Quadriceps Muscle Strain

Introduction

Quadriceps femoris muscle (green)

A quadriceps strain is an acute tearing injury of the quadriceps muscle. This injury is usually due to an acute stretch of the muscle, usually in conjunction with a powerful contraction or repetitive functional overload. [1]

Injuries to the quadriceps muscle group can be painful and debilitating. Quadriceps strains and contusions are common in athletics and can result in lost time in training and games. [2]

Clinically Relevant Anatomy: The quadriceps is the hip flexor and knee extensor. It is located on the front of the thigh. Check out the link to learn more. This muscle is made up of 4 subsections: rectus femoris (RF); vastus lateralis; vastus medialis; vastus intermedius.

Epidemiology

Sprinting: risk factor for RF strain

Quadriceps injuries are a common injury in athletes, and the muscle is prone to strain during certain sports that require explosive movements.

• The rectus femoris is the most common trigger for RF in quadriceps injuries, including crossing two joints, a high proportion of type II fibers, and having a complex tendon architecture [2]
• Injuries to the vastus are the least common, while the vastus intermedius is most commonly affected by contusions.
• Quadriceps tendon rupture is an uncommon debilitating diagnosis that is more common in older men. [3]

Etiology

Hurdles possible overstretched RF

Acute strains of the quadriceps are common in:

• Sports that often require sudden, powerful eccentric contractions of the quadriceps during the adjustment of knee flexion and hip extension, such as rugby and rugby.
• Eccentric contraction occurs when high forces occur on the muscle-tendon unit.
• When excessive passive stretching or maximally stretched muscle activation occurs.
• When a muscle is fatigued[2]

There are generally three mechanisms of injury for a quadriceps strain: 1. Sudden deceleration of the leg (e.g. kicking) 2. Intense contraction of the quadriceps (sprinting) and 3. Overstretched muscles decelerate rapidly (by rapidly changing direction).

Classification of Quadriceps Strains

Provided below is an overview of the clinical grading system for muscle strains. Consideration of pain loss in strength and physical examination findings in the grading system can help guide treatment for recovery and eventual return to competition. [2]

1. Grade I (mild) strains affect only a limited number of fibers in the muscle. There is no drop in strength and there is full active and passive range of motion. Pain and tenderness are usually delayed until the next day.
2. A grade II (moderate) strain tears nearly half of the muscle fibers. Acute and significant pain is accompanied by swelling and a slight decrease in muscle strength.
3. A grade III (severe) strain represents a complete rupture of the muscle. This means that either the tendon separates from the muscle belly, or the muscle belly is actually torn in two. Severe swelling and pain and complete loss of function are characteristic of this type of strain. [4]

Muscle injuries are also broadly classified as acute or chronic injuries.

1. Acute Injury: Usually the result of a single traumatic event with macroscopic damage to the muscle. There is a clear link between the cause and the apparent symptoms. They mostly occur in contact sports like football and basketball because of their dynamic and high-impact nature natural[5][6]
2. Overuse: (Chronic or exercise-induced injury) is subtle and usually lasts for a longer period of time. They are the result of repetitive microtrauma to the muscles. Diagnosis is more challenging because the link between the cause of the injury and the symptoms is less obvious. [5]

Grades of quadriceps strain

1. Grade 1 Symptoms: Symptoms of a Grade 1 quadriceps strain are not always severe enough to stop training at the time of the injury. Tingling and tightness may be felt in the thigh. Athletes may experience mild discomfort and may find it difficult to walk and run. Not too possible swelling. A lump or cramped area at the injured site may be felt.
2. Grade 2 symptoms: Athlete suddenly feels severe pain when running, jumping or kicking and cannot continue to compete. Pain can cause difficulty walking, and swelling or mild bruising may occur. Painful quadriceps tear when pressing on the suspect area. straighten Resistance of the knee against resistance will most likely cause pain, and the injured athlete will not be able to fully flex the knee.
3. Grade 3 Symptoms: Symptoms include sudden, severe pain in the front of the thigh. Patients are unable to walk without the aid of crutches. Severe swelling occurs immediately, followed by significant bruising within 24 hours. Static muscle contractions can be painful and are likely to produce a The muscles bulge. Patients are expected to be out of competition for 6 to 12 weeks. [7]

Differential Diagnosis

• Soft tissue tumours/ bone tumours
• Myositis ossificans[3]

Diagnosis

Most muscle injuries can be clarified with a thorough history and physical examination. [8]

1. The clinical history of a quadriceps strain varies from severe thigh pain and/or sports-related hip pain to vague pain or thigh enlargement and associated strength deficits. Tenderness on direct palpation is a typical finding and can often trigger pain By stretching and resisting muscle activity.
2. Imaging, especially ultrasound and MRI, can provide information about the extent, type and prognosis of muscle damage. [3]

Examination

After a thorough history is obtained, a careful examination should be performed, including observation, palpation strength testing, and motor assessment.

• Observation: The therapist carefully observes the injured area, especially for swelling and bruising. They should also observe the patient for abnormal posture when standing and walking. They may have obvious deformities, such as muscle bulges or defects abdomen.
• Palpation: Palpation of the quadriceps should be done along the entire length of the muscle and aponeurosis. This requires identification of swollen thickened tender defects and masses (if present). If fascia is tight, consider acute compartment syndrome The capsule and pain around the compartments are out of proportion to the clinical situation.
• Strength testing: Strength testing of the quadriceps should include resistance to knee extension and hip flexion. Adequate rectus femoris strength testing must include resistance knee extension with knee flexion and hip extension. In practice, this is best accomplished by assessing the patient in both sitting and and prone position. The prone position also provides the best assessment of quadriceps movement and flexibility. Pain is usually felt by patients with blocked muscles activating passive stretching and direct palpation of muscle strains.
• Assess for tenderness: Any palpable deficit and strength at the onset of muscle injury will determine the grade of the injury and provide guidance for further diagnostic testing and treatment.

Outcome Measures

• Muscle Strength Testing
• ROM.
• Voluntary activation by superimposition of transcutaneous electrical stimulation to the isometric quadriceps muscle. When the muscle is fully activated, electrical stimulation produces no additional force above voluntary contraction.

Medical Management

Management of quadriceps injuries depends on the type and location of the injury. A complete tear of the quadriceps tendon and loss of the extensor mechanism requires surgery and reattachment of the quadriceps tendon. See Surgery for Ruptured Muscle. [3] All other quadriceps injuries can be managed An early conservative use of an accepted approach to treating muscle strains was the RICE (Rest Ice Compression and Limb Elevation) principle or the POLICE principle.

Physical Therapy Management

Acute phase: An initial rest period may be used as a measure to prevent further deterioration of the injury, and more severe strains may require the initial use of crutches. Limb elevation and intermittent ice and compression aimed at reducing blood flow and increasing blood volume Interstitial fluid accumulation. Ice compresses also have an analgesic effect and can be supplemented with nonsteroidal anti-inflammatory drugs (NSAIDs) initially. The use of NSAIDs remains controversial and their benefit costs and potential adverse effects may be considered consider. If used, it should be during the inflammatory phase (48h-72h) [9].

Knee Positioning: When a quadriceps strain occurs during a game or practice, it is important to respond immediately. Immediate flexion of the knee of the affected leg to 120° is required within 10 minutes of trauma. [9][10] This avoids potential muscle spasm reduction bleeding and minimize the risk of developing myositis ossificans [10]. In practice, this can be achieved by placing the patient in a hinged knee brace with the knee flexed to 120° or using an elastic compression wrap to maintain this flexed position. If the knee is left with extension therapy The process will be slower and more painful because the quadriceps will begin to heal in the shortened position. [10]

Active Phase of Management

Quadriceps Stretch

Hip Flexor Stretc

Once the injured leg has recovered well, the acute phase of treatment is followed by an active management phase. This stage usually begins about 3-5 days after the initial injury, depending on its severity. Stretching enhances aerobic range maintenance Fitness proprioceptive exercises and functional training are major components of this phase [11].

1. Stretching: Stretching should be done carefully and always to the point of discomfort but not pain. Various techniques can be used, including passive active-passive dynamic and proprioceptive neuromuscularly facilitated stretching. Ballistic stretching is generally discouraged because Risk of re-tearing muscle fibers. If there is no pain, stretch the quadriceps.

Static quadriceps stretch: This can be done standing or lying down in front of you. Pull the foot of the injured leg toward the buttock until you can feel a slight stretch in the front of the thigh. To increase the stretch, lean your hips back. Hold for 20-30 seconds and repeat 3 times. Do Take at least 3 times a day.

Hip Flexor Stretch: This stretch will focus on the rectus femoris and iliopsoas muscles. Kneel on one knee on the floor, extend the other foot forward, and bend the knee. Push your hips forward and keep your back straight. You should feel a stretch in the front of your buttocks and top of your thighs. hold down Repeat at least 3 times a day for 20-30 seconds.

2.Strengthening exercises:

The purpose of strengthening exercises is to gradually increase the load on the muscles. Strengthening exercises can start as early as day 5, as long as they are low-intensity and performed pain-free. Isometric or static exercises are recommended first, followed by dynamic exercises Resistance bands and complete sport-specific running and sprinting workouts. The principles of muscle injury treatment lack scientific basis [1]

• Axonometric view: initial axonometric view, quadriceps contracted, knee fully extended, and in various positions in 20 degree increments, as knee flexion improves, when the patient can sit comfortably, possibly Stop the isometric drawing.

[12][13] Straight Leg Raise: Sit flat on the floor with your legs straight out in front of you. Lift one leg off the ground, keeping the knee straight. Hold for 3 to 5 seconds, then lower back to the ground. Repeat 10 to 20 times. This exercise can be done every day. Advance the practice by Increase the length of the hold and the number of repetitions. Isotonic: Once the terminal knee extension is done correctly, with no extensor lag, free weights are added to the SLRs and terminal knee extension. Start with the lightest free weight the patient can lift; three sets of 10 repetitions, up to three sets several times a day. Gain no more than 2-3 pounds at any given time and no more than every two consecutive workdays. Wall squat: Slowly lower your body from your starting position and hold for a while. As you progress, you can extend the amount of time you spend squatting against the wall. Sure Keep your pelvis back and your head against the wall. Keep moving pain free. (A variation to increase VMO activation is to squeeze a ball between the knees while performing the exercise. Typically the ball is about 12 inches in diameter.) Perform 3 sets of 15-20 second holds Once a day. [14] Stepping: Start with a box height that allows you to step comfortably. Be sure to keep your knee aligned with your second toe. Strengthen and keep the pelvis level and knees aligned. Be sure to engage your glutes and lock your knees out completely. return Slowly return to the ground. The emphasis should be on a slow eccentric (lowering) back to the ground, 1 second up and 3 seconds down. Perform 2 sets of 15-20 repetitions per day. Tip: Stand facing the steps. Place the affected leg on a step. Step up place your other leg on Take one step, then return to the starting position with the same leg. Make sure your knees move forward over your toes during this exercise. Your affected leg will remain on the step throughout the exercise. Example of rehabilitation program [15] Acute phase week 1-2 Goals: Pain relief and Inflammation gradually improves flexibility and ROM Delays muscle atrophy and loss of strength Strengthens healing of muscle strains Preventive measures Avoid excessive active or passive lengthening of the quadriceps RehabRICE–Rest Cryotherapy Compression wrap and elevation Initially use crutches to facilitate Rest and Immobilization of Quadriceps NSAIDsSoft tissue mobs/IASTM Pulse Ultrasound (Duty Cycle 50% 1 MHz 1.2 W/cm2) Conventional TENS Ankle Pump Isometric Quadriceps Group Hamstring Group Excess Group Phase 2: Secondary Phase (Weeks 3 – 12) Goals Recovery Pain-Free Quadriceps Strength Progression Pass Complete ROM Develop neuromuscular control of the trunk and pelvis Gradually increase motion and speed in preparation for functional movement Precautions If painful, avoid prolonged quadriceps rehabilitation Cryotherapy NSAIDs Electrical stimulation Complete quadriceps Initial isometric diagram of muscle contraction Knee fully extended and in different positions in 20 degree increments as knee flexion improves Isometric contraction can be stopped when sitting comfortably Straight leg raise isotonic at 0 degrees, 20 degrees and 40 degrees— —start with the lightest free weight the athlete can lift; Three sets of 10 repetitions, up to 3 times per day Perform terminal knee extension in 20 degree increments as comfort and knee flexion allow No more than 2-3 pounds at any given time, and no more than every two consecutive workdays Add about 15-20 pounds when the athlete is near his or her maximum weight Try isokinetic exercise Conditioning with upper body exercises Swimming Treadmill Walking Cycling When Knee ROM is Greater Flexion over 100 degrees Phase 3 (week 12+) Goals Symptom-free in all activities Achieve normal concentric and eccentric strength with full ROM and speed Improve neuromuscular control of the trunk and pelvis Integrate postural control into specific movements Precautions for Asymptomatic Training Intensity Rehabilitation Ice – Post – As Needed Treadmill Moderate to High Intensity Isokinetic Eccentric Training (Hyperflexion) STM/IASTMP Isokinetic Jumping 5-10 Yards Acceleration/Deceleration Single Limb Balance Windmill Contact Unstable weight surfacesport-specific drills that incorporate positional control and progressive speedEccentric protocol including higher speed eccentric Ex, including plyometric and exercise-specific activities Examples: including squats jumps split jumps jumps jumps and deep jumps single leg jumps jumps backwards Lateral jumps Lateral jumps Zigzag jumps Boundary-enhanced box jumps Eccentric backward steps Eccentric lunge drops Eccentric forward pulls Single and double leg deadlifts and split stance deadlifts (Good Morning Ex) Return to sports standards Full power pain free in extended state Test Site Complete ROM Painless Reproduces sport specific movement at race speed, asymptomatic. Isokinetic force testing should be performed under concentric and eccentric motion conditions. Knee flexion 120°, hip extension [16] Clinical baseline Acute Quadriceps strains commonly occur in sports such as rugby and rugby. These movements typically require a sudden, powerful eccentric contraction of the quadriceps to regulate knee flexion and hip extension. Greater force across the muscle-tendon unit Eccentric contractions can cause strain injuries. Excessive passive stretching or activation of the most stretched muscle can also lead to a strain. Of the quadriceps, the rectus femoris is most commonly strained. There are several factors that make this muscle and other muscles more frequently strain. These include muscles that cross both joints with a high proportion of type II fibers and muscles with complex tendon structures. Muscle fatigue has also been shown to play a role in acute muscle injury. Treatment is based on 3 principles: 1. Police or RICE2. knee Mobilization 3. Quadriceps functional training