Anterior thigh pain or injuries at the front of the thigh. An acute thigh injury comes on suddenly and includes muscle strains (tears) or contusions which are caused my direct impact or collision. Chronic or gradual onset pain at the front of the thigh occurs over time. The athlete may not be able to identify a specific moment the injury was caused.
On this page:
- Quadriceps strain
- Quadriceps contusion
- Myositis ossificans
- Fractures
- Other causes
Quadriceps strain (thigh strain)
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.
Symptoms of a quadriceps strain or thigh strain typically include a sudden sharp pain at the front of the 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. Athletes with a grade one strain may be able to carry on running at the time of injury but a grade 2 or 3 will be severe enough to result in the athlete having to stop training or competition.
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.
Treatment consists of immediate first aid applying the PRICE principles of protection, rest, ice, compression, and elevation followed by a full rehabilitation program of stretching, strengthening, and sports specific exercises.
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Quadriceps contusion (thigh contusion)
A dead leg, also known as a charley horse is a bruise or contusion caused by a direct impact to the leg, crushing the muscle against the femur (thigh bone) resulting in swelling and sometimes bruising of the thigh muscles.
Symptoms include pain at the time of injury and the athlete is likely to have restricted movement in the muscle. Swelling and later bruising may appear over time. Thigh contusions can range in severity from very mild which is hardly noticeable at the time, to severe injuries where the athlete is unable to walk. Contusions are grade 1, 2 or 3 depending on the severity. It is important the correct diagnosis is made as what may seem like a minor injury can develop more serious complications such as myositis ossificans which is when bone tissue forms within the muscle.
Contusions are either intramuscular or intermuscular depending on whether the bleeding is contained within the muscles surrounding sheath, or whether the sheath is damaged as well. Treatment consists of applying the PRICE principles of protection, rest, ice, compression, and elevation as soon as possible. Rest is essential and heat or massage should not be applied during the acute phase as this may lead to myositis ossiicans.
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Myositis Ossificans
Myositis ossificans can occur as a complication of not treating a contusion correctly and involves a small growth of bone within the muscle. It usually occurs a while after a severe impact to the knee that causes internal damage, which is subsequently left untreated.
Myositis ossificans develops some time after a contusion or blow to a muscle usually in the thigh. Symptoms of myositis ossificans include pain in the muscle, particularly during exercise. The athlete will have a restricted range of movement in the leg and a hard lump may be felt deep in the muscle. An X-ray can confirm the diagnosis and show bone growth.
What is Myositis ossificans? If a bad muscle strain or contusion is neglected then it is possible myositis ossificans can occur. It is usually as a result of impact which causes damage to the sheath that surrounds a bone called the periosteum as well as to the muscle.
Bone will grow within the muscle, called calcification which is painful. The bone will grow 2 to 4 weeks after the injury and be mature bone within 3 to 6 months.
Common myositis ossificans causes include failing to apply cold therapy and compression immediately after the injury or applying heat too soon. Ice will help reduce pain, inflammation, and swelling and encourage the injured muscle to heal. Having intensive physiotherapy or massage too soon after the injury which may increase internal bleeding and prevent healing. Returning too soon to training after exercise is also a cause of myositis ossificans.
Myositis ossificans treatment: If you suspect you have myositis ossificans then seek professional advice from a sports injury specialist or doctor as soon as possible. They will advice conservative treatment initially which will include rest, possible immobilization of the affected limb for 3 or 4 weeks. This may give time for the body to reabsorb the calcification.
An X-ray of the muscle can be done to see when it is safe to start rehabilitation and strengthening exercises. In particularly severe cases surgery can be performed to remove the bone growth.
Expert interview (play video) Susan Findlay of the North London School of Sports Massage talks about the use of sports massage myositis Ossificans. There is debate surrounding the use of sports massage treatment for myositis ossificans. If massage is performed then it must be done very lightly and not within the first 24 hours as it may increase bleeding and make the injury worse.
Femur Fracture
A traumatic femur fracture is serious and usually fairly obvious injury caused by accident or severe impact. The patient will feel severe pain in the thigh. There may be deformity in the thigh for example the leg may be at an angle or the injured leg appearing shorter than the other. A considerable amount of swelling may be visible and the patient will be unable to move their leg.
Read more on Femur fracture.
Femur Stress Fracture
The femur bone is the long thigh bone. Prolonged overuse can cause a stress fracture known as a femoral stress fracture. Pain may come on gradually as a dull ache which intensifies if a bending force is applied to the femur. Rest is the key to recovering from this injury.
Read more on Femur stress fracture.
Rectus femoris tendon injuries
These cause pain at the top of the thigh where the tendon of the powerful rectus femoris muscle inserts. Read more on:
- Rectus femoris tendon strain - a tear in the tendon.
- Rectus femoris tendon avulsion - where the tendon tears at the point of attachment pulling a fragment of bone with it.
- Rectus femoris tendon inflammation - gradual onset pain at the point of attachment to the pelvis.
Other muscle strains in the thigh include; Sartorius muscle strain & Gracilis muscle strain
Other causes of anterior thigh pain which should not be missed:
- Slipped capital femoral epiphysis occurs when there is a fracture at the neck or top of the thigh bone. The injury happens to the epiphysis which is where the bone grows as children grow older. It is more common in boys aged 11 to 16 years old and occurs gradually over a period of time.
- Perthes' disease affects children, most commonly aged between four and eight, but can also occasionally occur in younger children and teenagers. Tiredness and groin pain are two common smyptoms, and they may have a noticeable limp. Medical help is needed to diagnose this condition as early as possible to try to prevent and limit any future problems.
- Compartment syndrome
- Tumor