Quadriceps Strain

A quadriceps strain is an injury caused by damage to the quadriceps muscle group at the front of the thigh. A mild (or grade I) strain involves overstretching of the quad muscle/tendon with no tearing. A moderate (or grade II) strain comprises a partial muscle or tendon tear. The strain can also be severe (or grade III), i.e. a complete severing of the muscle or tendon.

A mild quadriceps strain is also commonly known as a pulled quadriceps muscle.

This is one of the three possible types of muscle strain that can constitute a thigh strain injury. The other two are hamstring strains and adductor strains.

Symptoms of a quadriceps strain are usually a sharp pain at the front of the thigh. This is usually followed by continual pain in the same region. In addition, there may be swelling, contusions (bruising) and tenderness in the same area.

Most quadriceps strain injuries are either mild or moderate in severity. These injuries are usually treatable at home using remedies like rest, ice, compression and pain relief medication. However, a severe strain that includes a complete muscle tear will usually require surgery to repair the damage.

Anatomy

The quadriceps muscle fibers are actually composed of 4 sub components:

• The Rectus Femoris, located in the upper central area of the anterior thigh;
• The Vastus Lateralis, situated in the outer portion of the anterior mthigh;
• The Vastus Medialis, which is close to the lower, inside area of the anterior thigh;
• The Vastus Intermedius, which is situated at the inner front area of the thigh.

Of these 4 sub components, the rectus femoris is the only one that crosses both the hip and the knee joints. It therefore plays a role in both hip flexion and knee extension. The other 3 play roles in knee extension only.

As the portion that crosses 2 joints, the rectus femoris  is most susceptible to damage due to stretching. It is therefore the portion of the quadriceps that is most often involved in strains of that muscle.

The parts of the rectus femoris most commonly damaged tend to be:

•  the junction of the muscle and tendon located just above the knee; and
• the muscle itself.

Causes Of Quadriceps Strains

Quadriceps strain injuries tend to most frequently be the result of:

• Abrupt deceleration of the leg (such as at the end of a kicking motion, for example);
• A sudden violent contraction of the quad muscle as for example during sprinting or “pushing off” to sprint;
• Rapid changes of direction while running at full tilt, when an already overstretched muscle is subject to sharp deceleration.

From this, you would expect that quadricep strains are frequently seen in sports that require plenty of sprinting and sudden changes of direction. This would include sports such as soccer, basketball, football and tennis.

However, any sport that also involves sudden sprinting, stopping and directional changes would increase the risk of a quadriceps strain.

Symptoms Of A Quadriceps Strain

These are:

• For a grade I strain, the patient may experience slight twinge in the thigh and general tightness in the area. He or she may also experience slight difficulty walking or running but will usually not suffer any other restriction in movement. Swelling is rare in cases of grade I strains;
• An individual experiencing a grade II sprain is likely to experience a sharp pain at the time the injury occurs. The pain will continue after the injury happens and may be severe enough to interfere with the ability to walk and (more likely) run. Swelling and bruising may be present over the injured area. In addition, the range of motion will be diminished.
• If a grade III strain is experienced, there will again be a sharp pain at the front of the thigh. The pain will continue and may be severe enough to make walking impossible without crutches. Significant swelling and contusions will soon appear over the site of the injury. A bulge may also appear over the injury site due to the recoil of the severed muscle. The patient will also experience significant loss of range of motion (both at the hip and knee).

Anyone experiencing these symptoms should consult a doctor for medical advice, especially if the symptoms include those listed under grade II injuries.

Diagnosis

To diagnose the nature of the injury, the doctor will likely examine the injured leg, looking in particular for swelling and bruising. He or she will also assess the difficulty the patient has in standing or walking.

The doctor will also palpitate (feel) along the length of the quadriceps. The goal here will be to identify swelling, tenderness or unusual masses within the thigh (as may result from a severed muscle, for example).

The doctor may also request a medical imaging scan (such as magnetic resonance imaging) to determine the extent of soft tissue damage within the thigh. Alternatively, X Rays or Ultrasound imaging may be used.

Treatment

Non Invasive

If the doctor concludes that the strain is either grade I or II in severity, he or she will likely suggest a R.I.C.E. based treatment strategy:

• Resting the quadriceps by avoiding any running or jumping activity. If the injury is a grade II strain, the patient may be asked to consider completely resting the quad muscle by using crutches to eliminate any weight bearing for a period.
• Applying Ice or a cold compress to the quad area. This may be done for 20-30 minutes at a time and at intervals of 2-3 hours. This will constrict the blood vessels and slow the rate of blood flow through the injury site, thus reducing inflammation. It will also help with pain relief.
• Applying Compression to the quad muscle with an elastic bandage or thigh compression sleeve. This will  help by reducing swelling;
• Elevating the injured quad muscle above heart level whenever possible will also reduce accumulation of interstitial fluid around the injury and thus ease any swelling;
• For further control of pain and swelling, the doctor may suggest using a non steroidal anti inflammatory medication such as Advil.

As the injury heals, the doctor may suggest a physical therapy exercise program to increase quadricep strength and recover the original knee and hip range of motion.

Surgery

As we suggested earlier, if the quad strain is in the grade III category (completely severed muscle), non invasive treatment approaches will not be adequate. Instead, surgery will be necessary to reattach the severed muscle and repair any other damage to bones or soft tissue.

The doctor or surgeon will be able to explain the options available and make a recommendation.