Below we outline exercises may form part of a rehabilitation program for a quadriceps contusion.
Depending on whether the injury is intra muscular where the muscle bleeds within the muscle sheath, or inter muscular which is bleeding outside of the muscle sheath will often determine the level of flexibility. An intramuscular injury takes longer to regain full flexibility. All exercises should be done pain free.
Stretching exercises should be done as soon as pain allows. This will depend on the type and severity of injury but may be as soon as 24 hours following injury. More severe injuries may take a few days or more.
Static stretches should be done very gently to begin with where the stretch is held for a period of time.
Later more advanced pnf type stretches can be done if there is a noticeable lack of flexibility in the muscle.
Quadriceps muscle stretch
Stand on one leg holding the leg to be stretched behind you. Pull the heel in towards the buttocks. Try to keep the knees together to avoid twisting the knee.Hold on to something if you need to balance. If you can't feel a stretch, tilt the pelvis backwards to further lengthen the quads. Hold for 20-30 seconds and repeat 3-5 times. Stretch at least 3 times a day.
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Hip flexor stretch
Place the knee on the floor and the other foot on the floor in front of you. Push your hips forwards, keeping the back upright. Once you feel a stretch at the front of the hip, hold the position for 20-30 seconds. Repeat 3-5 times and do this at least 3 times a day.
The stretch on the rectus femoris and other quadriceps muscles can be increased by lifting the foot upwards, although avoid this if pressure on the knee causes pain. Use a padded cushion if necessary.
Strengthening exercises should only be done well after the acute stage. Exercising too hard with a muscle which has suffered a contusion can lead to myositis which is bone growth within the muscle. If in doubt concentrate on stretching exercises only until full range of motion and complete pain free movement has been restored.
Isometric or static contractions 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.
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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.
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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. Start 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.
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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.
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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 forwards past your toes. Start with 2 sets of 10 reps and gradually increase to 3 sets of 15 before progressing.
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