Quadriceps Tendon Rupture, Repair and Rehab

[martyg]

@martyg I am glad your recovery seems to be off to a good start.
This thread was always a bit of an odd duck -- a public service on Epicski that was carried over to pugski after the transition.
(I read a lot of the thread when I was in ACL recovery -- it made me think "ah, this is nothing!" about my injury.)
I think you may be the first user of this thread that was already active on the site (or its predecessor) before joining the thread!
Good luck.

Thanks. All us relatively good. It is certainly one of the most linear recoveries from a catastrophic structural failure that I have experienced i Military or civilian life. Every day is a bit better. Usually Zi have several good days, and then a wretched day.

Likewise, PT is relatively easy at this point. The goal being to allow fell division, and the tendon to repair, while introducing, strengthening and range of motion drills.

If anything, I am just bored. Every day is a carbon copy of the last, with slight improvements.

Thanks for the comment.

 

[peter826]

Boredom, yes! My surgery coincided with my office being shut down for two months due to Covid. So there were no concerns about going anywhere or doing anything. I spent two months sitting on the couch answering the odd e-mail here and there. I certainly got caught up on all the streaming programs I'd wanted to watch. Of course, I read this whole thread, more than once.

What I take away from this injury is how different everyone heals. My PT was working with three of us who had this same injury around the same time. Guy 1 had no fear and was back playing tennis in a 3-4 months. I was guy two, sort of in the middle. Guy 3 couldn't bend past 60 degrees even at 6 months and was looking at some sort of secondary surgery to help regain range of motion. My PT beat into my head, ROM, ROM, ROM...and I am glad he did. I have full ROM and no problems there. I found that I was still pretty unsure/unsteady even at six months. I seem to have made a lot of progress from 6-9 months. I have been trying to unlearn a lot of little things I was doing to cope with my left leg not being as strong, some of them being subconscious at this point. Stuff like getting into the car differently, always timing my steps to use my better leg to push off when going over a step or curb, etc.

Wishing everyone a fast and full recovery!

 

[Old Runner Frank]

Hey n0ragrace, thanks so much for your helpful advice and kind words of encouragement.

A few additional notes;
1. I suppose I was predisposed to this injury, as tendons have always been my weakest link. I have rarely had joint or muscle injuries, but I have had tendinitis/tedinosis for years at a time in my Achilles and elbows, and most recently for the last few years in my quad tendons.

2. This is an extremely debilitating injury. I am so thankful that my wife has been incredibly helpful in getting me places, helping me with personal hygiene, and setting up a comfortable rehab environment. I have no idea how someone single is able to deal with everyday problems like getting food, going to doctor's appointments, and even simple things like changing socks.

3. I am very fortunate to have recently retired. While this is certainly not the way I wanted to start my retirement, I am thankful that I don't have to worry about getting to and around my office, and that I have the time for the extensive rehab that is going to be required.

4. I'm also thankful that I've been able to do a lot of walking, currently up to an hour to an hour and a half a day, with no pain during or after. Much of it is doing laps in my basement, but I've also been able to get outside to enjoy the mild winter that we've been having so far in the northeast. It's not running, but at least it's something.

I wish all of you the best, and I will continue to follow everyone's progress.

 

[martyg]

In the For What It Is Worth column.

Going into week three from surgery today:
- 60 degrees ROM.
- Unassisted leg lefts, 2 x 10, 3x / day.

Pretty OK with this. My PT is mapping out the start of squat workouts in two weeks. Progress feels amazing.

 

[Old Runner Frank]

In the For What It Is Worth column.

Going into week three from surgery today:
- 60 degrees ROM.
- Unassisted leg lefts, 2 x 10, 3x / day.

Pretty OK with this. My PT is mapping out the start of squat workouts in two weeks. Progress feels amazing.

Hey martyg, glad to hear your recovery is coming along so well! You are on a far more aggressive rehab protocol than I am. I had my surgery about a week before yours, so four weeks now, and I'm still immobilized for at least another week or two. As noted above, I've done some strength training and lots of walking, but recovering my ROM is something I can only dream about at this point.

 

[martyg]

Hey martyg, glad to hear your recovery is coming along so well! You are on a far more aggressive rehab protocol than I am. I had my surgery about a week before yours, so four weeks now, and I'm still immobilized for at least another week or two. As noted above, I've done some strength training and lots of walking, but recovering my ROM is something I can only dream about at this point.

Still in the brace until the beginning of Feb. No load at anything but zero degrees. However I can go to 60 degrees of passive stretching for the next few weeks, then ramp it up.

My PT wants very little walking. Devoting time and metabolic energy to 4 PT sessions per day with he above mentioned, and hip strengthening drills which I did a ton of before this.

Best to you.

 

[Old Runner Frank]

OK, so inspired by martyg, peter826, and all the other posters' emphasis on range of motion, I decided to see just how much I could bend my knee when I was out of the brace sitting on my bed yesterday. Holy crap is it tight! I could just lift my knee off the bed a slight bit. There was no pain, but it felt like I hit a wall, almost as if it wasn't really my leg, but some artificial appendage. Do most people have that feeling at first? Does it eventually start to feel normal again? (I'm four and half weeks post surgery at this point.)

 

[martyg]

OK, so inspired by martyg, peter826, and all the other posters' emphasis on range of motion, I decided to see just how much I could bend my knee when I was out of the brace sitting on my bed yesterday. Holy crap is it tight! I could just lift my knee off the bed a slight bit. There was no pain, but it felt like I hit a wall, almost as if it wasn't really my leg, but some artificial appendage. Do most people have that feeling at first? Does it eventually start to feel normal again? (I'm four and half weeks post surgery at this point.)

Quick notes on my experience. I'm 3.5 weeks out from surgery. Hope that it provides context for you.

- I think that at my first PT session, after my PT did patella manipulation, massage and manual manipulation I was at 20 degrees. Subsequent sessions, by myself, just sucked.
- Now I am at 60 degrees. At that benchmark, I worked my ass of to get there - maybe 5 minutes of progressively more ROM. At the end, maybe 3 reps at 60 degrees.
- Over the course of maybe 2 days the effort to get to 60 decreased. It is not "effortless" now, but it is comfortable.
- With leg raises, for the first day or two, I needed help clearing my heel from the floor. A gentle spot of a few pounds of pressure was all that I needed. In the beginning they were intense. Now they are casual.
- Yes. Hitting a wall. Fatigue. Like I had a really good leg workout, but it was 6 minutes at a time.

One of the things that USOPCs head nutritionist stressed to me was a post workout recovery drink for PT. It is helping me get four productive sessions in a day. I used Proven4Sports. Their major channel of distribution is the NBA and MLB, their athletes, coaches, trainers. They are also independently third party certified by the NSF.

I'm finding the manipulation / massage is helping a lot. Sessions with my PT 2X per week. One 90 minute deep tissue massage per week.

Do shop for a very solid PT. I don't need someone standing urging me on to get those last few reps. I need someone smarter than me to help guide me. Once I have direction from a reiable Source of the Truth I am a machine.

The other utility that my PT serves: after being immobilized for 4 weeks +, my quad has forgotten how to move. It feels like my brain can command it, but it just doesn't fire. Your PT will lead you down that oath, first manipulating your leg so that your muscles learn that it is OK to move after trauma, then they help those neurons start to fire, then, under their direction, you train your muscles to regain strength.

Best to you.

 

[peter826]

Frank, much of my ROM work was laying on my back on the floor, with a strap wrapped around my foot, gently pulling my foot back which bends the knee. PT called them "heel slides". I was doing this 3-4x per day, usually 3 sets of 10 slides. My doc told me that he could bend my knee at 60 degrees when he finished putting it back together without putting strain on the repair, so that was the initial goal. Obviously, you want to be able to do this under your own power at some point....it may be easier to pull back with the strap than using your leg muscles, but it's passive ROM not active ROM.

The other early exercise was to put a folded towel under the knee, then contract the quad and push the knee downward in an attempt to straighten it. PT called these "quad sets". I think these help the quad re-learn how to fire correctly..

Leg raises are good, too, but normally you won't be able to lock your knee enough to keep the foot from lagging. In other words, as you raise your leg, your foot will drop. Obviously this depends on whether your have your brace on or not. It took me months to get rid of the lag in a straight leg raise.

 

[mdf]

There was no pain, but it felt like I hit a wall, almost as if it wasn't really my leg, but some artificial appendage. Do most people have that feeling at first?

It was a different injury and a different surgery, but the first time I tried to raise my leg at PT one of my muscles just would not fire at all. As I continued to try, the PT tapped on the muscle to "wake it up". That worked pretty quickly, and once it started to respond it worked pretty normally. If it hadn't, the next step would have been electrical stimulation.

 

[martyg]

My progression is more aggressive. My PT came out of the Center for the Intrepid, where high value JSOC Military go for rehab. He's seen a ton of lower extremity trauma there. I am a product of a JSOC training, and he seems to be treating my like I am a young 20something. I am OK with that.

No towel on heel. He wants my hamstring and hip flexors firing to raise that knee. No brace on for leg raises, planks, bridges, glut leg raises and back extensions.

He has squat workouts mapped out in two weeks from now, when the brace comes off.

 

[martyg]

The other early exercise was to put a folded towel under the knee, then contract the quad and push the knee downward in an attempt to straighten it. PT called these "quad sets". I think these help the quad re-learn how to fire correctly..

I layered up 5mm and 2mm ethafoam. It works so much better than a towel, which is extremely imprecise. With the ethafoam I can objectively gauge progress, and its density doesn't change.

 

[Old Runner Frank]

Thanks everyone for all the helpful advice and encouragement. What a great group!

I have an appointment with my doc today, and I believe I will be starting PT within the next week or so. I really had not given much thought to selecting a therapist, but martyg has helped to make me aware of typical PT for old folks to get me back to walking eventually with a barely noticeable limp vs. aggressive PT to get me back to running and doing hardcore military-style workouts.

Keep trucking along everyone, and I'll check back to let you know how things are progressing.

 

[n0ragrace]

For folks still working on ROM, something I found really helpful beyond the leg pullbacks and towel exercises listed above was a standing exercise: Stand facing a chair (or couch, etc); place your foot on the seat, and with something to stabilize your upper body (crutches, a table, or the back of a chair), carefully and slowly lean forward while bending your knee. This really got me past the 70 degree mark and I kept doing it with considerable ease to push through to 130 degrees.

Proud to say that I went skiing for the first time in two years yesterday. It's like riding a bike, picking it back up with some hesitation but easing into it like no time has passed, and it really felt amazing. I'm paying for it today with some quad and calf soreness but being on the slopes again is priceless. Thanks, everyone, for the constant encouragement and words of advice over the last few years. I'm a lucky gal!

 

[Old Runner Frank]

N0ragrace, I'm both happy for you and inspired by your return to skiing. It's quite encouraging to hear about people returning to strenuous activity after this debilitating injury.

Doc said I'm progressing well. Started PT yesterday. Measured my ROM at a comfortable 30 degrees. I think he didn't push me too hard because he wants me to see rapid progress. We did a lot of strength stuff, but I'm thinking I need more ROM. Did some work on my own today. Still doing a lot of walking.

 

[Old Runner Frank]

This discussion has been quiet for almost a week, so I hope that means there have been no new members in "the club." Let me see if I can get things moving again. BTW, I forgot to mention that when I saw my doc last week, I told him of this group, and he said to me that this is a very common injury that he sees quite often, more so than torn ACL's. I found that odd, as I know of many more people who have torn ACL's than have suffered this fate, but as with so many things in life, once one becomes aware of something, more cases of it tend to appear. So I have subsequently heard more people who have suffered QTR's.

I had my third PT session yesterday as I marked six weeks post surgery, and have been diligently working on strength and ROM on my off days. I may have overdone it on the leg lifts, because I have some tenderness in my hip flexor (psoas) on the injured side. I am happy to report that while I could barely bend my knee a few degrees on my first attempts a week ago, the PT measured me at 68 degrees ROM yesterday, so quite happy about that progress. Obviously, still a long way to go. (From 40+ years of running, I've always been pretty tight, so my ROM on the other side is only around 135 degrees.)

I was finally released from complete immobilization yesterday, and given 30 degrees of freedom. Feels a little weird, but I'm sure it will feel better over the next few days. I'm continuing to walk 1.5-2 hours per day, getting to around 10,000 steps, and having no problems with it.

Hope everyone on here is continuing to progress. Hey martyg, I know you have been pursuing your recovery quite aggressively. Curious how much time you spend daily on your rehab regimen?

 

[martyg]

Hope everyone on here is continuing to progress. Hey martyg, I know you have been pursuing your recovery quite aggressively. Curious how much time you spend daily on your rehab regimen?

About 4 hours / day over 4 sessions. 0900 = 90min. 1200 = 30minutes. 1600 = 90min. 1900 = 30min. Three days on. One day off. During on days I basically have time to finish fuel,and get a few hours recovery for the next session. Quite gassed by he middle of he third day.

I wouldn't worry about hip flexor soreness. What you want to be super aware of is tenderness at the repair site. Hip flexor soreness (or psoas - different muscles) might be a signal that you are not recruiting your quads enough on leg lifts. Your quads should be the primary movers for this drill. If your heel drops even a fraction of an inch during leg raises that could be a clue.

Best to you.

 

[Old Runner Frank]

I have continued to be pretty diligent with my rehab, putting in a few 15-20 minutes sessions each day working on strength and mobility and walking an hour and a half to two hours, plus three formal PT sessions each week. In addition, I have been mixing in core and upper body strength workouts. But marty, I am awed and humbled by your single-minded dedication to your recovery! Would you be able to provide any details on how you spend that much time? Is a lot of it riding an exercise bike or using a similar piece of equipment?

 

[peter826]

Well, Frank, how goes it?

I just passed my 10 months anniversary for surgery. It's amazing how much better everything feels now than it did even a couple of months ago. Far more confident, stairs are so much better, etc.

Lots of ice here, so I'm walking carefully!

 

[martyg]

I have continued to be pretty diligent with my rehab, putting in a few 15-20 minutes sessions each day working on strength and mobility and walking an hour and a half to two hours, plus three formal PT sessions each week. In addition, I have been mixing in core and upper body strength workouts. But marty, I am awed and humbled by your single-minded dedication to your recovery! Would you be able to provide any details on how you spend that much time? Is a lot of it riding an exercise bike or using a similar piece of equipment?

Right now...

AM session:
- Calf raises 3 x 50
- Shallow squats - working on perfect form 4 x 10
- Leg raises 5 x 10 w / 2.5 pounds
- Single leg bridges 3 x 20 / leg
- Planks 3 x 1 min.
- Glut leg lifts 3 X 20 / leg
- Transverse abdominal heel slides 3 x 40
- Alternate various ab motions
- Mobility work

Afternoon 1:
- Leg raises 5 x 10 w / 2.5 pounds
- Mobility work

Afternoon 2:
- Leg raises 5 x 10 w / 2.5 pounds
- Mobility work
- Upper body work - pull-ups, rows, dead lifts, benches, presses, delt work, external rotators, etc.

PM:
- Leg raises 5 x 10 w / 2.5 pounds
- Mobility work

3 days on. One day off. My PT is just throwing some new stuff at me. He wants me to smoke my quad every other day. Looking forward to the new routine.