Kinesiology THURSDAY – When Quad Tightness isn’t….

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Often when treating patients with hip and knee discomfort or pain we look at specific muscles that could be potentially short and tight which prevents movement at one of these joints. The quadriceps would be one of these muscle groups. However just focusing on stretching the quadriceps may not gain the best results for your patient. As clinicians we need to look elsewhere for other biomechanical issues. Maybe its not the quadriceps causing the problem, hence the need for further investigation.

Quick fix

  1. Test quadricep flexibility in prone (hip extension/knee flexion)
  2. Check for trigger points in the med/lat gastrocnemius (thickest part of the muscle belly) and medial/lateral hamstring muscle bellies (remember, they form an “A” in the posterior thigh). 
  3. Release trigger points with deep tissue massage
  4. Re-check quadricep tightness (did it change?)
  5. Prescribe exercises accordingly. Hint: base your exercise prescription on what actually normalizes quadricep flexibility
Muscle minute Tuesday

If you’re in the mood to be a little geeky, read this


“My ankle is feeling better,” she said, “but now my knees are hurting.” These were the words of my patient rehabbing from a calcaneal osteotomy to fix over supination. Her right one was performed on in October 2022. Her left one in June 2023. She described superior patellfemoral pain on the right and anterior medial knee joint line pain on the left. 

I tested quadricep flexibility in prone and she displayed moderate tightness (approximately 100Ëš knee flexion) with feelings of tightness in the anterior thigh bilaterally. I intended to check for quadriceps trigger points, but while she was prone, I checked for trigger points in the gastrocnemius and medil/lateral hamstrings. This is what I found.

  • Right lateral hamstring/lateral gastrocnemius trigger point
  • Left medial hamstring/medial gastrocnemius trigger point

Release of the above trigger points yielded normal quadriceps flexibility. There was no stretching of the quad required to restore quadriceps flexibility.

Corrective exercises

  1. Right side revolving triangle (Right foot forward)
  2. Left side triangle (Left foot forward)
  3. Gravity drop with rotation

Why did this work?


In short, gastrocnemius and hamstring trigger points may create abnormal rotational scenarios at the knee, causing quadriceps tightness. If stretching the quad is not yielding long term results, look elsewhere.

Your curiosity makes a difference to the people you treat.

Until next time…

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