Quadriceps Strain

Description:

The quadriceps muscles and tendons are located at the front of the upper legs and are referred to as the four heads of the femur. The quadriceps can be referred to as the quads, the quadriceps femoris musle or the quadriceps extensors. They comprise of four muscles: the vastus lateralis, vastus medialis, vastus intermedius and the rectus femoris. The rectus femoris is the largest of the four muscles, and is located in the middle of the thigh. The vastus lateralis is situated on the outside of the thigh. The vastus medialis is located on the inside of the thigh and the vastus intermedius is deep to the rectus femoris and is found between the vastus lateralis and the vastus medialis.
The quadriceps cross the knee, and are extensors of the knee. The quadriceps muscles help stabilise the knee cap (the patella). They are also flexors of the hip, as the rectus femoris originates from the hip, the ilium. They allow activities such as climbing stairs or lunges. The quadriceps play a vital role in jumping, walking, and particularly running.
A quadriceps strain is caused when the muscle or tendon is overstretched and becomes strained. A quadriceps strain can also be referred to as a pulled muscle, and can be a tear or a complete rupture. Injury often occurs as a result of an impact, an extrinsic injury, when the muscle is contracted (the muscle fibres are shortened and tight); for example, when a player is kicked. The most typical area for a tear to occur is at the point where the tendon joins the muscle.

Causes:

A quadriceps strain is a common sports injury in runners.
It often occurs in athletes involved in sports that involve sprinting, jumping or kicking, such as football, interval training or hockey. It particularly occurs if the quadriceps has not been warmed up sufficiently. It can also happen as a result of a direct impact (extrinsic injury), for instance a kick.

Diagnosis:

A quadriceps strain is divided into 3 categories, grade 1, 2 and 3, depending on its severity.
Pain can be felt when the knee is straightened against resistance, and when the knee is bent.
Grade 1 (a partial tear)
In a grade 1 strain the pain is moderate, and tightness can be felt in the quadriceps.
During exercise pain can disappear and might not resume until after exercise.
The area around the muscle tear might be tender to touch, warm and red.
Grade 2 (a partial tear)
Pain is immediate and can be sudden and sharp.
There might be slight swelling and the area will be tender to touch.
It might be difficult to bend the affected leg.
Pain can be felt when the leg is straightened against resistance.
The hamstring muscles might be tight, and tightness tends to occur the day after exercise.
Grade 3 (a complete rupture)
Pain is severe, and walking is difficult.
Pain is worse when the knee is flexed (bent), for example walking upstairs, sitting.
Inflammation and bruising is more severe.
A lump can be felt where thickening has occurred. This happens as a result of the build-up of scar tissue caused by the rupture of the quadriceps muscles, which then forms scar tissue as it heals (these are the nodules).
A gap might be felt where the muscle has ruptured.

Treatments:

It is important to seek early treatment to avoid developing a chronic quadriceps strain and weakening the quadriceps.
Rest: to prevent further damage, and avoid any exercises that put a strain on the quadriceps muscles until the muscles have completely recovered.
In the sub acute (3 days to 3 weeks) and the chronic stage (3 weeks to 2 years) it is important that training should be adapted to avoid jumping or any exercises that put excessive strain on the quadriceps. A physiotherapist or sports therapist or sports massage therapist can advise when exercise should be resumed and what exercise would be appropriate. It is important to always warm up and cool down properly when exercising.
Ice treatment: Ice can be applied for 10-15 minutes, every 2-3 hours in the acute and sub- acute stage (frequency can be reduced according to recovery, and can be continued for as long as deemed necessary). An ice stick can be good for massaging the specific area. As the ice is directly massaged onto the skin, and is quite intense, it can be applied for less time 7-12 minutes.
In the sub-acute stage (3days – 3 weeks) heat therapy can be applied, usually in the form of a hot bath.
Compression: to reduce swelling and restrict movement.
NSAIDS (anti-inflammatories) and paracetamol can be taken to aid pain relief. Medical advice should be sought, in case of possible side effects.
Steroid injections (under medical guidance) can alleviate pain, but it is recommended exercise should be avoided for 1-2 weeks after an injection.
Orthotics can prevent overprontation and make sure there is no undue strain placed on the quadriceps by inadequate footwear. It is therefore, worth consulting a podiatrist, who can perform gait analysis and advice on appropriate foot wear.
Kinesology taping aids recovery by assisting with lymphatic drainage, and the repair of damaged tissues.
A doctor or physiotherapist might recommend an MRI scan to assess the extent of rupture. In severe cases surgery might be performed.
Ultrasound may be prescribed by the physio to help speed up the repair process, by breaking down tissues and stretching them. It can also help alleviate pain.
Massage can help aid recovery and be an effective form of treatment, as it helps to stretch the muscle, stimulate repair, by bringing vital nutrients and oxygen to the site of injury, and helps break down the formation of scar tissue. It should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
Kinesio taping techniques for the quadriceps can sometimes show remarkable improvements in low grade quadriceps strains.
A physiotherapist or sports therapist can recommend strengthening, flexibility and proprioceptive exercises in the sub-acute and the chronic stage of recovery. Exercises should focus on strengthening the quadriceps, for example, squats and lunges and quadriceps stretches to improve flexibility. The intensity of the exercises should be increased gradually and in a controlled way. Swimming (front/back crawl, not breaststroke) is a good way of maintaining fitness while the quadriceps recover. Initially a pull buoy can be used to rest the leg.