What two schools played the
first game of football?
First Game of Football
• In 1869, the first game
played in the United
States occurred,
between Princeton and
Rutgers. This is also
often considered to be
the first U.S. game
of college football
Who invented the forward pass?
Chopper?
Granddaddy?
Dead Leg?
Corked thigh or "corky.
What is it?
Guess again?
Put two and two together?
Charley Horse (where did the name come
from?)
Quad Contusion
• he term may date back to American slang of
the 1880s, possibly from the pitcher Charlie
"Old Hoss" Radbourn who is said to have
suffered from cramps.[
What is a quadriceps contusion?
• A quadriceps contusion is
one of the more common
injuries seen in athletes
competing in contact sports
and results from a direct
blow to the front of the
thigh.
• This type of injury often
goes undertreated and may
result in serious
complications for the
athlete.
Two types of Contusions
• Intramuscular which is a tearing of the muscle within the sheath
that surrounds it. This means that the initial bleeding may stop
early (within hours) because of increased pressure within the
muscle however the fluid is unable to escape as the muscle sheath
prevents it. The result is considerable loss of function and pain
which can take days or weeks to recover. You are not likely to see
any bruising come out with this type - especially in the early stages.
• Intermuscular which is a tearing of the muscle and part of the
sheath surrounding it. This means that the initial bleeding will take
longer to stop especially if you do not ice it. However recovery is
often faster than intramuscular as the blood and fluids can flow
away from the site of injury. You are more likely to see bruising
come out with this one.
Deep Quad Contusion
• Because of the location of
the quadriceps, they can be
subject to direct blows
during sports competition.
• A deep quadriceps
contusion can be one of the
most disabling injuries for
an athlete because injury
to these muscles can
severely impact an
athlete’s ability to
effectively use his/her leg.
Physiological Responses
• Broken blood vessels
resulting in bleeding
(hematoma) into the
injured area
•
Crushed muscle tissue
resulting in hip and knee
dysfunction
Myositis Ossificans
•
If there is major untreated and/or
unresolved bleeding deep in the
muscle tissue, a serious condition
known as myositis ossificans can
occur.
•
Myositis ossificans is the result of
a hematoma within a muscle that
calcifies rather than heals. Rather
than the body healing the
hematoma with fibroblasts (baby
collagen fibers), the body lays
down baby bone cells resulting in
a bony growth deep in the muscle
tissue.
Imaging
• Indications for imaging
• imaging not necessary if mild
contusion and extensor
mechanism intact
• Radiographs
• plain radiograph to evaluate for
myositis ossificans in chronic
injuries
• MRI
• has the highest sensitivity and
specificity for disorders of the
quadriceps
• MRI helpful in moderate to
severe contusions or if
quadriceps tendon competency
in doubt
MO
•
A myositis ossificans located
deep within a quadriceps
muscle can cause significant
pain and disability for the
athlete.
• The specific cause of this
occurrence is not known, but
there seems to be a
correlation between the
severity of the quadriceps
contusion and the incidence
of myositis ossificans.
What are the classifications of
quadriceps contusions?
• Quadriceps contusions can be
classified as mild, moderate, and
severe. Mild injuries result in
mild pain and swelling, but the
athlete is able to walk without a
limp.
• Contusions are referred to as
mild, moderate or severe
determined by the amount of
motion of the knee after injury;
(mild > 90˚, moderate 45-90˚ and
severe < 45˚).
Quad Classifications
• A moderate muscle
contusion results in an
increase in bleeding into
the muscle tissue and more
damage to the actual
muscle fibers.
• The signs and symptoms
will be more pronounced
including a noticeable limp,
more bruising and swelling,
and an inability to flex the
knee past 90 degrees
without significant pain.
Quad Classifcations
• With a severe contusion, the
bleeding may actually track
down into the knee area and
down in to the lower leg creating
extensive discoloration
(bruising). Swelling may continue
to increase over a 24 hour period
resulting in stiffening of the thigh
and knee as the effusion
increases.
• Athletes with severe contusions
may not be able to bend their
knee past 45 degrees and may
have significant difficulty
walking. These athletes may
need to be placed on crutches.
• Last, a palpable
hematoma may be felt in
an athlete with a severe
contusion. When the
muscle is palpated, a firm
mass may be felt
(hematoma) with
defined borders. This
area will be very tender
for the athlete so care
should be taken when
palpating a deep
contusion.
Presentation
• Symptoms
• pain at anterior thigh
• Physical examination
• tenderness at anterior thigh
• limited active knee flexion due to pain
• possible knee effusion
• perform straight leg raise to ensure extensor mechanism
is intact
• test sensory branches of femoral nerve (lateral,
intermediate, and medial cutaneous nerves) during
evaluation for compartment syndrome
Causes
• Contact sports
• Poor padding
What can I do to prevent a quadriceps
contusion?
• In sports that require protective
thigh equipment (football,
hockey), athletes should take
care in ensuring that protective
pads are correctly sized to fit the
front of the thigh and that they
are correctly positioned prior to
competition.
• However, in most sports,
preventing a quadriceps
contusion is not possible.
Prevention of Myositis Ossificans
• The athlete returns to
participation too soon
• The thigh is re-injured before
healing occurs
•
Massage or heat are applied
during the treatment phase
• The hematoma is improperly
treated
Initial Treatment
• Immediately after the
injury apply ice to the
injured area and place the
muscle on a light stretch
(90˚) for 20 minutes
• Repeat the “ice-on-stretch”
1–2 times every 2 hours for
the first 48–72 hours
Treatment
• Unlike most injuries, a
quadriceps contusion
needs to be treated with
unique positioning of the
athlete. The athlete needs
to be positioned with the
knee bent in maximal
flexion while the ice pack is
applied.
Treatment
• The athlete should be
immediately pulled from
participation.
• Continued activity will result in
increased bleeding into the thigh
because the heart is pumping
harder and faster during physical
exertion.
• This may result in prolonged
rehabilitation to remove the
resulting hematoma and return
function to the leg.
Treatment
• After the ice treatment is
completed, a six inch
compression wrap should be
applied to the thigh using
slightly overlapping circles
beginning at the knee and
working up the thigh.
• The compression wrap should
be snug, but not too tight.
The wrap will provide a
mechanical barrier to help
keep the swelling out of the
muscle tissue.
Treatment
• If the athlete has pain while
walking and is limping, the
athlete should be placed on
crutches and be non-weight
bearing for the first 24 – 48
hours.
• Pushing through pain is not an
option with this type of injury
because of the seriousness of
the complications.
• Athletes should be encouraged
to continue the use of crutches
moving from non-weight bearing
to partial-weight bearing as pain
diminishes.
Regaining Range of Motion and
Strength
• As the pain begins to diminish
and the muscle begins to heal
(usually after 48 hours),
gentle range of motion
exercises and muscle setting
exercises can be started.
• The athlete should be careful
not to overstretch the muscle
(move through pain) or push
too hard to regain the range
of motion of the knee.
Treatment
• Quadriceps muscle
setting exercises are
isometric contractions
(no movement of the
knee or hip). The athlete
is asked to tighten
his/her quadriceps with
the knee in an extended
position. The athlete
should hold the
contraction for five to ten
seconds and repeat ten
times every hour.
Treatment
• It is important that the
athlete understand that
he/she not contract the
quadriceps past the point
of pain.
• Early in the rehabilitation,
the athlete might only be
able to contract the
quadriceps at 50%
intensity.
• As the muscle heals, the
athlete can increase
his/her contraction
intensity as able.
Treatment
• the athlete can complete a
quadriceps muscle set at full
intensity without pain, the
athlete can then progress to
straight leg raises.
• These are performed with the
athlete lying on a table,
unaffected knee bent, upper
body resting on elbows, and
injured leg straight.
• The athlete then contracts the
injured quadriceps, lifts the leg
equal to the height of the
uninjured knee, and then slowly
returns the injured leg to its
resting position.
Treatment
• The athlete can initially
perform 3 sets of 5
repetitions of these exercises
and gradually work up to 3
sets of 10 repetitions.
• When the athlete can
perform 30 pain free
repetitions, the athlete can
add increasing increments of
ankle weights for added
resistance.
Functional Sport-Specific Training
• The final component in any
rehabilitation program is the
addition of sport specific
exercises.
• These are exercises specifically
designed to put the athlete
through the skills and demands
of his/her sport in a progressive
fashion so as to ensure that the
muscle has completed healed
and that the athlete has the
confidence necessary to return
to sport.
Fundamental Sports Specific Training
•
The athlete’s sport is analyzed for a
breakdown of fundamental skills.
•
The athlete is then asked to perform
these skills beginning at 50%
intensity.
•
As the athlete continues through the
list of basic skills, the intensity is
gradually increased incrementally
over time until the athlete performs
the skills full out.
•
Depending on the classification of
the injury, this phase may take
anywhere from several days to
several weeks.
When can I return to play?
• Pain free full range of motion of
the hip and knee
• Pain free full strength equal to
the uninjured quadriceps
•
Completion of sport-specific
functional training
• Protective padding of the
quadriceps if appropriate
Treatment
• Once the athlete has full
pain-free range of motion
of the leg and strength
equal to the uninjured
quadriceps, the athlete
may begin functional sport
specific exercises in order
to prepare the athlete to
return to sports
participation.
Operative
• thigh fasciotomies if indicated for compartment
syndrome