Patrick Gilbert PT, DPT, ATC, CSCS
Let’s head back to anatomy class, shall we? We all know that the quadriceps femoris is made up of four muscles. Quad = four (hence the name). The four muscles of the quadriceps are unique, in that they are the only muscles that have an extensor action at the knee. While there has been some debate recently about exactly how many muscles are in the quadriceps1, one thing we can all agree on is that they attach distally to the tibial tuberosity via the patella tendon, patella and quadriceps tendon. But how about the proximal attachments? I want to focus in on where exactly the lateral quad muscle, the vastus lateralis, attaches to the femur.
If we go back to our anatomy textbooks, you can see that the vastus lateralis attaches to the greater trochanter and the lateral lip of linea aspera2. Here is a screenshot of a muscle chart I made to study when I took gross anatomy. (Who said physical therapy students were type-A…?)
So why does everyone say that any pain or discomfort along the lateral thigh is always caused by a “tight IT band”? Yes, the IT band might be a more superficial fascial structure compared to the vastus lateralis, but there is still a good portion of that muscle that lies not only deep to the IT band, but also posterior to it. If the vastus lateralis attaches to the lateral lip of linea aspera, that is nearing the middle portion of the posterior side of the femur. With that said, the vastus lateralis is covering some serious femoral real estate!
Before I get sidetracked and start bashing “IT band syndrome”, just know that when you are foam rolling your “IT band”, you are likely feeling more of that tension stemming from a dense vastus lateralis.
When the muscles of the quadriceps act in concert, they provide a superior (upward) force on the patella via the quadriceps tendon. When all four of these muscles are firing properly, the patella should move directly superior. But what happens when one or more of these muscles is not pulling its’ weight? The force vectors imparted on the patella changes and you have biomechanical alterations which cause the patella to track slightly off from its’ intended groove in the femur, known as the trochanteric groove. When you look at the fiber orientation of the vastus medialis and the vastus lateralis, you will notice that the lateralis has a much “steeper” vertical angle than the medialis, which pulls more horizontally. With shorter muscle fibers, the vastus medialis is put at a mechanical disadvantage when compared to the longer muscle fibers of the vastus lateralis. The further into flexion the knee goes, the stronger the vastus lateralis’ mechanical advantage and pulling power on the patella3.
With this said, we need to ensure that the vastus lateralis does not become overdeveloped and carry too much tissue tension. When knee issues arise, densities of the vastus lateralis are some of the lowest hanging fruit when it comes to impairments that may be causing this pain. This is not to say that this is the full picture – but it may be a great place to start. If you can relieve some tension from the vastus lateralis, you may be able to help equalize the pull from all four quadriceps muscles. One of the best ways to do this is by foam rolling. The lateral quadriceps should be emphasized during foam rolling sessions for the very reasons I specified. For an explanation and demonstration on proper foam rolling technique to relieve areas of tension, check out this short video I put together.
A foam roller is a fantastic piece of equipment to have at your disposal. There are a TON of different foam rollers out there, but here is one of my favorites. It is simple, cheap and extremely durable:
PB Elite Firm Molded Foam Roller
If you are looking to spend a little bit more, this version is good for travel as you can pack different items inside its’ hollow design:
The Grid Foam Roller
Now, assessing and treating the vastus lateralis is only one part of the “knee pain equation”. Stay tuned for other ways to help assess and treat various ailments of the knee.
1. Ruzik K, Wasniewska A, Olewnik L, Tubbs RS, Karauda P, Polguj M. Unusual case report of seven-headed quadriceps femurs muscle. Surg Rad Anat. 2020 April 21: 1-5.
2. Hansen JT. The Thigh. Netter’s Clinical Anatomy. 2nd Edition. Saunders Elsevier. 2010.
3. Bordoni B, Varacallo M. Anatomy, Bony Pelvis and Lower Limb, Thigh Quadriceps Muscle. Treasure Island (FL). StatPearls Publishing. 2020.
About the Author – Patrick Gilbert PT, DPT, ATC, CSCS
Patrick is a physical therapist, athletic trainer and personal trainer. He runs Summit Performance and Therapy in Indianapolis, Indiana. He has been training clients of all backgrounds for years and has been a practicing physical therapist since 2016. His training philosophy combines his knowledge of rehabilitation as well as strength and conditioning in order to train clients to achieve great results and avoid injuries in the process. His physical therapy practice focuses on a three-dimensional view and treatment of the body and its many parts. Treatment emphasizes manual techniques and rehabilitative exercises to get patients back to previous activity levels without pain or dysfunction.
For more information about training or rehabilitating with Patrick, contact him at SummitPerformancePT@gmail.com or visit SummitPerformancePT.com