■ ■ ■ Description

Quadriceps strain is characterized by inflammation and pain in the front of the thigh along the quadriceps muscles. There are four muscles that comprise the quadriceps muscle group, going from the hip across the knee to the leg. This muscle group is important for straightening your knee and bending your hip and is used for running and jumping. This is usually a grade 1 or 2 strain of the muscle-tendon unit. A grade 1 strain is a mild strain. There is a slight pull without obvious tearing (it is microscopic tearing). There is no loss of strength, and the muscle-tendon unit is the correct length. A grade 2 strain is a moderate strain. There is tearing of fibers within the substance of the muscle or tendon or where the tendon meets the bone. The length of the muscle-tendon-bone unit is increased, and there is decreased strength. A grade 3 strain is a complete rupture of the tendon.

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■ ■ ■ Common Signs and Symptoms

• Pain, tenderness, swelling, warmth, or redness over the quadriceps muscles at the front of the thigh

• Pain that is worse during and after strenuous activity

• Muscle spasm in the thigh

• Pain or weakness with running, jumping, or straightening the knee against resistance

• Crepitation (a crackling sound) when the tendon is moved or touched

• Bruising in the thigh 48 hours following the injury

• Loss of fullness of the muscle or bulging within the area of muscle with complete rupture

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■ ■ ■ Causes

• A single violent blow or force to the knee or the quadriceps area of the thigh

• Strain from overuse of the lower extremity or sudden increase in amount or intensity of activity

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■ ■ ■ Risk Increases With

• Sports that require quick starts (sprinting or running races and other track events, racquetball, squash, badminton)

• Sports that require jumping (basketball and volleyball)

• Contact sports such as soccer or football

• Poor physical conditioning (strength and flexibility)

• Inadequate warm-up before practice or play

• Previous quadriceps or knee injury

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

  • Hip and thigh flexibility

  • Muscle strength and endurance

  • Cardiovascular fitness

• Wear proper protective equipment (thigh pads).

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■ ■ ■ Expected Outcome

This condition is usually curable within 6 weeks if treated appropriately.

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■ ■ ■ Possible Complications

• Prolonged healing time if not appropriately treated or if not given adequate time to heal

• Chronically inflamed tendon, causing persisting pain with activity that may progress to constant pain

• Recurrence of symptoms if activity is resumed too soon

• Proneness to repeated injury

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■ ■ ■ General Treatment Considerations

Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises (particularly bending the knee), and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. An elastic bandage or neoprene (wetsuit material) sleeve may help reduce swelling and reduce symptoms. If the strain is severe and the athlete is limping, crutches may be recommended for the first 24 to 72 hours, until the pain and inflammation settle down. Rarely surgery is necessary to reattach muscle if it pulls off bone (uncommon) or if chronic, persistent pain exists for more than 3 months despite appropriate conservative treatment for strains. Suturing or sewing torn muscle is usually not successful, although complete tendon rupture often requires surgical repair. Single muscle ruptures are not usually fixed surgically because these rarely cause problems.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take for the first 3 days after injury or within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician.

       Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Topical ointments may be of benefit.

• Pain relievers may be prescribed as necessary by your physician. Use only as directed.

• Injections of corticosteroids may be given to reduce inflammation, although not usually for acute injuries.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 to 4 weeks despite treatment

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)