The hip joint is a complex ball-and-socket joint that supports the weight of the human body and is widely responsible for the movement of the upper leg. It consists of two main parts, which is a ball (femoral head) at the top of the thighbone that fits into a rounded socket. The rectus femoris is an anterior muscle of the quadriceps femoris. The quadriceps femoris is a group of four muscles on the anterior thigh. The rectus femoris has two heads originating from the pelvis. Additionally, the straight head arises from the anterior inferior iliac spine and the reflected head arises from the groove superior to the acetabulum. The rectus femoris muscle is inserted into the superior border of the patella through the common quadriceps tendon. This particular muscle flexes the thigh at the hip and extends the knee. Then, the muscle crosses the hip joint anteriorly, so it flexes the hip joint.
A rectus femoris rupture at the top of the muscle near the hip can result from either overuse or explosive loads on the muscle, such as in kicking or sprinting. Typically, inflammation of the rectus femoris muscle may cause pain in the groin during any physical activity that involves excessive use of this particular muscle within the quadriceps group. You may also experience pain during knee raises when the muscle is ruptured or inflamed. In most severe cases, a surgical procedure may be required to repair the muscle if it has been completely torn.
Generally, injury to the rectus femoris muscle is most common in athletes, second only to hamstrings among lower extremity injuries. Therefore, it is the most common lower extremity muscle injury among sports, such as soccer, football, and basketball. The rectus femoris is vulnerable to injury because it crosses two joints, has a high proportion of fast-twitch fibers, and because when performing any kicking motion, it undergoes forceful eccentric contraction while passively stretched at the onset of the forward swing phase.
Causes & Symptoms
Rectus femoris ruptures can be considered within two types of injuries, which are partially torn or complete ruptures:
- Partial tears – Many tears do not completely disrupt the soft tissue. For instance, this may be similar to a rope stretched so far that some of the fibers are frayed, but the rope is still in one piece.
- Complete rupture – A complete rupture will split the soft tissue into two pieces. When the rectus femoris tendon completely ruptures, the muscle is no longer anchored. Without this attachment, the knee cannot straighten when the rectus femoris muscle contract.
The hip pain can be located anywhere in the thigh, however, one of the most common causes of hip pain that is often forgotten is the strain of the rectus femoris muscle and tendon. It causes groin pain or anterior hip pain in some athletes. Rupturing the rectus femoris muscle is common in athletes who participate in sports, such as track, baseball, hockey, and soccer. The injury may occur suddenly when kicking a ball or sprinting from a standing position. It is an overuse problem with repeated tearing and stretching of the rectus femoris tendon. There will often be some scarring, adhesions, or tightness. A strain of the rectus femoris is similar to two other conditions known as a tennis elbow-type problem or Achilles tendonitis. It is important to understand that there are several causes of hip pain…
Within the hip joint, hip pain may be caused by loose bodies, labral tears, avascular necrosis of the femoral head, and arthritis. Therefore, when a physician completes a diagnosis for hip pain, he or she typically ensures to include the rectus femoris rupture / strain, which occurs from tearing of the muscle fibers due to stretching of this muscle.
Symptoms linked to rectus femoris ruptures include the following below:
- Pain with ambulation (movement) in the thigh.
- Difficulty straightening the affected knee.
- Pain on Palpation of the ruptured area.
- Bruising may be present at the site of the injury.
- Sudden sharp pain in the muscle. Injury is often felt at the mid-belly.
- Increased chance of re-injury if left untreated.
Another condition that plays a role alongside rectus femoris rupture is an avulsion fracture. A rectus femoris avulsion fracture occurs when the tendon tears, pulling a small piece of bone away. Symptoms are the same as a rectus femoris rupture with sudden pain at the front of the hip. Avulsion fractures of the rectus femoris attachment point occur most often in adolescents. This is because the area is one of the last to fully harden from cartilage to bone. Therefore, apophysitis develops, which is an inflammatory reaction to repeated stress on the soft bone attachment.
Who gets Rectus Femoris Rupture?
Rectus femoris rupture risk factors include:
- Sports participation – Sports that require repeated sprinting or running, or other activities such as dancing that might require extreme stretching, make a rectus femoris tendon tear more likely.
- Age – Patients who are older than 50 years old are more prone to tearing their rectus femoris tendon due to general wear and tear.
- Sports activities – Certain sports activities can increase your risk of rectus femoris ruptures, such as football, soccer, basketball, and track.
How Does it Affect You? How Serious is it?
Typically, if you have completely torn your rectus femoris tendon, surgery is required. All surgeries require incisions (cuts that allow surgeons to open an area of the body and make repairs). Therefore, this means there is a chance of infection but with a low percentage of it happening. When infections do arise, they’re considered serious – that is why it’s very important to follow the care instructions given to you by your doctor, including keeping your wound clean and dry and taking any prescribed antibiotics.
Complications of rectus femoris tendon surgery include:
- Persistent thigh pain – Some patients tend to continue to have persistent thigh pain after surgery. When this happens, your doctor will work with you to create a treatment plan, which may include additional physiotherapy or medicines to help you recover regularly.
- Longer-term leg stiffness – Long-term leg stiffness is usually caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint.
- Blood clots – Because surgery to the rectus femoris tendon affects the way blood flows around your thigh, it can increase your risk of developing blood clots.
Recommended Treatment & Rehabilitation
During a diagnosis of a rupture from your rectus femoris muscle, your doctor will typically begin by discussing your general health and the symptoms you are experiencing and your medical history. Some of these questions might include if you have had a previous rectus femoris injury or hip injury; if you have ever injured a quadriceps muscle; or if you have other medical conditions that might have predisposed you to a rectus femoris rupture. After discussing your symptoms and medical history, your doctor will conduct a thorough examination of your entire knee.
In order to determine the correct cause of your rectus femoral symptoms, he or she will test on how well you can extend, strengthen, or straighten your knee where your thigh is affected. While this part of the diagnosis can be painful, it is very important to identify a rectus femoris rupture. Another helpful test your doctor will most likely perform is a compression adduction test. During this test, you will have pain and decreased strength with resisted leg adduction. During the adductor muscle assessment, while in a sitting position, your doctor will have you squeeze your thighs with resistance placed at the inside of the knees.
For adolescent patients, X-rays may be needed to ensure that there is not an avulsion of the anterior inferior iliac spine. An X-ray will probably be normal so an MRI may be necessary in severe cases that aren’t getting better with treatment.
Immediately after performing a diagnosis of a rectus femoral rupture, physiotherapy will be the next step to rule out this condition. A physiotherapist will create an individualized treatment plan based on your condition and goals. Certain plans may include treatments to:
- Reduce your pain – Your physiotherapist may use different types of treatments and technologies to manage and reduce your pain, including ice, heat, ultrasound, taping, and electrical stimulation (TENS), and hands-on therapy, such as massage. These treatments can help decrease the requirement for pain medications, including opioids.
- Improving your strength – Certain exercises will benefit healing at each phase of recovery; your physiotherapist will choose and teach you the most appropriate exercises to steadily restore your strength and agility. These may include using cuff weights and stretchy bands.
- Improve your motion – Your physiotherapist will choose specific activities and treatments to help restore regular movement in the leg and hip. These might begin with passive motions that your therapist performs for you to gently move your leg and hip joint, and progress to active exercises and stretches that you can perform yourself.
- Boost recovery time – Your physiotherapist will design the right treatment plans that will help you boost your recovery faster than its regular amount of time.
- Safely return to your regular activities – Your physiotherapist will collaborate with you to decide on your recovery goals, including your safe return to work or sport.
- Prevent future re-injury – your physiotherapist may recommend a home-exercise program to strengthen and stretch the muscles around your hip, thigh, and upper leg to help prevent any future re-injury of your rectus femoris rupture.
Below are a few great exercises examples that can help you improve your recovery time regarding your rectus femoral pain:
Lay on your back with your legs bent and feet flat on the ground. Next, place your right ankle on your left knee, loop your hands around the back of your left leg, and draw it toward your chest. After holding your stretch for 10 seconds, repeat this method 2-3 times a day.
Lie on your side, with your affected hip on top. Then, tighten the front thigh muscles of your top leg to keep your knee straight. Keep your hip and your leg straight in line with the rest of your body and keep your knee pointing forwards. Lift your top leg straight up toward the ceiling, about 30 centimeters off the floor. Hold for about 6 seconds, then slowly lower your leg before repeating 8-12 times a day.
Hip rotator stretch
Lie on your back with both knees bent and your feet flat on the floor. Next, put the ankle of your affected leg on your opposite thigh near your knee. Use your hand to gently push your knee away from your body until you feel a gentle stretch around your hip. Hold the stretch for 15-30 seconds before repeating 2-3 times a day.
Alternative & Homeopathic Treatment
Mild or moderate symptoms of a rectus femoris tear can be treated homeopathically without the need for surgery or prescriptions (such as opioids). Some of these treatments include:
- Protect – This may include the use of crutches to assist with walking. In addition, using a simple ACE wrap is a great method of protecting the rectus femoris tendon.
- Rest – In this case, rest would indicate tapering down from your regular exercise activity or any activity that involves using your leg.
- Ice application – Apply ice to the painful area to help reduce further swelling and inflammation.
- Compression – Compression helps to prevent and decrease swelling.
- Elevation – Compression and elevation may not be fully possible if the injury is much more severe. However, if there is mild swelling in the affected area, then elevating the leg may be helpful.