Quadriceps Muscle Strain

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Original Editors - Maxime Tuerlinckx

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Search Strategy

Databases: Pubmed, PeDro, eMedicine, Medscape

Keywords: quadriceps muscle strain, muscle strain, strain injuries, strain injuries treatment, rectus femoris strain injury,...

Definition/Description

A quadriceps muscle strain is an acute tearing injury of the quadriceps. This injury is usually due to an acute stretch of the muscle often at the same time of a forceful contraction or repetitive functional overloading. The quadriceps which consists of four parts, can be overloaded by repeated eccentric muscle contractions of the knee extensor mechanism.[7] When the muscle is elongated by an eccentric contraction, high muscle forces are generated during the elongation and added to the forces produced by the passive connective tissue so it almost certainly induces a muscle strain injury. This force is several times higher than the force produced during a maximal isometric contraction.[1,5]

Clinically Relevant Anatomy

The quadriceps femoris acts as a hip flexor and knee extender. This muscle is composed of 4 subcomponents:
-M. Rectus femoris
-M. Vastus medialis
-M. Vastus lateralis
-M. Vastus intermedius

The M. Rectus femoris is the only part of the muscle participating in both flexion of the hip and extension of the knee. [8] The other 3 parts are only involved in the extension of the knee. The M. rectus femoris is the most superficial part of the quadriceps and it crosses both the hip and knee joints. So it is more susceptible to stretch-induced strain injuries. [1] The most common sites of strains are the muscle tendon junction just above the knee (both distal and proximal but most frequently at the distal muscle-tendon) and in the muscle itself.[5]

Mechanism of injury

There are generally three mechanisms for quadriceps strain.
(1) Sudden deceleration of the leg (kicking),
(2) violent contraction of the quadriceps (sprinting) and
(3) rapid deceleration of an overstretched muscle (by quickly change of direction).

The most commonly strained quadriceps muscle is the M. Rectus Femoris, because he crosses two joints and has a high proportion of type 2 fibers. [10,11]

Risk Factors

The strongest risk factor for developing a quadriceps muscle strain injury is a recent history of this injury and the next strongest risk factor is a past history of a quadriceps muscle strain. Other risk factors for this injury may include low muscle strength or when there is a imbalances between the quadriceps and the hamstrings, limited flexibility, muscle fatigue, a poor technique, and when there was not a warming up before the exercices or a bad warming up. [10,11]

Characteristics/Clinical Presentation

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Differential Diagnosis

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[[|]]Diagnostic Procedures

Muscle_Injuries 

Outcome Measures

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Examination

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Medical Management

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Physical Therapy Management

When a quadriceps muscle strain occurs during a competition or training, it is important to react immediately. In the 10 minutes following the trauma immediately put the knee of the affected leg in 120° of flexion.[2,3] This avoids potential muscle spasms, reduces the hemorrhage and minimizes the risk of developing myositis ossificans (myositis ossificans: emedicine.medscape.com/article/327648-overview). [2] If the knee is left in extension the healing process will be slower and more painful because the quadriceps will start to heal in a shortened position. [2,3] The rest of the therapy during the healing process is based on the RICE therapy. This includes Rest, Ice treatment for 20 minutes every 2-3 hours, Compression with an ACE bandage and Elevation.[2,6. This hasn’t been proved in scientific literature, but it is commonly used by physiotherapists and doctors] Before to turn back to normal activities, the patient should do some exercises and stretching to reinforce the quadriceps and hamstrings- muscle. The exercises can be isometric, isotonic, isokinetic and in a later stage of the revalidation sport- or ADL-specific.[3] -isometric: muscle contraction without change in muscle length (mostly against a fixed object). -isotonic: muscle contraction against a constant resistance with a shortening/lengthening of the muscle. -isokinetic: muscle contraction by a specific movement (e.g. flexion-extension of the knee).
All of these exercises should be done in a range of motion that is pain-free. These strengthening exercices will also help in preventing from a new strain injury[3]

Key Research

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Resources

1.Thomas M De Bernardino, MD; Leslie Milne, MD. Quadriceps injury. 19 januari 2010 http://emedicine.medscape.com/article/91473-overview (D)
2.Michael A Herbenick, MD; Michael S Omori, MD; Paul Fenton, MD. Contusions. 17 april 2009 http://emedicine.medscape.com/article/88153-overview (D)
3.Thomas M De Bernardino, MD; Leslie Milne, MD. Quadriceps injury: Treatment&Medication. 19 januari 2010 http://emedicine.medscape.com/article/91473-treatment (D)
4.Thomas M De Bernardino, MD; Leslie Milne, MD. Quadriceps injury: Differential Diagnosis&Workup. 19 januari 2010 http://emedicine.medscape.com/article/91473-diagnosis (D)
5. T. Kirkendall,PhD, William E. Garrett Jr., MD, PhD. Muscle strain injuries: Research findings and clinical applicability. Medscape general medicine. 22/03/1999 http://www.medscape.com/viewarticle/715533 (C)
6.Elizabeth Quinn. Quadriceps muscle group- Quad injuries, pulls and strains: Diagnosis, treatment and prevention of quad injuries, pulls and strains. About.com guide. 08/02/2010 http://sportsmedicine.about.com/cs/leg_injuries/a/aa031501a.htm (D)
7.Joel M. Kary. Diagnosis and management of quadriceps strains and contusions. Curr rev Musculoskeletal Med. October 2010. (published online 30/7/2010) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941577/ (D)
8.Prof. Dr. J.P. Clarys, Prof. Dr. P. Van Roy, Drs. S. Provyn, Prof. Dr. E. Cattrysse, Drs. V. Janssens. Compendium topografische en kinesiologische ontleedkunde. 3rd edition 2009 (D)
9.R. Putz, R. Pabst. Sobotta: Atlas of human anatomy, Elsevier 14th edition. P 564-574 (D)

Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

10. Robert A. Pedowitz, Donald Resnick, Christine B. Chung, 2008, Magnetic Resonance Imaging in orthopedic sports medicine, Springer, 445p.
11. Douglas B. McKeag, James L. Moeller; second edition, ACSM’s Primary Care Sports Medicine,2OO7, Lippincott Williams & Wilkins, 656p.