Quadriceps Strain

(Pulled Quadriceps)

Definition

Quadriceps strain is a partial tear of the small fibers of the muscles that make up the quadriceps group. The quadriceps are the large group of muscles in the front of the thigh. They consist of four muscles in each leg that run from the hips to the knees.
The Quadriceps Muscles
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Causes

A quadriceps strain can be caused by stretching the quadriceps beyond the amount of tension or stress that they can withstand.

Risk Factors

Factors that may increase your chance of a quadriceps strain include:
  • Suddenly putting stress on the quadriceps when the muscle is not ready for the stress
  • Using the quadriceps too much on a certain day
  • Experiencing a blow to the quadriceps
  • Doing a strenuous quadriceps activity
  • Sports that require bursts of speed or sudden twists and turns, such as running, jumping, basketball, or football
  • Fatigue
  • Tight quadriceps
  • Cold weather
  • Previous quadriceps injury

Symptoms

Quadriceps strain may cause:
  • Pain and tenderness in the front of the thigh
  • Stiffness and swelling in the quadriceps
  • Weakness of the quadriceps
  • Bruising on the front of the thigh—if blood vessels are broken
  • Popping or snapping sensation as the muscle tears—rare

Diagnosis

Your doctor will ask about your symptoms and medical history, your recent physical activity, and how the injury occurred. Your thighs will be examined for:
  • Tenderness and/or bruising directly over the quadriceps
  • Pain or weakness when contracting the quadriceps, particularly against resistance
Imaging tests evaluate your leg muscles and surrounding structures. They may include:Muscle strains are graded according to their severity:
  • Grade 1—Some stretching with micro-tearing of muscle fibers.
  • Grade 2—Partial tearing of muscle fibers.
  • Grade 3—Complete tearing of muscle fibers. This may also be called a rupture or avulsion.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment depends on the severity of the strain. Recovery time ranges depending on the grade of your injury. Treatment steps may include:

Acute Care

RestYour muscle will need time to heal. Avoid activities that place extra stress on these muscles:
  • Do not do activities that cause pain. This includes running, jumping, and weight lifting using the leg muscles.
  • If normal walking hurts, shorten your stride.
  • Do not play sports until your doctor has said it is safe to do so.
ColdApply an ice or a cold pack to the area for 15-20 minutes, 4 times a day, for several days after the injury. Do not apply the ice directly to your skin. Wrap the ice or cold pack in a towel.Pain Relief MedicationsTo manage pain, your doctor may recommend:
  • Over-the-counter medication, such as aspirin, ibuprofen, or acetaminophen
  • Topical pain medication—creams or patches that are applied to the skin
  • Prescription pain relievers
CompressionCompression can help prevent more swelling. Your doctor may recommend an elastic compression bandage around your thigh. Be careful not to wrap the bandage too tight.ElevationElevation can also help keep swelling down. Keep your leg higher than your heart as much as possible for the first 24 hours or so. A couple of days of elevation might be recommended for severe strains.

Recovery Steps

Rehabilitation with a physical therapist may be required.HeatUse heat only when you are returning to physical activity. Heat may then be used before stretching or getting ready to play sports to help loosen the muscle.StretchingWhen the acute pain is gone, start gentle stretching as recommended. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times. Stretch several times a day.StrengtheningBegin strengthening exercises for your muscles as recommended.

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Prevention

To help reduce your chance of a quadriceps strain:
  • Keep your quadriceps muscles strong so they can absorb the energy of sudden physical stress.
  • Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, including your quadriceps.
  • Warm up and stretch before vigorous activity.

RESOURCES

American Council on Exercise
http://www.acefitness.org

Family Doctor—American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES

The College of Family Physicians of Canada
http://www.cfpc.ca

Canadian Physiotherapy Association
http://www.physiotherapy.ca

References

Deleget A. Overview of thigh injuries in dance. J Dance Med Sci. 2010;14(3):97-102.

Douis H, Gillett M, et al. Imaging in the diagnosis, prognostication, andmanagement of lower limb muscle injury. Semin Musculoskelet Radiol. 2011;15(1):27-41.

Garrett WE, Kirkendall DT. Exercise and Sports Sciences. Philadelphia, PA: Lippincott Williams and Wilkins; 2000.

Muscle strains in the thigh. American Academy of Orthopaedic Surgeons. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00366. Updated March 2014. Accessed September 26, 2014.

10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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