Have you taken off for a sprint and felt a pull in your thigh? Or taken a big swing at the ball and the top of your hip suddenly hurt? If you’ve experienced something like this, you may have injured your rectus femoris muscle! (Rec fem or RF for short.)
The RF is part of a large group of muscles that sit on the front of the thigh called the quadriceps. As a group, the quadriceps straighten (or extend, if we’re being scientific) the knee.
However, the RF also has a second job. In addition to straightening the knee, it also bends (flexes) the hip, such as when you bring your knee up to your chest. When the RF does both of its jobs simultaneously, it looks a little bit like this:
So, we’ve got two movements for the price of one muscle, which is super cool! But it does come at a cost. Muscles that work over two different joints, or your biarticular muscles like the RF, are more prone to being injured. Biarticular muscles tend to be longer and have more potential to be stretched like a spring, so the body will often rely on these for acceleration and deceleration.
In the clinic, the following are the three most common injuries we see involving the RF muscle:
- Muscle strains
- Avulsion fractures
- Traction apophysitis
Rectus femoris muscle strains
Mechanism of injury
Muscle injuries are the most common injury seen in football. RF strains occur more frequently in the pre-season, as shown by data gathered from the English Premier League. RF strains accounted for 29% of all injuries during the pre-season and can result in a loss of playing time.
RF strains tend to happen during the following movements:
- Kicking (most common)
- Deceleration/change of direction
Players will often report a tearing sensation in the front of the thigh and will usually have to stop playing as a result.
Strains can happen anywhere along the length of the muscle but is most common right through the middle in soccer players.
Once a strain occurs, players are advised to rest from aggravating activities, which are usually high-speed activities like running, kicking, and rapid change of direction. However, it is safe to start doing some simple strengthening exercise as guided by a physiotherapist or other health and exercise professional. The aim of rehab is to make sure that the RF is strong throughout its entire range of motion!
Recovery and return to play times will vary from athlete to athlete depending on previous injury history, athletic background, and strain type and location.
Injury timelines will vary from athlete to athlete, depending on previous injury history, athletic background and strain type, and location. Players with less serious strains can often return to play within three weeks, whereas those with more serious strains or where the strain involves other structures can take up to four months.
Avulsion fractures of the hip
Mechanism of injury
In contrast to a muscle strain, an avulsion fracture happens when the RF muscle is pulled away from the bone where it joins in the hip.
Similar to muscle strains, avulsion fractures happen during forceful activities like kicking, sprinting, decelerating and changing direction rapidly. The player will often report feeling or hearing a loud pop followed by an inability to move the leg.
Avulsion injuries are much more common between the ages of 14 to 17 and tends to occur more often in boys than girls.
In order to determine if an avulsion fracture has occurred, your GP or physio will refer you for a scan.
Although this injury sounds nasty, recovery from this is quite good. In almost all cases, surgery is not needed and over 90% of cases end up returning to sport. A surgical opinion may be required if the bone is pulled off far enough away from the hip (>2cm) or if the bone doesn’t heal properly.
Generally, avulsions are managed by avoiding weight bearing on the injured leg and using crutches for up to six weeks. It is safe to commence simple exercises in this stage, and this is usually what we recommend. This means that when you come off the crutches, you are ready to start more advanced exercises, meaning a quicker return to the field! Most athletes can expect to return to sport within ten weeks of coming off the crutches.
Growing pains (traction apophysitis)
Mechanism of injury
Growing pains (traction apophysitis) can also be a cause of hip pain in adolescents. These represent more of an overuse injury where muscles pull on a sensitive part of growing bones (the growth plate) and irritate it. Common areas for this condition are shown in red in the picture below.
This sort of injury tends to happen gradually over time with no specific incident, unlike a muscle strain or avulsion fracture. Sometimes, it can be due to a sudden increase in overall activity, such as increasing the amount of training or in the preseason.
Management of traction apophysitis
To manage this condition, players need to temporarily avoid aggravating activities which usually include sprinting and hard kicks. In addition to modifying your activities, your physiotherapist will also assess your movements and strength to help you work on strengthening the rest of your body.
If you think you might have had an injury like this, or previously had one and would like to make sure you’re in a good spot before returning to play, pop in to see one of our physiotherapists for an assessment!
We will be able to determine the nature of the injury, make sure you get imaging if necessary, and help you build up your strength so that you can return to play safely!
Mendiguchia, J., Alentorn-Geli, E., Idoate, F. and Myer, G., 2012. Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. British Journal of Sports Medicine, 47(6), pp.359-366.
Pollock, N., James, S., Lee, J. and Chakraverty, R., 2014. British athletics muscle injury classification: a new grading system. British Journal of Sports Medicine, 48(18), pp.1347-1351.
Serbest, S., Tosun, H., Tiftikçi, U., Oktas, B. and Kesgin, E., 2015. Anterior Inferior Iliac Spine Avulsion Fracture. Medicine, 94(7), p.e562.