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Titletrigger point therapy book
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Table of Contents
                            TRIGGER POINT THERAPY BOOK
MYOFASCIAL SYNDROMES
	DIAGNOSIS
	Myofascial Physical Examination
	DIFFERENTIAL DIAGNOSIS
	TREATMENT
	Description of the myofascial syndromes
	
	http://www.geocities.com/alexandr_semikin/muscles/myofasci.htm
	DIGASTRICUS
	
	SPLENIUS
	
	SEMISPINALIS; MULTIFUNDI; ROTATORES
	
	RECTUS CAPITIS POSTERIOR MAJOR & MINOR; OBLIQUUS CAPITIS SUPERIOR & INFERIOR
	
	LEVATOR SCAPULE
	
	SCALENUS
	
	SUPRASPINATUS
	INFRASPINATUS
	
	TERES MINOR
	
	LATISSIMUS DORSI
	TERES MAJOR
	
	SUBSCAPULARIS
	
	RHOMBOIDEUS MAJOR & MINOR
	
	DELTOIDEUS
	CORACOBRACHIALIS
	
	BICEPS BRACHII
	
	BRACHIALIS
	
	TRICEPS BRACHII
	
	ANCONEUS
	
	EXTENSORES CARPI
	EXTENSOR CARPI RADIALIS LONGUS, BREVIS
	
	EXTENSOR CARPI ULNARIS
	
	BRACHIORADIALIS
	
	EXTENSOR DIGITORUM
	
	SUPINATOR
	
	PALMARIS LONGUS
	
	FLEXOR CARPI RADIALIS
	
	FLEXOR CARPI ULNARIS
	
	FLEXOR DIGITORUM SUPERFICIALIS
	
	FLEXOR DIGITORUM PROFUNDUS
	
	FLEXOR POLICIS LONGUS
	
	PRONATOR TERES
	
	ADDUCTOR POLICIS
	
	OPPONENS POLICIS
	
	INTEROSSEI
	
	PECTORALIS MAJOR
	
	SUBCLAVIUS
	
	STERNALIS
	
	SERRATUS SUPERIOR POSTERIOR
	
	SERRATUS ANTERIOR
	
	SERRATUS INFERIOR POSTERIOR
	
	ILIOCOSTALIS
	
	SEMISPINALIS, MULTIFUNDI, ROTATORES
	
	OBLIQUUS ABDOMINIS
	
	TRANSVERSUS ABDOMINIS
	
	RECTUS ABDOMINIS
	
	PYRAMIDALIS
	
	QUADRATUS LUMBORUM
	
	ILIOPSOAS
	
	PELVIC FLOOR MUSCLES
	
	GLUTEUS MAXIMUS
	
	GLUTEUS MEDIUS
	
	GLUTEUS MINIMUS
	
	SHORT LATERAL ROTATORS
	
	TENSOR FASCIAE LATAE SARTORIUS
	
	PECTINEUS
	
	RECTUS FEMORIS
	
	VASTUS MEDIALIS
	
	VASTUS LATERALIS
	
	ADDUCTOR
	
	HAMSTRING MUSCLES
	
	POPLITEUS
	
	TIBIALIS ANTERIOR
	
	PERONEAL MUSCLES
	
	GASTROCNEMIUS
	SOLEUS PLANTARIS
	TIBIALIS POSTERIOR
	
	LONG EXTENSORS OF TOES
	
	LONG FLEXOR MUSCLES OF TOES
	SUPERFICIAL INTRINSIC FOOT MUSCLES
	
	DEEP INTRINSIC FOOT MUSCLES
                        
Document Text Contents
Page 1

1

TRIGGER POINT THERAPY
BOOK

MYOFASCIAL SYNDROMES
DIAGNOSIS
Patients with chronic myofascial pain are people who have suffered more than just pain for many months or longer. The severity and
chronicity of their "untreatable" pain has often reduced their physical activity, limited participation in social activities, impaired sleep,
induced a major or minor degree of depression, caused loss of role in the family, led to loss of employment, and deprived them of control
of their lives. Many have been depersonalized by the ultimate indignity-the conviction that their pain is not "real," but psychogenic. Well-
meaning practitioners sometimes have also convinced the patients' families and friends that the pain is not real, leaving many patients
nowhere to turn for help. The patients come to the clinician seeking relief from their suffering, which they may present only in terms of
pain.
When examining the patient who has presented with chronic enigmatic pain, the diagnostician must first conduct a thorough, time-
consuming history and physical examination to identify what conditions are contributing to the patient's pain and to determine whether
there is a significant myofascial component. If it appears likely that the patient does have chronic myofascial pain syndrome, the
diagnostic task becomes twofold. In addition to identifying which TrPs, in which muscles, are causing what portion of the patient's total
pain complaint, the examiner must determine what perpetuating factors converted the initial acute myofascial pain syndrome to a chronic
one. Myofascial TrPs may be perpetuated by mechanical (structural or postural) factors, by systemic factors, by associated medical
conditions, and by psychological stress.
The central nervous system powerfully modulates pain input from the muscles in ways that can explain referred pain and altered
sensation from TrPs. In phase 1 (constant pain from severely active TrPs), patients may already have such intense pain that they do not
perceive an increase and cannot distinguish what makes it worse. Phase 2 (pain from less irritable TrPs that is perceived only on
movement and not at rest) is ideal for educating the patient as to which muscles and movements are responsible for the pain, and how to
manage it. In phase 3 (latent TrPs that are causing no pain), the patient still has some residual dysfunction and is vulnerable to reactivation
of the latent TrPs.
Myofascial Physical Examination
Specific myofascial examination of the muscles is undertaken following a complete general physical examination.
When searching for active TrPs that are responsible for the patient's pain, it is essential to know the precise location of the pain and to
know which specific muscles can refer pain to that location. Muscles that could be causing the pain are tested for restriction of passive
stretch range of motion and for pain at the shortened end of active range of motion, as compared with uninvolved contralateral muscles.
Suspected muscles are also tested for mild to moderate weakness either by conventional isometric strength testing or during a lengthening
contraction. Such weakness is not associated with atrophy of the muscle.
The muscles showing abnormalities in these tests are the ones most likely to have the taut bands and spot tenderness of the TrP. The taut
bands are located by palpation and then tested for a local twitch response and reproduction of the patient's pain complaint by digital
pressure on the TrP. One must try to distinguish active TrPs from latent ones, which can also respond positively to the tests described but
are not responsible for a pain complaint. Active TrPs are more irritable than latent TrPs and show greater responses on examination. If
inactivation of the suspected TrP does not relieve the pain, it may either have been a latent TrP or it may not have been the only active TrP
referring pain to that area.
Examination for mechanical perpetuating factors requires careful observation of the patient's postures, body symmetry, and movement
patterns. Common mechanical factors that can influence many muscles are the round-shouldered, head-forward posture with loss of
normal lumbar lordosis, and body asymmetries including a lower limb-length inequality and a small hemi-pelvis. Tightness of the
iliopsoas and hamstring muscles can also seriously disrupt balanced posture.
DIFFERENTIAL DIAGNOSIS
Two variants of myofascial pain syndromes should be recognized: the myofascial pain modulation disorder, which leads to diagnostic
confusion, and the post-traumatic hyperirritability syndrome, which complicates management. In addition, either fibromyalgia or articular
dysfunction can confusingly mimic a chronic myofascial pain syndrome. Each requires an additional specific examination technique and
its own treatment approach.
Myofascial Pain Modulation Disorder
It appears that the aberrant referral patterns are caused by a distortion of sensory modulation in the central nervous system. Many of these
patients had previously experienced trauma or painful impact at the focus of pain, but often not of such severity that it would be expected
to cause structural damage to the central nervous system. The mechanism behind this sensory nervous system dysfunction is not clear, but
possible mechanisms are being explored in current neurosensory research.
Post-traumatic Hyperirritability Syndrome
This syndrome follows a major trauma, such as an automobile accident, a fall, or a severe blow to the body that is apparently sufficient to
injure the sensory modulation mechanisms of the spinal cord or brain stem. The patients have constant pain, which may be exacerbated by
the vibration of a moving vehicle, by the slamming of a door, by a loud noise (a firecracker at close range), by jarring (bumping into
something or being jostled), by mild thumps (a pat on the back), by severe pain (a TrP injection), by prolonged physical activity, and by

Page 42

STERNALIS

Anatomy Reflected pain





42

Page 43

SERRATUS SUPERIOR POSTERIOR
Anatomy Reflected pain


Palpation and massage



43

Page 83

ADDUCTOR HALLUCIS
Anatomy


Function and PIR, home therapy



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Page 84

FLEXOR DIGITI MINIMI BREVIS, INTEROSSEI
Anatomy




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