Quadriceps Tendonitis: Signs You Have It and How to Treat It

If you’ve ever experienced pain in your upper knee area after running a hilly route or playing an intense game of basketball, there’s a good chance you’ve been acquainted with quadriceps tendonitis (tendinitis). “Tendinitis itself is a common overuse injury that happens when you ramp up activity too quickly or put more pressure on a joint than it’s used to,” says Vanessa Matos, PT, DPT, a physical therapist at Hinge Health.

Quadriceps tendinitis can crop up in anyone who’s active, especially during a sport that involves a lot of running, pivoting, or jumping — all moves that rely heavily on your quadriceps muscles. Beyond sports, it can also happen if you go from being sedentary to active too quickly. The good news: Most of the time, quadriceps tendinitis can be treated conservatively at home with activity modifications and simple strengthening and stretching exercises, reassures Dr. Matos. 

Read on to learn more about quadriceps tendinitis: what it is, what causes it, and how to treat it with exercises from our Hinge Health physical therapists.

What Is Quadriceps Tendinitis?

Quadriceps tendinitis is caused by an irritation or overuse of your quadriceps tendon, which attaches the quad muscle in the front of your thigh to the top of your kneecap and helps your knee to extend or straighten, explains Dr. Matos. 

Quadriceps tendinitis is often confused with patellar tendinitis, but the two aren’t the same. “Your patellar tendon attaches the bottom of your kneecap to the top of your shinbone, or tibia,” says Dr. Matos. “If you develop symptoms above the knee, it’s usually quadriceps tendinitis, and if it’s right below your knee, we usually suspect patellar tendinitis.” 

There is one important thing that both your quadriceps tendon and patellar tendon have in common: They work together to allow you to bend and straighten your knee so that you can stay active with both daily activities and exercise.

Quadriceps Tendinitis Symptoms

The classic symptom of quadriceps tendinitis is knee pain above your kneecap, right where your quad tendon is located, says Dr. Matos. Other quadriceps tendinitis symptoms include:

• Pain that worsens when you bend your knee, or when you do activities such as running, jumping, or squatting.

• Tenderness when you touch right above your kneecap.

• Swelling above the knee.

• Stiffness that makes it hard to straighten your knee.

If you have mild quadriceps tendinitis, you may only notice symptoms when you do intense activity. But if it progresses, you may begin to experience pain with any sort of activity, including walking and going up stairs.

Quadriceps Tendinitis Causes

Quadriceps tendinitis usually occurs when you push your quads more than what they’re ready for. There are a few situations in which that can happen:

• Certain sports. Any activity that involves a lot of sprinting, jumping, or kicking can lead to quadriceps tendinitis if your body isn’t prepared for these types of activities. “We see quadriceps tendinitis a lot in soccer players, as well as people who play basketball or volleyball, because they all require you to use your quads to jump up,” explains Dr. Matos. Quadriceps tendinitis can also develop if you do a lot of downhill running. “Your quadriceps muscles help you decelerate and provide stability as you run downhill, but it places greater stress on your tendons,” says Dr. Matos. 

• Normal, age-related changes. As you get older, changes occur in the collagen that makes up your tendons. This may decrease their strength and make them stiffer, two things that raise the risk of tendinitis. Muscle strength also decreases as you age, which can put more stress on tendons, points out Dr. Matos.

• Muscle imbalances. If one leg has weaker or tighter muscles than the other, it can lead to quadriceps tendinitis. “You need your leg muscles to work in coordination to have ideal knee mechanics,” says Dr. Matos. “Otherwise, it can put more stress on your quad tendon.”

Quadriceps Tendinitis Treatment

If you develop quadriceps tendinitis, you’ll want to focus on what’s known as the PEACE & LOVE approach to healing. This is a two-part care model that was introduced in 2019 in the British Journal of Sports Medicine. “Unlike the RICE (rest, ice, compression, and elevation) method, which used to be recommended, this new approach focuses on movement after an injury, rather than complete rest, to help promote healing,” explains Dr. Matos.

You should start the PEACE part of the method as soon as you are injured, for the first 48-72 hours. Here’s how to follow this for quadriceps tendinitis treatment:

• Protect the injured quad by scaling back on activity that causes an increase in pain. Don’t avoid movement entirely — light movement will increase blood flow to your sore quads, says Dr. Matos.

• Elevate your quad above your heart when resting to reduce pain and swelling.

• Adjust anti-inflammatories, like ibuprofen. It’s best to limit their use, as high doses can impact tissue healing. But if you’re in a lot of pain or your symptoms are limiting your function and movement, talk to your doctor about whether it’s safe for you to use them. Another option is an over-the-counter topical NSAID gel like diclofenac (Voltaren), which may also help to reduce inflammation.

• Compress your quad with an elastic bandage or sleeve to reduce swelling.

• Educate yourself on the benefits of movement and exercise therapy. “You want to listen to your body, so that you can safely work on active recovery,” explains Dr. Matos. “This will help you heal faster.”

After about 72 hours, you’ll be ready to move on to the LOVE method. This means:

• Load your quad tendon by gradually returning to regular activities using pain as a guide. “Some discomfort during exercise is okay, but you shouldn’t push through unacceptable levels of pain for you,” advises Dr. Matos.

• Optimism. This means that you believe that your quad tendon can heal, and you’ll be able to return to physical activity. Research shows your thoughts play a big role in helping you get stronger. If you have confidence in yourself, it’s likely that you’ll have a faster recovery, reassures Dr. Matos.

• Vascularization. You want to do as much as you can to increase blood flow to the injured area, says Dr. Matos. This includes cardio activities such as walking, biking, or swimming, as well as stretching and strengthening exercises for your quad tendon (see below). Research shows that the latter actually has an immediate effect on pain reduction.

• Exercise. It’s important to take an active approach to recovery. “You want to strengthen and stretch your quad muscle and tendon to prevent tendinitis from reoccurring,” explains Dr. Matos. Use pain as a guide to progress through workouts.

You may benefit from physical therapy during your recovery process, adds Dr. Matos. A PT can work with you to formulate an exercise plan, including targeted stretches for quadriceps tendinitis. They can also check your feet. “If you have flat feet, or overpronate, it can affect your knee position and, as a result, put added strain on your quad tendon,” explains Dr. Matos. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

The above quadriceps tendinitis exercises are recommended by Hinge Health physical therapists to help with symptoms. While most of these moves focus on the quad, stretching and strengthening the muscles in all parts of your legs, hips, and core can help ease quadriceps tendinitis pain by making all the structures that support the quads and knees stronger.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Don’t Forget the Warm Up

It’s always important to warm up before a workout, advises Dr. Matos. “And it’s a key part of quadriceps tendinitis prevention, because it increases blood flow to your quad muscles and improves their flexibility,” she points out. “It also activates communication between your brain and body, for better, more coordinated movement.” Dr. Matos recommends that you follow the above exercises, and use them as a warm-up routine.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Kwan, K. Y. C., Ng, K. W. K., Rao, Y., Zhu, C., Qi, S., Tuan, R. S., Ker, D. F. E., & Wang, D. M. (2023). Effect of Aging on Tendon Biology, Biomechanics and Implications for Treatment Approaches. International Journal of Molecular Sciences, 24(20), 15183. doi:10.3390/ijms242015183

2. Dubois, B., & Esculier, J.-F. (2019). Soft-tissue Injuries Simply Need PEACE and LOVE. British Journal of Sports Medicine, 54(2), bjsports-2019-101253. doi:10.1136/bjsports-2019-101253

3. Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., Straker, L., Maher, C. G., & O’Sullivan, P. P. B. (2019). What Does Best Practice Care for Musculoskeletal Pain Look like? Eleven Consistent Recommendations from high-quality Clinical Practice guidelines: Systematic Review. British Journal of Sports Medicine, 54(2), bjsports-2018-099878. doi:10.1136/bjsports-2018-099878

4. Briet, J. P., Houwert, Roderick. M., Hageman, M. G. J. S., Hietbrink, F., Ring, D. C., & Verleisdonk, E. J. J. M. (2016). Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury, 47(11), 2565–2569. doi:10.1016/j.injury.2016.09.016

5. Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277–1283. doi:10.1136/bjsports-2014-094386

6. Von Fange, T. J. (2019). Quadriceps muscle and tendon injuries. UpToDate. https://www.uptodate.com/contents/quadriceps-muscle-and-tendon-injuries