Pinning Quads: Pros & Cons

This article is in a slightly different format, which I hope you will appreciate. /u/stolenlunches has written up an excellent guide on why and how to pin quads, really focussing on addressing common issues and reasons why folks might choose not to pin quads, while I do my best to argue there are better, alternative sites.

/u/stolenlunches runs /r/anabolic, an excellent resource that logs scientific articles and one I use regularly to find references. He also has a ton of real world experience, having a few years head start on most of us. Check out his sub if it interests you.

Why Pinning Quads Is The Right Place To Pin by /u/stolenlunches

A lot of people seem to have issues injecting the vastus lateralis muscle, as it relates to pre- and post-injection pain. This is most likely due to a number of confounding issues that lead individuals to the assessment that this site is not ideal. These issues, I believe, typically result from either improper injection site location, improper needle length, and/or lack of applied technique to mitigate negative outcomes.

The vastus lateralis injection site is an ideal and safe IM injection site with no major nerves close to the musculature, except for the lateral femoral cutaneous nerve; which originates from the second and third lumbar nerves and is primarily only responsible for sensory innervation of the skin. A cross sectional view of the leg is shown here, to highlight the locations of major nerves and blood vessel.

The vastus lateralis also has reasonable bulk in most people, which again lends to the likelihood of injury being acceptably lower than some other sites. Because of this bulk, the vastus lateralis can also accept larger doses of medications (up to 3 ml depending on the bulk of this muscle in the individual) and also has good absorption characteristics promoted by its size and extensive blood supply.

Because of these reasons, this site is attractive for safe IM injections and I feel it is worth reviewing how to properly locate this site and apply technique to mitigate negative outcomes such as pre- and post-injection pain.

Step 1: The following diagrams show how to divide the anterolateral thigh to find the ideal site for injection into the vastus lateralis at the mid- to upper-thigh on the outside of the leg. It should be noted that the first image is representative of many of the images displayed in the literature, which is to say that it is an anterior (front) view of the thigh, and I believe this view leads a good many people to falsely believe that this site should be approached and injected from this angle, when it should not be. Anterior view.

As shown in the above image, and In order to locate the ideal site for injection, it is best to start by separating the anterior thigh into thirds, where the middle third of the vastus lateralis represents the ideal cross section for IM injection. This can also be done by sitting in a chair, and placing one hand across the thigh, where the thigh meets the hip and another hand across the thigh just above the knee. As mentioned, however, many resources stop at this explanation and show only an anterior view of the injection site location (like the image above) and this can be misleading.

Step 2: Step 1 being understood, the next step is to now locate the vastus lateralis on the lateral (side) of the thigh, and separate the thigh, on this side, into four quadrants as seen in the lateral view.

If you imagine bisecting the cross sectional area of the thigh located in step 1 (both horizontally and vertically) then you are left with four quadrants on the anterior (side) of the thigh, as seen in the image above. The most ideal quadrant to inject the vastus lateralis is the upper right quadrant, toward the vertical bisection. However, while this quadrant has been the best experience of many, it does not mean it is ideal for everyone. Some may find that moving distally toward or into the lower right quadrant is a more comfortable location, as the locations of nerves will vary between individuals.

Reducing pain

The major variables in post-injection pain apply to direct needle trauma of nerves, toxic effects of injected depot on nerve fibres and/or nerve compression from local reactions such as hematoma, abscesses or edema formation. A great technique to apply in order to mitigate the pain experienced both pre- and post-injection, is the application of manual pressure to the chosen injection site, in order to try and locate the most likely areas to be free of nerve pain post-injection, as well as apply the gate control theory to mitigate pain during the injection procedure itself.

Note: do this BEFORE you swab the area with alcohol

Once you have located the quadrant of the vastus lateralis you will be injecting, use your thumb to push into the musculature with reasonable force at different locations within the quadrant. The purpose in doing this, is to locate a site that is most likely to reduce the risk of nerve damage through direct needle trauma, or nerve compression post-injection. You can improve the resolution of this technique (finding more precisely defined areas) if you use the syringe needle, with the protective cover in place, to apply pressure to smaller areas within the defined quadrant.

Once a relatively comfortable and pain-free area is located, apply reasonable pressure again to this site for a 10-15 second count, then swab with an alcohol pad before injecting. Applying this second step technique, takes advantage of the gate control theory and doing so can reduce the pain encountered while inserting the needle through the skin. References for this technique: 1, 2, 3

Needle length

Appropriate needle length is widely ignored and information seems to be passed around in very general terms that can not work for everyone. Every individual varies in the thickness of their tissues, and this can also change based on small changes in the location of the injection within a site. An example of this varying thickness of subcutaneous tissue can be seen in the following two images of a cross section of the leg, within the area we have defined as the optimal site for injection into the vastus lateralis:

Cross section at the top of this injection site

Cross section at the bottom of this injection site

Note the varied thickness of the subcutaneous tissue from top to bottom of the thigh, within this target area we have defined for injection into the vastus lateralis.

Coupled with the previous techniques for reducing pain, needle length needs to be considered in order to avoid injected depot leaking or being directly deposited into subcutaneous tissues; which can lead to nerve compression and/or nerve damage from toxic depot excipients, abscess, hematoma, etc. Needle length and its implications has been studied many times, and the following information from one such study makes a striking argument for proper technique and assessment of needle length requirements:

“A study, analysing over 200 simulated injections to the dorsogluteal region by nurses, found through computerized axial tomography (CAT) scans of the sites that under 5% of the women and under 15% of the men would have actually received an intramuscular injection into the glutei’.”

With this in mind, it is best to apply technique in order to determine, individually, our requirements for needle length. This can be done using what is termed the “pinch test”, whereby you grasp the tissue at the site, between your thumb and forefinger. Once the tissue is pinched between the forefinger and thumb, you measure half the distance between the thumb and forefinger and add one centimetre to the result. This can give you a good estimate of the length of needle required to ensure delivery of the injection into the target muscle and not into the subcutaneous tissues. Pinch test to determine proper needle length

Conclusion

Proper injection and site location should not result in excessive pre- or post-injection pain. Hopefully this information helps reduce the incidents of this issue.

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Why Pinning Quads Is The Wrong Place To Pin by /u/comicsansisunderused

Because there are better places to pin.

I am mostly indifferent to the location of the injection site, personally preferring subq gut, im glutes and delts, and am (bi)curious about pinning pecs. Some of my reasons for not pinning quads could easily be applied to my site of choice, but this ain’t about my choice, it’s about why I think quads are a bad idea.

First of all, I have personally had horrible experiences pinning quads. Half a dozen times over the years I’ve pinned a quad and ended up tasting it within a minute and have the awful feeling of my heart rate slow right down as it struggles to clear the oil. Once was right in front of my TRT doc at the time, early on in my PEDs experience, and to whom I was trying to show him my technique after having hit a blood vessel in my prior injection at home. He agreed there was nothing wrong with my technique, I had selected the site correctly, aspirated, and advised I pin glutes instead.

Me being the genius I am, I continued to pin quads off and on when desperate for pin locations though haven’t done it in at least two years now.

Dave Palumbo (old school bodybuilder) gives us his opinion on the matter here. His opinion is summarized as the following:

  1. Muscle is very dense in the quad, and oil absorption may be slower than other areas, leading to lumps (comic: this sounds like broscience to me)
  2. There’s a lot of blood vessels, increasing the likelihood of ruining your pin at the very least, worst leaving you on the floor coughing your lungs up or ending up with an embolism
  3. Nerves. When you hit one, the muscle twitches, nerve is traumatized, causes inflammation, and seems to lead to infection (comic: seems plausible)
  4. The quad is such a prominent muscle that scarring is very visible, especially if you’re competing, but likely equally awkward explaining the marks to your wife, girlfriend, ladyboy prostitute.

Now I’ll grant that /u/stolenlunches cross-section image of the thigh makes it look a very safe place, with the sciatic nerve and major blood vessels tucked right out of the way. However, let me offer an alternative view. As you can see, the femoral artery, femoral vein and great saphenous vein all run on the inside of the thigh, making the outer thigh a perfect spot to inject at first glance. But from these major blood vessels, there are several branches radiating horizontally/diagonally across the upper to mid outer thigh - running right along the third of the quad you are going to pick to pin. It’s often just luck that more folks don’t hit it.

And, as /u/stolenlunches concedes, the outer thigh is home to a nerve. I’ve hit nerves a couple of times, it makes the muscle twitch, causes some inflammation and apparently increases the risk of infection though praise be to Brodin, with the worst that occurred being some lipohypertrophy.

Lastly, Dave Palumbo claims that muscle density impacts the speed of oil absorption. We know subq is more slowly absorbed than im for other reasons, but I can’t find anything specific to muscle density so I’m gonna call bs unless someone can show me he’s right. And I’m going to say that scarring is a ‘whatever’ as well - it happens, it’s not often pretty, but relatively rare and barely noticeable for those not competing.

My closing argument can be summarized as this:

The ventrogluteal site is free from blood vessels and nerves, and has the greatest thickness of muscle when compared to other sites. Why pin quad, when you have a perfect spot in the glute already that can take several mL weekly?

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Conclusion

I appreciate /u/stolenlunches excellent write-up focussing on mitigating risk and his contribution here. He is no doubt right that when done correctly, pinning quads is low risk. In my opinion, it’s going to come down to comfort and familiarity. The science on site selection varies, and mostly in the hands of a trained and experienced professional any site can work.

8

This is in addition to any warm sets, generally three at lower 1RM%. Training should be split up so that you have a max effort days and dynamic days, using the lower % of 1RM. This may add some complexity for the average gym goer, but this kind of variation in training can be commonly found in intermediate and advanced programs. My bro-science opinion is that it the light days help reduce load on weaker spots such as joints while still enabling hypertrophy, and allowing you to hit 1RM’s on your strength days (if that’s your goal).

Prilepin was also specifically referencing a type of movement too. The total rep ranges are not total rep ranges for the muscle group, but instead are rep ranges to progress for that specific exercise. For example, the snatch which was a focus of his. I would advocate utilizing this table for key lifts that you are looking to consistently improve - in my case, that would be bench press, OHP, trap deadlift and front squat. Your supporting exercises are going to be a little different.

Once you are able to exceed the goal reps, increase the weight by 2-10%, and start again.

Data on the TOTAL volume that a muscle group grows at most optimally is a missing data point in my review. I’ve seen mentioned between 60-120 reps per muscle group per week is optimal - that’s a total of all reps that hit that particular muscle group - but how they arrived to that number is fuzzy.

Rest Period

Where volume and intensity is the objective (i.e. you want to move the maximum amount of weight within a given amount time you have to spend at the gym) you want to have a 3-5 minute rest between sets. In this study, the number of reps that could be achieved after a 4 minute rest period was significantly more than those with lower rest times. On average, with only a minute rest between sets subjects did 3.66 and 6.77 less reps in their second and third sets respectively.

Personally, I opt for 3-5 minute rest periods on my working weight, though I tend to have shorter rest periods in my warm-ups to each exercise. Since many of us have short windows in which we look to make the most our time in the gym, pairing two unrelated exercises together can help get through exercises. Example: in between sets of OHP, do leg raises.

How Often?

Exercising each muscle group twice per week is superior than doing it once per week.

Recovery

After workout, muscle protein breakdown is increased but to a lesser extent than muscle protein synthesis, except where the body is a caloric deficit. Muscle hypertrophy is possible only when net protein synthesis occurs: when muscle protein synthesis exceeds breakdown.

Synthesis and breakdown will spike about 3 hours post exercise, and return to baseline at 48 hours post in a linear-ish fashion. Synthesis will be far greater in enhanced individuals such as ourselves.

Training Differences On Cycle & Off

This comes up all the time in /r/PEDs, and is an incredibly subjective question. In my opinion, training should be different on cycle. Firstly, your cardio becomes less a luxury and more of a necessity. Work it in as much as you can without impacting your routine.

Second, your lifts are going to progress much faster on cycle then off, and you can take advantage of this benefit. Your progressive overload should be more aggressive, and since your protein synthesis is higher you can work out major muscle groups more often, at least twice a week.

If you typically follow a 4 week progressive overload program, such as 5/3/1, you might want to consider opting for a simpler progression, adding some weight every workout session from about the second week onward. Due to these changes, some customization of your program is generally in order.

Conclusion

Work out muscle groups more than once per week. Rest between sets. Choose your rep range depending on if you want to be strong like man, or weak like pussy. Consider using Prilepin’s table to create alternating strength and hypertrophy days, using the % of 1RM and rep ranges for your key exercises.