Copyright Feb 2003
1 ABDUCTOR DIGITI MINIMI (FOOT)
& FLEXOR DIGITORUM BREVIS
2 ABDUCTOR DIGITI MINIMI (HAND)
& DORSAL INTEROSSEI (HAND)
5 ADDUCTOR HALLUCIS & FLEXOR
HALLUCIS BREVIS
8 ADDUCTOR POLLICIS, & OPPONENS
POLLICIS
11 BICEPS FEMORIS, SEMITENDINOSUS
& SEMIMEMBRANOSUS
14 COCCYGEUS (ISCHIOCOCCYGEUS)
SPHINCTER ANI, LEVATOR ANI, & OBTURATOR INTERNUS
16 DELTOID ANTERIOR, DELTOID
MIDDLE, & DELTOID POSTERIOR
17 DIGASTRIC ANT & POST BELLY
(SUPRAHYOID)
18 DORSAL INTEROSSEI (FOOT) &
PLANTAR INTEROSSEI (FOOT)
19 EXTENSOR CARPI RADIALIS BREVIS,
EXTENSOR CARPI RADIALIS LONGUS, & EXTENSOR CARPI ULNARIS
20 EXTENSOR DIGITORUM, &
EXTENSOR INDICIS
21 EXTENSOR DIGITORUM BREVIS &
EXTENSOR HALLUCIS BREVIS. 42
22 EXTENSOR DIGITORUM LONGUS &
EXTENSOR HALLUCIS LONGUS. 44
23 EXTERNAL ABDOMINAL OBLIQUE=ANT
DIV & EXTERNAL ABDOMINAL OBLIQUE=LAT DIV
24 FLEXOR CARPI RADIALIS, FLEXOR
CARPI ULNARIS, FLEXOR DIGITORUM SUPERFICIALIS
25 FLEXOR DIGITORUM LONGUS &
FLEXOR HALLUCIS LONGUS
26 FLEXOR POLLICIS LONGUS, &
PRONATOR TERES
27 FRONTALIS (EPICRANIUS) &
OCCIPITALIS (EPICRANIUS) 54
33 ILLIOPSOAS (ILIACUS, PSOAS
MAJOR, & PSOAS MINOR)
34 ILIOCOSTALIS LUMBORUM,
ILIOCOSTALIS THORACIS, & LONGISSIMUS THORACIS
41 MULTIFIDUS, SEMISPINALIS
CAPITIS, & SEMISPINALIS CERVICIS
43 ORBICULARIS OCULI, PLATYSMA,
& ZYGOMATICUS MAJOR. 86
46 PECTORALIS MAJOR CLAVICULAR
& PECTORALIS MAJOR STERNAL
48 PERONEUS BREVIS, PERONEUS
LONGUS, & PERONEUS TERTIUS
49 PIRIFORMIS, GEMELLI, QUADRATUS
FEMORIS, OBTURATOR INTERNUM, & OBTURATOR EXTERNUS
55 RECTUS ABDOMINIS &
PYRAMIDALIS
57 RHOMBOID MAJOR, & RHOMBOID
MINOR
59 SCALENUS ANTERIOR, SCALENUS MEDIUS,
& SCALENUS POSTERIOR. 118
61 SERRATUS POSTERIOR INFERIOR
62 SERRATUS POSTERIOR SUPERIOR
64 SPLENIUS CAPITIS & SPLENIUS
CERVICIS
81 VASTUS INTERMEDIUS (QUADRICEPS
FEMORIS)
82 VASTUS LATERALIS (QUADRICEPS
FEMORIS)
83 VASTUS MEDIALIS (QUADRICEPS
FEMORIS)
84 FIBULAR COLLATERAL LIGAMENT
1 ABDUCTOR DIGITI MINIMI (FOOT) & FLEXOR DIGITORUM BREVIS
Back Table of Contents References
1.1 Illustration Notes
1.1.1
1.2 Illustration
1.2.1 ABDUCTOR DIGITI MINIMI (FOOT)
1.3 Location
1.3.1 ABDUCTOR DIGITI MINIMI (FOOT)
1.3.1.1 Located between the base of the 5th metatarsal and the anterior lateral calcaneus along the belly of the muscle.
1.3.1.2 The Abductor digiti minimi is usually most effectively examined by pincer palpation along the lateral edge of the sole of the foot. The examiner should explore both distal to and proximal to the base of the fifth metatarsal for taut bands and TP tenderness.
1.3.2 FLEXOR DIGITORUM BREVIS
1.3.2.1 Located between the bases of the 2nd thru 4th metatarsals and the anterior calcaneus along the belly of the muscle.
1.3.2.2 This muscle lies deep to the Thick plantar aponeurosis.
1.4 Pain Referral
1.4.1 ABDUCTOR DIGITI MINIMI (FOOT)
1.4.1.1 Concentrates along the plantar aspect of the fifth metatarsal head and may spill over onto the adjacent sole.
1.4.1.2 The plantar spill over pattern may also include some of the distal lateral side of the forefoot.
1.4.2 FLEXOR DIGITORUM BREVIS
1.4.2.1 Pain and tenderness are projected from the TPs to the sole over the heads of the second to fourth metatarsal bones with occasional extension over the head of the fifth metatarsal.
1.4.2.2 The referred pain does not extend back as far as the center of the sole, nor forward onto the toes.
1.4.2.3 The bony portion of the plantar forefoot is “sore” and tender, leading to the complaint of “sore foot”.
1.4.2.4 In his study of 100 patients complaining of painful feet caused by myalgic spots in foot muscles, Good found the short flexors of the toes to be responsible for this complaint in more than half of the subjects.
1.5 Synergists and Antagonists
1.5.1
1.6 Patient Report
1.6.1 Patient Complaints
1.6.1.1
1.6.2 Pain Relief
1.6.2.1
1.7 Activation and Perpetuation of Trigger Points
1.7.1 Activation
1.7.1.1
1.7.2 Perpetuation
1.7.2.1
1.8 Patient Examination
1.8.1 Examination for Involvement
1.8.1.1 Physical Examination
1.8.1.1.1
1.8.2 Differential Diagnosis
1.8.2.1
1.9 Trigger Point Examination
1.9.1
1.10 Associated Trigger Points
1.10.1
1.11 Corrective Actions
1.11.1
2 ABDUCTOR DIGITI MINIMI (HAND) & DORSAL INTEROSSEI (HAND)
Back Table of Contents References
2.1 Illustration Notes
2.1.1
2.2 Illustration
2.2.1 ABDUCTOR DIGITI MINIMI (HAND)
2.3 Pain Referral
2.3.1
2.4 Synergists and Antagonists
2.4.1
2.5 Patient Report
2.5.1 Patient Complaints
2.5.1.1
2.5.2 Pain Relief
2.5.2.1
2.6 Activation and Perpetuation of Trigger Points
2.6.1 Activation
2.6.1.1
2.6.2 Perpetuation
2.6.2.1
2.7 Patient Examination
2.7.1 Examination for Involvement
2.7.1.1 Physical Examination
2.7.1.1.1
2.7.2 Differential Diagnosis
2.7.2.1
2.8 Trigger Point Examination
2.8.1
2.9 Associated Trigger Points
2.9.1
2.10 Corrective Actions
2.10.1
3 ABDUCTOR HALLUCIS
Back Table of Contents References
3.1 Illustration Notes
3.1.1
3.2 Illustration
3.2.1 ABDUCTOR HALLUCIS
3.3 Location
3.3.1 Along the medial longitudinal arch beginning proximal to the base of the first metatarsal bone extending to the medial and plantar calcaneus bone. Locate the spot tenderness of deep TPs.
3.3.2 The Abductor Hallucis is a surprisingly thick muscle.
3.3.3 The Thickness renders its deeper fibers relatively inaccessible and may require strong deep palpation rather than gentler flat palpation to elicit tenderness from its deep TPs.
3.4 Pain Referral
3.4.1 Center along the medial side of the heel
3.4.2 Spill over to the instep and additional extension to the back of the heel medially.
3.4.3 Myofascial TPs sometimes occur in the abductor hallucis muscle in children and were identified as the source of their heel pain. In a study of painful feet caused by myalgic spots in muscles, Good found the abductor hallucis to be responsible for heel pain in 10 of 100 cases. Kelly reported that a myalgic lesion in the abductor hallucis muscle produced cramps in the foot.
3.5 Synergists and Antagonists
3.5.1
3.6 Patient Report
3.6.1 Patient Complaints
3.6.1.1
3.6.2 Pain Relief
3.6.2.1
3.7 Activation and Perpetuation of Trigger Points
3.7.1 Activation
3.7.1.1
3.7.2 Perpetuation
3.7.2.1
3.8 Patient Examination
3.8.1 Examination for Involvement
3.8.1.1 Physical Examination
3.8.1.1.1
3.8.2 Differential Diagnosis
3.8.2.1
3.9 Trigger Point Examination
3.9.1
3.10 Associated Trigger Points
3.10.1
3.11 Corrective Actions
3.11.1
4 ABDUCTOR POLLICIS BREVIS
Back Table of Contents References
4.1 Illustration Notes
4.1.1
4.2 Illustration
4.2.1 ABDUCTOR POLLICIS BREVIS
4.3 Pain Referral
4.3.1
4.4 Synergists and Antagonists
4.4.1
4.5 Patient Report
4.5.1 Patient Complaints
4.5.1.1
4.5.2 Pain Relief
4.5.2.1
4.6 Activation and Perpetuation of Trigger Points
4.6.1 Activation
4.6.1.1
4.6.2 Perpetuation
4.6.2.1
4.7 Patient Examination
4.7.1 Examination for Involvement
4.7.1.1 Physical Examination
4.7.1.1.1
4.7.2 Differential Diagnosis
4.7.2.1
4.8 Trigger Point Examination
4.8.1
4.9 Associated Trigger Points
4.9.1
4.10 Corrective Actions
4.10.1
5 ADDUCTOR HALLUCIS & FLEXOR HALLUCIS BREVIS
Back Table of Contents References
5.1 Illustration Notes
5.1.1
5.2 Illustration
5.2.1 Adductor Hallucis & Flexor Hallucis Brevis
5.3 Location
5.3.1 Adductor Hallucis
5.3.1.1 TPs along the oblique head palpable near the proximal metatarsal heads and along the 2nd and 3rd metatarsal bones.
5.3.1.2 TPs along the transverse head palpable near the proximal metatarsal heads of the 2nd and 3rd metatarsal bones.
5.3.1.3 To create a moderate stretch on the muscle, the great toe is gently abducted passively during examination.
5.3.1.4 The adductor hallucis must be palpated through the plantar aponeurosis in the distal forefoot proximal to the heads of the four lesser metatarsals.
5.3.1.5 The transverse head of the muscle extends across the foot just proximal to the metatarsal heads and the oblique head angles slightly across the instep from the bases of the second, third, and fourth metatarsals.
5.3.1.6 Only rarely is a taut band of either head palpable; however, one can detect TP tenderness
5.3.2 Flexor Hallucis Brevis
5.3.2.1 TPs along the belly of the muscle over the first metatarsal bone of the big toe (Hallucis).
5.3.2.2 Because the plantar aponeurosis covers much of the flexor hallucis brevis, the medial head of this muscle is most effectively palpated using flat palpation through the thinner skin along the medial margin of the sole of the foot.
5.3.2.3 Lateral head TPs must be examined for spot tenderness by deep palpation through the plantar surface of the foot. The tendon of the abductor hallucis should not be mistaken for a taut band in the flexor hallucis brevis. Occasionally, the taut band of a TP is palpable in the medial head of the flexor hallucis brevis against the underlying first metatarsal bone.
5.4 Pain Referral
5.4.1 Adductor Hallucis
5.4.1.1 Pain and tenderness referred from TPs in either the oblique or transverse head of the adductor hallucis muscle are felt in the distal portion of the sole of the foot, primarily in the region of the first through fourth metatarsal heads.
5.4.1.2 The TPs in the transverse head of the adductor hallucis are likely to cause a strange “fluffy” feeling of numbness and a sense of swelling of the skin over the region of the metatarsal heads.
5.4.2 Flexor Hallucis Brevis
5.4.2.1 Refers pain and tenderness primarily to the region of the head of the first metatarsal on both its plantar and medial aspects, with a spill over pattern that may include all of the great toe and much of the second toe.
5.4.2.2 Kelly described pain radiating from a “fibrosistic” lesion TP in the flexor hallucis brevis muscle as causing cramps in the foot.
5.5 Synergists and Antagonists
5.5.1
5.6 Patient Report
5.6.1 Patient Complaints
5.6.1.1
5.6.2 Pain Relief
5.6.2.1
5.7 Activation and Perpetuation of Trigger Points
5.7.1 Activation
5.7.1.1
5.7.2 Perpetuation
5.7.2.1
5.8 Patient Examination
5.8.1 Examination for Involvement
5.8.1.1 Physical Examination
5.8.1.1.1
5.8.2 Differential Diagnosis
5.8.2.1
5.9 Trigger Point Examination
5.9.1
5.10 Associated Trigger Points
5.10.1
5.11 Corrective Actions
5.11.1
6 ADDUCTOR LONGUS & BREVIS
Back Table of Contents References
6.1 Illustration Notes
6.1.1
6.2 Illustration
6.2.1 ADDUCTOR BREVIS
6.3 Pain Referral
6.3.1
6.4 Synergists and Antagonists
6.4.1
6.5 Patient Report
6.5.1 Patient Complaints
6.5.1.1
6.5.2 Pain Relief
6.5.2.1
6.6 Activation and Perpetuation of Trigger Points
6.6.1 Activation
6.6.1.1
6.6.2 Perpetuation
6.6.2.1
6.7 Patient Examination
6.7.1 Examination for Involvement
6.7.1.1 Physical Examination
6.7.1.1.1
6.7.2 Differential Diagnosis
6.7.2.1
6.8 Trigger Point Examination
6.8.1
6.9 Associated Trigger Points
6.9.1
6.10 Corrective Actions
6.10.1
7 ADDUCTOR MAGNUS
Back Table of Contents References
7.1 Illustration Notes
7.1.1
7.2 Illustration
7.2.1 ADDUCTOR HALLUCIS
7.3 Pain Referral
7.3.1
7.4 Synergists and Antagonists
7.4.1
7.5 Patient Report
7.5.1 Patient Complaints
7.5.1.1
7.5.2 Pain Relief
7.5.2.1
7.6 Activation and Perpetuation of Trigger Points
7.6.1 Activation
7.6.1.1
7.6.2 Perpetuation
7.6.2.1
7.7 Patient Examination
7.7.1 Examination for Involvement
7.7.1.1 Physical Examination
7.7.1.1.1
7.7.2 Differential Diagnosis
7.7.2.1
7.8 Trigger Point Examination
7.8.1
7.9 Associated Trigger Points
7.9.1
7.10 Corrective Actions
7.10.1
8 ADDUCTOR POLLICIS, & OPPONENS POLLICIS
Back Table of Contents References
8.1 Illustration Notes
8.1.1
8.2 Illustration
8.2.1 ADDUCTOR LONGUS
8.3 Pain Referral
8.3.1
8.4 Synergists and Antagonists
8.4.1
8.5 Patient Report
8.5.1 Patient Complaints
8.5.1.1
8.5.2 Pain Relief
8.5.2.1
8.6 Activation and Perpetuation of Trigger Points
8.6.1 Activation
8.6.1.1
8.6.2 Perpetuation
8.6.2.1
8.7 Patient Examination
8.7.1 Examination for Involvement
8.7.1.1 Physical Examination
8.7.1.1.1
8.7.2 Differential Diagnosis
8.7.2.1
8.8 Trigger Point Examination
8.8.1
8.9 Associated Trigger Points
8.9.1
8.10 Corrective Actions
8.10.1
9 ANCONEUS
Back Table of Contents References
9.1 Illustration Notes
9.1.1
9.2 Illustration
9.2.1 ADDUCTOR MAGNUS
9.3 Pain Referral
9.3.1
9.4 Synergists and Antagonists
9.4.1
9.5 Patient Report
9.5.1 Patient Complaints
9.5.1.1
9.5.2 Pain Relief
9.5.2.1
9.6 Activation and Perpetuation of Trigger Points
9.6.1 Activation
9.6.1.1
9.6.2 Perpetuation
9.6.2.1
9.7 Patient Examination
9.7.1 Examination for Involvement
9.7.1.1 Physical Examination
9.7.1.1.1
9.7.2 Differential Diagnosis
9.7.2.1
9.8 Trigger Point Examination
9.8.1
9.9 Associated Trigger Points
9.9.1
9.10 Corrective Actions
9.10.1
10 BICEPS BRACHII
Back Table of Contents References
10.1 Illustration Notes
10.1.1
10.2 Illustration
10.2.1 ADDUCTOR POLLICIS
10.3 Pain Referral
10.3.1
10.4 Synergists and Antagonists
10.4.1
10.5 Patient Report
10.5.1 Patient Complaints
10.5.1.1
10.5.2 Pain Relief
10.5.2.1
10.6 Activation and Perpetuation of Trigger Points
10.6.1 Activation
10.6.1.1
10.6.2 Perpetuation
10.6.2.1
10.7 Patient Examination
10.7.1 Examination for Involvement
10.7.1.1 Physical Examination
10.7.1.1.1
10.7.2 Differential Diagnosis
10.7.2.1
10.8 Trigger Point Examination
10.8.1
10.9 Associated Trigger Points
10.9.1
10.10 Corrective Actions
10.10.1
11 BICEPS FEMORIS, SEMITENDINOSUS & SEMIMEMBRANOSUS
Back Table of Contents References
11.1 Illustration Notes
11.1.1
11.2 Illustration
11.2.1 ANCONEUS
11.3 Pain Referral
11.3.1
11.4 Synergists and Antagonists
11.4.1
11.5 Patient Report
11.5.1 Patient Complaints
11.5.1.1
11.5.2 Pain Relief
11.5.2.1
11.6 Activation and Perpetuation of Trigger Points
11.6.1 Activation
11.6.1.1
11.6.2 Perpetuation
11.6.2.1
11.7 Patient Examination
11.7.1 Examination for Involvement
11.7.1.1 Physical Examination
11.7.1.1.1
11.7.2 Differential Diagnosis
11.7.2.1
11.8 Trigger Point Examination
11.8.1
11.9 Associated Trigger Points
11.9.1
11.10 Corrective Actions
11.10.1
12 BRACHIALIS
Back Table of Contents References
12.1 Illustration Notes
12.1.1
12.2 Illustration
12.2.1 BICEPS BRACHII
12.3 Pain Referral
12.3.1
12.4 Synergists and Antagonists
12.4.1
12.5 Patient Report
12.5.1 Patient Complaints
12.5.1.1
12.5.2 Pain Relief
12.5.2.1
12.6 Activation and Perpetuation of Trigger Points
12.6.1 Activation
12.6.1.1
12.6.2 Perpetuation
12.6.2.1
12.7 Patient Examination
12.7.1 Examination for Involvement
12.7.1.1 Physical Examination
12.7.1.1.1
12.7.2 Differential Diagnosis
12.7.2.1
12.8 Trigger Point Examination
12.8.1
12.9 Associated Trigger Points
12.9.1
12.10 Corrective Actions
12.10.1
13 BRACHIORADIALIS
Back Table of Contents References
13.1 Illustration Notes
13.1.1
13.2 Illustration
13.2.1 BICEPS FEMORIS
13.3 Pain Referral
13.3.1
13.4 Synergists and Antagonists
13.4.1
13.5 Patient Report
13.5.1 Patient Complaints
13.5.1.1
13.5.2 Pain Relief
13.5.2.1
13.6 Activation and Perpetuation of Trigger Points
13.6.1 Activation
13.6.1.1
13.6.2 Perpetuation
13.6.2.1
13.7 Patient Examination
13.7.1 Examination for Involvement
13.7.1.1 Physical Examination
13.7.1.1.1
13.7.2 Differential Diagnosis
13.7.2.1
13.8 Trigger Point Examination
13.8.1
13.9 Associated Trigger Points
13.9.1
13.10 Corrective Actions
13.10.1
14 COCCYGEUS (ISCHIOCOCCYGEUS) SPHINCTER ANI, LEVATOR ANI, & OBTURATOR INTERNUS
Back Table of Contents References
14.1 Illustration Notes
14.1.1
14.2 Illustration
14.2.1 BRACHIALIS
14.3 Pain Referral
14.3.1
14.4 Synergists and Antagonists
14.4.1
14.5 Patient Report
14.5.1 Patient Complaints
14.5.1.1
14.5.2 Pain Relief
14.5.2.1
14.6 Activation and Perpetuation of Trigger Points
14.6.1 Activation
14.6.1.1
14.6.2 Perpetuation
14.6.2.1
14.7 Patient Examination
14.7.1 Examination for Involvement
14.7.1.1 Physical Examination
14.7.1.1.1
14.7.2 Differential Diagnosis
14.7.2.1
14.8 Trigger Point Examination
14.8.1
14.9 Associated Trigger Points
14.9.1
14.10 Corrective Actions
14.10.1
15 CORACOBRACHIALIS
Back Table of Contents References
15.1 Illustration Notes
15.1.1
15.2 Illustration
15.2.1 BRACHIORADIALIS
15.3 Pain Referral
15.3.1
15.4 Synergists and Antagonists
15.4.1
15.5 Patient Report
15.5.1 Patient Complaints
15.5.1.1
15.5.2 Pain Relief
15.5.2.1
15.6 Activation and Perpetuation of Trigger Points
15.6.1 Activation
15.6.1.1
15.6.2 Perpetuation
15.6.2.1
15.7 Patient Examination
15.7.1 Examination for Involvement
15.7.1.1 Physical Examination
15.7.1.1.1
15.7.2 Differential Diagnosis
15.7.2.1
15.8 Trigger Point Examination
15.8.1
15.9 Associated Trigger Points
15.9.1
15.10 Corrective Actions
15.10.1
16 DELTOID ANTERIOR, DELTOID MIDDLE, & DELTOID POSTERIOR
Back Table of Contents References
16.1 Illustration Notes
16.1.1
16.2 Illustration
16.2.1 BUCCINATOR
16.3 Pain Referral
16.3.1
16.4 Synergists and Antagonists
16.4.1
16.5 Patient Report
16.5.1 Patient Complaints
16.5.1.1
16.5.2 Pain Relief
16.5.2.1
16.6 Activation and Perpetuation of Trigger Points
16.6.1 Activation
16.6.1.1
16.6.2 Perpetuation
16.6.2.1
16.7 Patient Examination
16.7.1 Examination for Involvement
16.7.1.1 Physical Examination
16.7.1.1.1
16.7.2 Differential Diagnosis
16.7.2.1
16.8 Trigger Point Examination
16.8.1
16.9 Associated Trigger Points
16.9.1
16.10 Corrective Actions
16.10.1
17 DIGASTRIC ANT & POST BELLY (SUPRAHYOID)
Back Table of Contents References
17.1 Illustration Notes
17.1.1
17.2 Illustration
17.2.1 BULBOCAVERNOSUS
17.3 Pain Referral
17.3.1
17.4 Synergists and Antagonists
17.4.1
17.5 Patient Report
17.5.1 Patient Complaints
17.5.1.1
17.5.2 Pain Relief
17.5.2.1
17.6 Activation and Perpetuation of Trigger Points
17.6.1 Activation
17.6.1.1
17.6.2 Perpetuation
17.6.2.1
17.7 Patient Examination
17.7.1 Examination for Involvement
17.7.1.1 Physical Examination
17.7.1.1.1
17.7.2 Differential Diagnosis
17.7.2.1
17.8 Trigger Point Examination
17.8.1
17.9 Associated Trigger Points
17.9.1
17.10 Corrective Actions
17.10.1
18 DORSAL INTEROSSEI (FOOT) & PLANTAR INTEROSSEI (FOOT)
Back Table of Contents References
18.1 Illustration Notes
18.1.1
18.2 Illustration
18.2.1 Interossei Foot
18.3 Location
18.3.1 The Interossei and Lumbricals may be palpated between adjacent metatarsal bones using a bimanual technique where the finger of one hand is used for palpation while the finger of the other hand provides counter pressure.
18.3.2 This technique tends to separate these bones and to increase the stretch on the muscles. The dorsal Interossei are palpated by the finger of one hand with precise counter pressure applied on the plantar surface by the finger of the other hand.
18.3.3 Then tenderness in the Lumbricals and plantar Interossei can be elicited by deep palpation through the plantar aponeurosis against counter pressure applied to the dorsal surface by the other hand. One often can palpate the taut bands of active TPs in a dorsal interosseus muscle against the adjacent metatarsal bone to which it attaches. In that case, one may elicit a local twitch response by snapping palpation of an active TP. However, one cannot distinguish between the Lumbricals and plantar Interossei by palpation through the plantar aponeurosis and/or the oblique head of the adductor hallucis muscle.
18.4 Pain Referral
18.4.1 The interosseous muscles of the foot refer pain and tenderness largely to the side of the digit to which the tendon attaches; however, in the case of the foot, these TPs also refer pain both to the dorsum and to the sole of the foot along the distal portion of the corresponding metatarsal. This pattern is illustrated for the first dorsal interosseous muscle from the dorsal view and plantar view.
18.4.2 TPs in the first dorsal interosseus muscle may produce tingling in the great toe; the disturbance of sensation can include the dorsum of the foot and lower shin.
18.4.3 The plantar Interossei produce a pattern comparable to that of the dorsal Interossei.
18.5 Synergists and Antagonists
18.5.1
18.6 Patient Report
18.6.1 Patient Complaints
18.6.1.1
18.6.2 Pain Relief
18.6.2.1
18.7 Activation and Perpetuation of Trigger Points
18.7.1 Activation
18.7.1.1
18.7.2 Perpetuation
18.7.2.1
18.8 Patient Examination
18.8.1 Examination for Involvement
18.8.1.1 Physical Examination
18.8.1.1.1
18.8.2 Differential Diagnosis
18.8.2.1
18.9 Trigger Point Examination
18.9.1
18.10 Associated Trigger Points
18.10.1
18.11 Corrective Actions
18.11.1
19 EXTENSOR CARPI RADIALIS BREVIS, EXTENSOR CARPI RADIALIS LONGUS, & EXTENSOR CARPI ULNARIS
Back Table of Contents References
19.1 Illustration Notes
19.1.1
19.2 Illustration
19.2.1 COCCYGEUS
19.3 Pain Referral
19.3.1
19.4 Synergists and Antagonists
19.4.1
19.5 Patient Report
19.5.1 Patient Complaints
19.5.1.1
19.5.2 Pain Relief
19.5.2.1
19.6 Activation and Perpetuation of Trigger Points
19.6.1 Activation
19.6.1.1
19.6.2 Perpetuation
19.6.2.1
19.7 Patient Examination
19.7.1 Examination for Involvement
19.7.1.1 Physical Examination
19.7.1.1.1
19.7.2 Differential Diagnosis
19.7.2.1
19.8 Trigger Point Examination
19.8.1
19.9 Associated Trigger Points
19.9.1
19.10 Corrective Actions
19.10.1
20 EXTENSOR DIGITORUM, & EXTENSOR INDICIS
Back Table of Contents References
20.1 Illustration Notes
20.1.1
20.2 Illustration
20.2.1 CORACOBRACHIALIS
20.3 Pain Referral
20.3.1
20.4 Synergists and Antagonists
20.4.1
20.5 Patient Report
20.5.1 Patient Complaints
20.5.1.1
20.5.2 Pain Relief
20.5.2.1
20.6 Activation and Perpetuation of Trigger Points
20.6.1 Activation
20.6.1.1
20.6.2 Perpetuation
20.6.2.1
20.7 Patient Examination
20.7.1 Examination for Involvement
20.7.1.1 Physical Examination
20.7.1.1.1
20.7.2 Differential Diagnosis
20.7.2.1
20.8 Trigger Point Examination
20.8.1
20.9 Associated Trigger Points
20.9.1
20.10 Corrective Actions
20.10.1
21 EXTENSOR DIGITORUM BREVIS & EXTENSOR HALLUCIS BREVIS
Back Table of Contents References
21.1 Illustration Notes
21.1.1
21.2 Illustration
21.2.1 Extensor Digitorum & Extensor Hallucis Brevis
21.3 Location
21.3.1 Extensor Digitorum Brevis
21.3.1.1 Draw a line from the dorsal bases of the 2nd thru 4th metatarsals (find base of the 5th metatarsal bump and mark a line across the top of the foot)
21.3.1.2 Extend the proximal phalanges of the 2nd thru 4th toes to feel the muscle and then palpate for trigger points.
21.3.2 Extensor Hallucis Brevis
21.3.2.1 Draw a line from the dorsal base of the 1ST metatarsal (find base of the 5th metatarsal bump and mark a line across the top of the foot)
21.3.2.2 Extend the proximal phalanges of the big toe to feel the muscle and then palpate for trigger points.
21.4 Pain Referral
21.4.1 Extensor Digitorum Brevis
21.4.1.1 The composite referred pain pattern of TPs in the extensor digitorum brevis and extensor hallucis brevis muscles covers the mid-dorsum of the foot.
21.4.1.2 In children, TPs are occasionally found in these short extensors of the toes. The referred pain pattern in children is similar to that seen in adults.
21.4.1.3 Kelly observed that a myalgic lesion in the extensor digitorum brevis muscle produced cramps in the foot and later reported, more specifically, that it referred pain to the instep.
21.4.2 Extensor Hallucis Brevis
21.4.2.1 The composite referred pain pattern of TPs in the extensor digitorum brevis and extensor hallucis brevis muscles covers the mid-dorsum of the foot.
21.4.2.2 In children, TPs are occasionally found in these short extensors of the toes. The referred pain pattern in children is similar to that seen in adults.
21.4.2.3 Kelly observed that a myalgic lesion in the extensor digitorum brevis muscle produced cramps in the foot and later reported, more specifically, that it referred pain to the instep.
21.5 Synergists and Antagonists
21.5.1
21.6 Patient Report
21.6.1 Patient Complaints
21.6.1.1
21.6.2 Pain Relief
21.6.2.1
21.7 Activation and Perpetuation of Trigger Points
21.7.1 Activation
21.7.1.1
21.7.2 Perpetuation
21.7.2.1
21.8 Patient Examination
21.8.1 Examination for Involvement
21.8.1.1 Physical Examination
21.8.1.1.1
21.8.2 Differential Diagnosis
21.8.2.1
21.9 Trigger Point Examination
21.9.1
21.10 Associated Trigger Points
21.10.1
21.11 Corrective Actions
21.11.1
22 EXTENSOR DIGITORUM LONGUS & EXTENSOR HALLUCIS LONGUS
Back Table of Contents References
22.1 Illustration Notes
22.1.1
22.2 Illustration
22.2.1 Extensor Digitorum Longus & Extensor Hallucis Longus
22.3 Location
22.3.1 EXTENSOR DIGITORUM LONGUS TPs
22.3.1.1 Approximately 8 cm (3 inches) distal to the level of the fibular head between the tibialis anterior and peroneus longus muscles.
22.3.1.2 At this level, the most proximal part of the extensor hallucis longus is deep to and between the extensor digitorum longus and the tibialis anterior muscles.
22.3.1.3 Contraction of the extensor digitorum longus usually is distinguishable by palpation when the patient selectively extends the lesser toes against resistance without exerting dorsiflexion effort at the ankle.
22.3.2 EXTENSOR HALLUCIS LONGUS TPs
22.3.2.1 Slightly distal to the junction of the middle and distal thirds of the leg anterior to the fibula.
22.3.2.2 In this region, the extensor hallucis longus may be emerging from between the tibialis anterior and the extensor digitorum longus, as the later becomes tendinous.
22.3.2.3 As the extensor hallucis longus becomes subcutaneous, it lies anterior and adjacent to the fibula.
22.3.2.4 Contraction of this muscle can usually be distinguished by palpation distal to the TP region when the patient selectively extends the great toe against resistance without exerting dorsiflexion effort at the ankle.
22.4 Pain Referral
22.4.1 EXTENSOR DIGITORUM LONGUS TPs
22.4.1.1 Refers pain primarily over the dorsum of the foot and toes, nearly to the tips of the middle three toes.
22.4.1.2 Sometimes the pain referred from extensor digitorum longus TPs concentrates more strongly at the ankle than over the dorsum of the foot.
22.4.1.3 A spill over pattern may extend halfway up the leg from the ankle toward the TP. Pain has been reported radiating to the anterolateral region of the ankle from TPs in this muscle.
22.4.2 EXTENSOR HALLUCIS LONGUS TPs
22.4.2.1 TPs refer pain primarily to the dorsum of the foot over the distal aspect of the first metatarsal and the base of the great toe with spill over patterns extending downward to the tip of the great toe and upward over the dorsum of the foot and leg, sometimes as far as the TP.
22.4.2.2 It has been reported that patients with increased tension of the long extensors of the toes experience pain on the anterior aspect of the tibia.
22.5 Synergists and Antagonists
22.5.1
22.6 Patient Report
22.6.1 Patient Complaints
22.6.1.1
22.6.2 Pain Relief
22.6.2.1
22.7 Activation and Perpetuation of Trigger Points
22.7.1 Activation
22.7.1.1
22.7.2 Perpetuation
22.7.2.1
22.8 Patient Examination
22.8.1 Examination for Involvement
22.8.1.1 Physical Examination
22.8.1.1.1
22.8.2 Differential Diagnosis
22.8.2.1
22.9 Trigger Point Examination
22.9.1
22.10 Associated Trigger Points
22.10.1
22.11 Corrective Actions
22.11.1
23 EXTERNAL ABDOMINAL OBLIQUE=ANT DIV & EXTERNAL ABDOMINAL OBLIQUE=LAT DIV
Back Table of Contents References
23.1 Illustration Notes
23.1.1
23.2 Illustration
23.2.1 CRICOPHARYNGEUS
23.3 Pain Referral
23.3.1
23.4 Synergists and Antagonists
23.4.1
23.5 Patient Report
23.5.1 Patient Complaints
23.5.1.1
23.5.2 Pain Relief
23.5.2.1
23.6 Activation and Perpetuation of Trigger Points
23.6.1 Activation
23.6.1.1
23.6.2 Perpetuation
23.6.2.1
23.7 Patient Examination
23.7.1 Examination for Involvement
23.7.1.1 Physical Examination
23.7.1.1.1
23.7.2 Differential Diagnosis
23.7.2.1
23.8 Trigger Point Examination
23.8.1
23.9 Associated Trigger Points
23.9.1
23.10 Corrective Actions
23.10.1
24 FLEXOR CARPI RADIALIS, FLEXOR CARPI ULNARIS, FLEXOR DIGITORUM SUPERFICIALIS
Back Table of Contents References
24.1 Illustration Notes
24.1.1
24.2 Illustration
24.2.1 CRICOTHYROID
24.3 Pain Referral
24.3.1
24.4 Synergists and Antagonists
24.4.1
24.5 Patient Report
24.5.1 Patient Complaints
24.5.1.1
24.5.2 Pain Relief
24.5.2.1
24.6 Activation and Perpetuation of Trigger Points
24.6.1 Activation
24.6.1.1
24.6.2 Perpetuation
24.6.2.1
24.7 Patient Examination
24.7.1 Examination for Involvement
24.7.1.1 Physical Examination
24.7.1.1.1
24.7.2 Differential Diagnosis
24.7.2.1
24.8 Trigger Point Examination
24.8.1
24.9 Associated Trigger Points
24.9.1
24.10 Corrective Actions
24.10.1
25 FLEXOR DIGITORUM LONGUS & FLEXOR HALLUCIS LONGUS
Back Table of Contents References
25.1 Illustration Notes
25.1.1
25.2 Illustration
25.2.1 FLEXOR DIGITORUM LONGUS & FLEXOR HALLUCIS LONGUS
25.3 Location
25.3.1 FLEXOR DIGITORUM LONGUS TPs
25.3.1.1 Found between the tibia and the soleus/gastrocnemius muscles on the medial side of the leg. With the knee bent to 90 degrees and the foot plantar flexed, the gastrocnemius muscle can be pressed posteriorly away from the tibia to expose the flexor digitorum longus to more effective palpation.
25.3.2 FLEXOR HALLUCIS LONGUS TPs
25.3.2.1 Located at the junction of the middle and lower thirds of the calf, just lateral to the mid-line, against the posterior face of the fibula.
25.4 Pain Referral
25.4.1 FLEXOR DIGITORUM LONGUS TPs
25.4.1.1 Refers pain and tenderness primarily to the middle of the plantar forefoot proximal to the four lesser toes and sometimes with spill over pain to these toes.
25.4.1.2 Occasionally refers pain to the medial side of the ankle and calf, but not to heel.
25.4.2 FLEXOR HALLUCIS LONGUS TPs
25.4.2.1 Refers pain strongly to the plantar surface of the great toe and head of the first metatarsal.
25.4.2.2 The pain may occasionally radiate proximally for a short distance on the plantar surface, but does not extend to the heel or leg.
25.5 Synergists and Antagonists
25.5.1
25.6 Patient Report
25.6.1 Patient Complaints
25.6.1.1
25.6.2 Pain Relief
25.6.2.1
25.7 Activation and Perpetuation of Trigger Points
25.7.1 Activation
25.7.1.1
25.7.2 Perpetuation
25.7.2.1
25.8 Patient Examination
25.8.1 Examination for Involvement
25.8.1.1 Physical Examination
25.8.1.1.1
25.8.2 Differential Diagnosis
25.8.2.1
25.9 Trigger Point Examination
25.9.1
25.10 Associated Trigger Points
25.10.1
25.11 Corrective Actions
25.11.1
26 FLEXOR POLLICIS LONGUS, & PRONATOR TERES
Back Table of Contents References
26.1 Illustration Notes
26.1.1
26.2 Illustration
26.2.1 INTERSPINALES
26.3 Pain Referral
26.3.1
26.4 Synergists and Antagonists
26.4.1
26.5 Patient Report
26.5.1 Patient Complaints
26.5.1.1
26.5.2 Pain Relief
26.5.2.1
26.6 Activation and Perpetuation of Trigger Points
26.6.1 Activation
26.6.1.1
26.6.2 Perpetuation
26.6.2.1
26.7 Patient Examination
26.7.1 Examination for Involvement
26.7.1.1 Physical Examination
26.7.1.1.1
26.7.2 Differential Diagnosis
26.7.2.1
26.8 Trigger Point Examination
26.8.1
26.9 Associated Trigger Points
26.9.1
26.10 Corrective Actions
26.10.1
27 FRONTALIS (EPICRANIUS) & OCCIPITALIS (EPICRANIUS)
Back Table of Contents References
27.1 Illustration Notes
27.1.1
27.2 Illustration
27.2.1 INTERTRANSVERSARII
27.3 Pain Referral
27.3.1
27.4 Synergists and Antagonists
27.4.1
27.5 Patient Report
27.5.1 Patient Complaints
27.5.1.1
27.5.2 Pain Relief
27.5.2.1
27.6 Activation and Perpetuation of Trigger Points
27.6.1 Activation
27.6.1.1
27.6.2 Perpetuation
27.6.2.1
27.7 Patient Examination
27.7.1 Examination for Involvement
27.7.1.1 Physical Examination
27.7.1.1.1
27.7.2 Differential Diagnosis
27.7.2.1
27.8 Trigger Point Examination
27.8.1
27.9 Associated Trigger Points
27.9.1
27.10 Corrective Actions
27.10.1
28 GASTROCNEMIUS
Back Table of Contents References
28.1 Illustration Notes
28.1.1
28.2 Illustration
28.2.1 Gastrocnemius
28.3 Location
28.3.1 TP 1 & 2
28.3.1.1 These are the most common gastrocnemius TPs and are found proximal to the midpoint of the bellies of the muscle along its medial or lateral borders.
28.3.1.2 Frequently local twitch responses (LTRs) can be elicited from these TPs by snapping palpation.
28.3.2 TP 1
28.3.2.1 TP 1 is the most common and occurs distal to the knee close to the medial border of the medial head of the gastrocnemius muscle.
28.3.3 TP 2
28.3.3.1 TP 2 is the next most common gastrocnemius TP and is found slightly more distal than TP1, near the lateral border of the belly of the lateral head of the gastrocnemius.
28.3.3.2 Located in the lower end of the upper 1/3rd of the lateral gastrocnemius near the lateral border of the belly of the lateral head of the muscle.
28.3.4 TP 3 (medial Head) & 4 (Lateral Head)
28.3.4.1 Located in the popliteal space near where the medial and lateral heads each attach to a femoral condyle. Only flat palpation can be used to palpate these proximal TPs. LTRs are rarely observed because of the greater depth of these TPs.
28.3.5 TP3
28.3.5.1 Located in the medial head of the gastrocnemius muscle in the popliteal space near where it attaches to the femoral condyle.
28.3.6 TP4
28.3.6.1 Located in the lateral head of the gastrocnemius muscle in the popliteal space near where it attaches to the femoral condyle.
28.4 Pain Referral
28.4.1 TP 1
28.4.1.1 Refers pain primarily to the instep of the ipsilateral foot.
28.4.1.2 Spill over zone extends from the region of the lower posterior thigh, over the back of the knee, and down the posteromedial aspect of the leg to the ankle.
28.4.2 TP 2, 3 & 4
28.4.2.1 Refers pain primarily locally around and near the TP.
28.4.3 TP2
28.4.3.1 Refers pain around the TP near the lateral border of the belly of the lateral head of the muscle at the lower end of the upper 1/3rd of the lower leg.
28.4.4 TP 3
28.4.4.1 Refers pain around the TP near the medial aspect of the popliteal space.
28.4.5 TP 4
28.4.5.1 Refers pain around the TP near the lateral aspect of the popliteal space.
28.5 Synergists and Antagonists
28.5.1
28.6 Patient Report
28.6.1 Patient Complaints
28.6.1.1
28.6.2 Pain Relief
28.6.2.1
28.7 Activation and Perpetuation of Trigger Points
28.7.1 Activation
28.7.1.1
28.7.2 Perpetuation
28.7.2.1
28.8 Patient Examination
28.8.1 Examination for Involvement
28.8.1.1 Physical Examination
28.8.1.1.1
28.8.2 Differential Diagnosis
28.8.2.1
28.9 Trigger Point Examination
28.9.1
28.10 Associated Trigger Points
28.10.1
28.11 Corrective Actions
28.11.1
29 GLUTEUS MAXIMUS
Back Table of Contents References
29.1 Illustration Notes
29.1.1
29.2 Illustration
29.2.1 INTERTRANSVERSARII
29.3 Pain Referral
29.3.1
29.4 Synergists and Antagonists
29.4.1
29.5 Patient Report
29.5.1 Patient Complaints
29.5.1.1
29.5.2 Pain Relief
29.5.2.1
29.6 Activation and Perpetuation of Trigger Points
29.6.1 Activation
29.6.1.1
29.6.2 Perpetuation
29.6.2.1
29.7 Patient Examination
29.7.1 Examination for Involvement
29.7.1.1 Physical Examination
29.7.1.1.1
29.7.2 Differential Diagnosis
29.7.2.1
29.8 Trigger Point Examination
29.8.1
29.9 Associated Trigger Points
29.9.1
29.10 Corrective Actions
29.10.1
30 GLUTEUS MEDIUS
Back Table of Contents References
30.1 Illustration Notes
30.1.1
30.2 Illustration
30.2.1 INTERTRANSVERSARII
30.3 Pain Referral
30.3.1
30.4 Synergists and Antagonists
30.4.1
30.5 Patient Report
30.5.1 Patient Complaints
30.5.1.1
30.5.2 Pain Relief
30.5.2.1
30.6 Activation and Perpetuation of Trigger Points
30.6.1 Activation
30.6.1.1
30.6.2 Perpetuation
30.6.2.1
30.7 Patient Examination
30.7.1 Examination for Involvement
30.7.1.1 Physical Examination
30.7.1.1.1
30.7.2 Differential Diagnosis
30.7.2.1
30.8 Trigger Point Examination
30.8.1
30.9 Associated Trigger Points
30.9.1
30.10 Corrective Actions
30.10.1
31 GLUTEUS MINIMUS ANT & POST
Back Table of Contents References
31.1 Illustration Notes
31.1.1
31.2 Illustration
31.2.1 INTERTRANSVERSARII
31.3 Pain Referral
31.3.1
31.4 Synergists and Antagonists
31.4.1
31.5 Patient Report
31.5.1 Patient Complaints
31.5.1.1
31.5.2 Pain Relief
31.5.2.1
31.6 Activation and Perpetuation of Trigger Points
31.6.1 Activation
31.6.1.1
31.6.2 Perpetuation
31.6.2.1
31.7 Patient Examination
31.7.1 Examination for Involvement
31.7.1.1 Physical Examination
31.7.1.1.1
31.7.2 Differential Diagnosis
31.7.2.1
31.8 Trigger Point Examination
31.8.1
31.9 Associated Trigger Points
31.9.1
31.10 Corrective Actions
31.10.1
32 GRACILIS
Back Table of Contents References
32.1 Illustration Notes
32.1.1
32.2 Illustration
32.2.1 INTERTRANSVERSARII
32.3 Pain Referral
32.3.1
32.4 Synergists and Antagonists
32.4.1
32.5 Patient Report
32.5.1 Patient Complaints
32.5.1.1
32.5.2 Pain Relief
32.5.2.1
32.6 Activation and Perpetuation of Trigger Points
32.6.1 Activation
32.6.1.1
32.6.2 Perpetuation
32.6.2.1
32.7 Patient Examination
32.7.1 Examination for Involvement
32.7.1.1 Physical Examination
32.7.1.1.1
32.7.2 Differential Diagnosis
32.7.2.1
32.8 Trigger Point Examination
32.8.1
32.9 Associated Trigger Points
32.9.1
32.10 Corrective Actions
32.10.1
33 ILLIOPSOAS (ILIACUS, PSOAS MAJOR, & PSOAS MINOR)
Back Table of Contents References
33.1 Illustration Notes
33.1.1
33.2 Illustration
33.2.1 INTERTRANSVERSARII
33.3 Pain Referral
33.3.1
33.4 Synergists and Antagonists
33.4.1
33.5 Patient Report
33.5.1 Patient Complaints
33.5.1.1
33.5.2 Pain Relief
33.5.2.1
33.6 Activation and Perpetuation of Trigger Points
33.6.1 Activation
33.6.1.1
33.6.2 Perpetuation
33.6.2.1
33.7 Patient Examination
33.7.1 Examination for Involvement
33.7.1.1 Physical Examination
33.7.1.1.1
33.7.2 Differential Diagnosis
33.7.2.1
33.8 Trigger Point Examination
33.8.1
33.9 Associated Trigger Points
33.9.1
33.10 Corrective Actions
33.10.1
34 ILIOCOSTALIS LUMBORUM, ILIOCOSTALIS THORACIS, & LONGISSIMUS THORACIS
Back Table of Contents References
34.1 Illustration Notes
34.1.1
34.2 Illustration
34.2.1 INTERTRANSVERSARII
34.3 Pain Referral
34.3.1
34.4 Synergists and Antagonists
34.4.1
34.5 Patient Report
34.5.1 Patient Complaints
34.5.1.1
34.5.2 Pain Relief
34.5.2.1
34.6 Activation and Perpetuation of Trigger Points
34.6.1 Activation
34.6.1.1
34.6.2 Perpetuation
34.6.2.1
34.7 Patient Examination
34.7.1 Examination for Involvement
34.7.1.1 Physical Examination
34.7.1.1.1
34.7.2 Differential Diagnosis
34.7.2.1
34.8 Trigger Point Examination
34.8.1
34.9 Associated Trigger Points
34.9.1
34.10 Corrective Actions
34.10.1
35 INFRASPINATUS
Back Table of Contents References
35.1 Illustration Notes
35.1.1
35.2 Illustration
35.2.1 INTERTRANSVERSARII
35.3 Pain Referral
35.3.1
35.4 Synergists and Antagonists
35.4.1
35.5 Patient Report
35.5.1 Patient Complaints
35.5.1.1
35.5.2 Pain Relief
35.5.2.1
35.6 Activation and Perpetuation of Trigger Points
35.6.1 Activation
35.6.1.1
35.6.2 Perpetuation
35.6.2.1
35.7 Patient Examination
35.7.1 Examination for Involvement
35.7.1.1 Physical Examination
35.7.1.1.1
35.7.2 Differential Diagnosis
35.7.2.1
35.8 Trigger Point Examination
35.8.1
35.9 Associated Trigger Points
35.9.1
35.10 Corrective Actions
35.10.1
36 LATERAL PTERYGOID
Back Table of
Contents References
36.1 Illustration Notes
36.1.1
36.2 Illustration
36.2.1 INTERTRANSVERSARII
36.3 Pain Referral
36.3.1
36.4 Synergists and Antagonists
36.4.1
36.5 Patient Report
36.5.1 Patient Complaints
36.5.1.1
36.5.2 Pain Relief
36.5.2.1
36.6 Activation and Perpetuation of Trigger Points
36.6.1 Activation
36.6.1.1
36.6.2 Perpetuation
36.6.2.1
36.7 Patient Examination
36.7.1 Examination for Involvement
36.7.1.1 Physical Examination
36.7.1.1.1
36.7.2 Differential Diagnosis
36.7.2.1
36.8 Trigger Point Examination
36.8.1
36.9 Associated Trigger Points
36.9.1
36.10 Corrective Actions
36.10.1
37 LATISSIMUS DORSI
Back Table of Contents References
37.1 Illustration Notes
37.1.1
37.2 Illustration
37.2.1 INTERTRANSVERSARII
37.3 Pain Referral
37.3.1
37.4 Synergists and Antagonists
37.4.1
37.5 Patient Report
37.5.1 Patient Complaints
37.5.1.1
37.5.2 Pain Relief
37.5.2.1
37.6 Activation and Perpetuation of Trigger Points
37.6.1 Activation
37.6.1.1
37.6.2 Perpetuation
37.6.2.1
37.7 Patient Examination
37.7.1 Examination for Involvement
37.7.1.1 Physical Examination
37.7.1.1.1
37.7.2 Differential Diagnosis
37.7.2.1
37.8 Trigger Point Examination
37.8.1
37.9 Associated Trigger Points
37.9.1
37.10 Corrective Actions
37.10.1
38 LEVATOR SCAPULAE
Back Table of Contents References
38.1 Illustration Notes
38.1.1
38.2 Illustration
38.2.1 INTERTRANSVERSARII
38.3 Pain Referral
38.3.1
38.4 Synergists and Antagonists
38.4.1
38.5 Patient Report
38.5.1 Patient Complaints
38.5.1.1
38.5.2 Pain Relief
38.5.2.1
38.6 Activation and Perpetuation of Trigger Points
38.6.1 Activation
38.6.1.1
38.6.2 Perpetuation
38.6.2.1
38.7 Patient Examination
38.7.1 Examination for Involvement
38.7.1.1 Physical Examination
38.7.1.1.1
38.7.2 Differential Diagnosis
38.7.2.1
38.8 Trigger Point Examination
38.8.1
38.9 Associated Trigger Points
38.9.1
38.10 Corrective Actions
38.10.1
39 MASSETER
Back Table of Contents References
39.1 Illustration Notes
39.1.1
39.2 Illustration
39.2.1 INTERTRANSVERSARII
39.3 Pain Referral
39.3.1
39.4 Synergists and Antagonists
39.4.1
39.5 Patient Report
39.5.1 Patient Complaints
39.5.1.1
39.5.2 Pain Relief
39.5.2.1
39.6 Activation and Perpetuation of Trigger Points
39.6.1 Activation
39.6.1.1
39.6.2 Perpetuation
39.6.2.1
39.7 Patient Examination
39.7.1 Examination for Involvement
39.7.1.1 Physical Examination
39.7.1.1.1
39.7.2 Differential Diagnosis
39.7.2.1
39.8 Trigger Point Examination
39.8.1
39.9 Associated Trigger Points
39.9.1
39.10 Corrective Actions
39.10.1
40 MEDIAL PTERYGOID
Back Table of Contents References
40.1 Illustration Notes
40.1.1
40.2 Illustration
40.2.1 INTERTRANSVERSARII
40.3 Pain Referral
40.3.1
40.4 Synergists and Antagonists
40.4.1
40.5 Patient Report
40.5.1 Patient Complaints
40.5.1.1
40.5.2 Pain Relief
40.5.2.1
40.6 Activation and Perpetuation of Trigger Points
40.6.1 Activation
40.6.1.1
40.6.2 Perpetuation
40.6.2.1
40.7 Patient Examination
40.7.1 Examination for Involvement
40.7.1.1 Physical Examination
40.7.1.1.1
40.7.2 Differential Diagnosis
40.7.2.1
40.8 Trigger Point Examination
40.8.1
40.9 Associated Trigger Points
40.9.1
40.10 Corrective Actions
40.10.1
41 MULTIFIDUS, SEMISPINALIS CAPITIS, & SEMISPINALIS CERVICIS
Back Table of Contents References
41.1 Illustration Notes
41.1.1
41.2 Illustration
41.2.1 INTERTRANSVERSARII
41.3 Pain Referral
41.3.1
41.4 Synergists and Antagonists
41.4.1
41.5 Patient Report
41.5.1 Patient Complaints
41.5.1.1
41.5.2 Pain Relief
41.5.2.1
41.6 Activation and Perpetuation of Trigger Points
41.6.1 Activation
41.6.1.1
41.6.2 Perpetuation
41.6.2.1
41.7 Patient Examination
41.7.1 Examination for Involvement
41.7.1.1 Physical Examination
41.7.1.1.1
41.7.2 Differential Diagnosis
41.7.2.1
41.8 Trigger Point Examination
41.8.1
41.9 Associated Trigger Points
41.9.1
41.10 Corrective Actions
41.10.1
42 MULTIFIDI
Back Table of Contents References
42.1 Illustration Notes
42.1.1
42.2 Illustration
42.2.1 INTERTRANSVERSARII
42.3 Pain Referral
42.3.1
42.4 Synergists and Antagonists
42.4.1
42.5 Patient Report
42.5.1 Patient Complaints
42.5.1.1
42.5.2 Pain Relief
42.5.2.1
42.6 Activation and Perpetuation of Trigger Points
42.6.1 Activation
42.6.1.1
42.6.2 Perpetuation
42.6.2.1
42.7 Patient Examination
42.7.1 Examination for Involvement
42.7.1.1 Physical Examination
42.7.1.1.1
42.7.2 Differential Diagnosis
42.7.2.1
42.8 Trigger Point Examination
42.8.1
42.9 Associated Trigger Points
42.9.1
42.10 Corrective Actions
42.10.1
43 ORBICULARIS OCULI, PLATYSMA, & ZYGOMATICUS MAJOR
Back Table of Contents References
43.1 Illustration Notes
43.1.1
43.2 Illustration
43.2.1 INTERTRANSVERSARII
43.3 Pain Referral
43.3.1
43.4 Synergists and Antagonists
43.4.1
43.5 Patient Report
43.5.1 Patient Complaints
43.5.1.1
43.5.2 Pain Relief
43.5.2.1
43.6 Activation and Perpetuation of Trigger Points
43.6.1 Activation
43.6.1.1
43.6.2 Perpetuation
43.6.2.1
43.7 Patient Examination
43.7.1 Examination for Involvement
43.7.1.1 Physical Examination
43.7.1.1.1
43.7.2 Differential Diagnosis
43.7.2.1
43.8 Trigger Point Examination
43.8.1
43.9 Associated Trigger Points
43.9.1
43.10 Corrective Actions
43.10.1
44 PALMARIS LONGUS
Back Table of Contents References
44.1 Illustration Notes
44.1.1
44.2 Illustration
44.2.1 INTERTRANSVERSARII
44.3 Pain Referral
44.3.1
44.4 Synergists and Antagonists
44.4.1
44.5 Patient Report
44.5.1 Patient Complaints
44.5.1.1
44.5.2 Pain Relief
44.5.2.1
44.6 Activation and Perpetuation of Trigger Points
44.6.1 Activation
44.6.1.1
44.6.2 Perpetuation
44.6.2.1
44.7 Patient Examination
44.7.1 Examination for Involvement
44.7.1.1 Physical Examination
44.7.1.1.1
44.7.2 Differential Diagnosis
44.7.2.1
44.8 Trigger Point Examination
44.8.1
44.9 Associated Trigger Points
44.9.1
44.10 Corrective Actions
44.10.1
45 PECTINEUS
Back Table of Contents References
45.1 Illustration Notes
45.1.1
45.2 Illustration
45.2.1 INTERTRANSVERSARII
45.3 Pain Referral
45.3.1
45.4 Synergists and Antagonists
45.4.1
45.5 Patient Report
45.5.1 Patient Complaints
45.5.1.1
45.5.2 Pain Relief
45.5.2.1
45.6 Activation and Perpetuation of Trigger Points
45.6.1 Activation
45.6.1.1
45.6.2 Perpetuation
45.6.2.1
45.7 Patient Examination
45.7.1 Examination for Involvement
45.7.1.1 Physical Examination
45.7.1.1.1
45.7.2 Differential Diagnosis
45.7.2.1
45.8 Trigger Point Examination
45.8.1
45.9 Associated Trigger Points
45.9.1
45.10 Corrective Actions
45.10.1
46 PECTORALIS MAJOR CLAVICULAR & PECTORALIS MAJOR STERNAL
Back Table of Contents References
46.1 Illustration Notes
46.1.1
46.2 Illustration
46.2.1 INTERTRANSVERSARII
46.3 Pain Referral
46.3.1
46.4 Synergists and Antagonists
46.4.1
46.5 Patient Report
46.5.1 Patient Complaints
46.5.1.1
46.5.2 Pain Relief
46.5.2.1
46.6 Activation and Perpetuation of Trigger Points
46.6.1 Activation
46.6.1.1
46.6.2 Perpetuation
46.6.2.1
46.7 Patient Examination
46.7.1 Examination for Involvement
46.7.1.1 Physical Examination
46.7.1.1.1
46.7.2 Differential Diagnosis
46.7.2.1
46.8 Trigger Point Examination
46.8.1
46.9 Associated Trigger Points
46.9.1
46.10 Corrective Actions
46.10.1
47 PECTORALIS MINOR
Back Table of Contents References
47.1 Illustration Notes
47.1.1
47.2 Illustration
47.2.1 INTERTRANSVERSARII
47.3 Pain Referral
47.3.1
47.4 Synergists and Antagonists
47.4.1
47.5 Patient Report
47.5.1 Patient Complaints
47.5.1.1
47.5.2 Pain Relief
47.5.2.1
47.6 Activation and Perpetuation of Trigger Points
47.6.1 Activation
47.6.1.1
47.6.2 Perpetuation
47.6.2.1
47.7 Patient Examination
47.7.1 Examination for Involvement
47.7.1.1 Physical Examination
47.7.1.1.1
47.7.2 Differential Diagnosis
47.7.2.1
47.8 Trigger Point Examination
47.8.1
47.9 Associated Trigger Points
47.9.1
47.10 Corrective Actions
47.10.1
48 PERONEUS BREVIS, PERONEUS LONGUS, & PERONEUS TERTIUS
Back Table of Contents References
48.1 Illustration Notes
48.1.1
48.2 Illustration
48.2.1 Peroneus Brevis Longus Tertius
48.3 Location
48.3.1 Peroneus Longus
48.3.1.1 Located 2-4 cm (approximately an inch or slightly more) distal to the head of the fibula over the shaft of the fibula.
48.3.1.2 Taut bands at this TP location are clearly delineated by palpation against the underling bone. This firm foundation makes it easy to elicit a local twitch response (LTR) in the peroneus longus muscle by snapping palpation.
48.3.1.3 The transient twitch causes the foot to swing outward and down.
48.3.1.4 The common peroneal nerve crosses diagonally over the neck of the fibula just below the fibular head and has a cordlike consistency. The nerve is distinguished from a taut band by its proximal position and a course running across the muscle rather than running the length of the muscle nearly parallel to the shaft of the fibula. Excessive pressure on the nerve may cause painful tingling sensations over the lateral side of the leg and the foot.
48.3.1.5 This location of peroneus longus TPs corresponds to the location where Lange found myogelosis of the peroneal muscles.
48.3.2 Peroneus Brevis
48.3.2.1 Located on either side of, and deep to, the peroneus longus tendon near the junction of the middle and lower thirds of the leg.
48.3.2.2 These TPs also are palpable against the shaft of the fibula.
48.3.2.3 Obvious LTRs are more difficult to elicit from this muscle than from the peroneus longus, but the visible response of the foot is essentially the same.
48.3.3 Peroneus Tertius
48.3.3.1 Located slightly distal and anterior to the peroneus brevis TPs and proximal and anterior to the lateral malleolus.
48.3.3.2 The tendon of this muscle stands out and is readily palpable in the anterolateral aspect of the ankle and foot (lateral to the extensor digitorum longus tendons) when the seated patient attempts to evert the foot by lifting the fifth metatarsal from the floor.
48.4 Pain Referral
48.4.1 Peroneus Longus & Brevis
48.4.1.1 Behind and distal to lateral malleolus of the ankle, above, behind, and below it with referred tenderness
48.4.1.2 Pain also extends a short distance along the lateral aspect of the foot.
48.4.1.3 Jacobsen[1] reported a pain pattern referred from peroneus longus and peroneus brevis TPs as going around the back of the lateral malleolus. Bates and Grunwaldt[2] reported that, in children, the referred pain pattern of the peroneus longus muscle also concentrates behind the lateral malleolus, but tends to extend up the side of the leg rather than along the side of the foot. Good[3] attributed the symptoms in 15 of 100 patients with painful feet to myalgic spots in the peroneus brevis muscle. Kellgren[4] reported that the injection of 6% hypertonic saline solution into the peroneus longus muscle evoked pain referred to the ankle.
48.4.2 Peroneus Longus
48.4.2.1 A spill over pattern of the peroneus longus TPs may cover the lateral aspect of the middle third of the leg.
48.4.3 Peroneus Brevis
48.4.3.1
48.4.4 Peroneus Tertius
48.4.4.1 Refers pain and tenderness along the anterolateral aspect of the ankle
48.4.4.2 Spill over pattern projects downward behind the lateral malleolus to the lateral aspect of the heel.
48.5 Synergists and Antagonists
48.5.1
48.6 Patient Report
48.6.1 Patient Complaints
48.6.1.1
48.6.2 Pain Relief
48.6.2.1
48.7 Activation and Perpetuation of Trigger Points
48.7.1 Activation
48.7.1.1
48.7.2 Perpetuation
48.7.2.1
48.8 Patient Examination
48.8.1 Examination for Involvement
48.8.1.1 Physical Examination
48.8.1.1.1
48.8.2 Differential Diagnosis
48.8.2.1
48.9 Trigger Point Examination
48.9.1
48.10 Associated Trigger Points
48.10.1
48.11 Corrective Actions
48.11.1
49 PIRIFORMIS, GEMELLI, QUADRATUS FEMORIS, OBTURATOR INTERNUM, & OBTURATOR EXTERNUS
Back Table of Contents References
49.1 Illustration Notes
49.1.1
49.2 Illustration
49.2.1 INTERTRANSVERSARII
49.3 Pain Referral
49.3.1
49.4 Synergists and Antagonists
49.4.1
49.5 Patient Report
49.5.1 Patient Complaints
49.5.1.1
49.5.2 Pain Relief
49.5.2.1
49.6 Activation and Perpetuation of Trigger Points
49.6.1 Activation
49.6.1.1
49.6.2 Perpetuation
49.6.2.1
49.7 Patient Examination
49.7.1 Examination for Involvement
49.7.1.1 Physical Examination
49.7.1.1.1
49.7.2 Differential Diagnosis
49.7.2.1
49.8 Trigger Point Examination
49.8.1
49.9 Associated Trigger Points
49.9.1
49.10 Corrective Actions
49.10.1
50 PLANTARIS
Back Table of Contents References
50.1 Illustration Notes
50.1.1
50.2 Illustration
50.2.1 Plantaris
50.3 Location
50.3.1 Taut bands in the Plantaris muscle are not likely to be palpable and the spot tenderness of its TPs is difficult to identify because of the overlying thick lateral head of the gastrocnemius muscle, which also may have TPs.
50.4 Pain Referral
50.4.1 Trigger points in the Plantaris muscle refer pain behind the knee and downward over the calf as far as the mid leg level. In some patients, a TP in the vicinity of the Plantaris refers pain to the ball of the foot and base of the big toe.
50.4.2 However, it is not clear whether this pain arises from TPs in the Plantaris muscle or in the fibers of the lateral head of the gastrocnemius.
50.5 Synergists and Antagonists
50.5.1
50.6 Patient Report
50.6.1 Patient Complaints
50.6.1.1
50.6.2 Pain Relief
50.6.2.1
50.7 Activation and Perpetuation of Trigger Points
50.7.1 Activation
50.7.1.1
50.7.2 Perpetuation
50.7.2.1
50.8 Patient Examination
50.8.1 Examination for Involvement
50.8.1.1 Physical Examination
50.8.1.1.1
50.8.2 Differential Diagnosis
50.8.2.1
50.9 Trigger Point Examination
50.9.1
50.10 Associated Trigger Points
50.10.1
50.11 Corrective Actions
50.11.1
51 POPLITEUS
Back Table of Contents References
51.1 Illustration Notes
51.1.1
51.2 Illustration
51.2.1 INTERTRANSVERSARII
51.3 Pain Referral
51.3.1
51.4 Synergists and Antagonists
51.4.1
51.5 Patient Report
51.5.1 Patient Complaints
51.5.1.1
51.5.2 Pain Relief
51.5.2.1
51.6 Activation and Perpetuation of Trigger Points
51.6.1 Activation
51.6.1.1
51.6.2 Perpetuation
51.6.2.1
51.7 Patient Examination
51.7.1 Examination for Involvement
51.7.1.1 Physical Examination
51.7.1.1.1
51.7.2 Differential Diagnosis
51.7.2.1
51.8 Trigger Point Examination
51.8.1
51.9 Associated Trigger Points
51.9.1
51.10 Corrective Actions
51.10.1
52 QUADRATUS FEMORIS
Back Table of Contents References
52.1 Illustration Notes
52.1.1
52.2 Illustration
52.2.1 INTERTRANSVERSARII
52.3 Pain Referral
52.3.1
52.4 Synergists and Antagonists
52.4.1
52.5 Patient Report
52.5.1 Patient Complaints
52.5.1.1
52.5.2 Pain Relief
52.5.2.1
52.6 Activation and Perpetuation of Trigger Points
52.6.1 Activation
52.6.1.1
52.6.2 Perpetuation
52.6.2.1
52.7 Patient Examination
52.7.1 Examination for Involvement
52.7.1.1 Physical Examination
52.7.1.1.1
52.7.2 Differential Diagnosis
52.7.2.1
52.8 Trigger Point Examination
52.8.1
52.9 Associated Trigger Points
52.9.1
52.10 Corrective Actions
52.10.1
53 QUADRATUS LUMBORUM
Back Table of Contents References
53.1 Illustration Notes
53.1.1
53.2 Illustration
53.2.1 INTERTRANSVERSARII
53.3 Pain Referral
53.3.1
53.4 Synergists and Antagonists
53.4.1
53.5 Patient Report
53.5.1 Patient Complaints
53.5.1.1
53.5.2 Pain Relief
53.5.2.1
53.6 Activation and Perpetuation of Trigger Points
53.6.1 Activation
53.6.1.1
53.6.2 Perpetuation
53.6.2.1
53.7 Patient Examination
53.7.1 Examination for Involvement
53.7.1.1 Physical Examination
53.7.1.1.1
53.7.2 Differential Diagnosis
53.7.2.1
53.8 Trigger Point Examination
53.8.1
53.9 Associated Trigger Points
53.9.1
53.10 Corrective Actions
53.10.1
54 QUADRATUS PLANTAE
Back Table of Contents References
54.1 Illustration Notes
54.1.1
54.2 Illustration
54.2.1 Quadratus Plantae
54.3 Location
54.3.1 Located just distal to the anterior aspect of the calcaneus.
54.3.2 Use deep palpation and exert sufficient pressure to penetrate deep to the plantar aponeurosis with the toes slightly extended. Spot tenderness is usually clearly definable, but one should not expect to feel a taut band in this muscle.
54.4 Pain Referral
54.4.1 Refers pain and tenderness only to the plantar surface of the heel.
54.5 Synergists and Antagonists
54.5.1
54.6 Patient Report
54.6.1 Patient Complaints
54.6.1.1
54.6.2 Pain Relief
54.6.2.1
54.7 Activation and Perpetuation of Trigger Points
54.7.1 Activation
54.7.1.1
54.7.2 Perpetuation
54.7.2.1
54.8 Patient Examination
54.8.1 Examination for Involvement
54.8.1.1 Physical Examination
54.8.1.1.1
54.8.2 Differential Diagnosis
54.8.2.1
54.9 Trigger Point Examination
54.9.1
54.10 Associated Trigger Points
54.10.1
54.11 Corrective Actions
54.11.1
55 RECTUS ABDOMINIS & PYRAMIDALIS
Back Table of Contents References
55.1 Illustration Notes
55.1.1
55.2 Illustration
55.2.1 INTERTRANSVERSARII
55.3 Pain Referral
55.3.1
55.4 Synergists and Antagonists
55.4.1
55.5 Patient Report
55.5.1 Patient Complaints
55.5.1.1
55.5.2 Pain Relief
55.5.2.1
55.6 Activation and Perpetuation of Trigger Points
55.6.1 Activation
55.6.1.1
55.6.2 Perpetuation
55.6.2.1
55.7 Patient Examination
55.7.1 Examination for Involvement
55.7.1.1 Physical Examination
55.7.1.1.1
55.7.2 Differential Diagnosis
55.7.2.1
55.8 Trigger Point Examination
55.8.1
55.9 Associated Trigger Points
55.9.1
55.10 Corrective Actions
55.10.1
56 RECTUS CAPITIS POSTERIOR MAJOR, RECTUS CAPITIS POSTERIOR MINOR, OBLIQUUS CAPITIS INFERIOR, & OBLIQUUS CAPITIS SUPERIOR
Back Table of Contents References
56.1 Illustration Notes
56.1.1
56.2 Illustration
56.2.1 INTERTRANSVERSARII
56.3 Pain Referral
56.3.1
56.4 Synergists and Antagonists
56.4.1
56.5 Patient Report
56.5.1 Patient Complaints
56.5.1.1
56.5.2 Pain Relief
56.5.2.1
56.6 Activation and Perpetuation of Trigger Points
56.6.1 Activation
56.6.1.1
56.6.2 Perpetuation
56.6.2.1
56.7 Patient Examination
56.7.1 Examination for Involvement
56.7.1.1 Physical Examination
56.7.1.1.1
56.7.2 Differential Diagnosis
56.7.2.1
56.8 Trigger Point Examination
56.8.1
56.9 Associated Trigger Points
56.9.1
56.10 Corrective Actions
56.10.1
57 RHOMBOID MAJOR, & RHOMBOID MINOR
Back Table of Contents References
57.1 Illustration Notes
57.1.1
57.2 Illustration
57.2.1 INTERTRANSVERSARII
57.3 Pain Referral
57.3.1
57.4 Synergists and Antagonists
57.4.1
57.5 Patient Report
57.5.1 Patient Complaints
57.5.1.1
57.5.2 Pain Relief
57.5.2.1
57.6 Activation and Perpetuation of Trigger Points
57.6.1 Activation
57.6.1.1
57.6.2 Perpetuation
57.6.2.1
57.7 Patient Examination
57.7.1 Examination for Involvement
57.7.1.1 Physical Examination
57.7.1.1.1
57.7.2 Differential Diagnosis
57.7.2.1
57.8 Trigger Point Examination
57.8.1
57.9 Associated Trigger Points
57.9.1
57.10 Corrective Actions
57.10.1
58 SARTORIUS
Back Table of Contents References
58.1 Illustration Notes
58.1.1
58.2 Illustration
58.2.1 INTERTRANSVERSARII
58.3 Pain Referral
58.3.1
58.4 Synergists and Antagonists
58.4.1
58.5 Patient Report
58.5.1 Patient Complaints
58.5.1.1
58.5.2 Pain Relief
58.5.2.1
58.6 Activation and Perpetuation of Trigger Points
58.6.1 Activation
58.6.1.1
58.6.2 Perpetuation
58.6.2.1
58.7 Patient Examination
58.7.1 Examination for Involvement
58.7.1.1 Physical Examination
58.7.1.1.1
58.7.2 Differential Diagnosis
58.7.2.1
58.8 Trigger Point Examination
58.8.1
58.9 Associated Trigger Points
58.9.1
58.10 Corrective Actions
58.10.1
59 SCALENUS ANTERIOR, SCALENUS MEDIUS, & SCALENUS POSTERIOR
Back Table of Contents References
59.1 Illustration Notes
59.1.1
59.2 Illustration
59.2.1 INTERTRANSVERSARII
59.3 Pain Referral
59.3.1
59.4 Synergists and Antagonists
59.4.1
59.5 Patient Report
59.5.1 Patient Complaints
59.5.1.1
59.5.2 Pain Relief
59.5.2.1
59.6 Activation and Perpetuation of Trigger Points
59.6.1 Activation
59.6.1.1
59.6.2 Perpetuation
59.6.2.1
59.7 Patient Examination
59.7.1 Examination for Involvement
59.7.1.1 Physical Examination
59.7.1.1.1
59.7.2 Differential Diagnosis
59.7.2.1
59.8 Trigger Point Examination
59.8.1
59.9 Associated Trigger Points
59.9.1
59.10 Corrective Actions
59.10.1
60 SERRATUS ANTERIOR
Back Table of Contents References
60.1 Illustration Notes
60.1.1
60.2 Illustration
60.2.1 INTERTRANSVERSARII
60.3 Pain Referral
60.3.1
60.4 Synergists and Antagonists
60.4.1
60.5 Patient Report
60.5.1 Patient Complaints
60.5.1.1
60.5.2 Pain Relief
60.5.2.1
60.6 Activation and Perpetuation of Trigger Points
60.6.1 Activation
60.6.1.1
60.6.2 Perpetuation
60.6.2.1
60.7 Patient Examination
60.7.1 Examination for Involvement
60.7.1.1 Physical Examination
60.7.1.1.1
60.7.2 Differential Diagnosis
60.7.2.1
60.8 Trigger Point Examination
60.8.1
60.9 Associated Trigger Points
60.9.1
60.10 Corrective Actions
60.10.1
61 SERRATUS POSTERIOR INFERIOR
Back Table of Contents References
61.1 Illustration Notes
61.1.1
61.2 Illustration
61.2.1 INTERTRANSVERSARII
61.3 Pain Referral
61.3.1
61.4 Synergists and Antagonists
61.4.1
61.5 Patient Report
61.5.1 Patient Complaints
61.5.1.1
61.5.2 Pain Relief
61.5.2.1
61.6 Activation and Perpetuation of Trigger Points
61.6.1 Activation
61.6.1.1
61.6.2 Perpetuation
61.6.2.1
61.7 Patient Examination
61.7.1 Examination for Involvement
61.7.1.1 Physical Examination
61.7.1.1.1
61.7.2 Differential Diagnosis
61.7.2.1
61.8 Trigger Point Examination
61.8.1
61.9 Associated Trigger Points
61.9.1
61.10 Corrective Actions
61.10.1
62 SERRATUS POSTERIOR SUPERIOR
Back Table of Contents References
62.1 Illustration Notes
62.1.1
62.2 Illustration
62.2.1 INTERTRANSVERSARII
62.3 Pain Referral
62.3.1
62.4 Synergists and Antagonists
62.4.1
62.5 Patient Report
62.5.1 Patient Complaints
62.5.1.1
62.5.2 Pain Relief
62.5.2.1
62.6 Activation and Perpetuation of Trigger Points
62.6.1 Activation
62.6.1.1
62.6.2 Perpetuation
62.6.2.1
62.7 Patient Examination
62.7.1 Examination for Involvement
62.7.1.1 Physical Examination
62.7.1.1.1
62.7.2 Differential Diagnosis
62.7.2.1
62.8 Trigger Point Examination
62.8.1
62.9 Associated Trigger Points
62.9.1
62.10 Corrective Actions
62.10.1
63 SOLEUS
Back
Table of Contents References
63.1 Illustration Notes
63.1.1
63.2 Illustration
63.2.1 SOLEUS
63.3 Location
63.3.1 TP1
63.3.1.1 3 cm (11/4 inches) below the end of the bulge that marks the lower border of the gastrocnemius fibers, slightly medial to the midline, or about 14 cm (51/2 inches) above the heel.
63.3.2 TP2
63.3.2.1 High on the lateral side of the calf.
63.3.3 TP3
63.3.3.1 Proximal and lateral to TP1 close to the lower end of the gastrocnemius fibers.
63.4 Pain Referral
63.4.1 TP1
63.4.1.1 Posterior aspect and plantar surface of the heel
63.4.1.2 Distal end of the Achilles tendon
63.4.1.3 Spill over pain in the region of the trigger point and slightly forward from the heel in the instep
63.4.2 TP2
63.4.2.1 Diffuse pain in the upper half of the calf
63.4.3 TP3
63.4.3.1 Deep pain in the ipsilateral sacroiliac joint in an area about 2.5 cm (1 inch) in diameter
63.4.3.2 Less intense spill over pain in the region of the TP itself and over the posterior and plantar surfaces of the heel, mimicking the pattern of TP1
63.4.3.3 Rarely referred to the jaw
63.5 Synergists and Antagonists
63.5.1
63.6 Patient Report
63.6.1 Patient Complaints
63.6.1.1
63.6.2 Pain Relief
63.6.2.1
63.7 Activation and Perpetuation of Trigger Points
63.7.1 Activation
63.7.1.1
63.7.2 Perpetuation
63.7.2.1
63.8 Patient Examination
63.8.1 Examination for Involvement
63.8.1.1 Physical Examination
63.8.1.1.1
63.8.2 Differential Diagnosis
63.8.2.1
63.9 Trigger Point Examination
63.9.1
63.10 Associated Trigger Points
63.10.1
63.11 Corrective Actions
63.11.1
64 SPLENIUS CAPITIS & SPLENIUS CERVICIS
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Table of Contents References
64.1 Illustration Notes
64.1.1
64.2 Illustration
64.2.1 INTERTRANSVERSARII
64.3 Pain Referral
64.3.1
64.4 Synergists and Antagonists
64.4.1
64.5 Patient Report
64.5.1 Patient Complaints
64.5.1.1
64.5.2 Pain Relief
64.5.2.1
64.6 Activation and Perpetuation of Trigger Points
64.6.1 Activation
64.6.1.1
64.6.2 Perpetuation
64.6.2.1
64.7 Patient Examination
64.7.1 Examination for Involvement
64.7.1.1 Physical Examination
64.7.1.1.1
64.7.2 Differential Diagnosis
64.7.2.1
64.8 Trigger Point Examination
64.8.1
64.9 Associated Trigger Points
64.9.1
64.10 Corrective Actions
64.10.1
65 STERNALIS
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Table of Contents References
65.1 Illustration Notes
65.1.1
65.2 Illustration
65.2.1 INTERTRANSVERSARII
65.3 Pain Referral
65.3.1
65.4 Synergists and Antagonists
65.4.1
65.5 Patient Report
65.5.1 Patient Complaints
65.5.1.1
65.5.2 Pain Relief
65.5.2.1
65.6 Activation and Perpetuation of Trigger Points
65.6.1 Activation
65.6.1.1
65.6.2 Perpetuation
65.6.2.1
65.7 Patient Examination
65.7.1 Examination for Involvement
65.7.1.1 Physical Examination
65.7.1.1.1
65.7.2 Differential Diagnosis
65.7.2.1
65.8 Trigger Point Examination
65.8.1
65.9 Associated Trigger Points
65.9.1
65.10 Corrective Actions
65.10.1
66 STERNOCLEIDOMASTOID
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Table of Contents References
66.1 Illustration Notes
66.1.1
66.2 Illustration
66.2.1 INTERTRANSVERSARII
66.3 Pain Referral
66.3.1
66.4 Synergists and Antagonists
66.4.1
66.5 Patient Report
66.5.1 Patient Complaints
66.5.1.1
66.5.2 Pain Relief
66.5.2.1
66.6 Activation and Perpetuation of Trigger Points
66.6.1 Activation
66.6.1.1
66.6.2 Perpetuation
66.6.2.1
66.7 Patient Examination
66.7.1 Examination for Involvement
66.7.1.1 Physical Examination
66.7.1.1.1
66.7.2 Differential Diagnosis
66.7.2.1
66.8 Trigger Point Examination
66.8.1
66.9 Associated Trigger Points
66.9.1
66.10 Corrective Actions
66.10.1
67 SUBCLAVIUS
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Table of Contents References
67.1 Illustration Notes
67.1.1
67.2 Illustration
67.2.1 INTERTRANSVERSARII
67.3 Pain Referral
67.3.1
67.4 Synergists and Antagonists
67.4.1
67.5 Patient Report
67.5.1 Patient Complaints
67.5.1.1
67.5.2 Pain Relief
67.5.2.1
67.6 Activation and Perpetuation of Trigger Points
67.6.1 Activation
67.6.1.1
67.6.2 Perpetuation
67.6.2.1
67.7 Patient Examination
67.7.1 Examination for Involvement
67.7.1.1 Physical Examination
67.7.1.1.1
67.7.2 Differential Diagnosis
67.7.2.1
67.8 Trigger Point Examination
67.8.1
67.9 Associated Trigger Points
67.9.1
67.10 Corrective Actions
67.10.1
68 SUBSCAPULARIS
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Table of Contents References
68.1 Illustration Notes
68.1.1
68.2 Illustration
68.2.1 INTERTRANSVERSARII
68.3 Pain Referral
68.3.1
68.4 Synergists and Antagonists
68.4.1
68.5 Patient Report
68.5.1 Patient Complaints
68.5.1.1
68.5.2 Pain Relief
68.5.2.1
68.6 Activation and Perpetuation of Trigger Points
68.6.1 Activation
68.6.1.1
68.6.2 Perpetuation
68.6.2.1
68.7 Patient Examination
68.7.1 Examination for Involvement
68.7.1.1 Physical Examination
68.7.1.1.1
68.7.2 Differential Diagnosis
68.7.2.1
68.8 Trigger Point Examination
68.8.1
68.9 Associated Trigger Points
68.9.1
68.10 Corrective Actions
68.10.1
69 SUPINATOR
Back
Table of Contents References
69.1 Illustration Notes
69.1.1
69.2 Illustration
69.2.1 INTERTRANSVERSARII
69.3 Pain Referral
69.3.1
69.4 Synergists and Antagonists
69.4.1
69.5 Patient Report
69.5.1 Patient Complaints
69.5.1.1
69.5.2 Pain Relief
69.5.2.1
69.6 Activation and Perpetuation of Trigger Points
69.6.1 Activation
69.6.1.1
69.6.2 Perpetuation
69.6.2.1
69.7 Patient Examination
69.7.1 Examination for Involvement
69.7.1.1 Physical Examination
69.7.1.1.1
69.7.2 Differential Diagnosis
69.7.2.1
69.8 Trigger Point Examination
69.8.1
69.9 Associated Trigger Points
69.9.1
69.10 Corrective Actions
69.10.1
70 SUPRASPINATUS
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Table of Contents References
70.1 Illustration Notes
70.1.1
70.2 Illustration
70.2.1 INTERTRANSVERSARII
70.3 Pain Referral
70.3.1
70.4 Synergists and Antagonists
70.4.1
70.5 Patient Report
70.5.1 Patient Complaints
70.5.1.1
70.5.2 Pain Relief
70.5.2.1
70.6 Activation and Perpetuation of Trigger Points
70.6.1 Activation
70.6.1.1
70.6.2 Perpetuation
70.6.2.1
70.7 Patient Examination
70.7.1 Examination for Involvement
70.7.1.1 Physical Examination
70.7.1.1.1
70.7.2 Differential Diagnosis
70.7.2.1
70.8 Trigger Point Examination
70.8.1
70.9 Associated Trigger Points
70.9.1
70.10 Corrective Actions
70.10.1
71 TEMPORALIS
Back
Table of Contents References
71.1 Illustration Notes
71.1.1
71.2 Illustration
71.2.1 INTERTRANSVERSARII
71.3 Pain Referral
71.3.1
71.4 Synergists and Antagonists
71.4.1
71.5 Patient Report
71.5.1 Patient Complaints
71.5.1.1
71.5.2 Pain Relief
71.5.2.1
71.6 Activation and Perpetuation of Trigger Points
71.6.1 Activation
71.6.1.1
71.6.2 Perpetuation
71.6.2.1
71.7 Patient Examination
71.7.1 Examination for Involvement
71.7.1.1 Physical Examination
71.7.1.1.1
71.7.2 Differential Diagnosis
71.7.2.1
71.8 Trigger Point Examination
71.8.1
71.9 Associated Trigger Points
71.9.1
71.10 Corrective Actions
71.10.1
72 TENSOR FASCIAE LATAE
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Table of Contents References
72.1 Illustration Notes
72.1.1
72.2 Illustration
72.2.1 INTERTRANSVERSARII
72.3 Pain Referral
72.3.1
72.4 Synergists and Antagonists
72.4.1
72.5 Patient Report
72.5.1 Patient Complaints
72.5.1.1
72.5.2 Pain Relief
72.5.2.1
72.6 Activation and Perpetuation of Trigger Points
72.6.1 Activation
72.6.1.1
72.6.2 Perpetuation
72.6.2.1
72.7 Patient Examination
72.7.1 Examination for Involvement
72.7.1.1 Physical Examination
72.7.1.1.1
72.7.2 Differential Diagnosis
72.7.2.1
72.8 Trigger Point Examination
72.8.1
72.9 Associated Trigger Points
72.9.1
72.10 Corrective Actions
72.10.1
73 TERES MAJOR
Back
Table of Contents References
73.1 Illustration Notes
73.1.1
73.2 Illustration
73.2.1 INTERTRANSVERSARII
73.3 Pain Referral
73.3.1
73.4 Synergists and Antagonists
73.4.1
73.5 Patient Report
73.5.1 Patient Complaints
73.5.1.1
73.5.2 Pain Relief
73.5.2.1
73.6 Activation and Perpetuation of Trigger Points
73.6.1 Activation
73.6.1.1
73.6.2 Perpetuation
73.6.2.1
73.7 Patient Examination
73.7.1 Examination for Involvement
73.7.1.1 Physical Examination
73.7.1.1.1
73.7.2 Differential Diagnosis
73.7.2.1
73.8 Trigger Point Examination
73.8.1
73.9 Associated Trigger Points
73.9.1
73.10 Corrective Actions
73.10.1
74 TERES MINOR
Back
Table of Contents References
74.1 Illustration Notes
74.1.1
74.2 Illustration
74.2.1 INTERTRANSVERSARII
74.3 Pain Referral
74.3.1
74.4 Synergists and Antagonists
74.4.1
74.5 Patient Report
74.5.1 Patient Complaints
74.5.1.1
74.5.2 Pain Relief
74.5.2.1
74.6 Activation and Perpetuation of Trigger Points
74.6.1 Activation
74.6.1.1
74.6.2 Perpetuation
74.6.2.1
74.7 Patient Examination
74.7.1 Examination for Involvement
74.7.1.1 Physical Examination
74.7.1.1.1
74.7.2 Differential Diagnosis
74.7.2.1
74.8 Trigger Point Examination
74.8.1
74.9 Associated Trigger Points
74.9.1
74.10 Corrective Actions
74.10.1
75 TIBIALIS ANTERIOR
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Table of Contents References
75.1 Illustration Notes
75.1.1
75.2 Illustration
75.2.1 Tibialis Anterior
75.3 Location
75.3.1 Near the sharp edge of the tibia at approximately the junction of the proximal and middle thirds of the leg.
75.3.2 Sola observed that the TPs were most commonly located in the upper one-third of this muscle, as we have found. Lange pictured myogelosis (tender taut bands (of TPs) as runni8ng vertically through the mid portion of the muscle belly.
75.3.3 Flat palpation reveals taut bands and TP spot tenderness in the muscle mass lateral to the tibia.
75.3.4 The taut bands in this muscle are parallel to the tibia. Snapping transverse palpation at the TP in the taut band evokes a vigorous and highly visible twitch response in this muscle.
75.3.5 This response appears as transient inversion and dorsiflexion of the foot if the foot is free to move.
75.3.6 Digital pressure applied to an active TP will usually evoke or intensify the spontaneous pain referred to the ankle and foot.
75.4 Pain Referral
75.4.1 Refers pain and tenderness to the anteromedial aspect of the ankle and over the dorsal and medial surfaces of the great toe.
75.4.2 Spill over may extend from the TP downward over the shin to the ankle and foot anteromedially.
75.5 Synergists and Antagonists
75.5.1
75.6 Patient Report
75.6.1 Patient Complaints
75.6.1.1
75.6.2 Pain Relief
75.6.2.1
75.7 Activation and Perpetuation of Trigger Points
75.7.1 Activation
75.7.1.1
75.7.2 Perpetuation
75.7.2.1
75.8 Patient Examination
75.8.1 Examination for Involvement
75.8.1.1 Physical Examination
75.8.1.1.1
75.8.2 Differential Diagnosis
75.8.2.1
75.9 Trigger Point Examination
75.9.1
75.10 Associated Trigger Points
75.10.1
75.11 Corrective Actions
75.11.1
76 TIBIALIS POSTERIOR
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Table of Contents References
76.1 Illustration Notes
76.1.1
76.2 Illustration
76.2.1 TIBIALIS POSTERIOR
76.3 Location
76.3.1 TP1
76.3.1.1 Located in the middle 1/3 of the lower leg by pushing the gastrocnemius aside from a lateral or medial direction and applying flat palpation thru the Soleus muscle to the trigger points of the Tibialis posterior
76.4 Pain Referral
76.4.1 TP1
76.4.1.1 Pain concentrates primarily over the Achilles tendon above the heel
76.4.1.2 Spill over pattern that spreads from the TP distally through the mid calf down to the heel and over the entire plantar surface of the foot and toes
76.5 Synergists and Antagonists
76.5.1
76.6 Patient Report
76.6.1 Patient Complaints
76.6.1.1
76.6.2 Pain Relief
76.6.2.1
76.7 Activation and Perpetuation of Trigger Points
76.7.1 Activation
76.7.1.1
76.7.2 Perpetuation
76.7.2.1
76.8 Patient Examination
76.8.1 Examination for Involvement
76.8.1.1 Physical Examination
76.8.1.1.1
76.8.2 Differential Diagnosis
76.8.2.1
76.9 Trigger Point Examination
76.9.1
76.10 Associated Trigger Points
76.10.1
76.11 Corrective Actions
76.11.1
77 TRAPEZIUS LOWER
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Table of Contents References
77.1 Illustration Notes
77.1.1
77.2 Illustration
77.2.1 INTERTRANSVERSARII
77.3 Pain Referral
77.3.1
77.4 Synergists and Antagonists
77.4.1
77.5 Patient Report
77.5.1 Patient Complaints
77.5.1.1
77.5.2 Pain Relief
77.5.2.1
77.6 Activation and Perpetuation of Trigger Points
77.6.1 Activation
77.6.1.1
77.6.2 Perpetuation
77.6.2.1
77.7 Patient Examination
77.7.1 Examination for Involvement
77.7.1.1 Physical Examination
77.7.1.1.1
77.7.2 Differential Diagnosis
77.7.2.1
77.8 Trigger Point Examination
77.8.1
77.9 Associated Trigger Points
77.9.1
77.10 Corrective Actions
77.10.1
78 TRAPEZIUS MIDDLE
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Table of Contents References
78.1 Illustration Notes
78.1.1
78.2 Illustration
78.2.1 INTERTRANSVERSARII
78.3 Pain Referral
78.3.1
78.4 Synergists and Antagonists
78.4.1
78.5 Patient Report
78.5.1 Patient Complaints
78.5.1.1
78.5.2 Pain Relief
78.5.2.1
78.6 Activation and Perpetuation of Trigger Points
78.6.1 Activation
78.6.1.1
78.6.2 Perpetuation
78.6.2.1
78.7 Patient Examination
78.7.1 Examination for Involvement
78.7.1.1 Physical Examination
78.7.1.1.1
78.7.2 Differential Diagnosis
78.7.2.1
78.8 Trigger Point Examination
78.8.1
78.9 Associated Trigger Points
78.9.1
78.10 Corrective Actions
78.10.1
79 TRAPEZIUS UPPER
Back
Table of Contents References
79.1 Illustration Notes
79.1.1
79.2 Illustration
79.2.1 INTERTRANSVERSARII
79.3 Pain Referral
79.3.1
79.4 Synergists and Antagonists
79.4.1
79.5 Patient Report
79.5.1 Patient Complaints
79.5.1.1
79.5.2 Pain Relief
79.5.2.1
79.6 Activation and Perpetuation of Trigger Points
79.6.1 Activation
79.6.1.1
79.6.2 Perpetuation
79.6.2.1
79.7 Patient Examination
79.7.1 Examination for Involvement
79.7.1.1 Physical Examination
79.7.1.1.1
79.7.2 Differential Diagnosis
79.7.2.1
79.8 Trigger Point Examination
79.8.1
79.9 Associated Trigger Points
79.9.1
79.10 Corrective Actions
79.10.1
80 TRICEPS BRACHII
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Table of Contents References
80.1 Illustration Notes
80.1.1
80.2 Illustration
80.2.1 INTERTRANSVERSARII
80.3 Pain Referral
80.3.1
80.4 Synergists and Antagonists
80.4.1
80.5 Patient Report
80.5.1 Patient Complaints
80.5.1.1
80.5.2 Pain Relief
80.5.2.1
80.6 Activation and Perpetuation of Trigger Points
80.6.1 Activation
80.6.1.1
80.6.2 Perpetuation
80.6.2.1
80.7 Patient Examination
80.7.1 Examination for Involvement
80.7.1.1 Physical Examination
80.7.1.1.1
80.7.2 Differential Diagnosis
80.7.2.1
80.8 Trigger Point Examination
80.8.1
80.9 Associated Trigger Points
80.9.1
80.10 Corrective Actions
80.10.1
81 VASTUS INTERMEDIUS (QUADRICEPS FEMORIS)
Back
Table of Contents References
81.1 Illustration Notes
81.1.1
81.2 Illustration
81.2.1 INTERTRANSVERSARII
81.3 Pain Referral
81.3.1
81.4 Synergists and Antagonists
81.4.1
81.5 Patient Report
81.5.1 Patient Complaints
81.5.1.1
81.5.2 Pain Relief
81.5.2.1
81.6 Activation and Perpetuation of Trigger Points
81.6.1 Activation
81.6.1.1
81.6.2 Perpetuation
81.6.2.1
81.7 Patient Examination
81.7.1 Examination for Involvement
81.7.1.1 Physical Examination
81.7.1.1.1
81.7.2 Differential Diagnosis
81.7.2.1
81.8 Trigger Point Examination
81.8.1
81.9 Associated Trigger Points
81.9.1
81.10 Corrective Actions
81.10.1
82 VASTUS LATERALIS (QUADRICEPS FEMORIS)
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Table of Contents References
82.1 Illustration Notes
82.1.1
82.2 Illustration
82.2.1 INTERTRANSVERSARII
82.3 Pain Referral
82.3.1
82.4 Synergists and Antagonists
82.4.1
82.5 Patient Report
82.5.1 Patient Complaints
82.5.1.1
82.5.2 Pain Relief
82.5.2.1
82.6 Activation and Perpetuation of Trigger Points
82.6.1 Activation
82.6.1.1
82.6.2 Perpetuation
82.6.2.1
82.7 Patient Examination
82.7.1 Examination for Involvement
82.7.1.1 Physical Examination
82.7.1.1.1
82.7.2 Differential Diagnosis
82.7.2.1
82.8 Trigger Point Examination
82.8.1
82.9 Associated Trigger Points
82.9.1
82.10 Corrective Actions
82.10.1
83 VASTUS MEDIALIS (QUADRICEPS FEMORIS)
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Table of Contents References
83.1 Illustration Notes
83.1.1
83.2 Illustration
83.2.1 INTERTRANSVERSARII
83.3 Pain Referral
83.3.1
83.4 Synergists and Antagonists
83.4.1
83.5 Patient Report
83.5.1 Patient Complaints
83.5.1.1
83.5.2 Pain Relief
83.5.2.1
83.6 Activation and Perpetuation of Trigger Points
83.6.1 Activation
83.6.1.1
83.6.2 Perpetuation
83.6.2.1
83.7 Patient Examination
83.7.1 Examination for Involvement
83.7.1.1 Physical Examination
83.7.1.1.1
83.7.2 Differential Diagnosis
83.7.2.1
83.8 Trigger Point Examination
83.8.1
83.9 Associated Trigger Points
83.9.1
83.10 Corrective Actions
83.10.1
84 FIBULAR COLLATERAL LIGAMENT
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Table of Contents References
84.1 Illustration Notes
84.1.1
84.2 Illustration
84.2.1 INTERTRANSVERSARII
84.3 Pain Referral
84.3.1
84.4 Synergists and Antagonists
84.4.1
84.5 Patient Report
84.5.1 Patient Complaints
84.5.1.1
84.5.2 Pain Relief
84.5.2.1
84.6 Activation and Perpetuation of Trigger Points
84.6.1 Activation
84.6.1.1
84.6.2 Perpetuation
84.6.2.1
84.7 Patient Examination
84.7.1 Examination for Involvement
84.7.1.1 Physical Examination
84.7.1.1.1
84.7.2 Differential Diagnosis
84.7.2.1
84.8 Trigger Point Examination
84.8.1
84.9 Associated Trigger Points
84.9.1
84.10 Corrective Actions
84.10.1
85 KEEPING THIS SPACE WARM
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Table of Contents References
85.1 Illustration Notes
85.1.1
85.2 Illustration
85.2.1 INTERTRANSVERSARII
85.3 Pain Referral
85.3.1
85.4 Synergists and Antagonists
85.4.1
85.5 Patient Report
85.5.1 Patient Complaints
85.5.1.1
85.5.2 Pain Relief
85.5.2.1
85.6 Activation and Perpetuation of Trigger Points
85.6.1 Activation
85.6.1.1
85.6.2 Perpetuation
85.6.2.1
85.7 Patient Examination
85.7.1 Examination for Involvement
85.7.1.1 Physical Examination
85.7.1.1.1
85.7.2 Differential Diagnosis
85.7.2.1
85.8 Trigger Point Examination
85.8.1
85.9 Associated Trigger Points
85.9.1
85.10 Corrective Actions
85.10.1