Hip Case Study 2: Thigh Strain

Karen Patton is a 21 year old club footballer who has recently pulled a muscle at the
front of her right thigh. The injury occurred whilst kicking a ball 5 days ago. She
attended the local walk-in centre where a diagnosis of grade 2 rectus femoris strain
was made and she was referred to physiotherapy. Karen walks on elbow crutches and
is partial weight bearing through her right leg. She is off work from her job as postal
worker. Apart from a previous similar injury 8 months ago she is otherwise fit and
well.

Anatomy & Pathology

Muscle Strains assosciated with overstreching of muscle tissue – in thigh. Hamstrings
strain come during active contraction – quadriceps – strain somes through direct blow.

Grades of muscle strains :

Grade 1 < 5% fibres damages - 2-3 weeks to recover
Grade 2 >5% damage - 3-6 weeks
Grade 3 – rupture – surgey may be necessary in sports person – 3 months

Subjective Examination
Where\What : pain in rectus femoris

When: 5 days ago

How: kicking a ball

0-10 rating: mid range

24 hour cycle: none

Better for: ask

Worse for: walking, stairs , stretching

Type of pain: expect burning/ tearing – not tingly or crepitus

Past Medical History/ General History: none

Red Flags and general concerns: proximal femur tumor – gives pain in groin at rest
or night.
SH: postman

DH: none

Patients main outcome: return to work

Objective Examination

Working Hypothesis: strain of rectus femoris

Advice & Consent: give and obtain

General Observations: abnormal gait – partial weight bearing

Acute Observations:
Skin colour
Swelling
Posture
Muscle bulk
Deformity - none

Active Tests:
adduction abduction – no problem
medial rotation lateral rotation – no problem
flexion + knee extension – pain because of tear
extension + knee flexion – more pain because of stretching torn muscle

adding knee movements distinguishes the rectus femoris from other quads which
don’t attach below the knee

Passive Tests:
As above but less pain because muscles are not engaged

Resisted Tests:
May omit these tests because of pain – but if performed as above expect pain in
flexion more than extension – muscle work challenged more than length

Special Tests:
None relevant diagnosis confirmed by variation between flexion and extension of
knee on flexed and extended hip during active tests .

Functional Tests:
May be restricted or accommodated hip flexion on walking – in heel strike and or
acceleration

Palpation:
Elicit tenderness around rectus femoris

Measurements:measure active extension in prone – with knee extended –

stop at pain - records how well the muscle streches – only add full knee flexion if no
pain – do the same and opposite active in hip flexion – record muscles ability to
contract concentrically.

Advice & Possible Treatment:

Pain after exam – may take longer to heal if there has een a previous muscle strain.
Advise in future – once recovered :

Warm up – gentle kicking

Strech – rectus femoris by extending leg behind hip
Balance strength with flexibility training (yoga)
Examine technique of kicking ball