Upload
butlerwilliamcarlos
View
226
Download
1
Embed Size (px)
Citation preview
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 1/103
12/09/08 1
Pain Reference Chart
HEADACHES• trapezius
• posterior neckmuscles
• scm
CHEST PAIN• scalenus
• serratus posterior
• thoracic paraspinal
ARM PAIN
• scalenus
• serratus posterior• infraspinatus
• teres major
• latissimus dorsi
THORACIC OUTLETSYNDROME
• scalenus
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 2/103
12/09/08 2
CARPAL TUNNELSYNDROME
• scalenus
• serratus posterior
• teres minor
•latissimus dorsi
PAIN WITH
BREATHING• serratus posterior
• serratus anterior
• thoracic paraspinal
HAND & FINGERPROBLEMS
• scalenus
• serratus posterior
• teres minor
• latissimus dorsi
NECK PAIN (BACK)
• trapezius
• levator scapulae
• posterior neckmuscles.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 3/103
12/09/08 3
FROZEN SHOULDER
• infraspinatus
• supraspinatus• teres major/minor
SIDE & STOMACH PAIN
• serratus anterior
• latissimus dorsi
NECK PAIN (SIDE)
• levator scapulae
• scm
SHOULDER PAIN(BACK)
• trapezius
• teres major/minor
• latissimus dorsi
• levator scapulae
• supraspinatus
• serratus posterior
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 4/103
12/09/08 4
EAR & JAW PAIN
• Trapezius
• Scm
SINUS, TONGUE,THROAT,
TEETH
• Scm
UPPER BACK PAIN
• Trapezius
• Teres minor
• Latissimus dorsi
• Levator scapulae
•Supraspinatus
• Serratus posterior &anterior
• Scalenes
• Rhomboids
SHOULDER PAIN(FRONT)
• latissimus dorsi• Infraspinatus
EYE PROBLEMS
• Trapezius
• Scm
• Posterior neck
muscles
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 5/103
12/09/08 5
HEAD & SCALPNUMBNESS
• posterior neck muscles
SHOULDER BURSITIS
• Trapezius
• Supraspinatus
DIZZINESS
• Trapezius
• Scm
TENNIS ELBOW
• Supraspinatus
BURNING BETEENSHOULDERS
• Trapezius• Rhomboids
• Thoracic paraspinal
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 6/103
12/09/08 6
HEADACHES & trigger points
• trapezius
• posterior neck muscles
• scm
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 7/103
12/09/08 7
Upper trapezius
Referral• Posterolateral
neck, mastoidprocess, templeand posteriorregion of thehead, occiput,
and angle of the jaw.
• One or more of these areas may
be a site of pain
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 8/103
12/09/08 8
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 9/103
12/09/08 9
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 10/103
12/09/08 10
Splenii
Referral
• Top of thehead
• behind theeye
• to the base of
the neck• and along the
side of theneck.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 11/103
12/09/08 11
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 12/103
12/09/08 12
Posterior cervical muscles
Suboccipital
muscles
Posterior cervical
muscles
multifidus
Semispinalis cervicis
Semispinalis capitus
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 13/103
12/09/08 13
Posterior Neck MuscleLocations and Trigger Points
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 14/103
12/09/08 14
Posterior Neck MuscleLocations and Trigger Points• Headaches are the most
troublesome pain experienced as aresult of Posterior Neck muscleTrigger Points.
•Migraine headaches, with paininside the head all along one sidegenerally result from Trigger Pointsin the muscles at the base of theskull.
• Headaches which feel like aconstricting band around the headare also attributed to thesemuscles. In addition, thesemuscles can be a cause of blurred
vision and pain behind the eyes
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 15/103
12/09/08 15
Sternocleidomastoid (SCM) Muscle
Location and Trigger Points
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 16/103
12/09/08 16
Sternocleidomastoid
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 17/103
12/09/08 17
Sternocleidomastoid
• Most common areas are in andbehind the ear, around the eye,forehead, cheek, teeth, tongue,
pharynx and upper aspect of thesternum.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 18/103
12/09/08 18
Brachialgia & trigger points (Chestpain)
• Scalene muscles
• Serratus posterior superior
• Thoracic paraspinal
•Latissimus dorsi
• Serratus anterior
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 19/103
12/09/08 19
Scalene Muscle Trigger Points
• The scalene muscles are
actually three muscles
found in the side of the
neck. Blood vessels
supplying the arm actuallypass between these
muscles.
• Trigger Points here can
cause chest pain similar to angina, as well as
upper back pain.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 20/103
12/09/08 20
Scalenes Referred Pain Patterns
• If you’ve had difficulty finding
relief from these symptoms,
addressing the problematic Scalene muscles could provide
better results. Remember, the
pain location is not always the
same location as the source of
pain.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 21/103
12/09/08 21
Scalenes
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 22/103
12/09/08 22
Serratus Posterior Superior MuscleLocation and Trigger Points
• This muscle runs underneaththe shoulder blade and attaches
to multiple ribs. Its primary
function is to help raise the
ribcage when breathing in.
• Since the muscle runs under the
shoulder blade, treating this
muscle requires moving the
shoulder blade out of the way.
When using the Pressure
Pointer, reach the arm of the
affected side across the chest to
move the shoulder blade away.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 23/103
12/09/08 23
• Trigger Points in the Serratus
Posterior Superior cause a deepaching pain under the shoulder
blade.
• Additionally, pain or numbness
can be found in the back of theshoulder, the elbow, and the
pinky finger of the hand.
• Finally, the Serratus Posterior
Superior can refer pain to theback of the upper arm and
forearm, as well as the pectoral,
or chest, region
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 24/103
12/09/08 24
• Superficialparaspinal muscles(iliocostalis &
longissimus).
– Midthoracicmuscles
– Lower thoracicmuscles
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 25/103
12/09/08 25
Deep paraspinal muscles (Rotators,semispinalis and multifidi)
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 26/103
12/09/08 26
Latissimus Dorsi MuscleLocation and Trigger Points• The Latissimus Dorsi is a large, broad
muscle that brings the arm down andback. (“swimmer’s muscle.”)
• Trigger Points in the Latissimus Dorsicause pain in the mid back, below the
shoulder blade. They also refer pain tothe lower back and stomach.
• Additionally, they cause pain along theinside of the arm, all the way to thefourth and fifth fingers of the hand.
Pain in the fingers, with no numbness,is usually due to the Latissimus Dorsi.
• Activities which involve repetitivemotions
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 27/103
12/09/08 27
Latissimus dorsi
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 28/103
12/09/08 28
• Refers pain: inferior angle of scapula and midthoracic area , canalso in the posterior shoulder,
posterior medial arm and forearm,and to the ulnar hand and fingers.
• Trigger points: a couple of centimeter below the top of thearch of the posterior axillary fold atthe midscapular level.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 29/103
12/09/08 29
• Activities which involve repetitive motionsof the entire arm, such as swimming,
rowing, throwing, tennis, and golf, are
common causes of Latissimus Dorsi
overuse.
Latissimus Dorsi Referred PainPatterns
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 30/103
12/09/08 30
Serratus Anterior Muscle Locationand Trigger Points
• The SerratusAnterior muscleattaches to the ribsand the shoulder blade.
• Its main functionsare to assist inraising the arm and
to expand the ribswhile breathing in.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 31/103
12/09/08 31
Serratus Anterior
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 32/103
12/09/08 32
Serratus Anterior Referred Pain Patterns
• Trigger Points in the SerratusAnterior muscle typically refer pain to the side and the lower portion of the shoulder blade.
• When Trigger Points arepresent in this muscle,breathing in causes a sharppain in the side.
• The pain of Serratus Anterior Trigger Points can mimic thepain of lung disease and heartattacks.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 33/103
12/09/08 33
Frozen shoulder & trigger points
• Infraspinatus
• Supraspinatus
• Teres major
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 34/103
12/09/08 34
Infraspinatus
• Refers pain in theanterior shoulder, tothe anterior arm, tothe wrist, and to the
radial fingers.• Occasionally to thevertebral border of thescapula and base of the skull.
• Trigger points:superior aspect of themuscle inferior to thescapular spine.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 35/103
12/09/08 35
Infraspinatus Muscle Locationand Trigger Points
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 36/103
12/09/08 36
Teres Major/Minor MuscleLocation and Trigger Points
• The Teres major and Teres minor
are two muscles that are closely
related, and also comprise part of
the rotator cuff muscles. Teres minor
helps rotate the arm outward, while
Teres major helps extend the armbackward and pull the arm down.
• Trigger Points in the Teres minor
refer pain to a very small and
specific area of the back of the
shoulder, near the outer edge of the
shoulder blade. Numbness andtingling, but not pain, in the fourth
and fifth fingers is also commonly
associated with Teres minor
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 37/103
12/09/08 37
Teres major
• Refers pain overthe posteriordeltoid, over thetriceps long head,
and occationallyinto the posteriorforearm.
• Trigger point: thegroove betweenthe lateral loweredge of the scapulaand the axillary
fold is palpated.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 38/103
12/09/08 38
Teres minor
• Refers pain to theupper posterior arm,proximal to thedeltoid attachmentand about 5cm in
diameter.
• Trigger point: in themuscle bellyalongthe lateral scapular
border between theteres major inferiorlyand the infraspinatussuperiorly.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 39/103
12/09/08 39
Teres Referred Pain Patterns
• Teres major Trigger Points
create a feeling of sharp pain in
the back of the shoulder and
arm, often feeling like pain in the
Deltoid muscle.
• These muscles are small, but
important. They become easilyfatigued and affected by Trigger
Points. Using the Pressure
Pointer to treat these muscles
can help decrease these
symptoms
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 40/103
12/09/08 40
Supraspinatus MuscleLocation and Trigger Points
• Supraspinatus Trigger Points cause adeep, aching pain in the shoulder.
• It is extremely painful, if not impossible,to raise your arm above your head.
• • This interferes with many simple, daily
tasks, and makes normal life verydifficult.
• If you’ve ever been diagnosed withbursitis, it’s possible the Supraspinatusis the true source of your pain, not theshoulder bursa. In this case, the paindoes not resolve with typicallyprescribed anti-inflammatorymedications.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 41/103
12/09/08 41
Supraspinatus
S i t
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 42/103
12/09/08 42
Supraspinatus
• The referred pain pattern is a deep ache thatoccurs around the lateral shoulder in the middledeltoid area down to the deltoid region.the paincan also be referred to the elbow’s lateralepicondyle.
• 2-3 cm lateral to the vertebral border the trigger
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 43/103
12/09/08 43
Supraspinatus Referred Pain Patterns
• Another interesting pain referrallocation of Supraspinatus Trigger Points is the outer portion of theelbow.
– This pain is often misdiagnosed as
Lateral Epicondylitis, morecommonly known as “Tennis Elbow.”
• Working on the computer with noelbow support, carrying a heavy
purse or briefcase at your side, or moving heavy objects canoverwhelm the Supraspinatus,causing increased incidence of Trigger Points.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 44/103
12/09/08 44
Burning Between the shoulderblades
• Rhomboids
• Levator scapulae
• Middle trapezius
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 45/103
12/09/08 45
Levator Scapula Muscle Location
• The Levator Scapula muscle’s
main function is to raise the
shoulder blade.
• Stress and tension keep the
shoulders raised, creating
increased tension on this muscle.
Poor posture can also be a factor.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 46/103
12/09/08 46
Levator scapulae
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 47/103
12/09/08 47
Levator Scapula Referred PainPatterns
• This muscle is typically involvedwhen you find yourself unable toturn your head. In this case, thedirection which you cannot turn isthe side that of the problematic
Trigger Point.
• Trigger Points in this muscle alsocreate pain and stiffness along theneck and the edge of the shoulder
blade.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 48/103
12/09/08 48
Rhomboid Muscle Locationand Trigger Points
• The Rhomboids are very thinmuscles which have thetremendous responsibility for
much of the movement of theshoulder blades.
• Due to the enormous amount
the shoulder blades are useddaily, the Rhomboids areoften overworked and over tired, leading to chronicTrigger Points.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 49/103
12/09/08 49
Rhomboids
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 50/103
12/09/08 50
Rhomboid Referred Pain Patterns
• The pain is generally extends from theedge of the shoulder blades to thespine.
• Since the Rhomboids on both sidesare almost always affected, this is aprimary source of mid back tightnessor aching between the shoulder blades.
• This pain is felt when the muscles arein use, but also at rest. Snapping or crunching noises when moving theshoulder can also be traced to theRhomboid muscles.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 51/103
12/09/08 51
Back pain & trigger points
• Quadratus lumborum
• Multifidus
• Psoas major and minor
• Gluteus medius
• Rectus abdominis
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 52/103
12/09/08 52
Quadratus lumborum • Translation: "Quadratuslumborum" means "therectangular muscle of theloins."
• It attaches to your lowestrib, the sides of thevertebrae in your lowerback, and the top of your
pelvis.
• Trigger points in thismuscle can cause pain inyour lower back, your
hips, your buttocks andeven around into yourgroin. It's one of the maincauses of low back pain.
Q d t l b
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 53/103
12/09/08 53
Quadratus lumborum
• The superficial fibres
refer pain along the iliaccrest or greatertrochanter or can wraparound outer groin
(Cephalad to the iliaccrest or distal of the 12th rib)
• The deep fibres referdown to the sacroiliac
joint or lower buttock
(just lateral to thearas inal muscles .
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 54/103
12/09/08 54
Deep paraspinal muscles
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 55/103
12/09/08 55
Rectus abdominis (abdominal, low back, pelvicpain)
• Rectus abdominisoriginates on thesternum and ribcageand inserts on thepubis. Its primary
function is flexion of the trunk.
• Trigger points inrectus abdominis
typically refer to theabdomen, low back,middle back, groinand pelvis.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 56/103
12/09/08 56
Iliopsoas (low back, abdomen, groin, pelvicpain)
D i t B i th
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 57/103
12/09/08 57
ILiopsoas• During wt. Bearing the
pain is noticed andreleived in non wt.
Bearing.• Referral: throughout
the lumbar paraspinalregion on the same
side or into theanterior thigh andgroin.
• Proximal trigger point: just behind the ASISand inside the rim of the iliac crest.
• Distal trigger point: onthe lateral wall of the
femoral triangle
Gl t di
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 58/103
12/09/08 58
Gluteus medius
• Pain is aggravated with walking,lying
supine, side lying on the affected side,or sitting in a slouched position.
• Point: down the sacrum, along theposterior iliac crest,lateral posterior
gluteal area.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 59/103
12/09/08 59
• This medium-sized buttmuscle lies under thebiggest butt muscle, andover the smallest buttmuscle.
• It attaches along the upperedge of the back of thepelvis, and to a sheet of connective tissue that
spreads from the butt upover the lower back.
• It also attaches to the upperback of the hipbone (theknob at the top of thethighbone).
• One of its jobs is to helpraise the leg away from thebody, but its main job is tohold the pelvis steady,especially when the hip onits side bears your weightwhile you're walking.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 60/103
12/09/08 60
Sciatica & trigger points
• Gluteus minimus
• Piriformis
• Tibialis anterior
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 61/103
12/09/08 61
Glueteus minimus
• Pain occurs whilegetting out of chair.
• Referral: lowerlateral buttock, downthe lateral thigh,
lateral leg to theankle for anteriortrigger points.Located distal to theASIS
• Referral:lowerposterior back,posterior thigh andproximal posteriorcalf for posterior
trigger points.located
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 62/103
12/09/08 62
Gluteus Minimus
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 63/103
12/09/08 63
Piriformis
• Refers pain intothe sacroiliac areaand posterior hip.
• A line from the
greatertrochanter to thesuperior border of the sciatic
foramen is thecourse of themuscle.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 64/103
12/09/08 64
Piriformis (low back, hip, sciatic,leg pain) • Piriformis originates on
the sacrum and inserts
on the medial surface of the head of the femur.
• It is the principal lateralrotator of the hip.
• The sciatic nerve maypass under or throughthe piriformis, causingentrapment.
• Much sciatic pain iscaused by the piriformis,as well as restless legsyndrome. Its triggerpoints typically refer intothe leg, the hip, and thelow back.
• Its main job is to rotate the
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 65/103
12/09/08 65
• Its main job is to rotate theleg outward, but it also helpsto hold the hip in joint whenit's bearing weight.
• Sciatic nerve, which is thenerve that goes down theback of your leg, passesunder or through thismuscle, so tightness in thepiriformis can cause sciatica,which is pain down the backof the leg.
• It can also cause what's
called "restless legsyndrome." Trigger points inthis muscle can cause painin the back of the leg, thehip, and the low back.
hi h i ( i & l l)
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 66/103
12/09/08 66
Thigh pain (Anterior & lateral)
• Quadriceps femoris
•Hamstring
• Tensor fascia lata
• Adductors
Q d i
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 67/103
12/09/08 67
Quadriceps
• Trigger points in thesemuscles can cause pain inyour knee and all along the
front and outside of yourthigh as far up as yourpelvis.
• Trigger points in quadricepsare one of the chief causesof knee pain in bothchildren and adults.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 68/103
12/09/08 68
Q d i
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 69/103
12/09/08 69
Quadriceps
• Rectus femoris and vastus mediali intothe anterior knee.
• Vastus lateralis to the posterolateralknee and lateral thigh
• Proximal thigh pain caused by VL canmake uncomfortable during sleepinf
• Rectus femoris described as a deepthigh ache especially at night
• Referred pain from VM sometimescause buckling of the knee.
• VIM cause pain in the mid and upperthigh
Q d i
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 70/103
12/09/08 70
Quadriceps
V t l t li
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 71/103
12/09/08 71
Vastus lateralis
H t i
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 72/103
12/09/08 72
Hamstring
• Referred painoccurs in glutealfold and posterior
knee.• Trigger points arelocated at themiddle third of the
muscles.
Hi dd t
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 73/103
12/09/08 73
Hip adductors
• Pain Referral Zone
• The hip adductor musclesoriginate along the pubicramus and ischialtuberosity.
• Adductor longus and brevisrefer pain deep into thegroin, anteromedial upperthigh, and upper medialknee.
• Adductor magnus refers
deep to groin andanteromedial thigh.
• Gracilis is the only one thatalso crosses the knee joint,and refers pain distally over
the anteromedial aspect of leg.
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 74/103
12/09/08 74
• These muscle on the inner thigh have the job of pulling yourleg toward the center, or pulling your legs together. At oneend they attach all along an arch of bone that goes from yourpubic bone down and back to your "sitbones." At the otherend, three of them attach at various points along the inner
part of your thighbone.• The fourth, gracilis (which means "the slender muscle"),
crosses your knee and attaches near the inner knob at the topof your lower leg.
• Trigger points in these muscles can cause pain along your
inner thighs and the fronts of your thighs.
T F i L t
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 75/103
12/09/08 75
Tensor Fascia Lata
• Refers a deep painin the anterolateralhip from thegreater trochanter
and can extend asfar as the knee.
• Trigger points:distal to the
anterior superioriliac spine andmedial andproximal to the
greater trochanter
Tensor fasciae
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 76/103
12/09/08 76
Tensor fasciaelatae
• Tensor fasciae latae originates onthe outer aspect of the ilium andinserts on the iliotibial band ortract, a band of connective andcontractile tissue extending down
the outside of the thigh.
• Its principal functions arestabilization of the hip and knee
joints, and assistance inabduction of the hip.
• Its trigger points typically refer
into the hip and leg.
Tensor fasciae latae
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 77/103
12/09/08 77
Tensor fasciae latae
• It attaches below to a bandof connective tissue thatruns down the outside of your thigh to the outer topof your lower leg. It helps tolift the leg away fromcenter, and to make the hipand knee joints more stable.
• Trigger points in this
muscle can cause pain inthe hip and down theoutside of the thigh
Leg pain
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 78/103
12/09/08 78
Leg pain
• Tibialis Anterior• Peroneus longus, brevis, tertius.
• Gastrosoleus
• Tibialis posterior• Extensor digitorum longus hallucis
longus
• Flexor digitorum longus, hallucislongus
TIBIALIS ANTERIOR
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 79/103
12/09/08 79
TIBIALIS ANTERIOR
Trigger Point Examination
• Most commonly found inthe upper one-third of themuscle.
• Transverse palpation will
reveal taut bands.• Digital pressure applied
to an active TrP will elicitthe referred pain in theankle or foot.
Tibialis anterior
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 80/103
12/09/08 80
Tibialis anterior
• Refers pain to theanteromedialankle and overthe dorsal andmedial big toe.
• Occationally tothe anterior shin.
• Trigger point
proximal andmiddle third of the anteriorextremity nearthe tibial ridge.
PERONEUS LONGUS BREVIS AND TERTIUS
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 81/103
12/09/08 81
PERONEUS LONGUS, BREVIS AND TERTIUS
Peroneal pain
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 82/103
12/09/08 82
Peroneal pain
• Pl & PB to the lateralmalleolus
• PT to theanterolateral area.
• PL triggerpoint: 2- 4cm distal to thefibular head
• PB at middle anddistal third of
extremity.
• PT just anterior tothe PB trigger point.
GASTROCNEMIUS
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 83/103
12/09/08 83
GASTROCNEMIUS
Gastrocnemius
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 84/103
12/09/08 84
Gastrocnemius
• Medial arch to the medial calf
• Close to the medial border of the
MG.
• Close to the lateral border of the
LG.
• Distal to the lateral head of
gastrocnemius.
SOLEUS
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 85/103
12/09/08 85
SOLEUS
Soleus
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 86/103
12/09/08 86
Soleus
• Referral: posteriorplantar heel area andin distal achilles.
• rarely into ipsilateralSI joint
TIBIALIS POSTERIOR
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 87/103
12/09/08 87
TIBIALIS POSTERIOR
• Patient will usually complainof pain in the sole of the footand achilles tendon duringambulation.
• Symptoms are exacerbatedby walking or running onuneven surfaces.
Trigger Point Examination
• TrPs lie deep to thegastrocnemius and soleus andare only palpable indirectly.
• They can be palpated with amedial or posterior approach.
Long toe extensors
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 88/103
12/09/08 88
Long toe extensors
• EDL & EHL• Cause night cramps in toes.
• Painrefers anterior ankle, dorsum
of foot and toes• EDL : 8cm distal to fibular head.
• EHL : ant. To the fibula at the
juncture of middle and distal thirds
EXTENSOR DIGITORUM LONGUS AND EXTENSOR
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 89/103
12/09/08 89
EXTENSOR DIGITORUM LONGUS AND EXTENSORHALLUCIS LONGUS
Long toe flexors
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 90/103
12/09/08 90
Long toe flexors
• FDL & FHL• Pain if the feet during walking.
• FDL ; sole of the forefoot
• FHL: plantar great toe and 1st metatarsal head.
FLEXOR DIGITORUM LONGUS AND FLEXOR
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 91/103
12/09/08 91
HALLUCIS LONGUS
Foot pain
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 92/103
12/09/08 92
Foot pain
• Abductor hallucis• Extensor digitorum brevis
• Extensor hallucis brevis
•Abductor digiti minimi and flexordigitorum brevis
• Quarratus plantae
• Adductor Hallucis and Flexor Hallucis
Brevis
• INTEROSSEI
• Intrinsic m scles of foot
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 93/103
12/09/08 93
• Intrinsic muscles of foot
• a) EDB &EHB
• b) AbDM• c) AbHB
• d) FDB
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 94/103
12/09/08 94
• Extrinsic musclesof foot
• QP• FHB
• AH
• Interosseii
ABDUCTOR HALLUCIS
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 95/103
12/09/08 95
ABDUCTOR HALLUCIS
EXTENSOR DIGITORUM BREVIS & EXTENSOR HALLUCIS
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 96/103
12/09/08 96
EXTENSOR DIGITORUM BREVIS & EXTENSOR HALLUCISBREVIS
ABDUCTOR DIGITI MINIMI AND FLEXOR DIGITORUM BREVIS
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 97/103
12/09/08 97
QUADRATUS
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 98/103
12/09/08 98
QUADRATUSPLANTAE
ADDUCTOR HALLUCIS AND FLEXOR HALLUCIS
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 99/103
12/09/08 99
ADDUCTOR HALLUCIS AND FLEXOR HALLUCISBREVIS
INTEROSSEI
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 100/103
12/09/08 100
INTEROSSEI
References
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 101/103
12/09/08 101
References
• Myofascial Release – CarolManheim
• Therapeutic exercises formusculoskeletal injuries – PeggyA.Houglum.
Address
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 102/103
12/09/08 102
Address
Physiotherapy college Raipur
Sapre School Campus
Budhapara
Raipur – 495001
Chattisgarh
•Email : [email protected]• Mobile: 09893385522
8/3/2019 1.1Myofasial Trigger Point
http://slidepdf.com/reader/full/11myofasial-trigger-point 103/103