This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
Quadriceps Contusion
The quads muscles are the main group of muscles in the front of your thigh. A direct blow to these muscles can cause bleeding of blood vessels leading to bruising and swelling and a reduced movement in the knee.
Physiotherapy treatment depends on the severity of the injury. If only mild then physiotherapy can help to control the bleeding and speed up the recovery with advice, massage, compression, ultrasound and taking you through a gradual progressive rehabilitation programme to enable you to return to sport. If more severe a period of rest before physiotherapy starts will be required.
Quadriceps muscle strain
The quadriceps includes 3 muscles and is located in the front of the thigh. The muscles are called vastus lateralis, vastus medialis and the rectus femoris. All 3 can be strained and there are different grades of strain with concern to the severity. A grade I strain means that only a small number of fibers of the muscle are affected and there will be pain felt at that point. A grade II strain means that a significant number of fibers have been torn and there is pain, swelling, reduced strength and movement may be reduced. A grade III strain means that the muscle is completely torn.
Physiotherapy treatment is determined by the grade of the strain. They are able to help with advice, ice, massage, soft tissue techniques, stretching, ultrasound and taping. A graduated progressive exercise programme is advised to regain flexibility and strength of the muscle and enable you to safely return to sport.
Sartorius muscle strain
The Sartorius muscle is long and thin and attaches to the ASIS (anterior superior iliac spine) which is at the top front of the pelvis and runs down and across the front of the thigh to attach to the inside of the main shin bone (tibia). This muscle can be strained.
Physiotherapy can help with advice, ultrasound, massage, taping and setting exercises to regain strength and flexibility of the muscle.
Femoral nerve pain
The femoral nerve is formed from nerve roots exiting the lumbar spine and travels through the pelvis and down the front of the thigh. The nerve can be affected where it exits the lumbar spine or any of the muscles it passes through if become tight can cause compression on the nerve. Also symptoms can arise if the nerve is directly injured ie. by pelvic fracture or if prolonged pressure is applied on the nerve. Symptoms include pain down the front of the thigh and numbness or pins and needles in the thigh. The knee may feel weak and like it will give way and there can be weakness felt in the knee and leg.
Physiotherapy can help by working on any structures that may be affecting the nerve and provide nerve gliding exercises for the nerve itself.
Slipped capital femoral epiphysis
This is a problem with the femur which can cause pain on the inside of the knee. It tends to be more common in boys around the age of 12-15 and being overweight can contribute. The slip of the growth plate over the femur can happen suddenly or more gradually.
Perthes disease
This is a breakdown of bone over the femoral head (top of the thigh bone) which particularly affects males between the age of 4 and 10. Symptoms commonly include a limp and ache in the thigh, groin and knee. Some movement of the hip may be stiff and reduced.
Physiotherapy can help with providing appropriate exercises and advice.
Referred pain
Pain on the outside of the thigh can actually be caused by a problem in another joint such as the hip, back and pelvis. Trigger points in muscles which are not on the front of the thigh can also refer pain there.
Stress fracture of the femur
With overuse a stress fracture of the thigh bone can occur which leads to a deep dull ache in the thigh which is worse if leg hangs over the edge of a bed and pressure applied. If this is suspected then immediate medical referral is required.
Physiotherapy can help to maintain strength in the rest of the body while healing and to restore movement, strength and function in the affected leg once the stress fracture has healed.
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend a top London pain consultant who can help you.
Other possible cause
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
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