A quad strain typically refers to an injury to the muscle which sits on the front of your thigh. ‘Quads’ stands for quadriceps which refers to the 4 thigh muscles: vastus lateralis, vastus medialis, vastus intermedius and rectus femoris. The quadriceps main function is to extend the knee and assist hip flexion – they are most commonly used with everyday activities such as walking, squatting and in sport with running and kicking.
A muscle strain is commonly known or defined as the overstretching or tearing of the muscle fibres which leads to damage, dysfunction and pain.
A quads strain is a common injury within football and athletics due to the high amount of thigh dominant movements that are performed with running and kicking.
Injury can quite often occur within this muscle because of:
- Overuse and repetition of the quads can cause injury
- Increased force or over contraction outside of its normal limits causing strain and damage to the muscle fibres.
- Exercising while fatigued can also increase the risk of injury
Quad strains can involve the muscle and the tendons dependent on location of the injury. If a muscle only strain occurs then this injury should resolve in a much quicker time frame than if tendon tissue is involved as well.
Symptoms
When suffering a quads strain, pain can be reported at the time of injury – for example a footballer kicking a ball and feeling a sharp pain develop in their thigh. Others may not feel any pain at the time and develop their symptoms after their activity or sometimes the day after. Typical symptoms of a strain are commonly reported as:
- Pain with movement and to touch
- Swelling / Bruising
- Difficulty with walking/movement of the thigh
- Loss of power
The level of symptoms experienced will depend on the severity of the injury suffered. Quad strains are typically graded as follows:
- Grade 1: Mild – low pain levels – minimal disruption to function – minimal muscle fibre disruption
- Grade 2: Moderate – medium pain – some loss of function and potential disruption to muscle fibres
- Grade 3: Severe – high pain levels and major loss of normal function – likely disruption to muscle fibres.
Grade 1 injuries of the quads are easy to manage and will not have many major visible symptoms – likely soreness and some minor dysfunction reported which should resolve within 1-2 weeks.
Grade 2 injuries can typically take between 2-6 weeks – these can display some swelling and potentially bruising as this indicates more tissue damage has occurred.
Grade 3 injuries can show notable defects such as disrupted fibres – this means there could have been a major tearing of the muscle or tendon resulting in a shortening of the muscle. The appearance of the thigh may change with this type of injury and loss of function will be major.
The first stage of the injury is known as the acute/inflammatory stage when the injured location has an inflammatory response leaking blood and chemicals required to deal with the injury to facilitate the healing process. After the first 72 hours the repair phase begins with the muscle trying to rebuild itself and strengthen – what you do with the muscle in terms of treatment and rehab can determine how well you progress.
Treatment
Treatment of the injury can begin immediately after onset – the quicker the acute management of the injury is started, the better effect it can have on the end result. Injuries that are not managed effectively at an early stage may result in longer recovery times and potential levels of increased symptoms.
A major factor with reducing the severity of the injury which has been sustained is the ability to control the bleed within the tissue and the development of swelling. Once the tissues have been overstretched or torn – they will start to bleed and the more you can control this with acute treatment then the less severe the symptoms will be in the coming days – effectively improving your recovery time.
The P.R.I.C.E principle can be applied to help manage symptoms:
Protection – of the quad from further injury, this may mean removing yourself from the activity which injured it or providing the limb with the support it requires to help reduce any further damage occurring. Reducing activity levels for the next 72 hours is advised.
Rest – or relative rest for the injured muscle. Relative rest can be summarised as rest which allows healing to occur but not total rest which may impede the progress of the healing process. Doing too little can also be bad for your injury in the long term. A good example could be if you are a very active person with a high intensity of exercise is to reduce the intensity level of your sports and think of alternatives – such as pool-based exercise or walking which can help to offload the injured muscle but keep it moving enough to help it heal.
Ice – Cold therapy helps to reduce swelling and bleeds within the tissue. Aim for the use of any cold item (frozen peas, ice wrapped in a tea towel, gel packs) and apply to the affected area for 10-15 minutes per time. Give yourself a rest from this for a minimum of 30 minutes until repeating. Icing is most important within the first 72 hours following muscle injury.
Compression – use of an elasticated bandage or sports support helps to provide comfort to the injured area but also acts as an aid to assisting the reduction of swelling. Movement may also feel easier when the limb is supported with compression.
Elastic Velcro wraps are a great tool that can be bought easily and cheaply online and they offer the most practical way to aid your injury with compression. Wrap the bandage below, above and through the injury. Be aware of the amount of compression you apply to the injury, it should not be so tight that it causes pain or significant changes in skin colour – if this happens, loosen the bandage. Use compression during your waking hours and remove for sleep.
Elevation – of the injured limb is necessary to avoid a build-up of swelling within the limb as this can then hinder your recovery. Increased amounts of swelling can make the area more painful, inhibit movement and power.
Elevate the limb above hip/heart height. This allows for more effective drainage of swelling with the use of gravity. Elevate the limb anytime you are off the feet – a perfect time and easy way to do this is in bed at night with the use of pillows while you sleep. The best time to elevate is within the first 48 hours of the injury occurring – if excess swelling continues after this period then continue with the previous principles until it is controlled or reduced.
General Advice and Rehabilitation Guidance
Avoid stretching the injury in the acute phase or any massage to the area that is deep or causing pain. Following injury the muscle is typically sore, could have a bleed and fibres can be disrupted – aggressive stretching or firm pressure to the symptomatic area can cause further exacerbation of the injury.
Over the counter medication such as paracetamol and ibuprofen can aid the healing process by reducing pain and inflammation levels. Topical creams can be used such as ibuprofen gel or hot and cold gels.
Rehabilitation exercises will be required to promote strength and allow the muscle fibres to heal correctly. This process can begin at home with simple range of motion exercises when pain allows for the knee and the hip. Taking the knee and the hip through its full movement at a slow pace can help the quads to regain function and encourage gentle muscle contraction.
Simple home exercises can be started when pain allows – a good first exercise is to start with static quads contraction which is an isometric exercise. This exercise should be performed for contractions of 5 seconds and more and repeated until the muscle fatigues. This is a great way to reduce pain levels and start the process of recovering strength back to the muscle. The leg muscles are used but without excessive load and this helps to keep them engaged while injured.
The next stage of the treatment process would be to visit a physiotherapist to have an assessment of the injury and assess its severity – unless you feel you can manage your recovery. As mentioned earlier – the severity of your injury will be graded and your treatment options will be based on what is most suitable for your injury.
Physiotherapy can then help to put a structured and phased plan in place to progress your recovery at the right time. In the early stages of the injury, there may be various passive treatment options which are available to you including massage, acupuncture and taping however the most crucial part of the recovery process is how the muscle is restored with exercise to bring it back to its pre-injury level. Gait re-education should be introduced at an early stage if required where people may have developed a limp during their injured period. Restoring your gait pattern will help you to recover faster and reduce the chances of you acquiring another injury through compensation.
As the recovery process moves past the painful stage and you become more physically capable with home exercises, the physiotherapist will progress your rehab in line with your usual activity levels and make it more specific to your goals. Knowing the right times to perform the correct exercise and also the correct amount of exercise is important to recovery as doing too much too soon with a muscular injury can result in re-injury.
If symptoms do not improve then medical attention should be sought. The physiotherapist can advise if this needs to be done but if you have worsening symptoms, extreme loss of function or a very high pain level then you may want to see the help of a doctor for further treatment or advice.
Summary
In conclusion, a quads strain can be easily managed by following the above information. A simple process of offload, reload and then progress the amount of load and activity you do. Use the PRICE principle and gentle home exercises to get the best start possible to your recovery. As time progresses and your function does also – seek a physiotherapist, should you need further help to return to your desired activity levels.
Prevention is the best way to remain injury-free, a good warm-up of the quads before exercise is a must – underprepared or underactive muscle groups that are suddenly placed under stress have a heightened chance of injury. Your warm-up will be specific to your activity however dynamic movements of the hip and knee to increase joint range of motion and low-grade muscle exercises like lunges, squats and static contractions of the quads are ideal to prepare for activity.
Partaking in regular resistive training or engaging in a strength and conditioning program can help to make our muscles more resilient and helps them to perform better. Without a variety of activity from your normal routine – there is the chance to build up imbalances and sometimes weaknesses in certain parts of your body which can lead to a breakdown of soft tissue resulting in injury. Strength training helps to correct imbalances and improve performance whilst also greatly reducing injury rate.
Planning of training to ensure adequate rest and recovery will always help to limit the chance of injury. Most injuries occur when fatigued or if your activity levels have not been well managed and your tissues aren’t capable of keeping up with the demand being placed on them. A great example of poor planning would be heavy weight lifting, focusing on the legs on a Monday – followed by a high intensity running activity such as 5 a side football the next day. The muscles and other soft tissues will be fatigued and will not have achieved an optimal recovery level to firstly perform well in this activity, but secondly, it greatly raises the risk of injury. Be smart with your physical exercise and you should hopefully stay injury free!