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INTRODUCTION

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It was the quad in my right leg, the tendon just kept tearing. I couldn’t get back to the point of playing and obviously after having a really good start last season, and not playing again, it was frustrating.

Joel Paris, promising Australian cricket fast bowler

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The anterior thigh region (Fig. 33.1) is a common site of sporting injuries. Quadriceps muscle strains and contusions constitute the majority of these injuries; however, referred pain from the hip, sacroiliac joint (SIJ) or lumbar spine may also cause anterior thigh pain.1 Stress fracture of the shaft of the femur is a less common but important diagnosis. A summary of the causes of anterior thigh pain is shown in Table 33.1.

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Figure 33.1

Anatomy of the anterior thigh (a) Surface anatomy (b) Muscles of the anterior thigh (c) Central tendon of the rectus femoris

Graphic Jump Location
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Table Graphic Jump Location
Table 33.1

Causes of anterior thigh pain

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EPIDEMIOLOGY

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Lower limb injuries, particularly thigh muscle injuries, are common in sport. In athletics, thigh muscle strains account for up to 13.5% of all injuries.2 In professional soccer, up to a third of injuries involve lower limb muscles and 19% of all muscle injuries involve the quadriceps.3 Recurrent quadriceps muscle injuries are associated with a significantly longer period of rehabilitation and time to return to sport. Therefore, an accurate initial diagnosis and a structured rehabilitation program are essential to ensure a safe return to sport.

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FUNCTIONAL ANATOMY AND BIOMECHANICS

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The thigh musculature is divided into anterior, medial and posterior compartments by intermuscular septa. The anterior compartment is the largest of the three, and includes the femur, quadriceps femoris and sartorius muscles. The quadriceps include the rectus femoris, vastus lateralis, vastus medialis and vastus intermedius muscles (Fig. 33.1b). Concentric contraction of the quadriceps muscles extends the knee against gravity, which is important in such activities as rising from sitting and climbing up stairs. Eccentrically, the quadriceps muscles have an important role in lowering body weight, for example during walking/running down hills and down stairs. The quadriceps muscles contribute enormously to acceleration and power during jumping and running. As a consequence, the quadriceps can be up ...

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