The quadriceps muscle group are made up of four muscles which sit on the anterior thigh and are responsible for knee extension and eccentric flexion such as controlling the speed you walk downhill. The quadriceps sit against the femur the whole way down so are susceptible to compression injuries. A contusion is an injury which results in muscular bleeding and therefore bruising. Most people do not seek medical help so exact injury prevalence is difficult but it is thought to be the second most common sports injury after sprains/strains. It is more common in contact sports such as rugby and judo.
The cause of a quadriceps contusion is a traumatic impact to the lateral, anterior or medial thigh, it is most common along the anterior thigh and therefore the rectus femoris muscle. The impact causes the muscle fibres and connective tissue to rupture, this leads to capillary disruption causing the tissue to bleed forming haematoma and swelling.
Signs and Symptoms
The injury severity is graded and based on the range of knee flexion Mild – >120* Moderate – between 90*-120* Severe – <90* Swelling and bruising which can take up to 48 hours to develop Decreased range of movement Pain when weight bearing Tenderness over the area Tense anterior compartment The signs and symptoms will gradually get worse over the following 24-48 hours after the injury occurs.
If treated correctly, there will be a full recovery but the healing times vary depending on the severity of the injury. An average timescale for returning to play is 13 days for a mild injury, 19 days for a moderate injury and 21 days for a severe injury. Initially compression and holding the knee in flexion is suggested with rest to reduce the bleeding. The use of anti-inflammatory drugs is to be avoided as this could increase the amount of bleeding and it interferes with the inflammatory response which is required for healing. A Sports Therapist can start treatment after 72 hours with treatments that include ultrasound, taping, TENS for pain control and rehabilitation exercises tailored to each patient. The rehabilitation will go through stages that decrease the swelling, increase the range of knee flexion, strength, proprioception and sport specific training. Acupuncture is also very effective but not all Sports Therapists offer, however I do offer this as a treatment. It is important to avoid all massage as this increases the blood flow to the area causing the injury to worsen.
If a contusion is left untreated or is treated incorrectly there is a chance it could develop into myositis ossificans which is a condition where there is bone formation in the muscle or soft tissue which then has to be removed. Compartment syndrome is where there is a build up of pressure within the anterior compartment of the thigh and cannot be relieved and when it exceeds the pressure of the blood vessels, they can no longer supply blood to the muscles. Due to the lack of oxygen and nutrients the muscles can no longer regenerate and therefore the cells die. This is a serious condition which must be addressed quickly to prevent too much damage from occurring.