Skip to Main Content




As strong as my legs are, it is my mind that has made me a champion.

Michael Johnson, four times Olympic Gold Medal winner who suffered from a very publicized quadriceps strain


The anterior thigh (Fig. 30.1) is the site of common sporting injuries such as quadriceps muscle contusion and strain of the quadriceps muscle. Referred pain from the hip, sacroiliac joint (SIJ) and lumbar spine can also cause anterior thigh pain.1 Stress fracture of the femur is an uncommon, but important diagnosis. The causes of anterior thigh pain are shown in Table 30.1.

Figure 30.1

Anatomy of the anterior thigh

(a) Surface anatomy

Graphic Jump Location
Table Graphic Jump Location
Table 30.1

Causes of anterior thigh pain


Clinical approach




The two most important aspects of the history of a patient with anterior thigh pain are the exact site of the pain and the mechanism of injury. The site of the pain is usually well localized in cases of contusion or muscle strain. Contusions can occur anywhere in the quadriceps muscle but they are most common anterolaterally and in the vastus medialis obliquus. Muscle strains generally occur in the midline of the thigh anteriorly.


The mechanism of injury may help differentiate between the two conditions. A contusion is likely to be the result of a direct blow, whereas a muscle strain usually occurs when an athlete is striving for extra speed when running or extra distance when kicking. In contact sports, however, the athlete may have difficulty recalling the exact mechanism of injury.


Whether the athlete was able to continue activity, the present level of function, and the degree of swelling are all guides to the severity of the condition. Determine whether the RICE regimen was implemented initially and whether there were any aggravating factors (such as a continued activity). Gradual onset of poorly localized anterior thigh pain in a distance runner worsening with activity may indicate stress fracture of the femur. If the pain is variable and not clearly localized, and if specific aggravating factors ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Subscription Options

Clinical Sports Medicine Collection Full Site: One-Year Subscription

Connect to one of the most renowned references in sports medicine and explore all aspects of diagnosis and management of sports-related injuries and physical activity. Subscription includes access to a library of sports medicine videos.

$65 USD
Buy Now

Pay Per View: Timed Access to all of Clinical Sports Medicine Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.