Progression of a Quadriceps Strain

This can be classified into 3 grades of quadriceps strain severity:

Minor - Grade 1 Quadriceps Strains involve lengthening of your quadriceps muscles which results in slightly pulled or excessively stretched muscles, or very small tears in your muscles. You will generally feel some specific point pain, tightness or muscle spasms in your quadriceps just above or below your injury, but you shouldn't experience any swelling or a major loss of strength. These symptoms may diminish with activity, but will return with a vengeance afterwards. You may find it difficult to extend your knee or flex your hip, and you may walk with a slight limp. Normally you will have greater than 90 degrees of knee flexion.

Moderate - Grade 2 Quadriceps Strains are more painful and involve a partial tearing of the quadricep fibers in your muscles, tendons, or at the tendon attachment to your bone. You will generally experience some pain that radiates through your leg during activity, while straightening your knee against resistance, or when you touch your quadriceps. Swelling, stiffness, decreased strength and range of motion (may not be able to fully bend your knee) will be apparent and can also cause you to limp. You may also experience some bruising due to bleeding within the injured muscle. Normally you will have between 45 - 90 degrees of knee flexion.

Severe - Grade 3 Quadriceps Strains involve a complete tear (rupture) of your quadriceps muscle fibers where your muscle belly attaches to your tendon or where your muscle belly rips in 2 separate pieces. It is very painful and rarer than the other strains. You will tend to experience a burning or stabbing pain, a lot of swelling and minimal strength, which may prevent you from walking without assistance (crutches) or make it difficult for you to move your leg (can't do a straight leg raise). Discoloration and widespread bruising in the injured area as a result of bleeding in the muscle tissue can also occur. You may notice a break in your normal muscle outline that makes a gap under your skin where the muscle has come apart. This can be seen or felt with your hands and looks like a knotting of the muscle that produces a bulge. Normally you will have less than 45 degrees of knee flexion.

The majority of quadriceps strains result from jumping which causes sudden stretching or repeated contraction. Acute tears or avulsion fractures tend to occur following a direct blow to the muscle during kicking, a sudden burst of speed, pushing off to jump, going uphill or falling on a partially bent knee. Tears can also result from tendinosis or previous knee/tendon surgeries (knee replacements, ligament surgeries, especially the ACL). If your quadriceps tendon tears your kneecap will lose its anchoring support in your thigh, and your knee cap will move down towards your foot. You won't be able to straighten your knee or put any weight on your leg, as your body won't be able to hold your knee in a straightened position.

Should you seek medical attention?

This is up to your discretion; however any continued discomfort in your quadriceps should be investigated. If you continue to experience the quadriceps injury symptoms and have tried the suggested conservative treatments for 2 -3 weeks, it is recommended that you seek professional medical attention. It is recommended you seek immediate attention if you:

• hear a "loud pop" in your muscle when injured
• have immediate severe pain, swelling or discoloration in your quadriceps
• experience severe weakness in your leg (compared to other leg) and have difficulty walking
• experience severe weakness in your leg (compared to other leg) and have difficulty walking
• have a temperature over 100.4 degrees F (38 degrees C)
• notice blue toe nails, numbness or coldness below your injury

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