Emergency and Urgent Care - Thigh Injury - Quadriceps

There are two main groups of muscles in the thigh that can be injured:

Quadriceps: consist of the vastus lateralis, vastus medialis, vastus intermedius, and the rectus femoris.

Hamstrings: consists of three separate muscles – Semitendinosus, Semimembranosus, Biceps femoris.

 What is a pulled quad muscle?

A pulled quadriceps (or quad) muscle is a tear in the fibres of the large muscle group on the front of the thigh. It is also known as a quad muscle tear, a quad muscle strain and a quad muscle rupture. Any of the quadriceps’s muscles can tear, but probably the most common is the rectus femoris. This is because it is the only one of the four muscles which crosses both the hip and knee joints. Therefore, this makes it more susceptible to injury.

How does a pulled quad muscle happen?

A pulled quad muscle is normally caused by a forcible contraction of the quad muscle. The quad is forcibly contracted; and therefore, vulnerable to tearing, in activities such as sprinting, jumping, kicking and weightlifting.

How does a pulled quad muscle feel?

The immediate sensation felt when a quad muscle is torn is pain on the front of the thigh. This sensation is often accompanied by a ‘tearing’ sensation. With a minor tear you may be able to continue activities or sport with minimal restriction. However, the pain and tightness may gradually increase following the exercise as bleeding and swelling occurs around the injured muscle. Other symptoms may include:

• Spasm
• Weakness
• Swelling/inflammation
• Reduced range of movement

What should I do if I have a pulled quad muscle?

The first 24–48 hours are important in the management of a pulled quad muscle. Swelling is necessary in the normal healing process; however, too much swelling can slow healing and cause further tissue damage:

P - Painkillers: it is important that you take regular painkillers to reduce the pain and help you keep moving around. Paracetamol and ibuprofen are effective painkillers if they are taken regularly and can be taken at the same time. These medications can be easily purchased over the counter at supermarkets and pharmacies. Please carefully read the instruction leaflet with the medication and only take the recommended dose; there may be reasons why you cannot take these medications, a pharmacist will be able to help you with this.

R - Rest: will help prevent further injury and allow the healing process to begin. For the first 2 days reduce the amount of walking you do and gently exercise your leg to prevent stiffness. Avoid forceful and strenuous activity, such as running, until you can walk without it causing pain.

I - Ice: can help reduce swelling and reduce pain. Make an ice pack by wrapping a small bag of frozen peas or some crushed ice cubes in a damp towel – DO NOT put ice pack directly onto skin. Put the ice pack on front of thigh for up to 20 minutes every 2 hours for the first 3 days after the injury. Then use the ice pack 3 times a day until the swelling has gone down. DO NOT eat food that has been thawed and refrozen.

M - Mobilisation: early weight bearing (putting weight on your injured leg) has been shown to help sprains to heal more quickly. Always try to walk normally, with your heel striking the floor first, then rocking forward onto your foot and pushing off with your toes. Using the exercises in this leaflet will help you to regain movement and build up strength and balance in your injured leg.

E - Elevation: keeping your injured leg raised above the level of your hips for the first 2 days after your injury. This will help to decrease the swelling and pain.

What shouldn’t I do if I have a pulled quad muscle?

If you have pulled your quad muscle then you should avoid any activities which increase blood flow to the injured muscle. These include hot showers, quads stretch, heat rubs, sports massage, consumption of alcohol and excessive activity. These activities can increase bleeding within the muscle, leading to further pain and an extended recovery period.

Physiotherapy treatment for a pulled quad muscle:

The assistance of a physiotherapist is important in the treatment of a pulled quad muscle. At the initial assessment your physiotherapist can diagnose your injury, explain which tissues you have damaged and to what extent they are damaged.
Following the assessment your physiotherapist can give you an indication of how long the injury should take to heal. Treatment varies dependent on the severity of the muscle tear. Possible treatments include:

• Electrotherapy
• Soft tissue treatment
• Exercise programme
• Massage

Could there be any long-term effects from a pulled quad muscle?

Most pulled quad muscles heal without complication in a couple of months. However, if a significant quadriceps tear occurs then a number of other structures contained within, and around the quad muscle can also be injured. Injury to these structures can delay recovery.

Thigh strain exercises

After the initial acute stage of the injury has passed a gradual rehabilitation program consisting of stretching and strengthening exercises should begin, under the guidance of a Physiotherapist.

Stretching exercises - should always be pain-free starting with gentle static stretches and progress through to more sports specific stretches performed dynamically (with movement). DO NOT START stretching too early as the healing of the muscle may be compromised (not before day 5 post-injury). The initial active range of motion exercises is done where the knee is bent through as full a range as possible. A simple static quadriceps stretch is done when pain allows.

Strengthening exercises – the aim of strengthening exercises is to gradually increase the load that is put through a muscle.
Strengthening exercises can start as early as day 5 as long as they are low-level and must be done pain-free. If it hurts do not do it! Isometric or static exercises are advised first and then progress to dynamic exercises with resistance band and finishing with sports specific running and sprint drills.

Stretching Exercises

Active range of motion exercises

This exercise is useful in the early stages of rehabilitation whilst motion is particularly limited.

• Simply bend and straighten the knee through its full pain-free range of motion
• This can be done in the sitting position, the standing position and lying down
• Do not overstretch too soon. If it is painful then avoid!
• Perform 10 reps at a time, at least 3 times a day

Static quadriceps stretch

This can be performed in either standing or laying on your front.

• Pull the foot of the injured leg towards your buttock until you can feel a gentle stretch on the front of the thigh
• To increase the stretch, tilt your hips backward
• Hold for 20-30 seconds and repeat 3 times
• Do this at least 3 times a day

Hip flexor stretch

This stretch will focus on the rectus femoris and Iliopsoas muscles.

• Kneel with one knee on the floor and the other foot out in front with the knee bent
• Push your hips forward and keep the back upright
• You should feel a stretch at the front of the hip and top of the thigh
• Hold for 20-30 seconds, repeat 3 times, at least 3 times a day

Strengthening Exercises Isometric quadriceps contractions

Static contractions can be used very early on in the rehab process. They involve contracting the muscle without any movement of the leg. This can be done in standing or sitting with the legs out straight.

• Hold contractions for 10 seconds at a time
• Relax for 5 seconds before repeating and perform 10 repetitions. As your strength improves, increase sets to 2 or 3 sets of 10 reps
• Although this exercise is boring it will maintain muscle bulk and ensure you are back to full fitness faster
• Continue with this exercise on a daily basis until you are able to perform the concentric exercises below

Straight leg raise

This exercise can be done lying down or sitting. Lying down is easier. Sit flat on the floor with the legs straight out in front of you.

• Raise one leg off the floor keeping the knee straight
• Hold for 3 to 5 seconds before lowering back to the ground. Repeat 10 to 20 times
• This exercise can be done daily
• Progress the exercise by increasing the length of hold and the number of reps
• Ankle weights can be added to increase the difficulty

Knee extensions

The quad muscles are responsible for straightening the knee. This exercise can be performed using no weight, ankle weights, a resistance machine or resistance band.

• Start with no weight and then progress to either ankle weights or a resistance band
• Straighten the knee then slowly return to the start position
• Begin with 2 sets of 10 reps and gradually increase to 3 sets of 15 gradually increasing the weight or resistance when comfortable to do so

Lunges

Lunges are a slightly easier version of a squat and are sometimes called split squats. Start with a wide stance.

• Bend the back knee towards the floor, but don’t let it touch
• Keep your back upright throughout and don’t let the front knee move forwards past the toes
• Start with 2 sets of 10 reps with the injured leg in front and then do 2 sets of 10 with the injured leg behind. Gradually increase to 3 sets of 15
• To make it harder, you can add either a dumbbell in each hand of a barbell over the shoulders

Squats

Squats can be performed in many ways including ball squats, double leg squats, and single leg squats.

• Fit ball squats are the easiest and so, if possible, should be performed first, followed by double leg and then single leg as progressions
• Ensure you do not bend your knees past 90 degrees, and you make sure your knees don’t move forward past your toes
• Start with 2 sets of 10 reps and gradually increase to 3 sets of 15 before progressing

Returning to physical activity

Returning to sport and work will depend on the demands of your job or chosen sport.  Recovery is faster if you stay at work, or go back to work as early as possible.  If you are on your feet all day you may need to gradually return to work, do light duties initially, or have regular breaks to elevate your leg.  Once you have regained movement, strength and balance you can slowly start to increase your activity back to your previous level.

Driving

It is important that you contact your insurance company to let them know about your injury. You may be able to drive once you are able to perform an emergency stop safely and fully operate your vehicle.

Physiotherapy

If you are unsure about what to do and feel you need support with your rehabilitation, then you can always go to see a Physiotherapist.

If you live in the Heywood, Middleton and Rochdale area, you can refer yourself by using the following link:
www.physiodirect.northerncarealliance.nhs.uk

Work

If you do not feel capable of working either due to pain or reduced movement/mobility, you are able to self-certify sickness for the first 7 days.

You must complete a self-certification form found on the government website and give this to your employer. This entitles you to statutory sick pay from your employer for up to 7 days.

To access the self-certification form, follow this link:
https://www.gov.uk/government/publications/statutory-sickpay- employees-statement-of-sickness-sc2

If you feel you need longer than 7 days off work, you must contact your GP for a sick note. The Urgent Treatment Centre does not issue sick notes.

Possible complications

If follow up has been arranged, you should attend this.

If your injury does not require, follow up you will have been given an approximate recovery time during your visit to the Urgent Treatment Centre.

• If the pain is ongoing despite treatment and analgesia
• You experience tingling/change in sensation to the leg/foot  
• You develop signs of a DVT such as hard swelling and redness to calf or thigh
• You develop chest pain please contact:

Rochdale Urgent Treatment Centre on 01706 517023 or return to the department.