Quadriceps (thigh) muscle strain, or avulsion fracture?
Approximately 60 million children ages 6-18 participate in some form of organized athletics, with 44 million participating in more than 1 sport. Greater numbers of participant in youth sports has led to more intense training and thus competition, which has increased susceptibility to over-use injuries. “Overuse injuries occur due to repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place”. These injuries may occur, but are not limited to muscle, tendons and bones. Further more, apophyseal injuries also almost exclusively occur in young athletes, especially those athletes who sports specialize (participate in intensive year-round training in a single sport at the exclusion of other sports).
So what now?
Seen below in blue, an apophysis is defined as a bony outgrowth or projection. This apophysis, the Anterior Inferior Illiac Spine (AIIS) of the pelvis, happens to be one of particular interest when considering injuries to youth athletes. Studies have demonstrated that soccer, track and field/running sports and baseball all pose an increased likelihood of injury, especially when considering the above paragraph.
So what is so special about the AIIS?
The AIIS is the origin of a muscle called the Rectus Femoris, which is located in the quadriceps muscle group. The rectus femoris aids in flexing the hip and extending the knee; conversely, this muscle is stretched with hip extension and knee flexion. Now, when eccentrically contracting (lengthening, or stretching, while simultaneously contracting) such as with a kicking motion, the rectus Femoris generates an extraordinary amount of force and pull on the AIIS, which in inadequately rested athletes may cause the AIIS to fracture.
Signs and symptoms
- “Popping” to hip/groin region during injury
- Point tenderness to AIIS/upper Rectus Femoris muscle
- Bruising to upper thigh/groin
- Pain with and without associated muscle weakness during hip flexion
- Pain with walking and climbing stairs
- Pelvic avulsions fractures are most often identified via X-ray imaging
- Adequate rest time/muscle recovery in between sport/training activities
- Foam Rolling Quadriceps musculature
- Perform lower extremity dynamic warm- up including sport specific movement patterns such as in the FIFA 11+
- Static stretching post activity
How Can Physical Therapy Benefit?
Studies have confirmed that non-surgical intervention can be effective in treatment of avulsion fractures at the hip with a mean return to play in 2.5 to 3 months. Most importantly, activity must be restricted initially in order to ensure proper tissue healing. Your physical therapist will assess all impairments and possible contributing factors in order to prescribe an individualized therapeutic exercise program including, strengthening (eccentric and concentric), stretching, balance/proprioception, and soft tissue mobilization. Manual therapy techniques may also include but are not limited to cross friction and soft tissue massage, tactile muscle cuing, and the addressing of associated impairment/restrictions that may predispose the athlete to injury. A home exercise program will be prescribed, as supplementation will improve healing time and patient tolerance to physical therapy appointments. It is also important to understand that once feeling better, with rest and treatment, your physical therapist will be in contact with your physical ensure to scheduling of follow up imaging studies to assess anatomical integrity prior to return to sport.
McKee, J. Conservative Treatment Effective for Most Apophyseal Fractures in Adolescents. American Academy of Orthopedic Surgeons. 2015: Volume 9 Number 8.