Quad strain (pulled quadriceps): symptoms, treatment and recovery

The quadriceps is a group of four muscles at the front of the thigh: vastus lateralis, vastus medialis, vastus intermedius and rectus femoris. Together they straighten the knee and, through the rectus femoris, help to flex the hip. A strain is an overstretched or torn muscle, also known as a pulled muscle, according to the NHS.

The Northern Care Alliance leaflet says a pulled quad is a tear in the fibres of the large muscle group on the front of the thigh. It may be minor, with only a few fibres affected, or, less commonly, a significant tear. Quad strains are different from hamstring strains, which affect the back of the thigh and involve a separate group of muscles.

The leaflet explains that a pulled quad is normally caused by a forcible contraction of the muscle, when it is vulnerable to tearing, in activities such as sprinting, jumping, kicking and weightlifting. The NHS adds that sprains and strains happen when you overstretch or twist a muscle, and that not warming up before exercising, tired muscles and playing sport are common causes.

The rectus femoris is more vulnerable than the other three quadriceps muscles because it is the only one that crosses both the hip and the knee. Kicking sports and sprinting, where the muscle works at both joints at once, are typical settings.

The immediate sensation is pain on the front of the thigh, often with a tearing sensation. With a minor tear you may be able to continue with minimal restriction, but the leaflet warns that pain and tightness may gradually increase after the activity as bleeding and swelling develop around the injured muscle.

• Pain and tenderness at the front of the thigh.

• Muscle spasm or cramping.

• Weakness when straightening the knee or walking.

• Swelling or bruising.

• Reduced range of movement, with the knee stiff to bend.

The Northern Care Alliance leaflet recommends a five-step approach for the first 24 to 48 hours: regular painkillers such as paracetamol and ibuprofen (with a pharmacist’s advice if you are unsure whether you can take them), relative rest with gentle movement to prevent stiffness, ice wrapped in a damp towel for up to 20 minutes every 2 hours for the first 3 days, early weight bearing and walking normally, and elevation of the leg for the first 2 days.

The NHS, in its more general advice on sprains and strains, recommends PRICE therapy for the first 2 to 3 days: protection, rest, ice for up to 20 minutes every 2 to 3 hours, compression with a bandage, and elevation. It suggests trying to avoid heat such as hot baths and heat packs, alcohol and massage for the first couple of days, and keeping the area moving once movement is possible without pain stopping you.

The leaflet specifically says to avoid activities that increase blood flow to the injured muscle early on, such as hot showers, quad stretching, heat rubs, sports massage, alcohol and excessive activity, because they can increase bleeding within the muscle and extend recovery.

A physiotherapist can diagnose the injury, explain which tissues are damaged and to what extent, and indicate how long healing should take. The leaflet lists electrotherapy, soft tissue treatment, an exercise programme and massage as possible treatments depending on severity.

Rehabilitation is staged. Stretching should be pain-free and not start too early, not before day 5 after injury; strengthening exercises can start as early as day 5 if they are low level and pain-free, beginning with isometric contractions, progressing to straight leg raises and knee extensions with resistance and finishing with sport-specific running and sprint drills. The leaflet’s rule is: if it hurts, do not do it.

The NHS says physiotherapy may help if a strain is taking longer than usual to get better, that it may not be available everywhere on the NHS and waiting times can be long, and that in many areas you can refer yourself to NHS community musculoskeletal services without a GP referral.

The Northern Care Alliance leaflet says that most pulled quad muscles heal without complication in a couple of months, though significant tears can injure other structures in and around the muscle, which can delay recovery. The NHS says that after 2 weeks most sprains and strains feel better, that you should avoid strenuous exercise such as running for up to 8 weeks because of the risk of further damage, and that severe strains can take months to get back to normal.

The NHS warns of a risk of further damage if you return to strenuous exercise too early, so a gradual increase in load, guided by pain and, where possible, by a physiotherapist, is safer than working to a fixed date.

The NHS says to get help from NHS 111 if the injury is very painful or the pain is getting worse, there is a large amount of swelling or bruising that is getting worse, you cannot put any weight on it or walk more than a few steps, it feels very stiff, it is not feeling better after treating it yourself, or you have a very high temperature or feel hot, cold or shivery, which could be an infection. See a GP if it is getting worse or not improving.

Call 999 or go to A&E if you heard a crack when you had your injury, the injured body part has changed shape or is pointing at an odd angle, it is numb, tingling or has pins and needles, or the skin around it has changed colour, such as blue or grey, or is cold to touch. You may have broken a bone and need an X-ray.