Quadriceps Strain

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Clinically relevant Anatomy

The quadriceps muscles are the muscles on the front of the thigh. They consist of the Vastus lateralis, Vastus medialis, Vastus intermedius and the Rectus femoris. A strain is a tear in the muscle. These can range in severity, from a very small tear to a complete rupture.

Aetiology and Epidermiology


Tears to the quadriceps muscles usually occur following an activity such as sprinting, jumping or kicking, especially if a thorough warm-up hasn’t been undertaken. Any of these muscles can strain (or tear) but probably the most common is the Rectus femoris. This is because it is the only one of the four muscles which crosses both the hip and knee joints. This make it more susceptible to
injury. The most common site of injury is around the musculotendinous junction (where the muscle becomes tendon), just above the knee.

Injuries that occur following a direct impact to the muscle, such as being hit by a ball or other hard object, are more likely to be contusions and should be treated slightly differently.

Muscle strains are graded 1, 2 or 3 depending on the severity of the damage. It is important you understand what grade of injury you have suffered to be able to treat it appropriately.


Characteristics and presentation 

Grade 1 thigh strain:

  • A twinge in the thigh is usually felt.
  • A general feeling of tightness in the thigh.
  • Mild discomfort on walking.
  • Probably no swelling.
  • Trying to straighten the knee against resistance may be uncomfortable (see assessment).
  • An area of local spasm may be felt at the site of the suspected tear.


Advice to the patient:

  • Apply Relative rest, compression and elevation.
  • Apply cold therapy as soon as possible and every 2-3 hours.
  • Use a compression bandage until you feel no pain.
  • Rest for at least 72 hours before commencing light training
  • If there is no pain, continue with training.
  • See a sports injury professional.


What can the healthcare professional or physiotherapist do?


Grade 2:

  • A sudden sharp pain when running, jumping or kicking.
  • Unable to play on.
  • Pain affects walking.
  • The athlete may notice swelling or even mild bruising.
  • Pain on feeling the area of the tear.
  • Straightening the knee against resistance causes pain.
  • Unable to fully bend the knee.


Advice to the patient:

  • Use the R.I.C.E procedure as above.
  • Apply cold therapy straight away and every 2-3 hours for 48 hours.
  • Wear a compression bandage and rest with the leg elevated.
  • Use crutches if necessary.
  • See a sports injury specialist.


What can the healthcare professional or physiotherapist do?


Grade 3:
  • Sudden, severe pain in the thigh.
  • Unable to walk without the aid of crutches.
  • Large swelling appearing immediately.
  • Bruising usually appears within 24 hours.
  • A static contraction will be painful and might produce a bulge in the muscle.
  • Expect to be out of competition for 6 to 12 weeks.


Advice to the patient:

  • Stop play immediately.
  • Rest with the leg elevated, using a compression bandage.
  • Apply cold therapy immediately.
  • Seek medical attention. It is important you do this if you suspect a grade three strain. If you do not you may be permanently injured or weakened.


What can the healthcare professional or physiotherapist do?

  • Use sports massage techniques to increase circulation, reduce trigger points.
  • Use ultrasound and electrical stimulation.
  • Prescribe a rehabilitation programme and monitor it.
  • Operate if needed (rare).


 Physiotherapy management

Things you need to consider when treating a quad strain.

Is it a rupture/ near full thickness tear? ie can you see a displacement of the muscle towards origin? If so this needs conservative management for the first 6 weeks. Consultants often won’t operate due the difficulty of tissue healing here. Tissue healing times: Check out revision notes on tissue healing. 


  • Reduce further tear (if not completely ruptured). ie immobilise/discourage excessive EOR stretch.
  • Controlled stretch is necessary to encourage good alignment of muscle fibres.
  • Increase circulation
  • Reduce pain (look at pain mechanisms and highlight which ones you feel are working here? Often in a complete rupture there is minimal pain)

As the severity of the tear reduces maintaining ROM, increasing strength and phased return to sport are all vital for an effective rehab program. Before a patient can return to sport they should have good ROM, near full strength and nil pain with training exercises.

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