Rectus Femoris and Vastus Intermedius Static Manual Release

14 Likes

0 Comments

Learn the proper technique for rectus femoris and vastus intermedius static manual release (a.k.a. soft tissue mobilization, ischemic compression, trigger point release) in this comprehensive step-by-step instructional video from the Brookbush Institute. This evidence-based course provides detailed guidance on assessment, positioning, tissue differentiation, and pressure application to release trigger points, decrease muscle overactivity, and restore optimal quadriceps function. Ideal for clinicians and movement professionals, including physical therapy students, massage therapists, athletic trainers, and chiropractors, seeking to enhance their manual therapy skills for knee health, rehabilitation, and performance.

Differentiation

The sartorius is a superficial muscle that courses vertically down the anterior thigh from the anterior superior iliac spine (ASIS) to the medial tibia, and the rectus femoris course vertically, originating deep to the sartorius on the anterior inferior iliac spine (AIIS) and inserting into the patella tendon of the knee .
This technique is likely easiest to perform with the patient/client in supine, close to the side of the table, with the target leg abducted enough to allow the lower leg to hang off the table with knee passively flexed to 90°.
The practitioner should be facing the patient with their thigh against the knee of the patient, so the practitioner may use their thigh to control the amount of knee flexion of the patient's target leg.
Start the palpation using a broad palpation (length of thumb and webspace) a few inches inferior to the ASIS and AIIS over the anterior thigh.
The rectus femoris and sartorius can be differentiated from the quadriceps muscle by asking the client to flex their hip while flexing at the knee . Note, knee flexion is is added to aid in reciprocally inhibiting the vastus muscles . Asking the patient to perform this action repeatedly should help the practitioner feel the muscle contract, on and off, at some point along the practitioner's broad palpation.
The sartorius may be specifically differentiated by asking the patient to repeatedly internally rotate their tibia (without hip flexion); that is, turn the foot in as far as they can repeatedly.
Once the muscle has been located, the practitioner may preposition their hands to apply direct force to the target muscles using thumbs or fingers.

Potentially Sensitive Tissues

The inguinal lymph nodes, femoral artery and vein, femoral and saphenous nerve, and additional distributions of these vessels and nerves in the femoral triangle and adductor canal may be palpated during this technique if palpation strays medial of the rectus femoris. If a pulse is felt, or the patient complains of numbness, tingling, burning, or searing pain, or pain that is diffuse and uncomfortable and unlike trigger point pain, adjust hand placement laterally. Since the sartorius is the lateral border of the femoral triangle, palpation of sensitive structures is likely a good indication that your palpation is not accurate.

Trigger Points

The common trigger point for the rectus femoris and sartorius are either a few inches distal the ASIS or close to the middle of the length of the thigh.

Release Technique

This technique is likely easiest to perform with the patient/client in supine, close to the side of the table, with the target leg abducted enough to allow the lower leg to hang off the table with knee passively flexed to 90°.
The practitioner should be facing the patient with their thigh against the knee of the patient, so the practitioner may use their thigh to control the amount of knee flexion of the patient's target leg.
Start the palpation using a broad palpation (length of thumb and webspace) a few inches inferior to the ASIS and AIIS over the anterior thigh.
The rectus femoris and sartorius can be differentiated from the quadriceps muscle by asking the client to flex their hip while flexing at the knee . Note, knee flexion is added to aid in reciprocally inhibiting the vastus muscles . Asking the patient to perform this action repeatedly should help the practitioner feel the muscle contract, on and off, at a point along the practitioner's broad palpation.
The sartorius may be specifically differentiated by asking the patient to repeatedly internally rotate their tibia (without hip flexion); that is, turn the foot in as far as they can repeatedly.
Once the muscle has been located, the practitioner may preposition their hands to apply direct force to the target muscles using a "thumb over thumb" or "thumb in thenar crease" hand position.
The fibers of the rectus femoris and sartorius are vertically oriented, so lateral strokes should be used to identify taut bands.
Once a taut band is located, the length of the band is explored for a dense nodule and consistent pressure is applied.
Generally, compressive force is sufficient to pin dense nodules; however, a slight posterior to anterior force may be added.
Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

Comments