Assignment 1 (Dr.

Ghada Koura)
Presented by Soliman M.Rashad - ID: O-0063

Muscle Trigger Points Stretched Position Position of Ease + Comment

1. Upper
trapezius

Supine lying position + slight

contralateral side bending
At angle of the neck and Neck flexion, side-bending toward
shoulder using pincer the opposite side, and slight rotation
palpation. toward the ipsilateral side. Give
emphasis on side bending.
2.
Scalene

Neck side-bending with mild Slight cervical side bending and

Against transverse extension. Use the hand to hold rotation to the contralateral side
processes of cervical onto the chair to stabilize the is essential to expose the full
vertebrae with flat scapula. muscle bulk
palpation. Use the
thumb or four fingers.
Make sure that fingers
are behind the SCM
muscle. The posterior
division may be treated
with the thumb.
3.
Pectorali
s Minor

Abduction of the shoulder to 120 Supine position + get down low

degrees and then horizontal next to the table + place your
abduction. The clinician facilitates forearm over the table + force is
shoulder movement. directed inward but also
In the midclavicular line superiorly up along to the rib
down to the third rib. cage + apply your technique
Two to three FB below
the lateral third of the
clavicle.
4. Deltoid

Anterior-Shoulder extension with Lateral decubitus (side lying) on

Anterior-Three FB below elbow extension and neutral the sound side + the affected
the anterior margin of position of the forearm. upper limb is rested of the trunk
the acromion. Posterior-Shoulder horizontal and Compression Inhibition
Posterior-Two FB adduction from a higher position technique for deltoid muscle is
caudal to the posterior and elbow flexed. applied
margin of the acromion. The clinician facilitates stretch.
Use flat palpation.
 (1) EXTENSOR
DIGITORUM

5.
Common
Extensor
s
Elbow extension, pronation, palmar
flexion of the wrist, and flexion of
the fingers. Emphasis should be
given on flexion
Four FB below the
of the fingers.
lateral epicondyle.
(2) EXTENSOR CARPI
ULNARIS Graston technique is a very
beneficial technique for elbow
trigger point release, Graston
technique is applied by
Instrument Assisted Soft Tissue
Mobilization (IASTM)

Elbow extension, pronation, and

palmar flexion of the wrist. The
clinician facilitates the wrist
movement.

Midpoint of the ulna, one

FB medial from the shaft
of the ulna. Flat
palpation.
(3) EXTENSOR CARPI
RADIALIS (LONGUS
AND BREVIS)

Extensor Carpi Radialis Brevis

Elbow extension, pronation, and
palmar flexion of the wrist. The
clinician facilitates the wrist
movement.

Two FB distal to the

lateral epicondyle with
flat palpation.
6.
Rhomboi
ds Major

The patient is in a sitting position

with the neck flexed and arms
crossed. The patient moves into
forward flexion, spreading the
crossed arms over the legs. The
Various trigger points
clinician facilitates scapular The key to releasing these trigger points
can be identified two is making sure that you have released
abduction.
FBs medial to the any trapezius trigger points first. If you
vertebral border of the don’t, you will never be able to
scapula. Use flat accurately locate the rhomboid trigger
palpation. points by palpation. Even with a relaxed
trapezius muscles, these trigger points
will feel rather deep to your touch (even
though they really aren’t that deep).
7.
iliocostal
is
thoracis

Side lying on the sound side +

the affected upper limb is rested
complete flexion and abduction
The patient is in a long sitting shoulder + Apply your technique
position. He or she flexes the trunk
forward and reaches with the arm to
the opposite side. The clinician
facilitates stretching of the muscle.

Along the belly of the

muscle. Flat palpation.
8.
iliocostal
is
lumboru
m

The patient is in a long sitting

position and flexes the trunk
forward, reaching with the arm to
the opposite side. The clinician
facilitates stretching of the muscle.
Along the muscle belly.
Flat palpation.
Extended Side lying position
Side lying on the sound side +
the affected upper limb is rested
complete flexion and abduction
shoulder + lower most lower limb
is flexed + upper most lower limb
is extended and adducted to
rested on the table + Apply your
technique
9.
Piriformi
s

Hip flexion (above 90 degrees),

adduction, and external rotation with
emphasis on external rotation. The
clinician facilitates movements in
the above-mentioned order.

Prone position + affected lower

Midpoint between the limb is be flexed knee at 90° -
posterior inferior iliac spine 100° & hip internal rotated +
and the greater trochanter. technique applied along the
Flat palpation using the
thumb or fingers of both muscle
hands moving through the
fibers of the gluteus maxim
us, reaching the piriformis
muscle.
10. (1) BICEPS FEMORIS
Hamstrin (LONG AND SHORT
gs HEADS)

Biceps femoris long The patient is in a supine position

head-Midpoint between and the knee is extended. The
the ischial tuberosity clinician facilitates stretching from
and the fibular head. hip flexion-abduction- external
Biceps femoris short rotation to hip flexion-adduction-
head-Four FB above the internal rotation.
fibular head, medial to
the tendon of the biceps
femoris long head.
(2) SEMITENDINOSUS
AND Prone position + affected lower
SEMIMEMBRANOSUS limb is to be ankle rest on a roll
to allow 30° - 40° knee flexion +
technique is applied

The patient is in a supine position.

The knee is extended. The clinician
facilitates stretching from hip
flexion-abduction- external rotation
Semitendinosus-Midway to hip flexion-adduction-internal
between the ischial rotation.
tuberosity and the
medial condyle of the
femur.
Semimembranosus-
Medial to the biceps
femoris long head in the
"V" apex between the
semitendinosus and the
biceps femoris long
head.
11. Calf (1) GASTROCNEMIUS

The clinician facilitates dorsiflexion

of the ankle with the knee
completely extended.

Lateral bead-One HB
below the lateral aspect
of the popliteal crease.
Medial bead-One HB
below the medial aspect
of the popliteal crease.
(2) SOLEUS

Prone position + affected lower

limb is to be ankle rest on a roll
to allow 30° - 40° knee flexion +
technique is applied

One HB above and

three FB posterior to the
medial malleolus. The clinician facilitates dorsiflexion
of the ankle with the knee bent.
12.
Iliotibial
Band

Its attachment to the

tensor fasciae latae, and
its fascia blends with the
ITB at the lateroanterior Side lying on the sound limb +
thigh one third of the sound limb is flexed + affected
way distally. limb is to be hip extended and
The intermuscular knee flexed 15° - 30° + technique
septum that connects is applied
the ITB to the linea
aspera femoris until
inserting just proximal to
the lateral femoral Standing hip crossover stretch
condyle.
Its insertion to the lateral
aspect of patella.
Over the lateral femoral
condyle.
13.
Tibialis
Anterior

Plantarflexion and eversion of the Supine position + affected lower

foot. The clinician facilitates foot limb is to be knee extended and
movement. supported in knee extension +
ankle planter flexion + traction
applied + technique is applied

Four FB below the tibial

tuberosity and one FB
lateral to the tibial crest.
Flat palpation.