How I Rehabbed My Quad Contusion in 1 Week

How I Rehabbed My Quad Contusion in 1 Week

Recently I sustained an impact injury to my right thigh. I thought it might be worthwhile to write down what the injury recovery process looked like for me so it might help others who either treat this injury, or deal with this injury themselves, in the future.

I was at a beach Ultimate Frisbee tournament and earlier on in the tournament I either caught a knee, or landed on my right quad (vastus lateralis) at some point earlier in the day because I started to feel a little bit of pain when walking after about our 2nd or 3rd game of the day. This did not bother me and it was not going to affect my ability to play at all. 

In the 4th game of the day, I dove to try and catch a disc thrown by my teammate (:16 in video below) and landed directly on the spot that was previously bothering me. This time however, there was a very high level of pain and I immediately called for an injury.  I took about 15 seconds to get my legs back under me and hobbled to the sidelines with a little help from my friends. 

At this point I wanted to assess the damage and see if I may be able to play the next day. I quickly realized that was very unlikely.  Upon palpation, gentle pressure was very painful, I was unable to actively extend my knee from a seated position beyond about 75 degrees of knee flexion, and I could not perform a straight leg raise. Most of the limitation was due to pain, but even when I tried to push through the pain to see if my muscle could actually do the work, it could not. It was like I lost quadriceps function almost completely.

For the remainder of the day, I ambulated with a very stiff knee to avoid any sort of load through my quadriceps. I would sporadically try to have a little bit of a weight acceptance phase of gait where I let my knee flex a little bit to try and put a little bit of load through my quads, but would be met with an immediate buckle or a lot of pain. 

About 3-4 hours after the injury, I went back to the house where I was staying (a long and slow 0.5 mile walk) where I was able to sit and work on bending my knee a little bit. This was very painful at first, but by the end of just a couple of minutes I was able to get my knee flexed to about 120 degrees. After this, I proceeded to do a couple of sets of 10-15 sit to stands. These looked very ugly, and most of the work was being done by my left leg and any work that was being done by my right was almost completely posterior chain at first, but by the end I felt like I was able to do the tiniest bit of work with my right. This made me a little more optimistic about the timeline of my recovery, though at this point I knew that playing the next day was out of the question.

It's important to note that this tournament is as much a party as it is an Ultimate Tournament, so at this point it was time to start consuming some adult beverages. My beach drink of choice is a "white lightning" which is vodka, water, and a bunch of lemons (credit goes to Richie McClatchy for the name).  After this it was time to venture out to the boardwalk to play some arcade games (yes, I'm almost 30 and this is what I wanted to do with my night).  This involved a lot of walking and since I did not really have much quad function at this point and my knee would buckle and have a lot of pain when I would try to walk normally, I reverted to a stiff leg gait. This worked ok, but was definitely difficult, and by the end of the night I was feeling some medial knee pain, maybe from a little bit of extra valgus straining my MCL a bit, or maybe just from the more extended position of my knee during ambulation caused that spot to be angry. Either way, I knew that this was not a pain that would last, but I knew that I wanted to try and walk as normally as possible as soon as possible, and that I should do my best to take it easy walking around the next day.

When I went to bed that first night, I tried to sleep with my knee in a little more of a flexed position than I normally do; and the few times in the middle of the night that I woke up I tried to re-flex my knee so that it would hopefully not be as stiff in the morning. 

Upon waking in the morning, my quad remained very sore and my gait pattern was still the same stiff leg walk that I had utilized the night before. I got ready, did a few sit to stands and took it easy as the rest of the people staying in the house did the lions share of the cleaning and I pretty much just packed up the food. 

We unfortunately had another 0.5 mile walk to where our games were to be played that day and I had to carry my belongings for the day. By the time we got to our field, my medial joint line was definitely feeling it, but it could have been worse. Sitting and getting up from my low beach chair was definitely a challenge, but once my knee was bent it felt easier to use my quad in deeper ranges of knee flexion. Outside of the one time that I almost fell getting up from my chair, I would say that my quad felt a little better than it did on the day of the injury. I was on the beach for about 6-7 hours and spend most of it sitting watching games with some shorter walks sprinkled in to say hi to people or to go get food. At the end of my time on the beach I felt that I was able to walk with a little bit more knee excursion as my quad was able to handle a little bit more load than it was earlier in the day. My girlfriend and I walked to get food, then walked the half mile or so back to the car before our drive home. 

My injury was on my right side, and I had difficulty and a lot of pain when attempting to lift my leg like I would need to when switching from the gas to the brake and vice versa, so I my girlfriend volunteered to drive home to save me the pain. It was a good thing that she did because there was one instance driving through town after we picked up her dog that a young college student pulled out in front of us without looking and we were forced to slam on the brakes. I was very lucky to not be driving in that situation because if I were, it would have been very painful.

The rest of the night went fairly well with the leg remaining pretty stiff. I did one or two more sets of 10 or so sit to stands, worked on bending it as far as I could a few times throughout the evening, and tried to use it when ascending stairs, though that did not go very well and I resorted to putting 2 feet on each step going up with my left.  When coming down, the easiest way was sideways going down with my right first and holding onto the wall for balance.

The next morning (Monday) was more of the same, but by the end of the night I was able to ascend stairs reciprocally with a little bit of compensation, but I thought of this as a pretty significant win.  I also had a little bit less difficulty getting my knee to it's maximum available flexion.  I had fortunately taken Monday off of work and I was very grateful that I did because it gave me more time to rest and I think my joint line would have been pretty mad at me if I needed to stand all day with a locked out knee.

Tuesday was my first day back to work and other than not really being able to demonstrate exercises the way that I normally would, the day went pretty well overall.  I sat whenever I could including for most of my documentation and when patients were doing exercises unless they needed close supervision and worked on keeping my knee flexed which seemed to make it easier to use my quad when I would stand and walk.  Later that night I tried to walk down stairs leading with my left to see what my right quad could handle and it was not yet able to handle that level of force without a lot of pain and completely buckling. Overall, I'd say it felt better enough to call it another day with significant improvement.

The improvement trend continued over the next few days, and by Wednesday morning I was able to descend stairs reciprocally, though there was definitely a bit of a buckle, and by Wednesday night the buckle was minimal and that evening I decided to give the gym a try.  I normally bike to the gym, and I wanted to see how my quad would fare on a bike, so I grabbed my bike, shifted my gear one lower than normal and bike the 2/3 of a mile to my gym.  My warm up was 5 minutes on the elliptical and 3 minutes walking backward on a slight incline on the treadmill; I rolled out my non-quad musculature (smashing a foam roller into a contusion is not a good idea) did a few squats, some bridges and some single leg RDLs. I wanted to keep some heavy load through my body, so I decided to try some stiff leg dead lifts and see how they went as they would not put much load through my quads.  I did 6 total sets: 3 warm up sets leading to 3 working sets of 3 reps at 225#. This is a little less than I would normally do for a workout like this, but all things considered I was very pleased.  I then used the hip adduction and abduction machine which barely missed putting pressure on my contused area which was nice.  I did some seated hamstring curls since lying prone would put too much pressure on my quadriceps and I super setted this with some knee extensions.  The knee extensions I knew would be difficult, but I was curious what my force output would look and feel like.  I started with some very light double leg knee extensions and my quad had pain but no more than when getting out of a chair so I added a bit more weight and tried to do a little more with my right. It continued to feel ok, so then I decided to see how big my force output difference was compared to my left side. I have some knee issues on my left and last I checked, my left was about 10% less than my right peak force output.  I was able to do a 90# single leg knee extension on my right with about a 5/10 pain and a 130# knee extension on my left, also painful, but more in my patellofemoral joint where I have some nagging issues. Again, I saw this as a win. I then stretched a bit then biked home.  My quad was definitely a little bit sore that night, but nothing too concerning as long as it felt back to normal the next day which it did.

Thursday at work I tried a few step and holds, which is a mini step or hop onto one leg working on low level shock absorption and balance.  This felt decent, and I felt I was able to squat to chair height, tap my butt and return to standing with hardly any compensation. Walking also felt a lot better, so that night I decided to give jogging a try. I was able to bike to the gym at my normal gear and my warm up was again: 5 minutes on the elliptical, rolling out my non-quad musculature, a few squats, some bridges and some single leg RDLs, and this time I tried to work in a few split squats which were painful, but I was able to do them with some buckle at the end. The buckle with the split squats was worse with my right leg trailing so I just put some more weight on my left leg and continued on with as much weight on my right leg as it would tolerate. I then made my way over to the treadmill.  My normal running pace on longer runs (> 4 miles) is 7.5 mph, or 8 minute mile pace, so I decided to try my hand at a 0.1 mile walk/0.1 mile jog interval with my walk at 2.5 mph and my jog at 6.0 mph.  The first few steps of my jog felt ok, but shortly after it felt like my quad was cramping.  For those that have suffered muscle cramps, it felt like when your muscle is not quite in full cramp, but that stage when every step gives you that tiny mini cramp that you know if you use that muscle any more it will lock up on you and go into full spasm.  I did not think that my muscle was going to cramp, but that is the closest way to describe what I felt. I ended up making it through 3 total intervals for a total of 0.3 miles of jogging at 6.0 mph and by the end of the 3rd one I started to feel it a little more than when I started so I decided to shut it down for the day. I then did a little bit of core work, stretched, and went home.

Thursday night was when I needed to decide if I was going to play in my Ultimate Frisbee tournament that weekend.  Even though jogging did not go super great, my quad felt so much better each day that I was fairly optimistic that as long as the recovery continued to trend the way that it was, I would likely to be able to play in some form or fashion, even if I wasn't 100%.

Friday I took it pretty easy and just worked on doing my day to day things without compensation. Going up and down stairs and walking symmetrically even if there was a bit of pain and getting in and out of a chair using my right leg as much as I could. At work I worked on a little bit of side to side shuffles and skiers to test my lateral movement which went pretty well other than a little bit of pain and some definite weakness, but again, significantly better than the day before.  Friday night we drove 4.5 hours from Philadelphia to Schnectady, New York, checked into our hotel and went to bed.

Saturday morning, I woke up, again feeling significant improvement compared to the previous day. My quad at this point remained tender to the touch, but strength was definitely returning and if I had to put a number on how I felt I would say about 80-85%.  I put on my padded compression shorts which I had bought earlier in the week so my quad would be better protected from more impact, ate some breakfast and left for the fields. I did some jogging, squats, shuffles, high knees, butt kickers, A and B skips, striders and some throwing which I knew would get me lunging in all different directions and all of that felt pretty good.  A little bit of pain with faster running and deeper lunges, but overall I felt confident that I would be willing to play.  Fortunately, we were favored to win the tournament so most of our games on Saturday were games where 85% was good enough for me to get onto the field, cover someone a little slower than what I would normally cover on the other team, and use the first few points to feel out how my quad felt at game speed.  I felt a little bit of that same "cramping" type feeling during the first 5 or so points that I played but I seemed to forget about it after that.  Again, a little bit lower competition so I was able to take my effort level down just a bit.  The only time I felt it later in the day was when I had to full sprint to make sure the person I was covering did not catch the frisbee and when I sprinted at 100% I again got that "cramping" feeling. This was during our last game of the day and there were only a few points left, so at that point I shut it down for the day.

Sunday morning we had one pool play game left, then re-seeding for semi-finals and finals.  Our first game was easy and I was able to not test my leg much, but it honestly felt pretty well overall.  My body and legs in general were sore, but my quad felt just about the same as the other side. In the semi-finals was the first time during the tournament that I laid out.  I was fortunate that the disc was not very high off the ground the the impact was not nearly as severe as it might be on a higher dive; and even though the guy I was covering caught it, I was happy that the impact did not cause pain (I like to think that the padded compression shorts I had on helped to keep this pain free).  The weekend continued and we went on to win the tournament which came with $700 in prize money given to us in $1 bills shoved into a paper bag.  At this point, I was able to give 100% effort with minimal to no pain and I considered my quad all but healed.  I took Monday off from the gym to let my body recover and then continued about my life as normal, getting back into my normal weight lifting and ultimate training without compensation.

When it was all said and done, my recovery took almost exactly 1 week, and while I do not have perfect data on if my force output returned to it's pre-injury levels, but I really don't care because I am back to doing what I want to do pain free. I will continue to get to the gym and do weight lifting training 1-2x/wk including single leg work which will fix any minimal remaining deficits that may be present, and I will continue to wear padded compression shorts when playing to decrease my risk of re-injuring the area.

Take aways from how I rehabbed:

• Keep it moving but don't be stupid about it.
• Work into flexion which was very limited but felt better after it was there. 
• Sit to stands which I can compensate my way through but work the quad just a tiny bit and get into deeper ranges of flexion
• Don't be afraid to poke into the pain just a bit.
• I was on a short time frame so if I was going to play in 1 week from the initial injury I needed to make sure my quad could handle the demands of sport, so each day I made sure I was working my quad at the highest level that it could tolerate. The approximate progression of how things went was....
• Sit to stand --> ascending stairs --> descending stairs --> light stuff at the gym + heavy stuff at the gym for all other musculature --> jogging --> rest day --> tournament.
• Understanding how to prevent further injury.
• I ordered padded compression shorts to help decrease risk of worsening my impact injury.
• Make sure the rest of my body was ready to handle sport.
• Got to the gym to get a heavy leg day in to keep my body resilient. Heavy for glutes, hamstrings, calves, add/abductors, and left quad.
• Work the right quad light in isolation to keep it firing and do a bunch of one rep knee extensions increasing the weight seeing where it's limit is. (keep pain < 4/10).
• Tested out jogging a couple of days before so the first time I ran wasn't tournament day.
• Crampy feeling was not my favorite but I'm glad I exposed my quad a little bit to running before Saturday when I had to run, sprint, cut, jump, hop, and pivot.

Not sure if this will help anyone, but I figured it might be nice for people to read through how I as a physical therapist handled my most recent injury with no fancy equipment or hundreds of dollars in medical bills.