Conditions and treatments
Quadriceps Injuries
The quadriceps muscle is one of the most important structures of the lower limb. Running along the anterior surface of the thigh it connects the thigh to the leg through 2 major tendons: quadriceps tendon, patellar tendon. Like most muscles, it has three major parts: tendons (which connects it to the bones), myotendinous portion, muscle belly. An injury may occur in any of these parts, being the healing and prognosis affected by its location. If the quadriceps loses its attachment to the lower leg, the capability of elevating the leg (extending/putting the leg straight) is lost. Thus, if there is a complete tear on the quadriceps or the patelar tendon, urgent medical assessment is needed not to dramatically compromise the lower limb function.
What causes a quadriceps tear?
It is mostly activated when you extend your knee, contributing to gait cycle during walking and running. So sudden movements like kicking a ball or sprinting may cause a tear. Factors that may contribute to a higher risk of injury are: greater training volume or improper warm-up, poor muscle strength, muscle fatigue that leads to overexertion. Fortunately, complete quadriceps or patellar tendon injuries are rare events. They are most likely to happen if frail/damaged tissue exists due to repetitive or collagen diseases, or in high energy impacts such as radical sports trauma or car accidents.
What are the symptoms and how is it diagnosed?
When there is a muscle tear, intense pain is felt on the anterior surface of the thigh, and there is loss of kicking, jumping or muscle power. But when the patellar or quadriceps tendon ruptures there is usually excruciating pain and inability to extend the leg is seen. In the former cases, the clinical setting is so dramatic that urgent care is needed, and a gap is usually palpated where the tendon tears. Ultra-sound along with the clinical assessment confirms diagnosis of a tendon tear, while for muscle injuries an MRI is needed for a more accurate assessment.
How is it treated?
In muscle tears, treatment and recovery time depends on the location, size, pattern and daily life/ sports activity demands. Most injuries are treated without the need of surgery. This involves pain management, and a specific rehabilitation programme to insure the risk of scar tissue and retear is minimised. A multidisciplinary team analyses the tear’s characteristics, and builds up a staged programme based on tissue healing time and your individual progress during each stage. When the patellar or quadriceps tendon completely ruptures, surgical repair is the only way to restore normal function of the limb. Options vary depending on the tear’s location. If it is avulsed from the bone (most commonly) a direct repair is performed, whereas an augmentation with a tendon graft may be needed when the rupture in its midsubstance. Afterwards, a prolonged staged rehabilitation programme takes place. In the first stages, protection of the repair is needed, so weight-bearing and flexion is controlled. As time progresses, free range of movement and normalised gait is introduced. Neuromuscular and proprioception training, muscle built (hypertrophy) follows, and progressively you will be introduced back to your daily life activities and sports.
