Treating a Quadriceps Strain with Physical Therapy
Quadriceps strains are common in sports like soccer, football, and rugby that require sudden, forceful eccentric contractions of the quadriceps when performing a rapid or powerful knee extension, such as when kicking, jumping, or sprinting. The quadriceps are a group of four powerful muscles that are located at the front of the upper thigh that is responsible for knee extension. Through a structured rehabilitation program, physical therapy can help athletes recover from a quadriceps strain safely, helping them regain normal muscle length, strength, and control, reduce pain, and improve running and kicking techniques to reduce the risk of future injury.
Anatomy of the Quadriceps
The quadriceps are a group of four powerful muscles that are located at the front of the upper thigh: the rectus femoris, the vastus medialis, the vastus intermedius, and the vastus lateralis. The muscles originate at the front of the hip and upper femur and insert into the lower femur, kneecap, and shin bone via the patellar tendon. The quadriceps are responsible for knee extension and the rectus femoris muscle also acts as a hip flexor.
What is a Quadriceps Strain?
Quadriceps strains are common in sports like soccer, football, and rugby that require sudden, forceful eccentric contractions of the quadriceps when performing a rapid or powerful knee extension, such as when kicking, jumping, or sprinting. The rectus femoris muscle is the most commonly injured quadriceps muscle. A quadriceps strain can also occur when a player is decelerating after a sprint, either because they are taking steps that are too small or too large.
The quadriceps are the second most commonly strained muscle group after the hamstrings among both professional and amateur football players. These two muscle groups, the quadriceps and the hamstrings, are particularly at risk for muscle strains because they cross both the hip and knee joints and are used for high-speed activities. A strain occurs when the muscles are stretched beyond their limit, tearing muscle fibers, such as when kicking, jumping, or running.
There are three grades of quadricep strains:
Grade 1: involves tightness in the front of the leg that can cause a minor limp. The quadricep muscle experiences minor tearing. The athlete may have mild pain and inflammation, minor bruising, and cannot run, kick, or jump with power or speed.
Grade 2: involves a more noticeable limp, tightness in the front of the leg, increased inflammation and bruising, and pain with any power movement (squat, lunge, or walk upstairs). A grade 2 strain involves a more severe disruption of the muscle fibers that contribute to significant pain and loss of strength.
Grade 3: involves complete tearing of the quadriceps muscles that are associated with severe pain and complete loss of strength. A palpable defect in the muscle tissue can be felt.
Symptoms of a quadricep strain can include:
A distinct pop or pull in the quadriceps muscles
Sharp pain and cramping in the upper thigh that eventually settles into a constant ache
Pain located at the front of the thigh between the knee and the hip
Pain during activities that engage the affected side by contracting the quadriceps (walking or squatting)
Pain when stretching the quadriceps (bending the knee behind you)
Swelling, tenderness, and bruising in the upper thigh
Risk factors for a quadriceps strain can include:
Muscle fatigue, which reduces the energy-absorbing capabilities of the muscle, making them more susceptible to injury
An imbalance of strength between the quadriceps and the hamstrings. Since the quadriceps and the hamstrings work together, if one is stronger than the other, the weaker muscle can become strained
Poor conditioning. If your muscles are weak, they are less able to cope with the stress of exercise and are more likely to be injured
Doing too much too soon, exercising for a duration and at an intensity the body is not ready for
Muscle tightness
A previous history of quadriceps muscle injuries
A recent hamstring strain injury
Physical Therapy for a Quadriceps Strain
Initially, the goal of treatment is to reduce pain and swelling through the use of ice, compression, rest, and elevation of the injured quadriceps. Once the pain has stabilized, the physical therapist begins the active phase of rehabilitation, involving stretching, strengthening and range of motion exercises, and aerobic conditioning through cross-training activities like swimming.
Strengthening exercises of the knee, hip, core, hamstrings, and quadriceps begin gradually, progressing sequentially through isometric, isotonic, and isokinetic exercises. Once the athlete can perform these strengthening exercises, they can progress to functional training (agility, balance, plyometric, and proprioceptive drills) and a progressive running program, moving from a slow jog and increasing to a sprint. Before returning to competition, the physical therapist guides the athlete through a return to sport protocol to minimize injury risk.
To prevent a quadriceps strain:
Always warm up before any exercise session or sports activity. A good warm-up prepares the body for more intense activity, getting your blood flowing, raising your muscle temperature, and increasing your breathing rate. A warmup gives your body time to adjust to the demands of exercise and can increase your range of motion.
After exercise, stretch slowly and gradually as you cool down, which allows the muscles time to respond and lengthen.
Maintain a consistent lower extremity strengthening program, focused on the hamstrings and quadriceps.
