Trigger Point Theory

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Author:
JennieF
ID:
226519
Filename:
Trigger Point Theory
Updated:
2013-07-25 00:45:49
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Trigger Point Massage
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Description:
Trigger Point Final Cards Posterior Hip to Crus
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  1. Gluteus maximus PRZ
    *NOT ON HANDS-ON FINAL*
    • sacrum
    • ischial tuberosity
    • lateral hip
    • deep aching in hip
  2. Gluteus maximus action of muscle
    *NOT ON HANDS-ON FINAL*
    abducts and laterally rotates thrigh; extends to the thigh
  3. Gluteus maximus activating & perpetuating factors
    *NOT ON HANDS-ON FINAL*
    • postural imbalance
    • prolonged sitting (desk jobs, truck drivers etc)
    • injury from fall
    • side sleeping
    • skiing
    • dancers
  4. Gluteus medius PRZ
    *NOT ON HANDS-ON FINAL*
    • low back
    • deep hip px
    • sacrum
    • lateral hip
  5. Gluteus medius activating & perpetuating factors
    *NOT ON HANDS-ON FINAL*
    • prolonged sitting (desk jobs, truck drivers etc.)
    • childbirth
    • horseback riding
    • SI joint misalignment
    • side sleeping
    • injury from fall
    • postural imbalance
  6. Gluteus medius homework
    *NOT ON HANDS-ON FINAL*
    • stretches
    • ice
  7. Gluteus mimimus PRZ
    *ON FINAL*
    • lateral posterior hip
    • lateral thigh
    • lateral gastroc
    • lateral malleolus
  8. Gluteus minimus insertion
    Anterior border of greater trochanter of femer
  9. Gluteus minimus activating & perpetuating factors
    *ON FINAL*
    • prolonged sitting (desk jobs, truck drivers etc.)
    • childbirth
    • horseback riding
    • side sleeping
    • postural imbalance
    • sitting on a fat wallet
  10. True or False
    Minimus does NOT cause knee px
    True
  11. Piriformis PRZ
    *ON FINAL*
    • sacrum
    • medial hamstrings
    • gluteal region
    • greater trochanter
    • rectal pain
  12. Piriformis activating & perpetuating factors
    *ON FINAL*
    • prolonged sitting (desk job, truck drivers etc.)
    • sitting on a fat wallet
    • postural imbalance
    • runners
  13. The sciatic nerve lies between...
    piriformis & superior gemellus
  14. Piriformis homework
    *ON FINAL*
    piriformis stretch (cross one leg over the other, hand through hole, pull towards stretch)
  15. 3 forms of sciatica
    • True sciatica :: nerve root impingement :: feels like lightening bolt down leg
    • Pseudo sciatica :: TrP mimicking true sciatica :: referral px
    • Piriformis Syndrome :: sciatic nerve is pinched between piriformis & superior gemellus :: deep aching px
  16. Hip crepitus
    • two major kinds of hip crepitus
    • 1. at the greater trochanter as the Tensor Fascia Late, Gluteus maximus, and IT band blend together
    • 2. at the lesser trochanter where Iliopsoas inserts. In layman's terms they can be referred to as an outside pop (lateral) and an inside (medial) pop
  17. Hip crepitus cause
    • an outside pop would be the IT band, TFL, Glutes, and Vastus Lateralis
    • an inside pop would be the Iliopsoas muscle flipping over the lesser trochanter of the femur
  18. Iliopsoas PRZ
    • low back px
    • SI joint
    • anterior thight
    • abdominal px
    • *cross-over/reflecting referral px
  19. Iliopsoas Symptoms
    *NOT ON HANDS-ON FINAL*
    • Weak back "throw out back" - probably threw out iliopsoas
    • Increased px when trying to stand upright
    • Irritable bowel syndrome symptoms (can go away with work to muscle)
  20. Iliopsoas activating & perpetuating factors
    *NOT ON HANDS-ON FINAL*
    • prolonged sitting or driving
    • overworking psoas - stair climbing, cycling, hiking
    • postural imbalance
    • improper form when doing sit-ups
    • weak abdominals
    • hang from bar & sit-ups
  21. Iliopsoas homework
    *NOT ON HANDS-ON FINAL*
    • hang leg off side of massage table, hand on other side (for support) and pull up ankle
    • hip flexor stretch :: kneel like you're proposing...
  22. Rectus abdominis PRZ
    *NOT ON HANDS-ON FINAL*
    • midback
    • low back
    • SI joint
    • lower quadrant of muscle
    • below umbilicus
  23. Rectus abdominis symptoms
    *NOT ON HANDS-ON FINAL*
    • pain below umbilicus (deep to umbilicus)
    • Somatovisceral - nausea, vomiting, dysmenorrhea, appendicitis-like px, heartburn
  24. Rectus abdominis activating & perpetuating factors
    *NOT ON HANDS-ON FINAL*
    • postural imbalance (#1 reason)
    • being hit in the abdominal area
    • surgery (the moment oxygen hits inside, it causes scar tissue)
    • emotional stress
    • visceral disease (Crohn's, diverticulitis etc.)
    • straining due to constipation
    • pregnancy
    • overworking (sit-ups, lifting)
    • tight belt around waist
  25. Rectus abdominis homework
    *NOT ON HANDS-ON FINAL*
    Yoga - cobra pose
  26. Rectus abdominis does not refer above the...
    xiphoid process
  27. Quadrant Syndrome
    • tight muscles
    • 4 different areas of abdomen :: upper right, lower right, upper left, lower left
  28. organ --> muscle
    viscero somatic
    • open educing dysfunction in muscle
    • appendicitis - low back px
    • menstrual - anterior pelvic px
    • pregnancy
  29. muscle --> organ
    somatovisceral
    • Abs --> IBS (irritable bowel syndrome)
    • pecs --> asthma, heart attack
    • pregnancy
  30. Quadratus lumorum PRZ
    *ON FINAL*
    • iliac area
    • SI joint
    • ischial tuberosity
    • greater trochanter
    • NO LOCAL REFERRAL
  31. Quadratus lumborum symptoms
    • low back pain (SI joint)
    • loss of ROM (may cause "hip hike"
  32. Quadratus lumborum activating & perpetuating factors
    *ON FINAL*
    • lifting & twisting at the waist (shoveling snow, gardening) #1 way to injure your lower back
    • picking up children
    • lifting and stacking boxes / massage table
    • prolonged sitting with uneven pelvis
    • slipping & falling transfers to lower back
  33. Quadratus lumborum homework
    *ON FINAL*
    • theracane
    • tennisball
    • bend over/touch toes
    • exercise ball "superman"
    • gravity chair
    • arm over head/stretch
    • hydrotherapy - ice pack
  34. Disc Injuries
    • Slow onset
    • Loss of ROM
    • Numbness & tingling
    • Referral Px
  35. Facet Injuries
    • Immediate onset
    • Localized Px (no referral px)
    • Hunched over / not walking up right
  36. Quadriceps (Vastus Lateralis) PRZ
    *ON FINAL*
    • Lateral hip
    • Lateral thigh
    • Lateral knee
  37. Quadriceps (Vastus Lateralis) Symptoms
    *ON FINAL*
    • Loss of patellar movement
    • Los of ROM in knee
  38. Quadriceps (Vastus Lateralis) Activating & Perpetuating Factors
    *ON FINAL*
    • Improper form when working out (squats - too deep)
    • Leg extensions - lateral rotation of foot
    • Postural imbalance - Anterior tilt (short quad, long ham)
    • Sports injuries
    • New workout routine
  39. Quadriceps (Vastus Lateralis) Homework
    *ON FINAL*
    • Work it with a rolling pin (marble rolling pin in freezer = cryotherapy)
    • Pull ankle up - behind (posterior)
  40. Quadriceps (Vastus Medialis) PRZ
    *NOT ON HANDS-ON FINAL*
    Deep medial knee
  41. Quadriceps (Vastus Medialis) Symptoms
    *NOT ON HANDS-ON FINAL*
    • Deep medial knee px
    • Inflammation in medial knee
    • Weakness - knee buckles
  42. Quadriceps (Vastus Medialis) Activating & Perpetuating Factors
    *NOT ON HANDS-ON FINAL*
    • Postural imbalance
    • Sports injuries
    • Pronation of foot
    • New or constant exercise
    • Improper form when working out
  43. Quadriceps (Vastus Medialis) Homework
    *NOT ON HANDS-ON FINAL*
    • Rolling pin
    • Quad stretch
    • Sit, figure 4, take elbow down quad
  44. Quadriceps (Vastus Intermedius) PRZ
    *NOT ON HANDS-ON FINAL*
    • Anterior thigh px
    • Difficulty extending knee
  45. Quadriceps (Vastus Intermedius) Symptoms
    *NOT ON HANDS-ON FINAL*
    • Difficulty with full knee extension
    • Knee px with movement, rarely at rest
    • Deep aching in upper thigh area
  46. Quadriceps (Vastus Intermedius) Activating & Perpetuating Factors
    *NOT ON HANDS-ON FINAL*
    This muscle is rarely the first of the quadriceps femoris to develop TrPs. Vastus Intermedius develops them secondarily as a result of overload from protecting TrPs points in the other quad femoris muscles which are members of the same function unit
  47. Quadriceps (Vastus Intermedius) Homework
    *NOT ON HANDS-ON FINAL*
    • Ice baths (not pleasant, but penetrates)
    • Ice massage
    • Rolling pin
  48. Sartorius PRZ
    *NOT ON HANDS-ON FINAL*
    • Local px
    • Numbness in medial thigh
  49. Sartorius Symptoms
    *NOT ON HANDS-ON FINAL*
    • Px in thigh
    • Superficial medial knee px
    • Numbness down front medial area of thigh
  50. Sartorius Activating & Perpetuating Factors
    *NOT ON FINAL*
    • Overuse (hacky-sack movements)
    • Pronated foot
    • Sitting for prolonged periods with legs crossed square
    • Knee injuries
    • Horseback riding
  51. Satorius Homework
    *NOT ON HANDS-ON FINAL*
    • Ice massage
    • Quad stretch
    • Rolling pin
  52. What are the most common types of knee sprains
    • medial collateral ligament sprain: where the knee is forced medially
    • lateral collateral ligament injuries: where the knee is forced toward pinky toe
    • anterior cruciate ligament (ACL) injuries: #1 most common way to injure ACL - planted foot and violent rotation
    • posterior cruciate and capsular ligament sprains (PCL): where knee is hyperextended, or forced backward (posterior displacement)
  53. The Terrible Triad
    • ACL
    • MCL
    • Medial miniscus
  54. The meniscus serves what purpose
    shock absorber
  55. Iliotibial Band Friction Syndrome (3 stages) *MBLEX
    • Stage 1: IT band syndrome overuse - pulling patella off track
    • Stage 2: Patellofemoral Syndrome - wearing away cartilage of knee
    • Stage 3: Chondromalacia - bone to bone contact, cartilage has completely worn away, causing need for knee replacement
  56. Osgood-Schlatters *MBLEX
    • common in children 10-15 yrs of age
    • more common in males
    • inflammation at the tibial tuberosity
    • usually result of a growth spurt/too fast
    • usually goes away 1-2 yrs after child grows quickly
    • Homework: Ice pack & stretching quads
  57. Hamstrings: Biceps femoris PRZ (local)
    *NOT ON HANDS-ON FINAL*
    • lateral & posterior thigh
    • posterior knee
  58. Hamstrings: Biceps femoris symptoms
    *NOT ON HANDS-ON FINAL*
    • aching and pain in posterior thigh
    • weakness during flexion
    • difficulty fully extending a flexing knee
    • RLS - Restless Leg Syndrome
  59. Hamstrings: Biceps femoris Activating & Perpetuating Factors
    *NOT ON HANDS-ON FINAL*
    • overworking (sports - running, cycling, lifting, squats)
    • prolonged sitting (edge of chair pushing into muscle)
    • postural distortion
  60. Hamstrings: Semitendinosus, Semimebranosus (live together) PRZ
    *NOT ON HANDS-ON FINAL*
    • posterior knee
    • medial/lateral knee
    • medial gastroc
    • ischial tuberosity
  61. Hamstrings: Semitendinosus, Semimebranosus Symptoms
    *NOT ON HANDS-ON FINAL*
    • lower glute aching
    • weakness in hamstrings
    • aching in calf
  62. Hamstrings: Semitendinosus, Semimebranosus Activating & Perpetuating Factors
    *NOT ON HANDS-ON FINAL*
    • overworking (sports - running, cycling, lifting, squats)
    • prolonged sitting (edge of chair pushing into muscle) Anterior/Posterior pelvic tilt
    • postural distortion
  63. Hamstrings: Semitendinosus, Semimebranosus Homework
    *NOT ON HANDS-ON FINAL*
    • Bend over touch toes
    • rolling pin
  64. What are adhesions?
    fascia clumped together
  65. What is a strain?
    musculotendinous injury
  66. Grades (3) of Strains
    • Grade I: muscle tear, soreness, no loss of ROM
    • Grade II: soreness, loss of ROM (noticeable), inflammation, moderate to severe --- DO NOT STRETCH A GRADE II, it will CREATE A GRADE III
    • Grade III: complete rupture
    • complete loss of ROM
    • has to have surgery to re-attach muscle
  67. What is a contusion?
    • a direct blow of some kind causes a deep bruising -- "bone bruise"
    • inflammation
    • can experience px on movement and loss of ROM
    • can occur in a lot of physical contact sports
  68. Postural Distortions:
    Anterior Pelvic Tilt
    Posterior Pelvic Tilt
    • Anterior Pelvic Tilt: lengthen quads, strengthen hamstrings
    • Posterior Pelvic Tilt: lengthen hamstrings, strengthen quads
    • If they have a posterior tilt, DO NOT DO TAPOTEMENT
  69. Tibialis anterior PRZ
    *ON FINAL*
    • anterior crus
    • anterior ankle
    • big toe
  70. Tibialis anterior symptoms
    *ON FINAL*
    • weakness in dorsiflexion
    • dragging foot due to weakness
  71. Tibialis anterior Activating & Perpetuating Factors
    *ON FINAL*
    • uphill & downhill walking
    • walking on uneven terrain - sand
    • wearing shoes without good support
    • sandals - slick surface (grip toes create cramping and shin splint)
  72. Tibialis anterior homework
    * ON FINAL*
    • tennis ball (circular friction)
    • ice massage (immersion - bucket, it is deep penetrating, vasodilation)
  73. Gastronemius PRZ
    *ON FINAL*
    • posterior crus
    • posterior knee
    • medial bottom foot
  74. Gastronemius Symptoms
    *ON FINAL*
    • medial and/or lateral knee px
    • posterior knee px
    • sometimes all at once (above)
    • calf cramps at night (blanket weight) RLS
  75. Gastronemius Activating & Perpetuating Factors
    *ON FINAL*
    • wearing high heels (shortens gastroc)
    • sandals - slick surface
    • dancing
    • sleeping supine with a heavy blanket on foot
    • uneven terrain
  76. Gastronemius Homework
    *ON FINAL*
    • dorsal flex
    • ice pack - immersion
  77. Soleus PRZ
    *NOT ON HANDS-ON FINAL*
    • heel px
    • medial arch px
    • SI joint
  78. Soleus Symptoms
    *NOT ON HANDS-ON FINAL*
    • plantar fascitis
    • Achilles tendonitis
  79. Soleus Activating & Perpetuating Factors
    *NOT ON HANDS-ON FINAL*
    • climbing/hiking, sports
    • wearing high heels
    • dancing
  80. Soleus homework
    *NOT ON HANDS-ON FINAL*
    • gastroc stretch
    • ice
  81. Plantar Fasciitis & Ankle/Foot Px
    • painful condition caused by excessive war leading to inflammation
    • felt on underside of heel
    • often most intense with the first steps of the day
    • commonly associated with long periods of weight bearing
    • obesity or sudden weight gain
    • often causes a heel spur (on calcaneus) - is an underlying condition
    • TREATMENT: stretching Achilles tendon, stop doing perpetuating factors that creates plantar fasciitis - perpetuating factors creates the slow healing of plantar fasciitis
  82. Periostitis (shin splints)
    • fascial layer that surrounds the tibialis anterior or tibialis posterior (grumpy friend) can be pulled away from their attachment to the tibia
    • Px through crus, particularly through anterior and medial crus
    • CAUSES: running with bad shoes, uneven surfaces, hard surfaces etc.
    • HOMEWORK: Ice bath 20 min. - extremely effective, massage not good in acute phase
  83. Cramps are...
    • painful involuntary spasm
    • perpetuating factors
    • pickle juice great for cramps (FYI)
  84. Tendonitis aka Achilles tendon
    • inflammation, pain & swelling
    • can be result of ankle sprain
    • typically the result of a chronic overuse
  85. Ankle sprains - Ligaments (3 Grades)
    • Grade I: mild to moderate px, swelling, inflammation and mild to moderate loss of ROM (not super noticeable)
    • Grade II: moderate to severe px, inflammation, swelling, redness and heat, severe limitation in function and ROM (limping version)
    • Grade III: complete rupture, contusion, severe px, may also cause avulsion fracture
    • requires surgery or physician intervention

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