When may your thigh pain be something to be more concerned about?

Injuries to the legs are common among athletes and active individuals and most problems seem to be of little concern for the majority of people. This is justly so, as most conditions resolve on their own and do not warrant further attention. However, sometimes leg injuries may seem to be more painful than anticipated or the pain is lasting longer than expected. Therefore, it may be useful to recognize some of the more common causes of thigh pain that may need the advice of a physician.

The thigh is mainly composed of the four muscles of the quadriceps group: the rectus femoris, vastus intermedius, vastus lateralis, and the vastus medialis. The rectus femoris muscle crosses-over both the hip and knee joints to aid the leg with hip flexion and knee extension. The other three muscles, the vasti, only cross the knee joint and cause extension of the knee. Injury to these muscles more commonly occur in activities that involve jumping and sprinting; commonly soccer, rugby, baseketball, and football.

Muscle Strain

A sudden-onset quadriceps muscle strain occurs after there is a sudden and forceful eccentric contraction. An eccentric contraction is a movement where the muscle fibers are attempting to contract normally, but the muscle is lengthening rather than becoming shorter. This type of muscle contraction occurs when landing from a high jump or when there is a sudden change of direction while running. Of the group of quadriceps muscles, the rectus femoris is the most commonly strained because it is the longest as it crosses two joints of the leg and has the greatest force placed upon it.

There are three grades of muscle strain:

  • Grade 1: Minor tearing of muscle fibers present with minimal to no loss of strength. Pain is mild to moderate. There is no palpable (able to feel) changes on a physician’s physical exam
  • Grade 2: Severe tearing of the muscle fibers occurred. Pain is significant. There is loss of strength in the leg. A physician may be able to palpate a defect on physical exam.
  • Grade 3: Complete tear of the muscle. Pain is severe and there is a complete loss of muscle strength. Frequently a physician can palpate a defect in the muscle.

With these types of injuries there are usually not any imaging techniques that are indicated to help aide in the diagnosis. The history the patient verbalizes and the physical exam performed by the physician are generally all that is needed for a diagnosis. At times, an ultrasound is performed on the thigh to reveal and determine the extent of the injury, determine is any other conditions are present, and to serially monitor healing.

Treatment for muscle strains has largely gone unchanged for many years. The acute treatment of a muscle strain is the RICE principle: rest, ice, compression, and elevation. This is implemented as after this injury as there is bleeding and an inflammatory reaction that occurs in the muscle. The RICE principle helps to allow the muscle to rest, to decrease the amount of blood flow to the injured area, and to decrease the extent of inflammation. Approximately 3-5 days after the injury occurred is when an individual can start the active phase of their recovery. This physical therapy aims to rehabilitate the muscle and focuses on gradual strengthening, stretching, and functional training of the injured muscle.

There are a few indications for referral to a surgeon; notably if there is suspicion of a Grade 3 tear, as this may need to be surgically put back together. Also, if there is any suspicion of a more severe diagnosis like compartment syndrome (see below).

 

Compartment Syndrome

Compartment syndromes are rare causes of thigh pain in the athlete, but are of significant concern.  The muscles of the leg are covered in a material called fascia, which covers the individual muscles as well as holds groups of muscles together, forming what is called a muscle compartment.  Compartment syndromes happen when there are elevated pressures within one of these muscle compartments. Here we will discuss two types of compartment syndrome: anterior thigh compartment syndrome and chronic exertional compartment syndrome.

The former may arise from a complication of a muscle strain or severe muscle contusion (bruise). This injury may cause there to be excessive bleeding into the muscle of a certain compartment. This causes the pressure to increase, as there is a progressive amount of fluid building-up within a confined space. This type of complication generally manifests as a tense muscle compartment on exam and the pain to touch is much worse than what would be expected. When this diagnosis is suspected it generally warrants a refferal to a surgeon because in order to decrease the pressure surgery is sometimes required.

Chronic exertional compartment syndrome also results from an increase in pressure within a muscle compartment of the leg, but this occurs differently. This condition is not fully understood by science yet, but is thought to occur because active muscles expand as more blood flows into them and their expansion may be limited by noncompliant (inflexible) fascia. This condition more commonly occurs in runners who have more vigorous training regimens. The way athletes describe this condition to a physician is also different. The typical history is of an athlete who typically starts to have pain (generally as a tightness, squeezing, or cramping) at a certain time point every time they physically exert themselves. And then their symptoms will completely go away shortly (approximately 10-20 minutes) after the stop their activity. 

Chase King, MS-IV

David Carfagno, D.O., C.A.Q.S.M.

 

Resources:

Brown, Jim, PhD. "Everything You Need to Know About Quadriceps Strains." Core Performance Core Daily. N.p., n.d. Web.

Kary, Joel M. "Diagnosis and Management of Quadriceps Strains and Contusions." Current Reviews in Musculoskeletal Medicine Curr Rev Musculoskelet Med 3.1-4 (2010): 26-31. Web.

Meehan, William, III, MD, Karl B Fields, MD, and Jonathan Grayzel, MD, FAAEM. "Chronic Exertional Compartment Syndrome." UpToDate. N.p., n.d. Web.

Von Fange, Timothy, MD, Karl B Fields, MD, and Jonathan Grayzel, MD, FAAEM. "Quadriceps Muscle and Tendon Injuries." UpToDate. N.p., n.d. Web.

"Managing Quadriceps Strains for Early Return to Play." Journal of Musculoskeltal Medicine, 257-262. Rheumatology Network. N.p., 28 June 2011. Web.

Image Credit: https://peakphysicaltherapy.net/images/knee-muscle-quadriceps.jpg

 

Disclaimer:  Articles are based on real cases seen at Scottsdale Sports Medicine. The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Please consult your medical professional for individualized healthcare.