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HUMAN + MUSCLES + PAIN

ADDUCTOR MUSCLES

ACTION: hip adductor


REFERRAL: thigh and knee

COMMENTS: These muscle groups- the


adductor magnus, longus, brevis and the
pectineus, make up the adductor group. Groin
pulls are a strain at the attachment of the
adductors to the pubic bone. An upslipped hip may have tight adductors on the same side.
Test the length of the adductors with clients who have lower back pain. Always drape
appropriately and be gentle. This area is sensitive and can often be sore.
TRICEPS BRACHII AND ANCONEUS

ACTION: extends the elbow


REFERRAL: posterior arm and elbow

COMMENTS:
The triceps muscle is not injured very often,
but it can feel really good to work it. When
working the attachment near the elbow, be
aware of the ulnar nerve that goes between
the medial epicondyle of the humerus and the
olecranon process of the ulna. The triceps
gets its name because it has three heads
superiorly. One that attaches to the humerus,
and two others that attach to the scapula. The
brachii part of the name refers to being on the
arm.
The anconeus is small and thin, and on the
other side of the elbow from the ulnar nerve.
This muscle also is rarely injured. Static pressure to the muscle belly with a fingerpoint while
flexing and extending the elbow is an effective and safe way to soften the muscle.

HAMSTRINGS: Biceps Femoris, Semitendinosus, Semimembranosus

ACTION: Flexes the knee, extends the hip


REFERRAL: Posterior knee

COMMENTS: These three muscles, the


biceps femoris, the semitendinosus and the
semimembranosus muscles control the pull on
the knee joint. The only one that refers pain
into the posterior knee, however, is the biceps
femoris. The other two muscles are covered
in the hip section. Also notice trigger points at
the top of the gastrocnemius that refer to the
posterior knee. There is also a trigger point on
the popliteus that refers to the same location.
For all posterior knee pain, address all these
muscles.

TALOFIBULAR AND
CALCANEOFIBULAR LIGAMENTS
ACTION: Lateral ankle support
REFERRAL: Lateral ankle

COMMENTS: These two ligaments (in yellow) are the most common ligaments involved in
ankle strains/sprains. After the initial inflammatory stage is gone, friction these ligaments
from 1 to 3 minutes. Also address the peroneus longus and brevis muscles.

DELTOID MUSCLE

ACTION: humeral abduction, internal rotation,


external rotation
REFERRAL: shoulder

COMMENTS: The deltoid wraps the shoulder


joint. The anterior deltoid pull the humerus
towards the front, the lateral deltoid helps with
abduction, and the posterior deltoid pulls the
humerus posteriorly. The deltoid is usually
involved in shoulder injuries. Although not part
of the rotator cuff muscles, the deltoid almost
always is strained when these muscles are
strained. The deltoid is ropey on most people,
and so static pressure on areas of inflammation
or frictioning are good ways to work
specifically. You can work broadly using your
forearm as shown in the DVD Deep Tissue &
Neuromuscular Therapy, the Extremities.

ERECTOR SPINAE MUSCLES


(SPINALIS, LONGISSIMUS,
ILIOCOSTALIS)

ACTION: extends spine


REFERRAL: back, ilium, sacrum
COMMENTS: The erector spinae group is made up of three muscles, the spinalis most
medially, the longissimus in the center, and iliocostalis laterally.

The spinalis is just next to the spine, and to work on this muscle you will need you use your
fingertips or thumbs.

The longissimus is the main meat of the erector group, and is palpated as a taught rope half
an inch lateral to the spine.

The main attachment of the iliocostalis is to the ilium and ribs. Because of it's lateral position,
a tight iliocostalis can bring a hip up, or bring the ribcage down toward the hip.

EXTENSOR CARPI RADIALIS LONGUS, EXTENSOR CARPI RADIALIS BREVIS,


EXTENSOR CARPI ULNARIS

ACTION: wrist extension


REFERRAL: posterior wrist

COMMENTS: Here are the three main


muscles of wrist extension. All these muscles
attach to the lateral epicondyle. When these
attachments attachments are strained, it is
called Tennis elbow. This most commonly
involves the two radialis muscles. Trigger
points in the bellies of these three muscles
refer pain into the posterior wrist.

EXTENSOR DIGITORUM

ACTION: finger extension


REFERRAL: posterior fingers

COMMENTS: The muscle of finger


extension is the extensor digitorum. This
muscle refers pain into the fingers. Always
work the opposing muscle group when you are working on the forearm and hand. In this case,
make sure to work on the finger flexors and well as the extensors. This will decrease tone
evenly and provide longer lasting results.

FLEXOR CARPI RADIALIS, FLEXOR CARPI ULNARIS, PALMARIS LONGUS

ACTION: wrist flexion


REFERRAL: wrist and palm

COMMENTS: All of these muscles attach to


the medial epicondyle of the humerus. Strain at
this attachment is known as Golfer's elbow.
Trigger points in the flexor carpiradialis, the
most lateral wrist flexor, refers pain into the
lateral part of the wrist. The flexor carpi
ulnaris refers pain a bit more medially. The
palmaris longus refers pain into the middle of
the palm. A great way to work these muscles is
to have the client flex their wrist while you
apply pressure to the muscle bellies with your
thumbs or palm.

ABDUCTOR POLLICIS, EXTENSOR POLLICIS BREVIS

ACTION: thumb extension and abduction


REFERRAL: thumb and medial wrist

COMMENTS: Assess these muscles for


health by having your client forcefully extend
their thumb against your resistance.
POPLITEUS & GASTROCNEMIUS

ACTION: Flexes the knee


REFERRAL: Posterior knee

COMMENTS: The popliteus is deep to the


gastrocnemius, and helps to unlock the knee
from a hyper extended state. Both these
muscles refer into the posterior knee and
should be addressed along with the biceps
femoris. When you are working on the heads
of the gastrocnemius, be wary of the large
artery, nerve and vein moving through the
popliteal space (back of the knee).

DEEP EXTERNAL ROTATORS (GEMELLI, OBTURATOR, QUADRATUS


FEMORIS)

ACTION: externally rotates the hip


REFERRAL: themselves

COMMENTS: These muscles are just


under and inferior to the piriformis. People
sometimes have a hard time distinguishing
deep hip pain from sacroiliac joint
pain(lower back pain). These muscles are
best worked with a thumb or elbow (you
have to get through the gluteus maximus),
then add some internal and external rotation
to the joint. The abbreviation of these
muscles is GOGO's. Gemellus superior,
Obturator internus, Gemellus inferior, Obturator Externus(not shown). The Quadratus
femoris is not included in the GOGOs acronym. The Gemelli muscle have a high
concentration of spindle cells, which leads researchers to view them as sensors for the
position of the hip joint rather than prime mover muscles.

To work on the obturator internus, you need to get fairly deep into the butt cheek, and is
usually done through a sheet, or wearing latex gloves. Obviously client education and a real
need is a prerequisite before you start digging around in this sensitive area.

GLUTEUS MAXIMUS MUSCLE

ACTION: externally rotates & extends the


hip
REFERRAL: posterior hip and leg

COMMENTS: Skin roll this muscle before


working on the deeper structures. This will
make the muscle plyable, and allow you to
reach the other deeper external rotators easily.

 
GLUTEUS MEDIUS MUSCLE

ACTION: abducts and internally rotates hip


REFERRAL: sacrum and crest of ilium

COMMENTS: This muscle is one of the


most important muscles to address with
clients who have lower back pain. Always
check for internal and external rotation of the
hips on clients with lower back pain. This
muscle is an internal rotator, and so will
restrict external rotation. This means that the
client will feel restriction when they turn their
leg out. The tensor fasciae latae also helps
with internal rotation, so address that muscle
as well.
TENSOR FASCIA LATAE MUSCLE

ACTION: flexes and internally rotates the


hip
REFERRAL: into itself and the lateral hip

COMMENTS: Remember this muscles


name because it "tenses a lot of fascia". The
fascia that it attaches to is the iliotibial band.
Work on this muscle when client has limited
external rotation. Include the gluteus medius
with your work.

THE TORSO MUSCLES

FLEXORS: rectus abdominus,


psoas(depending on position)
EXTENSORS: spinalis, longissimus,
iliocostalis, multifidus
SIDE BENDERS (LATERAL FLEXION):
quadratus lumborum

COMMENTS: When working on the back,


the two most common muscles involved are
the multifidus and the quadratus lumborum.
The next most common muscle is the gluteus
medius, which refers pain into the sacro-iliac
joint. Working these muscles will usually
help most back pain.
PSOAS AND ILIACUS MUSCLES

ACTION: flexes the hip, increases lordosis


REFERRAL: anterior thigh and lower back

COMMENTS: The psoas and iliacus muscle


also refer to the lower back area. This muscle
is primarily responsible for anterior rotation
of the pelvis, which increases the lordosis of
the lumbar spine. When working around the
psoas, be cautious of the inguinal ligament.
On the inferior attachment, be careful of the
femoral artery.

INFRAHYOID AND SUPRAHYOID MUSCLES

ACTION: Infrahyoids: flex the neck,


Suprahyoids: open the jaw.
REFERRAL: Anterior neck

COMMENTS: The infrahyoids are made up


of three muscles, the omohyoid, the sterno
hyoid, and the thyrohyoid. They lie right over
the trachea. The infrahyoids can be damaged
in whiplash cases. To release these muscles
apply gentle frictioning with the tips of your
fingers. Be careful not to put pressure on the
internal jugular veins, which are just lateral to
the trachea. See also the longus colli and
capitis, which lie deep, right over the anterior
part of the cervical vertebrae, and can also be
important to work on in cases of whiplash.
The suprahyoid group hardly ever has any problems, except maybe after a thanksgiving
eating marathon.

INFRASPINATUS MUSCLE

ACTION: external rotation of


humerus
REFERRAL: upper back, anterior
shoulder

COMMENTS: This muscle can also


refer pain into the vertebral border of
the scapula. This muscle has a large
attachment and is fairly thin. Because
of this, it is normal for it to be a little
tender when compressed against the
scapula. The lateral trigger point
shown refers pain to the anterior
shoulder. In sports this muscle
becomes strained because its action of
decelerating a throwing motion, or racquet swing. It is one of the 4 rotator
cuff muscles.

ROTATOR CUFF MUSCLES: (acronym SITS) Subscapularis,


Infraspinatus, Teres minor, Supraspinatus  

LEVATOR SCAPULA MUSCLE

ACTION: Neck rotation


REFERRAL: top of shoulder

COMMENTS: This muscle


should be in the shoulder
section, yet when it is tight it's
main action is to restrict neck
rotation. Whenever a client
enters with restricted rotation,
suspect this muscle, and
release the upper back area
before working on the neck
proper.
LONGUS COLLI AND LONGUS CAPITIS MUSCLES

ACTION: Neck flexion


REFERRAL: Anterior neck

COMMENTS: These muscles can be


damaged in whiplash cases. They lie right
over the anterior cervical vertebrae. To get to
these muscle, push aside the trachea and
apply gentle pressure with your fingertips. Be
wary of the carotid artery and internal jugular
vein. Obviously this is a technique to be
properly trained in before experimenting. See
also the infrahyoids.

If you want to learn to work these muscles,


the DVD Deep Tissue & Neuromuscular
Therapy: The Torso, has this information.

MULTIFIDUS MUSCLE

ACTION: extends and rotates the spine


REFERRAL: itself

COMMENTS: This muscle is located under


the erector group, and is often missed.
However, it is one of the most important
muscles regarding lower back pain. It is the
only muscle that has fibers that actually attach
to the posterior part of the sacrum.
OPPONENS POLLICIS, ABUCTOR POLLICIS BREVIS, ADDUCTOR POLLICIS

ACTION: thumb flexion, adduction &


abduction
REFERRAL: thumb and wrist

COMMENTS: These three muscles control


much of the movement of the thumb.
Specifically trigger points in the opponens
pollicis can refer pain into the lateral wrist
and thumb itself.

PECTORALIS MAJOR MUSCLE

ACTION: internally rotates and laterally


flexes the humerus
REFERRAL: chest, ulnar side of the arm

COMMENTS: This muscle is involved in


forward shoulder position. Include it when
you work on the pectoralis minor.
PECTORALIS MINOR MUSCLE

ACTION: depresses and rotates the scapula


forward
REFERRAL: shoulder, chest, ulnar side of
the arm

COMMENTS: A tight pectoralis minor will


cause the shoulder to move inferior(down)
and possibly forward. This muscle can also
impinge on the brachial plexus, causing
numbness, tingling or pain down the radial
side of the arm. This is called pectoralis
minor entrapment. When working on this
muscle, also release the pectoralis major.

PERONEUS LONGUS AND BREVIS

ACTION: Everts the ankle


REFERRAL: Lateral ankle

COMMENTS: Trigger points in these


muscles can often be active after a person
suffers a strained or sprained ankle. Work
these two muscles, as well as the tibialis
posterior to help balance the tone in the ankle
joint. Remember that the most common
ligaments damaged are the calcaneofibular
and talofibular liagments.
PIRIFORMIS MUSCLE

ACTION: externally rotates the hip


REFERRAL: sacroiliac joint and leg

COMMENTS: The piriformis is an important


external rotator. The most medial trigger point
refers to itself, and can mimic sacroiliac joint pain
(lower back pain). A tight piriformis can also
impinge on the sciatic nerve. This is called
piriformis muscle syndrome, and the client will
experience pain, numbness or tingling down the
back of their leg. The sciatic nerve can also be
impinged at the sacral or lumbar nerve roots, so
these areas must be tested as well. The best way to
test the lumbar area for involvement is with the
spring test- as shown in the DVD Deep Tissue and
Neuromuscular Therapy, the Torso.

When working the piriformis muscle, also include


the quadratus femoris, obturators and gemelli.

PRONATOR TERES AND


PRONATOR QUADRATUS
ACTION: forearm pronation
REFERRAL: anterior/medial wrist

COMMENTS: These two pronator muscles,


the pronator teres and quadratus, both pronate
the forearm. The pronator teres is more of a
trouble maker, because it does the majority of
the work . Whenever someone has wrist pain,
check this muscle for tension and tenderness.
Also evaluate for range of motion and pain on
resistance.
QUADRATUS LUMBORUM MUSCLE
ACTION: hip hiker, side bender
REFERRAL:sacro-iliac joiont, lateral hip,
gluteal area.

COMMENTS: The quadratus lumborum is


a well known muscle that is a primary cause
of lower back pain. Its action of bringing the
hip up is important for balancing postural
distortion. Not only does it refer into the
Sacro-Iliac joint, but can cause stress in that
joint by pulling the hips out of alignment.

RECTUS ABDOMINIS MUSCLE


ACTION: torso flexor
REFERRAL: mid and lower back

COMMENTS: The fact that this muscle


refers pain to the back means that if your
work on the back erector group is not
providing relief, look to this muscle. The
rectus abdominis also will be tight in clients
who slouch, and have a posteriorly rotated
pelvis. If a client has an anteriorly rotated
pelvis (most common) strengthening this
muscle can help the hips to come back into
alignment. It is not true, however, that
strengthening the rectus abdominis will
automatically help the lower back.
RECTUS FEMORIS AND VASTUS MEDIALIS
ACTION: Extends the knee
REFERRAL: Anterior and medial knee

COMMENTS: These are two of the four


quadriceps muscles. The trigger point in the
rectus femoris muscle is located near the hip.
The trigger point in the vastus medialis is just
at the distal end. This usually is tender on
people who have knee pain. Always check
both trigger point areas on people with
anterior and medial knee pain.

RHOMBOID MUSCLE
ACTION: retracts the scapula
REFERRAL: itself

COMMENTS: The rhomboid major and


minor are next to each other. We will refer to
them both as one muscle, the rhomboid. This
muscle retracts the scapula, pulling it towards
the spine. It can also help to angle the scapula
down(when the lower fibers fire) or up (when
the upper fibers fire). Realize that when
people have pain here, it is not really a back
issue- but rather a shoulder issue, since this
muscle moves the shoulder. The trapezius
muscle is another shoulder muscle located on
the back and lies over the rhomboid.

SCALENES: SCALENE
MEDIUS, ANTERIOR AND
POSTERIOR MUSCLES
ACTION: Neck lateral flexion, helps raise ribs
REFERRAL: Anterior chest, radial side of arm, and upper back(not shown)

COMMENTS: A tight scalene group will pull the head to the same side. Test by laterally
flexing the neck and noticing where the motion is restricted. (If the head won't go to the left,
the scalenes on the right are tight.) When working on the scalenes, be wary of the sensitive
nerve and arteries nearby. The scalenes can impinge on the briachial plexus, causing nerve
pain or numbness down the arm. This is called thoracic outlet syndrome.

Our DVD, Nerve Mobilization shows techniques to


evalute the nerves as they move through the
scalenes and other muscles, and shows how to free
them.

SERRATUS ANTERIOR MUSCLE

ACTION: upward rotation & protraction of


scapula
REFERRAL: lateral torso

COMMENTS: This muscle attaches to the rib


cage and the edge of the underside of the
scapula. It counters the action of the rhomboid
muscle. When you put your arm over your
head, this muscle helps to rotate the scapula up
and keep it close to your rib cage. If this
muscle becomes paralyzed, the scapula will
wing out.

STERNOCLEIDOMASTOID MUSCLES
ACTION: Individually: rotation of head to
opposite side. Together: neck flexion.
REFERRAL: forehead, ear, occiput, eye.

COMMENTS: This muscle can cause


headaches. Be wary of the carotid artery
nearby, and don't apply pressure directly onto
the muscle. Instead use pincer palpation
(squeeze the muscle between your fingers and
thumb).
SUBOCCIPITALS
ACTION: extends and rotates head
REFERRAL: posterior skull and temples

COMMENTS:These small posterior neck


muscles do a lot of the work of moving our
head around. Fully 45 degrees of rotation can
happen just at the top between the atlas and
axis. These muscles stabilize this area.
Tension in these muscles can contribute to
headaches. To reach these muscles, you must
sink through the splenius capitis and
semispinalis capitis first.

SUPINATOR
ACTION: forearm supination
REFERRAL: lateral elbow and wrist

COMMENTS: Strain in this muscle can be


involved in Tennis elbow. The referral pattern
is split, sometimes referring into the lateral
elbow(tennis elbow), and other times into the
lateral wrist. This muscle is under the brachioradialis, so it takes some maneuvering to get at
it. It is almost always a little sore on people, since the radial nerve pierces the muscle. To
work this muscle- first find it, then supinate and pronate the client's wrist while you apply
pressure. They will thank you later.

SUPRASPINATUS MUSCLE

ACTION: abducts the humerus (lifts the arm)

REFERRAL: lateral shoulder and arm

COMMENTS: This muscle runs under the


clavicle, attaching to the top of the humerus.
It pulls the arm out to the side. The
supraspinatus and deltoid are the only two
muscles that lift the arm to the side (the
trapezius helps to stabilize and helps after 90
degrees). If strained, it can mimic
subacromial bursitis. To work the muscle
belly, you must work through the trapezius.
This is one of the 4 rotator cuff muscles.

ROTATOR CUFF MUSCLES: (acronym SITS) Subscapularis, Infraspinatus, Teres minor,


Supraspinatus

SUBSCAPULARIS MUSCLE
ACTION: internally rotates the humerus
REFERRAL: posterior shoulder and wrist

COMMENTS: This "rotator cuff" muscle


attaches to the anterior part of the scapula. It
lies between the scapula and the rib cage.
Distally it attaches to the anterior part of the
humerus, just next to the pectoralis major
attachment. This attachment is normally a
little tender. You can evaluate if this muscle
is strained by internally rotating the arm
against resistance. Note that this muscle refers pain to the back of the shoulder. When
evaluating the rotator cuff, include this muscle.

ROTATOR CUFF MUSCLES: (acronym SITS) Subscapularis, Infraspinatus, Teres minor,


Supraspinatus

TERES MAJOR AND TERES MINOR MUSCLES

ACTION: Minor- externally rotates humerus.


Major- adduction and internally rotates
humerus
REFERRAL: Minor- posterior shoulder.
Major- lateral shoulder.

COMMENTS:
The teres minor is the little helper of the
infraspinatus. It attaches just next to it on the
posterior humerus, and helps external
rotation. When strained, people feel a deep
ache the size of a silver dollar on humeral
attachment.

The teres major attaches to the posterior


scapula, then straight across to the anterior
(front) of the shoulder, attaching to the front
of the humerus. This muscle along with the
latissimus dorsi, forms the back part of your armpit. This muscle refers pain into the lateral
shoulder and sometimes into the lateral forearm.

These two muscles are rarely inflamed, and are ignored by most therapists.

TRAPEZIUS MUSCLE
ACTION: multiple actions involves pulling
the scapula towards the body. Also involved
in neck extension.
REFERRAL: temples and occiput
(headaches)
COMMENTS: This muscle has numerous referral patterns. The one pictured here is a
common one. Another very common trigger point not shown is on the very lateral edge of the
trapezius, which refers to the temples.

VASTUS LATERALIS
ACTION: Extends the knee
REFERRAL: Lateral knee pain

COMMENTS: This is a side view of the leg, the


white band is the Iliotibial band. Trigger points in
this muscle run up and down its length. There may
also be trigger points in the iliotibial band. Also test
and check the lateral collateral (fibular collateral)
ligament in the knee.

HAMSTRINGS: BICEPS
FEMORIS, SEMITENDINOSUS,
SEMIMEMBRANOSUS
ACTION: Flexes the knee, extends the hip
REFERRAL: Posterior knee

COMMENTS: These three muscles, the


biceps femoris, the semitendinosus and the
semimembranosus muscles control the pull on
the knee joint. The only one that refers pain into the posterior knee, however, is the biceps
femoris. The other two muscles are covered in the hip section. Also notice trigger points at
the top of the gastrocnemius that refer to the posterior knee. There is also a trigger point on
the popliteus that refers to the same location. For all posterior knee pain, address all these
muscles.

SPLENIUS CAPITIS, SPLENIUS CERVSI, SEMISPINALIS


CAPITIS MUSCLES

ACTION: Splenius: neck rotation.


Semispinalis: neck flexion.
REFERRAL: occiput, neck, upper shoulder

COMMENTS:These three muscles make up


the majority of deep neck muscles under the
trapezius. Since they are layered and close,
usually you just work on them all together. It
is important to note that they all attach to the
middle of the back- so when dealing with
neck pain, you must release down the back as
well.

The splenius capitis can be palpated directly


by finding the space between the trapezius
and the sternocleidomastoid at the top of the
neck. Both splenius muscles are a potent
source of headaches.

The semispininalis capitis is deep to the splenius capitis, and is often a cause of neck pain.
Even through its main action is extension, restriction in this muscle can cause pain on rotation
at the end of the range.

TRICEPS BRACHII
AND ANCONEUS

ACTION: extends the elbow


REFERRAL: posterior arm and
elbow

COMMENTS:
The triceps muscle is not injured
very often, but it can feel really good to work it. When working the attachment
near the elbow, be aware of the ulnar nerve that goes between the medial
epicondyle of the humerus and the olecranon process of the ulna. The triceps
gets its name because it has three heads superiorly. One that attaches to the
humerus, and two others that attach to the scapula. The brachii part of the name
refers to being on the arm.

AREA:
NECK MUSCLES

MUSCLES:
FLEXORS: longus colli & capitis, infra
hyoids

EXTENSORS: splenius capitis, semispinalis


capitis, suboccipitals, trapezius

ROTATORS: splenius capitis,


sternocleidomastoid, levator scapula,
suboccipitals

LATERAL FLEXORS: scalenes

COMMENTS: The motion of the neck can


be divided into rotation (looking side to side),
lateral flexion (ear to shoulder), flexion (chin
to sternum) and hyperextension (looking up).
Knowing which muscles do each motion will
take you a long way towards proper evaluation and treatment.

INJURY: The most common neck injury is whiplash, which involves the infrahyoid muscles,
longis colli and longis capitis, as well as the sternocleidomastoid muscles. Another common
neck problem is limited rotation, which involves the levator scapula, the suboccipitals, or the
deep neck muscles.

ASSESSMENT: Neck evaluation includes passive range of motion in the various directions,
looking for restriction and pain. When working on older clients or people who have had
severe neck trauma check that moving the neck into these various positions does not impinge
the vertebral artery. An occluded vertebral artery does not deliver enough blood to the brain
and is therefore a dangerous situation.

MASSAGE: Massage is an excellent treatment for the neck muscles in cases of restriction.
Whiplash responds well to massage after the initial inflammatory stage is over. In the acute
phase, Positional Release is the best therapy.
SHOULDER MUSCLES  

HUMERUS MOVER MUSCLES:


supraspinatus, infraspinatus, teres minor,
subscapularis

SCAPULA MOVERS MUSCLES:


PROTRACTORS:
pectoralis major
pectoralis minor
serratus anterior
RETRACTORS:
trapezius
rhomboids
ELEVATORS:
levator scapula
trapezius

CONDITIONS:
pectoralis minor entrapment

COMMENTS: The shoulder can be divided


into two functional groups. One group is the
muscles that move the humerus in
relationship to the the scapula. All the muscles that support this "gleno-humeral"joint are
called the rotator cuff muscles, and they all originate from the scapula and insert on the head
of the humerus. These muscles can be remembered in that they spell SITS. Supraspinatus
abducts, Infraspinatus and teres minor externally rotate, Subscapularis internally rotates.

The other grouping of muscles are those that position the scapula on the rib cage. These
muscles originate from the rib cage and spine and insert on the scapula or humerus. The
muscles on the back (rhomboids, trapezius, and latissimus dorsi) are often confused in that
they are not really back muscles (they don’t move the back), they are really shoulder and arm
muscles. When people complain of mid to upper back pain it is usually related to these
shoulder moving muscles. The deeper neck muscles have their root in the upper back as well.
Always check the neck range of motion when you find upper back tension.

 
THE ELBOW MUSCLES:

FLEXORS: biceps, brachialis, brachioradialis


EXTENSORS: triceps, anconeus

ELBOW INJURIES:
golfers elbow, tennis elbow

COMMENTS:
The elbow is the joint of self care. This joint allows our
hands to come into contact with our bodies. Without an
elbow joint, we wouldn't be able to feed or clean
ourselves. Try straightening your arm for 5 minutes,
and living life without an elbow joint!  

THE HAND MUSCLES:

WRIST FLEXORS: flexor carpi radialis, flexor carpi


ulnaris, palmaris longus
WRIST EXTENSORS: extensor carpi radialis longus &
brevis, extensor carpi ulnaris

FINGER FLEXORS: flexor digitorum superficialis and


profundus
FINGER EXTENSORS: extensor digitorum

THUMB FLEXORS: flexor pollicis longus & brevis


THUMB EXTENSORS: extensor pollicis longus &
brevis,

FOREARM SUPINATOR: supinator


FOREARM PRONATOR: pronator teres & quadratus

WRIST INJURIES:
carpal tunnel syndrome

COMMENTS:
All the muscles in the forearm operate the hand. The
easiest way to grasp these muscles is to divide them into
function, as we have done here. Think of the hand as 3
major joints- the wrist, fingers and thumb. The muscles
can easily be divided into these groups and then it makes
evaluation and treatment really easy. For detailed
evaluation on yourself, our DVD Heal Your Wrist Pain
is great! If you want to learn to evaluate all these muscles on a client, our DVD Deep Tissue and NMT, the
Extremities is what you want.

THE TORSO MUSCLES

FLEXORS: rectus abdominus, psoas(depending on position)


EXTENSORS: spinalis, longissimus, iliocostalis, multifidus
SIDE BENDERS (LATERAL FLEXION): quadratus lumborum

COMMENTS: When working on the back, the two most common


muscles involved are the multifidus and the quadratus lumborum. The
next most common muscle is the gluteus medius, which refers pain into
the sacro-iliac joint. Working these muscles will usually help most back
pain.

THE HIP MUSCLES

EXTERNAL ROTATORS: piriformis, GOGOs,


quadratus femoris
FLEXORS: psoas, iliacus, rectus femoris
ADDUCTORS: adductor magnus, adductor longus &
brevis, pectineus, gracilis
INTERNAL ROTATORS: gluteus medius, gluteus
minimus, tensor fascia latae
EXTENSORS: semiteninosus & semimembranosus,
biceps femoris, gluteus maximus
ABDUCTORS: gluteus medius, gluteus minimus

COMMENTS: The hips are the foundation of our


lower bodies. They are the bowl that carries our
deepest selves, our organs. The hips are balanced upon
each femur, and then support the spine where the
lumbar vertebrae meet the sacrum. The shape of the
hip bones create an arch, with the top being the
sacrum, and the sides coming down onto the femurs.
This arched structure allows the hips to transfer the
weight of the body to the femur bones.

There are 4 groups of muscles around the hips. These are the adductors (on the inside), the abductors (on the
lateral hip), the flexors (on the anterior side) and the extensors (on the posterior aspect). These muscles control
the movements of the hips. When we think about movement of the hips, there are two possibilities. The first
possibility is that someone is placing their weight on one leg, and so the opposite hip joint is able to move
between the femur and ilium. This happens when someone takes a step. The other possibility is that both feet are
planted on the ground, becoming the foundation, and the hips move in relation to both femurs but affect the
curve of the lumbar vertebrae. There are two major hip/back movements that we can evaluate- anterior rotation
(tilting forward and an increase in lordosis) and posterior rotation (tilting back and an increase in kyphosis, or
flat back).

With each distortion, there will be a diagonal pattern of tension through the body. For example, with posterior
rotation the hamstrings and rectus abdominis will be tight. In an anterior rotation the rectus femoris and ilio-
psoas on the front and the back erectors on the back will be tight. When the movement of the hips is
exaggerated one way or another, it can result in lower back pain.

THE KNEE MUSCLES

FLEXORS:
Hamstrings (semi membranosus, semiteninosus, biceps femoris)
gastrocnemius
popliteus

EXTENSORS:
vastus medialis
vastus lateralis
vastus intermedius
rectus femoris

LIGAMENTS:
medial and lateral collateral
anterior and posterior cruciate
infrapatellar
coronary

COMMENTS: The main movements of the knee are flexion and extension. For lateral knee pain, look at the
vastus lateralis. For anterior knee pain, see the vastus medialis. For posterior knee pain, see all the flexors.

THE ANKLE MUSCLES:

EVERTERS: peroneus longus & brevis, ligments


PLANTER FLEXORS: gastrocnemius, soleus
DORSI FLEXORS: tibialis anterior

COMMENTS: The most common ankle injuries involve talo-


fibular and calcaneo- fibular ligament strain and achilles’ tendinitis.
Working these injuries consists of frictioning the ligaments,
releasing the muscles, and suggesting that the client perform ankle
strengthening exercises at home.

INJURY: The ankle joint can respond in two ways to a strain. The
ankle ligaments could be stretched, causing the ankle to be unstable
and to feel looser than the healthy side. When someone has a loose
ankle they should perform exercises to strengthen the ankle. The
main muscles of stabilization of the ankle joint are the peroneus
brevis, peroneus longus, and the deep ankle flexor such as the
tibialis posterior. Trigger points in the muscles will also make the
muscles weak and unable to support the joint. The other response is
a buildup of scar tissue that causes limited range of motion in the ankle. Ankles that have a restricted range of
motion should be loosened by massage, cross-fiber frictioning and stretching.
ASSESSMENT: In order to test the ankle the client should be supine. Take both feet in your hands and turn
them towards each other (inversion). This can tell you if the ligaments on the outside have been torn or
stretched. Notice which foot is restricted. Use slow stretches to release the restriction.

MASSAGE: Only work on an ankle injury after the initial inflammatory stage (1-3 days) is over. It is
contraindicated to do deep massage over an area that is inflamed or puffy. When there is excessive edema
(swelling) the appropriate form of treatment is manual lymphatic drainage.

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