Quadriceps Strain

The quadriceps are a group of four muscles consisting of the rectus femoris, vastus lateralis, vastus medialis and vastus intermedius that reside on the anterior thigh. These muscles are responsible for straightening the knee (such as during walking). The rectus femoris muscle also crosses the hip, meaning that it can perform hip flexion movements (bringing knee towards chest) however making it more susceptible to stretch-induced strain injuries.

There are generally three mechanisms of injury for a quadriceps strain:

• Sudden deceleration of the leg (eg, kicking)

• Violent contraction of quadriceps (eg sprinting)

• Rapid deceleration of an overstretched muscle (eg changing direction, or falling onto knee and the trunk falls backwards, performing a stretching based movement)

While quadriceps strains can affect anyone, acute strains are more common in athletes that participate in sports such as soccer, rugby and football.

Muscle strains are graded from 1-3 based on severity, with the former being more mild than the latter. 

• Grade 1: A twinge may be felt in the thigh at the time of injury however it may not be severe enough for the person to stop their activity. There may some feelings of discomfort and tightness on walking however it will be unlikely that any bruising or swelling may appear

• Grade 2: The person may report an acute, sudden, sharp pain during their activity that will prevent them from continuing. Mild swelling and bruising may be evident soon after and mobility may be impacted. There would be pain and discomfort when palpating the injured tissues. Active range of movement may be limited towards end of range knee flexion and extension due to symptoms, while muscle strength testing would likely identify some weakness due to pain inhibition

• Grade 3: The person would likely report a severe, acute episode of pain at the front of the thigh and the person would be unable to continue their activity and my find weight bearing through the affected leg difficult. Significant swelling and bruising would likely appear within 24 hours. There would be pain on palpation and if significant muscle fibre disruption is present then defect within the tissues may be identified. Range of movement and muscle strength testing would be significantly impacted due to pain.

Following a thorough history of the onset of symptoms, a thorough physical assessment will be performed which entails:

• Observation: Looking for swelling, bruising or defect within the muscle belly. Your gait pattern and any provocative movements or activities will also be assessed in an attempt to illicit symptoms

• Palpation: Looking for tenderness along the entire length of the anterior thigh, also looking for any defect within the muscle belly.

• Range of movement: Looking for both active and passive range of movement of the knee looking for quality and available movement.

• Muscle strength: Comparing against the non-affected side to assess any deficits in strength that may be due to pain or actual weakness as a result of disruption to a large proportion of muscle fibres

Once a positive diagnosis of a quadriceps strain has been obtained, physiotherapy can help with:

• Management in the acute phase as well as altering weight bearing status as needed

• Soft tissue massage / fascial work

• Graded stretching

• Electrotherapy

• Taping

• Graded exercise programme

• Discussion around return to sport and graded programme to help facilitate this