Treatment methodologies for quadriceps tendonitis are all over the place, from resting, to icing, to exercise, to massage, and everything else in between and beyond.
The best treatment method for quadriceps tendonitis is a combination of strength training, rest, and other modalities to reduce symptoms in the short term such as ice, heat, or the use of medication.
In this article I’ll discuss the various different types of treatment methods, their pros, cons, and I’ll also discuss what people also get wrong. I will also briefly describe the difference between a tendonitis vs a tendinosis.
Let’s jump in!
What is quadriceps tendonitis and where is it usually felt?
Quadricep tendonitis is an inflammatory process that affects the tendon connecting the quad muscle to the top of the patella (bone).
Patellar tendonitis is similar in that it connects the bottom of the patella to the tibia (lower leg bone).
Both portions of the patellar tendon or patellar ligament play a crucial role in transmitting force from the quadriceps through the knee.
Signs and Symptoms
- Pain with heavy squats
- Pain with kneeling
- Pinpoint pain directly on the tendon
- Pain with pressing on the tendon that increases with increased pressure
How To Best Treat Quad Tendonitis?
There are many different approaches to treating quad tendonitis or tendinosis.
If you’ve only had symptoms for a few days my best advice to you is to not freak out, return to normal activities gradually over the course of a week or two and see if things get better. If they get better, congrats, no need to go into some extensive rehab program.
If you’ve been having symptoms for weeks and months without improvement then I’d recommend #1 reading this article about how to modify your exercises, and then #2 following along as you see fit with this program.
Keep in mind that this is a generic program and can in no way be specific to you because I haven’t evaluated you.
The most important thing to keep in mind when performing these exercises is to ensure that 24 hours after the activity you haven’t irritated the tendon > than a 4/10 on the pain scale. If your symptoms start getting above that after a workout then you’ve gone too hard and likely need to scale back.
You can read this article about when pain is okay or not to get more info on that.
An example rehabilitation program that you can follow on your own
My advice is to test out one of these exercises per day before you start combining them together. It will feel slow at first, but it will be more efficient in the long run, just trust me. (if none of these work for you just leave a comment at the bottom of this article and I’ll update the article)
- Straight leg raise – 3 sets x 10 reps
- Bodyweight squats or goblet squats – 3 sets x 10 reps
- Kettlebell deadlift or barbell deadlift – 3 sets x 10 reps
- Reverse Lunges – 3 sets x 10 reps
- Single leg box squat – 3 sets x 10 reps
- Step up to high box 20” or greater – 3 sets x 10 reps
Start with straight leg raises as these are the easiest and most straightforward movement.
Bodyweight squats or goblet squats can be done free standing or to a box/chair. Feel free to use a higher surface to start with between 20-24” and then progressively work yourself down to 17” and lower.
Kettlebell or barbell deadlift is a great way to add some additional load to the quad. Some people tolerate this well, others do not. Start light and work your way up. If you’re not sure you’re doing it properly, consult your physical therapist or personal trainer to help you with your form. As an aside, there are many different ways to do many of these exercises.
Reverse lunges. Okay now we are getting into the single leg activities which generally are more uncomfortable for quad tendinitis. Start light and progress as symptoms allow.
Single leg box squat. Using the same logic as above for the lunges, start light and with a higher box and then progress to heavier and with a lower box.
Step up to a high box ~ 20”. This one is pretty challenging but give it a go if you feel comfortable with it. Again, start light and progress from there.
When should you seek help from a professional (physical therapist)?
As I discussed a bit earlier, you should seek help if you’ve been struggling to make progress with this issue for several weeks or months.
The best type of professional to contact for this issue is a physical therapist.
A physical therapist will be able to accurately diagnose the issue and then appropriately prescribe exercise that will help load the tissue in a progressive fashion.
If you are an athlete and the therapist doesn’t have a plan to get you back to sport or doesn’t have a plan that progressively increases the weight and difficulty of the exercise, find a different therapist.
What causes quadriceps tendonitis?
Generally, any type of tendonitis is a result of overuse.
This overuse can come in the form of high-intensity jumping, lifting, sprinting, etc.
Tendonitis can also occur due to a period of inactivity followed by an activity spike or accumulation of excessive activity that exceeds to current load tolerance of the tissue.
How to diagnose quadriceps tendonitis
To differentiate between a muscle strain and quad tendonitis is a difference of location. If your pain is along the tendon towards the distal portion of the quad muscle belly, it’s like the tendon.
If pain is in the muscle belly itself this is likely related to a muscle strain.
This diagnosis is as simple as asking “where does it hurt,” in addition to testing active and passive range of motion. Since a tendon is contractile I would expect for this to be painful with an active contraction of sufficient load.
Often times these injuries are load-dependent meaning that it takes a certain amount of contraction for symptoms to flare up.
Fully extended and at rest, this tendon is usually asymptomatic, but, when placed at maximal flexion and stretch this is when symptoms also start to show up.
Are Injections ever useful for quadricep tendonitis?
I am not a big fan of corticosteroid injections for any sort of tendonitis as this is largely if not 100% treatable without injections or surgery.
Activity modification is the best way to treat this and the only time I would recommend any sort of injection is if symptoms are so bad that you cannot walk and you have exhausted your other treatment options. Injecting directly into a tendon is not advised by many physicians due to the risk or degradation of collagen.
- Quadricep tendonitis is usually caused by overuse or overexertion
- It feels achy, burning, and sometimes sharp. Deep knee flexion and higher-intensity activities tend to flare it up the most.
- The best treatment for quad tendinitis is a short bout of rest, progressive exercise, ice/heat/NSAIDs as needed.
- I do not recommend injections for this condition