17 Effective Quad Tendon Rehab Exercises After Quadriceps Repair

Quad tendon injuries can be debilitating, especially after quadriceps repair surgery. The best rehab program will focus on facilitating quadriceps activation, improving the strength of the quadriceps muscles, improving range of motion and overall function so that you can return to your favorite activities. This article will guide you through the 17 most effective quad tendon rehab exercises to speed up your healing process.

All of these physical therapy exercises are designed by a physical therapist, me!

What Are The Best Exercises After Quad Tendon Repair?

Physical therapy exercises after quad tendon repair are categorized into 5 phases:

• Phase I (0-2 weeks)
  1. Quad Sets
  2. Ankle Pumps
• Phase II (2-6 weeks)
  3. Sidelying Hip Abduction
  4. Sidelying Hip Adduction
  5. Prone Hip Extension
  6. Heel Slides
• Phase III (6-12 weeks)
  7. Straight Leg Raise
  8. Wall Slides
  9. Mini Bodyweight Squats
  10. Stationary Bike
  11. Short Arc Quads
  12. Terminal Knee Extension
• Phase IV
  13. Leg Press
  14. Split Squat
  15. Hamstring Curls
  16. Step Down
  17. Leg Extension
• Phase V
  • Return to sport activities

The following exercises should be performed in physical therapy and supervised by a physical therapist. This is a guide to a general quad tendon repair surgery. As always it is important to listen to your surgeon and follow any specific precautions given by your surgeon. 

There are other more conservative treatment options, however, this article is focusing on post surgical treatment. Your physical therapist will most likely perform manual therapy which includes working on the soft tissue around your knee, mobilizations, and PROM to improve range of motion of the knee joint. This post is focused on quad tendon rehab exercises.

(0-2 weeks) Phase 1

The goal of phase I is to achieve full knee extension and decrease swelling. The exercises included in phase I are quad sets and ankle pumps, however stretches such as a hamstring or calf stretch can also be performed during this phase.

1. Quad Sets

• The goal of this exercise is to increase quad activation and to achieve full extension.
• Start by lying down with a rolled up towel underneath your ankle.
• Now squeeze your quad muscle and try to push the back of your knee into the surface below you.
• You should feel the front of the knee contracting when performing this exercise.

2. Ankle Pumps

• This exercise is good for blood flow and decreasing the risk of developing a DVT after surgery
• This exercise is best performed with your feet elevated with a pillow underneath your ankles. Now pump your ankles up and down.

(2-6 Weeks) Phase II

This phase will primarily focus on open kinetic chain exercises which are exercises in which you are not weight bearing on your affected leg. These exercises include 3. Sidelying Hip Abduction 4. Sidelying Hip Adduction 5. Prone Hip Extension 6. Heel Slides.

3. Sidelying Hip Abduction

• Lie on your side with your legs stacked on top of each other.
• This exercise is best performed when the bottom leg is bent and the top leg is straight.
• Now lift your top leg up.
• This exercise strengthens your hip and glute muscles.

4. Sidelying Hip Adduction

• The hip adductors or inner thigh muscles are a commonly forgotten muscle when it comes to rehab.
• To perform this exercise lie on your side with your affected leg on the bottom and straight. Now bend your top leg over your bottom leg.
• Lift your bottom leg 1-2 inches off the ground and then return to starting position.
• For sidelying hip abduction, extension and adduction you can add a resistance band around the ankles as you get stronger.

5. Prone Hip Extension

• Start by lying on your stomach with both of your legs straight.
• Now lift up your affected leg.
• You should feel your butt muscles working with this exercise. If you are feeling pain in your back then you are lifting your leg up too high.

6. Heel Slides

• This is a great exercise to improve knee mobility.
• At this point in your rehab your surgeon has most likely given you a precaution of knee flexion to 90 degrees.
• This means that you should not bend your knee further than 90 degrees.
• However you aim to bend your knee close to 90 degrees in order to prevent knee stiffness.
• Once your precautions are lifted which will most likely be at the 6 week mark you can progress to full ROM.
• To perform this exercise you will need a strap.
• If you do not have a strap you can also use a sheet or towel.
• Place the strap around your foot and slowly bend your knee while also using your arms to pull your knee closer to you.

(6- 12 weeks) Phase III

The goal of phase III is to initiate progressive quadriceps loading/resistance exercises. These include 7. Straight Leg Raise 8. Wall Slides 9. Mini Bodyweight Squats 10. Stationary Bike 11. Short Arc Quads 12. Terminal Knee Extension.

7. Straight Leg Raise

• This is an excellent quad strengthening exercise.
• To perform this exercise start with your good leg bent and your other leg straight. For example if the good leg is the right leg then the left leg will be straight.
• Now tighten your quad muscle and lift your leg up.
• You should feel the  front of the thigh working.
• Raise your leg to the height of your other leg and then bring it down.

8. Wall Slides

• This is a great exercise to perform as a replacement for a squat because it places less stress on your quad tendon and is easier than a regular squat.
• Start with your back on the wall and your feet 1 foot away from the wall.
• Now slowly slide yourself down the wall and then push back up to starting position.
• When you are first starting this exercise do not slide down too far.
• You can start at 45-60 degrees and progress from there.
• Be sure to maintain equal weight bearing when performing this exercise.
• If you feel yourself shifting away from your affected leg try to shift back.
• You can also perform this exercise with a physioball behind your back for added difficulty.

9. Mini BodyWeight Squats

• Start by holding onto a sturdy surface such as a kitchen counter.
• Now perform a mini squat, making sure to bear weight evenly on both legs.
• If you are feeling stable on your feet and want a challenge you can perform this with trx straps.

10. Stationary Bike

• This is a great exercise to improve knee mobility.
• Start with the seat height high and no resistance.
• If you do not have enough knee range of motion you can perform half circles frontward and backward instead of performing the full cycle.

11. Short Arc Quads

• This is a great exercise for quad activation.
• To perform this exercise place a foam roller underneath the knee.
• Now kick your leg up and hold it in the air while squeezing your quad.
• This exercise allows you to work in 0-30 degrees of knee extension.
• If you are looking for other variations of a short arc quad exercise you can find them at How To do Short Vs Long Arc Quad Exercise With Variations.

12. Terminal Knee Extension

• Terminal knee extension activates the quad while also working in the end range knee extension.
• To perform this wrap a resistance band around the back of your knee and a sturdy surface.
• Start with your affected knee bent and slowly squeeze your quad and push the back of your knee into the band.
• Hold this position for 5 seconds and then return to starting position.

(16-20 weeks) Phase IV

13. Leg Press

• You will need a leg press machine for this exercise.
• Start with your legs hip-width apart on the platform.
• Push until both your legs are straight but not “locked out” and then slowly and controlled bend your legs until you are back in the starting position.
• Be sure to push evenly with both legs.

14. Split Squat

• Start with one foot on a bench or couch behind you and one foot is in front of you.
• Now squat straight down and bend both of your knees towards the ground.
• Now push back up to starting position.
• Your front knee shoulder not come forward over your toes.

15. Hamstring Curls

• You can perform this exercise either lying down on your stomach or standing.
• Bend your knee by bringing your foot towards your butt.
• If this is too easy you can add an ankle weight.

16. Step Down

• Eccentric exercises are great after any quad injury.
• You can perform this exercise on a step.
• I prefer to use steps that you can buy and stack on top of each other because it allows you to start at a lower height and slowly progress to a higher height.
• Start by holding onto a sturdy surface if you need it for balance and stand on your surgery leg.
• Now slowly lower yourself down leading with your good leg.
• Do not allow your knee to cave in while stepping down.

17. Leg Extension

• You will need a leg extension machine for this exercise.
• The key with this exercise is to start with a low weight and slowly progress from there.
• Make sure that you are pushing evenly with both legs.

(20-24 weeks) Phase V

Phase V is the exciting stage because if your recovery is going well you can begin running and agility exercises at this point. You can also begin to return to some sports activities.

Physical therapy at this point will be sports specific. For example, if you are returning to basketball your rehab will focus on pivoting and quick change of direction agility exercises.

Anatomy of Quad Tendon

The quad muscles are the muscles at the front of your thigh. The muscles of the quads are comprised of four muscles, the rectus femurs, vastus intermedius, vastus lateralis, and vastus medialis.

The quad tendon attaches the quad muscles to the patella or knee cap. The patella is also held in place by the patella tendon which attaches the patella to the tibia or lower leg bone. When a quad tendon tears it causes knee instability due to the patella no longer being anchored in place. 

Other Knee Pathologies

• Quadriceps Tendonitis 
• Quadriceps Tendinopathy
• Patellar Tendonitis
• Jumper’s Knee
• Quadriceps Tendon Tears
  • Partial Tears
  • Complete Tears

Causes of Quad Tendon Tear

• Use of corticosteroids
• Weakness in knee joint
• Chronic conditions
  • Hyperparathyroidism
  • Gout
  • Leukemia
  • Rheumatoid Arthritis
  • Systemic Lupus Erythematosus (SLE)
  • Diabetes Mellitus

Symptoms of Quad Tendon Tear

• Knee pain
• Tenderness to the front of the knee
• Bruising
• “Sagging” of the kneecap
• Difficulty walking

How Long Does it Take To Rehab a Quad Tendon Tear?

Every patient will recover at their own pace, however, typically most people will be back to walking normally without the use of a brace or crutches within 6-12 weeks. However, most people will not be able to return to full sports activities until 6-8 months. These quad tendon rehab exercises can help to speed up the recovery process.

Summary of Quad Tendon Rehab Exercises

Although a quad tendon repair is a long recovery requiring significant activity modification, it is worth it in the end when you can return to all of the activities you love. These 17 quad tendon rehab exercises will help you to improve knee stability, knee mobility, knee strength and overall function.