By Robert Barker Physiotherapist.
Treatment / management
Management of a rectus femoris tear consists of conservative treatments initially. If the tendon is completely ruptured or if conservative treatments fail to heal the muscle-tendon unit, then surgery is recommended. Conservative management of acute tears consists of pain relief, controlling inflammation, optimising tissue healing properties, then progressively strengthening the muscle to build resilience and return the muscle back to pre-injury loading capacity.
In the early stages of a rectus femoris tear (Imediate-72 hours) the POLICEMM therapy method should be applied.
Protect: Protecting the injury means resting and immobilising. Protecting will stop the injury from becoming worse (increase the tear size) and reduce the intra muscle bruising and inflammation. It will also allow the formation of required connective scar tissue to re-attached and bind the torn muscle fibres in these early stages. Further protection by using crutches should be implemented if you have a grade 2 or 3 tear.
Optimise Loading: Whilst early formation of scar tissue through rest is important to gain a good strong attachment site and form the ‘scaffolding’, it should be balanced out with gentle muscle contraction. Performing gentle mobility and quadriceps contraction exercises will allow for faster healing and stronger formation of myofilaments (muscle fibres), rather than just scar tissue. In order to muscle tissue to regenerate it has to be contracted to stimulate the muscle and tendon building cells.
Ice: Ice should be applied directly over the injured site immediately following the tear for 15-20 minutes every 2 hours for the first 24 hours or whilst the site is swollen and painful. Ice reduces the temperature inside the muscle to reduce blood flow. This minimises the intramuscular bleeding and limits the spread of inflammation and prevents further tissue damage at the tear site.
Compression: Compression of the upper thigh should be applied by using bandages, tapping, and braces. This also helps restrict blood flow and build-up of unwanted interstitial fluid (swelling) as a bi-product of the inflammatory process.
Elevate: Elevating your injured leg above heart level can help with reducing pressure build up within the leg. This will limit how much fluid (swelling) accumulates at the injured site, causing further tissue damage.
Medications: If the tear is significant, non-steroidal anti-inflammatory (NSAID’s) medication can be taken. They should only be used for a short period of time (2-4 days) during the protection and inflammatory stage.
Medical referral: If the tear is significant and you are experiencing a great deal of pain and disability, or you suspect you have a full rupture, then referral to a medical professional is recommend. This can either be a GP or Physiotherapist, who will know what the next best course of action is. Normally with or high grade 3 or a tendon rupture an imaging scan will be acquired, and possible review with an orthopaedic surgeon.
This is by far the most important of all the stages. Following the acute trauma of the tear and the short period (2-5 days) of inflammation control and muscle protection, the muscle has to be gradually and adequately loaded in order to heal correctly and lay down sufficient strong new muscle tissue and connective tissue (collagen). This will allow the tear to heal faster and significantly stronger, than leaving it to heal by itself. Completing sufficient rehabilitation will allow you to go back to performing your sport or activity at your pre-injury level and prevent re-tearing of the muscle. Rest alone will allow excessive scar tissue formation at the tear site, causing the muscle to become permanently stiff, weaker (10-20%) and lack power required for sprinting and kicking based activities.
Rehabilitation exercises are graded from the initial time of injury to when you return to sport. A good Physiotherapist will guide you on the length of your rehabilitation program and the type and intensity of exercises you need to be doing at each stage and depending on what sport/activity you participate in. Generally, exercises consist of early gentle mobility, stretching, and light isometric (holding) type exercises. In the later rehabilitation stages exercises will be aimed at increasing the muscles loading tolerance and power producing properties and often mimic the demands of your sport. For example; if you play football, running drills, kicking drills, agility and hip control exercises, specific plyometrics, and other forms ballistic type exercises will be included into your program.
Best preventative strategies include completing a thorough warm up before vigorous exercises and game play. Research has proven static (holding) stretching not only doesn’t reduce the rate of injury, it also can reduce performance in power or sprinting based sports, which require the muscle fibres to be taught and maintain their powerful rigid properties. Dynamic stretches, such as leg swings, marching, and lunge walking have shown to increase muscular performance and reduce injury rates.
Having strong hip flexors, such as the Iliopsoas helps prevent rectus femoris strains. Iliopsoas work together with the quadriceps muscle in most actions. Having insufficient iliopsoas strength will place more load on the rectus femoris, thus lead to strain.
Strength and conditioning exercises that focus on the eccentric contraction of the muscle are very important in preventing strains. The rectus femoris muscle produces its greatest force during the eccentric contraction phase of sprinting, kicking, and rapid changes of direction.