Background

The quadriceps are a group of muscles that are located on the front part of the thigh. This group consists of four muscles, which are active during jumping, kicking and running. A strain is defined as stretching or partial tearing of the muscle fibers. The muscles are typically injured by over-stretching the muscle, like during the backswing in preparation for kicking a ball. It is also possible to injure them when the contracting muscles meet resistance, like when two players kick a soccer ball at the same time. If something hits the thigh, then it will result in a quadriceps bruise, or a contusion, in the thigh.

Symptoms

A quadriceps strain will happen suddenly, and the athlete will often feel pain on the front of the thigh, but not necessarily experience a pop. The tear in the muscle fibers will result in a loss of strength of the thigh muscles. Sometimes the athlete will also have swelling and bruising at the location of the injury, and he or she may also have difficulty with bending their knee or straightening the knee against resistance. Quadriceps strains are most common in muscles that are tired and fatigued or that had a previous injury.

Sports Medicine Evaluation and Treatment

A sports medicine physician will evaluate the athlete to determine the injury. He or she will perform a detailed physical examination to see if the patient has a defect in the thigh and test the athlete’s strength. Initial treatment includes PRICE (protection, rest, ice, compression, and elevation) to help control pain and swelling. The physician may also recommend using an NSAID (an anti-inflammatory, such as ibuprofen). Imaging is not usually necessary, but an X-ray may be ordered if it is a younger athlete, to see if the athlete has had a more severe injury.

Many sports medicine physicians may also perform a diagnostic musculoskeletal ultrasound. This allows the physician to evaluate the degree of the injury by evaluating the muscle both at rest and while moving. If the pain continues during the rehabilitation process, they may order an MRI to evaluate the injury. The sports medicine physician will recommend a detailed rehab program that will work on strengthening and range of motion.

Injury Prevention

An early evaluation by a sports medicine physician can help prevent a rare complication of quadriceps strains, called myositis ossificans. This is abnormal growth of bone and cartilage within the quadriceps muscle after an injury. It is more common with quadriceps contusions and less common with strains. Proper conditioning helps decrease the risk of injury. There is a high risk of reinjuring the quadriceps, so proper rehabilitation is essential.

Return to Play

Most athletes recover very well after a quadriceps strain. The length of recovery depends on both the severity and the location of the tear in the muscle. A mild strain can take two weeks to heal, while a severe strain can take up to 2 months to heal. An athlete can return to play once they have normal knee range of motion, normal strength (when compared to the uninjured leg), and they are pain-free. The athlete should be able to participate in all the demands of his or her sport pain-free prior to returning to full participation. After the athlete returns to sports, he or she should continue to focus on strengthening the quadriceps muscles to prevent reinjury.

AMSSM Member Authors
Namita Bhardwaj, MD and Jose R. Rodarte, MD

References
Kary JM. Diagnosis and management of quadriceps strains and contusions. Curr Rev Musculoskelet Med. 2010;3(1-4):26-31. doi:10.1007/s12178-010-9064-5.
Madden CC, ed. Netter’s Sports Medicine. Philadelphia: Saunders/Elsevier; 2010.
Zakaria AA, Housner JA. Managing quadriceps strains for early return to play: the diagnosis is made clinically, but imaging may help determine the severity. J Musculoskel Med. 2011;28(7):257–262.