A quadriceps strain, also known as a quad pull or thigh strain, is a relatively common running injury.
Strains can range from a mild discomfort to a full blown tear of most of the muscle which can result in severe pain and the inability to run or walk. The injury typically happens when one or more of the quadriceps muscles become overloaded.
In this post you will discover the factors that increase your risk of straining your quadriceps, and learn specific strategies to implement during your rehabilitation and return to activity.
How to Recover Quickly from a Quadriceps Strain/Pull
A thigh strain or quadriceps strain is a tear in one of the four quadriceps muscles at the front of the thigh. These muscles consist of the vastus lateralis, vastus medialis, vastus intermedius, and the rectus femoris. The most common muscle to injure is the rectus femoris as it crosses both the hip and the knee joint (where the others only cross the knee joint via the patellar tendon).
In the case of a quadriceps injury, there is a strain (which is a small tear of the muscle). Like sprains, strains are also categorized as Grade I, II, or III. A minor strain is classified as a Grade I tear, whereas a complete rupture, or tear, is classified as a Grade III tear. Grade II tears are partial ruptures or tears. Severe Grade II and Grade III tears cause impaired muscle function and usually have associated bruising that occurs near the site of injury.
With a Grade I strain, you may be able to carry on running at the time of injury. Grade I injuries tend to be mild in that they tend to heal fully. With proper care and rehabilitation, the healing times can be reduced.
A Grade II or III strain will be severe enough that you will have to stop training or competition. Grade II tears can often be rehabilitated as well although the healing time is longer. Grade III tears may require surgical intervention.
Symptoms of a Quadriceps Strain/Pull:
- Sudden sharp pain at the front of your thigh.
- Swelling and bruising may develop.
- A lump, bump or muscle spasms may occur.
- In the case of a Grade III tear, a gap in the muscle may appear and you lose the ability to straighten your knee.
A quadriceps strain most commonly occurs during running or jumping (in particular during sudden movements or when quickly starting and stopping). However, you could just as easily pull your quadriceps while weightlifting, working in the yard or accidently stepping into a hole.
Factors that can increase your risk of straining your quadriceps include:
- Not warming up prior to exercise.
- Tightness in your hip flexors or quadriceps muscles.
- Weakness in your glutes/buttock muscles.
- Performing activities that are above your ability level.
- Performing tasks that your quadriceps muscles are not accustomed to or haven’t performed before.
The course of treatment is dependent on the severity of the pain and the location of the injury. Please seek competent advice from a medical doctor, physical therapist or athletic trainer if you’re experiencing severe pain. A professional can assess the severity of the strain and address how to handle the injury.
For the purpose of this discussion, I will address a Grade I or minor Grade II injury. The initial course of treatment following the sprain includes PRICE, which stands for Protection, Rest, Ice, Compression, and Eelevation.
- Protect. Initially, you may choose to “protect” the injury site. This may include the use of crutches to assist with walking. Even using a simple ACE wrap is a method of protecting the site from further injury. Refrain from an activity that may have caused the injury. Avoid aggressive stretching.
- Rest. In this case, rest would indicate tapering down from your regular exercise activity or any activity that involves using your quadriceps (running, weightlifting, jumping or even excessively bending your knee).
- Ice. Apply ice to the painful area. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
- Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible. You can utilize a common ACE wrap.
- Elevation. Compression and elevation may not be fully possible if the injury is located higher into the thigh. If there is swelling in the lower leg, then elevating the leg may be helpful.
During this acute phase, gently move the leg as you can tolerate. Don’t be aggressive with the movement. Walking is usually the best way to keep the area moving. Be sure to keep your steps shorter if you are experiencing pain. Keep to level ground. You may also try gently floating or walking in a pool as long as the pain does not worsen.
Depending on the severity of a Grade I or mild Grade II strain, the initial acute protection phase may last anywhere from three to five days and up to two weeks. Continue to monitor your symptoms closely as you progress into the sub-acute phase of treatment. If your pain increases or additional bruising occurs, you will need to taper back off your activity and possibly seek additional advice.
How to Self-Treat a Quadriceps Strain/Pull:
Mobilize the fascia and muscle tissue.
Work on restoring normal pain free movement of the leg. Start with mobilization of the areas above and below the injury site by using a Thera-Band Standard Roller Massager. Please refer to Mobilizations for a Quadriceps Strain.pdf. Be gentle and initially, do not mobilize over the site of injury. As pain decreases and you are tolerating mobilization over adjacent sites to the injury, you can gentle start mobilizing the injured area.
You are likely to experience tightness throughout the lower leg including the buttocks, hip flexors, and IT Band. You may also experience spine tightness or pain due to altered movement patterns in the lower extremity. I recommend using a foam roller to address tightness in the lower leg. Care should be taken, and don’t roll too aggressively on the site of the injury.
You may also utilize a tennis or lacrosse ball to mobilize the deeper hip and buttock muscles or to more deeply and aggressively mobilize the restricted areas appropriately. Take caution with any mobilization directly over the site of injury. This is healing tissue, and it needs to be treated like a healing scar. Initially, it will be fragile, but over time proper mobilization will help increase its strength and robustness.
As you progress through your rehabilitation, care should be taken when stretching the quadriceps and hip flexors. I tend to utilize both mobilization and gentle stretching to help maintain quadriceps and lower leg motion. Don’t let the quadriceps become tight and restricted, but don’t be aggressive with your stretching either. The goal is to keep full range of motion in both the knee and hip joints. Pain may initially limit the full motion, but over time progress back into full range of motion.
Initiate a strengthening program
Any injured area will be weak initially. Slowly start progressing into strengthening the injured area. Focus on body weight exercise before returning to any weightlifting activities. Please refer to Strengthening and Rehabilitation Exercises for the Quadriceps.pdf. These exercises are listed easiest to hardest. Once you can easily perform them without pain or discomfort, then progress back into weightlifting activities. This process should be slow and graded.
The human body is primarily made of water, which is critical for all body functions. Hydrate more frequently during recovery. Adequate water intake is critical as your body attempts to heal and flush out metabolic wastes. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Keep steady supplies of nutrients going to/from the site of the injury. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce. Water is best.
Start a supplement
A quadriceps strain is typically associated with a specific event and an active inflammatory process typically occurs. I am a supporter of natural supplements and remedies. Many supplements include herbs which are designed to help reduce inflammation and support the healing response. My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra. Another option would be Tissue Rejuvenator by Hammer Nutrition.
Consuming an adequate level of protein is necessary in order to repair injured tissues. I recommend eating additional plant based protein as well as protein from meat sources.
Return to Activity
Once your pain decreases and your hip and knee range of motion has returned to normal, slowly start tapering back into your training routine. During this time, you remain at a higher risk of injury. As you continue working through your rehabilitation and your return to activity, implement the following strategies:
- Warm up prior to exercise. Increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also prepares the tissues for exercise. Use a self-massage tool or a foam roller to roll up and down the quadriceps as part of your warm up. If you perform quadriceps and hip flexor stretches, be mindful that prolonged static stretching before exercise may worsen performance. Warm up exercises may include light jogging, bicycling, rowing or any activity to get the heart rate up and the blood flowing in the lower legs. Be careful when performing any movement that puts the hip flexors and/or quadriceps in a stretched positon with speed or force.
- Cool down. After performing your exercise or activity, take the extra time to cool down and stretch. Focus on quadriceps stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up.
- Initially avoid potential high risk activities. As your recovery progresses and you return to activity, initially avoid high risk activities that put the quadriceps muscle under heavy load or a very quick load. Progress slowly. If an activity begins to cause pain in the quadriceps, don’t push through it. Instead, stop and give your quadriceps more time to heal prior to trying it again. You should be pain free before you progress the intensity of the activity or sport. Quadriceps pulls have a high likelihood of re-injury if you rush the process.
- Regain full strength and motion before returning to sport. Before a full return to sport or activity is initiated, you should have full lower leg and quadriceps mobility and strength without pain. If you continue to experience soreness or restriction, continue to work on your rehabilitation until the leg and quadriceps have returned to normal. Then initiate a full return to activity.
If you’re not experiencing relief and progressing in your recovery after two to three weeks of aggressively managing the symptoms, contact your medical doctor, physical therapist or athletic trainer for an assessment and help in managing the injury. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.
For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.
Disclaimer: This article is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.