Lionel Pannunzio PT / SCS
Quadriceps Strains in Soccer Players
Research shows that Thigh muscles injuries represent a common finding in athletes. Recent papers on professional soccer players demonstrated that thigh muscle injuries represent more than 30% of all injuries and cause the majority of days lost from competition
Anatomy of the Injury
The four muscles that make up the quadriceps are (see picture above) :
1) Vastus Medialis
2) Vastus Lateralis
3) Vastus Intermedius
4) Rectus Femoris
The Quadriceps femoris is a hip flexor and a knee extensor. It is located in the anterior compartment of the thigh.The rectus femoris is the most superficial part of the quadriceps and it crosses both the hip and knee joints, thus also making it more susceptible to stretch-induced strain injuries.
Quadriceps Muscle Function
The Quadriceps Muscle Group is responsible for many important actions ( see picture above) required in Soccer Players:
Decelerating Landing from a Jump
Why soccer players suffer Quadriceps injuries?
There are generally three mechanisms of injury for a quadriceps strain.
Soccer regularly requires sudden forceful eccentric contraction of the quadriceps during regulation of knee ﬂexion and hip extension.
The most common mechanism of injury in soccer are:
1. Sudden deceleration of the leg (e.g. kicking), When a soccer player winds up to kick a ball, they go into hip extension and knee flexion. This, will create a demand on this muscle at both joints. Then, the player performs a rapid and intense contraction of the Rectus Femoris during the actual kicking action. It is usually that “wind-up” movement the mechanism that strains the muscle
2. violent contraction of the quadriceps (sprinting) and
3. rapid deceleration of an overstretched muscle (by quickly change of direction).
Fatigue will play an important role in this injury. Players’ fatigue over the course of a game and season may increase the risk of injury.
Quadriceps tears can sideline a player anywhere from two weeks to three months depending on the severity.Pain, swelling, bruising and muscle tenderness may also occur.
Quadriceps Muscle Strain - Type of Injury
The Rectus Femoris is the most commonly strained muscle of the quadriceps because it crosses both the hip and knee joints.
The Rectus Femoris is commonly injured in one of these 4 locations
Proximal Tendon Injury, Direct Head and Indirect Head
Musculotendon junction Injury
Muscle Belly Injury
Quadricipital tendon Rupture .
Quadriceps Strains are graded according to the amount of muscle damage that has occurred:
Grade 1. A mild or partial stretch or tearing of a few muscle fibers. The muscle is tender and painful, but maintains its normal strength. Use of the leg is not impaired, and walking is normal.
Grade 2. A moderate stretch or tearing of a greater percentage of the muscle fibers. A snapping or pulling sensation may occur at the time of the injury and after the injury. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. Use of the leg is visibly impaired, and limping when walking is common.
Grade 3. A severe tear of the muscle fibers, sometimes a complete muscle tear. A “popping” sound may be heard or felt when the injury occurs. Bruising is apparent, and sometimes a “dent” in the muscle where it is torn is visible
How does it feel to suffer a Quadriceps strain ?
Sharp pain or weakness in the front of the thigh anywhere from the hip to the knee.
A throbbing pain at rest with sharp stabs of pain occurring when you try to stand or walk.
A feeling of tightness or weakness in the anterior thigh area.
Spasms (a gripping or severe tightening feeling in the Quadriceps muscle).
Sharp pain in the front of the thigh, when trying to stretch or move the hip or knee.
A “pop” or hear a “pop” sound at the time of injury (with a Grade 3 strain).
Weakness in the thigh when trying to walk, climb stairs, or stand.
Limping when walking.
Difficulty performing daily activities that require standing and walking.
An inability to run or jump on the affected leg.
Bruising: When muscles are strained or torn, muscle fibers and other cells are disrupted and bleeding occurs, which causes bruising. Within a few hours of the injury, swelling can occur, causing the injured area to expand and feel tight and stiff.
Quadriceps Strain Rehabilitation
Early Stage (1 week)
Here we tried To protect the area from further injury by avoiding soccer exercises or activities that produce pain.
Player will rest from soccer activity but early rehabilitation and controlled exercises are mandatory for a timely and full recovery.
TRX and Wall Slides
These are assisted movements to lengthen the quadriceps’s fibers and promote healing.
The use of the TRX or the wall will assist the quadriceps to contract with less discomfort.
We start with isometric Holds of 5-10 seconds till you can tolerate Contraction Holds of 45 seconds. Recommended 2 sets of 5 repetitions.
Mid Stage (2-3 weeks)
In this stage with try to restore the strength of the quadriceps. During this phase the pain is minimal.
TRX reverse lunges
The exercises selection for This phase are:
TRX reverse lunges for isolation of the affected lower extremity
Do both sides because When the leg is Forward it creates a full length contraction of the quadriceps. When the affected leg is back the quadriceps stretches.
Recommended 2 sets of 8-10 repetitions on each side.
Rear-Foot-Elevated Split Squat
A variation I love to work on quadriceps and gluteal strength is the Rear-Foot-Elevated Split Squat (RFESQ) also known as Bulgarian Squat.
This exercise serves a double purpose, when the affected leg is the leading leg pure strengthening , when it is the trailing leg , you can cue the athlete to put pressure on the pad to load the quad into lengthening and create stiffness later needed for supramaximal contractions like hitting the ball with the laces.
Recommended 2-3 sets of 5-8 repetitions as heavy as tolerated.
Late Stage (2-3 weeks)
Split squat mobility and Strengthening on Sliding Board .
If you've been following my post you’ll know by now I really like mobility drills for muscle injuries where the muscle is moved back and forth through full range ( in contrast with static stretching holds ).
In this video we are doing exactly that, going into deep lunge position to achieve full range.
On the same token, we can add a band and simulate the kicking movement with increased resistance as tolerated for strengthening and in preparation for shooting.
The reverse Nordic curl is a body-weight exercise which mainly works the quadriceps and hip flexors. It has a large eccentric component, meaning the muscles are working whilst lengthening, very important in sports movements.
Many quadriceps exercises such as squats, lunges or leg extensions all place the hip into flexion. These work three of the four quadriceps to a great degree. But, the fourth muscle in this group, the rectus femoris, crosses both the hip and the knee. It acts to bend the knee, and to flex the hip with the other hip flexor muscles. This exercise puts the hips into full extension, lengthening and working all four of the quadriceps, strengthening the rectus femoris as well!
Many injuries occur when a muscle undergoes rapid lengthening, such as when running, kicking a ball, quickly decelerating or landing from a jump.
By improving a muscles eccentric strength, it is possible to reduce injury risk by being better prepared to handle such forces and prevent injury is done regularly, similar to the Nordics for Hamstrings.
Thigh muscles injuries represent a common finding in athletes. Recent papers on professional soccer players demonstrated that thigh muscle injuries represent more than 30% of all injuries and cause the majority of days lost from competition.
The reason for Quadriceps injuries is an overstretching of the muscle
Poor conditioning, tightness in the muscle and age are the usual reasons for Quad strain injuries
Grade 2 and 3 injuries will take longer to heal due to the injury to the muscle fiber
Above your have some of the exercise we successfully use with our athletes.
Do you want to find out more about what you can do to get better from your Quadriceps Strain?
Click the link below to get access to our PDF E-Book where you'll find valuable information about Muscle Injuries in general and Quadriceps Injuries in Particular
Muscle Injuries in Soccer Players
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