Whether you play AFL, rugby union, rugby league or soccer, you have to be able to kick the ball with skill, precision and power. A great kick can be the difference between losing or winning a game – something we have seen frequently. But the kicking action – bringing your leg backwards, then accelerating it forward rapidly and kicking the ball, will put strain on the muscle rectus femoris, which is a part of the big muscle on the front of the thigh, the quadriceps (commonly called the quads).
Quadricep muscle anatomy
Quadricep Muscle Anatomy
These are the four muscles at the front of the thigh that make up the quadricep muscle
The first three mentioned muscles extend the knee but the rectus femoris is the only part of the quad that works over both the knee joint and also the hip joint as it is attached to the ilium (pelvic bone)- that bony part that sticks out of your hip. All four parts of the quadriceps muscle attach to the top of the patella (the knee cap) via the quadriceps tendon. The innervation comes from the femoral nerve which comes from the lumbar spine (lower back).
Injury to the rectus femoris usually involves a forceful movement such as explosively sprinting or forcefully kicking a ball (especially when the athlete’s foot strikes another player whilst trying to kick). You can also injure the rectus femoris with other explosive movements that occur in athletics or gymnastics. Even excessive stretching or fatigue due to overuse or simply not having enough recovery time can also result in injury. The second most common muscle to strain in the lower limb is rectus femoris. Injuring the quads can be painful and debilitating and therefore can result in lost time from training and sporting events.
The rectus femoris muscle crosses the hip and knee putting it under particular stress during kicking activities.
A rectus femoris injury can occur anywhere in its structure, including closer to the knee cap, in the mid section of the muscle or closer to the hip (ilium). The exact location of the injury can be isolated by your health professional.
On injury, the athlete will usually notice a sudden sharp pain and loss of function, however, these symptoms can sometimes present after the activity, up to several days later. Loss of function can mean limping off the field, not being able to weight bare or experiencing pain when bending the knee. There can be tightness, swelling, loss of range of motion in either the knee or the hip joint and bruising.
A physiotherapist can assess what grade your injury is. We use a grading system that ranges from 1 to 3.
Grading of Muscle Injury
Grade 1: mild to moderate pain on touching (palpating) the injured area, with minor tearing of muscle fibres and none or minimal loss in strength. Usually a you can still weight-bare or walk with a limp. The prognosis is good and you will be able to return to sport within a reasonable amount of time.
Grade 2: moderate to severe pain when touching the affected area. Palpable defect in the muscle or tendon. There is significant tearing of muscle fibres/bundles and reduced muscle strength. You would need support to offload the injury as weight-bearing puts too much strain on the injured site. The prognosis can still be good but it will take more time, depending on the severity, to get back to sporting activities.
Grade 3 Rectus Femoris Strain
Grade 3: complete tearing of the muscle with associated (severe) pain and complete loss of strength. When touching the affected area a defect can be felt and sometimes even be seen. May be associated with a piece of bone being torn off the pelvis. This type of fracture is called a Anterior Inferior Iliac Spine Avulsion (AIIS). An operation is usually not necessary as conservative treatment can be sufficient.
Risk factors
For the initial stages of management, 24-72 hours, we recommend implementing the PEACE & LOVE method.
After the first few days have passed, the muscle needs ‘LOVE’
It is important to see a physiotherapist after a muscle strain and before returning to sport, as the single BIGGEST risk factor for a quad strain occurring is if there has been a previous muscle strain in that same muscle.
the single BIGGEST risk factor for a quad strain occurring is if there has been a previous muscle strain in that same muscle
Timeframes for the same grade of tear can differ from person to person based on location of tear, age, sport, previous level of activity, previous injury and other individual factors.
The general guidelines are as follows;
however, we recommend consulting with an experienced professional to guide you. There are so many examples of athletes returning too early…
Conservative treatment is shown to be successful for all grades of tears. Surgical treatment also remains an option for failed conservative treatment of RF injuries across all the injury groups.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941577/
https://www.ortho.com.sg/tear-of-the-rectus-femoris-direct-head-surgical-repair/
https://www.orthobullets.com/knee-and-sports/3104/rectus-femoris-strain
