1.1Myofasial Trigger Point

8/3/2019 1.1Myofasial Trigger Point

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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

12/09/08 2

CARPAL TUNNELSYNDROME

• scalenus

• teres minor

•latissimus dorsi

PAIN WITH

BREATHING• serratus posterior

• serratus anterior

• thoracic paraspinal

HAND & FINGERPROBLEMS

• scalenus

• teres minor

NECK PAIN (BACK)

• trapezius

• levator scapulae

• posterior neckmuscles.

12/09/08 3

FROZEN SHOULDER

• infraspinatus

• supraspinatus• teres major/minor

SIDE & STOMACH PAIN

• serratus anterior

NECK PAIN (SIDE)

• scm

SHOULDER PAIN(BACK)

• trapezius

• teres major/minor

• supraspinatus

12/09/08 4

EAR & JAW PAIN

• Trapezius

• Scm

SINUS, TONGUE,THROAT,

• 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

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

12/09/08 6

HEADACHES & trigger points

• trapezius

• posterior neck muscles

• scm

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

12/09/08 8

12/09/08 9

12/09/08 10

Splenii

Referral

• Top of thehead

• behind theeye

• to the base of

the neck• and along the

side of theneck.

12/09/08 11

12/09/08 12

Posterior cervical muscles

Suboccipital

muscles

Posterior cervical

muscles

multifidus

Semispinalis cervicis

Semispinalis capitus

12/09/08 13

Posterior Neck MuscleLocations and Trigger Points

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

12/09/08 15

Sternocleidomastoid (SCM) Muscle

Location and Trigger Points

12/09/08 16

Sternocleidomastoid

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.

12/09/08 18

Brachialgia & trigger points (Chestpain)

• Scalene muscles

• Serratus posterior superior

• Thoracic paraspinal

•Latissimus dorsi

• Serratus anterior

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.

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

12/09/08 21

Scalenes

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.

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

12/09/08 24

• Superficialparaspinal muscles(iliocostalis &

longissimus).

– Midthoracicmuscles

– Lower thoracicmuscles

12/09/08 25

Deep paraspinal muscles (Rotators,semispinalis and multifidi)

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

12/09/08 27

Latissimus dorsi

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.

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

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.

12/09/08 31

Serratus Anterior

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.

12/09/08 33

Frozen shoulder & trigger points

• Infraspinatus

• Supraspinatus

• Teres major

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.

12/09/08 35

Infraspinatus Muscle Locationand Trigger Points

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

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.

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.

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

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.

12/09/08 41

Supraspinatus

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

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.

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Burning Between the shoulderblades

• Rhomboids

• Levator scapulae

• Middle trapezius

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.

12/09/08 46

Levator scapulae

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.

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.

12/09/08 49

Rhomboids

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.

12/09/08 51

Back pain & trigger points

• Quadratus lumborum

• Multifidus

• Psoas major and minor

• Gluteus medius

• Rectus abdominis

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

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 .

12/09/08 54

Deep paraspinal muscles

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.

12/09/08 56

Iliopsoas (low back, abdomen, groin, pelvicpain)

D i t B i th

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

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.

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.

12/09/08 60

Sciatica & trigger points

• Gluteus minimus

• Piriformis

• Tibialis anterior

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

12/09/08 62

Gluteus Minimus

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.

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

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)

12/09/08 66

Thigh pain (Anterior & lateral)

• Quadriceps femoris

•Hamstring

• Tensor fascia lata

• Adductors

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.

12/09/08 68

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

12/09/08 70

Quadriceps

V t l t li

12/09/08 71

Vastus lateralis

12/09/08 72

Hamstring

• Referred painoccurs in glutealfold and posterior

knee.• Trigger points arelocated at themiddle third of the

muscles.

Hi dd t

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.

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

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

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

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

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

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

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

12/09/08 81

PERONEUS LONGUS, BREVIS AND TERTIUS

Peroneal pain

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

12/09/08 83

GASTROCNEMIUS

Gastrocnemius

12/09/08 84

Gastrocnemius

• Medial arch to the medial calf

• Close to the medial border of the

• Close to the lateral border of the

• Distal to the lateral head of

gastrocnemius.

SOLEUS

12/09/08 85

SOLEUS

Soleus

12/09/08 86

Soleus

• Referral: posteriorplantar heel area andin distal achilles.

• rarely into ipsilateralSI joint

TIBIALIS POSTERIOR

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

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

12/09/08 89

EXTENSOR DIGITORUM LONGUS AND EXTENSORHALLUCIS LONGUS

Long toe flexors

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

12/09/08 91

HALLUCIS LONGUS

Foot pain

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

12/09/08 93

• Intrinsic muscles of foot

• a) EDB &EHB

• b) AbDM• c) AbHB

• d) FDB

12/09/08 94

• Extrinsic musclesof foot

• QP• FHB

• AH

• Interosseii

ABDUCTOR HALLUCIS

12/09/08 95

ABDUCTOR HALLUCIS

EXTENSOR DIGITORUM BREVIS & EXTENSOR HALLUCIS

12/09/08 96

EXTENSOR DIGITORUM BREVIS & EXTENSOR HALLUCISBREVIS

ABDUCTOR DIGITI MINIMI AND FLEXOR DIGITORUM BREVIS

12/09/08 97

QUADRATUS

12/09/08 98

QUADRATUSPLANTAE

ADDUCTOR HALLUCIS AND FLEXOR HALLUCIS

12/09/08 99

ADDUCTOR HALLUCIS AND FLEXOR HALLUCISBREVIS

INTEROSSEI

12/09/08 100

INTEROSSEI

References

12/09/08 101

References

• Myofascial Release – CarolManheim

• Therapeutic exercises formusculoskeletal injuries – PeggyA.Houglum.

Address

12/09/08 102

Address

Physiotherapy college Raipur

Sapre School Campus

Budhapara

Raipur – 495001

Chattisgarh

•Email : rmozhi@gmail.com• Mobile: 09893385522

1.1Myofasial Trigger Point

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