Quadriceps muscle tears occur frequently in runners and sportspeople. They cause muscle pain and reduced function, often stopping people from enjoying sports. What is a quadriceps tear, and how do we manage it?
What is the quadriceps muscle?
The quadriceps muscle is located at the front of the thigh. It comprises four muscle parts, with the rectus femoris muscle in the middle. The muscle starts at the hip and passes down over the tibia to attach to the lower leg. Its function is to bend the hip (hip flexion) and straighten the knee (knee extension). We use this muscle to run, jump, and kick.
What does a quadriceps tear feel like?
Quadriceps tears occur more commonly in rugby and football. These sports require high explosive forces, making the muscle vulnerable to tearing. The rectus femoris part of the quadriceps muscle is more frequently injured.
Generally, sportspeople report sudden pain when sprinting, changing direction, jumping, or kicking. These athletes often know that they’ve pulled their quad muscles and usually find it challenging to keep going. Sometimes, we see significant swelling or bruising after a tear.
How to manage a quadriceps muscle tear
When your doctor examines you, she may find swelling or bruising in the lower quad muscle. Contracting the quads muscle produces pain. Touching the quadriceps muscle tear is often painful. In severe cases, the muscle can fully tear, leading to a muscle bulge or defect.
Do you need investigations for a quadriceps tear?
Although a quadriceps tear can be diagnosed from the story, we often use imaging to help with diagnosis. We use ultrasound or MRI to assess the severity of quadriceps injuries. Investigations can also rule out other causes of quadricep pain, such as a femoral stress fracture, myositis ossificans, dead leg, and tumours.
Recent studies also suggest that the location of the quadriceps tear determines how long the muscle will take to heal. Quadriceps stains can occur at the muscle surface (myofascial), the muscle belly, or the large tendon in the muscle (also called the central tendon). Muscle surface injuries quickly recover (3-4 weeks). In contrast, injury to the intramuscular central tendon has the worst outcome, leading to a longer time to return to sport (3-4 months).
Treating a quadriceps muscle tear
You should follow a simple but comprehensive rehab programme when recovering from a muscle tear.
First, we need to reduce swelling and bleeding in the muscles. Simple RICE principles will help stem the bleeding and should be continued for 2-3 days. Allowing the muscles to rest from sport is critical. In severe cases, crutches are needed to get around. Regular icing for 10 minutes every few hours will minimise further bleeding. A tight compression bandage will also help.
Next, it is time to get the muscles moving. This phase usually starts at 3-5 days but maybe a little longer if the muscle tear is severe. Gentle stretching and mobility exercises, such as repeatedly bending and straightening the knee, will improve muscle length. Then, it would be best to move on to strengthening the muscle, progressing from isometric holds to isotonic exercises such as squats, lunges, step-ups, and leg presses. Concurrently, you should perform general aerobic activities like swimming and cycling to maintain fitness. Exercise should not worsen your pain either during or after the activity.
Finally, once your strength has regained, you should slowly progress into sports-specific training. Examples include sprints, change of direction and controlled kicking.
Other frequently asked questions about a quadriceps tear:
How long does a pulled quad take to heal?
Healing time varies depending on the severity of the quad strain. However, recent studies suggest that the location of the quad tear is a critical determinant of healing time. We know that tears involving the muscle surface heal the fastest, while those that affect the large central tendon take the longest.
Can I run with a strained quad?
Yes, but not in the initial recovery phase. You should ensure your quadriceps strength has returned to normal before resuming running. Swimming or cycling is a great way to maintain fitness while building strength.
Are anti-inflammatory medications like ibuprofen helpful in treating a pulled quadriceps muscle?
Generally no. Ibuprofen might be helpful in the first few days after injury to control swelling. However, taking them longer may interfere with the natural healing process in the later stages.
Are injections beneficial to accelerate recovery of a quadriceps muscle tear?
As a general rule, we don’t advise injections. Cortisone injections may retard healing and are unhelpful. PRP or platelet-rich plasma are used in some cases where recovery is slow. However, studies suggest that PRP are generally unhelpful for muscle tears.
Quadriceps tear surgery: when would you consider surgical repair?
Surgery is rarely needed for quadriceps muscle tears. However, we consider surgery in high-level athletes who fully rupture the large intra-muscular tendon in the quadriceps. Surgery to repair the large central tendon requires 4-6 months of recovery.
What are the other common causes of thigh pain?
Not all thigh or quadriceps pain is caused by a quadriceps muscle tear. Other causes include femoral shaft stress fractures, thigh nerve trapping, dead leg and referred pain from the hip joint or lower back.
Final word from Sportdoctorlondon about quadriceps tears
Quadriceps muscle tears are common in sportspeople who perform explosive activities such as rugby, football and soccer. The location of the tear is the most critical factor in determining healing time. If you have a quadriceps muscle tear, you should see a doctor with experience treating muscle injuries.
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