The quadriceps muscle is generally strained during activities that require high demand such as soccer, rugby, and football. The more commonly injured muscle out of the four muscles that make up the quad is the rectus femoris muscle. The reason for this is that it is a muscle that spans two joints; the hip and the knee. Usually muscles that have been exposed to a high eccentric load to the muscle or excessive load to an overly stretched muscle.
Strains can be characterized into 3 grades:
Grade 1 = minor tears with no to minimal loss of strength with minor to moderate pain and no palpable tissue damage
Grade 2 = tears that result in moderate pain and loss of strength and a defect in the tissue can possible be felt
Grade 3 = a complete tear with significant pain and complete loss of strength with an obvious palpable change in tissue
Treatment should be broken down into Acute and Post-acute.
- Acute treatment (the first 24-72 hours) should involve RICE or rest, ice, compression and elevation. For Grade 3 and possible Grade 2, crutches may be recommended to prevent further injury to the muscle. The purpose of this phase of treatment is to let the muscle heal and recover.
- Post-acute treatment (about 3 to 5 days after the initial injury) should involve a more active approach such as stretching, strengthening, range of motion, aerobic activity, proprioceptive activities, and functional activities.
- Strengthening should follow a specific progression: isometric, isotonic, isokinetic, finally followed by functional activities. Before progressing to the next type of strengthening, an individual should be able to fully complete normal strength levels or be comparable to the other leg.
If an individual is not healing, symptoms are worsening, and there is a loss of knee flexion range of motion after 2-3 weeks one can start considering Myositis Ossificans as a potential diagnosis.
Kary JM. Diagnosis and management of quadriceps strains and contusions. Cur Rev Musculoskelet Med. 2010; 3: 26-31.