complete quad rupture and how to get back on track ...

I debated with myself whether to share this expericence or not and then I said what the hell, if it helps someone then I share this ...

January 06, 2015, family walk on a lazy winter afternoon. Everything is frozen and some places are icy. Out of the blue, I slipped on ice, left leg folded under me and I fell with full weight on my knee.

Then I crawled to the nearest bench and my wife called ambulance.

I thought I only dislocated my knee but the exams in the hospital showed I had torn completely the quadriceps muscle (all heads) off the patella.

Under the knife I went immediately, woke up after several hours with a cast from my balls to my heel.

But all this is not interesting. The comeback is interesting and the experience I would like to share.

Four months after the surgery I went to the doctor and to say he was shocked with the progress would be an undestatement. When I had the surgery he told me I would get back on track in 6-12 months, would not do any sport anymore and would have problems for the rest of my life. The doc never did any sports himself.

As of now, I walk normally, ride a bike, started doing light leg presses of 20 reps with 120k (260 lbs) and do deadlifts with 140k (315 lbs) for easy sets of 5. Every week I am stronger. The ROM is back to about 90-95%, and the quad returned to about 80% of its original size and is growing every week.

These are things that helped and they might help you as well with similar injury and comeback:


Believe
All doctors who do no sports will tell you you are done. They also tell you that you will rehab for many months. Take their advice very seriously because they know their shit but remember their typical patient is usually an overweight person with zero sport experience. You are different: muscles are highly trained, you've got lots of veins in your muscles and you have way faster recover abilities than the average coach potato. You must obsessively believe that you are a super healer and that you will recover 100%. It can be done. Soccer players tear off muscles and they go back to playing. But you must believe and you must be very serious with your rehab.

Rehab in hospital
Start immediately after the surgery. There was a very good doc who told me to start moving the newly re-attached muscle only several hours after the surgery. What can you do when on pain pills with the whole leg in a cast? Muscle contractions. You have to remember the brain shuts off all injured muscles after the rupture to prevent any further damage. They atrophy very fast. Your quad disappears in a matter of days. I did sets of 500 contractions. Slow and controlled. In total I did 5000-10000 contractions a day. The good news is once the cast comes off, the muscle returns very quickly. The muscle contractions pump blood in the injured area, help building of the scar tissue, keep the muscle fibers firing. It is boring as hell but well worth it. You should also do tons of circling movements with your ankle.

Nutrition
This is very easy and simple. Clean out your diet immediately. Drop out all shit. Tons of protein, collagen, vitamin C for healing, fish oil. Mostly collagen. Tons of it.

Sport rehab guy
Here I was very lucky. The rehab center where I went 4 weeks after the surgery (when the cast went off) had some rehab guy of whom one was a former active soccer player. He had me doing lots of mobility movements, as soon as I could I did some static quad holds, lots of movements with a large Swiss ball, manual hamstring curls and tons of other stuff. Later when I regained most of my ROM and some quad strength he kicked my ass with lots of proprioceptic drills, stability exercises, quad strenthening static holds, quarter squats. It is important that your rehab guy works on 3 things at the same time: quad strenthening, regaining active and passive ROM, knee stability in different motions and stances.

Soft tissue work
I cried on this one. I had two guys working on me. One did mild massage of the scars, of the repaired region above my knee. His goal was to keep the scar tissue soft and elastic. He still does my knee area today and I will keep him for 2 more months. Remember that your knee will be swollen like mutherfucker which is normal. There are fluids above patella, on both sides of patella, under the patella and on top of it. Four months after the surgery I still have some very small swelling there. The knee can be swollen for 4-6 months after the surgery which is completely normal so do not sweat it. On the other hand you want the swelling go away ASAP because it obstructs the patella in free movement. Once the swelling is fully gone, you will then achieve a full 100% contraction and full ROM. The other guy was massaging my injured quad. Man, did I cry. He literally dug his elbows into my quad, IT band, hips and glutes. He said I had tons of tight spots inside the muscles after years of lifting. But I felt so relaxed and great every time after the massage that I knew it must be working.

Ice
Ice the knee and the injured area a lot. As said before, the sooner the swelling goes away, the better. Be patient. Ice several times a day if you can. If you work somewhere where you cannot, ice in the morning and in the evening. For good 20-30 minutes. I still ice today, 4 months after surgery.

Pussy movements
Leg partial knee extensions, sliding heels ham curls, hip extensions, band leg curls, hip cirles. All these are your friends. As soon as the cast went off, although I was very weak, immobile and stiff, I started working the leg from as many angles as I could imagine. Blood must flow, you must regain your mibility (you will be stiff as fuck after 4 weeks in a cast) and you must start strengthening the muscles again.

Bike
When I regained about 60-70 degress in my knee I could pedal through the whole ROM on a stationary bike. Once you can do that, watch your rehab speed up big time. Now I do 20-30 min session multiple times a week with different intensities. It builds the strength back and pumps the muscles and knee with lots of blood.

All surrounding muscles
When I was given the green light from the doc to start gym rehab I was happy as hell but there is not much you can do. Squats are out of the question yet so in the beginning I did partial light leg presses, machine adductors, machine abductors, hip extensions, light Romanian deadlifts, leg curls. Lots of volume. Weight is not important. Regain ROM, work the muscles and pump blood. 4 sets of 20 per exercise or whatever. Increase weights as possible. After only 2 weeks in the gym my walking gait went back to normal because all the surrounding muscles got so much stronger. Now 4 months after the surgery I do leg presses with sets of 20, 30, 50, deadlifts, Romanian deadlifts, very light box squats, BW only squats and super heavy and high volume hamstring work and calf work. I promised myself that I will build some huge quads, huge hams and huge calves, to stabilize the knee as much as possible. In about 2 months I plan to return to back squats and front squats as I believe they are the best rehab and strengthening exercises you can do for legs. Important: forget leg extensions. They are unnatural, dangerous and put torque on your knees. Closed-chain leg exercises are best for both rehab and strength. All upper body heavy lifting done as soon as I could walk without crutches and wore the leg brace only.

Proprioceptic drills
Boring as shit but it has to be done. Remember, if you gain ROM very fast and regain strentgh very fast, the joint has to keep up as well and the re-attached tendons must be up to par. That's where all the boring stabilization drills become helful. Standing on uneven surfaces, mild jumps, side shallow lunges, all kind of athletic foot work, changing directions while mild running, walking backwards, etc., etc., Just google it and there is tons of good info there.

Patience
Last but the most important. Listen to your doc but make your own judgement; follow the rehab guys to the letter and never ship the rehab. Never. Do not rush it. Do more and faster if your leg allows but do not rush it and don't risk anything by pushing more. Don't be stupid. Completely torn quad takes 6-12 months to be fully recovered. The muscle must get strong back to 100% before you crawl under a heavy bar, the ROM must be 100% and most importantly the tendons and scars must be fully recovered, healed, and strengthened back to 100%. If you re-tear it again, you are fucked. I keep telling this to myself when my brain is telling "put some more plates on the leg press". Be patient. Really. Complete quad tear is a major injury.


But I will be back to heavy squats and deadlifts. But not before the leg is back 100%.

I will share more progress as time goes. Keep you posted.

In the meantime, stay injury-free ;-)