Anatomy of the quadriceps
The quadriceps is the most voluminous muscle in the anterior region of the thigh and, as the name may suggest, is composed of four heads:
- rectus femoris
- vast media
- broad lateral
- large intermediate
Tearing of the quadriceps
The quadriceps is mainly formed by white fibers (IIa), which allow powerful and explosive movements. During these violent contractions, the quadriceps can break near the musculotendinous junction. In this case we speak of muscle tearing, a traumatic event that can cause the rupture of a reduced number of fibers (first degree tear), or affect a more important part of the muscle (second degree tear) up to its complete tear ( third degree muscle tear).
Other times the break of the fibers is caused by a trauma that hits the quadriceps when it is contracted (impact of the opponent's knee against the thigh in football). In these cases the muscle is violently compressed against the underlying bone and can be damaged.
A tear can strike the quadriceps even when the muscle is excessively stretched. Often in these cases there is not a real break but a simple elongation of the muscle fibers which, although exceeding their tolerance limit, are damaged but not lacerated. In these cases one speaks of muscular stretching, a medium-sized lesion, often due to an imbalance between the strength of the quadriceps and that of the posterior thigh muscles (ischiocrural) in favor of the latter.
Symptoms
- Sharp and violent pain at the time of the trauma, the stronger the percentage of injured fibers
- A muscle spasm follows the initial pain
- The pain increases during palpation of the injured area
- Limitation of mobility; in case of simple stretching or muscle tearing of first degree the pain can be tolerated and allow the continuation of the sporting activity; however it is advisable to stop training even if the pain felt is minor.
- Appearance of swelling and hematoma, often extended
- Tactile perception of a step in the front part of the thigh near the injured area (in case of severe injury)
- Pain can be evoked by contraction against resistance
Care and treatment
We recommend the immediate application of RICE, the most accredited protocol for acute musculotendineous lesions. In this initial phase the treatment objectives are: immobilization, the application of a cold compress for 15-20 minutes every two or three hours (ice bag or spray) and a compression bandage to reduce bleeding and mechanical stresses on the damaged structure. If the pain is very intense do not hesitate to use crutches, in any case avoid contracting or straining the injured muscle.
Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) like or ibuprofen to reduce inflammation and pain. In the event of complete rupture and / or severe bleeding, hospitalization may be required to keep the situation under control; especially in similar situations, intake of aspirin (acetylsalicylic acid) is contraindicated, due to the anti-platelet aggregation power (from irreversible platelet-1 blockade), superior to the reversible one of ibuprofen and other NSAIDs.
If after 48-72 hours from the trauma the swelling has diminished, bruises appear and an improvement in the contractile capacity is recorded, the rehabilitation program can be started. If, on the other hand, the symptoms do not improve, contact a doctor who will carry out further investigations to clarify the situation and exclude complications.
Strengthening of the quadriceps combined with stretching exercises is necessary to prevent the chronicization of the lesions. It is advisable to gradually increase the intensity of these exercises: in the initial phase, for example, it is good to work with moderate loads and a high number of repetitions; in this way the local blood supply, oxygen and nutrients will be favored, facilitating the regeneration process and limiting the formation of scar tissue. In these first phases, rehabilitation in water is particularly useful, which limits the load on the injured limb.
Among the most useful physical therapies we mention ultrasounds and tercar therapy.
RECOVERY TIMES : healing generally occurs in 2-12 weeks depending on the extent of the lesion and hematoma.
Surgery is only necessary in the most severe cases or when the lesions become chronic.
