Fantasy Impact
The data below shows that running backs appear to be impacted in the first few games when returning from a quadriceps injury. Fantasy football players may think twice about starting their RBs when returning from this injury. Wide receivers and tight ends as groups both average below baseline at all time points; however, even by the first game back from injury, nearly half of the WRs are meeting or exceeding their pre-injury baseline, and by games 2-3, 80% of tight ends have met or exceeded their baseline at one or more time points.
Players Who Have HAd a Quadriceps Injury
Quarterbacks
No Quarterbacks since 2017 have suffered a quadriceps injury.
Running Backs
| Running Backs | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Josh Jacobs (2022 week 14) | 0 | 20.3 | 11 (-10.3) | N/A | N/A |
| AJ Dillon (2022 week 12) | 0 | 4.9 | 19.4 (+14.5) | 16.5 (+11.6) | N/A |
| Damien Harris (2022 week 12) | N/A | N/A | N/A | N/A | N/A |
| Deon Jackson (2022 week 6) | 0 | 2.3 | 0.3 (-2) | 2.1 (-0.2) | 1.2 (-1.1) |
| Christian McCaffrey (2022 week 3) | 0 | 16 | 21.3 (+5.3) | 19.6 (+3.6) | 19.5 (+3.5) |
| Elijah Mitchell (2021 week 13) | 3 | 14.7 | 20 (+5.3) | 11.8 (-2.9)ρ | 8.6 (-6.1)ρ |
| Jeff Wilson Jr. (2021 week 13) | 0 | 3.4 | 5.6 (+2.2) | 16 (+12.6) | 0 (-3.4) |
| Rhomandre Stevenson (2021 week 11) | 0 | 9.4 | 4.6 (-4.8) | 6.2 (-3.2) | 11.6 (+2.2) |
| Jordan Howard (2021 week 11) | 2 | 13 | 6.9 (-6.1) | 4.6 (-8.4) | N/A |
| Justin Jackson (2021 week 8) | 2 | 3.7 | 0.2 (-3.5) | 1.6 (-2.1) | 15.1 (+11.4) |
| Jamaal Williams (2021 week 7) | 2 | 9.3 | 1.1 (-8.2) | 9.7 (+0.4) | 8.4 (-0.9) |
| Malcolm Brown (2021 week 7) | 6 | 3.9 | N/A | N/A | N/A |
| Kareem Hunt (2021 week 5) | 0 | 13.1 | 9.3 (-3.8) | N/A | N/A |
| Peyton Barber (2021 week 4) | 1 | 6.4 | 0.3 (-6.1) | 1.9 (-4.5) | 5.3 (-1.1) |
| Latavius Murray (2020 playoffs) | 1 | 9.9 | N/A | N/A | N/A |
| Jamaal Williams (2020 week 15) | 1 | 6.6 | 2.6 (-4) | 6.5 (-0.1)ρ | N/A |
| Christain McCaffrey (2020 week 14) | 4 | 27.3 | N/A | N/A | N/A |
| James Conner (2020 week 14) | 1 | 10.5 | 15.1 (+4.6) | 8.7 (-1.8)* | N/A |
| Sony Michel (2020 week 3) | 6 | 8 | 6.3 (-1.7) | 5.5 (-2.5) | 14 (+6) |
| Justin Jackson (2020 week 1) | 2 | 3.4 | 3.1 (-0.3) | 10 (+6.6) | N/A |
| James Conner (2019 week 16) | 1 | 13.3 | N/A | N/A | N/A |
| Rashaad Penny (2018 week 14) | 2 | 8 | 2.9 (-5.1)ρ | N/A | N/A |
| Sony Michel (2018 week 7) | 2 | 13.5 | 3.1 (-10.4) | 14.5 (+1) | 9.7 (-3.8) |
| Leonard Fournette (2017 week 14) | 1 | 15.2 | 14.5 (-0.7) | 12.5 (-2.7) | 23.4 (+8.2) |
| Average | 1.9 | -1.8 | +0.5 | +1.3 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Points | 6/19 (32%) | 8/18 (44%) | 11/17 (65%) |
Wide Receivers
| Wide Receivers | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Tyreek Hill (2022 week 4) | 0 | 13.9 | 9.5 (-3.6) | 18.2 (+4.3) | 22.1 (+8.2) |
| Michael Pittman Jr. (2022 week 1) | 1 | 12.6 | 11.2 (-1.4) | 7.9 (-4.7) | 12.7 (+0.1) |
| Byron Pringle (2022 preseason) | 0 | 7.4 | 2.7 (-4.7) | 0.8 (-6.6)μ | |
| Robby Anderson (2022 preseason) | 0 | 8.7 | 18.7 (+10) | 2.3 (-6.4) | 2.6 (-6.1) |
| Jaylen Waddle (2022 preseason) | 0 | 15.3 | 15.7 (+0.4) | 23.9 (+8.6) | 7.5 (-7.8) |
| Emmanuel Sanders (2021 week 14) | 1 | 4.5 | 10.6 (+6.1)ρ | 2.1 (-2.4)ρ | N/A |
| Elijah Moore (2021 week 13) | 5 | 14.8 | N/A | N/A | N/A |
| Kadarius Toney (2021 week 11) | 4 | 8.3 | 4.8 (-3.5) | N/A | N/A |
| Marquise Brown (2021 week 10) | 1 | 15.2 | 9.1 (-6.1) | 7.3 (-7.9) | 6.2 (-9) |
| TY Hilton (2021 week 8) | 1 | 13.8 | 1 (-12.8) | 7.2 (-6.6) | 6.2 (-7.6) |
| Sterling Shepard (2021 week 8) | 4 | 16.1 | 3.7 (-12.4) | N/A | N/A |
| AJ Brown (2021 week 8) | 0 | 8 | 4.2 (-3.8) | 3.6 (-4.4) | N/A |
| N’Keal Harry (2021 week 8) | 1 | 1.9 | 3.1 (+1.2) | 0.2 (-1.7) | 2.9 (+1) |
| Tyreek Hill (2021 week 5) | 0 | 18 | 18.1 (+0.1) | 15.6 (-2.4) | 14.9 (-3.1) |
| Dionte Johnson (2021 week 2) | 1 | 13.3 | 19.7 (+6.4) | 14.2 (+0.9) | 10.6 (-2.7) |
| Danny Amendola (2021 week 2) | 3 | 6.7 | 3.2 (-3.5) | 3.9 (-2.8) | 1.9 (-4.8) |
| Cordarrelle Patterson (2020 week 15) | 0 | 5.9 | 0 (-5.9) | 1.8 (-4.1)* | N/A |
| Robert Woods (2020 week 14) | 0 | 14.2 | 18.6 (+4.4) | 6.3 (-7.9) | 10.7 (-3.5)ρ |
| Cordarrelle Patterson (2020 week 8) | 0 | 2.8 | 6 (+3.2) | 6.4 (+3.6) | 5.5 (+2.7) |
| Juju Smith-Schuster (2020 week 2) | 0 | 6.5 | 14.3 (+7.8) | 3.2 (-3.3) | 13.8 (+7.3) |
| Marquez Valdes-Scantling (2019 week 6) | 0 | 7.3 | 20.3 (+13) | 0.5 (-6.8) | 0.4 (-6.9) |
| TY Hilton (2019 week 3) | 1 | 16.1 | 5.7 (-10.4) | 11.4 (-4.7) | N/A |
| Cordarrelle Patterson (2018 week 16) | 1 | 6.4 | 0.3 (-6.1)ρ | 3 (-3.4)ρ | N/A |
| Devante Adams (2018 week 16) | 1 | 18.6 | N/A | N/A | N/A |
| Odell Beckham Jr. (2018 week 13) | 4 | 16.3 | N/A | N/A | N/A |
| Danny Amendola (2018 week 12) | 1 | 10.3 | 1.5 (-8.8) | 4.9 (-5.4) | 4.6 (-5.7) |
| DJ Chark (2018 week 11) | 5 | 3.4 | 0 (-3.4) | N/A | N/A |
| Devante Parker (2018 week 3) | 2 | 6.4 | 16.4 (+10) | 4 (-2.4) | 5.7 (-0.7) |
| John Brown (2017 week 1) | 2 | 4 | 6.2 (+2.2) | 11.7 (+7.7) | 3.5 (-0.5) |
| Average | 1.3 | -0.9 | -2.6 | -2.3 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Points | 12/26 (46%) | 13/26 (50%) | 14/25 (56%) |
Tight Ends
| Tight Ends | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Darren Waller (2021 week 12) | 5 | 10 | 3.2 (-6.8) | 11 (+1)*ρ | N/A |
| Mo Allie-Cox (2020 week 5) | 1 | 6.9 | 5.2 (-1.7) | 4.6 (-2.3) | 2.4 (-4.5) |
| Mark Andrews (2020 week 4) | 0 | 11.1 | 14.6 (+3.5) | 3.9 (-7.2) | 10.5 (-0.6) |
| Darren Waller (2020 week 2) | 0 | 11.8 | 1.9 (-9.9) | 12.3 (+0.5) | 10 (-1.8) |
| Rob Gronkowski (2017 week 4) | 1 | 14.6 | 23.3 (+8.7) | 10.4 (-4.2) | 12.4 (-2.2) |
| Average | 1.4 | -1.2 | -2.4 | -2.3 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Points | 2/5 (40%) | 4/5 (80%) | 4/5 (80%) |
Anatomy of a quadriceps injury
The quadriceps or “quads” is a group of four muscles that act together to straighten the knee. One of these muscles, the rectus femoris, also acts to bend the hip. The muscles involved in quadriceps strains are rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius. The focus of this page will be on the rectus femoris, which is the most commonly strained muscle of the quadriceps femoris group.1
The quadriceps have a common attachment point at the top portion of the patella (knee cap). However, each of them starts in a different portion of the hip or thigh. The rectus femoris muscle attaches to the pelvis, which is why it also functions to bend the hip. Whereas the vastus lateralis attaches to the outer portion of the femur and the vastus medialis attaches to the inner portion of the femur. The vastus intermedius sits deep to the rectus femoris and attaches to the front and outside portions of the femur.2
Quad strains are relatively uncommon in football players, with an injury rate of 4.5%. The injury site is usually located in the mid-portion of the top aspect of the rectus femoris, but they can also occur at the bottom portion of the muscle.3 Like all soft tissue injuries, there are different grades of injury; this is listed below.4
- Grade 1: Mild pain with minor tearing of the muscle causing little to no strength loss.
- Grade 2: Significant pain, moderate to maximum tearing of the muscle without a complete rupture causing significant loss of strength. A palpable defect can sometimes be felt with this grade of strain.
- Grade 3: Severe pain with complete rupture of the muscle with full loss of strength. A palpable defect can be easily felt with this grade of strain.
Cause of a quadriceps Injury
As with most muscular injuries, the typical cause of a quadriceps injury occurs due to excessive eccentric loading, which means the muscle is generating a high amount of force while it is being stretched. Quadriceps injuries are caused by eccentric hip flexion and knee extension when the hip is forced into extension (thigh moving behind the body) and the knee is forced into flexion (bent position), which is why the rectus femoris is most commonly involved.1 The majority (63.2%) of quad strains are non-contact injuries. Many of these injuries happen during practice, but the injury rate is higher in games. It is also of note that they are much more common in the pre-season.
The recurrence rate for quad strains is 9.5%, which is relatively high, but most players were able to return to sport within 1-6 days.1 This bodes well for fantasy purposes because most players will not miss any playing time.
Risk factors for quadriceps injury and recurrence are related to positional needs. Positions that require kicking, jumping, and sudden change of direction are all at increased risk. The greatest risk factor for recurrence is a recent history of the same injury. Muscle fatigue also increases injury risk.3 Further modifiable risk factors consist of strength asymmetries and flexibility asymmetries. Interestingly, shorter and heavier athletes are also at increased risk.5
quadriceps injury Rehab Process
The timeline for return to sport from a quadriceps injury depends heavily on the grade of the muscle strain. As stated previously, most players were able to return to sport within one week of the initial injury, and most athletes with grade 1 and 2 strains respond well to conservative treatment.1 Grade 3 strains or full-thickness ruptures will require surgical intervention and an extensive rehabilitation process that generally takes 3-5 months to return to play.6
The initial phase of rehabilitation focuses on protecting the muscle, reducing pain, and reducing swelling. However, initiating rehab as quickly as possible post-injury is crucial to prevent muscle weakness and atrophy.6 In general, this will be accomplished through rest, ice, compression, elevation, NSAIDs, and crutches for grade 3 strains.3,6 Protection is also vital to prevent myositis ossificans, which is abnormal bone growth within the muscle that can occur from improper healing.4
Once tolerable, the active phase of rehabilitation begins. This stage initially focuses on pain-free active range of motion and pain-free stretching, which will help the damaged tissue heal properly.3 Progressive and controlled muscle loading will also be initiated with isometric contractions (muscle activates but the joint does not move) and will progress to concentric (muscle activates and joint moves) and eccentric loading as the muscle heals.6 Maintenance of aerobic fitness is also encouraged in this stage to maintain fitness and reduce muscle fatiguability, which in itself is a risk factor for injury. Similarly to stretching, all strengthening exercises should be pain-free. Progression of strengthening should be done cautiously and based on symptoms post-treatment.4 Jogging within tolerance will also occur in this phase and is often initiated with an anti-gravity treadmill.
The return to sport phase should be progressed once range of motion is symmetrical and pain-free. Strength testing should also be pain-free and symmetrical, which is often confirmed by isokinetic testing via a special Biodex machine.4 Sprinting, jumping, and cutting drills will be one of the final components to rehab and are vital to injury prevention. Once athletes pass all these check-points, they will begin position-specific training and contact drills. The return to sport phase is also where other preventative treatments can be utilized effectively. This will often include hip flexor strength training, core strength training, and proprioception (balance) exercises.
| Rehab Phase | Treatments | Criteria to Enter Phase |
|---|---|---|
| Early Phase | Rest, ice, compression, elevation, NSAIDs. Crutches if needed. Soft tissue work, dry needling, electrical stimulation (pain control). Ankle and hip mobility exercises. Glute and core strength. Hip flexion and knee extension isometrics if tolerable. | N/A |
| Intermediate Phase | Soft tissue work, dry needling. Hip flexor and quad stretching. Ankle and hip mobility. Glute and core strengthening. Balance exercises. Jogging progression (anti-gravity treadmill) if tolerable. | Little to no pain with walking or isometrics. |
| Sports-Specific | Full weight lifting. Progress to 100% speed running. Agility, plyometrics. Position-specific drills. | Symmetrical and pain-free hip/knee mobility and strength. Adequate core stability. Adequate ankle mobility. Adequate single-leg balance. No pain with jogging. |
Mason Dwinnell
References
- Eckard TG, Kerr ZY, Padua DA, Djoko A, Dompier TP. Epidemiology of Quadriceps Strains in National Collegiate Athletic Association Athletes, 2009-2010 Through 2014-2015. J Athl Train. 2017;52(5):474-481.
- Donnelly JM, Fernandez-de-las-Peñas C, Finnegan M, Freeman JL. In: Travell, Simons & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. 3rd ed. United States: Wolters Kluwer Health; 2019
- Lamplot JD, Matava MJ. Thigh Injuries in American Football. Am J Orthop (Belle Mead NJ). 2016;45(6).E308-E318.
- Kary JM. Diagnosis and management of quadriceps strains and contusions. Curr Rev Musculoskelet Med. 2010;3(1-4):26-31. Published 2010 Jul 30.
- Fousekis K, Tsepis E, Poulmedis P, Athanasopoulos S, Vagenas G. Intrinsic risk factors of non-contact quadriceps and hamstring strains in soccer: a prospective study of 100 professional players. Br J Sports Med. 2011;45(9):709-714.
- Lempainen, L., Mechó, S., Valle, X. et al. Management of anterior thigh injuries in soccer players: practical guide. BMC Sports Sci Med Rehabil 14, 41 (2022).