Quadriceps Tendon Rupture, Repair and Rehab

[martyg]

Hello Everyone, I unfortunately joined the club 5 weeks ago today surgery was done to reattach the quad tendon. Doc said I was lucky that the meniscus, acl, mcl etc were all ok. I did not feel so fortunate but I guess for the accident that occurred it could have been way worst.
At 5 weeks post op I am at 88-90 degrees and walking around with no crutches. Still have to wear the brace for another couple weeks but at least I do not have to sleep with it.
Has anyones Doctor assured them that when pushing for more flexion to push through the pain that flexion is even more important than strength? Doc said that the little bit of swelling is normal and that the way to keep that diminishing will be to push through for some more flexion. Goal is 10% a week.
I am trying the stationary bike but can only go forward and backward. Seems like a full revolution is a long process. Thanks for listening.

Based on my experience, my doc had little input post surgery, and deferred to my PT.

At 5 weeks you are just getting to the point where you can start to think about strength training. Up until now you have been playing the cell division game. Even if everything about your hormone levels and diet are dialed, there is no cheating cell division.

I wouldn’t say that flexion is more important than strength. But up to now, flexion is what you needed to work on.

One tool that helped me ( and I don’t have a pic) was a jig that objectively measured progress. Picture a yardstick, perpendicular to the floor. I secured it to a beefy piece of oak as a base. Then I created a moveable cross piece that was secured with a rubber band. That cross piece was parallel to the ground. It did not measure degrees, but it did measure inches. I tried to bump range 0.5” per day.

As far as strength training, once your PT says that it is go-time you need to be prepared to kill yourself in the gym. Only full range strength training is going to fully stimulate quad tendon growth. However training is the easy part. Employing all the best practices for recovery will be your challenge. Optimizing all aspects of recovery will allow you to consistently have killer workouts. Without that aspect your strength, and building a robust tendon, will be compromised.

Best to you.

 

[Old Runner Frank]

I am going to defer to martyg here, as he seems to be incredibly knowledgeable about this. I will add that my surgeon said that there is a window to recover range of motion, somewhere around six months. So that should be the main focus at first, whereas there is unlimited time to rebuild strength. As martyg notes, once you get the green light, it's go time to restore strength and function.

Good luck to you!

 

[nvr2old]

Thank you for the replies. I have been focusing on the ROM and for strength the PT has me doing sit to stands, squeezing the quads etc. I have been doing them a couple times a day daily. Each day it seems the tightness in the knee loosens up a bit and it is easy to get to 90 degrees now.
My doctor said that Even though we are middle of the 5th week to start pushing for 100 degrees. He does not want me to add any additional weight. I believe that I will be allowed to walk without the brace either this week or next week.

My struggle is I was a competitive bodybuilder for a long time and even though I have not been at show weight I consistently trained so it is hard to not want to put even a few pounds of weight on the leg to straighten it. It is very odd to see the left leg smaller compared to the right leg. Amazing how it happens so fast. Doc says I have been advancing faster than normal as I was consistently training.

When should I expect to be able to do a full revolution on a stationary bike or elliptical?

I appreciate all the information that I have read on this thread from start to finish. Thank you

 

[martyg]

Thank you for the replies. I have been focusing on the ROM and for strength the PT has me doing sit to stands, squeezing the quads etc. I have been doing them a couple times a day daily. Each day it seems the tightness in the knee loosens up a bit and it is easy to get to 90 degrees now.
My doctor said that Even though we are middle of the 5th week to start pushing for 100 degrees. He does not want me to add any additional weight. I believe that I will be allowed to walk without the brace either this week or next week.

My struggle is I was a competitive bodybuilder for a long time and even though I have not been at show weight I consistently trained so it is hard to not want to put even a few pounds of weight on the leg to straighten it. It is very odd to see the left leg smaller compared to the right leg. Amazing how it happens so fast. Doc says I have been advancing faster than normal as I was consistently training.

When should I expect to be able to do a full revolution on a stationary bike or elliptical?

I appreciate all the information that I have read on this thread from start to finish. Thank you

Your time as a competitive bodybuilder will suit you well for this recovery. I dabbled in bodybuilding, but spent a lot of time in the gym as a sprint athlete.

I'd have to go through my notes to be exact, but I think that I was around 110 degrees at 6 weeks. At that same time I couldn't quite get around a full crank rotation on the trainer, so I was going forwards and back - using it as a ROM device. At 8 or 9 weeks I think that I was doing little rides around the block. At 11 weeks full squats with 115, 5 working sets, 8 -10 reps. At 6 months I was doing agressive 2 hour + road rides. Mtn biking still felt clumsy. At 14 months a month of heli skiing in Iceland.

It will not only be your quad that is screwed, but everything about that leg. Anything that activates the hamstring, calves, gluts / medial gluts should be emphasized. My PT is a competitive powerlifter. His go-tos were squats, deadlifts, and split squats with the front foot elevated to get maximum extension on the quad - the back foot just adds some stability - everything happens off of the front foot. Anything big and compound (he did not see the beauty of leg extensions. I never emphasized them, but did do them for a few months). Then finish with super slow free squats to just toast your legs. Everything was slow and deliberate, full ROM, pause at the bottom before coming up. This is after the base of PT work. You want to make sure that the tendon is healing and adhered.

Your body will be building muscle tissue. So that same bodybuilding diet applies here. Also boosting T and HGH levels to boost recovery. Also consider Garmin dual sided power meter pedals. I started using a set about a year after surgery. Despite good numbers in the gym my L to R power output difference was crazy. I am sure that I had / have all sorts of compensation patterns that have yet to be discovered.

Best to you on your journey. Feel free to DM for more.

 

[nvr2old]

Your time as a competitive bodybuilder will suit you well for this recovery. I dabbled in bodybuilding, but spent a lot of time in the gym as a sprint athlete.

I'd have to go through my notes to be exact, but I think that I was around 110 degrees at 6 weeks. At that same time I couldn't quite get around a full crank rotation on the trainer, so I was going forwards and back - using it as a ROM device. At 8 or 9 weeks I think that I was doing little rides around the block. At 11 weeks full squats with 115, 5 working sets, 8 -10 reps. At 6 months I was doing agressive 2 hour + road rides. Mtn biking still felt clumsy. At 14 months a month of heli skiing in Iceland.

It will not only be your quad that is screwed, but everything about that leg. Anything that activates the hamstring, calves, gluts / medial gluts should be emphasized. My PT is a competitive powerlifter. His go-tos were squats, deadlifts, and split squats with the front foot elevated to get maximum extension on the quad - the back foot just adds some stability - everything happens off of the front foot. Anything big and compound (he did not see the beauty of leg extensions. I never emphasized them, but did do them for a few months). Then finish with super slow free squats to just toast your legs. Everything was slow and deliberate, full ROM, pause at the bottom before coming up. This is after the base of PT work. You want to make sure that the tendon is healing and adhered.

Your body will be building muscle tissue. So that same bodybuilding diet applies here. Also boosting T and HGH levels to boost recovery. Also consider Garmin dual sided power meter pedals. I started using a set about a year after surgery. Despite good numbers in the gym my L to R power output difference was crazy. I am sure that I had / have all sorts of compensation patterns that have yet to be discovered.

Best to you on your journey. Feel free to DM for more.

Thank you very much for the reply. It was motivation to read that you were equating with some weight by the 11th week. I thought I was going to be stuck waiting to use any type of weight for squats, deadlifts etc.
So you basically had full ROM but 12 weeks? 135-140 Degrees?

I have been using the bicycle forward and backwards although backwards seems to be a bit easier. It feels like it will never get there but then again I am still 5.5 weeks in so I know I need to have patience as well. Everything I have read and what the doctor told me was that biological speaking the 4 month mark is when the bone and tendon is healed. I am wondering if my doctor will let me squat more then my weight before that 4 month mark?

What exercises did you do to help with the ROM? I do all the typical heel slide, back and forth on the bike, pull my leg towards me with the strap... When I get to 100 degrees it is pretty painful. Doc said I have to push through it that I can not cause damage if I am smart about it. Problem I have is how much pain is not good if that makes sense.

 

[martyg]

Thank you very much for the reply. It was motivation to read that you were equating with some weight by the 11th week. I thought I was going to be stuck waiting to use any type of weight for squats, deadlifts etc.
So you basically had full ROM but 12 weeks? 135-140 Degrees?

I have been using the bicycle forward and backwards although backwards seems to be a bit easier. It feels like it will never get there but then again I am still 5.5 weeks in so I know I need to have patience as well. Everything I have read and what the doctor told me was that biological speaking the 4 month mark is when the bone and tendon is healed. I am wondering if my doctor will let me squat more then my weight before that 4 month mark?

What exercises did you do to help with the ROM? I do all the typical heel slide, back and forth on the bike, pull my leg towards me with the strap... When I get to 100 degrees it is pretty painful. Doc said I have to push through it that I can not cause damage if I am smart about it. Problem I have is how much pain is not good if that makes sense.

Not full ROM as in my heel touches my butt - but doing full squats. That being said, on weight days I stretched for 10 - 20 seconds between sets. I found that at probably 16 weeks, I could on occasion get my heel to my butt when warmed up, and with my foot propped up on something like the back of an incline bench. Maybe 100% of the time 4 weeks later.

I'd get with a PT who has completed their fellowship (their equivient of a PhD). Better still if they are a strenghth athlete. That will be your best source of the truth. My PT never mentioned the 4 month mark. However every movement was executed slowly on the eccentric, which is how you build muscle anyway.

Best to you.

 

[nvr2old]

Yes, I mentioned the eccentric movement but the reply toady was no weight bearing movements yet. I said you have me doing ball wall partial squats in which I am lowering slow and holding static which is eccentric in its own right but I didn't get a response. Finding a pt that is a straight athlete in my location I think is impossible and I feel that my progress will be up to me.

Did you alway have that tight feeling in your knee? Once I get to 95-100 degrees it just feels like it's so tight. It lessens once warmed up and stretched but the second I am not moving it it tightens up again to where I need to continually stretch it to get back to the 95-100.

Thank you for your help

 

[LAQuad]

Did anyone else notice their knee looks different after the surgery? Like the position is different. Mine seems to be positioned lower and more lateral than before.

 

[Old Runner Frank]

LAQuad, I did not notice a different appearance once the initial inflammation resolved, but three years later it still feels different from my other knee, and at this point I can't help believing that it always will.

 

[MTMatt]

I joined the club 9 weeks ago--was walking the dogs in the rain on the ski area and slipped on a piece of wood under the grass. 911, whambulance, ER, the whole 9 yards. Luckily I have my orthopedic surgeon's number and texted him from the ER. He got me in that afternoon, got an MRI, and had surgery 2 days later. I've been weight bearing since day 1 and started PT a few days after surgery. I was locked in extension for 6 weeks and have really only been using the brace when hiking since I got unlocked. I'm at 135 degrees ROM which is pretty close to full. My knee is still a little puffy for sure.

I feel like I could maybe ski groomers in a couple of months, but that may be delusion. I had a heli trip planned the first week of March which I've cancelled. I have another trip the 2nd week of April which I have not cancelled yet... I don't feel like I've lost a ton of quad strength, but I can't push it yet. I did a pretty agressive hike Wednesday (850 vertical in a mile and a half, up and back, ski poles, spikes and the brace) and A buddy who is a PT read me the riot act--way to early, irresponsible, etc etc. My actual PT took it in stride and basically said it's all good as long as you don't fall. My surgeon said "You and Aaron Rogers--pushing the envelope."

I see the surgeon again in 2 weeks. We'll see what he says. I haven't lost my mind yet, but the possibility is always there.

 

[Old Runner Frank]

Sorry to hear of your misfortune! I believe it is important to be patient with your recovery. Keep in mind that Aaron Rogers gets paid big buck to push the envelope. Take it a day at a time, and you will be back to full activities in a few short months.

 

[MTMatt]

Sorry to hear of your misfortune! I believe it is important to be patient with your recovery. Keep in mind that Aaron Rogers gets paid big buck to push the envelope. Take it a day at a time, and you will be back to full activities in a few short months.

Well, he also sacrifices big bucks if he re-injures it... I saw the surgeon's PA (who skis at least 100 days a year) Wednesday, and he thinks I'm well ahead of schedule, although 50% healed. He winced at some of the things I've been doing in PT--16" step-ups for one. But my PT thinks they are reasonable. I think I'll keep the April heli trip on the books. I have travel insurance (and it's a half-price trip to Last Frontier--pretty sure I could find a friend to take it). I'm hoping I could start skiing groomers 3/1. We'll see. I hiked 30 miles last week and did PT every day. I'm lucky to have that as an option!

 

[Old Runner Frank]

Glad to hear you are doing great in your recovery. Sounds like much of the difference in our experience could be age-related. I am 71 (68 when I had my injury), and I suspect you are considerably younger.
Hope things continue to progress well for you!