A quadriceps tear (aka strain) is not as common as a hamstring tear, but they do occur. The quadriceps are very large, powerful muscles and play an important role in sports and everyday activities. I have treated several quadriceps injuries as an orthopedic physical therapist including my own. I have strained my own quadriceps while doing a yoga pose called kapotasana. That is a pretty unusual way to strain your quadriceps. Read on to learn more about the typical quadriceps strain and how to treat it. Let’s start with anatomy!
The knee joint
The knee is the largest joint in the body. The knee is made up primarily by the tibiofemoral joint and patellofemoral joint. The tibiofemoral joint is what most of us think of as the knee. It is the joint made between the bottom of the femur (the thigh bone) and the top of the tibia (the larger lower leg bone). The patellofemoral joint is the joint made between the femur and the patella (the kneecap).
The quadriceps
The quadriceps are a group of 4 muscles on the front of the thigh. These muscles include the rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. These are very large powerful muscles that activate to straighten the knee. They are extremely important in performing everyday activities such as squatting, walking, running, jumping, kicking, and many others.
The rectus femoris originates at the pelvis while the other 3 originate on the femur (the thigh bone). The 4 quadriceps muscles extend the length of the femur and come together towards the bottom of the femur (the thigh bone) and form a common tendon called the quadriceps tendon. Tendons connect muscle to bone. The quadriceps tendon then attaches to the patella and the patella connects to the tibia (the shin bone) through the patellar tendon (which is actually a ligament). The patella acts as a pulley when the quadriceps contract to straighten the knee. This is known as the extensor mechanism.
What is a quadriceps strain?
A strain is a tear of the muscle fibers. The rectus femoris is the most common quadriceps muscle that is torn. This is because the rectus femoris is the only quadriceps muscle that crosses two joints. It crosses the hip and the knee.
There are a few different ways that the quadriceps is typically strained.
- Sudden deceleration of the leg – kicking a ball
- Sudden, strong contraction of the quadriceps – sprinting
- Quick deceleration of the quadriceps while it is in a stretched position – rapid change in direction.
Not all strains are the same. Some are more severe than others. There are grades that describe the severity of a strain.
- Grade 1: This is the mildest strain. Only a few muscle fibers are damaged. Walking will, most likely, not be affected but running might be painful. Pain will be mild and may not be present until the next day. No loss in strength or motion.
- Grade 2: This is a moderate strain with about half of the muscle fibers torn. Walking will be affected. Acute pain and swelling will be present. There is a minor decrease in muscle strength.
- Grade 3: This is a severe strain in which there is a complete tear of the muscle. The muscle could be torn where it transitions to tendon or mid muscle.  There will be massive swelling and pain and a complete loss of strength. Person will need crutches to aid in walking.
What are the symptoms of a quadriceps strain?
There are several symptoms of a quadriceps strain. These include:
- Sudden onset of pain in the front of the thigh
- There can be minimal to severe pain depending on the severity of the strain
- Swelling and bruising – These might not be present in milder strains and might be delayed by several days in more severe strains.
- Tenderness in the area of the muscle tear
- Decreased quadriceps strength
- Decreased quadriceps flexibility
- Pain or difficulty with walking depending on the severity of the strain
- Pain with straightening or bending the knee
What are the risk factors for quadriceps strains?
There are a few risk factors which increase the chances of a quadriceps strain. These include:
- Previous quadriceps injury
- Previous hamstring strain
- Playing certain sports
- Football
- Soccer
- Rugby
- Muscle fatigue
- Skipping proper warm up before activity
Who should I see to treat a quadriceps strain?
- Physical therapist – If the injury is mild, it will probably heal on it’s own in a week or two. However for moderate to severe strains, physical therapy is going to be needed. Physical therapists can aid in decreasing pain and swelling, increasing strength and flexibility, and returning to sport safely. It is important to have a physical therapist assist in determining when the person is appropriate to return to sport and provide direction in how to prevent the injury from reoccurring.
- Orthopedist – If it is a high grade tear or a complete rupture of the tendon or muscle is suspected, then the person would need to see an orthopedist. Imaging would be required to confirm the extent of the tear. The orthopedist would discuss options including surgical repair if the complete tear was present.
What can I do at home?
Most mild strains can be managed at home. Even if the injury is of higher grade, there are still things that you can do to help the healing process.
- Relative rest – Resting the area to decrease further pain and damage from occurring and allowing healing to begin is very important. This could include a week or two of relative rest to allow a mild injury to heal. However, it could take several weeks or months for a more severe injury. Performing other activities while the quadriceps is healing is a good way to keep up cardiovascular and muscle strength. Walking, swimming and gentle biking would be good alternative activities that do not put much stress through the quadriceps.
- Ice – Ice can help decrease the pain and swelling at the quadriceps. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or there is still swelling present. Ice immediately after activity.
- Stretching – Stretching the quadriceps is important. This allows the fibers to lengthen as they heal. Stretching will be very gentle after the initial injury. Also it is important to stretch the hip flexors, calves, and quadriceps. You will need a stretch strap, dog leash, yoga strap, or something similar. See the video below.
- Strengthen the quadriceps – You will need to strengthen the quadriceps as it heals. This is to be done slowly as to not place too much stress on the muscle too quickly. This is why having a physical therapist to guide you through the rehab process is essential. The first video is isometrics and can be done at the beginning of your healing process. The next video is more mid-stage strengthening and should only be performed when the pain has subsided significantly. There should be minimal soreness when performing the exercises and no pain afterwards. Using resistance bands and ankle weights can increase strength and difficulty of the exercises. See the videos below.
- Strengthening the core and hamstrings – It is also important to strengthen the core muscles, as well as, the other muscles in the hips and thighs. See the videos below.
In review
- The quadriceps are a group of 4 muscles on the front of the thigh.
- These muscles include the rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius.
- These are very large powerful muscles that activate to straighten the knee.
- A strain is a tear of the muscle fibers.
- The rectus femoris is the most common quadriceps muscle that is torn.
- There are grades that describe the severity of a strain.
- Symptoms of a quadriceps strain include pain in the front of the thigh.
- Physical therapy is vital for higher grade strains.
- An orthopedist will need to be consulted if a complete tear is suspected.
- There are many things that you can do to help your quadriceps.
- Relative rest
- Ice
- Stretching
- Strengthening
As always, if you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Quadriceps_Muscle_Strain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941577/