Do you experience pain in the front of your knee or the inner side of your thigh? Do you feel like your knee is unstable or buckling? You might be dealing with vastus medialis pain or trigger points. In this blog post, we'll delve into the anatomy and function of the vastus medialis 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 Medialis Muscle?

The vastus medialis is one of the four muscles that make up the quadriceps muscle group, along with the vastus lateralis, vastus intermedius, and rectus femoris. These muscles are located in the front of the thigh and are primarily responsible for extending the knee. The vastus medialis is particularly crucial for knee stability and counterbalancing the lateral pull of the vastus lateralis on the kneecap.

The muscle originates along the entire back and inner side of the femur's shaft, connecting to various other muscles and structures. It attaches distally not only to the medial border of the patella but also through the patellar ligament to the tibial tuberosity. The diagonal fibers at the lower end of the vastus medialis, known as the oblique fibers, serve a critical function in maintaining knee stability.

Indications for Vastus Medialis Pain

• Anterior Knee Pain

• Anteromedial Knee Pain

• Buckling Knee

• Medial Thigh Pain

• Problems Climbing Stairs

Muscle Action and Functionality

The primary function of the vastus medialis is to extend the knee. It also plays a vital role in stabilizing the knee and patella during movement, particularly when walking on uneven terrain.

Origin and Insertion

The vastus medialis origin is along the entire length of the posteromedial aspect of the femur's shaft. It attaches distally to the medial border of the patella and through the patellar ligament to the tibial tuberosity.

Signs and Symptoms

Trigger point pain in the vastus medialis muscle generally has these signs and symptoms:

• Knee instability

• Buckling knee sensation

• Difficulty walking down stairs

• Difficulty sleeping due to pain in the knee joint

Perpetuating Factors of Vastus Medialis Muscle Pain

• Sudden overload or athletic activity

• Direct trauma to the knee or muscle

• Prolonged immobility

• Foot structure issues, such as a longer second metatarsal or hyperpronation

Vastus Medialis Trigger Points

Understanding Pain in the Vastus Medialis

Trigger points in the vastus medialis can cause a deep, toothache-like pain in the knee joint that disrupts sleep. This pain often fades over time and is replaced by episodes of unexpected knee instability, particularly when walking on uneven terrain. These trigger points are often overlooked because they minimally restrict knee movement and may not always cause pain but rather dysfunction.

• Role of Oblique Fibers: The diagonal fibers at the lower end of the vastus medialis (vastus medialis oblique or VMO) counter the lateral pull of the vastus lateralis on the patella, a critical function.

• Associated Conditions: TrPs in the vastus medialis are often associated with Morton's foot structure. They can also be perpetuated by excessive foot pronation and strenuous activities like jogging, skiing, and soccer/football.

Trigger Point Referral Pattern

• TrP#1: More common - refers pain to the front of the knee

• TrP#2: Refers pain over anteromedial knee and lower thigh

The vastus medialis trigger points can refer pain to the front and inside of the knee and up the inner side of the thigh. Understanding these trigger points and their referral patterns is crucial for diagnosing and treating pain in the vastus medialis.

Acupuncture and Dry Needling for Vastus Medialis Trigger Points

Acupuncture and dry needling are highly effective treatments for trigger points in the vastus medialis muscle. These treatments can be particularly beneficial for those experiencing symptoms like anterior knee pain, inner thigh pain, and knee instability. A skilled practitioner will use the needle to probe for trigger points that may not be evident on initial palpation and exam.

One research study found that dry needling (DN) led to a decrease in pain and an increase in the range of motion (ROM) in knee flexion. Specifically, for the Vastus Medialis (VM), dry needling resulted in significant reductions in muscle decrement and resistance. These findings suggest that dry needling could be a beneficial treatment option for addressing trigger points in the Vastus Medialis, especially during late-stage rehabilitation of ACL-reconstructed patients.

In another study on dry needling for patellofemoral pain, researchers found that dry needling in the quadriceps (including the vastus medialis) combined with stretching alleviated pain and improved muscle function in people the patellofemoral pain.

Associated Trigger Points

• Gluteus minimus

• Tensor fasciae latae

• Other quadriceps muscles

• Biceps femoris

Differential Diagnosis

• Hip joint disease

• Pain from hip surgery

Pain in the vastus medialis can mimic pain from hip joint degeneration as well as pain after hip surgery since those issues tend to place more strain on the knee joint.

Corrective Actions for Vastus Medialis Pain

• Footwear Adjustments: Consider shoe inserts if the second metatarsal is longer than the first or if there is excessive foot pronation.

• Avoid Prolonged Immobility: Long periods of immobility can exacerbate trigger points in the vastus medialis.

• Exercise Therapy: Incorporate stretching and strengthening exercises to improve knee stability and alleviate pain.

Final Thoughts

Understanding the role and function of the vastus medialis can help in diagnosing and treating various forms of knee and thigh 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 medialis or other quadriceps muscles, consider scheduling an appointment with us for a comprehensive treatment plan.

Over to you

If you liked this article, please share with friends and family who may be suffering with lateral thigh or lateral knee pain.

Sources:

• Travell, J. G., Simons, D. G. (1993). Myofascial pain and dysfunction: The trigger point manual. London: Lippincott Williams & Wilkins.

• Biel, A., & Dorn, R. (2010). Trail guide to the body: A hands-on guide to locating muscles, bones and more. Boulder, CO: Books of Dicovery.

• Janda, Vladimír. “Muscle Function Testing.” (1983).

• 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

• Ortega-Cebrian, S., Luchini, N., & Whiteley, R. (2016). Dry needling: Effects on activation and passive mechanical properties of the quadriceps, pain and range during late stage rehabilitation of ACL reconstructed patients. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 21, 57–62. https://doi.org/10.1016/j.ptsp.2016.02.001

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