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A thigh strain or quadriceps strain is a tear in one of the quadriceps muscles at the front of the thigh. It can range from a mild discomfort to a full blown tear of most of the muscle resulting in severe pain and inability to walk. We explain thigh strains and how best to recover from one.
Thigh strain symptoms
Symptoms of a quadriceps strain or thigh strain typically include a sudden sharp pain at the front of the thigh. Swelling and bruising may develop. A thigh strains are graded 1 to 3 depending on how bad the injury is with a grade 1 being mild and a grade 3 involving a complete or near complete tear of the muscle.
Grade 1 thigh strain
Symptoms of a grade 1 quadriceps thigh strain are not always serious enough to stop training at the time of injury. A twinge may be felt in the thigh and a general feeling of tightness. The athlete may feel mild discomfort on walking and running might be difficult. There is unlikely to be swelling. A lump or area of spasm at the site of injury may be felt.
Grade 2 thigh strain
Grade 2 symptoms are more severe than a grade two. The athlete may feel a sudden sharp pain when running, jumping or kicking and be unable to play on. Pain will making walking difficult and swelling or mild bruising would be noticed. Pain would be felt when pressing in on the suspected location of the quad muscle tear. Straightening the knee against resistance is likely to cause pain and the injured athlete will be unable to fully bend the knee.
Grade 3 thigh strain
Grade 3 symptoms consist of a severe, sudden pain in the front of the thigh. The patient will be unable to walk without the aid of crutches. Bad swelling will appear immediately and significant bruising within 24 hours. A static muscle contraction will be painful and is likely to produce a bulge in the muscle. The patient can expect to be out of competition for 6 to 12 weeks.
Thigh strain treatment
Initial treatment for a thigh strain should be to apply ice or cold therapy and compression as soon as the injury is felt. This is part of the PRICE principles of protection, rest, ice, compression and elevation.
This will help stop internal bleeding and swelling and hopefully limit the extent of the injury. After the initial acute stage treatment will depend on the severity of the injury.
Grade 1 - Apply the R.I.C.E (rest, ice, compression, elevation) procedure for the first 24 hours. A cold therapy compression wrap should be applied as soon as possible and initially every hour for 10 to 15 minutes. Later this can be extended to every 2 to 3 hours. Use a compression bandage or thigh support until you feel no pain. Rest for at least 72 hours before commencing light training. If there is no pain then training can continue gradually. See a sports injury professional who can advise on quad strain rehabilitation.
Grade 2 - Apply rest, ice and compression as for a grade 1 injury. Ice can be applied for 10 to 15 minutes every hour for the first 48 hours reducing frequency afterwards as swelling and pain reduces. Wear a compression bandage and rest with the leg elevated. Use crutches if necessary and seek professional advice.
After the acute stage alternating hot and cold may be more beneficial. Apply hot for 2 minutes, cold for 1 minute x 6 times making 18 minutes of treatment. This can be done twice a day. Sports massage can help remove tissue fluids and stimulate blood flow. Massage will be light initially but deeper as the injury heals. Electrotherapy treatment can also be used during the subacute stage and a full stretching and strengthening program should be done before returning to full fitness.
Grade 3 - Stop play immediately. Rest with the leg elevated, using a compression bandage. Apply cold therapy and compression immediately and seek medical attention. It is important you do this if you suspect a grade three strain. If you do not you may be permanently injured or weakened.
P.R.I.C.E stands for Protection, Rest, Ice, Compression and Elevation. The treatment principles of PRICE should be used in the first 72 hours of an injury. Protection of the injured thigh muscles can be achieved by wearing an elasticated support and this will make the injured area feel more comfortable especially in more severe injuries. The muscle should be rested from all sporting activities in the early stages of healing and cold therapy applied to the area for no more than 15 minutes at a time - this is best achieved by using a cold pack and compression bandage as this applies both cold and compression in one application. Elevation of the injured limb should also be done in the early stages and this is best achieved by lying on a sofa with the leg rested up on 2 pillows.
Massage may help once the acute stage has passed (after 72 hours) by releasing tension in the muscle and encouraging blood flow and nutrients. Caution is advised as massaging an injury too soon may increase the bleeding and may make the injury worse and therefore it is important to wait until the initial healing is complete. Very gentle massage can be applied in the early stages and as the injury heals and muscle gets stronger, massage can be applied more deeply. Massage should always be performed by a professional therapist to avoid causing additional damage to the injury.
Read more on sports massage for thigh strains
Electrotherapy such as ultrasound which transmits high frequency sound waves into the muscles may be used to help reduce swelling and stimulate blood flow.
Supports & strapping
The use of thigh supports or compression shorts is useful to protect and support the muscle while it is healing. They can also be used during the various stages of rehabilitation and when finally returning to playing sport to warm up and support the muscle during exercise. Thinner lycra type compression shorts can then be used when rehabilitating the injured muscle in the later stages and when returning to full fitness.
After the initial acute stage of the injury has passed, a gradual rehabilitation program consisting of stretching and strengthening exercises should begin. 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). Initiall active range of motion exercises are done where the knee is bent through as full a range as possible. A simple static quadriceps stretch is done when pain allows. 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.
Read more on quad strain stretching 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 PAIN FREE. 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.
Strengthening begind with isometric or static exeericses which invovle contracting the muscle with the leg straight. This is progressed to a straight leg raise exercises before moving onto dynamic strengthening exercises using resistance from resistance bands, your own body weight or weight training equipment.
Eventually more sports specific or functional strengthening exercises are done involving sprinting, change of direction and plyometric or hopping type exercises.
Read more on strengthening exercises
A professional practitioner will advise on the best course of treatment which is either a long period of rest until the swelling goes down or in rare cases a surgeon can operate.
See thigh strain rehabilitation for more details.
Quadriceps strain explained
The quadriceps muscles are the muscles on the front of the thigh. They consist of the vastus lateralis, vastus medialis, vastus intermedius and the rectus femoris. A strain is a tear in the muscle. These can range in severity, from a very small tear to a complete rupture.
Tears to the quadriceps muscles usually occur following an activity such as sprinting, jumping or kicking, especially if a thorough warm-up hasn't been undertaken. Any of these muscles can strain or 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. This make it more susceptible to injury.
A strain can occur either at the musculotendinous junction where the muscle becomes tendon just above the knee, or higher up in the belly of the muscle. Injury to the rectus femoris tendon at the hip either as a tear or an overuse inflammation type injury can also occur.
Injuries that occur following a direct impact to the muscle, such as being hit by a ball or other hard object, are more likely to be contusions and should be treated slightly differently.
More on Quadricep Strains:
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