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Quadriceps Tendon Rupture, Repair and Rehab - Page 198

post #5911 of 10797
Originally Posted by skicarver View Post

17 Weeks post op - Bilateral tears.  I have been given a new exercise this AM by the PT.  Treadmill inclined and walking backwards!  Really targets the Extensor Lag issue.  Make sure you have a spotter to adjust the speed/incline as you are facing away from the control panel.  

Skicarver that was one of my regular exercises when I had this same injury several years ago.  I had a great recovery from that QTR and I can only think it was because my PT was so good.  Good luck with it!

post #5912 of 10797

All good stuff NJ Pete.  My first visit with a Hospital Physiotherapist at 10 weeks post-op was less than encouraging.  I was told I would NEVER be able to lift heavy furniture again and that driving was out of the question for a while without even testing me.  I was more scared I would never ski again than moving stupid furniture.  I was surprised she just didn't hand me a suicide kit.   By this point I had 90+ degrees ROM and was walking in braces without any other aids.  When she tried to bend my leg she found out she was unable to until I relaxed the muscle.   That was the point for me when I decided that she was wrong for me and a Private Physiotherapist would serve me better.  As suggested by other members I interviewed my PT before going to him.   His goal was, and still is, to rehabilitate my injuries so that I will be stronger than pre-injury.  Day 1 he told me I could drive as my legs were stronger than some able body patients he treats.  It makes such a difference when the people treating you have the same or even higher goals for you to achieve with a plan to get there.  There is NO ROOM for NEGATIVITY.  There are tons of people worse off than us.  One of my hospital roommates actually died before Christmas!!  We have to attack this rehab every day but also must find the reasons why we are so lucky.  I already told my Physiotherapist that I would take him to skiing next year if he gets me back on the slopes.  We both BELIEVE in the power of positive healing.   

post #5913 of 10797

@kcarp1 Thanks for the advice. I think I will definitely hold back on the jogging until this soreness completely goes away. I've noticed the exact same thing as you: No matter how hard I try to work the muscle (holding a squat or doing step downs, etc.), the quads themselves don't get a sore feeling, just the tendons and joint feel sore. I think its normal? My muscle is coming back albeit slowly and I suppose that's what matters.


I did ask the OS at the 12 week follow up about whether I should limit myself from running. His words were that he'd be "wouldn't be surprised" if I could run before the 6 month mark but would be "impressed". He didn't give me a hard prohibition against jogging/running and said it would be up to me and my PT. At around the 14 week period, my PT was happy with my progress and voiced similar view of optimism that I could probably be running before 6 post injury. Regardless of what they said, I need to take it a step at a time..


This morning I saw the OS and a resident (for hopefully the last time) and they weren't too worried about the puffiness/soreness issue I mentioned in my last post. They predicted it would resolve itself as my strength returns over the next 3-4 months. That said, if it doesn't go away during this time they did want to know about it.


Regarding numbness, they said that it only affects sensation and is separate from the nerves which fires the muscles. It shouldn't affect my strength.


@RUNNERMX That is some really great progress you're making on the jogging and the complete recovery during your cycling.  Does your knee joint or quad muscles get sore feeling after running? How does it compare with cycling? 

post #5914 of 10797

NJPete, thanks for the good word. I'm curious to hear about your athletic progress. I ran across your "Mr. America" posting when I was browsing the site a few weeks ago.


Skicarver, I've endured my share of negative comments too. My P.T. once floated the notion that my knees might not bend beyond 115-120 degrees. Some of my family and friends have floated the notion that I might never run again. This motivates me to try harder and prove them wrong. In the end, it's up to me to decide what I can and cannot do.


Richie88, cycling on the stationary bikes never hurt because I automatically slow down before I overdo it. The two-mile runs aren't long enough to hurt my quad muscles or joints. I plan to stay around that distance until my running becomes more normal and natural. Today I did another 28-minute run (thus confirming the peculiar 4-minute improvement from Monday to Wednesday). I will continue to update running progress because I haven't seen very many postings on how people are improving.


As far as I can tell from the postings, it's pretty normal to start running at a fumbling, 17-18 minute pre mile pace. Some of the people are trying to wait until the awkwardness goes away before making a serious effort to run. That can take a very long time. If you are at a point where you can push yourself a mile or two at that pace, then the best approach might be to do just that, frequently and persistently. I improved my 2-mile time by 7 minutes in a week by doing that, and I'm sure there is more improvement on the horizon. Take care, and wishing everyone a 100% recovery.

post #5915 of 10797

@skicarver, I could not have said it better myself "There is NO ROOM for NEGATIVITY"!!!  You are absolutely right about finding the right PT that has the perfect amount of optimism for you. It helps push your progress along at a good pace.


@RUNNERMX, Progress is progress. I continue to PT myself but not as much effort these days. I am inundated with work. I stick to the basics like bands, leg weights and recumbant bike for now. Until I am done with this current project not much I can do.

post #5916 of 10797

Hi Everyone,


I recently found out that my old PT who I worked with when I last had this injury is no longer working so I need to find someone new.  Any recommendations from folks on questions to ask or just general guidelines to follow in choosing a PT. 



post #5917 of 10797

@Graceella, I think a lot more will be added here as well from everyone else. These are the ones I have found to be helpful.


My Questions:

1. Have you ever worked with rehabilitating a Patella or Quad Tendon rupture?

2. Do you have all modalities available - E.G. TENS(Transcutaneous Electrical Nerve Stimulation), NMES (Neuro Muscular Electrical Stimulation)

3. Do you know the procedures for Patalla mobilizations?

4. Do you know how to massage(break up) fibrosis or scar tissue?

5. How many other patients do you usually treat during a given session? - This helps understand the kind of attention

6. Are you affiliated with a specific hospital or the hospital(or Surgery Center) where you had the surgery?

7. How will you measure my progress? E.G. ROM, Strength, Pain...etc.

post #5918 of 10797

@Graceella....as usual, NJPete has nailed it. I think the key one is having experience working with rehab of this particular injury. I would also ask to see if they have any printed protocol guidelines for you to read. My OS issued me a copy of the UW Sports Medicine protocol and was adamant that the PT department follow it to the letter. I think that in itself aided in my relatively quick recovery. You might even print it off and share it with your porspective PT to see what kind of feedback you get. If they balk or don't really receive it well maybe I'd shop around. I understand that not everyone follows that protocol, but it's hard for me to be dissuaded that it's not the best.


post #5919 of 10797

@Graceella  I think anybody that can pass NJ Pete's test would be perfect.  In addition maybe ask "How far back will I get".  Anything less than stronger than you were before is not acceptable. 

BTW  Had OS appointment this AM.  He wanted to know the name of the wonderful PT that worked on me.  He then said the results were 5% his work and 95% my rehab work.  He then said I would get back to my old self but Mother Nature just takes a bit of time in combination with the physio to work her magic.  I thought I was with the wrong surgeon from past visits.  2 hr bike, elliptical, treadmill, leg press,upper body workout, and a 2.5 km walk on slippery roads followed the OS visit.

You'll have no problem finding a great PT!!  

post #5920 of 10797

Hi all,


Wow those questions are great!  Hits the nail on the head for everything my PT did the last time and had all of the equipment N.J. Pete mentioned.  I didn't do the Tens, she had me doing something she called the "Russian" not sure if that was her name or the common name but I used a Tens unit but turned it up higher or to a different frequency I think...  I also agree that I need someone who will help me get to 100%.  I am very determined and I will settle for nothing less.  


My biggest concern goes back to my first time around with this injury... My OS gave me the name of a specific PT he wanted me to work with at the PT facility that was associated with the OS's office.  So I tried to work with that PT but when I arrived I was told I needed to work with a different PT just for scheduling purposes.  I went with it and she was WONDERFUL, again did everything you all mentioned above and I made great progress, was jogging on treadmill four months post surgery.  One PT session she was out sick and I had to work with the original PT my OS had referred me to.  He worked me differently and I hurt myself, lost a week due to the pain in my knee cap.  I am fairly certain my OS will refer me to the same original PT this time around and I am worried about working with him.  I thought I would shop around and not just go with who my doc recommends, not sure if that is wise or not, thoughts??   Any other advice as this goes along is greatly appreciated!!


I know you all recommend the protocol from the University of Wisconsin... I have looked at it several times.  I am just curious, is this protocol being used by other docs across the country or one that was recommended on here and you all like?  I don't recall the specifics of my protocol the last time around.  Since it is so highly successful and well thought of I do like the idea of taking it with me to discuss with the PT. 

Thanks all!!

post #5921 of 10797

I can tell you for sure they are either using it or designing their protocol very close to it. I have collected 3 of them here - http://www.quadtendon.com/rehab/Documents/Forms/All_Public.aspx


Take a look at all 3 and you decide. I like the UW protocol because it is easy to follow. I personally followed the UW guide the second time around for me.


My reasons for the questions

1. Have you ever worked with rehabilitating a Patella or Quad Tendon rupture?  - They know when to perform which exercise at what point without too much pain

2. Do you have all modalities available - E.G. TENS(Transcutaneous Electrical Nerve Stimulation), NMES (Neuro Muscular Electrical Stimulation), Ice and Heat  - The modalities help!!

3. Do you know the procedures for Patalla mobilizations? - It is a MUST during the beginning phases. Your OS should agree with this. Someone who has worked with Quad or Patella tendons should know exactly how much pressure to apply.

4. Do you know how to massage(break up) fibrosis or scar tissue?  - This can be VERY painful if NOT done correctly. Someone who has worked with Quad or Patella tendons should know exactly how much pressure to apply.

5. How many other patients do you usually treat during a given session? - This helps understand the kind of attention you will need in the beginning phases.

6. Are you affiliated with a specific hospital or the hospital(or Surgery Center) where you had the surgery? - They can easily correspond back and forth with your OS or OS Team

7. How will you measure my progress? E.G. ROM, Strength, Pain...etc. - How do they know they are performing good for you.


PS. I take no credit for the knowledge I have with this injury. I simply have been through this nightmare twice.(a little experience) I HOPE I can help others NOT have to go through it like I did.

post #5922 of 10797

I had a great PT  and he still answers any question I have but it really was me who put in all the work. I did PT with them 3 days a week and on my own the rest of 2 sessions twice a day 7 days a week. I did get my knee hurt by an intern whcih set me back a few weeks but another intern was great and celebrated every accomblishment with me. It was great and kept me movitvated. Iam at 4 months and my bend is full and PT is now all up to me. Getting the quad muscle strong is my total focus. Work hard and stay positive. Golf in March is my goal for now.

post #5923 of 10797
Hi guys, not saying my PT this time around was right or wrong... But I never had any patella mobilisation, scar tissue massage or ROM stretching. Focus was purely on function and knee control. Recovery was no slower or quicker than 10 years ago when that PT did all the above. To be honest, I was happy not to endure all of that fun stuff smile.gif
post #5924 of 10797

Hi all,


I had my third surgery on Thursday afternoon.  This surgery was for infection in my left knee.  I had bi-lateral quad rupture surgery back in July 2013.  On Aug. 20, I had surgery on my right knee due to infection.  That surgery was rough and I nearly died.  I was in patient from July 22, 2013 to October 28, 2013.  I returned to work on Jan. 2, 2014 after several months of in-home PT.  Had surgery on left knee, Jan. 23, 2014.


This surgery went a lot better than the other surgery for infection.  With an immobilizer, I was able to stand and walk the next day. Today, I was walking up and down the hall with no pain.  I think I actually feel better than I did before the surgery.  Unfortunately, the OS told me this morning that the cultures showed small amount of infection in the knee joint.  He is going to leave the treatment up to the infectious disease doctor.  This will probably mean a long in-patient stay for IV antibiotics.  The stay will probably be 6 weeks.  Personally, I would like to get the hell out of these hospitals that are giving me these infections.  The infection I have is a very common hospital acquired infection.  I really want to return to work as I was so happy at work these last few weeks.


This is just so frustrating.  Glad I have this group for advice and support.

post #5925 of 10797

It's just going to be a bit uphill for a while, poodiesmom.  An extra step to conquer.  Some things are in your control and others need help from others.  Just have to find out how to make a glass of lemonade each day until the ball gets back in your court.  Keep your chin up and tackle every day with a smile!!

post #5926 of 10797

Thanks for the encouragement.  Things could definitely be worse, so I am going to buck up and get through this.  My OS was not kidding when he told me this was a difficult injury.

post #5927 of 10797
Originally Posted by poodiesmom View Post

Thanks for the encouragement.  Things could definitely be worse, so I am going to buck up and get through this.  My OS was not kidding when he told me this was a difficult injury.

Great attitude! It becomes extremely mental after a time and you will conquer. I did all my PT sessions at my local VA hospital and whenever I started feeling down and sorry for myself I just looked around the room at the 22 year old amputees who had been maimed in Afghanistan. Puts our injury in a whole new perspective. Please don't hesitate to continue posting...it will be fun to keep giving you encouragement.

Edited by Eric308 - 1/27/14 at 6:59am
post #5928 of 10797

Thanks, Eric308.  I have a friend that is terminally ill with cancer and I know she would gladly trade places with me.  I like your comment about this becoming mental.

post #5929 of 10797
Hi folks, It has been a while since my last post and I finally have something to write about.

Exactly 18 weeks post-op on my left QTR and I have just arrived for 11 days intensive physiotherapy at a Fire Service rehabilitation centre in England.

Today was mainly induction and assessment so that the PT's can present me with an exercise programme tomorrow.

On the positive side, at present I have full ROM, the scar has healed nicely and I ditched the crutches around Christmas.
The negatives are mainly walking with a normal gait as I am flicking my left leg forward as though I am trying to kick a ball with every step ( the Quad tendon now much prefers a straight leg situation)..........also, my knee still feels 'sticky', which I assume is the scar tissue in the area of the patella anchor sutures which have hopefully dissolved by now.
I had a rupture above the patella so no drill holes required but the surgeon told me he inserted a whole load of anchor sutures on the patella to provide support.

I was asked what I hoped to gain from the next 11 days and my answer was............to walk normally, climb and come down stairs normally, and if I am lucky perhaps manage a gentle jog as well.

The other 'guests' have told me to expect a lot of hard work during my stay but the effort will be worth it.................nothing could be a hard as those heel slides...........could it?

I'd be happy to answer any questions about my exercise regime during my stay.

Take care guys.
post #5930 of 10797

Redgranite good luck at the rehab center. I am at 16 weeks and my ROM is full too. Please note what excercises tehy give you to build up the quad. I am out of Pt so building it on my out with sqats with a excersie ball on the wall and 15 pound in my hands, squats raising my arms with 8 lbs ( goal is to squat to a seat but tired 10 and it hurt so not going that far yet) do the seated let push with 2 legs and then 1 leg doing 3 sets of each. Do hanstring extentions and calf raises. I stil do the behind the back stretch while laying down until my foot hit my butt. (about an inch away) Stretch hamstrings and calfs. Do bike 25 -30 minutes 4 times a week. Trying the Elicptical but my knee does not like it so I will ease into it. Mine was the quad tendo but I think the rehab is the same.

post #5931 of 10797

I did my first sets of deadlifts as part of my six-month celebration. The weight I can do has literally been cut in half; I struggled with sets of 5 at 155 lbs. I could feel the weakness in the quads all the way down and all the way up. To the extent that my goal is to focus on exercises that are still very hard to do, the deadlifts definitely make the list.

post #5932 of 10797

Hey NJ Pete,


How's it hangin?   Long time.     I have an update:   good news / bad news.


The good news is I've recovered 100% and I'm lifting at world class level for an Masters 2 (over 50) lifter.    Here's a pic of a 655 deadlift on Nov. 9th.




Bad news:  I attempted 705 Nov. 17th and detached my distal biceps tendon on my right arm.... you just gotta laugh at that.   Really.   'Cause if you don't...you'll cry.

Anywho, successful surgery the following week  (drilled hole and attached with a titanium anchor).   Recovery smooth.   Started very light lifting last weekend (8 weeks post op).   It won't surprise y'all that there is an active Distal Biceps Tendon board out there.   Oh the irony.


Did your website go up?   



post #5933 of 10797

@Scoobs, Patellar mobilizations are a good way to reduce the loss of ROM and reduce the chances of scar tissue forming.  Not everyone will benefit from mobilizing the patellar. They simply recommmend it as a preventative measure.


@poodiesmom, that is aweful about your infection. Please please please, rememeber the juices. It is the ONLY way to get a concentrated amount of healthy, living enzymes, that carry critical vitamins into your body to help promote a healthy immune system. There is NO easier way in my perspective. The more healthy living enzymes that carry vitamins you get into your body, the easier it will be to potentially flush that. The removal of the toxins is equally important to consuming healthy living enzymes. Unfortunatly, if you not at a clinich were they can force your body to flush those toxins, you are stuck relying on urination only...unless that do a dialysis. The only other method is not up for discussion on this forum. I talk about it in the diet section of the Quad Tendon website. You should also consider eliminating your caffein intake if you have not already done so.


@bigggfred, What on earth are you doing over there? I can ONLY say this because I have been through the same. I ruptured my biceps tendon back in June, 2010. It stinks...I know. This is just another setback for you. You will make it through. The distal placement of ANY tendon is typically the spot to rupture. This is beacuse of many factors like, reduced long term ciculation, Eccentric loading, direct impact...etc. You should be close to out of your brace and starting PT. What are you going to do for PT?


@RUNNERMX, just the fact that you did them is amazing. I have yet to do a real deadlift. I miss them and look forward to getting back to them someday. I agree about those being on the hard list. The full squat is still on my hard list as well as the clean and jerk for me these days.

post #5934 of 10797

Just found this forum as I too have joined the quad rippers society.  I wish I could say it happened while busting some moves down a mogul field but not quite the story .  Heading down my cellar stairs, my cat had left a little pile of puke.  Long story short, left foot stepped in it and shot straight out and the right leg folded like a cheap suit.  Never felt anything like that in my life.  I'm just starting my tenth week and have been making pretty solid progress.  I have about 120 degrees rom and am walking fairly well.  Using a stationary bike although going over the top still does hurt.  Still use the brace outside on uneven surfaces for insurance.  It has been tough at times and I still am having some degree of pain on the knee cap where the tendon I guess there is a thin line between being aggressive and overdoing it.  I'm not sure which side of that line I'm on yet.

It has been a big help reading through the posts.  Correlating others experience to your own has a calming affect knowing what your experiencing is normal for this type of injury.

post #5935 of 10797

@nidas, Welcome to the board of QTR's. Glad you are doing good. Agressive is anything outside of what the UW Guide states. At your phase (Phase 3), you could be doing both closed and open chain exercises. Read the UW guide and go from there.


Don't sweat the uneventfullness of your injury. I think most of us can say the same. 95% of the stories that I have gathered, folks have either slipped or fell; sometimes both. My injury was very uneventful. Keep posting back your progress. Build a goal for youself once you understand where you can be at what phase. Read the PLAN here.

post #5936 of 10797

Nidas--- Welcome to the group. It is good you found it. It has been helpful. Make sure you feel what your body is telling you. If you worked to hard take a day or two off. I beat mine up Sunday and Biked Monday and it felt a little weak so I am off today and will kill it tomorrow. You will love it when the brace is done. I am at 18 weeks and do not miss it. I did get a neoprene sleeve to use when I need it. There is hope just keep the focus especially when PT ends and it is all on us to get better.

post #5937 of 10797

Had surgery for infection on Thursday and I have been up walking a lot.  Today was the first day without being hooked up to the IV pole 24/7.  I walked and walked and walked.  It felt so good.  I actually feel better than I did before the surgery.  Hmmmmm, maybe the infection was slowing me down.

post #5938 of 10797

Just a note to Runners: I have not been on this site for over 4-5 months but just a post to some of the newbies....especially runners. I had quad tendon surgery in Oct. 2011 and old posts will show my numerous and laborious rehab from too many types to mention. I was a veteran of 36 marathons including 3 Boston's. Bottom line after 2 1/2 years and seeing several specialists I can not run. I can cycle 60 plus miles, I can squat 230 lbs ...I can do stairmasters and elip machines but can not run. Look at the quad tendon as a rubber band. I tore that band and had it reattached. It is strong but not flexible thus not allowing me to stride as a runner. Imagine a strong tight rubber band with no flex...thats me. I know many of you will come back with theories and things to try. Believe me I have tried them all. My conclusion is that a 64 year old tendon can regain strength but not flexability. I do not mean to discourage anyone because the vast majority of you will recover fully. I am gratefull I can exercise every day doing something but will always miss my passion.....running which is now only a memory.

post #5939 of 10797
Old Runner Dude... Interesting how you can do all those other activities but can't run. Is it due to pain when attempting ? I recall it took me 3 or 4 years before I was comfortable running. But not being much of a runner anyway, it didn't concern me. Wasn't something I worked on either. But after a number of years it felt natural. Never pressure tested it with a long run though... I have noted plenty of others that reported successfully returning to running.
post #5940 of 10797

OLD RUNNER GUY, I have seen your posts and understand your frustration. Maybe you have already tried this, but I can't tell from your posts. Go out there today and run two miles at that fumbling, slow pace that we are all familiar with. Then, do the same thing tomorrow and the day after. Take a couple of days off each week and maybe include a longer, 4-mile run on the weekend. Keep this up day after day, week after week, mile after mile and see if you don't gradually shave minutes and seconds off of your time. I've been doing this for a couple of weeks (I'm about 6-monhs post bilateral surgery) and have improved my two mile run from a fumbling, 17:30 minutes per mile to a fumbling, sub-14 minutes per mile. I managed 4 miles on Saturday at the 14-minute pace. It's still early in the game, but every week feels more like a natural run. I will continue to update my progress.

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