Bodyworks: Quadriceps Injuries

How to recognise them, how to overcome them

by Patrick Milroy

The quads and hams, to be colloquial, surround the knee in a tripod-like fashion, the quadriceps through the patella and its tendon acting to straighten the knee, while the hamstrings at the back of the thigh diverge, to be inserted behind the knee on the inside and outside to complete our tripod. If you think of them as being like the guy ropes of a tent, a tightening of one group will stretch the other, and it is this alternate movement that enables the knee to function.

The quadriceps muscles may be torn anywhere from hip to knee.

The common acute tear will cause sudden pain, accompanied by weakness which may make you stumble or fall. It is more likely to occur if you are pushing off to jump a hurdle or obstacle, or to go uphill.

Little difficulty is usually experienced in the diagnosis of a quadriceps tear. There is pain at the site of injury and any resistance to straightening of the knee will cause pain at this site. As a bruise forms, there is thickening of the muscle, which becomes hard and tender, although, if the muscle is severed completely (a not uncommon situation) a gap may be visible when the muscle contracts.

Medical investigation
Because the diagnosis is so obvious, investigations are rarely required unless the condition becomes chronic, with the risk of the scar changing to bone (myositis ossificans). An x-ray will confirm whether bone is forming within the scar tissue.

What else could it be?
Other causes of pain in the thigh are rare, though it is not impossible for a stress fracture of the femur, an adductor muscle tear or referred pain from the lower back to appear as quadriceps pain.

The basic principles of RICE apply to early management. This should occupy 48 hours, with ice being applied for 15 minutes per hour, as often as feasible. This will limit bleeding and aid later rehabilitation as you attempt to stretch, then strengthen the damaged muscle.

Medical treatment
Apart from professional guidance as to the optimum time-scale for patient-initiated treatment, some forms of electrical therapy may further speed up healing. The risk is always of over-enthusiastic treatment and the complications mentioned above.

Can you run through it?/Recovery time
While a simple tear may recover in a week, a complete rupture or deep tear of the muscle may have effects for several weeks. If there is a complete rupture, surgical repair is not necessary, as accessory muscles will take the strain and build power and strength to mimic the actions of the injured muscle. A return to full strength may take three months.

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Discuss this article

I am training for the FLM and have developed a quad pain. I cann't feel it when I am running but afterwards it hurts when I stand up and walk around. The pain doesn't really go away until I start running again. Anyone any ideas on what might be causing it?
Posted: 02/03/2003 at 11:38

Theresa, this doesn't sound like much to worry about. Suggest you make a point of stretchin them after your run - hold your ankle or top of your shoes, not your toes and keep everything straight while you gently pull upwards.

I usually hold for twenty seconds and do three reps on each leg.
Posted: 02/03/2003 at 11:47

Glenn, I do stretch after every run as you suggest and I have iced the area. The pain is in my left quad only and can be quite painful after sitting for while causing me to limp. I have had this pain for about two weeks and it is not getting any better.
Posted: 02/03/2003 at 11:54

Theresa - I could write a thesis on quad pain like yours. Have you run marathons before / had this pain before ?

Without knowing more - sounds very much like a severe muscle imbalance, if you're lucky. Have you had random stabbing pains in your leg before now - maybe about a month ago?

Do you know if you've got permantly tight quad muscles (trying rolling on a floor - face down - you'll feel a band of rigidity in your leg if you have)

If any of these sound familiar, e-mail me and I'll send you a doc with loads of info in it.

Meanwhile - if you can

a) run on grass - even if it means doing just one long slow 3 hour run a week round and round a school playing field

b) do as much cross training as you can in a gym - (no impact and it helps muscle balance as well). You can convert hill / speedwork sessions to the other machines - yes it's nowhere near as good as running but if your goal is completion - without being in agony - rather than a time - then you can definately still do it..
Posted: 02/03/2003 at 12:59

PS quad stretches can help - but you also need to hold the foot a) with the hand on the same side as the quad being stretched and then b) with the alternate hand. This second one helps reduce the knee problems - which come later if you don't sort the quads out

Also - never ever run fast down hill til you get over this problem - it can really make it soooo much worse

And NEVER ever do leg extensions / leg presses in the gym - as if you have a quad imbalance they actually make it worse
Posted: 02/03/2003 at 13:03

I have been reading the various threads for a while now. At the beginning of May I stumbled through a race with a pain on the "inside" of my right knee. I have been seeing a physio and a chiro. The physio says its to do with the ITB. But according to all the threads the pain would be on the outside. The chiro says my hips were out of line (being corrected) and my knee turns in. I have a lot of discomfort down the right thigh. I have been doing exercises for ITB. Should I be doing these? When can I start running again.....I'm one or the mad people who misses it......I am doing the R4L on Sunday and hope to run and walk it. Any advice would be appreciated.
Posted: 20/06/2003 at 13:30

Hi Tez

I had a similar problem while training for the FLM. The pain I felt disappeared when I was a couple of miles into a run and would then return with vengence soon after I stopped. The pain generated down my left thigh. It was diagnosed as an ITB problem. I went for deep muscle massage twice a week and was advised to massage it myself regularly and stretch it. I didn't stop running. The pain slowly disappeared and hasn't returned 'touch wood'.

Good luck hope you're soon back running.
Posted: 22/06/2003 at 18:17

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