Trigger Point Therapy
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Figure 2: Common Quadriceps Trigger Points

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Trigger Points (figure 2) can cause localized muscle pain, offer radiating out from the trigger point, as well as knee pain
. Symptoms includes:
  • Pain radiating from a trigger point to the surrounding muscle.
  • In the case of the rectus femoris, deep knee pain or pain above the knee. Referred knee pain can mimic arthritic or bursitis of the knee.
  • Restless leg syndrome.
  • Pain increasing as you walk and stiffness of the knee.
  • In the case of the vastus medialis, pain is sent to the inner thigh and often in the lower half of the knee, a bit to the inside.
Causes:
  • Over use in athletes caused usually associated with repetitive action as seen with cyclist can cause trigger point in many portions of the muscle.
  • Over use as seen in strong action (kicking) by soccer players or swimmers with a strong flutter kick.
  • Deep knee bends and running can commonly overwork the vastus medialis.
  • Walking in high heels or wedged shoes is frequent, unsuspected cause of trigger points in the rectus femoris.
  • Over use of almost any activity will cause trigger points in the vastus lateralus.
Treatment: You will usually feel pain in various portions of the muscle when you use a roller as demonstrated in our video on Self Massage Quadriceps. This will indicate a good starting point for locating trigger points (small painful knots of muscle about the size of a quarter which radiate pain to a wider area.
  • Use your hand to warm up the area as described in the video.
  • Move the palms of your hand, pushing firmly, along the muscle which may help in identification or areas of soreness.
  • Palpate the portions of the muscle with your fingers or thumbs while sitting or standing. This may be difficult to do since the areas may lie deep in the muscle. For this reason, a Thera Cane or use of your elbows will allow identification of these trigger points.
  • Move your elbow or end of the Thera Cane along the muscle until you find a trigger point which may only be the size of a quarter.
  • Apply pressure to the trigger point (about a 7 out of 10) for 15 to 20 seconds. You can move the elbow or cane in one direction (side to side for cross friction or up and down - but movement should be very minimal.
  • Identify other trigger points and repeat.
  • Be sure to ice the area for around 15 minutes when finished to prevent further inflammation.
Short intervals of treatment of individual trigger points repeated several times a day will have better effects then prolonged treatment.

Remember: Severe pain, pain that increases with treatment, recent injury or surgery require an evaluation by your medical specialist

References:
  • The Trigger Point Therapy Workbook. Clair Davies NCTMB with Amber Davies NCTMB, New Hampshire Publications Inc., 2004, ISBN-10-57224-375-9.
  • Baron's Anatomy and Physiology. I. Edward Alcamo, Ph.D. and Barbara Krumhardt, Ph.D., 2nd Edition, Baron's Educational Series, Inc., 2004, ISBN-13: 978-0-7641-1979-8.
  • Quad Massage: Do It While You View It  by Rich Poley: Excellent techniques for quad massage. And as he says: "Do it as you view it."
  • Massage Your Upper Legs   from Rich Poley.

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Quads

The quadriceps femoris group of muscles is a single muscle with four heads wrapping about three quarter around the upper leg. The lower part of the entire muscle attaches to the kneecap (patella) and enclose it within this tendon and moves with it.
The central part of the muscle, the rectus femoris and originates from the ilium; below that sits the vastus intermeduis. On the medial side of the leg is the vastur medialis and to the lateral side sits the vastus lateralis. These latter 3 muscles originate from the femur (see figure 1). The quadridceps femoris group is the largest and most powerful muscle in the body. This muscle allows one to straighten the knee and flex the hip. The dual function of the muscle makes it vulnerable to abuse.
Figure 1: Anatomy of the Quadriceps