Acupuncture for Vastus Lateralis Pain
Lateral thigh pain can be caused by vastus lateralis trigger points
Do you struggle with pain in your lateral thigh or knee, especially while walking or running? Does your knee cap feel stuck? You might be dealing with vastus lateralis pain or trigger points. In this blog post, we'll dive deep into the vastus lateralis muscle, explore its trigger points, and discuss why acupuncture and dry needling could be the solutions you've been searching for.
What is the Vastus Lateralis Muscle?
The vastus lateralis muscle is a muscle located in the thigh. It is one of the four muscles that make up the quadriceps muscle group, the other three being the vastus medialis, the vastus intermedius, and the rectus femoris. The quadriceps are a group of muscles located in the front of the thigh and are responsible for extending the knee. The vastus lateralis is the largest and most powerful of the quadriceps muscles. They all connect through the knee cap via the quadriceps tendon.
The vastus lateralis muscle originates on the femur bone, specifically on the greater trochanter, and inserts on the tibia bone via the patella tendon. It is responsible for extending the knee, as well as for stabilizing the knee and patella during movement.
As a key component of the quadriceps muscle group, the the vastus lateralis engages at the end of the swing phase in walking to prepare the knee for weight bearing. This quadriceps muscle group is crucial for absorbing most of the impact force created during the heel strike part of the gait cycle. It also contracts while walking downhill or going down stairs.
The vastus lateralis muscle is often targeted in exercises aimed at strengthening the quadriceps, such as squats and leg presses. Strengthening the vastus lateralis can help to improve knee stability and prevent knee injuries.
It's also worth noting that muscle imbalances, particularly between the vastus lateralis and the vastus medialis (the muscle located on the medial side of the thigh) can cause knee problems such as patellofemoral pain syndrome, commonly known as Runner's knee.
The vastus lateralis muscle can also get aggravated in cases of IT band syndrome due to excessive stress on the lateral thigh.
Indications for Vastus Lateralis Pain
Lateral Leg Pain
Lateral Knee Pain
Lateral Thigh & Hip Pain
Numbness/Tingling on the Outer Thigh (Meralgia Paresthetica)
Problems Climbing Stairs
Muscle Action and Functionality
The primary function of the vastus lateralis is to extend the knee.
Signs and Symptoms
Stuck patella
Posterior knee pain
Difficulty sleeping on affected side
Pain while walking
Perpetuating Factors
Sudden overload
Direct trauma from a fall, bumping into something, or lurching during sports
Lack of movement and immobilization
Exercise with deep knee bends
Trigger points in the vastus lateralis muscle are often activated by sudden stress on the muscle, especially during activities that involve lengthening contractions, such as skiing.
Additionally, the muscle's large size and vulnerable position make it susceptible to direct trauma and injuries. These can occur from running into something, or sudden movements during athletic activities.
The activation of trigger points in the vastus lateralis can be sustained if the muscle remains in a shortened state for an extended period. This commonly happens when sitting for long durations with the knee fully extended.
Vastus Lateralis Trigger Points
Vastus lateralis trigger points
Understanding Pain in the Vastus Lateralis
The vastus lateralis muscle, often referred to as the "stuck patella muscle," is known for developing multiple trigger points (TrPs) along the side of the thigh. This muscle is the largest among the four quadriceps muscles and has five key trigger point locations that can cause pain throughout the lateral thigh and knee. Sometimes, this pain even extends up to the pelvic crest.
Vastus lateralis trigger points can result in gait and movement issues, such as walking with a stiff leg and dragging one foot due to a "stuck patella." This limited range of motion in the knee leads to a noticeable limp. Rising from a chair becomes challenging, requiring the individual to lean their torso forward to reduce the strain on the thigh muscles. While walking on tiptoe on the affected side may temporarily alleviate the limp and prevent hip buckling, this compensatory action can lead to other complications.
Lastly, it's worth noting that the lateral collateral ligament (LCL or fibular collateral ligament) may contain a ligamentous trigger point that refers pain to the side of the knee, which could be mistaken for pain originating from the distal trigger points in the vastus lateralis muscle.
Trigger Point Referral Pattern
The vastus lateralis has up to 5 trigger point areas along the lateral thigh that can refer pain throughout the lateral thigh and knee as high as the crest of the hip.
When the trigger points are closer to the surface of the vastus lateralis, the pain is usually localized. However, deep-set trigger points can cause pain that radiates up and down the thigh. One unique feature of the first trigger point (TrP1) in the vastus lateralis is that it can cause a "stuck patella" and pain that may extend around the side of the knee and sometimes even to the back of the knee.
This trigger point (TrP) in the lower part of the vastus lateralis that leads to a stuck patella is close to the surface. However, it can only be identified if the patella is shifted downward to expose the trigger point for flat-touch examination.
Another trigger point, known as TrP2, is located more towards the back and causes pain that extends up the side of the thigh. TrP3, located at the mid-thigh level, can cause pain that travels the entire length of the back and side of the thigh, including the lateral half of the area behind the knee, making it the only quadriceps trigger point that produces posterior knee pain.
Additionally, there's a cluster of trigger points, often described as a "hornets' nest," at the mid-thigh level that can cause severe pain over the entire length of the side of the thigh. This pain can extend upward almost to the pelvic crest and swing around the side of the knee. This group of deep trigger points found in the central portion of the vastus lateralis are typically numerous and necessitate deep-touch palpation and examination for detection, although pinpointing their exact location can be challenging.
Understanding these trigger points and their referral patterns is crucial for diagnosing and treating pain in the vastus lateralis, especially for those experiencing lateral thigh and knee pain.
The Patella and Knee Stability
In the context of patellar health and knee stability, balanced tension between the vastus medialis and the vastus lateralis muscles is crucial for maintaining the patella's normal position and movement. When patients experience pain while walking, particularly along the side of the thigh and knee, trigger points (TrPs) in the vastus lateralis muscle are often the culprits. This pain can also make it uncomfortable to lie on the affected side and may even disrupt sleep.
Trigger points in the lower part of the vastus lateralis can lead to patellar immobility, making it difficult to straighten or bend the knee, especially after rising from a seated position. In extreme cases, a completely "locked patella" can immobilize the knee joint, making walking nearly impossible and even sitting in a wheelchair uncomfortable if the knee has to be bent close to 90 degrees.
A study by Troedsson found that among 35 patients with unstable knees, each had a tender area along the lower medial border of the vastus lateralis muscle in the symptomatic limb. Physical therapy targeting the vastus lateralis relieved knee instability in 24 out of 25 patients.
As mentioned above, vastus lateralis pain is often linked with other conditions like IT band syndrome and patellofemoral pain syndrome. Understanding the role of the vastus lateralis in these conditions can provide a more comprehensive approach to treatment and pain relief.
Differential Diagnosis
Hip joint disease
Pain from hip surgery
Trochanteric bursitis
The lateral thigh pain often associated with trigger points in the upper part of the vastus lateralis muscle is frequently misdiagnosed as trochanteric bursitis. This is due to the pain referral and tenderness that radiate to the area around the greater trochanter. Similar symptoms can also be caused by trigger points in the front portion of the gluteus minimus muscle or in the tensor fasciae latae muscle.
Associated Trigger Points
Other quadriceps muscles
Biceps femoris
Vastus Lateralis Treatment
Acupuncture and dry needling are highly effective treatments for trigger points in the vastus lateralis muscle. These treatments can be particularly beneficial for those experiencing symptoms like lateral leg pain, knee pain, and difficulty climbing stairs. They can also help treat symptoms of patellofemoral pain syndrome which often involves the vastus lateralis and vastus medialis muscles.
In treating vastus lateralis pain, it's important to note that this muscle can sometimes develop a myofascial syndrome independently, without affecting other parts of the quadriceps femoris. The vastus lateralis often has multiple trigger points (TrPs), many of which are deep within the muscle.
It is important to see a skilled practitioner, as these taut bands can be challenging to locate, even with flat palpation directly against the underlying bone. The extensive distribution of these trigger points throughout the muscle adds complexity to both diagnosis and treatment.
Particularly in the anterolateral part of the midthigh, where the muscle is thickest and its fibers merge with those of the vastus intermedius, the specific trigger point tenderness is difficult to pinpoint through palpation, and a skilled practitioner will use the needle to probe for trigger points that may not be evident on initial palpation and exam.
Corrective Actions for Vastus Lateralis Pain
To prevent further issues with the vastus lateralis, consider incorporating stretching and strengthening exercises into your routine. Pay attention to your posture and movement patterns, especially during activities that involve the legs. If you're experiencing ongoing pain or discomfort in the vastus lateralis, acupuncture and dry needling offer promising avenues for relief and recovery.
Avoid Overload
Patients with active trigger points in the vastus lateralis muscle should be cautious when lifting heavy objects or picking things up from the floor. The goal is to avoid overloading the quadriceps femoris muscle group, which includes the vastus lateralis. Deep knee bends and complete squats should be avoided as these can cause significant stress on the quadriceps, especially when trying to rise from a squatting position.
Avoid Prolonged Immobilization
Sitting in a position that immobilizes the vastus lateralis for an extended period can exacerbate trigger points. For instance, sitting with one foot under the other buttock or sitting with legs straight out in front can aggravate existing trigger points. It's advisable to use a rocking chair to keep the hips and knees in motion, thereby mobilizing the quadriceps femoris muscle group, including the vastus lateralis.
Exercise Therapy
A home self-stretch program can be beneficial for nearly every patient with quadriceps femoris trigger points, including those in the vastus lateralis. Passive stretching exercises can be performed either while side-lying or standing. These stretches are particularly effective if done in a pool of warm water that supports most of the body weight.
Self-Mobilization of the Patella
For those who experience a "stuck patella" due to a vastus lateralis trigger point, self-mobilization of the patella can be helpful. This involves manually moving the patella in all directions with the knee straight and the quadriceps relaxed.
Tennis Ball Technique
Patients can use a tennis ball for self-administered ischemic compression to inactivate superficial trigger points in the vastus lateralis. The patient controls the amount of body weight resting on the ball and rolls it along the muscle to locate and treat tender trigger points.
By following these corrective actions, patients can manage and alleviate vastus lateralis pain effectively and help prolong the effects of acupuncture and dry needling treatments.
Final Thoughts
Understanding the role and function of the vastus lateralis can help in diagnosing and treating various forms of leg and knee pain. Acupuncture and dry needling are effective methods for treating trigger points in this muscle, especially when combined with other forms of physical therapy and exercise.
If you're experiencing symptoms related to the vastus lateralis or other quadriceps muscles, consider scheduling an appointment with us for a comprehensive treatment plan.
Over to you
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Sources:
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Janda, Vladimír. “Muscle Function Testing.” (1983).
Biondi NL, Varacallo M. Anatomy, Bony Pelvis and Lower Limb: Vastus Lateralis Muscle. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532309/
Troedsson B. S. (1972). The buckling knee syndrome. Minnesota medicine, 55(8), 722–724.
Ma, Y. T., Li, L. H., Han, Q., Wang, X. L., Jia, P. Y., Huang, Q. M., & Zheng, Y. J. (2020). Effects of Trigger Point Dry Needling on Neuromuscular Performance and Pain of Individuals Affected by Patellofemoral Pain: A Randomized Controlled Trial. Journal of pain research, 13, 1677–1686. https://doi.org/10.2147/JPR.S240376
Bethel, J., Killingback, A., Robertson, C., & Adds, P. J. (2022). The effect of stretching exercises on the fibre angle of the vastus lateralis and vastus medialis oblique: an ultrasound study. Journal of physical therapy science, 34(2), 161–166. https://doi.org/10.1589/jpts.34.161
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