balance - still standing on injured leg for 15 seconds, repeat 5 times. I'm getting much steadier at that.

No new exercises this week. I need to find out if we are going to add anything new next week.

When I was leaving, the one therapist said I was doing really good on the Total Gym. Nice someone noticed. I sure don't make that look easy. That is where I give it my all to go down as far as possible and hold 10 seconds, then come up 10 seconds, and do that 10 times at level 7, then 10 times at level 3. I'm sure at times when I go down I'm grimacing. It isn't painful, I just try to go a little lower than the previous time and it is a fine balance.

The same therapist said "When are you going to ditch the crutch?" Well, I only use my jointed knee brace and one crutch when I leave the house. The brace comes off at therapy. I don't wear it at home and I don't use any crutches inside my house. I don't really use the crutch for support. However, I noticed that I walk so darn slow without the crutch that I feel better having it when I have to go across crosswalks. Also, the crutch came in handy at Office Depot today. I had to get something way back on a shelf beyond my reach, but I was able to stick my crutch in the back and scoot the item I wanted up closer! (I don't use the crutch in stores, I just stick in a shopping cart and wheel the cart around.)

However, I just ordered a handy item to use for situations that might require a lot of walking and I might need a rest. It is called a folding cane sling seat. It folds up and has a velcro strap to wrap around the seat part so it functions like a 4-footed cane, then when you need a seat, bingo. I was also thinking it would come in handy to sit on a bench or seat and then put my leg up in the sling. Might even come in handy to put my leg up on when I go back to work. I'm not sure if it will fit under my desktop until I get back to work.

You can find these at Amazon dot com for about $24 or so. I found one at a medical supply place near my house, but they wanted $55 and they still had to order it! So why bother having them order it when I could do it myself and have it delivered to my doorstep at a cheaper price? Even with shipping and tax it was $20 cheaper than the local place. I was just thinking this thing would have come in really handy when my leg was in the immobilizer! This thing would also come in handy for parades, and other outdoor events where you need to bring your own seat. It is very light weight.

Future therapy - Since I only have 4 more weeks of therapy at the facility, I have to make the best use of my time. I'm pretty sure my doctor will release me back to work in 4 weeks. Thankfully, the disability insurance I've paid into for almost 8 years is helping me out.

I'm going to ask at therapy next week what our goals are for the next 4 week and to help me with an exercise plan I can continue at a regular gym and anything I should never do as far as weight machines, etc.

I've asked my Dad to bring back my stationary bike (I loaned it to him a year or so ago). It isn't fancy, but it will help me on the weekends with loosening up the leg.

ConnieP - I guess you need to do what the doctor says. My doctor said I could put my weight on my leg right after surgery. Of course, I have a different repair. Forget TV. I listened to a lot of talk radio while I was doing my exercises. Although while elevating and icing I had plenty of DVDs I own that I have never watched, so I was able to watch some of those. Since I was able to walk (like a mummy) in the immobilizer, I didn't need help in the bathroom. However, I had a thin towel on the floor, so when I put my foot on that, when I sat down the leg would slide out on the towel (a simple thing, but very handy).

Dude - This is my 2nd surgery (that other surgery was for a completely different thing). Anyway, that is pretty standard--usually the nurse removes the staples and the doctor just takes a quick look at the surgical site. Immobilizer - once you get your leg propped on pillows, or up on the couch, bed or recliner chair, you should be able to loosen the straps. As long as the leg is straight, there is no problem. However, I would keep the straps kind of snug when taking a nap or at bedtime--you never know when you leg might jerk in your sleep.

Helmut2468 - When my brace (you mean immobilizer?) came off after 6 weeks, I had already been doing PT so my leg was able to hold its own and not be wobbly. I didn't have pain, just felt unstable.

paulsenw - I'm with you on being careful about letting someone forcing the leg to bend more beyond what you know to be the limit. I was really concerned when my leg was bent from 50 to 60 and it was swollen all weekend. That was the last time that happened. Considering I got to 105 rom on my own without anyone manipulating my leg, I think they should have left mine alone. But, live and learn, and do the exercises 3x/day and it makes all the difference while at the therapy facility.
I don't have a bump over my incision, but then I had several deep tissue massages, laser, and ultrasound therapy at PT, so maybe all that helped. It had to because the scar is no longer pucky and lumpy bumpy like it was months ago.

bulldog - amazingly, my injured leg does not look smaller than my other leg. If anything, the injured leg looks slightly larger--slight swelling around the knee. I elevate and ice, but after a 2 hour workout at PT, it is going to swell. I get my leg way up high to elevate.

donjp - I think this injury was a reminder that we are not 20. I retired from marathon running many years ago because I didn't want to have a knee or hip replacement in my late 40s. So what do I get for being careful? A quad rupture--and mine was pretty messy too. I also retired from marathon running because in my 30s I came down with Infectious mononucleosis and that put me out of commission for about 2 months, and then I got a relapse. I could barely move out of bed at that time--I cursed my upstairs bathroom at that time too. So, I realized I had to limit my activity level. Then, about 10 years later I was diagnosed with a thyroid condition. So, I have to pace myself as I only have so much energy for the day. I take various vitamins that seem to help with my energy level and I'm not on medication.

Duncan - I can't even imagine jumping on the ground, let along a little trampoline at this stage. That seems like an advanced exercise for later down the road.

Tiger Bait - that is my concern--going back to work. I'm afraid once I start the grind at work my PT will suffer. I know after a PT session now at the facility I need to eat a good dinner then go home and rest.

willthethrill - I know MRIs are expensive, but is there a reason an MRI wasn't done sooner to see if there was additional injury to the repair? Good luck with everything.

Best wishes to all!
post #559 of 10808

Thanks for the encouragement

Guys thanks for the words of encouragement. Yes it is good to hear the progress of people that are further along. I guess I have to change my attitude about the healing process. Also, I guess I just had to let the idea of being immobile for 4 more weeks sink in.

ConnieP, I feel so much better getting the staples out. It was an easy process. It's 24 hours later and I'm hardly in any pain at all. I just took ibuprofin in the middle of the night and I'm not feeling much pain now. The doctor says I can take a shower on Sunday whoooo hoooooo. You are so right, I'm going to try to work on some projects that I've been putting off for ever. I live on two levels. I've been pretty much confined to one level since the accident. I'll try to mix it up. Thanks for the info about the ace band and immobilizer. I hate being confined when I'm sleep, so before I got the staples removed, I would loosen the imobilizer when I went to sleep. But you guys make a good point, I probably should tighten before I actually go to sleep to prevent injury in my sleep. I always tighten before I get up to go to the bathroom. When i got to the OS's office, the assistant said that my ace bandage wasn't tight enough. So I will make sure that the ace is always on tight.

CaliforniaQuadPop, thanks for all the good info and advice. All of it's great info.
post #560 of 10808

Article from CaliforniaQuadPop

That article's pretty good info. I injured my leg almost identically to the way President Clinton injured his leg. Missed a step and fell. i guess the quad tear is more prevalent than what I thought.
post #561 of 10808
Connie, great to hear that your surgery went well. Hopefully now your recovery will go just as well. Pain after surgery was not as bad as before surgery. But contrary to what we tell young people, "just say YES to drugs".

I agree with Helmut re movement. The sooner you start this the better. Not only does it help for clots, but for circulation, muscles, etc. Be careful of too much walking too soon. I know I got a lot more swelling in the leg when I got up. So keep the leg elevated as much as you can and remember the ice packs/frozen peas etc. They help the swelling.

Good luck.
post #562 of 10808
Thanks Ankhsign....I just would like for the foot to feel OK being down for longer than a few minutes... so with that does there ever come a time when you can rest it on the floor without it swelling up and turning a darker color. I have to be up for about 20 minutes to a half hour before it feels engorged and turns a little purpleish..After I put it back up (elevation) the color returns to normal and I can feel the swelling going away...You know I could sit on a milk crate and try to pull a few weeds in my flower garden IF I could just get past the swelling part...I don't have a problem keeping my leg straight...it's just that I can't keep it down too long at all.....

Am I expecting too much too early??
post #563 of 10808

Removing the Breace

Originally Posted by Helmut2468 View Post
Hi all. Well the brace comes off on Monday and I was wondering what to expect after that. I am nervous thinking that the new lack of support is start a whole new round of pain. What have you experiences been?
My OS still has me in the brace, but I walk around the upstairs without it. My leg is strong enough, I am just very careful not to trip. I do not notice any additional discomfort.

post #564 of 10808

Staples out today...

Staples out today....I'm sooooo tired. I had one of the worst nights I've had since surgery last night. For the life of me I could not get leg comfortable. Everything hurt, finally hubby gave me hydrocodone 10 with 325mg. (Saying "YES" to drugs) Last time I looked at clock was 2:53 AM. When I woke up at 7:00 AM to see my son off for school, I'd lost 2 pillows and my leg was
barely elevated at all....but it didn't hurt, it' was just sore...I don't even know why I tell you this.......?? Here I am complaining and though this discomfort is not even close to the actual injury, it did get the best of me last night. I was almost in tears....pain-frustration-anger

I sure hope everyone here has a wonderful day....truly, I do.

Helmut - Good Luck to you today....Let us know what it's like to be free of the brace/immobilizer!! Go Slow......

Ok, talk soon.......
post #565 of 10808

3 days after Staples removed


Good luck with your staple removal today. I've had a couple of those frustrating painful nights. I thought I was done with the pain medication when I got my staples out 3 days ago. I'm down to like maybe 1 or 2 per day and usually at night for some reason.

I'll really be glad when the actual surgical wound heals. As I'm not in much pain anymore, it's harder not to get up and do small things around the house. But I don't tear again...so I'm just trying to continue sitting....

Helmut, good luck with the removal of your immobilzer!!!
post #566 of 10808

I have the velcro strapped leg thingy that probably everyone has. It's been 4 weeks since the accident and no move midnight twiches thank god.
Sleep is good now that i figured out how to roll on my side. I also went out and bought some weights, elastics and and chin bar to keep the upper body toned during this downtime. Even figured out how to do push ups without flexing or straining the bad knee. This is the only thing keeping me from going insane at this time.


Thanks for the welcome and NO lucky still stands (there are other things in life that make me lucky) just not my knee apparently.
post #567 of 10808

Strength and stamina coming back, Other quad ripper at PT warned about doing too much

Hi all,

Well, it was a good Monday at PT. My knee wasn't too swollen, because I made sure to ice and elevate more on Sunday.

I've been balancing so well on my leg that now they had me balance on my leg and throw a rubber ball against the mirror 10 times (for 3 sets). This is even harder, but a good exercise for balance and stability.

I was able to do my side-to-side steps and forward steps leading with injured leg without using the railings! Of course my hands were hovering over it just in case.

I know how you get to a point and you want to do more. However, it is a balancing act between doing just enough without overdoing it and then icing and elevating the leg to keep down swelling. You can't do your best at PT if you knee is all swollen because you overdid something over the weekend. Sure, when your knee can bend more you feel like you are better, but there is a lot more work to do.

As luck would have it, the only other fellow quad ripper at my PT facility was in at the same time I was today. I was on the table next to his at the end of our workout so I overheard what the therapist was telling him. This guy is restless too, but his surgery was June 14 (mine was June 6) and he is only at about 80 rom. The therapist has been working on him. He says he works out at his regular gym, but whatever he is doing there is not helping his rom! Today I saw he was doing his steps with two platforms under the Fonda step! He told the therapist his knee hurt. The therapist told him to only do one platform under the step or just use the step as is. He told him he was overdoing it and could easily re-injure himself and set himself back to zero!!

So, this guy actually needs to do less at the gym. In fact, the therapist told him he didn't want him doing steps at the gym and some other exercises. He said he wanted to observe him doing certain exercises before he approves him to do them at his gym. This guy can't even use the bicycle in a full turn yet. I know he is restless, but he is going to have to back down. I asked him if he did his heel slides 3 times a day at home along with the ball under his knee. I don't think he is doing that, instead doing the gym.

So, for you new people out there. It might seem like doing more would be best, but that simple heel slide and foam ball under the knee, and the leg raise, and side-to-side slide on the bed are the best things you can do (only when approved by your doctor) three times a day. They may seem simple, but they really get your leg moving and get your strength and rom back without injuring yourself. The weights at the gym and more strenuous exercises can come later.

Oh, and when you are able to ride the bike, that also loosens the joint without injury. I really enjoy getting on the stationary bike for 10 minutes here and there (I'm not a long distance biker so that amount of time works for me right now).

I ditched the crutch and walk around with just my brace. However, if I will be in a crowded place, I'm bringing my crutch.

I also noticed as time goes by and with more strength, my leg doesn't feel weird if I accidently bump my leg into something. When my leg was in the immobilizer, the slightest bump or unexpected foot hitting a table leg or something would almost make me fall over and cause pain!

luckyleckman - I was able to get on my side--but did it easier with my back side against the back of the couch. That way I wouldn't fall over.

Connie P & others still on drugs - For the first 5 days after surgery, I would take those pain meds every 4 hours. I would set the alarm and get up in the middle of the night. I did not exceed the recommended daily dose, but that way I had continuous drugs in my system and that really helped control the pain. I found that sometimes you can't even really recognize that what you are feeling is pain! You get short and cranky around others and then realize--oh it is an hour past when you should have taken those pain meds.

But, even with the pain meds, the first 3 nights I had some rough nights and even after that. All you can do is sleep when the feeling hits you. Remember rest and therapy is 85% of getting better! As my ex husband said, there is a lot of repair going on in your body while you are sleeping, so get plenty of rest!

Also, ConnieP, forget about picking the weeds. If your foot is swelling that much, you need to keep it elevated. I did not get a purple foot. My foot got swollen, which told me--time to get it back up again! You will have plenty of time to pick weeds later.

And when you do get back to picking weeds, here is just the thing you will need (and others that do yard work):

Garden Scooter ends stooping and bending to do ground work. Maneuvers in the garden and indoors! Sturdy 4-wheel cart has molded plastic seat and wide plastic wheels. Tool tray below makes down-low planting and pruning easy! Supports up to 250 pounds. Assembly required. $24.99 (from wdrake dot com)

I actually bought one of these a few years ago before my accident ever happened because I realized I should not be kneeling on my knees and this allows you to roll along and pick weeds, plant, and prune close to the ground without a lot of stooping and kneeling. Also, the little tray underneath allows you to put your tools and stuff there. There are bigger and fancier ones that look like large rolling ice chests, but they make no sense because who wants to keep getting up to lift the drawer to get to the storage area?

Kneeling. I decided to try to get in a kneeling type position on my bed the other day. That lasted about 2 seconds. While I don't feel pain in my knee and I do not have holes drilled in my knee, putting some weight on the knee, even on the comfy bed, just doesn't work. It hurts and it probably isn't a good idea.
post #568 of 10808

Hey guys,

Sounds like everyone's plugging along in their recovery. Keep the faith...

Anyway, we always mention ROM, but I'm curious how bad the lag is at various points in the recovery. CQP Don jp, and I are at about the same time frame post op. My lag is still about 20 degrees. Where is everyone else at? I'm not going to compare ROM since I cheated with a manipulation

Hey Don, I am curious about your squats that caused the rupture. Were you going very deep, and how heavy? I'm 40 and was still squatting heavy (405 for 10 reps), until this... But never ever went quite to parallel. I always feared this sort of thing from squatting, but fate intervened.

Good luck to everyone in their recovery.
post #569 of 10808

26 Days Post - Lag Question

Ill Tripper - 405 for 10 reps, wow! Not something I'll be trying anytime soon. There's been a consensus on this site that the leg extension machine would be a good one to avoid permanently. Squats being a compound movement would seem to be a safer choice. The lag issue is something I've given a lot of thought to lately. After my original surgery, 14 weeks ago, I noticed about a 10% lag. My OS assured me it would go away in time as I built the quad muscles back.

After my fall and reinjure at the 3 week point, the lag became even more pronounced and that part of my ROM became extremely weak. After my 2nd surgery (26 days ago), I noticed immediately that the lag was gone, and I could straighten even further than 0 degrees, maybe -10.

I wonder how much of what we are seeing is due to how tight things are pulled, how many sutures are used, even the skill level of the OR. I don't believe any of them are doing more than 1 or 2 of these a year, vs. hundreds of other surgeries. There's no such thing as a QTR specialist. The injuries all sound pretty similar, the protocol mostly the same, drilling the patella, even the suture material the same. But these are human beings reattaching by hand, our knees. I do know of one surgeon who's done at least 2 of these in the past 3 months, and I'll bet he's getting better every time.

Had my 4 week post-op today. I dug out my immobilizer and crutches to appear compliant since on my last visit (2 weeks ago) my OS had told me he was putting me in a full cast. After assuring me there was no punch line, he did say I could refuse the treatment but he would have to note that in my medical file. I spent the rest of the day depressed and discouraged. The next day I set my hinged brace to lock at 40 degrees and got back to the gym and the ski machine to get back in shape. If I don't make it to 52 (I'm 51) it'll be my heart, not my knee that failed me.

Back to today. He first had me flex my quad while he held the leg, and then tested my ROM to about 90% without much trouble. He was absolutely beaming when he asked me if he hadn't done a pretty good job. I said "no sh*t." Then he told me to switch to the hinged brace set at 60-70 degrees, work up to 90 degrees over the next 2 weeks, then ditch it completely. At 6 weeks post! I'm going to wear it a little longer than that just to be safe, but he said the repair would be at about 80% strength by that point.

I'm not trying to promote blatant disregard for the protocol our OSs and PTs are giving us. But I do believe we have the right and responsibility to decide for ourselves what will work best. Someone put a link on this site to an article about the benefits of early movement, stretching and strengthening of QTRs. More blood flow, better healing, stronger repairs, better ROM. Do our ORS and PTs really have the time to fully research such a rare injury? I believe anyone who reads this entire thread can't help but wonder if a more aggressive approach could work better.

I'll let you all know how it works out for me.

post #570 of 10808

I'm just wondering what is to be gained by a full cast? Any ideas?

Will-You going to go with or without the cast?

CQP-That balance is pretty impressive. We're about the same time post OP, and I'm nowhere near balancing comfortably.
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