Quadriceps Pain

The quadriceps are a group of four powerful muscles located on the front of the thigh; namely the vastus lateralis (most outer) vastus medialis (most medial) vastus intermedialis (central) and rectus femoris – which sits above the rest. All four of the ‘vastus’ muscles originate from the upper, front part of the thigh, with the rectus femoris originating from the front of the pelvic bone and all attach onto the kneecap via the quadriceps tendon. These four muscles are supplied by the femoral nerve.

The four quadriceps muscles are all extensors of the knee joint, helping it to straighten and perform actions such as kicking, jumping, or squatting or functional activities such as standing from a seated position, or walking up and down stairs.

As a result of this muscle groups function in such large, strong movements, they can often become injured, either in the bulk of the muscle itself or in the form of a strain or tear or nearer to the knee cap itself where the four muscles come together to attach into the kneecap via the quadriceps tendon.

  • Quad muscle strain

    A strain or a complete tear to one of the quadriceps muscles can occur, often during activities such as sprinting, kicking, or jumping. A history of sudden pain, or pain to stretch and contract are signs of a torn/strained muscle. Muscle strains/tears can be graded on a scale…

    Grade 1 – no pain to stretch or contract. There is a general ache that is fatigue based or a delayed onset of muscular soreness issue. Rest and gentle stretching over a few days should ease this.

    Grade 2 – no specific time of injury. There is tightness to stretch and to press but no contraction pain, suggesting there is increased tension in the muscle. This could be linked to pelvic/spinal issues or could be a local issue to the muscle on a small scale. Rest, gentle stretching, massage and an easy return to exercise should resolve this.

    Grade 3a – Sharp pain at the time of injury followed by pain to stretch, variable pain to contract dependent on extent and tender spot to palpate. This needs to be rested for 5 days and treated with ice and anti-inflammatories. If in doubt and if the pain continues to be there after 5 days then seek help from your physio.

    Grade 3b – This is the ‘sniper shot’. These are proper injuries with sharp pain on stretch and contraction, plenty of bleeding and swelling and you are unable to really use the leg. It needs to be rested to stop further damage, to reduce the amount of bleed and to allow healing. These are when you need to be assessed properly by a physio.

    Should you experience pain during one or both of these, you can suspect a strain to the muscle. Recovery from a muscle strain can vary depending upon the severity of it…

    There are a number of reasons for muscle strains/tears, not only locally in the injured muscles but also from the spine/pelvis areas…

    • Poor warm up
    • Muscle weakness
    • Muscle tightness
    • Muscle overload

    All of these things can have an impact on the likelihood of straining a muscle, especially if you are participating in one of the above activities. It is not only important to treat the symptoms but also the root causes of the injury, which our team of physios here focus on.

  • Quadriceps tendon pain

    The quadriceps tendon brings together the four quadriceps muscles as they attach onto the top part of the kneecap. This tendon can therefore be acutely damaged, ruptured and strained similar to the quad muscles themselves, or you can also develop what is known as a tendinopathy to the quadriceps tendon, which is a more degenerative breaking down of the tendon over time.

    Tendinopathies often develop due to combination of poor biomechanics and overuse, which over time leads to degeneration of the tendon as it struggles to keep up with the demands asked of it. Symptoms associated with quadriceps tendinopathy will often include pain to touch above the kneecap. The tendon will often feel stiff when beginning exercise and gradually ease as the tissues warm up, and will typically feel stiff the following morning.

  • Femoral nerve

    Arising from the spine at the second, third and fourth lumbar nerves (L2, 3, and 4) the femoral nerve supplies the muscles of the front of the thigh, which extend the knee, and the skin on the upper thigh and inner leg. From the lower back it descends in the abdomen, through the front of the pelvis and down the anterior thigh towards the inside of the leg.

    In order for nerves to function as effectively as possible, they must smoothly slide and glide through the muscles, joints, and other structures they pass by. If there is restriction along the course of the nerve, discomfort, numbness, weakness and overall impaired function can result.

    In the case of the femoral nerve, restriction in the lower back, abdomen/hip area, or muscular restrictions into the front/inside of the thigh may be the cause of your symptoms.

    All of these are things your physiotherapist can assess and treat if they suspect femoral nerve irritation from your history.