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Tag Archives: quadriceps strain

What's In Store As A-Rod Joins Jeter WIth Quad Strain

With a pair of

Grade 1 quad strains between them, the contributions expected of Derek Jeter and Alex Rodriguez are obviously lowered further and delayed longer.

One consideration that appears to have been left out of the equation in planning both players’ re-entry following this glitch is simply an issue of cause and effect.

It was an all out sprint that caused each of the strains; Jeter trying to beat out an infield grounder and A-Rod attempting to stretch a base hit into a double. Whether or not it was the first time either athlete had pushed his limit since his most recent injury (or surgery in A-Rod’s case) is something only they – and perhaps the Yankees’ medical team – know.  If so, it certainly wasn’t the best idea to wait until a game situation to do so. If not, well, their vulnerabilities are once again exposed.

Regardless, what should be kept in mind is that the rest and rehab required to completely heal and get back to playing shape keeps these guys from running altogether in the early phases of recovery. Consistent with that was WFAN's Sweeny Murti’s weekend report that Jeter no longer has any symptoms, though had yet to run.  Refraining from the activity that caused the injury is a good thing. But, it is crucial to recognize that if these guys weren’t equipped to run full-out before these strains, they will be even less equipped to do so afterward. That will take time. So, if they do return before repeatedly pushing their limits over sustained periods in training, look for a different level of effort and/or a pattern of re-injury. I’m just sayin’…

Follow Abby  Sims on Twitter @abcsims.

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Quad Strain Sends Jeter To The DL

Derek Jeter finds himself on the 15-day DL once again, this time because of a Grade 1 right quad strain that he sustained on July 11th, in his first appearance after rehabbing successive left ankle fractures. Though no one could have predicted what would fail Jeter upon his return, it seemed almost inevitable that it would happen. And, when it did, word that he might return only days later – whether before or possibly immediately after the All Star Break – repeated a pattern we’ve seen before; the expectation that an aging superstar would overachieve. It isn’t easy to bounce back from strains, even when only Grade 1. And, when you are nearing 40 instead of 20 it is generally just a little bit more difficult. Add to that the extreme level of demand that a return to competition places on healing tissue and you have a formula that doesn’t compute.

With top flight docs and trainers in the Yankee system it would seem likely that Jeter passed rigorous tests of both his left ankle as well as his overall functional ability prior to rejoining the big club. However, his immediate injury certainly leads one to speculate that perhaps he had not been tested sufficiently. Before athletes return to play, they must be able to perform all the tasks required of their sport; repeatedly and for a sustained period. For a baseball player, that obviously means sprinting, sliding, batting and, especially for those playing the field, all sorts of directional agility drills, movement drills that also require bending to the floor, as well as throwing – accurately and for the necessary distance.

I’ve not spoken with anyone managing Jeter’s medical care and have no personal knowledge of his specific rehab program or the return to field criteria to which he was held. However, the outcome gives one pause.

You might be thinking, ‘it is his right quad not the left that is injured, so it probably was just a freak thing and not related to recovery from his left ankle injuries.’ That isn’t necessarily the case. If Jeter favored his left ankle at all:

  • He was likely to place additional demands on his right side to compensate, particularly an issue with sprinting around the bases
  • He risked injuring any part of his lower body – left or right

Other issues that can adversely impact an athlete’s return to play include any deficit leaving a player shy of full capacity in:

  • Muscular strength, endurance and power
  • Range of motion (in Jeter’s case, at the left foot and ankle)
  • Flexibility
  • Agility, proprioception (position sense), and balance
  • Cardiovascular endurance

Muscle fatigue is frequently a precursor to overuse. It is why, for instance, many skiers suffer injury late in the day or toward the end of a ski vacation, when muscles no longer have the capacity to exert the necessary force or sustain that effort.

Training in the late phases of rehab focuses on enabling athletes to meet high-level functional demands – both those that are prolonged and those requiring bursts of activity. Rushing or compromising this stage and getting back out there too soon – even when pain is no longer an issue and it appears healing has been satisfactory – can prove problematic. Feeling okay and performing well are two different things.

You’ll note that it wasn’t until the eighth inning that Jeter, who was slotted at DH, left the game with his quad strain. According to WFAN’s Sweeny Murti, he’d first noted the tightness/discomfort in his third at-bat when “busting it” (unsuccessfully) to beat out the second baseman’s throw to first on a grounder up the middle. Jeter grounded out again in his final AB and didn’t run very hard down the line, making it clear something was amiss. He was removed for a pinch-hitter late in the game.

When a player is cleared to play only as a DH it is a sign that there is some reservation about his overall level of function. It is clearly a way to reintroduce, yet limit demand. However, “busting it” on the base path – though it doesn’t challenge lateral mobility and all the other skills playing shortstop would – is demanding. Only a home run bestows absolution.

Jeter played 7 innings without incident the night prior at AAA, though I’ve no idea whether he pushed as hard on the base paths; perhaps not.

Follow Abby Sims on Twitter @abcsims.

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Quad Strains: A Problem For Ruben Tejada

At least for now, the Mets’ slumping Ruben Tejada avoided a trip to Triple A via a detour to the DL courtesy of a right quad strain. It is the same quad that caused him to miss a good deal of time last season, though the player commented that he believes this one is much less severe. He’d better hope so.

The quadriceps is a muscle group in the anterior (front of the) thigh that is comprised of four individual muscles, hence the prefix quad. The primary action of the quadriceps is to extend the knee, and because one of the four muscles in the group also crosses the front of the hip, it also acts as a complement to the hip flexors.

Other parts of the extensor mechanism of the knee include: the quadriceps tendon, which attaches the quads to the patella (kneecap); the patellar tendon, which provides a connection between the patella and the tibia (the larger bone of the lower leg); and ligaments and other soft tissues that help stabilize the patella.

Muscle strains – which are really tears in the tissue – range from a mild stretch at Grade 1 involving minimal disruption, to complete ruptures, or Grade 3 strains.

Strain injuries occur for two primary reasons:

  1. Demand on a muscle/tendon unit that exceeds the capacity of the tissue – as when working against excessive resistance or continuing to exert a significant force beyond the fatigue point of the muscle. This is why we work to fatigue but not exhaustion or failure when we weight train.
  2. When a muscle/tendon unit is placed on excessive stretch, particularly an issue with a quick stretch that occurs frequently in sports when players reach, dive or stretch out to make a play.

Another type of quad injury with symptoms similar to a strain is a muscle contusion, or bruise, which involves a direct blow to the area.

Quad strains are most likely to occur in athletics because of the intensity of sudden and forceful eccentric contractions of the muscle rather than because of excessive stretch.

However, we hear of hamstring strains so much more often than quad strains in baseball. The hamstrings are comprised of three muscles in the back of the thigh, all of which cross the back of the knee joint in addition to spanning the hip. They act to either bend the knee or extend the hip and are put on full stretch in sports more often than the quads. First basemen, in particular, have to have flexible hamstrings as they reach with a free foot to make plays while anchoring the other foot on the base.

We’ve seen many athletes with recurrent strain issues at a particular muscle. Once the area has suffered an injury, it may be more vulnerable, particularly if not allowed to heal sufficiently before return to play. Tejada has undoubtedly learned this from experience.

Follow Abby on Twitter @abcsims.

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  • “I’ve been having PT sessions with Nicole steadily since March of this year.  At first I went in for lower back pain and she noted that I had a leg length discrepancy and suggested I see an orthopedic doctor who confirmed her findings and sent me for custom orthotics.  He also sent me for X-rays […]” Read More- Gil S.,
    Patient at RPT Rockefeller Center
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