**10. Quadriceps**

One of the largest muscles in our body is the one on the front of the thigh. It is called the Quadriceps because it has four distinct beginnings (heads) that form separate muscles (vastus medialis, vastus intermedius, vastus lateralis and rectus femoris) that come together and insert as a single unit to the superior pole of the patella wrapping it and then inserting into the anterior tibial tuberosity.

Functionally, the quadriceps contributes significantly to the knee's stability. The quadriceps is a prime mover of knee extension and assists in hip flexion. The athlete can be injured in two ways. One is by a direct blow to the muscle and a second method is when the extension movement is performed suddenly.

A direct blow can cause blood vessels to break leading to intermuscular or intramuscular hematomas.

Physical examination includes a direct palpation to the injured area that should provoke pain and limping by the patient. This diagnosis is not difficult to determine because the athlete's history leaves no doubt (figure 17).

When there is a torn muscle caused by an overexertion, the examiner can also palpate under‐ lying edema. The athlete will usually be quite uncomfortable in the area of the injury and unable to perform an isometric contraction of the thigh similar to the unaffected leg.

We can check the range of motion of the leg with the athlete lying supine on the edge of the examination table and bending the knee to the limit of pain (figure 18). At this point, stop the

**Figure 17.** A visible bruise is often seen

In carrying out exploratory maneuvers, a patient is unable to laterally raise the leg without

With the athlete lying supine, ask him to to flex the knee and hip to 45° and then ask him to let the leg drop outward to the point of pain., If the injury is minor, the examiner may need to

**Figure 16.** a) With the knee flex at 45° and lying over the lateral side ask the patient to rise it against resistance; b)

One of the largest muscles in our body is the one on the front of the thigh. It is called the Quadriceps because it has four distinct beginnings (heads) that form separate muscles (vastus medialis, vastus intermedius, vastus lateralis and rectus femoris) that come together and insert as a single unit to the superior pole of the patella wrapping it and then inserting into the anterior

Functionally, the quadriceps contributes significantly to the knee's stability. The quadriceps is a prime mover of knee extension and assists in hip flexion. The athlete can be injured in two ways. One is by a direct blow to the muscle and a second method is when the extension

A direct blow can cause blood vessels to break leading to intermuscular or intramuscular

Physical examination includes a direct palpation to the injured area that should provoke pain and limping by the patient. This diagnosis is not difficult to determine because the athlete's

When there is a torn muscle caused by an overexertion, the examiner can also palpate under‐ lying edema. The athlete will usually be quite uncomfortable in the area of the injury and

We can check the range of motion of the leg with the athlete lying supine on the edge of the examination table and bending the knee to the limit of pain (figure 18). At this point, stop the

unable to perform an isometric contraction of the thigh similar to the unaffected leg.

(a) (b)

)

pain and may require help to perform this movement.

apply some resistance to provoke pain (figure 16a,16b).

With the knee flex at 45° ask the patient don´t let you push it out

**10. Quadriceps**

148 Muscle Injuries in Sport Medicine

tibial tuberosity.

hematomas.

movement is performed suddenly.

history leaves no doubt (figure 17).

movement and measure the hip and knee angles. Repeat the test with the uninvolved leg and determine the difference in the measurements. Treatment should be instituted immediately to prohibit the injury from complicating and increasing the pain as time passes.

**Figure 18.** With the injured leg hanging from the lateral of the examination table flex the knee and measure the an‐ gle at which the pain is triggered and you can compared it to the contralateral side

Some times in the clinical history we have reports of previous ruptures that left an obvious muscle deformity (such a depression in the rectus femoris), but from the functional point of view the athlete's performance is unaffected even although the defect could be very large and might even need surgery, [8].

**12. Gastrocnemius tear**

These muscles are the gastrocnemius (medial and lateral head), and soleus and all combine to form the Achilles tendon. Their function is to help flex the knee and the foot (plantar flexion) and also the supination of the foot. Injuries in the calf are often due to lack of adequate warm

Overview of Different Location of Muscle Strain

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151

Generally speaking, the injury usually occurs acutely and patients say it feels as if someone had stuck in the back of the leg, yet when they turn around nobody is behind them, [11].

Pain is present immediately and the athlete can no longer stand and may have to be removed from the field on a stretcher. On physical examination, the prone patient is examined and the site of injury can be determined by palpation; edema is not always present (figure 20).

With the athlete still lying prone, the knee is flexed to 90°. Pain is triggered when the athlete

A complication of this condition is when the Achilles tendon ruptures; it is very important to rule out this complication. With the patient in a sitting position, compress the muscles (figure 21) to make the toes goes directly downward (Thompson sign). If this movement does not

Standing on the toes causes too much pain and the patient is unable to apply equal force by

occur, the tendon could be completely torn and surgical treatment may be necessary.

up, stretching, or by overexertion when the muscle is already fatigued.

**Figure 20.** The gastrocnemius with patient prone is palpate all along

is asked to perform plantar flexion.

both legs to remain standing (figure 22).
