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Tendinopathy grading
According to classifications of Blazina et al.
Grade 1:
-Pain after activity such as running, sports or squatting
(all done with satisfactory form)
Grade 2:
-Pain at the beginning of an activity
-Pain goes away once you warm up
-Comes back after the activity
Grade 3:
-Pain that remains throughout and after an activity
-You’re almost unable to participate in sport.
Grad 4:
-Your quad is basically completely torn
-You can't extend your knee (AKA you f’ed up)
The quadricep or the quad for short is made up of 4 muscles or heads. Vastus medialis obliques (VMO), Vastus intermedius (VI), Vastus lateralis (VL) and the rectus femoris. They all join into one tendon forming the quadricep tendon. This tendon then hugs the knee cap aka patella and from there forms the patella tendon that attaches to the tibial tuberosity. The quad does extension of the knee and flexion of the hip. The Vastus intermedius in specific elevates the patella during terminal knee extension.
The quad tendon is basically the tendon that connects your quadricep muscles to your kneecap or patella.
Quad tendinopathy is defined as a disorganisation of collagen protein fibres in your tendon.
Tendinopathy happens when a tendon is shocked by an unexpected increase in load, and is unable to adapt in time. Either you had a long break from your training and went straight back to your normal intensity, or you progressed too quickly and prematurely increased your training intensity. Scenario 1, an olympic weightlifter who took a 2 week break and went straight back to snatching 200kg on his first session, boom quad tendinopathy.
Scenario 2, a rock climber who took a 2 month break because of lock down and went straight back to climbing 6 days a week, boom tendinopathy.
Personally, when I had quad tendinopathy. I had pain here when standing up after sitting for more than 10 minutes.
Kneeling down for even just 20 seconds and getting up
also, when I had quad tendinopathy, there would be pain in the first few reps of a squat session or activity, then pain would go away after warming up, but pain would then be worse after the squat session or activity.
How do we test for quad tendinopathy?
3 Pain provocation tests, a pain provocation test means, if it hurts it's a positive test.
No.1 Palpation, so pressing the tendon to see if it hurts.
2. A single leg decline squat
And 3 a Resisted knee extension. Test it in full range, 3 repetitions, it should reproduce pain slightly above the knee cap.
We can also use an ultrasound scan or a doppler.
Criteria for what grade of tendinopathy you're in. is in the description below.
Treatment
Before you start your rehab, do the single leg decline squat to establish baseline, rate your pain out of 10. Mine was 5/10 at baseline.
Now
Phase 1 of our 4 phase rehab.
Isometric exercises.
Exercise 1: inner range quads, place a rolled up towel under your knee, and press down while lifting your heel. Aim to hold it for 45 seconds, repeat for 5 repetitions and do every single day. Your effort level should be about 7/10, once this becomes too easy, you can progress to exercise 2: an isometric wall squat. Go against a wall, sit at about a 80 to 90 degrees angle, for the same 45 seconds 5 reps everyday and should feel like 7 out of 10 effort.
Phase 1 should last at least 1 week. Retest with the single leg decline squat, if pain is about a 3/10 after a week then you can progress to phase 2, if not then continue then retest.
Phase 2
In phase 2, you will start exercise 3: lunges. For lunges, start with 4 sets of 15 repetitions with 10 to 60 degrees of knee flexion. To progress, either add weights and increase knee angle to full extension and 90degrees knee flexion. Or start exercise 4: bulgarian split squats. Do the same progressions as lunges. In phase 2 you will do phase 1 exercises every first day and phase 2 exercises every second day. Repeat for about a week, again test it with the single leg decline squat, if it is less painful after week 2 then progress to phase 3, if not then continue phase 2.
Phase 3
In phase 3 you will do phase 1 and phase 2 exercises every first and second day, then phase 3 exercise every third day. Phase 3 exercise is exercise 5: reverse nordic curls. Kneel on a pillow, keeping your hips and upper body straight, lean backwards, your quads slowly letting you down. Start with just a 30degree hold, then progress to lowering down to 45 or lower if you are a brave soul.
After a week or so, retest with the single leg decline squat, if better than before then progress to phase 4.
Exercise 6 box jumps. and other running and dynamic drills if you are an athlete.