I was on a nice steady squat progression, did an easy 325 lb squat (a 5 lb PR) and on to my second rep when my quad tendon tore away from the patella. For fun, I broke my ankle on the way down. I’m having surgery on the knee, tendon and ankle in a few days, and am just curious about the general time-frame for recovery. I’m going to be 6-8 weeks with an immobilized leg (except for whatever they do in PT). I’m wondering about returning to lifting and whether you all have general guidelines for returning, and the long term issues of the injury. I am 65, lifting seriously for about 15 years, decently strong. I plan to lift again, so just curious about the big recovery picture.
Hey man, I am genuinely sorry to hear this. Some of these progressions are going to be determined by your surgeon post operatively with the procedure. There are still plenty of things that you can work on early in the process. We tend to design some more upper body heavy programs that don’t use any leg drive. You can also take advantage of some machine based exercises on your non-surgical leg. Now, for the surgery it is pretty typical to use and immobilizer and crutches for 6-10 weeks. A lot of loading progressions depend on your range of motion so I would really work on making sure you are getting full extension and working on flexion within the constraints of your protocol. You are going to have a quad deficit that persists for a while after surgery. We can normally “start” doing things like squatting and deadlifting around 8-10 weeks but this isn’t as much the barbell variety as much as working on technique. You’ll see that you develop a shift towards your non-surgical side but this goes away with work. Once you can start loading your surgical leg, it is a good time to really emphasize some quad work almost with a bodybuilding type approach. We tend to hammer things like knee extensions, split squats, hack squats-basically all the things powerlifters aren’t huge fans of. But you will get back to squatting. If there is anything we can do to help let me know.
Welcome to the Stiff Tendon Club!
First, you have to understand why this happened…and why similar things will happen again if you don’t make the appropriate adjustments. As we age, our tendons tend to become less elastic (primarily because our collagen composition changes). Where this really affects us in terms of exercise is that things that rapidly stretch tendons - eccentric movements performed in a ballistic manner (the catch phase of a squat clean( - tend to do more tearing than stretching. At first, these are micro tears. Because we don’t heal as rapidly (this is especially true for tendons that have relatively poor blood flow), we set ourselves up for chronic overuse injury patterns and tendonopathy (degenerative ttendonosis instead of inflammatory tendonitis). This is usually heralded by a chronic nagging ache that we tend to shrug off until one day we push things a little too hard or we land on the limb awkwardly or unexpectedly and the diseased tendon ruptures. PRO TIP: Don’t repeat this as it’s really difficult to repair a repeat rupture and even harder to rehab it.
Number Two: You’re probably 9-10 weeks post op now and still in the immobilizer, but with increasing permissible knee flexion. Still sucks, but beats the straight leg torture and those f–ing metal rods digging into your foot and ankle. (PRO TIP [NODE=“2”]Forums[/NODE] - you could have asked the medical professionals to adjust it). Depending on your surgeon, you may or may not already be doing range of motion and/or strengthening exercises. Do NOT neglect or downplay Range of Motion or assume that range of motion will take care of itself if you do the strength exercises. In terms of strength, play plenty of attention to terminal knee extension. Two exercises I found very helpful were a reverse step up: https://youtu.be/jAbO12BipQU
and https://youtu.be/F2-Rc1TFUm0
This video goes over progressions: https://youtu.be/nfJ5QCx_fSg
Number Three: This process will take longer than you think, but consistency is the key. You may not regain your previous range of motion or strength - don’t turn a good result into a disaster trying to make things “perfect”. As your range of motion comes back and you are squatting deeper and deeper, if you feel your patella (knee cap) grinding or popping or sliding on the bone beneath it, STOP and ask your orthopedic surgeon about it. You absolutely do not want to wear down the cartilage that cannot be replaced and end up with a new problem. You can get strong, but you may need to do so by using different exercises.
Good luck.
Yeah, there are some things here that I do not think are the best explanations. While there are tendon changes as we age, the data is typically compared to the “average” person which is not representative of someone hitting physical activity or training regularly. It’s also just not a good way of thinking about the issue. Same with the clicking/popping during rehab as that is a very normal occurrence and if you use that as a litmus it will almost guarantee you to slant too conservative. I’m not overly surprised by the heterogeneity in treatments but I would definitely say 9 is on the high end of what I would have heard for number of PT’s 8 weeks out.
I would agree with the range of motion and TKE comments. At this phase it is much more about volume than intensity and you are better off doing morre “easy” reps than trying to force anything. The work now sums to later. You can also be working your other leg and upper body. There is something to be said for generally staying in shape through the process and there are numerous ways of working around this until you can begin specific strengthening.