Knee Pain
Quadriceps Tendinopathy
The quadriceps tendon attaches your quadriceps muscles to your kneecap (patella). It works to straighten your knee and helps you walk, jump, and climb stairs.
If the tendon becomes inflamed, it’s called quadriceps tendinitis (tendonitis) or tendinopathy.
Inflammation of the tendon, or tendinitis, is most common in athletes whose sports involve frequent jumping, but people who don’t play any sport can get quadriceps tendinitis.
Physiotherapy treatment is often very successful but if persistent there are a lot of other treatments available, such as prolotherapy.
The most common cause of quadriceps tendinitis is overuse. This occurs when the tendon repeatedly moves in a specific way, which leads to small tears.
Normally, your body tries to fix these tears. But if you continue repeating the same movement, more tears will develop.
Repeated actions can also cause quadriceps tendinitis, like:
sports
trauma, like jumping on a hard surface
sudden increase in physical activity
poor posture
poor walking habits
Any active person can get quadriceps tendinitis. But the risk is higher in athletes, especially if you:
run on hard surfaces
play jumping sports, like volleyball and basketball
exercise without warming up
exercise without enough recovery time
repeatedly squat or kneel
Other factors that increase your risk include:
Age. As you get older, the tendons become less flexible and more prone to inflammation.
Weight. Excess body weight puts extra stress on the tendons.
Tight muscles. Tight hamstrings and quad muscles increase pressure on your tendons.
Chronic disease. Some diseases, like lupus and diabetes, reduce blood supply to the knee. This weakens the tendons and increases the risk of tendinitis.
Alignment problems. If your joints or bones aren’t properly aligned, one leg will be placed under more stress. Muscular imbalances can have a similar effect.
Activity-Related Anterior Knee Pain: pain at the bottom of the thigh, just above the kneecap that gets worse with activity
Localised Tenderness: discomfort when you press on the top edge of the kneecap
Knee Swelling: around the tendon and kneecap
Knee Stiffness: particularly when you first get up in the morning or after sitting down for a while
Weakness: in and around the knee, decreased power during “push-off” phase of running/jumping
Symptoms of quadriceps tendinopathy can be classified into 5 stages:
Stage 0: No pain
Stage 1: Pain only after intense sports activities. No functional impairment
Stage 2: Moderate pain during sporting activities. No restriction on performance
Stage 3: Pain during sporting activities with slight restriction on performance
Stage 4: Pain with severe restriction of sports performance
Stage 5: Pain during daily activities. Unable to participate in sports activities
Generally, common symptoms of quadriceps tendon pain include:
Quad pain above kneecap that is worse during and after activity.
Often, there is no swelling, locking, or giving away of the knee.
It is often tender to touch the quadriceps tendon.
Your doctor will perform a clinical examination to rule out other causes of pain above kneecap or at the front of the knee, such as kneecap arthritis, fat pad impingement, torn meniscus, pes bursitis, housemaid’s knee, and patellar tendonitis.
Often, we use imaging to diagnose quad tendonitis and rule out other causes. Usually, ultrasound and MRI scans can see changes in swelling and collagen breakdown of the tendon. Generally, ultrasound has advantages over MRI scans, including seeing calcification more clearly and at a lower cost.