Quadriceps anatomy
The quadriceps is the most voluminous muscle in the anterior region of the thigh and, as the name suggests, is made up of four heads:
- rectus femoris
- vastus medialis
- lateral vastus
- vast intermediate
Quadriceps tear
The quadriceps is made up predominantly of white fibers (IIa), which allow for powerful and explosive movements. It is during these violent contractions that the quadriceps can rupture near the musculotendinous junction. In this case we speak of a muscle tear, a traumatic event that can cause the rupture of a small number of fibers (first degree tear), or affect a more important part of the muscle (second degree tear) up to its complete laceration ( third degree muscle tear).
Other times the fiber break is caused by a trauma that affects 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 injured.
A tear can affect the quadriceps even when the muscle is overstretched. Often in these cases there is not a real break but a simple elongation of the muscle fibers which, while exceeding their tolerance limit, are damaged but not torn. In these cases we speak of muscle strain, a medium-sized injury, often due to an imbalance between the strength of the quadriceps and that of the hamstrings (hamstring) in favor of the latter.
Symptoms
- Sharp and violent pain at the time of the trauma, the stronger the greater the percentage of injured fibers
- The initial pain is followed by a muscle spasm
- Pain increases when palpating the injured area
- Mobility restriction; in the case of simple first degree muscle strain or strain, the pain can be endured and allow the continuation of sporting activity; however, it is advisable to stop training even if the pain felt is slight.
- Appearance of swelling and hematoma, often extensive
- Tactile perception of a step in the anterior 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 musculotendinous injuries. In this initial phase, the objectives of the treatment are: immobilization, the application of a cold pack for 15-20 minutes every two or three hours (ice pack or spray) and a compression bandage to reduce bleeding and mechanical stress on the injured structure. If the pain is very intense, do not hesitate to use crutches, in any case avoid contracting or straining the injured muscle.
The doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to reduce inflammation and pain. In case of complete rupture and / or heavy bleeding, hospitalization may be necessary to control the situation; especially in such situations, the intake of aspirin (acetylsalicylic acid) is contraindicated, due to the antiplatelet power (from irreversible blockade of platelet COX-1) higher than that, reversible, of ibuprofen and other NSAIDs.
If after 48-72 hours from the trauma the swelling has subsided, bruises appear and there is an improvement in contractile abilities, the rehabilitation program can be started. If, on the other hand, the symptoms do not show signs of improving, it is good to contact a doctor who will carry out further investigations to clarify the situation and rule out complications.
The 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 flow of blood, oxygen and nutrients will be favored, facilitating the process. of regeneration and limiting the formation of scar tissue. In these early stages, rehabilitation in water is particularly useful as it allows to limit the load on the injured limb.
Among the most useful physical therapies we remember ultrasounds and tercar therapy.
RECOVERY TIMES: healing generally takes 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.
