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Pulled Quad Injury Overview

by Jaydee Vykoukal, PT, DPT July 04, 2018 0 Comments

Sitting on a bench outdoor

Although a pulled quad muscle isn’t the most common injury sustained by athletes, it often affects middle-aged or older adults who remain active. When this muscle becomes strained or torn, it causes symptoms that range from minor twinges to full-blown pain. Luckily, most pulled quad muscles are easily treated with home remedies. In this post, we tell you all you need to know about recognizing and treating a quad tear.

What is a Pulled Quad?

A pulled quad refers to a strained or torn quadriceps muscle. Located in the front of the thigh, the quadriceps muscles comprise the following:

  • rectus femoris
  • vastus intermedius
  • vastus lateralis
  • vastus medialis

While any of these muscles can become strained, the rectus femoris muscle is most likely to get injured. This is because, unlike the other quad muscles, it crosses over both the knee and hip joints. If the tear occurs at the point that the muscle becomes tendon (the musculotendinous junction), it may be referred to as a quad tendon tear.

Pulled quadriceps muscle injuries range in severity, from small strains to complete ruptures. Medical professionals grade these injuries from one to three to make it easier for doctors to diagnose and treat the tear.

Grades of Quadriceps Tendon Tear

  • Grade 1 Quad Tear

    This level of injury is typically a minor strain or small micro-tear. It often causes a mild twinge or spasm and a feeling of tightness at the front of the thigh. Sometimes, people will not notice the injury until they stop training and the muscles cool down. Typically, a grade one tear is easy to treat and recovery is quick.

  • Grade 2 Quad Tear

    A grade two tear is usually a partial quadriceps tendon tear or muscle belly tear. It may result in a sudden, sharp pain that causes athletes to stop playing. This grade of tear can impact a person’s mobility. With time, grade two tears heal, although recovery is slower than with a grade one injury.

  • Grade 3 Quad Tear

    This is the most severe type of pulled quad and requires immediate medical attention. It involves a complete rupture of the muscle. Athletes may feel a popping sensation and will feel pain immediately after the muscle is damaged, and they will also experience swelling and bruising at the front of the thigh within 24 hours. Additionally, the muscle will often retract and result in a balled up area of muscle fibers as well. Mobility is severely impacted and most people are unable to walk without crutches or a cane. Recovery takes several weeks to months and surgery is often required for appropriate healing.

Causes of a Pulled Quad Muscle

Essentially, a pulled quad muscle occurs when the muscle becomes overstretched or damaged. In some severe cases, the muscle can completely tear. A pulled quad muscle usually results from an activity that involves using the legs in a high force, also known as plyometric, weight bearing position, such as running, kicking, or jumping.

Direct impact with the quads tends to cause contusions rather than strains or tears. These require slightly different treatments when compared to pulled quad injuries.

Risk factors

Several factors increase the likelihood of experiencing a quad muscle tear or quadriceps strain. These include:

  • Failure to warm-up properly

    A proper warm-up routine can loosen up tight muscles and increase the range of motion of the local joints (hips and knees). In general, when muscles and joints are more flexible, they are less likely to become injured.

  • Weak muscles

    Having weak muscles or a lack of muscle mass increases the risk of pulled or torn muscles. Older adults or those who do not engage in strength training are more likely to have weak muscles.

  • Muscle imbalances

    If the leg muscles do not work in sync, or one area is overworked, it can increase your risk of injury. For example, imbalances between the hamstrings and quads can notoriously lead to injury. Coordinated leg use is vital to preventing muscle strains in the quads and other local muscles. 

  • Tired muscles often provide inadequate support to the joints.

    When you are fatigued, you are less likely to maintain proper form and engage the right muscles. Improper form and lack of endurance puts undue stress and strain on joints and muscles. Thus, it’s important to recognize your limits.

  • Poor footwear and exercise equipment

    Wearing worn-out or unsuitable shoes and using poorly maintained sporting equipment puts you at increased risk of a pulled quad. This is because it throws off your movement mechanics, putting unnecessary strain on your muscles and joints.

  • Activity environment

    The surfaces you exercise on contribute to your overall risk of injury. If the ground is slippery or uneven, you are more likely to fall or overextend muscles in an effort to remain upright.

Quadriceps Tendon Tear Symptoms

Pulled quad symptoms vary depending on the severity of the injury. A grade one tear will cause:
  • A twinging or tight sensation in the thigh
  • Mild pain when walking and running
  • Minor spasms
  • Small lump at the site of the injury

Grade two quad tear symptoms include:

  • Sudden, sharp pain at the time of injury
  • Inability to continue working out without significant pain or discomfort
  • Difficulty walking or fully bending the knee
  • Pain when pressing on the thigh or extending the knee
  • Swelling
  • Mild bruising

Grade three quadriceps tear symptoms include:

  • Severe, sudden knee pain
  • Inability to continue working out
  • Loss of strength in the thigh with weight bearing and lifting the leg
  • Loss of mobility, inability to bear weight through your leg, unless using crutches
  • Poor tracking of the knee cap
  • Severe swelling
  • Extensive bruising
  • Bulging muscle (opposite of the tear site)

Diagnosis

If your muscle pain becomes debilitating or is accompanied by severe swelling, you should see your doctor for diagnosis and treatment. To diagnose a pulled quad, your doctor will ask about your symptoms and how you sustained the injury.

They will also perform a physical examination that involves checking the thigh for swelling, pain, and tenderness and moving the leg into several positions. As part of a complete quadriceps tendon tear test, you may be asked to straighten your knee. They will also assess your lower body strength, coordination, and flexibility to get an idea of your overall leg health. This portion of the assessment can be painful, but it is a key step in helping doctors identify a pulled quad muscle and determine whether you’d benefit from treatment options like physical therapy.

In addition, your doctor may order imaging tests. Usually, for a quadriceps tendon tear, MRI scans are the best option. They show the soft tissues in the leg, allowing the doctor to view the extent of the injury. Occasionally, an X-ray may be taken to rule out bone injuries as a source of pain.

Pulled Quad Recovery

When it comes to healing from a quad tear, recovery time varies significantly. People with a grade one tear will often feel better after two weeks of rest and home remedies. Those with a grade two tear may need up to six weeks before they feel better.

For grade three pulled quad muscles, recovery takes even longer. Most people won’t be able to return to their full activities until ten or twelve weeks after injury (more if surgery is needed).

You’ll know that you have made a full recovery when you no longer have pain in the quad muscle and you can move around with ease and appropriate leg coordination. To avoid re-injury, return to activities slowly and take precautions.

Prevention

To prevent a pulled quad muscle, try the following:

  • Warm up fully with a stretching routine before engaging in sports or other exercises.
  • Apply a heat source to the quads for fifteen minutes before activities, especially in cold weather.
  • Stop exercising if the quads feel tight or begin to spasm. It’s important to tune into how your body is feeling and adjust your intensity as needed. 
  • Gradually increase the duration, intensity, or frequency of an exercise routine.
  • Wear thigh supports such as compression wraps and braces to keep muscles warm and blood flow adequate.
  • Ice, stretch, and take anti-inflammatory medications as needed (such as ibuprofen) for sore muscles after workouts.
  • Use massage balls or a foam roller on tight or sore quad muscles.

Finding Relief from Pulled Quad Muscles

It’s relatively common for older athletes to strain their quad muscles, especially if they engage in activities that involve squatting, running, jumping, or kicking. This is because their connective tissue is innately more stiff and less able to adapt to added strain. Although most cases of pulled quad muscle aren’t serious and resolve quickly, some quad injuries can put you out of action for several weeks or months.

Act fast when you feel the symptoms of a tight or weak quad muscle and apply the most important initial pulled quadriceps treatment for your injured leg—rest, ice, compression, and elevation (known as RICE). From there, prevent future damage by supporting your legs with a brace and full warm-up routine. Additionally, always talk to your sports medicine doctor or physical therapist about an appropriate exercise program that promotes optimal muscle balance, strength, and flexibility to keep you moving comfortably without injury. With these treatments in mind, you can minimize your risk of quadriceps injury and aggravation for years to come. 

Resources:

https://www.healthline.com/health/fitness-exercise/pulled-quad-treatment

https://www.medicalnewstoday.com/articles/322812

https://www.webmd.com/fitness-exercise/features/quadriceps-strain

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Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.



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