Professional Documents
Culture Documents
ADDUCTOR MUSCLES
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.
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
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 DIGITORUM
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 MEDIUS MUSCLE
INFRASPINATUS MUSCLE
MULTIFIDUS MUSCLE
RHOMBOID MUSCLE
ACTION: retracts the scapula
REFERRAL: itself
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.
STERNOCLEIDOMASTOID MUSCLES
ACTION: Individually: rotation of head to
opposite side. Together: neck flexion.
REFERRAL: forehead, ear, occiput, eye.
SUPINATOR
ACTION: forearm supination
REFERRAL: lateral elbow and wrist
SUPRASPINATUS MUSCLE
SUBSCAPULARIS MUSCLE
ACTION: internally rotates the humerus
REFERRAL: posterior shoulder and wrist
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.
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
HAMSTRINGS: BICEPS
FEMORIS, SEMITENDINOSUS,
SEMIMEMBRANOSUS
ACTION: Flexes the knee, extends the hip
REFERRAL: Posterior knee
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
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
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
CONDITIONS:
pectoralis minor entrapment
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:
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!
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.
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.
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.
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.