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Dr. Andrew Rynne

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What causes knee pain after exercising for a while?

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Dr. Karl Logan

Orthopaedic Surgeon

Practicing since :1999

Answered : 705 Questions

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Posted on Sat, 9 Aug 2014 in Back Pain
Question: I have been running a lot in the last month or so and have cut down on a lot of weight but now my knee hurts right above my kneecap when standing back up from squatting down or sometimes when I just straighten it. Played sports my whole life and never had any major knee injures before. Never been overweight. It doesn't hurt most of the time unless under those circumstances but when it does it is a 9 on the pain level. What could this possibly be?
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Answered by Dr. Karl Logan 1 hour later
Brief Answer:
Quadriceps tendonitis

Detailed Answer:
hi,

thanks for your question.

your symptoms are consistent with an insertional tendonitis of the quadriceps tendon.

Quadriceps tendonitis is a condition characterized by tissue damage and inflammation to the quadriceps tendon.

This occurs at the quadriceps' attachment to the top of the knee cap causing pain in the front of the knee just above the knee cap.

The quadriceps muscle originates from the pelvis and thigh bone (femur) and inserts into the top of the knee cap (patella) which in turn attaches to the top of the tibia (shin bone) via the patella tendon.

The quadriceps is responsible for straightening the knee during activity and controlling the bend of the knee during weight bearing activity. It is particularly active during sprinting, jumping, hopping, squatting or kicking activities. During contraction of the quadriceps, tension is placed through the quadriceps tendon. When this tension is excessive due to too much repetition or high force, damage to the quadriceps tendon may occur.

Quadriceps tendonitis is a condition whereby there is damage to the quadriceps tendon with subsequent degeneration and inflammation.

Although this condition can occur at any age, it is more common in the older athlete.

Quadriceps tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the quadriceps tendon. This typically occurs due to repetitive running, jumping, hopping, squatting or kicking activities. It is also particularly common in sports requiring frequent acceleration and deceleration or repetitive jumping (such as basketball or netball).

Occasionally, patients may develop this condition suddenly due to a high force going through the quadricep tendon beyond what it can withstand. This may occur during rapid acceleration whilst running, when landing from a height or due to a direct blow to the quadriceps tendon.

Patients with quadriceps tendonitis typically experience pain that develops gradually at the front of the knee just above the knee cap. In less severe cases, patients may only experience an ache or stiffness in the knee that increases with rest following activities requiring strong or repetitive contraction of the quadriceps muscle. These activities typically include running, jumping, hopping, squatting or kicking. The pain associated with this condition may also warm up (or feel better) with activity in the initial stages of the condition.

As the condition progresses, patients may experience symptoms that increase during activity and affect performance. Occasionally, local swelling and a feeling of knee weakness may also be present particularly when attempting to accelerate whilst running or attempting to perform a squat. Other symptoms may include pain on firmly touching the quadriceps tendon (figure 1) and in some cases pain or a limp may be present when walking (particularly up hills or on uneven surfaces). Pain or stiffness may also be experienced upon stretching the quadriceps (i.e. taking your heel to your backside in standing).

Investigations such as an Ultrasound, X-ray, MRI or CT scan may be required to assist with diagnosis and assess the severity of the condition.

Most cases of quadriceps tendonitis settle with appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Activities which place large amounts of stress on the quadriceps tendon should also be minimized, these include: running (especially up or down hills, or, on uneven surfaces), jumping, hopping, squatting and kicking. Rest from aggravating activities allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.

Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Immediate, appropriate treatment in all patients is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.

Patients with quadriceps tendonitis should follow the R.I.C.E. Regime in the initial phase of injury. The R.I.C.E regime is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain, night pain or pain with rest). The R.I.C.E. regime involves resting from aggravating activities, regular icing, the use of a compression bandage and keeping the affected leg elevated. Anti-inflammatory medication may also hasten the healing process by reducing the pain and swelling associated with inflammation.

Manual "hands-on" therapy from the physiotherapist such as massage, trigger point releases, joint mobilisation, dry needling, stretches and electrotherapy can also assist with hastening healing and improving flexibility and function in patients with quadriceps tendonitis.

Patients with this condition should perform pain free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome.

Typically, the rehabilitation program will focus on stretches for the quadriceps muscles and strengthening exercises for the quadriceps, gluteals and core stabilisers.

In the final stages of rehabilitation, a graduated return to running program is required to recondition the quadriceps tendon to running in a safe and effective manner. This should include the implementation of progressive acceleration and deceleration running drills before returning to sport and should be guided by the pain.

With appropriate management and physiotherapy treatment, most minor cases of quadriceps tendonitis usually recover and return to normal function in a number of weeks. In more severe and / or chronic cases, recovery can be a lengthy process and may take many months in those who have had their condition for a long period of time.

I hope his answers your question.

best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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