- sports leg injury - stock.xchng
Thigh contusions can be sustained in a number of different sports including soccer, baseball, softball, football, rugby, and basketball. They can range from mild to severe depending on the amount of bleeding and damage sustained to the musculature.
The quadriceps muscle group is a group of four muscles including the rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius (deepest muscle of the four). This muscle groups runs from the pelvis through the thigh and inserts below the patella.
Because of its location on the thigh, these muscles are at risk for injury from an external force. The external force can be provided by an opponent (such as in soccer with a misplaced kick) or a piece of sports equipment (i.e., softball with an inside fastball to a batter hugging the plate).
Signs and Symptoms of a Quadriceps Contusion
The signs and symptoms of a quadriceps contusion include:
- acute pain
- swelling (may be severe)
- inability to fully straighten or flex the knee
- inability to fully contract the quadriceps muscle
- discoloration
- localized hematoma
- inability to fully bear weight (walking with a limp)
If the athlete receives a blow to the thigh and continues to play, the thigh may become progressively stiff. This is caused by the blood flowing into the tissues from the broken blood vessels in and around the damaged tissue.
The bleeding can either be intramuscular or intermuscular. Intramuscular bleeding occurs within the muscle compartment increasing the pressure within the compartment. This type of injury is more severe because of the risk of compartment syndrome and the possibility of calcification of the deep tissue actually.
Intermuscular bleeding occurs when the blood can escape through the fascia surrounding the muscle. This bleeding moves distally (area of discoloration moves down the leg) and is distributed between the compartments of the upper thigh. Intermuscular bleeding is less severe with the athlete better able to flex and extend the knee soon after the injury.
When the athlete first sustains this type of injury, he/she will not be able to determine the type of bleeding inside the thigh. Because of this, any quadriceps contusion that is caused by a significant force should be treated the same.
PRICE Treatment Priciples
Treatment should consist of the PRICE principles of treating acute injuries. The PRICE principles include:
- Protection and Rest
- Ice
- Compression
- Elevation
Because of the amount of bleeding that can occur with a moderate or severe quadriceps contusion, the thigh needs to be immediately wrapped with an ice pack and ace bandage and placed in a position of full knee flexion while the athlete is lying on his/her back. This is the only injury in which a specific joint position is recommended while the ice pack is applied.
If the leg is initially iced with the knee in a straight position, there may be marked stiffness in the quadriceps muscle the day after the injury. With the bent knee method of icing, the flexibility of the quadriceps should be able to be maintained at or near normal. This method of icing can be repeated every two hours for twenty minutes for the first 48 hours post-injury.
In between icing, the athlete should keep a compression wrap on the thigh and keep the leg elevated as much as possible. If the athlete has difficulty walking, the athlete should be placed on crutches and provided with crutch walking instructions.
Beginning Rehabilitation Exercises for Quadriceps Injury
Once the initial two days of PRICE treatment have passed, the athlete can then begin gentile isometric contractions (also known as quad sets). The athlete contracts the quadriceps muscle group with the knee extended and holds the contraction for 8 – 10 seconds. Care must be taken not to go into pain during these contractions.
The athlete can repeat quad sets 10 times every hour. As the healing process continues, the intensity of the quad sets can be increased. Once these exercises can be performed comfortably, the athlete can then advance to straight-leg raises.
If the muscle is tight, the athlete can begin gentle static stretching exercises to begin to increase the flexibility of the muscle. The athlete can either stand or lie down to stretch the quadriceps. The athlete should reach back and grab the foot of the injured leg bending his/her knee. The athlete can pull harder on the foot to increase the amount of stretch. The stretch is only effective if the athlete keeps his/her pelvis in a neutral position.
The athlete should not go into pain during any recovery exercises. Rehabilitation that is too aggressive can further the recovery time. The athlete can return to play when the athlete has full range of motion of the knee along with full strength.
If the athlete is returning to a contact or collision sport, the athlete should return with protective padding over the thigh to prevent re-injury of the same muscle tissue.
References:
Bahr, R., & Maehlum, S. (2004). Clinical Guide to Sports Injuries. Human Kinetics: Champaign, IL.
Irvin, R., Iverse, D., & Roy, S. (1998). Sports Medicine: Prevention, Assessment, Management, and Rehabilitation of Athletic Injuries. (2nd Ed.). Allyn and Bacon: Boston, MA.
Terry Zeigler - Educating through writing with over twenty-five years of experience as a Kinesiology Professor and Certified Athletic Trainer.
