Quadriceps Tendinopathy

 

 

Sometimes it’s nice to be able to see things in a different perspective, and in hindsight that’s what I appreciate the most about being on the other side!

As a physio – I’m often the one telling people to be patient, do their rehab, modify training/other activities to get back to injury free training and life!

Recently I’ve dealt with a bout of quadriceps tendinopathy, and for anyone who’s had a tendinopathy – this can be crippling and go on for what feels like forever (and I was lucky that it didn’t actually last that long!).

Towards the end of last year, my training was going great! I’d hit a double body weight backsquat, I was consistently hitting numbers close to my max on the snatch, clean, and jerk!
Even with all of this – I wanted more. Maybe that’s something we all deal with, impatiently wanting more!

So I took up sprinting as well. I wanted to develop more explosive power to help with my lifts. I was only doing this 1xweek (and it was enough! All the 10 year old kids were beating me by so much it was very humbling being there).

I was doing well in training, in fact in a comp (I didn’t deload for – so I’m positive I could’ve hit numbers bigger than this too!) I PR’d my snatch by 5 kgs! (Not my C&J but we hadn’t really pushed this anyway).

I was so excited about my progress, but very impatient about the process of getting better.

Then one day I started to notice a little aching above my knee-cap. I put this down to DOMs (or delayed onset muscle soreness). I was so distracted by wanting to get even better, that I didn’t really pay close attention to this.
Then I noticed that I wasn’t able to keep hitting the same numbers I was (it was like my legs were also in a constant state of fatigue). Actually in hindsight it was my power that reduced first – I wasn’t able to power clean/snatch close to my usual numbers, the strength loss I noticed later.

Not taking too much notice of this I kept going.

After a couple of weeks (I can’t actually even tell since I didn’t pay too much attention prior to this) this led to an ache that was there a lot of the time, and every time I did a simple air squat it felt like crippling knee pain.

I couldn’t get off the couch without that sharp stabs through my knees, and then pain that hung around for hours, which was only aggravated again if I did something simple like squat down to pick something up off the floor!

I had to stop training, stop sprinting and even modify tasks like getting off the couch!

After finally admitting to myself that things weren’t right I realised I’d let myself develop a tendinopathy and had let it go on for a while; knowing the recovery time made me feel super depressed (can be from a couple of months up to years if you don’t modify load and manage it well!)
Perhaps someone who didn’t have the background knowledge that I do could’ve been a little more optimistic at the start, but I knew what a tendinopathy was, and I’ve treated people with one – some with very bad cases!

Rehab works – for real!

Then began my process of rehab, the first thing I started with was modifying my sleeping position.
Because I slept with my knees bend up (quadriceps tendon on stretch – meaning more compressive forces through it for ~ 8 hours/day), I had to change this. I conciously put pillows between my thigh and shin when I went to sleep, still waking up if I kicked the pillows away and the pain woke me up.

I had to start at the basics – I would do isometric quad exercises 3-4x day (I now realise what a pain this is when someone asks this of you – so I set up reminders on my phone so that I didn’t forget it, and even if I ignored them the reminder stayed on the screen everytime I looked at my phone). If anyone has trouble remembering to do these because they “don’t have time,” this is a great way to remind you – and remember, you only don’t have time for the things you don’t prioritize.

Eventually I progressed to isometric squat holds (I’d find any excuse when I was around people to walk away and do this – since I didn’t want to look like a wierdo).

Finally I felt like I had kind of got hold of my pain (this was maybe 3 weeks down the track!)

Not training was killing me!

In fact, my original plan was to get my numbers up more, then start dropping weight for the Australian Open to compete in a lower weightclass.
I was about 53.5kgs at the start of this, my intentention was to drop to 48kg, and if I maintained the numbers I was hitting – I was close to hitting the qualifier numbers for the commonwealth games. So you can imagine that this injury messed up my plans a lot!)

 I was able to bring back some sort of training, once the constant ache was gone, I started to address my quadriceps tendon.

I started squatting!

This was very exciting, and I started doing weighted incline, and normal squats and started at about a 12rep range and the plan was to work my way heavier towards a 4-6RM.
If you’ve read up much about tendon adaptation (read my post about tendons here) you’ll know that tendon’s are not like muscles, and I promise I’ll go into depth in another post a little more about tendon adaptation and what you need to do for recovery – but the gist of it is that and they need SLOW, HEAVY load for adaptation.
I couldn’t even get to full depth squats (started to bring on too much pain)

This mean I wasn’t able to do any snatching, cleaning or jerking! I tried (shouldn’t have) powers but i should’ve known better and this flared me up for a couple of days when I did.

Eventually with persistence, and it probably took 3 months for get get better control of my tendinopathy, I was able to get back to training – just before Aus open (luckily!) Unfortunately my numbers just weren’t there for what I would’ve like to hit! Failure is always a bummer – but atleast I can say I’ve learned something from this experience!

Not only have I not been able to hit heavy lifts but I’ve dropped a lot of weight off my strength lifts as well (this also has a lot to do with me keeping my body weight low – and unfortunatly I have to accept).

I will be going into Australian Nationals as a 48kg lifter again, and my strength remains low. Although I’m able to snatch, squat and clean and jerk without any pain! – those number are slowly on the rise again, and I’m sure once I let my body gain weight I’ll be back on track!

 

EDIT :

Since I didn’t post this before Nationals – I’ll give you an update on how I went at Nationals. I came 4th with a 53kg snatch and 67kg clean and jerk (my best numbers are 61kg/74kg) in the U48kg category. I didn’t do as well as I wanted, and the weight-cut definitely took it out of me – spending hours in the sauna and limiting food and drink intake doesn’t help with performance apparently – who knew?

 

So what have I learned from this?

A couple of things, firstly injury is frustrating AF! And although it’s crucial to stay patient and follow the rehab plan, trust the process blah blah blah (all this crap really does work! ) it can be very hard to stay focused, and disheartening as well!

Secondly, I did not realise what a big impact keeping my body weight down had on my strength, and I’m unsure if all the dieting while doing my rehab prolonged the process, was I not allowing my body to recover as well as it could’ve?

And last and definitly the most important – I need to remember to listen to my body!
Not to just ignore niggles – to listen to them, and modify load if it continues. As physio’s we are probably the worst at taking care of out bodies!