(Also known as Quadriceps Tear, Strained Quadriceps Muscle, Torn Quadriceps Muscle, Pulled Quadriceps)
What is a quadriceps strain?
A quadriceps strain is a condition that is frequently seen in kicking and running sports and is characterised by partial or complete tearing of the quadriceps muscle located at the front of the thigh (figure 1).
The large muscle group at the front of your thigh is called the quadriceps (figure 1). The quadriceps comprises of 4 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 controlling knee and hip movements 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 fibres. When this tension is excessive due to too much repetition or high force, the quadriceps muscle fibres 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 fibres are torn resulting in some pain, but allowing full function.
- Grade 2 Quadriceps Tear: a significant number of fibres are torn with moderate loss of function.
- Grade 3 Quadriceps Tear: all muscle fibres 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 footballer is kicking on the run or performs a long kick, or, following an inadequate warm-up. Quadriceps strains are commonly seen in running sports such as football and athletics.
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, the patient may be able to continue activity only to have an increase in symptoms upon resting later (often that night or the next morning). 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 limp or be unable to walk off the playing field.
Patients with a quadriceps strain usually experience an increase in pain during activities which place tension on the quadriceps muscle. These activities may include squatting, going up and down stairs, running, jumping, hopping, kicking or performing a quadriceps stretch. It is also common for patients to experience pain or stiffness after these activities with rest, especially upon waking in the morning.
Patients with this condition may also experience swelling, pain on firmly touching the affected region of the quadriceps muscle and bruising in the front of the thigh. 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 physiotherapist 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
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
Physiotherapy for a quadriceps strain
Other intervention for a quadriceps strain
Exercises for a quadriceps strain
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.
Static Inner Quadriceps Contraction
Tighten the muscle at the front of your thigh (quadriceps) by pushing your knee down into a towel (figure 2). Put your fingers on your inner quadriceps to feel the muscle tighten during contraction. Hold for 5 seconds and repeat 10 times as hard as possible provided there is no increase in symptoms.
Knee Bend to Straighten
Bend and straighten your knee as far as possible without pain and provided you feel either nothing, or, no more than a mild to moderate stretch (figure 3). Repeat 10 – 20 times provided the exercise is pain free.
Begin this exercise lying on your back in the position demonstrated (figure 4). Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Perform 10 – 20 repetitions provided the exercise is pain free.
Rehabilitation Protocol for a quadriceps strain
Find a Physio
Find a physiotherapist in your local area who can treat this condition.
Physiotherapy products for a quadriceps strain
Some commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
Physiotherapy products that may be beneficial after the initial 72 hour period following injury and under guidance by the treating physiotherapist include:
To purchase physiotherapy products for a quadriceps strain click on one of the above links or visit the PhysioAdvisor Shop.
- Quadriceps Stretches.
- Quadriceps Strengthening Exercises.
- Balance Exercises.
- How to use Crutches.
- R.I.C.E. Regime.
- Ice or Heat.
- Return to Running Program
- Thigh Diagnosis Guide.
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