Quadriceps Muscle Tears & Strains
Your quadriceps are a group of muscles are located on the front of your thigh and extend down to just below your kneecap. Your quadriceps tendon then passes over your kneecap, connects to your patellar tendon and can be felt as bump (inserts into the tibial tuberosity) on the front of your shin just below your knee. In Latin quadriceps means "four heads" or four muscles. These long muscles are at high risk for muscle strain because they cross both the hip and knee joints.
The quadriceps muscles relate directly to the hamstring muscles as the hip moves and the knee flexes during athletic activities. Therefore, a strain or tear in the hamstring muscles or the quadriceps muscles directly affects the stress or load placed on the other. A quadriceps muscle strain refers to damage in the muscle fibers and possibly their associated tendons in the anterior upper thigh. This can happen with a seemingly innocent movement, like lifting, changing direction suddenly, and twisting. Many athletes will strain a muscle as a result of their sport, but weekend warriors who are active only occasionally are more vulnerable to muscle injuries, especially if they don't warm up and stretch properly.
The upper leg muscles provide your knees with mobility (extension, flexion and rotation) and strength. Your quadriceps muscles are located on the front of your thigh and extend down to just below your kneecap. They work closely with your hamstring muscles (back of your thigh), your gluteal muscles, and your calf muscles to move your leg, knee and hip.
These tendon and muscles work to help to stabilize your knee. Hip flexors, two muscles that work together to work your knee are the rectus femoris is the longest quadriceps muscle; it connects your hip and knee joint. And, the sartorius muscle is a rotator of the tibia that works with your quadriceps to help straighten your knee and flex the hip - (contract, relax, flexed and extended), you are able move your knee from a bent position to a straight and move your knee from a straight to a bent position (as seen in kicking motions). The quadriceps muscles in the front of the leg, hamstring muscles in the back, and adductor muscles on the inside are responsible for the trunk and legs' multi-directional movements.
The muscles primarily responsible for bringing the leg forward from the hip are the psoas and rectus femoris. The hamstring and gluteus maximus bring the leg behind the body from the hip. The adductor magnus and adductor longus draw the leg to this inside of the body. The gluteus medius, gluteus minimus and tensor fascia lata bring the leg towards the outside of the body. They are also the group of muscles responsible for stabilizing the hip, especially with weight bearing activities.
When straining a muscle in the thigh, it is common that more than one muscle and possibly the associated tendon can be affected. There are varying degrees of muscle strain injuries. Some are mild and can heal well with conservative treatment. Severe muscle injuries, also known as ruptures, are usually a result of a traumatic injury such as a fall or an accident and may accompany a fracture.
Symptoms of a Quadricep Muscle Strain
Thigh muscle pain symptoms can be mild to extreme based on the level of your injury. A sharp pain or pulling may be felt in the area of the pull, strain or tear. This can radiate along the length of your quadriceps muscle up to your hip and pelvis, and/or down through your knee.
You will feel tightness, tenderness and/or muscle spasms in your thigh (quadricep) muscle after and acute injury or during active and resistive movements. Point tenderness may also be felt, especially when touched. If you have a chronic injury, you may feel more of a dull ache that lasts for long periods of time.
You may experience stiffness or decreased range of motion, such as difficulty fully flexing your knee, or stretching your thigh. Tightness in your rectus femoris muscle can pull your pelvis forward creating a sway back and causing hyperextension in your knee. This is very common in gymnasts, ballerinas and soccer players.
Swelling in your quadriceps muscles is a result of your tissues becoming inflamed; this normally occurs just above or below a more severe quadriceps strain or tear. Warmth and redness may accompany swelling in severe cases. You may also feel a gap, dent, bulge or thickening in your muscle or tendon that is not normally present.
Weakness or complete loss of function of your quadriceps muscle can also be experienced as a result of a quadriceps strain. This along with your other symptoms may make it difficult for you to walk or run and can result in you walking with a limp.
Occasionally, bruising (broken blood vessels) and discoloration (black, blue and/or purple) over your quadriceps muscle may appear immediately or after a few days with severe quadriceps strains.
Grinding and crackling (crepitus) in your knee can result from improper tracking of your kneecap.
A popping or snapping sensation on the front of your thigh can often be heard and felt when your quadriceps muscles are tearing. This doesn't happen very often.
Thigh Muscle Pull Severity
There are three grades of quadriceps muscle strain injuries.
Grade 1, Minor - thigh muscle pain involve lengthening of your quadriceps muscles which results in slightly pulled or excessively stretched muscles, or very tiny tears in your muscles. You will feel some specific area pain, tightness or muscle spasms in your thigh, just above or below your injury, but you shouldn't experience any swelling or a major loss of strength. These symptoms may lessen with activity, but will return with a extreme pain afterwards. You may find it difficult to extend your knee or flex your hip, and you may walk with a slight limp.
Grade 2, Moderate - thigh muscle pain are more painful and involve a partial tearing of the quadricep muscles, tendons, and/or at the tendon attachment to your bone. You will generally experience some pain that radiates through your leg during activity, while straightening your knee against resistance, or when you touch your thigh. Swelling, stiffness, decreased strength and range of motion (may not be able to fully bend your knee) will be apparent and can also cause you to limp. You may also experience some bruising due to bleeding within the injured muscle.
Grade 3, Severe - thigh muscle pain involve a complete tear (rupture) of your one of your quadricep muscles. Where your muscle belly attaches to your tendon or where your muscle belly rips in 2 separate pieces. The type of thigh muscle injury is very painful. You will may experience a burning or stabbing pain, a lot of swelling in the muscle and minimal strength, which may prevent you from walking without crutches or make it difficult for you to move your leg (can't do a straight leg raise). Discoloration and widespread bruising in the injured area as a result of bleeding in the muscle tissue can also occur. You may notice a break/bulge in your normal muscle outline that makes a gap under your skin where the muscle has come apart.
The majority of thigh muscle injuries are a result from jumping which causes sudden stretching or repeated contraction. Acute tears or avulsion fractures tend to occur following a direct blow to the muscle during kicking, a sudden burst of speed, pushing off to jump, going uphill or falling on a partially bent knee. Tears can also result from tendinosis or previous knee/tendon surgeries (knee replacements, ligament surgeries, especially the ACL). If your quadriceps tendon tears your kneecap will lose its anchoring support in your thigh, and your knee cap will move down towards your foot. You won't be able to straighten your knee or put any weight on your leg, as your body won't be able to hold your knee in a straightened position.
Causes of a Thigh Muscle (Quadriceps) Strain
Quadriceps muscles are normally injured during very active sports where there's sudden speed increase and/or explosive jumping (running, track & field, baseball, football), a sudden change of direction and/or strenuous kicking motions (squash, tennis, soccer, karate, kickboxing), or heavy overloading (weightlifting or leg presses on machines). During dynamic activities you often load your hip joint by up to eight times your body weight, which can put a lot of continuous pressure on your quadriceps.
Muscle exhaustion and fatigue decrease your strength, power and endurance which increase your risk for injury. Overstretching, overexertion and overuse of your quadriceps muscles occurs frequently in sporting activities and/or daily life. When you have not warmed-up and stretched properly before moving, your muscles aren't ready for the stress, therefore your chances for injury are increased. Doing too much, too soon, too fast, or exercising and moving about in cold weather, puts you at even more risk for thigh muscle injuries. Sometimes you will get a pulled thigh muscle doing very simple tasks like jumping off a higher surface, or running after your kids or the bus.
Utilizing poor technique (under-striding: running at full speed then slowing down too quickly), improper equipment (old shoes) or hard and uneven training surface during activities will often put your body at a higher risk for injury. These will also make you feel more tired as the inefficient movements require you to use more energy to complete tasks than required.
Repeated quadriceps injuries are very common. You lose the function and strength of your thigh (quadriceps) over time, and encourage inflammation, scar tissue and calcification development, so these damaged parts never heal properly. Impatience and not letting injuries heal, so your body can return to peak performance level is often the reason for repeat injury. Previous injuries to your lower back, pelvis, thighs, hips, knees, and/or calf can also encourage a thigh muscle injury (especially if they haven't healed properly).
The above causes are often self-imposed; which means with a little self-management you can have some control over the outcomes. However, the following conditions can make you more prone to quadriceps injuries and are often the cause of a number of the above situations.
Muscle imbalances or weakness in your muscles (especially in your quadriceps and hamstrings, or your lower back and pelvis muscles) can cause strength differences and poor coordination that results in pulled quadriceps muscles. Your thigh muscles are normally stronger they your hamstring. There are cases where the hamstring are stronger, common with runners and teenage girls often have a vastus lateralis muscle that overpowers their weaker vastus medialis muscle. This occurs because their muscles can't keep up with the widening of their hip bones. If no stretching or extra strengthening of the vastus medialis is done, it can result in knee locking, kneecap tracking issues and other knee discomfort.
Tight quadricep muscles often result from not stretching properly before your activities. However, shortened and tightened muscles, spine stiffness and poor flexibility can be hereditary and/or a side-effect of aging; this is seen more frequently in men than women. All of these can cause a lot of pressure on your body (injured psoas and iliacus which causes weakness in hip flexion, restricts your lower back movement and the femoral nerve) and require a lot of work on your part with daily stretching.
Alignment issues, leg length differences, or which affects the way your foot hits the ground when you walk (overpronation or supination) can put a lot of stress on your quadriceps muscles and result in a pulled thigh muscles. These often add to the imbalance in your quadriceps and hamstrings.
A general summation of the most common causes of a quadricep injury is as follows:
- Not warming up properly
- Inactivity followed by sudden activity
(i.e. a game of football on the weekend)
- A traumatic fall or accident
- Quadricep muscle fatigue
- Activity during cold weather, which causes muscles to contract
Other factors that can put extra tension on your quadriceps and increase your risk of injury to your thigh muscles would be:
- Poor fitness levels and lack of exercise
- Poor nutrition and obesity
- Posture irregularities (lumbar lordosis)
- Neural tension (scar tissue around the nerves)
- Diabetes, gout, rheumatoid arthritis, renal (kidney) failure or bleeding disorders
Diagnosing a Quadricep Strain
To help your doctor give you a diagnosis, he/she will begin with your medical history, current condition and symptoms. He/she will ask how much pain you are having, if you heard a popping noise when you first experienced your injury, how long you have had the type of symptoms and limitations that you are experiencing. Further details will be requested - such as about what brought about your problem, when it started, and whether or not you have ever had treatments for this or a similar condition in the past. All this information will be very helpful in assessing your injury.
A physical examination done by your doctor will look and feel the muscles, bones and other soft tissue in and around your knee and thigh (quadriceps muscles), as well as your entire leg/knee, pelvis and lower back, to evaluate sameness (symmetry), recognize differences and identify pain and tenderness. This will help in the discovery of any abnormalities such as mild or severe inflammation, fluid, bruising, bone or tissue deformity, and leg length discrepancies. He/she may ask you to complete a series of flexing and extending leg movements to see what motions cause pain, weakness, tightness, or instability. Your doctor will also likely test for the grade of muscle strain and try to identify any muscle imbalances. Generally with a strain you will experience resisted extension and pain, whereas with a tear you will not be able to complete a straight leg raise. The physician will also evaluate your feet and gait (the way you walk) to determine if you overpronate, or have other alignment issues.
Most Common Quadriceps Injury Diagnostic Tests:
Most grade 1 or 2 quadriceps strains don't require diagnostic testing. The severity of quadriceps injuries can often be missed, hidden or underestimated because swelling and bleeding can occur deep within the muscle. Without a diagnostic test, it can be difficult to separate a fractured kneecap from a quadriceps tendon tear.
X-rays will provide a two-dimensional image of the overall structure of your upper leg (pelvis, femur and knee). They are helpful in pointing out instability, fractures, abnormal bone shapes (bone spurs, calcifications or cysts, joint degeneration), and/or other leg problems.
MRIs (magnetic resonance imaging) will provide more detailed information and will help the doctor see soft tissues in and around your area of injury (muscles, tendons, ligaments, fascia, and other connective tissues). The accuracy of an MRI will most likely provide your doctor with plenty of information to determine the grade of your thigh muscle tear. The MRI will also determine if there is additional ligament or tendon damage, inflammation, tendinopathies and many other associated conditions.
Should you seek medical attention?
This is up to your discretion; however any continued discomfort in your thigh area should be investigated. If you continue to experience the thigh muscle related injury symptoms and have tried the suggested conservative treatments for 2 -3 weeks, it is recommended that you seek professional medical attention. It is recommended you seek immediate attention if you:
- hear a "loud pop" in your muscle when injured
- have immediate severe pain, swelling or discoloration in your quadriceps
- experience severe weakness in your leg (compared to other leg) and have difficulty walking
- experience severe weakness in your leg (compared to other leg) and have difficulty walking
- have a temperature over 100.4 degrees F (38 degrees C)
- notice blue toe nails, numbness or coldness below your injury
Preventing Quadriceps Injuries
It is always better to prevent injuries rather than try to fix them after they happen, however that is not always the situation. A thigh muscle strain can be difficult to prevent as your major symptoms may start long after you've had the condition. In any case, there are a number of things you can do to keep yourself healthy and prevent further damage.
Maintain a strong and proper posture, and wear proper footwear and gear for your activity. This will ensure your body is properly aligned, and will prevent against slouching or bad form which will make you more prone to injury. Your equipment should be comfortable and provide enough padding (knee or thigh pads), and your shoes should provide sufficient sole stiffness and arch support.
Avoid doing too much to soon to give your body an opportunity to build up its endurance. This is especially important when participating in a new activity. Gradually increase your participation to prevent overstraining your muscles.
Always warm up your muscles (especially your leg muscles) before working them to prepare your body and to raise your body temperature (15-20 minutes is the recommended time). Recovery from your activity can be enhanced by doing a cool down to lower your body temperature and relax your muscles.
To stabilize your thigh muscles, and increase your range of motion, maintain and build your strength, stability and flexibility of your quadriceps as well as your hamstrings, IT band, lower leg, gluteal, pelvis, low back and core body muscles. Light weights, exercise bands and balls are very beneficial for strengthening your lower body. Core balance training and exercises to develop strength, speed and agility, such as jumping or bounding movements (plyometrics). Yoga, tai chi, or a daily stretching routine will help to keep your muscles and joints supple - avoid sudden twisting and turning motions.
A regular exercise program that focuses on total body fitness and includes low-impact aerobic activity at least 3 days per week, such as walking, swimming or biking will help to keep you healthy overall and will strengthen your body to prevent against further quadriceps injuries.
Proper food and fluid intake prior to and/or during activities will ensure you have enough energy and will help to prevent against fatigue. Ensure you avoid dehydration which can lead to muscle cramping. Weight loss and/or weight maintenance involves eating a balanced diet full of protein, complex carbohydrates, fats, vitamins, minerals, phytochemicals and antioxidants which will help support a healthy system. If you gain just 10 pounds, your joints must bear from 25 up to 100 pounds extra, which can add unnecessary stress to your body. Limiting your caffeine, alcohol and nicotine consumption will also improve your health.
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