In this weeks installment of our “injury of the week” series we’re going to be talking about quad strains. We’re going to keep the same format we’ve had all along. First we’re going to start off with a review of what the injury is and talk about if this is what you have have and when you need to worry/consult your doctor. From there we’re going to take you through the steps of the A-T-A self treatment system.
The front of my thigh (quad) hurts. Why?
If you’re involved in sports, this one is bound to get you sooner or later. The worst part? It’s typically a sign of the quad getting cooked by trying to compensate for something else. The good news, however, is that if you take the time to fix the injured muscle and correct whats going on in the rest of the chain, you can keep this one away for a long time.
So what are some ways that it can happen?
- In normal propulsion (walking, running, etc), the leg works by absorbing the shock of weight-bearing and then continues to carry us forward all the way to push off. This requires all of the muscle groups in the leg to work together. The quads carry us from that first touch of the foot all the way to full weight bearing. From there, hamstrings and glutes take over to push us forward through the hip.
- The above sounds easy right? I think most of assume that we do that with every step we take. The reality is that most of us don’t. Our muscles stiffen up from the work load and slowly we start to lose that ability to fully extend our hip and push off properly. The same goes for the cycling. The glutes are a big part of the pedal stroke and give the quads time to relax and regroup before it’s their turn again.
- If you never get to the glutes biking, running, swimming, etc then quads never get to relax 100%. They’re always on essentially.
- “Always on” = injury at some point.
Whenever I see a quad injury in the clinic I like to look at a few things:
- What’s their range of motion (ROM) look like. Does the hip move all the way? The foot/ankle? Can they straighten their knee all the way? If there are restrictions (and with quad strains there ALWAYS are)… is it muscular or is the joint locked up.
- What does their strength look like. Are they strong through the core meaning that the pelvis is level during activity or does it fall forward pinching the top of the quad and hip flexors? Do they have the strength to get to and fully fire the glutes or do they get stuck along the way?
- Is it equipment related. Are they in the right shoes for their foot or are they listening to running buddies and ads about the latest minimal shoe/racing flat. Same goes for cycling shoes and bike set up. Is it a setup that is honest about your flexibility/strength/fitness or is it strictly looking at maximum speed. Equipment choices always have a way of catching up to you and everything starts from the ground up. How your foot handles that first impact largely determines how the rest of the leg will handle it. If you’re ankle is blocked or your arch caves in, the knee will have to compensate (either by moving in/out or not straightening all the way). Whatever it does, by the time you get to the hip that stride/pedal stroke is going to look very different than it should.
- What’s their work setup like. Is this someone stuck at a desk or in a car commuting for 8+ hours a day? If yes, what’s their at home maintenance/mobility plan look like to counteract it?
As you can see, there are lots of things to consider with quad strains and even the knee in general. This is an area of the body that is literally stuck in the middle of the “leg chain”. If this is the part that breaks down, you better be looking at the other two ends of the chain! (***note: this is referring to gradual onset/overuse injuries, not acute trauma where you caught your foot in a pothole or fell or got tackled, etc etc. If you’re in that camp? hint hint- see your doc. )
note #2. If you’re symptoms are closer to the knee cap, be sure to check out our post on patellofemoral syndrome as well (PFS).
How to treat it.
Step 1- Traditional R.I.C.E. treatment:
When a new injury occurs, the first and most important goal is always to decrease pain and any swelling that may be present. In other words, we want to decrease inflammation. That means ice is mandatory. Absolutely no heat no matter how good it feels. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. It’s now easier than ever to smuggle an ice pack into the office fridge and wear compression gear under your dress clothes. Use that to your advantage when working to heal an injury!
Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle/joint will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery.
Ice: while heat may feel better on stiff and sore muscles, ice only during the first 7 days following injury. This will help to decrease swelling, inflammation and pain. 10-15 minutes is sufficient and you can perform every hour as needed. Avoid direct ice to skin contact.
Compression: thanks to the recent explosion of compression sleeves, tights, shorts, etc, you have several options in this department. Ideally you want something that is snug without being uncomfortably tight (think recovery tights if you’ve ever worn them). You can also use a store brought ace wrap to accomplish this. Start the wrap below the injury using good tension on the bandage and move up above the injury. This will help keep swelling from moving down the leg.
Elevation: This is critical in the early days following acute injury where swelling may be present. In the case of an ankle injury for example, elevate the leg so that it is above chest level. This can be accomplished by laying down and propping for your foot up on the arm of the couch with pillows.
Step 2- Kinesiology taping:
For quad strains, we have some options in terms of tape applications. There are some that work up on the muscle itself and others that work on the knee cap. That being said, this is one of those injuries where you can absolutely use both. Tape the muscle and scoop up the knee cap with the U-strip and see how that feels. If you’re symptoms are up higher near the hip- add in the hipflexor and muscle application.
1) Quad strain application – Click here
2) U-Strip- Click here (you want the first video in this link! )
3) Hip flexor application. Click here.
Step 3- Getting mobility back:
The second goal is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Healing a muscle sprain/strain isn’t about no pain, no gain. The muscle needs to heal! Don’t overdo it in an attempt to speed up your recovery.
1) R.I.C.E. + gentle stretching. There should be no pain with stretching. .
2) Begin using the foam roller AROUND the injured area. The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or mobilizations. The order should be foam roll around injury -> stretch -> RICE.
3) Begin using the foam roller over the injured area to tolerance. The order should be foam roll around injury-> over injury -> stretch -> RICE.
4) Begin using the tennis ball for mobilizations. The order should be foam roll around injury -> over injury -> active/joint mobilizations -> stretch -> RICE.
5) Begin using the tennis ball for cross friction + trigger point. These are the deepest of the soft tissue techniques so you want to save them for last to target specific adhesions and restrictions. Consider this your fine tuning step.
How long do you need to R.I.C.E for??? Until it’s 100% gone.
Here’s what it looks like for a quad strain. Use the guidelines above.
Step 4: Strengthening
We’ve broken the exercises down into three levels based on pain levels. This stuff should NOT hurt. If it does, go back a level or ease up on the resistance. Only progress as pain free.
What you’ll need: 1) ankle weights or 2) resistance band/tubing. Both are easy to find in any sporting good store these days or walmart/target.
Optional equipment: 1) a balance disc. Always good to add difficulty to your strength exercises. Affordable too at $20. 2) Suspension trainer. I’m a big believer in these because it takes up zero space in my house and is an easy/inexpensive way to add a dynamic component to my strength training. Prices range anywhere from $30-200. Click here to see some of the options out there.
Video’s for each level are here. Please note, in the PDF download you will find details for reps and difficulty progression, as well as, benchmarks you should meet before progressing to the next level. The number one thing to remember is that these exercises should be pain free. If you’re getting discomfort, go back a level. You can’t force this injury to heal, but you certainly can make it worse if you over do it.
Hope that helps, and fire away with any questions in the comments section!
1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.
2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
3) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
4) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.
5) Michaud, Thomas C. (2011). Human Locomotion. Newton Biomechanics, Newton, MA.
6) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.