The Thigh Who Loved Me

Muscle of the Month: Quadriceps

Quads - ottawa massage blog

The quadriceps (‘quads’) are the beautiful muscles that make up the fronts of your thighs. They are a group of four muscles that, working together, help flex (bend) the hip and extend (straighten) the knee. Only one of the quad muscles actually flexes the hip, while all four of them help stabilize and extend the knee. The more support and strength the knee has, the less likely it is to be prone to injury; so it is important to keep the quads strong and healthy to ensure a healthy knee joint later in life.

Rectus Femoris: This one muscle moves two joints: hip and knee

Actions – Flexes the hip, extends the knee

Common pain culprits – excessive stair climbing, running

The rectus femoris is the longest of the four quad muscles and is the only one to cross over two joints: hip and knee. This placement allows the muscle both to flex the hip and to extend the knee. This is why mounting many sets of stairs during a day might cause pain in the rectus femoris. As you take each step, you are flexing the hip then extending the knee, engaging the entire muscle repeatedly.  As with most muscles, the stronger the muscle gets, the less likely that this pain will arise.

The fix: Strengthen the rectus femoris. Keep both its actions in mind while strengthening this muscle – if you only do hip flexing exercises (such as straight leg raises) you will not address the lower fibers; and vice versa, if you only do knee extensions, you will not be targeting the upper fibers. Aim for a dynamic exercise like squats or lunges.

Vastus lateralis, Vastus Medialis, Vastus Intermedius: The three buddies of knee pain

The vastus muscles - Ottawa Massage Blog

Rectus Femoris has been removed to show Vastus Intermedius

Actions – Extends the knee

Common pain culprits – Running

These three muscles make up the rest of the quadriceps group and cause the majority of knee pain. They are located beside and underneath the rectus femoris. As they all do the same action, the only way to differentiate which one is impaired is to look for specific pain patterns, which your therapist is trained to do. The vastus medialis lies on the inside of the thigh and causes inner and deep knee pain, as well as weakness in both the knee and thigh. Vastus lateralis is on the outside of the thigh and causes outer knee pain, as well as pain that flares up while lying on one’s side. Lastly, the vastus intermedius lies deep to the rectus femoris and is the toughest to isolate, as typically it mimics the vastus medialis pain pattern and is hard to reach with massage.

The fix: Stretch before and after running, and strengthen quads. Your RMT can help you with strength tests to determine if any of these muscles is weak, and can suggest specific strength exercises for each muscle.

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The Gluteals – a pain in the ……

Muscle of the month: The Gluteals

Gluteals, glutes, buttock, rear-end, hiney; these muscles have been given many names over the years, and I’m sure you can think of a few more!  But (pun intended), did you know you have three gluteal muscles on each side? The gluteals consist of the gluteus maximus, the gluteus medius, and the gluteus minimus. Each has its own specific actions and pain pattern, which helps your massage therapist differentiate which glute is the dysfunctional one.

Gluteus Maximus: The big Kahuna

Gluteus maximus - ottawa massage blog

Gluteus maximus (cut) lies over top of all hip muscles

Actions – Extends, laterally rotates, abducts and adducts the hip (moves leg away from or toward the body)

Common pain culprit – Sitting for an extended period of time (underwork), or conversely, excessive hill or stair climbing (overwork)

The gluteus maximus is the largest of the glute muscles, as you can tell by its name. It covers the whole span of one cheek and plays a big role in the appearance of the buttock. When we sit for long periods of time, the glute slowly atrophies, reducing its ability to contract properly for actions such as ascending stairs.

The fix: Get up often from seat, prevent atrophy by hypertrophy (exercising)!

Squats, lunges, and stair climbing are good examples of exercises that engage the gluteus maximus. If you are unsure whether you are performing them correctly, ask your massage therapist, who can help you make the proper adjustments.

Gluteus Medius: The deltoid of the hip

Actions – Abducts, flexes, medially and laterally rotates, and extends hip

Common pain culprit – Standing on one side more than the other, jutting the hip out

Lateral view of Glutues Medius - Ottawa massage blogThe gluteus medius is similar to the big shoulder muscle, the deltoid. This is because of its position and actions: it covers both the front and the back of the hip joint, allowing it to do every movement of the hip (except for adduction, bringing the leg toward the body). This is the same as what the deltoid does for the shoulder joint. Having the hip too far forward or too far back can put this muscle into a shortened position, compromising its ability to contract fully. This can also happen when you place all your weight onto one hip or have even a slight imbalance of weight.

The fix: Share the weight of the hips, and strengthen the gluteus medius with abduction exercises (bringing the leg away from the body)

Gluteus Minimus: Pseudo sciatica

Actions – Abducts, medially rotates, and flexes the hip

Common pain culprit – Getting in and out of car

Gluteus Minimus Trp Referral - Ottawa Massage BlogThis muscle is the deepest of the glute muscles, and can cause some of the most intense pain. The trigger point referral pattern for the gluteus minimus mimics that of sciatic pain. Many clients fear that they have developed sciatica when it is, luckily, only a flare-up of the glute min trigger point. How can you tell? The sensation you feel normally lets you differentiate between a trigger point and sciatica. Sciatica will be a very sharp, shooting, and almost burning pain. Gluteus minimus trigger point will be a dull, achy pain along the same sciatic pathway down the back of the leg. If the trigger point is activated, getting in and out of the car or other hip actions can aggravate it further.

The fix: Massage, heat and stretch.  The best stretch for glute minimus is the Figure 4 stretch, or pigeon pose (depending on your flexibility). Ask your RMT for guidance.

Stay tuned! Next week: How to stretch piriformis, one of the hip’s lateral rotators.