It’s week 7 of the NFL season and there seems to be an inordinate amount (8) of “quad injuries”. Having no personal knowledge of the actual injuries or stages of treatment and rehab I can’t know the specifics of each case. This is an overview of the quadriceps muscle group, it’s function and the possible issues that could be associated with the term quad injury. I have too much respect for the athletic trainers and doctors of the NFL to pretend to know what is actually going on in their training rooms. There may be people out there that have had quad injuries without the support of an NFL sports medicine team. I’ve had fans tell me they read something about a player’s injury and they think they may have the same thing and what should they do about it. This blog is an attempt to give you an understanding of what a quad injury might be.
The term quad is short for quadriceps derived from latin meaning quad (four) and ceps (heads) . The quadriceps are the four muscles that make up the front of the thigh. Distally the quad muscle group turns into the quad tendon which then engulfs the patella (kneecap) to attach onto the tibia. The part of the tendon above the patella is called the quad tendon and below the patella is called the patella tendon. The patella acts as a pulley over the femur (thigh bone) to extend the lower leg. The quad also acts as a hip flexor. It is the most voluminous muscle of the human body and is integral in running, jumping, climbing, squatting etc. Improper quad function could have repercussions on both the knee and hip.
The several issues associated with quad injury are a quad strain (tear), quad contusion (bruise) and quad tendon strain (tear). Throughout my career I had many athletes confused about the difference between the terms strain or sprain and a tear. A strain occurs to muscles or tendons and a sprain occurs to ligaments and joints. The terms strain and sprain respectively are synonymous with a tear. When you hear the words strain or sprain that means the athlete has torn some soft tissue. A tear sounds more severe than a strain or sprain but in our vernacular, it’s the same. Strains, sprains or tears are classified as mild, moderate and severe or 1st, 2nd and 3rd degree. The pros think it’s better to use the numbered system so you can go a step further and classify injuries as 1+, 2-, or 2+. A 1+ means that the injury is closer to a 2nd degree than a 1st-degree strain. This system covers the grey areas so to speak.
Putting the grading system into perspective, think of it like this: a 1st degree is some stretching of the fibers, some pain but no loss of range of motion and no loss of strength and no loss of time. A second degree is a partial tear of the tissue with increased pain, some loss of range of motion, some loss of strength and some loss of time. A third degree is a complete tear, a significant amount of pain, an almost complete loss of range of motion and a significant loss of strength and time.
Trying to put these quad injuries in perspective, let’s first look at what’s been reported. Justin Grasso reported on insidetheiggles.com that Darren Sproles of the Philadelphia Eagles had a quad strain. So we know he sustained some degree of tearing of the quad muscle or quad tendon but probably not a complete tear since he’s not out for the season.
Dave Bryan reported on steelersdepot.com that James Conner of the Pittsburgh Steelers “took a shot in the quad”. This quote sounds like a quad contusion or a deep thigh bruise which I will address later.
Steve Rebeiro reported on the ramswire.usatoday.com that Todd Gurley of the L.A.Rams sustained a thigh contusion. Same as James Conner.
Adam Schefter of ESPN reported that Buffalo Bill offensive tackle LaAdrian Waddles is out for the season with a torn quad. It’s only speculation on my part but given the timeline of out for the season there is a strong possibility it’s a torn quad tendon. It is the same for Destiny Vaeao of the Carolina Panthers and J.T. Cummings of the Chicago Bears as reported by Rotoworld. Interestingly enough most complete quad tendon ruptures require surgery and that has not been reported so maybe it’s a third degree quad muscle tear.
The Bills have given no information on Andre Roberts beyond quad injury which has me thinking quad strain of a significant degree but not a quad tendon rupture as with LaAdrian Waddles of the same team as a quad tendon rupture would mean he was out for the season.
The same holds true for Dontrelle Inman of the L.A. Chargers. Gavino Borquez reported on chargerswire.usatoday.com that Inman made a big catch over a defender and came up limping. He tried to make it to the sidelines but needed help from the athletic trainers. They have put him on injured reserve but have not said he is out for the season. Reading between the lines he has a significant quad strain but not a quad tendon tear.
With the use of MRI and diagnostic ultrasound sports medicine doctors can accurately diagnose the location and amount of tissue damage. In terms of degrees of injury and return to play we know a couple of things. We know that soft tissue healing time for significant injuries is six weeks. At the pro level, athletes are getting diagnostic ultrasounds and or MRI’s every two weeks to see how the injury is progressing. But the magic number of six weeks is just the approximate amount of time for the body to lay down new cells to heal the tear. There Is a next step we call the remodeling phase.
The remodeling phase is the adaptation to the loads put upon that tissue. At 6 weeks although the injured tissue has healed and matured there still needs to be additional stimulation of new tissue to support the load of exercise. If the healed tissue is under stimulated it will be too weak to meet the demands of the load. If the healed tissue is overstimulated, it will go through a metabolic change causing an inflammatory response that will delay return to play. There is a sweet spot that is the correct amount of stress to apply to healing tissue to insure the athlete can meet specific exercise demands. This is an inexact science but today’s technology can help the athlete return from practice to competition safely.
Quad contusion or deep thigh bruise is a different animal. The big concerns here are two fold: if the muscle is not able to fully function then it may lack the dynamic stability to protect the knee joint. Secondly, about 20% of quad contusions if inadequately treated can result in a condition called myositis ossificans. This condition is a result of the body mistakenly sending immature bone cells (osteoblasts) instead of soft tissue cells (fibroblasts) to heal an injury. Basically a calcium deposit in the muscle which will prevent the muscle from contracting normally. This generally occurs over a two to three week period post injury. In some cases surgical excision is required therefore it is key to treat the initial quad contusion appropriately.