Sports Medicine
Sports Injury Prevention & Rehabilitation

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Quadriceps Strain

(Also known as Quadriceps Tear, Strained Quadriceps Muscle, Torn Quadriceps Muscle, Pulled Quadriceps)
What is a quadriceps strain?

The large muscle group at the front of your thigh is called the quadriceps. The quadriceps comprises of four muscle bellies which originate from the pelvis and thigh bone (femur) and attach to the shin bone (tibia) via the knee cap (patella). They are:
  • rectus femoris
  • vastus medialis
  • vastus lateralis
  • vastus intermedius
The quadriceps is responsible for straightening the knee during activity and is particularly active during sprinting, jumping, hopping or kicking. Whenever the quadriceps muscle contracts or is put under stretch, tension is placed through the quadriceps muscle fibers. When this tension is excessive due to too much repetition or high force, the quadriceps muscle fibers may be torn. When one or more parts of the quadriceps muscle tear, the condition is known as a quadriceps strain. The rectus femoris is the most commonly affected muscle belly in a quadriceps strain.
Tears to the quadriceps can range from a small partial tear whereby there is minimal pain and minimal loss of function, to a complete rupture whereby there is a sudden episode of severe pain and significant disability.

Quadriceps strains range from a Grade 1 to a Grade 3 tear and are classified as follows:
  • Grade 1 Quadriceps Tear: a small number of fibers are torn resulting in some pain, but allowing full function.
  • Grade 2 Quadriceps Tear: a significant number of fibers are torn with moderate loss of function.
  • Grade 3 Quadriceps Tear: all muscle fibers are ruptured resulting in major loss of function.
The majority of quadriceps strains are grade 2 tears.

Causes of a quadriceps strain
Quadriceps strains most commonly occur due to a sudden contraction of the quadriceps muscle (particularly when the muscle is on stretch – e.g. kicking). They often occur during sprinting, jumping, hopping or kicking activities. This is particularly so during explosive acceleration (e.g. sprinting), when a soccer player performs a long kick or following an inadequate warm-up. Quadriceps strains are commonly seen in running sports such as football and track.

Signs and symptoms of a quadriceps strain

Patients with a quadriceps strain usually feel a sudden sharp pain or pulling sensation in the quadriceps muscle at the time of injury. In minor cases, pain may be minimal allowing continued activity. In more severe cases, patients may experience severe pain, muscle spasm, weakness and an inability to continue the activity. Patients with a severe quadriceps strain may also be unable to walk without limping.
Patients with a quadriceps strain usually experience pain during activities such as squatting, going up and down stairs, running, jumping, hopping, or kicking. It is also common for patients to experience pain or stiffness after these activities with rest, especially upon waking in the morning. Swelling, tenderness and bruising may also be present in the quadriceps muscle. In severe cases, a visible deformity in the quadriceps muscle may also be detected.

Diagnosis of a quadriceps strain
A thorough subjective and objective examination from a physician is usually sufficient to diagnose a quadriceps strain. Further investigations such as an MRI scan or Ultrasound may be required, in rare cases, to confirm diagnosis.

Treatment for a quadriceps strain
Most patients with a quadriceps strain heal well with an appropriate physical therapy program. The success rate of this program is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Activities which place large amounts of stress through the quadriceps should be minimized, these include: running, jumping, hopping, squatting, lunging and kicking. Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
  • Ignoring symptoms, or adopting a 'no pain, no gain' attitude is likely to lead to the problem becoming chronic. Immediate, appropriate treatment in patients with a quadriceps strain is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
  • Diligently following RICE in the initial phase of injury (first 72 hours) will greatly assist in improving recovery time in patients with a quadriceps tear. This involves rest from aggravating activities, regular icing, the use of a compression bandage, and keeping the injured leg elevated above the level of your heart. Anti-inflammatory medication may also help to reduce inflammation, pain and swelling. The use of crutches when walking may be necessary to protect the quadriceps muscle from further damage and to the hasten healing process.
  • A graduated flexibility and strengthening program guided by a physical therapist is essential to recondition the quadriceps muscle and reduce the likelihood of injury recurrence. Careful assessment by the physical therapist to determine which factors have contributed to the development of the quadriceps strain, with subsequent correction of these factors is also important to ensure an optimal outcome.
  • A graduated return to running program in the final stages of rehabilitation is required to recondition the quadriceps for running in a safe and effective manner. This should include the implementation of progressive acceleration and deceleration running drills.

Prognosis of a quadriceps strain
With appropriate management, patients with minor quadriceps strains can usually recover in one to three weeks. With larger tears, recovery may take four to eight weeks or longer depending on the severity of the injury. Complete ruptures of the quadriceps muscles are rare and are usually managed conservatively. In these cases, recovery may be significantly longer.

Contributing factors to the development of a quadriceps strain

There are several factors which can predispose patients to developing a quadriceps strain. These need to be assessed and corrected with direction from a physical therapist. Some of these factors include:
  • poor quadriceps flexibility
  • quadriceps weakness
  • muscle tightness (particularly the hamstrings, gluteals, hip flexors)
  • other muscle weaknesses (such as gluteals)
  • inappropriate training
  • inadequate warm up
  • joint stiffness (especially the lower back, hip or knee)
  • poor biomechanics
  • inadequate rehabilitation following a previous quadriceps injury
  • decreased fitness
  • fatigue
  • poor core stability
  • muscle imbalances

Physical therapy for a quadriceps strain

Physical therapy for patients with a quadriceps strain is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • joint mobilization
  • stretches
  • dry needling
  • anti-inflammatory advice
  • the use of crutches
  • ice or heat treatment
  • progressive exercises to improve strength and flexibility (particularly of the quadriceps)
  • education
  • biomechanical correction
  • activity modification advice
  • establishment of an appropriate return to activity or sport plan

Other intervention for a quadriceps strain
Despite appropriate physical therapy management, some patients with a quadriceps strain do not improve adequately. When this occurs, your treating physical therapist or doctor can advise on the best course of management. This may include investigations such as an ultrasound, CT scan or MRI, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition.