Muscles and Knee Pain

The Quadriceps

Quadriceps Muscle Pain Identification

The quadriceps is muscle named for its "four-heads" of origin. That is, the muscle "originates" in four separate areas and the divisions are given four different names. These separate divisions eventually blend together to form the powerful quadriceps tendon which attaches to your shin just below the kneecap where you may feel a prominent bump.

Each of the four muscles has a unique pain pattern. In the following diagrams, the black X's or large solid dots mark the most common locations of trigger points. Solid shading indicates the "essential" pain pattern. A stippled pattern indicates areas of "spillover" pain. Pain in these areas is less common or less severe or may not appear at all unless the muscle is severely shortened.

Pain Pattern
(click on image to enlarge)
Muscle Name and Pain Pattern Description
Rectus femoris: pain refers to the front and middle of knee and middle of knee/kneecap, especially on walking downhill.

This is the longest of the quadricep muscles, running "straight" down the "femur" (thigh). Because it crosses two joints (both knee and hip, the only quad to do so) it is rarely fully stretched; a trigger point is commonly found an inch or so below its attachment at the anterior superior iliac spine).
Test and treat rectus femoris.

Vastus intermedius: pain radiates to the upper thigh especially when walking up stairs or uphill. It can also cause difficulty in straightening the leg after prolonged sitting or driving.

Vastus intermedius is often overlooked in treatment because it lies beneath the larger rectus femoris muscle.
Test and treat vastus intermedius.

Vastus medialis: pain on the medial (inner) side of knee and kneecap.

Vastus medialis is the muscle behind "buckling knee" and the second most common muscle in "growing pains" of the legs in children.
Test and treat vastus medialis..

Vastus lateralis: pain on lateral (outer) side of knee sometimes as far down as the calf and as high as the crest of the hip. Responsible for the feeling that the kneecap isn't working quite right.

Vastus lateralis is the 800-pound gorilla of knee pain, the Number One cause of "growing pains" in children's legs, and just as painful in adults. A tight vastus lateralis can pull the kneecap awry, locking the knee. This is often interpreted as "weakness" of the medialis muscle, common in adolescent girls and blamed on failure of the muscle to keep up with widening hip bones. Coincidentally, this is about the time that girls start worrying about thin thighs and working out on thigh machines. If not stretched afterwards, the muscle will tighten and weaken.
Test and treat vastus lateralis.

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