Quadriceps Femoris: Pain & Trigger Points

The quadriceps femoris is the largest and heaviest muscle of the body. It is situated on the front of your thigh and consists of four muscle heads.

Muscular dysfunctions, tensions and trigger points can lead to pain in the entire thigh and knee.

With a self-massage you can relieve tensions and eliminate trigger points.

Here you will find out how it works!

You will also learn

  • in which areas the muscle can cause pain.
  • where exactly the muscle is located.
  • which functions it performs.
  • how trigger points get activated.
  • how to palpate it.
  • how to massage it.

1. Pain Patterns & Symptoms

As already mentioned, the quadriceps femoris is a muscle composed of four parts. These are…

  • Rectus femoris
  • Vastus lateralis
  • Vastus medialis
  • Vastus intermedius

Don’t be scared of these names and just read on.

In the following, I will show you in which areas these individual parts can lead to pain.

1.1 Pain patterns of the rectus femoris

Trigger points in the rectus femoris may lead to pain in the anterior area of the middle of the thigh, but overall to pain on the kneecap. In addition, the pain often feels as if it is deep inside the knee.

You should know that the responsible trigger point is far away from the painful kneecap. Namely in the area under your spina iliaca anterior superior or your iliac spine, more or less at the level of your pubic bone.

You can feel your iliac spine.

It is a bony protrusion that  forms the anterior extremity of the iliac crest of your pelvis.

1.2 Pain patterns of the vastus medialis

Trigger points in the vastus medialis can cause pain on the kneecap, in the inside of the knee and at the inner thigh.


1.3 Pain patterns of the vastus lateralis

Trigger points in the vastus lateralis can lead to pain in the entire area of your leg and in the posterior lateral part of your knee joint, depending on the location of the trigger point.


1.4 Symptoms and ailments

In addition to the pain illustrated above, trigger points in the quadriceps femoris might result in weakness of the thigh.

This often is accompanied by an occasional “buckling” of the knee. Trigger points in the vastus medialis are responsible for this – see above.

Furthermore, trigger points in the quadriceps femoris can lead to difficulties and pain during full knee extension.

2. Attachment Points

Generally speaking, the muscle extends from your pelvis and femur/thigh bone via your patella/kneecap to your lower leg.

3. Functions

Here we distinguish between the rectus femoris, which spans over two joints (hip & knee), and the three vasti, which span over one joint (knee).

The rectus femoris runs over the hip and knee joint and thus influences the movements of both joints.

It assists in extending the knee and flexing the hip. This means that the thigh is raised, or the upper body tilted forward. Both movements are hip flexions.


Hip flexion with fixed upper body.


Hip flexion with fixed legs.


Knee extension.

The vastus medialis, lateralis and intermedius only span over the knee.

Their main function is the extension at the knee.

In its entirety, the muscle also “guides” and stabilizes the patella and kneecap, respectively.

3.1 Faulty assumptions regarding its functions

It is commonly believed that the last 15° of knee extension are performed by the diagonal fibers of the vastus medialis which are located close to the knee.

Based on this assumption, therapists often want to train a weak vastus medialis with full knee extensions.

However, this assumption could not be proven by electromyography (EMG) studies.

These fibers, which are far from the body and run diagonally, most likely serve primarily to stabilize the patella medially. This means that they prevent the kneecap from moving too far to the side.

4. Quadriceps Femoris – Trigger Point Activation

The following activities and scenarios can lead to an activation of trigger points in the quadriceps femoris.

4.1 Eccentric overloads

This is where the muscle has to contract while being lengthened. In 99% of cases, this reflects muscle tension during knee flexion.

Such situations occur when one’s own body weight is cushioned:

  • Cushioning a fall
  • Going downhill/descending stairs
  • Downhill jogging
  • Side lunges – tennis, basketball, soccer, … –

4.2 Acute or chronic overstrain

In these cases, the muscle is stressed beyond its current capacity, too. The overload is usually acute and high or chronic and relatively low.

Often, but not exclusively, it is a matter of sports where you have to crouch down.

  • Doing knee-bends
  • Lunges
  • Sumo dead lifts
  • Leg training in general
  • Jogging

4.3 Direct external force impact

An acute high pressure on the muscle or a permanent low pressure can activate trigger points.

  • Bruise on the thigh
  • Child on the lap

4.4 Permanent shortening

Only the rectus femoris is affected here. The positions in question are all sitting positions, as the hip is bent, and some fibers of the rectus are shortened.

  • Driving a car
  • Sitting in a deep armchair
  • Desk work

4.5 Short and tight hamstrings

The hamstrings are the opponents/antagonists to the quadriceps and therefore involved in knee flexion and hip extension.

If these muscles are shortened, extension of the knee and thus the work of the quadriceps femoris becomes more difficult. In the long run, this usually unconscious additional strain can lead to problems in the quadriceps.

5. Palpation

You can easily feel three of the four parts of the muscle. Simply sit on a chair, stretch your knee and then tighten your thigh vigorously.

Now you can feel the entire muscle. Try to feel the contracted fibers from your pelvis, across the entire front and lateral compartments of your thigh all the way down to your knee. You can also feel the tendon of the muscle, which attaches directly below your kneecap onto the lower leg.

This is enough to know in order to perform a self-massage. Of course, you can examine the muscles more closely and try to distinguish the three superficial parts.

The easiest way to feel the vastus medialis, is starting on the inner part of the knee moving the hand upwards.

The vastus lateralis is the flat muscle that you can feel contracted on the outside of your thigh.

The rectus femoris is best felt in the upper middle half of your thigh.

The vastus intermedius is covered by the rectus femoris and is therefore not “accessible” for you.

6. Self-massage of the Quadriceps Femoris

The self-massage is divided into four areas. As a massage tool we will use our hands and a foam roller.

In the following, I describe the massage based on text and pictures.

6.1 Self-massage of the rectus femoris

The trigger point of the rectus femoris is not easy to feel. But with a little patience and practice you will certainly succeed.

Lie down on the edge of a bed or table and let the affected leg hang down. Now use your fingers to find your iliac spine. Once you have found it, move down your fingers a few centimeters until you are approximately at the level of your pubic bone.

Now start extending your knee repeatedly. During these extensions, try to find the origin of the muscle, which contracts slightly with each extension and thus becomes hard.

Take your time, because this is a relatively small area, and if you are not experienced at palpating muscles and tendons, it may take some time until you can feel the muscle and find “the spot”.

Once you have identified the muscle’s origin, press on the muscle and, in the course of its next few centimeters, search for painful points by pressing into it.

If you find a painful point, you can massage it with the thumb technique or the pressure-motion technique.

Massage with your thumb from just before to just after the point, or hold the thumb on it, while flexing and extending your knee a few times.

6.2 Self-massage of the vastus intermedius

Here you use a foam roller. Lie face down and place the foam roller under your thigh.

Now support yourself off the ground and exert more pressure on your thigh.

Now roll very slowly over your thigh and seek for painful points.

Once you find one, concentrate exclusively on it and massage it a few times with very short and slow rolling movements.

This way, you examine the entire area of the anterior thigh, down to your knee. Of course, you can change the roll’s position several times.


Normal massage pressure


Increased massage pressure

6.3 Self-massage of the vastus medialis

Again, we use a foam roller and lie face down. Spread out the leg to be massaged and flex the affected knee. Now place the roll under your thigh.

Massage this area by actively pressing on the roll with your leg and at the same time rolling over it to a small extent.

Of course, you can only perform small movements, so you will need to frequently change the roll’s position in order to massage the entire area.

Especially the lower half of the inner thigh is of interest for you, because this is where most tensions and trigger points are located.

6.4 Self-massage of the vastus lateralis

Here we massage the entire lateral compartment of your thigh, also with a foam roller.

To do this, lie on your side, place your upper leg in front of the lower leg and place your foot on the ground. Place the roll under your hip and support yourself on your elbow off the floor.

Now you can examine your vastus lateralis step by step for sensitive points and massage them.

To increase the massage pressure, place one leg on top of the other.


Normal massage pressure.


Increased massage pressure.


  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. The Lower Extremities. Baltimore, MD: Williams & Wilkins, 1993. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print