Quadriceps Injuries, Pulls, and Strains

Diagnosis, Treatment, and Prevention

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The quadriceps is a group of muscles along the front of the thigh. A pull, strain, or tear of the quadriceps muscles or the quadriceps tendon is a common sports injury. You use your quadriceps in running, jumping, and kicking.

Overview

The quadriceps muscles are the rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. They work to flex the hip and extend the knee. They originate on the hip and femur and connect to the knee (patella) with the quadriceps tendon.

Causes

Typically, a pulled quad is the result of a strength imbalance between the quadriceps and the hamstring group, where the hamstrings are more powerful. This is a common muscular imbalance in runners because running tends to use the hamstrings more than the quadriceps. An injury to the quadriceps tendon can happen with an awkward landing of a jump or a fall.

Signs and Symptoms

A pulled or strained quadriceps muscle can be identified by a pain in the front of the thigh. A severe tear is abrupt, sudden, and results in acute pain during the activity (often sprinting) and may be accompanied by swelling or bruises on the thigh and a loss of function. If there is a tear to the quadriceps tendon, you won't be able to straighten your knee. Sometimes, the pain doesn't develop until the end of a game or activity.

Diagnosis

A doctor will take your history and do a physical examination, checking for strength with knee extension and hip flexion and evaluating motion.

The doctor will grade the injury based on the tenderness, palpable defect, and strength. Imaging might not be needed to make a diagnosis.

  • Grade 1 strains are minor tears.
  • Grade 2 strains are more severe with significant pain and loss of strength.
  • Grade 3 strains are a complete tear of the muscle with severe pain and loss of strength.

    Treatment

    For immediate treatmentR.I.C.E. treatment plan (rest, ice, compression, and elevation) is used, as with all pulls and strains, for the first 24 to 72 hours. You may need to use crutches in these first few days with a grade 2 or 3 strain. An anti-inflammatory can be helpful to reduce pain and inflammation. After applying the ice, wrap your thigh in an ACE bandage to keep it compressed.

    After three to five days, depending on the severity of the strain, you can begin active recovery with stretching, range of motion, and keeping up your aerobic fitness. Once activity is started again, ice the muscle after exercise to reduce any swelling. Research on icing has not yet proven that it hastens healing and return to athletics, but it does help decrease pain.

    Once you are able to use your leg without pain, you can begin a slow jogging program and avoid any sudden accelerations and sprints. You will need to ensure you get an active warm-up before activities. Pay attention to signs of pain or increased tenderness, and reduce exercise if any develops. Proper stretching of the quadriceps is essential.

    Recovery typically occurs within two or three weeks. You should not return to sports until you are free of pain, have a normal range of motion, and have near normal strength in the affected leg compared with your non-injured leg.

    Prevention

    The way to prevent this injury is to strengthen the quadriceps muscles, warm up thoroughly before exercise and stretch regularly. Quad extensions, squats, biking, and stair climbing are all worthwhile exercises for runners to use as cross training.

    Source:

    Kary JM. Diagnosis and Management of Quadriceps Strains and Contusions. Current Reviews in Musculoskeletal Medicine. 2010;3(1-4):26-31. doi:10.1007/s12178-010-9064-5.

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