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Quadriceps Tendon Rupture, Repair and Rehab - Page 217

post #6481 of 10808

@RUNNERMX...nice shot in the wet! Did you bust 3 hours? Keep up the inspirational posts...dude, you look about 20 years younger than you are. Thumbs Up

post #6482 of 10808

Eric308, I read somewhere that there is one guy in Illinois in the 55-59 age group who can do sub-3hrs. (Hint: It's not me; my time was 3:57). You're correct, it rained through the entire race with a temperature in the low 40s. There were wide puddles everywhere; no choice but to splash through them.

post #6483 of 10808

I'm 10 months post-op (tomorrow) and wanted to share a little more on extensor lags. An extensor lag is when you can passively extend your knee to a greater extent that you can actively extend it, meaning that you have a strength deficit (zone of weakness) in the final degrees of extension. Anyone who finds it harder to descend stairs, run or jump than before is probably experiencing this.


For discussion sake, let's use extensor lags of 7, 5 and 3 degrees. Maybe it's more appropriate to use 9, 6 and 3 degrees, but I'll wing it. At 7 degrees, you might have to lean on the rail when descending stairs. Without the rail, the knee would essentially buckle the first 7 degrees and cause you to tumble forward. At 5 degrees, you might still have to use the rail but not lean on it. By the time you get it down to 3 degrees, you might be able to carefully descend without the rail if you need to.


Running with a 7-degree extensor lag will feel awkward and fumbling because the knee will flop around whenever you kick it forward and will slightly buckle when it's behind you. As you reduce the extensor lag to 5 and 3 degrees, running becomes more natural and the fumbling disappears. Yet you still run slowly and it might seem like you are stuck at a slow pace. This is because running fast requires full thrust in the final degrees of extension. You need to get the extensor lag all the way down to zero before you can recover your pace.


Getting rid of extensor lag requires exercises that target (and really smoke) the quads in the final degrees of extension. This is easier said than done. Most leg exercises (leg press, cycling on flat surfaces, and even squats) build up enough momentum to carry you to full extension without requiring much exercise in the final degrees. I've recently been getting a lot of benefit from using the recumbent bike at maximum resistance with the seat way back, and using the elliptical at high resistance, both for 99 minutes. Running is getting more and more comfortable, but still not fast. I can comfortably run 9-10 miles at an 11-12 minute pace. I can descend stairs without he rail if I need to, and can jump into the pool without using stairs.


At 10 months post-op, I'm about 90% recovered from my bilateral rupture. I'm clearly not back to running a marathon at a 9:06 pace, or descending stairs with a 40-lb bag of salt in each hand. But considering where I was in September (when I hopped on crutches between machines in the gym) and October (when I didn't have enough quad strength to step over a curb), yeah, I'm 90% back.

post #6484 of 10808

@RUNNERMX: great information regards the extensor lags. Although I still have a deficit (may be 5 degrees) I don't feel any limitation with running, even downhill running is being improved, whereas descending stairs especially with additional weight is still not nice. My understanding is,with a natural running style extensor lag may not impacts significantely. 13 month post OP  my first half marathon in April 2014 was finished in 1:55 although under high temperature conditions, another step to recovery and - no problems thereafter.

Knee was supported with kinesiotape applied by my PT


post #6485 of 10808

Richie1, that's a great time on the half. Congratulations! I have a mid-foot strike, no problem with hills but still slow. I feel like I need more strength in the final degrees of extension to get the thrust needed for a faster speed. I will get there eventually. Month after month, I improve on various exercises and am able to do things that I could not do before. It would seem a mathematical certainty that if I get stronger every month, I will reach full recovery at some point.

post #6486 of 10808

Congratulations on the race Richie1! What an accomplishment! 


I am 13 weeks post-op today and the Doc freed me from  the immobilizer! WOOHOO! I am walking with no crutches but I admit I look like a toddler learning to walk...a little wobbly with my arms out for balance! No jumping, running, or sports, but other than that no restrictions. I have made it from 40 degree knee bend to 95 in 3 1/2 weeks of PT. My PT stressed the importance of straightening the leg...she said otherwise I will have lifelong limp...so make sure you all are doing your extension exercises and pushing that knee BACK as well as bending. 


@Melnnym: as for not using crutches or brace, I guess every doc is different, but I stopped using my crutches a couple of weeks ago, and today as I said above I am free of immobilizer, so practice at home and get comfortable and try to go without as soon as possible. It is scary, but will strengthen that quad nicely


Love seeing the pictures of everybody! 

post #6487 of 10808


Dogs waiting for me to recover to the point when we can run again. At 16 weeks I am close but not quite there yet. Exercise bike, Stairmaster, weight work, walking, water walking and exercises from PT all helping but earlier rapid progress is slowing. It's a marathon type recovery.
post #6488 of 10808
Congrats on everybody's post surgery PRs (personal records)!!! I've been calling any improvements in life since surgery, PRs. It helps keep me from getting frustrated with my inabilities.

I started PT last Tuesday and I've increased my ROM from 23 degrees on my evaluation, to 38 degrees yesterday, yay!!!! However this week has been super frustrating to me b/c I'm hardly in any pain and I feel like I should be able to do more than my brace allows me. However, I'm really glad I'm in the brace and I'm super anal about following doctor's and PT's orders, so I don't hurt myself again.

Richie, do you have a pic of how your k-tape was applied? Did your PT do any lymphatic taping on you at all? Has anybody else used RockTape or k-tape for this injury? I have used RockTape a lot on my knee pre first surgery (my first surgery and 18 years of previous knee issues is partially responsible for my QTR).

Also, looking in the distant future, do any of you have to use any type of support while being active? I had my first surgery done b/c my knee brace and years and years of PT wasn't yielding any long term relief (my patella partially dislocated while wearing a robust brace designed to keep dislocations from happening).
post #6489 of 10808
@CFFF. On being active and using a neoprene or other brace, both my OS and PT were strongly opposed to my using anything. They said I needed to get by the fear of knee buckling and truly build the knee back to normal. Caveat is that I didn't have any other underlying knee issues.
post #6490 of 10808
Originally Posted by old bruce View Post

@CFFF. On being active and using a neoprene or other brace, both my OS and PT were strongly opposed to my using anything. They said I needed to get by the fear of knee buckling and truly build the knee back to normal. Caveat is that I didn't have any other underlying knee issues.

@old bruce...That sleeve or support protocol varies. My OS and PT highly recommended that I wear one until I gained confidence after I ditched the brace. It provides compression and warmth and was just "there". I only wore it for about 10 days. Here's a copy of the Mass General protocol for 12 weeks post surgery. Glad to hear all the great feedback and POSITVE attitudes!

Phase  IV:
 12  weeks  after  surgery  onward
Progress  strengthening  of  quadriceps
Preserve  range  of  motion
Protect  repair
Walking:    you  should  be  walking  without  the  aid  of  a  brace  or  crutches.    If  you  
feel  conVident  walking  on  the  operated  limb  and  have  good  strength  and  knee  
motion  you  can  begin  attempting  to  walk  up  stairs  on  the  operated  limb.    
Knee  support:    Buy   an  elastic   knee  sleeve  (made  of  neoprene  rubber  and  
available  at  most  sporting  good  or  drug  stores).    It  should  have  an  opening  for  
the  knee  cap  and  Velcro  straps,  but  does  not  need  hinges  on  the  sides.    Use  

this  sleeve  if  you  are  on  your  feet  for  a  prolonged  period  of  ti

post #6491 of 10808

Old Bruce, you're too early for the recovery to be leveling off. Try breaking up your routine and include some different but related exercises. Instead of water walking, kick and swim. Try shallow water deep squats where you stand in 3 feet of water, squat and touch both hands on the pool bottom. Then try some freestyle squats without water. On the leg press, move seat way forward for deep bending, then way back for working the extensor with heavy weight. At 4 months, you might be comfortable using the elliptical and/or the back and forth strider.


I had some interesting events this week.


1. Walked down a flight of stairs with a case of water in one hand and a 12-pack of beer in the other hand.

2. New record on the 99-min recumbant bike, 1717 calories, 62.5 (artifcial) miles.

3. New post-op high on the deadlift, 275 lbs, 7 reps.

4. Solid hour on reverse elliptical at max 20/20 resistance. 900 calories, really works the extensors.

5. 40-mile outdoor bike ride. This was overdue, but weather was bad until recently.


Keep up the hard work everyone! Once you pass 90% recovery, the century mark is just over the horizon.

post #6492 of 10808
@Runnermx: Great advice. What has been improving the most lately is the regular walking and that is where I have been hitting tougher trails and terrain. Many thanks.
post #6493 of 10808

Hello Newbie here.  Going to Quad surgery on Thursday this week.  Can anyone tell me what to expect right after the surgery and the next couple of days?  Also, will I be able to get upstairs to my bedroom or should I move a bed to the first floor to avoid the stairs?  Appreciate any help you can give me.  Thanks

post #6494 of 10808
Welcome Casa: The first week is rough, but it gets you on the road to a full recovery. My advice is take the meds they give you as you need them, take a stool softener a to deal with the med related constipation, sleep whenever you can, realize it is normal to feel a bit depressed to realize you are stuck in a brace for what looks like a long time and follow your surgeon's advice and directions. It should markedly improve after the first week.

I was able to negotiate stairs with locked straight brace right from the get go. Take your time and find what is safe for you. Lead with good leg going up and bad leg down at the start. Do a step up and then bring the other leg to the same level. Slow but sure. I am assuming you are single quad rupture.

You can also find great advice in old posts. This question comes up from time to time. Again, good luck.
post #6495 of 10808
Originally Posted by Casa View Post

Hello Newbie here.  Going to Quad surgery on Thursday this week.  Can anyone tell me what to expect right after the surgery and the next couple of days?  Also, will I be able to get upstairs to my bedroom or should I move a bed to the first floor to avoid the stairs?  Appreciate any help you can give me.  Thanks

@Casa...Well, you found the right place for sure. Great questions, and if you have the time to scroll back you will find a very comprehensive check list provided by NJPete. As far as your above questions....right after surgery you can expect some pain. I stayed over one night in the hospital, but a lot of folks are having day surgeries. The first few days are the worst...you do have your pain meds, but typically you can wean yourself off them in a couple of days. They create horrible constipation and you don't want to have to rely on them for very long...obvious reasons. I was able to have partial weight bearing right after surgery and actually navigated the stairs without my crutches fairly well. You MUST have a handrail, though. You will be in a locked at ZERO degrees (straight) leg brace, but you can still gimp around with it. You will also benefit from having a pee bottle in bed for the first few days (available at drug stores). I also had a raised toilet seat deal that really helped the other aspect. I HATE bed pans and have never actually used one. Again, good luck. It's surely no fun, but we all survived. I had my surgery on 2/20/13 and four months later I was back up and doing everything I was doing prior. Here's a U of Wisconsin Sports Medicine Protocol I followed to the letter in rehab.



post #6496 of 10808

Thanks, appreciate the information.  Hopefully things will go well and I can being to recover quickly.  Uncertain about one other thing.  I work from home on my computer - how long do you think it will be before I can get back on the phone and computer?

post #6497 of 10808
I think you can begin doing some phone and computer work right away, but you will probably feel pretty "off" for a few days and not want to do business while affected by the pain meds. People vary on how quickly they bounce back, but I think that you should be pretty functional on computer and phone from home after the first week.

I would put your recovery above all else. Protect the tendon as your surgeon directs you. You don't want to redo this surgery.
post #6498 of 10808

Thanks again.  I really appreciate the information.  Now if I could just relax a little before surgery I will be fine.  A few cold one's tonight should do the trick!

post #6499 of 10808
Originally Posted by Casa View Post

Thanks again.  I really appreciate the information.  Now if I could just relax a little before surgery I will be fine.  A few cold one's tonight should do the trick!

@Casa...couple more things come to mind. Are you doing day surgery or overnight? If given the option stay overnight. Also, what kind of anesthesia are you scheduled for? I had general (totally out) and don't regret it at all. Some folks here have had a "nerve block" as well. (just google it) I didn't, but had no problems. Another huge plus for me was that my surgeon used steri-strip closures and no staples. Much more comfortable during healing and hardly a scar. Depends on the surgeon I guess. Another big thing is ice applications after surgery. You could look into a Cryo ice machine as some have suggested, but I just used frozen ice pack wraps. You will probably have a minimal appetite for the first few days post surgery, but nourishment and vitamins are important for healing. I pretty much lived on yogurt and smoothies for a few days....make sure to stay hydrated as well.

post #6500 of 10808

Best of Luck Casa.  RUNNERMX and myself were lucky enough to have to get both quad tendons (bilateral) reattached last summer and fall.  RUNNERMX is ahead of me and most humans in his recovery.  He is kicking this thing in the teeth!!  I was able to negotiate my bicycle today for about 20 miles on an abandoned rail line crusher dust path so recovery and normal life will return.  I am now faster on a bicycle than most non-injured folks.   I had surgeries last Sept and would say I am about 75% recovered.  Don't take it lightly.  It is seriously disabling during the first 3 months of the rehab, with bilaterals.  I was off work until April of this year and still have limitations.  Surround yourself with supportive people and keep your chin up.  You might as well laugh as cry.  As for being nervous before surgery, this was my first surgery and I was a basket case.   I thought I was going to the Electric Chair!!  But everything will work out in time.   Keep your laptop close and shoot off any questions you have.  We have all been through it and can answer alot of the "How can I do" questions you will have.  

If RUNNERMX and I can survive 2 of these at once then one should be a walk in the park....over a bumpy path.  


Update on my son.....He had his colon removed in March and had the bag reversal surgery done 2 weeks ago.  He is doing fantastic and his life will return to pain free and productive within a few weeks.  I am proud of his courage.  He is doing a fundraiser walk for the Crohns and Colitis Charities and is the top fundraiser in the Victoria, British Columbia.  

post #6501 of 10808
Sorry to hear about your injury Casa!!!' I hope surgery goes well for you! I had my surgery one month ago tomorrow. The first few days are painful, very painful. I woke up from surgery crying (but I'm a girl so that expected). It took me well over an hour from waking up until I was able to get myself dressed to go home (I had surgery on the same knee 7 weeks prior and was out the door in under 30 min). If you have the option I'd do inpatient surgery! The pain is pretty manageable after the first 3-4 days. Sleeping in the beast of a brace is a different story, use lots of pillows.

Stairs are tricky the first day when you're still a little doped up. I bent over forward, put my hands on the steps a few ahead of where my feet where and walked up one by one with my good leg first. I was weight bearing right after surgery and only used crutches to slow me down.

As far as work, I worked from home until I could figure out how to get in my car and drive. I was working about 6 hours each day, but would drift in and out of sleep throughout the day b/c of the pain meds. My surgery was on a Friday and I was working a bit the following Monday (from home). This past week I worked two 13 hour days and drove 2 hours to my company's HQ one day stayed two nights and drove the two hours back after working 10 hours on Friday.

Biggest thing is take your pain meds to stay ahead of the pain and be patient and try not to get frusrated (easier said than done)!
post #6502 of 10808
This might sound dumb, but I took a real shower finally!!!! Stood up the entire time!!! I've been HATING "showers" since surgery, so this puts me in a really good mood this evening!
post #6503 of 10808
Hi Everyone!
Just wanted to thank all of you for sharing your journey!!! I've been reading all of your post since April 10th and it has helped me out tremendously. I had left quad rupture- complete on 4/8 followed by surgical repair on 4/16. My orthopedic surgeon is very aggressive so I was weight bearing ASAP and no bend for only 3 weeks. I unfortunately got a blood clot in my lower calf and will be on anticoagulants for 3 months. However it has not really interfered in my recovery. I Started physical therapy 5/10. Last session Saturday I had 96 degree rom and finally was able to do 2 sets of leg lifts. Quad is finally firing!!! I'm still on crutches and zero degrees when ambulated but can get around pretty good. Next os appointment Thursday and hoping he will give me some rom on the brace for walking.

I had my right acl reconstructed about 15 years ago and realized that my recovery was hampered because of my fear of hurting myself again. On Saturday after reading some of your posts, I had a talk with myself about fear and decided to confront this injury with a new attitude and it worked. I was so proud of myself for something I took for granted 7 weeks ago---a leg lift.
Edited by Lashep68 - 6/1/14 at 8:37pm
post #6504 of 10808
@Skicarver: Thanks for the update on your son---he's a battler. Wonder where he gets that from?
post #6505 of 10808

Casa and Lashep68....welcome....of course this is a club no one WANTS to join, but the support here is good :)  At Casa: Yes, as others have said if you can stay overnight one night in the hospital it is helpful...just to regulate the pain and have the help is good. I had my surgery at 5PM and the next morning by 9AM the hospital physical therapist was there to get me out of bed walking. It felt like I had a brick on my knee, and it was difficult to move. I told the PT I had stairs at my house so he took me to the hospital staircase and taught me how to go up and down the steps with my crutches.  If I were you I would set up camp on the first floor, at least for the first week.  This is what I did to set up....put a tv in my room, got a tv pillow for my bed, a body pillow to sleep at night, a neck pillow for neck support,  had the laptop nearby always, a raised toilet seat, a grabber, .....I never let my pain get above a 5 or 6, but I only used pain pills for about a week after surgery, then I didn't need them anymore. I forgot about the stool softener, but yes, you will need that. My doc also put me on aspirin to avoid a blood clot following surgery.   You will also need someone or something to move your leg out of bed for the first few days. I rigged an ace bandage as a pulley to get my leg out of bed......but for the first few days my husband actually moved my leg out of bed.   Best wishes to you and let us know if you have any questions. It WILL get better!


@skicarver Gald to hear your son is doing so well!

post #6506 of 10808

Skicarver, I didn't realize your son had his colon removed due to colitis. I had a run-in with colitis in my mid-20s, caused by a series of stressful events and maybe an unhealthy habit ... I drank a lot of beer back then. One guy wanted to remove my colon, so I switched and got a second opinion. The second guy really ramped up the meds, some kind of corticosteroids. Then one day, I got fed up with it and stopped taking all the meds and switched from beer to Scotch whiskey. I also ramped up my running. The colitis completely went away after lasting about a year and I was discharged.


One thing I've observed about this bilateral quad tear is that I've had to fight for every inch of recovery. This injury gives you nothing. I suppose it's a simple formula a that the body's natural response to exercise is to get stronger. My O.S., to his credit, simply told me to push it as hard as I can. t don't think he knew how long it would take, or how hard I would be able to push. Once the leg shackles come off, you have to take full ownership of this recovery. You have only you to complete the job, and there is no deal.

post #6507 of 10808
Originally Posted by Casa View Post

Hello Newbie here.  Going to Quad surgery on Thursday this week.  Can anyone tell me what to expect right after the surgery and the next couple of days?  Also, will I be able to get upstairs to my bedroom or should I move a bed to the first floor to avoid the stairs?  Appreciate any help you can give me.  Thanks

I agree this is a really painful injury post op. I think there was a discussion about this back on page 138 in December 2012 and I have reproduced my post from there.

If I had a chance to go back in time and speak to my Anaesthetist (who is responsible for the post op pain relief) I would say please give me an IVI narcotic  (like pethedine) - preferably via PCA Patient Controlled Analgesia where they use an electronic pump to vary the rate and the patient can vary this by pushing a button. My mother had a hip replacement in Sydney and she said that this form of pain relief was excellent (she also has a problem with post op vomiting- so its genetic presumably). I think the problem is that this is a rare injury and they are much more used to patients who are having cruciate repairs which I suspect are much less painful post op. I think a lot of the discomfort comes from the fact the surgeon has to stretch the muscle to rejoin it to the tendon and this chronic stretch allied to the trauma of the surgery is very painful initially. Once I was through the first 24 hours the pain was quite manageable on Ibuprofen and codeine. I was just on ibuprofen after about 4 days.

post #6508 of 10808

Thanks for the information.  If I can survive the first few days I am sure it will start to hurt less quickly. 

post #6509 of 10808

You will do fine Casa.  Just prepare to do battle once the tendon repair gets strong enough.  Protect it early in the recovery stage.  Now is not the time to worry (says the biggest chicken on the planet).  General anesthetic is the way to fly for an operation.  I don't want to see or remember anything.  First few days are rough.  I spent a week in the hospital with mine until they kicked me out.  Look at it this way...You are useless the way you are now so it is just some nuisance you have to go through to get back to normal.  I never thought I would be recovered enough to participate in a Specialized Demo Day today.  Got to ride the best Carbon Road Race bikes out there.  Now I just need to spend $7000 without my wife knowing it.....not going to happen!  

post #6510 of 10808

First off, best of luck on your surgery. My two cents on some things you asked about;

I set up a bed downstairs in order to not deal with stairs. The less I had to deal with stairs that early in the recovery period, the better.
I worked after the second day from home; only issue was the spacey feeling from the painkillers but I took breaks if I felt too woozy.

Good luck again. It'll be rough the first few days but it gets better!
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