A Quadriceps muscle strain is a tear of one of the four thigh muscles in the front of the thigh. Also referred to as a Quad strain. Your Quad muscles allow you to jump, walk, land and climb stairs. These muscles are mainly responsible to extend your knee and tilt your pelvis forward. A torn Quad  muscle is not a walk in the park.

“Quad” means four, so we have the Vastus Medialis muscle on the inside, Vastus Lateralis muscle on the outside, and Vastus Intermedius & Rectus Femoris overlapping each other in the middle. All four these muscles originate from the pelvis and runs down the femur (thigh bone), they attach to top part of the patella to form the supra-patella tendon and infra-patella tendon. These tendons anchor the quads onto the top part of the shin bone called the Tibia.

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Quadriceps strains usually affect the Rectus femoris muscle and occurred during sports that involve sprinting, jumping, or a kick in such as rugby and soccer. In extreme cases the force that these movement place on the muscle cause it to rupture, tearing along the muscle fibers or rupturing the membrane that contains the thigh muscles. In contact sports where a direct blow to the thigh can lead to localised bleeding in the muscle and under the skin.

The Quad muscle tears when its forcefully contracted while its in a stretched position. In other words, the muscle fibers can’t manage the amount of stress placed on them due to this overload. Let us examine this in detail.

Your Quadriceps muscle straitens your knee, flexes your hip and tilts your pelvis forward. To understand how the muscle gets injured you must first know how it works. Lets look at these three movements. When you are standing and can activate your quads by just trying to straighten your knee (you will feel the patella move upwards). Lift your knee to your chest (flex your hip) while your knee is bent, you will realize that the quads tilt your pelvis forward.

Quad under tension & stretch

To put the quads in a stretch, you must bend your knee backwards while standing (hold it with the same side’s hand). Contract your abdominal muscles and you will feel the pull over your thigh. Now slowly take that same knee backwards without allowing your lower back to collapse forward. This is a very common quad stretch among athletes, but very few do it correct.

We go into this stretched position every time we give a stride when we run, jump, hop and kick. Your quadriceps muscles is capable of generating large amount of force to propel us forward and control our landing. The muscle fibers contract and the tension runs along the vertical lines of each of the muscles. The small muscle fibers will tear when the force of contraction is too much. Even more so, when the muscle is in its stretched position.

Small tears rips the quad to pieces

Repetitive overload on the muscle will cause small tears in the quadriceps muscle. Your body will react by contracting your quad to protect it from further strain, but patients tend to train through this ‘niggle’ of a pain and continue to run, cycle, jump etc. Eventually a small quad tear develops into a bigger tear, until its too painful to contract or stretch the quads at all. The torn quad fibers split apart usually accompanied by tears in some of the blood vessels inside the muscle. This bleeding inside the confined space of the muscle compartment can be quite painful and stiff when you try to bend your knee.

A Quadriceps strain develops where the forces are concentrated over a specific area of the muscle. The most common site for this type of tear to develop is where the tendon meets the muscle (Musclotendinous junction). In most of these cases there is a quadriceps tendinitis that can make matters even worse.

In Practice we perform a wide range of tests not only on the quads, but all the surrounding structures as well. This is to exclude any other muscle, ligament or tendon that can be involved with the same injury. If you’re unsure and determined to make a ‘self-diagnosis’, these are some of the test that we’ve modified to help you test your own Quads at home:

If this position is painful going into it, or when taking the knee backwards, the test is positive. Meaning you need help…

If it is painful when trying to contract the muscle or move it through the range, the test is positive.

1. Sudden deceleration of the leg (e.g. kicking)
2. Violent contraction of the quadriceps (sprinting)
3. Rapid deceleration of an overstretched muscle (by quickly change of direction).

The most common quadriceps muscle that gets strained is the Rectus Femoris muscle, because it crosses two joints and has a high proportion of type 2 fibers.

Vastus medialis muscle is in the front of the thigh towards the inside. This muscle is used to straighten the knee and to stabilize the patella (kneecap). The vastus medialis muscle plays a vital role in controlling where the patella should move during movement (patella tracking).

A portion of the muscle fibres of vastus medialis runs diagonally towards the patella which plays a very important role in locking the knee in full extension.

Vastus lateralis muscle runs on the front and outside of the thigh. This muscle is used to straighten the knee and provide stability to the outer part of the upper leg. The vastus medialis and vastus lateralis muscles work together on either sides of the patella to control its movement as your knee bends.

The rectus femoris muscle is the only muscle that directly attaches to the pelvis. It lies on top of vastus intermedius and between vastus medialis and vastus lateralis. Its used to raise your knee towards your chest and helps to extend your knee. It is also able to tilt your pelvis forward. It is the only one of the four quadriceps that runs over two joints (hip and knee).

With a Torn Quad muscle, specifically the Rectus femoris muscle, you’ll find it very difficult to stand up straight from the pain in your thigh. Pelvic and knee movement will be stiff & painful. Therefore take extra caution if you suspect your Rectus Femoris muscle is torn.

The vastus intermedius runs directly underneath the rectus femoris muscle in the front of the thigh on the femur(thigh bone). This muscle is used to straighten the knee. This muscle contracts in unison with the rectus femoris muscle but still remains a separate group of muscle fibres.

We use a scale from 1 to 3 to determine how bad the Quadriceps muscle strain is. This gives us a clear picture of how severe the tear in the quads are. We’ll tell you where, and to what extent the muscle is torn.

Here’s a short breakdown of how the different degrees of quadriceps muscle strains will look (For a more detailed analysis click here)

Even walked into the side of a table, get hit by a ball on your thigh? Leaving you with a massive bruise on your quad the size of a fist, or a line of bruising. This is called a contusion. This is due to direct impact to the quadriceps muscles. Same goes for blunt trauma like a shoulder to the thigh tackle (rugby) or a direct kick from an opponent (Soccer & MMA fighting).

This direct impact causes the muscle fibers to split and usually cause the membrane called the epimysium (Outer casing surrounding the muscle) to rupture. Bleeding will be excessive and a dip in the tissue can be felt over the impact site on your quad. A Gr 2 Quadriceps muscle tear is very closely related to contusions of the thigh. Its important to identify if the depth of the bruise. Because if it extends deep into the quad muscles, you may risk tearing it even more.

The amount of session will depend on the severity of the quad tear and your co-operation with the advice we give you. Every person is unique, so it varies. A general rule of thumb our Physiotherapist tend to stick to are 2 treatments in the first two weeks, then only one treatment session for the next two weeks. Total 4 weeks (6 sessions).

Our Physiotherapist are able to accurately diagnose the site & severity of a quadriceps muscle strain. Our physios will make a diagnosis through physical examination. In some cases we refer for a sonar or diagnostic ultrasound to get a clear image of the torn quad muscle. This gives us valuable information regarding the length, depth and total size of the tear. This provides us with more detail so we can more accurately define the prognosis (how long recovery will take) especially when you are pressed for time.

X-rays

We may refer you for X-rays if we suspect that the femur bone has been fractured or cracked. However, its rare. X-rays show only bones and therefore does not give us any indication of whats happening in the quadriceps muscles. X-rays will only be necessary if we suspect a fracture. Usually when there was direct trauma to your thigh.

Sonar (US)

Sonar or Diagnostic Ultrasound is very often used because it is relatively inexpensive. But it also has a quite big disadvantage, namely the fact that it’s highly operator dependent and requires a skilled and experienced clinician. Another advantage of Ultrasound is the fact that it has the ability to image the muscles ‘live’ and we are able to asses bleeding and hematoma formation via Doppler. We’ll ask you to contract and move your quads during the Sonar, and you’d be able to see the torn fibers.

MRI

Magnetic resonance imaging is a very expensive test. But in this scenario, it is a good way to give a detailed images of the torn quadriceps muscle. However, its very excessive if only the quad muscle is torn.

An untreated quad tear can lead to severe loss of mobility and flexibility in your hip and knee. Rarely, a contusion can lead to myositis ossificans, a painful condition involving muscle calcification. This is when bone crystals starts to grow inside the quadriceps muscle.

The four quadriceps muscles are involved in walking, running, straightening and bending the leg. They’re large muscles that covers the front of your thigh. The severity of injuries to these muscles range from minor bruises called contusions or small tears of the quadriceps muscles, to massive tears along the thigh and even  complete ruptures.

A Quadriceps strain can affect any of the four muscles at the front of the thigh that connects to the patella (kneecap). They mainly straighten your knee, but also allow the knee to bend. In the case of Rectus Femoris muscle, it flexes your hip as well.

1. Follow the PRICE procedure for 24 hours with your knee at maximum flexion.
2. Immobilize your leg immediately keeping it bent at 120°, and use crutches.
3. Call us to set up an appointment to determine the extent of the damage

A Quadriceps muscle tear can re-attach successfully if you guide and protect it throughout its healing phases.
Our Physiotherapists follow a 6 phase rehabilitation process where we guide you through each step.

If you are diagnosed with a Quadriceps strain your physio will advise you to continue with the PRICE protocol for up to 72 hours. We’ll advise you on some pain relief medications. You’ll have to use crutches for a few days, if you’re at high risk of tearing the muscle even further. Following the steps and guiding you as you progress safely from one phase to the next is the most important part of the rehabilitation process.

• Physiotherapy treatment focuses on pain management and accelerating the healing process by using Ultrasound and Laser
• Strapping and Taping to support and protect your quad from further injury by limiting knee flexion.
• Acupuncture or Dry Needling of the affected quadriceps muscles.
• Electrotherapy to desensitize the muscle’s protective mechanisms.
• Massage, Soft tissue mobilization and Myofascial release of Quadriceps muscles to guide the scar tissue formation.
• Dynamic, static and ballistic stretches
• Eccentric loading exercises to condition the quad muscle fibers.
• Compression braces like compression socks or neoprene sleeve can promote blood flow through the site of injury and prevent the blood pooling in the lower leg.
• Crutches for the first 2 weeks to keep your weight off the leg.
• We will gradually progress your rehabilitation exercises to regain full function and range of movement of all your quadriceps muscles.

When a quadriceps muscle strain occurs during a competition or training, it is important to react immediately. In the 10 minutes following the trauma one needs to put the knee of the affected leg in 120° of flexion. This avoids potential muscle spasms, reduces the hemorrhage. If the knee is left in extension the healing process will be slower and more painful because the quadriceps will start to heal in a shortened position.

By placing the injured leg to rest the first 3-7 days after the trauma, we can prevent further retraction of the ruptured quadriceps muscle (the formation of a large gap within the muscle), reduce the size of the hematoma, and subsequently, the size of the connective tissue scar. Elevation of an injured leg above the level of your heart results in a decrease in hydrostatic pressure, and subsequently, reduces the accumulation of interstitial fluid, so there is less swelling at the site of the tear.

Prolonged rest causes more damage than good

During the first few days after the injury, a short period of immobilization accelerates the formation of granulation tissue at the site of injury, but it should be noted that the duration of reduced activity (immobilization) ought to be limited only until the scar reaches sufficient strength. This means that the scar is able to withstand the muscle-contraction induced pulling forces without re-rupture.

Rest prevents worsening of the initial injury, but you must not stay off the leg for too long. At this point, gradual mobilization is started followed by a progressively intensified exercise program to optimize the healing by restoring the strength of the injured muscle, preventing the muscle atrophy, the loss of strength and the extensibility, all of which can follow prolonged immobilization.

Ice or cold application is to lower intra-muscular temperature and decrease blood flow to the injured area. Compression may help decrease blood flow and accompanied by elevation to decrease both blood flow and excess interstitial fluid accumulation. The goal is to prevent hematoma formation and interstitial edema, thus decreasing tissue ischemia. However, a prolonged immobilization phase, will be detrimental for the quadriceps muscle regeneration.

You may begin:

• Practicing squats. This should cause minimal pain.
• Deep-water running at 20 -30 minutes at high intensity intervals.
• Upper limb weight training (non weight bearing on the legs) – start from the first day after the injury.
• Cycling as pain allows.

1. Isometric: Quad muscle contraction without change in muscle length (mostly against a fixed object).
2. Isotonic: Quad muscle contraction against a constant resistance with a shortening/lengthening of the muscle.
3. Isokinetic: Quad muscle contraction into a specific movement, through the available range (e.g. flexion-extension of the knee).

All of these exercises should be done in a range of motion that is pain-free.

You should now be able to go up & down stairs pain-free, and complete a single leg squat at 90 Degrees.

You may begin:

• Gentle stretches of your quadriceps muscles. Aim for symmetry in both legs.
• Functional warm-up drills such as walking lunges, full body exercises, low-level foot plyometrics, low levels sideways drills.
• Box step ups
• Interval cycling at a medium to high intensity
• Low level running

This must be done in available pain free, and end of range as guided by your physiotherapist.

Most quadriceps strains heal within 4 to 8 weeks.  If your thigh muscle injury is not healing as expected our physiotherapist may refer you for further investigations. If your quadriceps strain failed to respond to non surgical treatment your physiotherapist will discuss the options of draining the heamatoma, or other treatment options.

Surgery to torn quad muscles are very rare. After surgery your doctor will put your leg in a cast or brace for 4 to 6 weeks, but you will need crutches for 6 to 8 weeks. Your doctor will refer you for a physiotherapy rehabilitation program to restore the normal quadriceps muscle strength and elasticity, so you can make a full recovery.

Quadriceps tear, Torn Quads, Strained Quadriceps muscle, Torn Quadriceps muscle, Pulled Quads. Quadriceps muscle strain, Torn Rectus femoris, Torn Vastus lateralis , Torn Vastus Medialis, Torn Vastus intermedius.

• Quadriceps tendinitis
• Tendinitis
• Knee Tendinitis
• Knee Meniscus Tear
• Contusions
• Runner or Jumper’s Knee
• Slipped Capital Femoral Epiphysis
• Hip pain
• Groin pain – Groin muscle strain