Nick Soloway, L.M.T., D.C., L.Ac
One of the most common misconceptions is that pain on the lateral side of the thigh is due to the iliotibial band being dysfunctional. In the vast majority of cases, this is not true. Pain on the lateral side of the thigh is primarily due to trigger points in the Vastus Lateralis muscle. According to Travell and Simon in their book Myofascial Pain and Dysfunction: the Trigger Point Manual, there are at least nine distinct trigger points in the Vastus Lateralis. Each of these trigger points can cause pain in the lateral thigh.
There are also two other muscles that can cause lateral thigh pain, the tensor fasciae latae muscle:
and the gluteus minimus muscle.
The most common cause of pain in the lateral thigh is due to the Vastus Lateralis trigger points.
In my experience, these trigger points develop as a result of the patella not tracking correctly between the femoral condyles. The patella, when palpated for medial and lateral glide should move equally medially and laterally when referenced to the midline of the knee. Again in my experience, I’ve noticed in the vast majority of cases, that the patella will move much more easily to the medial direction then to the lateral direction. As a result, in order to have the patella tracking properly in the condyles the Vastus Lateralis will chronically tighten to hold the patella centered in the condyles, and trigger points will develop within the muscle.
The most common treatment of the tension in the lateral thigh is to do stripping massage on the side of the thigh. This can be one of the most painful massage experiences there is. Even if there is some resolution of the tightness in the lateral thigh, it will come back because the underlying cause has not been treated.
There is a much easier way to resolve the trigger points in the Vastus Lateralis, and that is to normalize the patella movement. In order to do this, you must first palpate patellar movement to determine where the restriction of the lateral glide is. In order to palpate the patella, your client should be lying supine on the table with the knee in full extension. Normally, when moving the patella medially and laterally it should pivot evenly around the insertion of infrapatellar tendon at the tibial tuberosity.
There are two common dysfunctions that I find. One is that the patella doesn’t rotate evenly around the tibial tuberosity with usually a restriction somewhere between the three o’clock to six o’clock position in the right knee and from six o’clock to nine o’clock position in the left knee. This restriction prevents the patella from moving correctly. Another restriction I find, but less often, is that when palpating the patella glide from medial to lateral instead of the patella remaining parallel to the table the medial side will tend to dip to the posterior. Both of these dysfunctions are usually a result of some connective tissue restriction along the inferior medial border of the patella. Treating these connective tissue restrictions will usually result in anywhere from a 50% to 100% resolution of the trigger points in the Vastus Lateralis and the pain on the side of the thigh.
Treating the restrictions on medial patella is relatively straightforward. The site of the primary restriction is identified visually and tactility and then the patella is moved laterally to put tension on this area. Light cross friction massage can be done on the restriction on the patellar border until a release is felt. The area of restriction is usually quite tender but should lessen within 10-20 seconds. The patellar motion is reassessed to find the next restriction, again light cross friction massage is done to the next restriction and so forth until the patellar glide movement is restored and balanced.
For even faster results, place finger pressure on the restriction point, pull the patella laterally and place a slow percussion massager on to hand to have the vibration transmitted to your finger. Usually, a release will be felt within ten seconds or less.
For times when the patella “dips” posteriorly, place the patella in a slack position and lift the side that dips toward the ceiling, vibrate, and wait for a release. Recheck the side to side movement and the dip should be less or gone.
The process of reducing the connective tissue restrictions on the medial patella usually takes less than five minutes and upon palpating the lateral thigh, the majority of tightness that was there will be gone much to the amazement of your client, and to yourself if you are new to this technique.
Here is a demonstration of the treatment:
