Quadriceps Muscle Strain: Difference between revisions
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There are generally three mechanisms for quadriceps strain. <br>'''(1)''' Sudden deceleration of the leg (kicking),<br>'''(2)''' violent contraction of the quadriceps (sprinting) and <br>'''(3)''' rapid deceleration of an overstretched muscle (by quickly change of direction). | There are generally three mechanisms for quadriceps strain. <br>'''(1)''' Sudden deceleration of the leg (kicking),<br>'''(2)''' violent contraction of the quadriceps (sprinting) and <br>'''(3)''' rapid deceleration of an overstretched muscle (by quickly change of direction). | ||
The most commonly strained quadriceps muscle is the M. Rectus Femoris, because he crosses two joints and has a high proportion of type 2 fibers. <ref name="9">Robert A. Pedowitz, Donald Resnick, Christine B. Chung, 2008, Magnetic Resonance Imaging in orthopedic sports medicine, Springer, 445p.</ref><ref name="10">Douglas B. McKeag, James L. Moeller; second edition, ACSM’s Primary Care Sports Medicine,2OO7, Lippincott Williams & Wilkins, 656p</ref>'''<br>''' | The most commonly strained quadriceps muscle is the M. Rectus Femoris, because he crosses two joints and has a high proportion of type 2 fibers. <ref name="9">Robert A. Pedowitz, Donald Resnick, Christine B. Chung, 2008, Magnetic Resonance Imaging in orthopedic sports medicine, Springer, 445p.</ref><ref name="10">Douglas B. McKeag, James L. Moeller; second edition, ACSM’s Primary Care Sports Medicine,2OO7, Lippincott Williams &amp; Wilkins, 656p</ref>'''<br>''' | ||
== Risk Factors == | == Risk Factors == | ||
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== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
Although most of the times trauma history is associated, evaluation methods can be used to identify the strained muscle. | Although most of the times trauma history is associated, evaluation methods can be used to identify the strained muscle. | ||
<br> | <br> | ||
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-Pain | -Pain | ||
{{#ev:youtube|Lv_uRBi_ZS0|500}} | {{#ev:youtube|Lv_uRBi_ZS0|500}} | ||
== Differential Diagnosis == | == Differential Diagnosis == | ||
-Contusion | -Contusion | ||
-Jumper's Knee | -Jumper's Knee | ||
-Femoral Neck Stress Fracture | -Femoral Neck Stress Fracture | ||
== Examination == | == Examination == | ||
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== Physical Therapy Management <br> == | == Physical Therapy Management <br> == | ||
When a quadriceps muscle strain occurs during a competition or training, it is important to react immediately. In the 10 minutes following the trauma one needs to put the knee of the affected leg immediately in 120° of flexion'''.<ref name="1" /><ref name="2">Michael A Herbenick, MD; Michael S Omori, MD; Paul Fenton, MD. Contusions, 2009 (A)</ref> '''This avoids potential muscle spasms, reduces the hemorrhage and minimizes the risk of developing myositis ossificans<ref name="2" />'''<br>'''If the knee is left in extension the healing process will be slower and more painful because the quadriceps will start to heal in a shortened position.<ref name="2" /><ref name="3" /> The rest of the therapy during the healing process is based on the [[RICE Therapy|RICE therapy.]] This includes: <br>'''R'''est, <br>'''I'''ce treatment for 20 minutes every 2-3 hours, <br>'''C'''ompression with an ACE bandage<br>'''E'''levation'''.<ref name="2" />''' | When a quadriceps muscle strain occurs during a competition or training, it is important to react immediately. In the 10 minutes following the trauma one needs to put the knee of the affected leg immediately in 120° of flexion'''.<ref name="1" /><ref name="2">Michael A Herbenick, MD; Michael S Omori, MD; Paul Fenton, MD. Contusions, 2009 (A)</ref> '''This avoids potential muscle spasms, reduces the hemorrhage and minimizes the risk of developing myositis ossificans<ref name="2" />'''<br>'''If the knee is left in extension the healing process will be slower and more painful because the quadriceps will start to heal in a shortened position.<ref name="2" /><ref name="3" /> The rest of the therapy during the healing process is based on the [[RICE Therapy|RICE therapy.]] This includes: <br>'''R'''est, <br>'''I'''ce treatment for 20 minutes every 2-3 hours, <br>'''C'''ompression with an ACE bandage<br>'''E'''levation'''.<ref name="2" />''' | ||
This hasn’t been proved in scientific literature, but it is commonly used by physiotherapists and doctors. Before a patient turn back to normal activities, he or she should do some exercises and stretching to reinforce the quadriceps and hamstrings- muscle. The exercises can be isometric, isotonic, isokinetic and in a later stage of the revalidation sport- or ADL-specific'''.<ref name="1" />'''<br>An overview of the types of exercises:<br>-isometric: muscle contraction without change in muscle length (mostly against a fixed object). <br>-isotonic: muscle contraction against a constant resistance with a shortening/lengthening of the muscle. <br>-isokinetic: muscle contraction by a specific movement (e.g. flexion-extension of the knee). | This hasn’t been proved in scientific literature, but it is commonly used by physiotherapists and doctors. Before a patient turn back to normal activities, he or she should do some exercises and stretching to reinforce the quadriceps and hamstrings- muscle. The exercises can be isometric, isotonic, isokinetic and in a later stage of the revalidation sport- or ADL-specific'''.<ref name="1" />'''<br>An overview of the types of exercises:<br>-isometric: muscle contraction without change in muscle length (mostly against a fixed object). <br>-isotonic: muscle contraction against a constant resistance with a shortening/lengthening of the muscle. <br>-isokinetic: muscle contraction by a specific movement (e.g. flexion-extension of the knee). | ||
All of these exercises should be done in a range of motion that is pain-free. These strengthening exercises will also help in preventing from a new strain injury.<ref name="1" /><br> | All of these exercises should be done in a range of motion that is pain-free. These strengthening exercises will also help in preventing from a new strain injury.<ref name="1" /><br> | ||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
Revision as of 20:50, 20 April 2014
Original Editors - Maxime Tuerlinckx
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Definition/Description[edit | edit source]
A quadriceps muscle strain is an acute tearing injury of the quadriceps. This injury is usually due to an acute stretch of the muscle often at the same time of a forceful contraction or repetitive functional overloading. The quadriceps which consists of four parts, can be overloaded by repeated eccentric muscle contractions of the knee extensor mechanism.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title When the muscle is elongated by an eccentric contraction, high muscle forces are generated during the elongation and added to the forces produced by the passive connective tissue so it almost certainly induces a muscle strain injury. This force is several times higher than the force produced during a maximal isometric contraction.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Clinically Relevant Anatomy[edit | edit source]
The quadriceps femoris acts as a hip flexor and knee extender. This muscle is composed of 4 subcomponents:
-M. Rectus femoris
-M. Vastus medialis
-M. Vastus lateralis
-M. Vastus intermedius
The M. Rectus femoris is the only part of the muscle participating in both flexion of the hip and extension of the knee. The other 3 parts are only involved in the extension of the knee. The M. rectus femoris is the most superficial part of the quadriceps and it crosses both the hip and knee joints. So it is more susceptible to stretch-induced strain injuries. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The most common sites of strains are the muscle tendon junction just above the knee (both distal and proximal but most frequently at the distal muscle-tendon) and in the muscle itself.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Mechanism of injury[edit | edit source]
There are generally three mechanisms for quadriceps strain.
(1) Sudden deceleration of the leg (kicking),
(2) violent contraction of the quadriceps (sprinting) and
(3) rapid deceleration of an overstretched muscle (by quickly change of direction).
The most commonly strained quadriceps muscle is the M. Rectus Femoris, because he crosses two joints and has a high proportion of type 2 fibers. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Risk Factors[edit | edit source]
The strongest risk factor for developing a quadriceps muscle strain injury is a recent history of muscle strains. The next strongest risk factor in line is a past history of a quadriceps muscle strain. Other risk factors for this injury may include low muscle strength, an imbalance between the quadriceps and the hamstrings, limited flexibility, muscle fatigue, a poor technique, and so on. Another possible cause of strain injury can be a bad warming-up before an exercise or no warming-up at all.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Characteristics/Clinical Presentation[edit | edit source]
Although most of the times trauma history is associated, evaluation methods can be used to identify the strained muscle.
Examples of evaluation methods:
-Hamstrings/Quadriceps ratio (H : Q)
-Range of motion (ROM) and End-feel
-Muscle strengh
-Skin temperature
-Pain
Differential Diagnosis[edit | edit source]
-Contusion
-Jumper's Knee
-Femoral Neck Stress Fracture
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
add text here
Physical Therapy Management
[edit | edit source]
When a quadriceps muscle strain occurs during a competition or training, it is important to react immediately. In the 10 minutes following the trauma one needs to put the knee of the affected leg immediately in 120° of flexion.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title This avoids potential muscle spasms, reduces the hemorrhage and minimizes the risk of developing myositis ossificansCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
If the knee is left in extension the healing process will be slower and more painful because the quadriceps will start to heal in a shortened position.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The rest of the therapy during the healing process is based on the RICE therapy. This includes:
Rest,
Ice treatment for 20 minutes every 2-3 hours,
Compression with an ACE bandage
Elevation.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
This hasn’t been proved in scientific literature, but it is commonly used by physiotherapists and doctors. Before a patient turn back to normal activities, he or she should do some exercises and stretching to reinforce the quadriceps and hamstrings- muscle. The exercises can be isometric, isotonic, isokinetic and in a later stage of the revalidation sport- or ADL-specific.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
An overview of the types of exercises:
-isometric: muscle contraction without change in muscle length (mostly against a fixed object).
-isotonic: muscle contraction against a constant resistance with a shortening/lengthening of the muscle.
-isokinetic: muscle contraction by a specific movement (e.g. flexion-extension of the knee).
All of these exercises should be done in a range of motion that is pain-free. These strengthening exercises will also help in preventing from a new strain injury.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
10. Robert A. Pedowitz, Donald Resnick, Christine B. Chung, 2008, Magnetic Resonance Imaging in orthopedic sports medicine, Springer, 445p.
11. Douglas B. McKeag, James L. Moeller; second edition, ACSM’s Primary Care Sports Medicine,2OO7, Lippincott Williams & Wilkins, 656p.
