Saturday, January 31, 2015

PART II: What is a Disrupted Quadriceps Tendon

Way back in the old days, I was a sprinter, something you certainly would not guess from the present day body that I drag around. I was fast... fastest in the state the year of my graduation. I was offered various full ride track scholarships, but opted to attend the University Of Kansas which had offered me only a small stipend, having spent all the scholarship money on lightning quick, out of state runners. But, it's where my friends were going -- particularly the guys in my high school band.

The point of this aside relative to the topic of this blog is that I injured by right quad so many times that I had to drop out of track entirely. I'm no newbie to Quadriceps Injuries in general. However, I entered college in 1966 when we wrote with pens and paper, added and subtracted by "thinking" (or more accurately, by counting on fingers and toes) We avoided long division entirely, when possible. There was NO internet -- all research was done by thumbing through the library's card index, then scouring the cavernous building's shelves until you discovered that the sought after book was checked out. With any luck, you might get the information you needed in a few weeks.

So, I knew what my quads were -- and in particular, that they were the most important muscle to speed. A good sprinter's legs work like pistons. You plant one foot, then raise the alternate foot in a straight a motion as possible to near the buttocks. Then you swing the knee/foot/calf/upper legs as a unit forward and quickly extend the foot and plant it on the track, which the process repeats with the other foot. This process of tucking, swinging and planting is the key to every good sprinter's motions. Here's a YouTube video that shows at about 0:48 seconds in slow motion the process I'm describing.

That quadriceps fueled kick is, in a large part what shaves those 1/100's of a second off a sprinter's time that today divides the winner from the "also-rans". I was fortunate to be tutored in the science of sprinting by a pioneer in the field, Cliff Abel, who later became head track and field coach at Cal State Northridge -- they fondly refer to him as "legendary men's track & field head coach". At the time, immature ingrate that I was, had no appreciation of his coaching talent. I'm glad he's been appropriately recognized by those more discerning that I was at that age.

But back to ruptured quadriceps tendons.

I never ruptured a tendon during my running career. My injuries at the time were confined to "pulled muscles", or tears in the muscle fiber -- serious enough, but not, on their own, totally debilitating. This was all in a time before the now well known pulled muscle treatment acronym -- RICE: rest, ice, compression, elevation. In fact, I don't recall any treatment at all beyond rest and limping for a few weeks.

Also, I was complicit in that I didn't like excessive warm up, despite Coach Abel's admonitions. To make matters worse, our early season track meets were in the Spring, when temperatures in the region were often in the 40s, 50s or 60s, at best. (By the end of the season, you could iron pants n the sidewalk, but in March you wouldn't take off those pants to iron them!) Also, my muscles are a little too short for my bones, I guess... the muscles always seemed to be stretched a little tightly.

I'm certain that although I didn't suffer actual ruptured tendons, the fact that I DID have repeated torn quads also suggests that there was a trap being laid.

Quadriceps Tendon damage is often referred to a "runner's knee", "jumper's knee", etc. Those who are most prone to this injury are runners, volleyball players, basketball players... anything that subjects a bended knee to repeated abuse. When these athletes mature (that is get older... some never mature), their knees are most prone to tendon damage.

I've now learned a lot about the knee, and associated ligaments, tendons, cartilage and its general engineering. Had I studied this earlier, I might have done a few things that might have prevented this.

Heading up the list -- LOSE WEIGHT. When you use the quadriceps muscles to, say, climb stairs, you place the entire weight of your upper body (about 80% of your total body weight) on the quadriceps tendons. Here's a diagram of the apparatus:

So, in order lift your self one stair step, you contract your Quadriceps Muscle, which pulls on the Quadriceps Tendon, which is draped over the Patella (Knee Cap), and pulls up on the Patellar Tendon, which is, in turn, connected to the Tibia (or Shin Bone)... sort of like the action of a backhoe loader where the hydraulic cylinders are replaced by tough little pieces of tissue called Tendons.

Probably as the result of a combination of my age, my "runners knee", fatigue, and poor warm up -- racquetball is famously hard on knees, too. This is article explains the nature of the injury much better than I can -- plus there's some good, grizzly, CSI type photos of an open incision with tendons and all: Quadriceps Tendon Rupture

Another good read is Michael LaBossiere's "Quadriceps Tendon Rupture" blog... full of information, entertaining and well written.

Next up...

PART III: Getting Treatment -- How I Did It vs. How it Should Be Done

Sunday, January 25, 2015

PART I: Disrupting the Quadriceps Tendon -- DON'T DO IT - E V E R

How it Happened

I suppose that if you're going to "disrupt" (i.e., rip like a cheap piece of packing tape) your quadriceps tendon, as I did, you might as well pick a really beautiful setting to do it... as I did.

Aunt Dana with Ruby and Rylee
My wife, Dana, and I took a little Christmas trip to SoCal for the holiday... a multitude of in-laws: sisters, brothers, parents, aunts, uncles, nieces, nephews, dogs, family friends... gazillions of people to visit... parties and feasts. The wads of colorful wrapping paper, which having delivered their mysterious payloads, now litter the living room in clumps, like used shell casings on a battlefield... AND,, most importantly, EXTREMELY cute. lovable kids everywhere.

Uncle Jim with Finley

Our friend, Rosie Flores (best living country/rockabilly singer on the planet, and a rockin' geetarist, to boot) was going to be playing a gig at Belly Up in Solana Beach during our stay. Dana and I made arrangements to get the entire "of-age" gang down there for the show -- roughly 16 of us. Knowing I'd be in the vicinity, Rosie asked me if I'd bring a guitar and join her for the set. Given how I feel about Rosie personally and professionally, I said YES!!!

So fast forward past all the Christmas frivolities -- every family with grandparents, parents, kids, nieces, nephews, friends, hangers-on, etc, knows the drill. Sound levels to rival a battle of the bands between "Blue Cheer", "Nine Inch Nails" and, (why this is in a battle of the bands, I don't know, but humor me) a DC-10 revved up for take off. It was Dec. 26, Belly Up Concert Day.

The quick 4 p.m. sound check left us with a couple of hours to kill prior to downbeat. One of Rosie's friends had graciously offered her rustic, sea side house as a place to nap, get dressed, and generally relax.

NOTE: All events which which follow are due COMPLETELY  to my carelessness, stupidity, crappy depth perception... you name it. Sometimes it would be nice to have someone to blame... in this case NADA... le coupable, c'est moi.

Leading from the house to the car parked in the drive was a simple, three step flight of stairs. I had gone UP them, earlier -- no problem. But somehow -- it was dusk, the step were gray, my night vision is not so good -- going down, I wasn't sure if I saw THREE steps or TWO. Whatever my selection, it was WRONG. My foot came down at a strange angle, my right knee buckled and I collapsed... accompanied by excruciating pain and a loud "T-W-I-N-G" from somewhere just above my knee -- sounded very much like a "D" string breaking. Although I wish that it hadn't happened at all, here's three things that I'm glad for:
  • This step was not step 1 of a 20 step marble, spiral staircase, leading to a landing of jagged rocks, or into a trash compactor;
  • The staircase was in Sunny California, not, say, miserably cold Buffalo, NY... and was in the US where my Medicare is honored; 
  • I was surrounded by a bunch of really nice people who helped me get up and get going, rather than a gaggle of YouTubers, just looking for something that might go viral.

So... you know the old adage -- THE SHOW MUST GO ON!

Rosie grabbed the keys to the bizarre FIAT rental... hard to grasp even after driving for a week. We sped to the venue, pulled around in back of the Belly Up and someone helped me get into the green room.

Dana, who had come down with family, managed to get past the crowd, and Nena Anderson (who among her many musical endeavors, plays "June Carter" of "Cashed Out", the Johnny Cash tribute anchor band) helped me get to ice on my wounded knee. I discovered that by locking my right leg, I could mount the stage stairs at Belly Up and Rosie delivered a rockin' set.

Part II of this blog will be informational -- just what is a disrupted quadriceps tendon? Part III will cover my "day after" trip to the Oso Urgent Care Clinic (possibly the WORST medical facility in existence, if you consider the fundamental criteria as the ability to diagnosis and appropriately treat medical issues. Later installments will cover rehab. Some of this writing, I hope is entertaining; other parts are to offer support and information to other unfortunates who have suffered a quadriceps tendon injury.

I encourage comments, particularly if you've had a similar experience,

PART II: What is a Disrupted Quadriceps Tendon?