DeMarcus Cousins – Torn Left Quadriceps Muscle (confirmed by MRI)

The MRI has confirmed a ‘torn left quadriceps muscle’ for Golden State’s starting center. He will remain sidelined indefinitely and begin rehab immediately (Warriors PR, ESPN). Doctors are reportedly still evaluating the severity of the quad tear and will provide updates “as appropriate” on the length of Cousins’ recovery timeline.

The former Kentucky Wildcat’s non-contact injury occurred as he dived for a loose ball just four minutes into Golden State’s historic loss to the LA Clippers in Game 2 of their playoff series. After deflecting a pass away from Clippers forward Danilo Gallinari, Cousins pursued the ball down the court and fell as he attempted to recover the ball. He immediately began clutching his upper left thigh but was able to stand up before signalling to come off the court.

Just before Boogie falls, his left knee can be seen over-striding as he decelerates to grab the ball.  This is mechanism of injury is commonly associated with quadriceps strains, especially in soccer players. The quads/quadriceps are a muscle group at the anterior (front) thigh comprising of the rectus femoris, vastus medialis, vastus lateralis and the vastus intermedius.

The likely injured muscle for Cousins is rectus femoris (RF) which originates at the hip and travels down the front of the thigh to insert on the tibia below the kneecap (see below). The attachment at the hip and the knee allows it to have two actions: hip flexion (bringing the knee up) and knee extension (straightening the leg). Because RF crosses over two joints, it is more vulnerable to injury than the other quad muscles. The remaining three quad muscles originate on the femur and solely perform knee extension.

Strains of the quads occur frequently but complete tears require a much longer rehab process. This injury differs from Oladipo’s season-ending traumatic injury earlier this year which was a complete rupture of his quadriceps tendon – the structure which connects the quad muscles to the kneecap.

One ominous sign for Cousins is the presence of an enlarged anterior thigh mass which may be associated with muscle retraction post-tear (notice that extra bulk on the front of the thigh).

Other signs and symptoms for the Golden State medical staff that may suggest a complete RF tear are the sudden onset of pain and inability to play after an intense play (sprinting and diving for the loose ball), tenderness in the anterior thigh and weakness and/or pain with such activities as running.

There is limited research on quadriceps tears but the available data has shown that complete RF tears can take anywhere from 5 to 7 months to recover from. Not many players in the NBA have suffered torn quadriceps muscles (different to quadriceps tendon injuries) so it’s difficult to compare return-to-play timelines in this case. Former Denver Broncos quarterback Peyton Manning reportedly played with a “torn right quad” during the 2014-15 NFL Season but this was later diagnosed as a strain rather than complete tear. Quad strains have a much shorter recovery timeline – anywhere from 4 to 27 days depending on the injury site.

League sources reportedly have some optimism that Cousins’ could return for the NBA Finals which will start in six to eight weeks which could potentially mean that Boogie’s is less severe than a complete tear. He will reportedly only require conservative treatment and will be re-evaluated in two weeks. However at this stage, from the current evidence that we have, it appears unlikely that he will play again this post-season.

Sources:
Brukner & Khan, 2017. Clinical Sports Medicine 5th ed
Brukner & Connell, 2015. ‘Serious thigh muscle strains’: beware the intramuscular tendon which plays an important role in difficult hamstring and quadriceps muscle strains. BJSM

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