Quadricep Strain or ‘Torn Quad’
By Brittany Taylor, Physiotherapist
Pulled up with a painful quadricep after a run or a game?
Felt a “popping” or “pulling” feeling as you went to take off or kick a ball?
Finding it hard to walk the following day?
You may be suffering from a quadricep strain!
What is a Quad strain?
A Quad strain occurs when fibers, which make up the muscle belly of the quad, become damaged or torn. This is most commonly due to a forceful contraction of the muscle during deceleration from running or change of direction but can also be caused by a high velocity stretching mechanism i.e. kicking a soccer ball.
When the Quadriceps muscle is torn the pain will typically be in the lower ½ of the anterior thigh. Less common, are tears of the upper ½ of the quadricep which will typically present as pain and spasm closer to the hip joint.
Grading Severity
When you injury your quad muscle the injury can be classified in terms of severity:
Grade I: The most minor and most common type of muscle tear. Usually you feel a sharp pain during an activity/sport in the muscle region. There is little or no loss of strength and only less than 10% of fiber destruction.
Grade II: A moderate injury with pain and pulling felt during an explosive or halting movement. This is coupled with moderate loss of power and some range of motion loss. Usually there will be enough pain to no longer continue the activity/sport. There is between 10 -50% fiber disruption associated with Grade II muscle strains.
Grade III: A severe injury which results in the complete rupture of the muscle. This is often felt via a similar mechanism as a Grade II injury but will involve significantly more severe pain, bruising, loss of strength and flexibility. Whilst usually a rare injury for the general population, Grade III injuries are more common for individuals competing in high intensity armature or professional sporting codes.
Signs and Symptoms
· Anterior thigh pain
· Cramping/spasming or pulling sensation
· Painful walking and/or running
· Painful sitting/standing
· Bruising
· Weakness on up-phase of squat
· Weakness on Single leg raise
· Tenderness on touch of the area
It is important to see your physiotherapist or health care provider to gain an accurate diagnosis.
Immediate management
When dealing with a soft tissue injury, the immediate treatment should always follow the POLICE principle for tissue healing:
· Protection - avoiding aggravating activities such as running/sport
· Optimal- choosing only appropriate activities, avoiding those that aggravate
· Loading - Using low load exercises to stimulate healing and maintain muscle strength
· Ice – icing for 10 minutes intervals in the first 72 hours (prolonged use of ice is not recommended)
· Compression – to provide some element of immobilisation and reduce swelling and bruising
· Elevation – will reduce swelling by increasing venous return
The No Harm protocol should be used during the initial days post injury:
This means avoiding:
· Heat
· Alcohol
· Running/activity
· Massage
It is also advised to avoid Non-steroidal Anti-Inflammatories (NSAIDS) as they dampen the body’s initial healing response and may increase the size of any hematoma’s that have formed.
When should you see a Physiotherapist?
As soon as possible! You need to see your physiotherapist to rule out any other more serious pathology like fractures, tendon ruptures and dislocations which can often present with similar symptoms.
Gaining quality advice on how to be manage your injury starts from day 1. Book in to see your physiotherapist as soon as possible to improve your recovery time and reduce re-occurrence in the future.
What should you expect when you see a physiotherapist?
Your physiotherapist will perform a thorough assessment and commence initial treatment which will involve:
· Preliminary diagnosis for severity using the grade system (Grade I-III)
· Initial management of swelling and pain using strapping and crutches if necessary
· Advice and education on prognosis and approximate prognosis of healing time
· Gentle ROM exercises and possibly commencing isometric exercise is appropriate
How long until I can get back to sport?
This will depend on the severity of your injury and the type of sport you do. It may be slightly longer if you play a jumping or sprinting sport.
Generally speaking the expected time frames are:
- Grade I Quad Strain = 1-2 weeks
- Grade II Quad Strain = 3-6 weeks
- Grade III Quad Strain= 6- 12 +weeks
- Grade III with tendon rupture = 6 months
Every injury and athlete is different so these times can vary.
What will my recovery look like?
Phase I:
Goal: Return to pain free walking
Reduce pain by offloading the quadricep
Gentle knee range of motion to improve flexibility
Commence gentle Quad Strengthening using isometric exercises (sustained hold)
Phase II:
Goal: Able to pain free squat
Double quad strengthening focusing on isometric exercises initially
Progressing to eccentric and concentric movements
Progressing to single strengthening
Commence flexibility program
Phase III:
Goal: Return to pain free running and change of direction (COD)
Progressive resisted concentric strengthening
Commence dynamic flexibility program
Commence plyometric (jumping and COD) program
Return to training/specific sports related skills i.e. kicking ball in soccer
Phase IV:
Goal: Return to sport and successful prevention from re-injury
Maintenance of flexibility and strengthening programs
Maintenance of plyometric exercises throughout pre-season- off season
Education and correct management of training volume/load
Your Physiotherapist will appropriately guide you through each stage and will work with you to appropriately get you back to sport.
Happy Rehabing!
To book in with one of our experienced physiotherapists at Sutherland Shire Physiotherapy Centre in Miranda call (02) 5524 4400 or book online.