Acupuncture for Rectus Femoris Pain
The rectus femoris muscle is located on the front of the thigh and is one of the four quadriceps muscles. The others are the vastus lateralis, vastus medialis, and the vastus intermedius. The rectus femoris is the only quadriceps muscle that crosses both the hip and the knee to make it both a knee extender and a hip flexor. The other three quadriceps muscles only cross the knee so they only extend the knee and do not flex the hip.
The rectus femoris is positioned between the vastus medialis and the vastus lateralis muscles, and sits above the vastus intermedius muscle and partly over the vastus medialis and lateralis muscles. It covers the entire length of the thigh.
The rectus femoris muscle can be the source of anterior thigh and anterior knee pain. It is an important muscle because it is involved in everyday activities like going up and down stairs, and getting up from a chair. It is prone to tightening to excessive sitting which can lead to restricted range of motion and the formation of trigger points that can cause pain.
The rectus femoris muscle is the most commonly injured quadriceps muscle and is relatively common in soccer players. The quadriceps femoris group together is the “most voluminous” muscle in the body.
Rectus femoris trigger points are a likely suspect if a patient has pain or weakness when going down stairs, or if they have anterior knee pain while sleeping. They can also cause pain deep in the knee joint that can mimic quadriceps and patellar tendonitis and knee joint dysfunction.
Read more to learn about the rectus femoris muscle, trigger points associated with it, and how acupuncture and dry needling can help relieve rectus femoris pain naturally.
Origin and insertion of rectus femoris
The rectus femoris origin is at the anterior inferior iliac spine (AIIS). It also has an indirect origin from the acetabular ridge. The two heads form a conjoined tendon below their origins.
The rectus femoris insertion is at the tibial tuberosity, via the patellar tendon below the knee.
Based on the origin and insertion of the rectus femoris, we can see that it pulls the hip and knee closer together, and extends the knee. Rectus femoris trigger points can cause pain in the thigh or in the front of the knee.
Actions of the rectus femoris muscle
Extend the knee
Flex the hip
When we think of moving this muscle we can think of straightening the knee or flexing the hip.
Synergists and Antagonists of the Rectus Femoris Muscle
Rectus femoris synergists include the other quadriceps muscles (vastus lateralis, vastus medialis, and vastus intermedius) during knee extension, and the iliopsoas, tensor fasciae latae, and pectineus muscles during hip flexion.
Rectus femoris antagonists include the hamstring muscles (semitendinosis, semimembranosis, and biceps femoris) and the gluteus maximus muscles.
Rectus femoris trigger points
Rectus Femoris Trigger Points
Main complaints related to rectus femoris trigger points:
Anterior knee pain
Anterior thigh pain
Anteromedial knee pain
Lateral thigh and hip pain
Problems climbing stairs
Rectus femoris trigger points refer pain to the anterior thigh and knee. Along with the vastus medialis, the rectus femoris can be the cause of anterior knee pain. Travell and Simons refer to rectus femoris trigger points as the “two-joint puzzler” since the muscle crosses both the hip and the knee and because the main trigger point that can cause anterior knee pain is in the superior portion of the muscle closer to the hip.
Rectus femoris trigger points often cause knee pain that feels deeper than trigger points from the vastus lateralis and vastus medialis muscle. They can commonly cause deep aching pain during sleep that is felt in the lower anterior thigh just above the knee.
The main rectus femoris trigger point is just below the anterior inferior iliac spine and can cause pain around the patella and deep in the knee joint. Another trigger point can be occasionally found just above the patella and can refer pain deep into the knee.
Associated trigger points include the quadriceps muscles and the hamstrings.
Signs and Symptoms of Rectus Femoris trigger points
Deep aching pain that can be in the lower thigh or over the anterior knee
Thigh and knee pain in the front of the knee cap during sleep
Pain and weakness when going down stairs
Pain deep in the knee joint
What causes rectus femoris trigger points?
A fall or accident that results in a sudden overloaded lengthening contraction like a ski accident or stepping in a hole
Sitting for long periods of time - especially with weight on the lap (like a child)
After hip fracture, hip surgery, or joint disease
Excessive use during activities that involve hip flexion like running, cycling, and going up and down stairs
Starting a new workout program that includes squats and lunges
Rectus femoris strains and trigger points are common in activities that involve excessive kicking and sprinting, which makes them very common in soccer players and runners.
Rectus Femoris Trigger Point Locations
Rectus femoris trigger point #1 - in the upper end of the muscle below its origin - refers pain to the lower anterior thigh and the anterior knee
Rectus femoris trigger point #2 - above the patella and can refer pain deep into the knee
Rectus femoris trigger points
How can acupuncture release rectus femoris trigger points?
Trigger point acupuncture and dry needling can provide a rectus femoris release by identifying the taut bands of muscle that create the pain referral pattern and eliciting a twitch response to relax the muscle to restore function, improve range of motion, and reduce pain.
Identifying trigger points and providing rectus femoris muscle release with acupuncture and dry needling is one of the most effective ways to relieve pain in this muscle.
Other modalities like electroacupuncture, cupping, gua sha, and tui na can also help with anterior knee and thigh pain.
Other muscles involved in knee pain:
Anterior knee pain: Vastus medialis, adductor longus & brevis
Anteromedial knee pain: Vastus medialis, gracilis, sartorius, adductor longus & brevis
Buckling knee: Vastus medialis, adductor longus & brevis
Lateral knee pain: Vastus lateralis
Posterior knee pain: Gastrocnemius, biceps femoris, popliteus, plantaris, semitendinosis, semimembranosis, soleus
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Sources:
Travell, J. G., Simons, D. G. (1993). Myofascial pain and dysfunction: The trigger point manual (Vol. 2). 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.
Mendiguchia J, Alentorn-Geli E, Idoate F, Myer GD. Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med. 2013 Apr;47(6):359-66. doi: 10.1136/bjsports-2012-091250. Epub 2012 Aug 3. PMID: 22864009.
Bordoni B, Varacallo M. Anatomy, Bony Pelvis and Lower Limb, Thigh Quadriceps Muscle. 2022 May 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30020706.
Murdock CJ, Mudreac A, Agyeman K. Anatomy, Abdomen and Pelvis, Rectus Femoris Muscle. [Updated 2021 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
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