Quadriceps Muscle Injury

A Quadriceps muscle strain is an acute tearing injury of the quadriceps muscle group. This injury is usually due to a sudden stretch of the muscle, powerful and forceful contraction or repetitive functional overloading. The quadriceps, which consists of four parts, can be overloaded by repeated eccentric muscle contractions of the knee extensor mechanism (straightening the knee).

The quadriceps muscle group extend the knee and help flex the hip. It is located in the anterior compartment of the thigh. The muscles which make up the quads are:

• Rectus Femoris

• Vastus lateralis

• Vastus Medialis

• Vastus Intermedius

The Rectus Femoris is the only part of the muscle group participating in both flexion of the hip and extension of the knee.  The other 3 parts are only involved in the extension of the knee. The Rectus Femoris is the most superficial part of the Quadriceps and it crosses both the hip and knee joints – making it more susceptible to stretch-induced strain injuries. The most common sites of strains are the muscle tendon junction just above the knee (both distal and proximal but most frequently at the distal muscle-tendon) and in the muscle itself.

Acute strain injuries of the quadriceps commonly occur in athletic competitions such as soccer, rugby and football. These sports regularly require sudden forceful eccentric contractions of the quads during regulation of knee flexion and hip extension. Higher forces across the muscle–tendon units with eccentric contraction can lead to strain injury. Excessive passive stretching or activation of a maximally stretched muscle can also cause strains. Of the quadriceps muscles, the Rectus Femoris is most frequently strained.

The key characteristics of muscle strain include:

• Swelling, bruising, or redness due to the injury

• Pain at rest

• Inability to use the muscle effectively

• Weakness of the muscle or tendons

(Burmitt & Cuddeford, 2015)

• Sports injury – for example kicking, landing in a peculiar way, sprinting, decelerating, overloading in contact.

• Work/domestic injury – for example stepping down from a higher surface, twisting, lifting something from the floor incorrectly.

At Pure, our Physiotherapists will take a detailed history to obtain more information about your injury to help provide an accurate diagnosis. Within the history, you may be asked exactly how the injury occurred, your pain levels, functional ability post-injury and the level of sporting performance (if applicable) you are involved in. We will also ask about your hobbies and lifestyle so that we can work with you to develop personalised goals.

Your Physiotherapist will then carry out a comprehensive physical examination to fully establish a working diagnosis. Having an early and precise diagnosis will ensure the most appropriate treatment and management plan can be implemented straight away.

If a quad strain/tear is suspected, you will be given information of the grade of the injury which we have outlined below:

• Grade 1: Mild damage to individual muscle fibres (less than 5% of fibres) that causes minimal loss of strength and motion.

• Grade 2: More extensive damage with more muscle fibres involved (approximately 40% of the muscle fibres). However, the muscle is not completely ruptured. These injuries present with significant loss of strength and motion. These injuries may require two to three months healing time.

• Grade 3: Complete rupture of a muscle or tendon. These can present with a palpable defect in the muscle or tendon. However, swelling in the area may make this difficult to appreciate. These injuries sometimes require surgery to reattach the damaged muscle and tendon.

(Javinen et al., 2000)

Muscle strain treatment & management depends upon an accurate diagnosis from your Physiotherapist. The severity of your muscle strain – and what function or loads your injured muscle will need to cope with, will influence the length of your recovery. You will be educated and guided on the first-line of treatment for a muscular strain in the acute phase which includes five steps commonly known as P.R.I.C.E.

• Protection: Apply soft padding to minimise impact with objects.

• Rest: To allow healing & reduce the potential for re-injury.

• Ice: To induce vasoconstriction (narrowing of blood vessels), which will reduce blood flow to the site of injury. Never ice for more than 20 minutes at a time.

• Compression: Wrap the strained area with a soft-wrapped bandage to reduce further swelling and promote lymphatic drainage.

• Elevation: Raise the leg onto a foot stool for example – keeping the strained area as close to the level of the heart as is possible. This promotes venous blood return to the heart and good for circulation for the injury and removing toxins from the area.

(Javinen et al., 2007)

Your Physiotherapist may also include interventions to help optimise your recovery. Manual therapy includes massage, joint mobilisations and trigger point release can reduce discomfort, promote healing and help achieve full function. Acupuncture may also be used which involves the insertion of fine, medical-grade needles, used for pain and healing assistance. These can help to relieve pain and increase movement to help you to perform the exercises prescribed and carry out the rehab. This may be performed in the clinic during your appointment and then you will be prescribed a progressive home exercise program and guided through this.

Regular re-assessment will ensure that you are making progress towards your goal and will allow for any adjustments to be made to your plan. Throughout and beyond your recovery, we offer ongoing support and guidance so that you can manage independently and minimise the likelihood of re-injury.

Below is an example of a typical phased rehabilitation plan:

Phase 1

After approximately 3-7 days we want to begin to activate the injured muscles at a low level, this may be through static hold exercises to begin with to start strengthening the muscles as the pain allows

Phase 2

Loading through movement: mini squats; bridging; knee extension; still at a moderately low level. This is putting resistance through a movement such a straightening the knee which is one of the functions of the Quadriceps. Over 1-4 weeks the intensity can be gradually increased

Phase 3

More functional strengthening can now start to be incorporated such as cycling, squats and static lunges – on your feet and replicating everyday life!

Phase 4

Our physiotherapist at Pure Physiotherapy will cater this to your lifestyle. If you’re a runner for example this is when we want to introduce jumping and bounding movements before we return to your sport.

Phase 5

Graded return to activity, if you are unfortunate enough to be off work for 1-2 weeks (not common with this injury) we perhaps want to think about what tasks you’re doing and introduce them gradually. Once we have gone through the basic principles of your sport like running, changing direction in your rehab, its possible we can think about returning to a training session and eventually game time!

• If you are experiencing constant pins & needles or numbness which is worsening.

• Redness or swelling in the calf.

• Significantly reduced function – unable to put weight through the injured leg.

Brumitt, J.& Cuddeford, T. (2015). Current concepts of muscle and tendon adaptation to strength and conditioning. International journal of sports physical therapy, 10(6), 748.

Järvinen, T. A., Järvinen, T. L., Kääriäinen, M., Äärimaa, V., Vaittinen, S., Kalimo, H., & Järvinen, M. (2007). Muscle injuries: optimising recovery. Best Practice & Research Clinical Rheumatology, 21(2), 317-331.

Järvinen, T. A., Kääriäinen, M., Järvinen, M., & Kalimo, H. (2000). Muscle strain injuries. Current opinion in Rheumatology, 12(2), 155-161.