Quadriceps muscle strain is an acute tearing injury of the quadriceps femoris. This injury is usually because of an acute forceful stretch of the muscle, often at the same time as a forceful contraction or repetitive functional overloading. Repeated eccentric muscle contractions of the knee extensor mechanism can overload the quadriceps which comprises four parts, comprises four parts, can be overloaded by repeated eccentric muscle contractions of the knee extensor mechanism.
Acute strain injuries of the quadriceps commonly occur in athletic competitions such as soccer, rugby, and football. These sports regularly require sudden forceful eccentric contraction of the quadriceps femoris during regulating knee ﬂexion and hip extension.
Higher forces across the muscle-tendon units with eccentric contraction will result in strain injury.
Excessive passive stretching or activation of a maximally stretched muscle also can cause strains.
Of the quad muscles, the rectus femoris is most frequently strained.
Several factors incline this muscle and others to a lot of frequent strain injury. These include muscles crossing two joints, those with a high proportion of Type II fibers, and muscles with complex musculotendinous architecture. It has also shown muscle fatigue to perform a role in acute muscle injury.
The quadriceps femoris is a hip flexor and a knee extensor. It is in the anterior compartment of the thigh, comprising four muscles:
- Rectus Femoris
- Vastus Lateralis
- Vastus Medialis
- Vastus Intermedius
The rectus femoris is placed in the middle of the front of the thigh; it is fusiform, and it arranges its superficial fibers in a bipenniform manner, the deep fibers running straight down to the deep aponeurosis.
Attachment: Rectus Femoris originates from the anterior inferior iliac spine and the part of alar of ilium superior to the acetabulum. Rectus Femoris together with other quadriceps and joins the quadriceps tendon to insert at the patella and tibial tuberosity.
Nerve Supply: Femoral nerve, derived from lumbar nerves 2, 3, and 4 nerve roots.
Blood Supply: Descending branch of the lateral circumflex femoral (LCF) artery.
Function: Its functions are to flex the thigh at the hip joint and to extend the leg at the knee joint.
The vastus lateralis is situated on the lateral side of the thigh. Together, the quadriceps acts on the knee and hip to promote movement and strength and stability. They provide power for and absorb the impact of daily activities such as walking, running, and jumping.
Attachment: Upper inter-trochanteric line, the base of the greater trochanter, lateral linea aspera, lateral supracondylar ridge, and lateral intermuscular septum. Lateral quadriceps tendon attached to the tibial tubercle.
Nerve Supply: Femoral nerve (L3,4), Posterior division.
Blood Supply: Lateral circumflex femoral artery
Function: Together with other muscles of the quadriceps group, it serves to extend the knee joint, moving the lower leg forward.
The vastus medialis is an extensor muscle situated medially in the thigh that extends the knee. The vastus medialis muscle is part of the quadriceps muscle group.
Attachment: Lower part of the intertrochanteric line, along the spiral line to the medial lip of the linea aspera, the medial intermuscular septum and the aponeurosis of adductor magnus. It inserts into the medial side of the quadriceps tendon, joining with rectus femoris and the other quadriceps muscles, enveloping the patella, then by the patellar ligament into the tibial tuberosity. Increase the mechanical advantage of the knee joint to perform knee extension by other heads of quadriceps.
Nerve Supply: Posterior division of the femoral nerve derived from L2, 3, and 4.
Blood Supply: The femoral artery and branches from the profunda femoris artery.
Function: Vastus medialis, together with the other muscles that make up the quadriceps femoris, extends the knee joint.
Vastus Intermedius is located centrally, underneath Rectus femoris in the anterior compartment of the thigh and on each side of it: Vastus medialis and Vastus Lateralis, respectively. It is one of the four muscles that form the quadriceps femoris muscle.
Attachment: Originating from the upper two-thirds of anterior and lateral surfaces of the femur and the intermuscular septum. It inserting via the Quadriceps femoris tendon to form the deep part of the tendon and then inserts into the lateral margin of the patella.
Nerve Supply: The Vastus Intermedius innervated by a branch of the Femoral nerve, derived from lumbar nerve 2, 3, and 4 nerve roots.
Blood Supply: The descending branch of the lateral circumference femoral artery supplies this muscle.
Function: Together with other muscles that are part of the Quadriceps femoris, it facilitates knee extension.
Quadriceps Muscle Strain Causes
There are four types of skeletal muscle injuries: muscle strain, muscle contusion, muscle cramp, and muscle soreness.
Literature studies do not reveal great consensus for classifying muscle injuries, despite their clinical importance. However, the most differentiating factor is the trauma mechanism. We can broadly classify muscle injuries as either traumatic (acute) or overuse (chronic) injuries.
Acute injuries are usually the result of a single traumatic event and cause a micro-trauma to the muscle. There is an obvious link between cause and any noticeable symptoms.
They principally occur in contact sports like rugby, soccer, and basketball because of their dynamic and high collision nature.
Overuse, chronic injuries are subtler and usually take place over a longer time. They result from repeated microtrauma to the muscle. Diagnosing is more challenging since there is a less obvious link between the cause of the injury and the symptoms.
Grades of Quadriceps Strain
It grades strains 1 to 3 depending on how bad the injury is, with a grade 1 being mild and a grade 3 involving a complete or near-complete tear of the muscle.
- Grade 1 symptoms
Symptoms of a grade 1 quadriceps strain are not consistently serious enough to quit training at the time of injury. A twinge may feel in the thigh and a feeling of tightness. The athlete may notice that mild discomfort on walking and running might be troublesome. There is unlikely to be swelling. An area of spasm at the site of injury may be felt.
- Grade 2 symptoms
The athlete may notice a sudden sharp pain when running, jumping or kicking and inadequate to play on. The pain will make stepping difficult and swelling or mild bruising may be noticed.
The pain would be felt once pressing in on the suspected location of the quad muscle tear.
The knee against resistance is likely to cause pain, and the injured athlete cannot fully bend the knee.
- Grade 3 symptoms
Symptoms include severe, sudden pain in the thigh’s front. The patient cannot walk without the help of crutches. Bad swelling will show immediately and significant bruising within 24 hours. A static muscle contraction will be unpleasant and likely to produce a nodule in the muscle. The patient can be out of competition for 6 to 12 weeks.
Quadriceps Muscle Strain Management
Using NSAIDs (nonsteroidal anti-inflammatory drugs) is still controversial, it may take their benefit, cost, and potential adverse effects into consideration. If accepted, it should be during the inflammatory period (48h-72h). You can treat minor injuries with the RICE technique at home.
Quad and Hamstring Support – Upper Leg Sleeves
It may need surgical intervention if there is a complete quadriceps muscle rupture. There has been an experimental study (1998) about the use of hyperbaric oxygen therapy. It should apply the therapy during the early phase of the repair of the injured muscle. This therapy could speed up the repair of the injured muscle. It should take care to extend these findings to clinical practice, as there is not enough scientific evidence on the use of hyperbaric oxygen therapy in the treatment of muscle or other soft tissue injuries in athletes.
Quadriceps stretching should be done carefully and always to the point of discomfort, but no pain. It can use various techniques, including passive, active-passive, dynamic, and proprioceptive neuromuscular facilitation stretching. It discourages ballistic stretching because of the risk of re-tearing muscle fibers. If it is pain-free, stretch the quad muscles.