Quadriceps Tendinitis

| August 15, 2011

What is it?

Quadriceps Tendinitis can be described as the inflammation of the quadriceps tendon.  It is essentially a microfracture of
some of the fibers of the quadriceps tendon or the muscle attachment to the tendon itself.

Similarly, there may be a minor avulsion (tear) of some of the quadriceps tendon from the top of the knee cap.  The inflammation that is common,  is due to this trauma itself and usually occurs in jumping sports like basketball, volleyball or netball.  Kicking, found in rugby or football/soccer, and sometimes in acute flexion injuries to the knee.

When It Is Most Likely To Hurt

Most of the time, pain will be felt at the front of the knee especially after sport.  Along the top of the knee cap will be tender, and it will be painful to contract your quads and hold this contraction (isometric contraction).  Stretching may also be painful , and changes to the area may be seen on Ultrasound or MRI, however are not possible to be seen via an X-Ray.


Early Management

A lot of this will depend on the severity of the injury.  I know a lot of people who like to ‘self-diagnose’ their injuries.  The internet is a great thing, however it is always best to get it checked out by a qualified professional.

Every once in a while you might even guess correct, but if you get it wrong you can end up wasting your time, as well as causing additional distress for no apparent reason.

Once a diagnosis is made, a treatment strategy can be devised and you can take it from there.

If it is money you are trying to save by not going to the physio or osteopath, then there is ways to do things smart AND cheap.  Especially nowadays.  Physios, Osteos and PT’s understand that there isn’t as much money floating about.

Other things take priority and that’s just a fact.

But you can work with the professional on this, and explain it and they can devise a programme that best suits your needs around you time-table, and your bank account.

Pull Back On the Reigns (at least for a while at least)

As with any injury, you must modify your activity levels accordingly.  This will depend on how bad the injury is, but if you are training hard for an event, or in pre-season for your sport, then a period of relatively lighter exercise, preparation and rest might be required.

Slowing down and allowing the body time to heal properly is essential. Image from Google

Pain is actually a pretty cool thing.  In a weird kind of way.  It indicates that something isn’t right and is asking you to stop.

Pay attention to what your body is telling you and take it easy for a while.  Let it do its job and recover.  After it heals you’ll be back out training, playing and competing in no time.

Keep on irritating it and you risk further injury to the area and more time out on the sidelines.


Generally for injuries such as this, the muscles that surround the knee joint need to be paid particular attention.

These muscles would include:

  • The quads
  • The hamstrings
  • The calves.

Also looking at the hip flexor group (iliopsoas) would be a good idea too.  If the hip flexors are tight, they pull the hip into flexion and this could cause the big quad muscle Rectus Femoris to become overactive and tight.

SMR and Stretching

SMR techniques combined with static stretching is highly advised for this type of injury.  This will relieve some of the tension found in the knees surrounding musculature.  Particular attention such be made to the hip flexor and quadriceps group.

The quads can be one of the most painful areas to foam roll and it is very easy to cheat.  I have clients who always roll a few centimeters away from the adhession (knot) because it is less painful.

Foam rolling is an effective way to relieve the stress on the fascia, and musculotendinous structures of the body. Image of a Glute Med release. Provided by Google

As soon as i gently roll them back to where they should be you can see how much more tender that area is.

Their face will tell you everything about how much it hurts, although other areas of the body that work are the toes and fingers. They’ll either clench, or open fully, or both.  It is also quite common that the odd bad word comes out of them too.  Sometimes its not directed at anyone or anything in particular, but sometimes it is directed straight at me!  I don’t mind and I’m well used to it.

I can guarantee that if you do this properly it will hurt to a degree.  All I know is the amount of times I’ve had people contact me to let me know they’re feeling brilliant afterwards is too many to remember, and that by far outweighs the negatives.

I would often give my clients a follow up call if we’ve had a hard session on the roller, which is a good habit to get into if you are a therapist; just to find out how they’re feeling.  It shows you care.  Which I do.

Is the pain or discomfort worse? better? nothing changed?  Depending on which one it is, you can make further advice and make a plan for the person to come back and see you in the future.


I would wait until the symptoms  of the tendinitis are relieved before beginning a strengthening programme.  Any additional load placed on the musculotendinous junction will only increase the chances of more stress, pain and injury.

It would be very useful to maintain as much of a ROM as possible, but limiting the stress through the area is just as important.  Some exercises which can be completed in water are very useful.

Hydrotherapy can be useful for maintaining ROM, and strengthening the body. Image taken from Google

Especially in warm water like in hydrotherapy.

While studying my post-grad, I used to have to get up at 4:45am, walk to the tram, and then get a train to the hydrotherapy pool where I would arrive at 8 spot on time.  It was early, and cold outside and nobody wanted to be anywhere but back in their beds snuggled up.

But all of us turned into giddy school children the minute we hit that warm water.  Its really is that nice!

You can gain the analgesic effects of the warm water, and gain an advantage via the buoyancy of the water which makes your body almost weightless.

Just think about how much easier it is on all of your bones, joints, ligaments, tendons and muscles when you don’t have the force of real life pushing down on you.

I really enjoyed my hydrotherapy module and I even use it from time to time still.  It is hard when you don’t have the space or the right pool to provide the same effects.  Some of the results we used to get were brilliant, and I wouldn’t be surprised if some of that could be attributed to the lovely feeling of the warm water, and not just the exercise.

Correction of Muscle Imbalances

This goes back to the point of balancing out the See-Saw.  It is so important that we maintain this balance throughout the body.

In the case of Quadriceps Tendinitis, it is quite common that there is tightness in the tendons of the hamstring group.  This causes the quadriceps to weaken in their inner range, which will ultimately overload the quadriceps tendon.  The inner range can be described as the beginning of a typical Leg Extension exercise.

It’s In Your Hands to be Pro-Active

Some of your rehab won’t require the skills of a physiotherapist, or a masseuse.  You have a lot of control over this stage of your rehab.  Self-applied transverse friction massage which will help to break down adhesions in muscle or cross-linkages in connective tissue.

Some anatomy knowledge or investigation would be helpful for this stage.  In order to apply these techniques to yourself, it is best you understand which way the muscle fibres are running in the first place.

Performing cross-frictions can help breakdown adhesions in the body, such as the quadriceps group; relieving tension and reducing symptoms. Image from Google

Transverse friction means to ‘go across’ the muscle.  In the case of the quads, they run down your leg, but can change angle which allows them to perform different movements. (See the diagram at the top of the page)

Knowing which way they run, will allow you to perform the Self-Friction massage in the opposite direction; therefore, getting the most of your time and effort.

If the osteopath etc  indicates there are areas of focal thickening in the quadriceps muscle, that’s where they earn their money.  Soft tissue techniques such as transverse glides of the patella, and myofascial release in the form of a longitudinal stretch could be applied to break the structures down and help form a realignment.

I’ll try to get some good pictures or videos soon of such techniques as the ones I found on the internet weren’t very specific to Quadriceps Tendinitis.  


Like many forms of injuries, Quadriceps Tendinitis  may benifit from the use of a brace or some form of support.  This could be particularly true as the exercise starts to increase in frequency, or intensity.

Postural Assessment/ Abnormal Biomechanics

Diagram shows the difference between good and bad posture. Good posture is ideal to eliminate imbalances and dysfunction which lead to pain. Image from Google

Posture and Biomechanics would be 2 of the most important aspect of movement for me.  I constantly try to help my clients maintain a decent level of both.

Sometimes this can be challenging.

It’s a Sunday morning, and I’m not long home from seeing Margaret.  A client I’ve been seeing for about 3 years now.  After we have our weekly ‘who got up the earliest contest’ we have we get stuck into the hard stuff.

This week she was up at 5am while I was up at 5:30am.  I’ll have to do better next time.  Not!

I often joke with her that if I had 10 pence for everytime I had to remind her to keep her head in the proper position I would be a very wealthy man and I wouldn’t have to come in on Sundays as I would be at my villa in the Tuscan Hills enjoying the sunshine!

Oh to dream!

But seriously, this is so important.  A proper analysis of posture can reveal important dysfunctions such as pronation of the subtalar joint, or poor training techniques (Like Margaret’s floppy

Posture analysis from head to toe is important in assessing pain and dysfunction. Pronation at the foot can lead to problems in the achillies, knees or even the hip. Image from Google

head!).  But like most things, this will require knowledge and experience.  If you are a PT, both will allow you to make the right calls on the advice you give to your clients.

Inflammatory Medication and Injections

NSAID’s might be useful in the initial stages to help calm down the inflammation.  An injection of local anesthetic may also be useful in the acute stage, however steroids should be avoided as they affect the collagen in the quadriceps tendon, making it weaker and increasing the possibility of tendon rupture.

Paying attention to all of these factors and being smart with your rehabilitation will ensure you get back to normality and training as quickly as possible.

Do this and you can’t fail!

Keep Your Knees Pain Free



Category: Ask the Knee Injury Experts, Knee Injury Scholarly Articles (PT/Fitness/Physio), Patella Tendinitis and Quadriceps Tendinitis

Comments (4)

Trackback URL | Comments RSS Feed

  1. mohamed essam says:

    can you pls list the needed advices

    just like what stretches you advice and what strengthening and so on

    i also had tight iliopsoas tight hamstring and patellar tendonitis pain that is not related to activity ?

    what do you advice me ?

    • Craig says:


      Thanks for the email.

      The best advice you could get would be to have a professional look at your body and see exactly what needs done.

      That being said, it is likely that you are experiencing tightness in your quadriceps and/or hip flexor muscles. There are standing and kneeling versions of both, so ideally whatever one suits you best and you find comfortable would be advised.

      You mentioned your ITB being tight as well. this is virtually impossible to stretch as it is a tight thick cord like band of fascia. Instead, massage and SMR (Self Myofascial Release) through foam rolling has been proved very useful.

      We will try to get some videos and pictures on the website asap, but until then you can find most of the stretches, exercises, and foam rolling online at youtube or any other self posting site.

      I hope that this helps you in someway.

      Please let me know how you get on, or if you need any further assistance

      Many thanks


    • Craig says:

      Hi Mohamed

      Firstly, as I do in all cases, is to advise you go and see a professional about your problems. Diagnosing over the internet is a tricky game.

      From what you have mentioned, it appears you need to be doing more static stretching for the areas you identify as being tight. There are many stretches for a tight hip flexor muscle, and the hamstrings too. Loosening off the structures around the knee should ease the pressure on the knee cap and could hopefully reduce the painful symptoms you are experiencing.

      I always recommend foam rolling (Self Myofascial Release) to help in reducing muscle/fascia tension. Investigate this further and see if you could benefit from it. It will more than likely be painful at the start but you can have some really good results from it so try it and stick with it!

      I hope that this is somewhat helpful?

      Let me know



  2. Tom says:

    What if the problem with tendonitis is chronic? I was diagnosed with patellar and quad tendonitis by doctors over and over again, but they mostly told me to rest and take ibuprofin. Apparently these injuries didn’t heal correctly, possibly because scar tissue built up over the years from injuries, I’m so accident prone I get reinjured easily when I become active again from cycling, hiking, etc. When I reinjure my tendons, I don’t get inflamation. I have tight hamstrings because of a back condition called lumbar spondyliolthesis, and I can never touch my toes (it hurts my hamstrings to do a forward bend). So I have lots of knee problems that never can seem to be fixed. Now I just swim laps as my only form of exercise.