Trigger Points Quick Reference Student Resource

Quick Reference to
Trigger Points
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Revised 5th Edition
Trail Guide
to the Body’s
Quick Reference to
Trigger Points 2nd Edition
ANDREW BIEL
DISCOVER
Trail Guide
to the Body’s
Quick Reference to
Trigger Points
2nd Edition
ANDREW BIEL
Illustrations by
ROBIN DORN
Second Edition
Copyright © 2012, 2019 text, illustrations by Books of Discovery.

All rights reserved. No part of this book may be reproduced in
any form, or by any electronic, mechanical or other means,
without prior permission in writing from the publisher.
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ISBN: 978-0-9987850-8-0
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Disclaimer
This book does not offer medical advice to the reader and is not
intended as a replacement for appropriate health care and treatment.
For such advice, readers should consult a licensed physician.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 1 Flexor Carpi Ulnaris . . . . . . . . . . . . . . . . 35

Flexor Digitorum .
Shoulder & Arm 3 Superficialis and Profundus . . . . . . . 36
Pronator Teres . . . . . . . . . . . . . . . . . . . . . 37
Deltoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Supinator . . . . . . . . . . . . . . . . . . . . . . . . . 38
Trapezius . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Adductor Pollicis . . . . . . . . . . . . . . . . . . . 39
Latissimus Dorsi . . . . . . . . . . . . . . . . . . . . 8
Flexor Pollicis Longus . . . . . . . . . . . . . . . 41
Teres Major . . . . . . . . . . . . . . . . . . . . . . . . . 9
Dorsal Interossei . . . . . . . . . . . . . . . . . . . 42
Supraspinatus . . . . . . . . . . . . . . . . . . . . . 10
Infraspinatus . . . . . . . . . . . . . . . . . . . . . . . 11
Spine & Thorax 43
Teres Minor . . . . . . . . . . . . . . . . . . . . . . . . 12
Subscapularis . . . . . . . . . . . . . . . . . . . . . 13 Iliocostalis . . . . . . . . . . . . . . . . . . . . . . . . . 43
Rhomboid Major and Minor . . . . . . . . . . 14 Longissimus Thoracis . . . . . . . . . . . . . . 44
Levator Scapula . . . . . . . . . . . . . . . . . . . . 15 Multifidi and Rotatores . . . . . . . . . . . . . .46
Serratus Anterior . . . . . . . . . . . . . . . . . . 16 Semispinalis Capitis . . . . . . . . . . . . . . . . 47
Sternalis . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Splenius Capitis . . . . . . . . . . . . . . . . . . . . 48
Pectoralis Major . . . . . . . . . . . . . . . . . . . . 18 Splenius Cervicis . . . . . . . . . . . . . . . . . . . 49
Pectoralis Minor . . . . . . . . . . . . . . . . . . . 20 Suboccipitals . . . . . . . . . . . . . . . . . . . . . . 50
Subclavius . . . . . . . . . . . . . . . . . . . . . . . . 21 Quadratus Lumborum . . . . . . . . . . . . . . 51
Biceps Brachii . . . . . . . . . . . . . . . . . . . . . 22 Rectus Abdominis .

and External Oblique . . . . . . . . . . . . . 53
Triceps Brachii . . . . . . . . . . . . . . . . . . . . . 23
Serratus Posterior Superior . . . . . . . . . 55
Coracobrachialis . . . . . . . . . . . . . . . . . . . 25
Serratus Posterior Inferior . . . . . . . . . . 56
Forearm & Hand 27

Head, Neck & Face 57
Brachialis . . . . . . . . . . . . . . . . . . . . . . . . . 27
Sternocleidomastoid . . . . . . . . . . . . . . . 57
Brachioradialis . . . . . . . . . . . . . . . . . . . . . 28
Scalenes . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Extensor Carpi Radialis .
Longus and Brevis . . . . . . . . . . . . . . . 29 Masseter . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Extensor Carpi Ulnaris . . . . . . . . . . . . . . 30 Temporalis . . . . . . . . . . . . . . . . . . . . . . . . 63
Extensor Digitorum and . Digastric . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Extensor Indicis . . . . . . . . . . . . . . . . . . 31 Occipitofrontalis . . . . . . . . . . . . . . . . . . . 65
Flexor Carpi Radialis . . . . . . . . . . . . . . . . 33 Medial Pterygoid . . . . . . . . . . . . . . . . . . . 66
Palmaris Longus . . . . . . . . . . . . . . . . . . . 34 Lateral Pterygoid . . . . . . . . . . . . . . . . . . . 67
iii
Pelvis & Thigh 69 Plantaris . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Popliteus . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Rectus Femoris . . . . . . . . . . . . . . . . . . . . 69
Fibularis Longus and Brevis . . . . . . . . . 96
Vastus Medialis . . . . . . . . . . . . . . . . . . . . 70
Fibularis Tertius . . . . . . . . . . . . . . . . . . . . 97
Vastus Lateralis . . . . . . . . . . . . . . . . . . . . . 71
Tibialis Anterior . . . . . . . . . . . . . . . . . . . . 98
Vastus Intermedius . . . . . . . . . . . . . . . . . 74
Extensor Digitorum Longus . . . . . . . . . 99
Biceps Femoris . . . . . . . . . . . . . . . . . . . . 75
Extensor Hallucis Longus . . . . . . . . . . 100
Semitendinosus .
Tibialis Posterior . . . . . . . . . . . . . . . . . . 101
and Semimembranosus . . . . . . . . . . 76
Flexor Digitorum Longus . . . . . . . . . . . 102
Gluteus Maximus . . . . . . . . . . . . . . . . . . 77
Flexor Hallucis Longus . . . . . . . . . . . . . 103
Gluteus Medius . . . . . . . . . . . . . . . . . . . . 79
Extensor Digitorum Brevis . . . . . . . . . 104
Gluteus Minimus . . . . . . . . . . . . . . . . . . . 81
Flexor Digitorum Brevis . . . . . . . . . . . . 105
Adductor Magnus . . . . . . . . . . . . . . . . . . 83
Abductor Hallucis . . . . . . . . . . . . . . . . . 106
Adductor Longus and Brevis . . . . . . . . 84
Abductor Digiti Minimi . . . . . . . . . . . . . 107
Pectineus . . . . . . . . . . . . . . . . . . . . . . . . . 85
Extensor Hallucis Brevis . . . . . . . . . . . 108
Tensor Fasciae Latae . . . . . . . . . . . . . . . 86
Flexor Hallucis Brevis . . . . . . . . . . . . . . 109
Sartorius . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Adductor Hallucis . . . . . . . . . . . . . . . . . 110
Piriformis . . . . . . . . . . . . . . . . . . . . . . . . . 88
Quadratus Plantae . . . . . . . . . . . . . . . . . 111
Iliopsoas . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Leg & Foot 91 Recommended Texts . . . . . . . . . . . . . . . 113

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Gastrocnemius . . . . . . . . . . . . . . . . . . . . 91
Differential Diagnosis Index . . . . . . . . . . 117
Soleus . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
iv Contents
Introduction
Our flagship text, Trail Guide to the Body: A hands-on guide to locating muscles,
bones, and more deals with the subject of palpatory anatomy. The intent of this
Quick Reference is to provide students and practitioners with a quick reference
guide to trigger points. Please see page 112 for a list of recommended texts that cover
trigger points in detail.
A trigger point is a “hyperirritable spot in skeletal muscle.” These sensitive points
of tissue are often associated with palpable nodules in taut muscle fibers and, when
compressed, elicit referred pain, local tenderness, or a twitch response.
An activated trigger point can often radiate a consistent pain pattern, often
referring distally. For example, the trigger points of the pectoralis minor can radiate
pain through the pectoral region and down the medial surfaces of the arm, forearm,
and hand.
Trigger points commonly originate at the midpoint of a muscle’s fibers.
Understanding the design of a muscle’s fibers will help you determine where the
trigger points are located.
Several pieces of information regarding each muscle’s trigger points have been
provided:
• An “X” indicates a common location where

a trigger point can be found in a particular
muscle belly. (An “X” may vary in size and
color to aid with visibility and in proportion
to the image.)
• Possible Causes of trigger points include
postural patterns, traumas, and overuse or
underuse actions.
• Symptoms/Indications cover the types of
pains or discomforts that the patient may be
feeling. For example, the symptoms of the
serratus anterior’s trigger points may include
chest pain and shortness of breath.
• Pain Patterns (also shown in corresponding
images) are the areas where the radiating
pain of a trigger point is felt. Pectoralis minor trigger
points
• An Associated Trigger Point (TP) is a
trigger point in one muscle that occurs
simultaneously with a trigger point in another
muscle. One point may cause the other, or they both may be induced by the
same neurologic or mechanical origin.
• Differential Diagnoses cover other conditions or dysfunctions that may present
similar signs and symptoms as a trigger point’s referred pain pattern. For example,
pain manifested by trigger points of the masseter could be confused with pain
stemming from a toothache. But please be aware that the pain pattern from an
assumed trigger point could actually be a serious malady, such as a heart attack or
other life-threatening condition.
Introduction 1
Shoulder & Armx
Shoulder & Arm

Deltoid
Possible Causes
Impact trauma during sports or other activities
Repetitive strain during prolonged lifting
Excessive poling while skiing
Symptoms/Indications
Difficulty abducting shoulder to a
horizontal position
Pain deep in the deltoid area
Pain Patterns
Anterior, lateral, and posterior
sides of the shoulder
Lateral views of right shoulder and

arm showing common locations of
trigger points of the deltoid
Shoulder & Arm 3

Deltoid
Associated TPs
Pectoralis major
Biceps brachii
Other sections of the deltoid
Differential Diagnoses
Rotator cuff tear
Bicipital tendinitis
Subacromial/subdeltoid bursitis
Glenohumeral joint arthritis
Lateral view of right

shoulder and arm
Anterior view of right

shoulder and arm
Posterior view of right

shoulder and arm
4 Quick Reference to Trigger Points

Trapezius
Shoulder & Arm

Possible Causes
Sudden trauma, such as falling
Whiplash injury
Walking with cane
Arm rests in high position
Severe neck pain
Headache
“Stiff neck”
Pain Patterns
Angle of mandible
Temporal region
Lateral and posterior sides of neck
Upper back
Medial border of scapula
Lateral views
Shoulder & Arm 5

Trapezius
Associated TPs
Temporalis
Occipitalis
Masseter
Pectoralis major and minor
Levator scapula
Temporomandibular joint disorder
TPs of masticatory muscles
Fibromyalgia
Posterior views

Shoulder & Arm
Posterior views
Shoulder & Arm 7

Latissimus Dorsi
Possible Causes Associated TPs
Repetitive shoulder extension Pectoralis major
Throwing a baseball Teres major
Hanging from a swing Subscapularis
Pulling weeds
Symptoms/Indications Entrapment of suprascapular nerve
Pain when stretching upward Bicipital tendinitis
or far out in front of the body Ulnar neuropathy
Pain Patterns
Region inferior to scapula
Radiating and skipping down
posterior arm to pinkie and
ring finger
Posterior views of right

thorax and arm
Anterior view of
right shoulder and
arm

Teres Major
Shoulder & Arm

Driving without power steering Latissimus dorsi
Reaching overhead and forward Long head of the triceps brachii
to lift heavy object
Symptoms/Indications Subacromial/subdeltoid bursitis
Pain upon muscle activation Supraspinatus tendinitis
Slight restriction in Thoracic outlet syndrome
overhead range
Pain Patterns
Posterior shoulder
Radiates down posterior arm
and forearm

shoulder and arm
Anterior view
of right side of
shoulder and arm
Shoulder & Arm 9

Supraspinatus
Possible Causes Pain Patterns
Carrying heavy objects that pull Top of shoulder
inferiorly, such as a suitcase Lateral arm to wrist
Walking a big dog that pulls
hard on the leash Associated TPs
Lifting heavy object above Infraspinatus
shoulder height Trapezius
Deltoid
Pain during shoulder abduction Differential Diagnoses
Severe, sleep-disturbing pain Cervical arthritis
Stiffness of the shoulder Spurs with nerve root irritation
Snapping or clicking sounds Brachial plexus injuries
at the shoulder Subacromial/subdeltoid bursitis
Rotator cuff tear

shoulder and arm

Infraspinatus
Shoulder & Arm

Acute stress or multiple Most intense in shoulder
overload stress Lateral arm, forearm, and hand
Reaching arm behind and away
Twisting arm during a fall Associated TPs
Teres minor
Symptoms/Indications Anterior deltoid
Pain when brushing teeth Supraspinatus
or combing hair Biceps brachii
Inability to medially rotate and
adduct shoulder simultaneously Differential Diagnoses
Inability to sleep on painful side Suprascapular nerve entrapment
Bicipital tendinitis
Scapulohumeral dysfunction
Posterior views
of right shoulder
and arm
Anterior view of
right shoulder and
arm
Shoulder & Arm 11

Teres Minor
Possible Causes
Reaching behind shoulder
in extension
Motor vehicle accident
Reaching overhead, such as
when playing volleyball
Posterior shoulder pain
Pain Patterns
Posterior shoulder and arm
Associated TPs
Infraspinatus
Compression of the axillary nerve
Ulnar neuropathy
Acromioclavicular joint separation

shoulder and arm

Subscapularis
Shoulder & Arm

Repeated, forceful medial rotation, Posterior shoulder, radiating
such as swimming or pitching over scapula
Repeated overhead lifting Posterior arm, skipping to wrist
Dislocation of glenohumeral joint
Prolonged immobilization of shoulder Associated TPs
Pectoralis major
Symptoms/Indications Teres major
Pain when arm at rest and in motion Latissimus dorsi
Restricted abduction of shoulder Long head of the triceps brachii
Inability to reach across to
opposite armpit Differential Diagnoses
Rotator cuff tear
Adhesive capsulitis
Thoracic outlet syndrome

shoulder and arm

shoulder and arm
Shoulder & Arm 13

Rhomboid Major and Minor
Painting overhead Scalenes
Prolonged leaning forward Levator scapula
Rounded shoulder position, Middle trapezius
such as when writing or sewing Infraspinatus
Symptoms/Indications Differential Diagnoses

Superficial aching pain at rest Fibromyalgia
Snapping, crunching noises during Scapulocostal dysfunction
movement of the scapula
Pain Patterns
Medial border and superior
region of scapula

shoulder and arm

Levator Scapula
Shoulder & Arm

Occupational stresses Posterior shoulder and neck
Typing with head and neck turned Medial border of scapula
Holding the phone between ear
and shoulder Associated TPs
Sleeping with neck in tilted position Trapezius
Walking with cane Rhomboids
Splenius capitis
Pain at the angle of neck Differential Diagnoses
“Stiff neck” Splenius cervicis TPs
Torticollis Scapulocostal dysfunction
Unable to turn head fully to same Sternocleidomastoid TPs
side or opposite side
Posterior views
Shoulder & Arm 15

Serratus Anterior
Excessively fast or prolonged running Lateral side of thorax, below axilla
Push-ups Radiating down medial side of arm
Lifting heavy weights overhead to hand
Severe coughing
Associated TPs
Symptoms/Indications Pectoralis major
Chest pain Sternocleidomastoid
“Stitch in side” while running Middle scalene
Unable to lie on affected muscle
Shortness of breath Differential Diagnoses
Costochondritis
Intercostal nerve entrapment
Herpes zoster
Broken rib
Lateral views of right

shoulder and arm

shoulder and arm

Sternalis
Shoulder & Arm

Acute myocardial infarction Pectoralis major
Angina pectoris Sternocleidomastoid
Direct trauma to chest
Symptoms/Indications Costochondritis
Intense deep substernal pain Cardiac disease
Soreness over the sternum
Pain Patterns
Heart-shaped over center
of chest
Radiates down anterior shoulder to
medial arm
Anterior views of thorax
Shoulder & Arm 17

Pectoralis Major
Possible Causes Symptoms/Indications
Rounded shoulder posture Activation of
Chronic shortening of the muscle sternocleidomastoid TPs
Heavy lifting Pain in front of shoulder
Overuse of shoulder adduction Pain over the pericardium
Immobilization of arm Limited abduction at the shoulder
Anterior views of right

shoulder and arm

Pectoralis Major
Shoulder & Arm

Pain Patterns Differential Diagnoses
Anterior shoulder Angina pectoris
Entire pectoral region Tear of muscle
Medial side of arm, down Bicipital/supraspinatus
to medial forearm tendinitis
Associated TPs
Latissimus dorsi
Teres major
Subscapularis

shoulder and arm
Shoulder & Arm 19

Pectoralis Minor
Rounded shoulders Anterior chest
Trauma, such as recoil from rifle Concentrated in anterior shoulder
Strain from overuse as a Radiates down medial side of arm
shoulder depressor to fingertips
Strain during inhalation
Associated TPs
Symptoms/Indications Pectoralis major
Major complaint is pain over the Anterior deltoid
anterior deltoid region Scalenes
Difficulty reaching forward and up Sternocleidomastoid
Neurovascular symptoms through
entrapment of neurovascular Differential Diagnoses
bundle Thoracic outlet syndrome
C-7, C-8 radiculopathy
Bicipital/supraspinatus tendinitis

shoulder and arm

Subclavius
Shoulder & Arm

Pain Patterns
Inferior to clavicle
Anterior arm
Lateral forearm and hand

shoulder and arm
Shoulder & Arm 21

Biceps Brachii
Elevation of arm above shoulder level Anterior shoulder down to anterior
Overstress during activities, such as surface of elbow
strong tennis backhand or lifting
a heavy object with palm of Associated TPs
hand facing upward Brachialis
Repeated supination Supinator
Triceps brachii
Superficial, anterior shoulder pain Differential Diagnoses
Tenderness over bicipital tendon Bicipital tendinitis
Weakness raising hand above Subacromial/subdeltoid bursitis
the head Bicipital bursitis

shoulder and arm

Triceps Brachii
Shoulder & Arm

Excessive city driving with Posterior shoulder
manual transmission Posterior arm and forearm down to
Overenthusiastic exercise pinkie and ring finger
Needlepoint without elbow support
Difficult to locate pain in
posterior shoulder
Inability to fully extend elbow
Posterior views
Shoulder & Arm 23

Triceps Brachii
Associated TPs Differential Diagnoses
Latissimus dorsi Entrapment of radial nerve
Teres major “Tennis elbow”
Teres minor Lateral or medial epicondylitis
Posterior views

Coracobrachialis
Shoulder & Arm

Possible Causes
Active trigger points in the anterior
deltoid, biceps brachii, and
pectoralis major
Pain with shoulder extension
Upper limb pain
Pain Patterns
Anterior shoulder, skipping
down posterior arm, forearm,
and hand
Supraspinatus tendinitis
Acromioclavicular joint dysfunction
Carpal tunnel syndrome
shoulder and arm

shoulder and arm
Shoulder & Arm 25

Forearm & Handx
Brachialis
Overload of forearm flexion Biceps brachii
during heavy lifting Brachioradialis
“Tennis elbow” Supinator
Forearm & Hand

Radial nerve entrapment C-5, C-6 radiculopathy
Soreness of the thumb Bicipital tendinitis
Pain over anterior deltoid Supraspinatus tendinitis
Pain Patterns
Anterior shoulder
Inner elbow
Thenar eminence

shoulder and arm
Dorsal view of
right hand
Forearm & Hand 27

Brachioradialis
Repetitive, forceful gripping, such Lateral elbow
as weeding with a trowel or Lateral forearm to dorsal side
scraping ice off a windshield of thenar eminence
Continual re-injury of area
Associated TPs
Symptoms/Indications Extensor carpi radialis longus
Pain in lateral epicondyle, spreading and brevis
to wrist and hand Extensor digitorum
Weakness of grip
Pain and limited movement Differential Diagnoses
Lateral epicondylitis
Lateral views .
of right hand

Extensor Carpi Radialis Longus and Brevis
Repetitive, forceful gripping, such Longus
as weeding with a trowel or Posterior elbow, forearm, and hand
scraping ice off a windshield Dorsal thenar eminence
Continual re-injury of area Brevis
Dorsal wrist and hand
Pain in lateral epicondyle, Associated TPs
Forearm & Hand

spreading to wrist and hand Extensor digitorum
Weakness of grip Brachioradialis
Pain and limited movement
Lateral epicondylitis
Extensor carpi
radialis longus
Extensor carpi
radialis brevis
Posterior view of right forearm, showing TP Posterior view of right forearm, showing TP .
of extensor carpi radialis longus of extensor carpi radialis brevis
Forearm & Hand 29

Extensor Carpi Ulnaris
Possible Causes
Gross trauma, such as fracture of ulna
Prolonged immobilization
Pain in lateral epicondyle,
spreading to wrist and hand
“Tennis elbow”
Weakness of grip
Pain and limited movement
Pain Patterns
Ulnar surface of wrist
Associated TPs
Extensor digitorum
Arthritis
Extensor carpi
ulnaris
Posterior view of
right hand

Extensor Digitorum and Extensor Indicis
Forceful or repetitive wrist Digitorum
or finger extension Posterior forearm to middle and ring
Fracture of forearm fingers
Anterior wrist
Symptoms/Indications Indicis
Weakness of grip, accompanied by Dorsal surface of wrist to index
pain in the elbow finger
Forearm & Hand

Pain on lateral elbow
Stiffness and painful cramping
of the fingers
Extensor
digitorum
Posterior view of right arm and hand (left),

anterior view (right); showing TP and pain
pattern of extensor digitorum
Forearm & Hand 31

Extensor Digitorum and Extensor Indicis
Associated TPs
Extensor carpi ulnaris
“Tennis elbow”
C-7 radiculopathy
Subluxations of carpal bones
Extensor
digitorum
Extensor
indicis
Posterior view of right arm and

hand, showing TP and pain pattern
of extensor digitorum
Posterior view of right hand, .

showing TP of extensor indicis

Flexor Carpi Radialis
Possible Causes
Acute or chronic overloading
of the muscle
Excessive gripping movements, such
as gripping steering wheel over
long drives
Forearm & Hand

Difficulty using scissors
Pain Patterns
Palmar surface of wrist and hand
Associated TPs
Surrounding flexor muscles
Medial epicondylitis
Ulnar neuropathy
Arthritis of wrist

arm and hand
Forearm & Hand 33

Palmaris Longus
Direct trauma Anterior forearm
Fall onto an outstretched hand Palm of hand
Tool pressed into a cupped hand
Leaning on a cane Associated TPs
Hand and finger flexors
Difficulty handling tools (pressure Differential Diagnoses
of tool in hand causes pain) Carpal tunnel syndrome
Tenderness in palm

arm and hand

Flexor Carpi Ulnaris
Possible Causes
of the muscle
Excessive gripping movements,
such as gripping steering wheel
over long drives
Forearm & Hand

Pain Patterns
Medial surface of wrist and hand
Associated TPs
Ulnar neuropathy
Arthritis of wrist

arm and hand
Forearm & Hand 35

Flexor Digitorum Superficialis and Profundus
Possible Causes
of the muscle
Excessive gripping movements,
such as gripping steering wheel
over long drives
Pain Patterns
Palmar surface of hand into middle,
ring, and pinkie fingers (and beyond)
Associated TPs
Ulnar neuropathy
Carpal tunnel syndrome Flexor
digitorum
Arthritis of wrist superficialis
Anterior view of right arm and

hand, showing TPs of flexor
digitorum superficialis

Pronator Teres
Fracture at the wrist or elbow Anterior surface of forearm,
Prolonged typing concentrated at wrist
Symptoms/Indications Associated TPs

Unable to supinate forearm Finger flexors
Scalenes
Forearm & Hand

Anterior views
of right arm and
hand
Forearm & Hand 37

Supinator
Resisting unexpected pronation Lateral elbow
Extremely forceful supination Dorsal surface of thenar eminence
Forceful and repetitive supination
of the forearm Associated TPs
Carrying heavy suitcase Triceps brachii
Extensors of the fingers
Symptoms/Indications Brachioradialis
Lateral epicondylar pain
Pain in web of thumb Differential Diagnoses
“Tennis elbow”
Entrapment of the posterior
interosseous nerve
Anterior view (left), posterior view

(right) of right arm and hand

Adductor Pollicis
Pulling weeds Thumb feels uncoordinated
Milking animals Poor handwriting
Repetitive fine movements Difficulty with fine movements
of thumb for specific tasks
Former bone injury
“Trigger thumb” Pain Patterns
All sides of the thumb and
Forearm & Hand

thenar eminence
Palmar view of right

hand
Forearm & Hand 39

Adductor Pollicis
Associated TPs
First dorsal interossei muscle
Flexor pollicis brevis
Abductor pollicis brevis
Carpometacarpal osteoarthritis
Palmar view of right hand
Dorsal view of right hand

Flexor Pollicis Longus
Possible Causes
Milking animals
Excessive weeding with clippers or other
hand tools
Forceful grasping joined with rocking,
twisting motions
Forearm & Hand

Pain in thumb
Pain Patterns
Length of thumb
Ulnar neuropathy
Arthritis of wrist
Anterior view of right .

arm and hand
Forearm & Hand 41

Dorsal Interossei
Possible Causes
Sustained or repetitive
pincer grasping
Playing the piano
Sustained forceful finger
movements
Arthritis pain in the fingers
Stiffness in the fingers
Sore, swollen joints
Dorsal view of right
hand, showing TP and
Pain Patterns pain pattern of first
First interossei interossei
Index and pinkie fingers
Dorsal surface of hand
Second interossei
Middle finger
Associated TPs
Intrinsic thumb muscles
Long extensors and flexors of fingers
C-6 radiculopathy
Ulnar neuropathy
Nerve entrapment of brachial plexus
Palmar view of
right hand, showing
pain pattern of first
interossei
Dorsal view of right

hand, showing TPs and
pain pattern of second
interossei

Spine & Thoraxx
Iliocostalis
Possible Causes
Sudden overload or traumatic event
Repeated muscular contraction
Quick bending and twisting
Prolonged immobility, such as sitting
on a plane
Pain in the back
Restricted spinal movement
Difficulty rising from chair and/or
climbing stairs
Pain Patterns
Spine & Thorax

Entire length of back next to vertebrae,
radiating into the region
of scapula, lower ribs, and buttocks
Posterior view
Spine & Thorax 43

Iliocostalis
Associated TPs
Latissimus dorsi
Quadratus lumborum
Serratus posterior inferior
and superior
Articular dysfunctions
Fibromyalgia
Visceral disease
Posterior views

Longissimus Thoracis
Possible Causes
Sudden overload or traumatic event
Repeated muscular contraction
Quick bending and twisting
Prolonged immobility, such as
sitting on a plane
Difficulty rising from chair and/or
climbing stairs
Pain Patterns
Buttocks and low back
Associated TPs
Latissimus dorsi
Spine & Thorax

Quadratus lumborum
Serratus posterior inferior
Articular dysfunctions
Fibromyalgia
Visceral disease
Posterior view
Spine & Thorax 45

Multifidi and Rotatores
Sudden overload or traumatic event Between scapulae
Repeated muscular contraction Sacrum
Quick bending and twisting Posterior buttock region
Prolonged immobility, such as
sitting on a plane Associated TPs
Latissimus dorsi
Symptoms/Indications Quadratus lumborum
Pain in the back Serratus posterior inferior and superior
Difficulty rising from chair and/or Differential Diagnoses
climbing stairs Articular dysfunctions
Fibromyalgia
Visceral disease
Posterior views, .
multifidi shown

Semispinalis Capitis
Possible Causes
Hitting head
Acute overload
Postural stress
Headache
Tenderness over back of
head and neck
Numbness, tingling, or burning
in the scalp
Pain Patterns
Headband pattern
around cranium
Spine & Thorax

Fibromyalgia
Facet joint osteoarthritis
Posterior view
of neck
Lateral view
Spine & Thorax 47

Splenius Capitis
Postural stress Erector spinae muscles
Falling asleep with neck in odd Semispinalis thoracis
position
Motor vehicle accident Differential Diagnoses
C-2 articular dysfunction
Symptoms/Indications Occipitoatlantal dysfunction
Pain at top of the head Whiplash syndrome
Pain Patterns
Top of the cranium
Lateral view

Splenius Cervicis
Possible Causes
Postural stress
Sleeping with neck in odd position
Excessive rotation or extension of head
Pain in neck, cranium and eye
“Stiff neck”
Pain Patterns
Lateral eyebrow, radiates to
temporal region
Posterior neck
Associated TPs
Erector spinae
Spine & Thorax

Semispinalis thoracis
C-2 articular dysfunction
Occipitoatlantal dysfunction
Whiplash syndrome Posterior
view
Lateral view
Spine & Thorax 49

Suboccipitals
Forward head posture Temporal and occipital regions
Sustained forward flexion
of the head Differential Diagnoses
Tension-type headache
Symptoms/Indications Cervicogenic headache
Headache Occipital neuralgia
Deep-seated pain in upper neck Articular dysfunctions in upper
Difficulty rotating head cervicals
Lateral view

Quadratus Lumborum
Possible Causes
Sudden trauma
Awkward movements
Low back pain
Chronic myofascial pain syndrome
Articular dysfunction
Restricted forward bending
Difficulty leaning to the
opposite side
Difficulty climbing stairs
Spine & Thorax

lumbar region
Spine & Thorax 51

Quadratus Lumborum
Pain Patterns
Lateral and posterior hip
Associated TPs
External and internal obliques
Psoas major
Erector spinae
Rectus abdominis
Sacroiliac joint dysfunction
Lumbar or sacral ligament pain
Bursitis of hip
Posterior view
Anterior/lateral view

Rectus Abdominis and External Oblique
Poor posture Surrounding abdominal muscles
Acute or chronic overload Hip adductor muscles
of the abdominals
Direct trauma Differential Diagnoses
Toxic or emotional stress Articular dysfunctions
Fibromyalgia
Symptoms/Indications Appendicitis
Pressure and bloating Peptic ulcer
Heartburn Colitis
Vomiting
Pain Patterns
Rectus abdominis
Across midback
Across posterior iliac crests
External oblique
Spine & Thorax

Inferior chest
Superior abdomen
Radiates down to opposite hip
Anterior view, showing TPs of

rectus abdominis
Posterior view, showing pain
patterns of rectus abdominis TPs
Spine & Thorax 53

Rectus Abdominis and External Oblique
Anterior views, showing TPs and pain

patterns for external oblique

Serratus Posterior Superior
Possible Causes
Excessive coughing (from
pneumonia or asthma)
Poor posture
Quick movements
Sitting for long periods
Deep ache at rest
Increased pain when lifting
Pain Patterns
Posterior scapula
Posterior shoulder, arm,
and forearm down to hand
Associated TP
Spine & Thorax

Scalenes
Rhomboids
Iliocostalis thoracis
Differential Diagnoses Posterior view of right

shoulder and arm
Radiculopathy
Olecranon bursitis

shoulder and arm
Spine & Thorax 55

Serratus Posterior Inferior
Combined movement of lifting, Iliocostalis thoracis
turning, and reaching Longissimus thoracis
Hyperextension of back
Symptoms/Indications Renal disease
Nagging ache in lower Lower thoracic radiculopathy
thoracic region
Pain Patterns
Directly over muscle
Posterior view

Head, Neck & Face
Sternocleidomastoid
Poor posture Soreness in the neck
Excessive forward head posture “Stiff neck”
Sitting with head turned to side for Tilting of head to same side
long period Tension headache
Protracted neck extension
Whiplash injury Pain Patterns
Face and cranium
Forehead, ear, and occiput
Strongly around eyebrow
Head, Neck & Face
Superficial head
Anterior, lateral view

Sternocleidomastoid
Opposite sternocleidomastoid Vascular headache
Scalenes Atypical facial neuralgia
Levator scapula Trigeminal neuralgia
Trapezius Ménière’s disease
Deep head

Scalenes
Accidental trauma Lateral shoulder, arm, forearm,
Carrying awkward, large objects index finger, and thumb
Whiplash injury Upper pectoral region
Medial border of scapula
Pain in shoulder, upper limb
Venous obstruction
Pain in upper back
Disturbed sleep
Numbness and tingling in hand
Anterior scalene
Middle scalene
Head, Neck & Face

Posterior scalene

of neck

Scalenes
Associated TPs
Other scalenes
Sternocleidomastoid
Splenius capitis
C-4 to C-6 articular dysfunction

shoulder and arm

shoulder and arm

Masseter
Sudden, forceful contraction Molars
Repetitive jaw habits Temporomandibular joint
Chronic mouth breathing Mandibular and eyebrow area
Psychological stress
Temporomandibular joint symptoms
Tension in masseter and temporalis
Restriction of jaw opening and
unilateral tinnitus
Head, Neck & Face

Lateral view of
superficial belly
Lateral view of
superficial belly

Masseter
Temporalis Tinnitus
Medial pterygoid Pulpitis
Sternocleidomastoid Inflammation of the periodontal
ligament
Tension-type headaches
Earache
Toothache
Lateral view of
superficial belly
Lateral view of deep belly,

superficial belly cut

Temporalis
Possible Causes
Grinding or clenching of teeth
Direct trauma, such as a fall
Forward head posture
Head pain
Toothache
Pain Patterns
Upper row of teeth
Temporal region
Over the eyebrow
Associated TPs
Masseter on same side
Temporalis on opposite side
Medial and lateral pterygoids
Temporomandibular
joint disorders
Diseased teeth
Tension-type headaches
Temporal tendinitis Lateral views
Head, Neck & Face

Digastric
Possible Causes
Retrusion of mandible
Mouth breathing
Excessive grinding of teeth
Difficulty swallowing
Sensation of lump in throat
Difficulty turning head
Pain Patterns
Lower front teeth
Upper, lateral neck below ear
Associated TPs
Masseter
Temporalis
Lateral views
Neighboring muscle TPs
Anterior, inferior view

Occipitofrontalis
Possible Causes
Frontalis
Sternocleidomastoid TPs
“Stress”
Chronically raised eyebrows
Occipitalis
Decreased visual acuity
Posterior cervical muscles TPs
Intolerance to pressure on back of head
Pain Patterns
Frontalis
Directly over muscle
Occipitalis
Parietal region and upper eyelid
Tension-type headache
Frontalis
Sternocleidomastoid TPs
Anterior view, highlighting
Occipitalis frontalis TPs and pain patterns
Occipital neuralgia
Head, Neck & Face
Lateral view, highlighting

occipitalis TPs and pain patterns

Medial Pterygoid
Forward head posture Refers pain into temporomandibular
Lateral pterygoid TPs joint and side of jaw
Excessive gum-chewing
Grinding and clenching of teeth Differential Diagnoses
Anxiety Lateral pterygoid, masseter,
and sternocleidomastoid TPs
Increased pain when opening mouth
wide or chewing food
Clenching teeth
Soreness inside throat
Painful swallowing
Lateral view, mandible cut

Lateral Pterygoid
Sternocleidomastoid TPs Temporomandibular joint
Mechanical stress caused Front of face
by poor posture
Excessive grinding of teeth Differential Diagnoses
Playing a wind instrument Medial pterygoid TPs
Trigeminal neuralgia
Severe pain in the temporo-
mandibular joint region
Shortening of muscle
Tinnitus
Pain when chewing
Head, Neck & Face
Lateral view, mandible cut

Pelvis & Thighx
Rectus Femoris
Possible Causes
Fall or accident that produces
sudden eccentric contraction
Skiing accident
Sitting for long time with heavy
object on lap
Recovery from hip surgery
Weakness of knee extension
Waking at night with pain in
front of patella
Weakness in knees when
going downstairs
Pain Patterns
Most intense at patellar region
Distal, anterior thigh
Associated TPs
Gluteus minimus and tensor
fasciae latae
Other quadriceps muscles
Biceps femoris
Disease of hip joint
Pain from surgical procedure of hip
Pelvis & Thigh

hip and thigh
Pelvis & Thigh 69

Vastus Medialis
Acute overload from sudden Medial knee and thigh
eccentric contraction
Stumbling or unexpectedly Associated TPs
stepping off a curb Gluteus minimus and tensor
Exercise that includes deep fasciae latae
knee bends Other quadriceps muscles
Biceps femoris
Weakness of knee extension Differential Diagnoses
Pain deep in knee joint Disease of hip joint
Buckling of knee Pain from surgical procedure of hip
Vastus
medialis

hip and thigh

Vastus Lateralis
Acute overload from sudden eccentric Weakness of knee extension
contraction Hurts to walk, pain on lateral
Stumbling or unexpectedly aspect of knee
stepping off a curb
Exercise that includes deep Pain Patterns
knee bends Lateral hip, thigh, and knee
Pelvis & Thigh

hip and thigh
Pelvis & Thigh 71

Vastus Lateralis
Gluteus minimus and tensor Disease of hip joint
fasciae latae Pain from surgical procedure of hip
Other quadriceps muscles Trochanteric bursitis
Biceps femoris

hip and thigh

Pelvis & Thigh

hip and thigh
Pelvis & Thigh 73

Vastus Intermedius
Acute overload from sudden Anterior thigh
eccentric contraction
Stumbling or unexpectedly Associated TPs
stepping off a curb Gluteus minimus and tensor
Exercise that includes deep fasciae latae
knee bends Other quadriceps muscles
Biceps femoris
Weakness of knee extension Differential Diagnoses
Difficulty straightening knee Disease of hip joint
Pain from surgical procedure of hip
Vastus
intermedialis
Anterior views of
right hip and thigh

Biceps Femoris
Posterior thigh compression by Posterior thigh
ill-fitting chair Most intense at posterior knee
Uncomfortable furniture
Prolonged sitting Associated TPs
Posterior adductor magnus
Symptoms/Indications Vastus lateralis
Pain on walking Gastrocnemius
When sitting, pain in buttock
and upper thigh Differential Diagnoses
Pain when getting up from Surrounding muscle TPs
a chair Sciatica/pseudo-sciatica
Biceps
femoris
Pelvis & Thigh
Posterior views of
right hip and thigh
Pelvis & Thigh 75

Semitendinosus and Semimembranosus
Posterior thigh compression Posterior thigh
by ill-fitting chair Most intense at proximal thigh
Uncomfortable furniture
Prolonged sitting Associated TPs
Posterior adductor magnus
Symptoms/Indications Vastus lateralis
Pain on walking Gastrocnemius
When sitting, pain in buttock
and upper thigh Differential Diagnoses
Pain when getting up from a chair Surrounding muscle TPs
Sciatica/pseudo-sciatica
Both semis
Posterior views of
right hip and thigh

Gluteus Maximus
Possible Causes
Walking uphill
Vigorous contraction in a shortened
position
Vigorous eccentric contraction
when preventing a fall
Direct blow to buttock
Sleeping on one side with hip flexed
Swimming front crawl
Sitting too long in one position
Repetitious tasks involving
leaning over
Uncomfortable and restless
when seated
Pain Patterns
Posterior buttock
Posterior surface of sacrum
Posterior views
Pelvis & Thigh
Pelvis & Thigh 77

Gluteus Maximus
Posterior portion of Differentiated from the medius and
gluteus medius minimus by topographical location
Hamstring muscles in the buttock, distribution of pain,
and depth of TP tenderness
Fibrosis of superficial lumbosacral
fascia
Posterior views

Gluteus Medius
Sudden falls Posterior, lateral buttock
Sports injuries Posterior surface of sacrum
Running Posterior iliac crest
Long tennis matches
Associated TPs
Symptoms/Indications Piriformis
Pain when walking Posterior aspect of gluteus
Difficulty sleeping on affected side minimus and maximus
Uncomfortable when sitting in a
slumped position Differential Diagnoses
Gluteus maximus TPs
Sacroiliac joint dysfunction
Pain in lumbar facet joints
Low back pain
Pelvis & Thigh
Posterior, lateral views of right hip and thigh
Pelvis & Thigh 79

Gluteus Medius
Posterior, lateral views of right hip and thigh

Gluteus Minimus
Sacroiliac joint dysfunction Hip pain that may cause limp
Nerve root irritation Pain when lying on affected side
Prolonged immobility Difficulty rising from a chair and
standing up straight
Pelvis & Thigh
Posterior, lateral views of right

hip, thigh, and leg
Pelvis & Thigh 81

Gluteus Minimus
Pain Patterns
Posterior buttock
Lateral, posterior thigh and leg
Associated TPs
Gluteus medius
Piriformis
Vastus lateralis
Trochanteric bursitis
Pain from articular dysfunction
Sciatica
Posterior, lateral view .

of right hip, thigh, and leg

Adductor Magnus
Sudden overload, such as Groin area
slipping on ice Medial thigh
Forcefully resisting hip abduction Rectum
Osteoarthritis of the hip
Strenuous horseback riding Associated TPs
Sitting for long periods of time Other adductors
(driving) Vastus medialis

Intra-pelvic pain, specifically localized Groin and medial thigh pain
to the vagina or rectum during Trauma to musculoskeletal structures
sexual intercourse Articular dysfunction
Groin pain
Pelvis & Thigh
Posterior view of right Anterior view

hip and thigh
Pelvis & Thigh 83

Adductor Longus and Brevis
Sudden overload, such as Anterior thigh, radiates down
slipping on ice anterior leg
Forcefully resisting hip abduction
Osteoarthritis of the hip Associated TPs
Strenuous horseback riding Other adductors
Sitting for long periods of time Vastus medialis

Pain in the groin during vigorous Groin and medial thigh pain
activity (not at rest) Trauma to musculoskeletal structures
Severe restriction of abduction of Articular dysfunction
thigh
Anterior views

Pectineus
Tripping or falling Iliopsoas
Unexpected strong resistance to Adductors
adduction of thigh Gracilis
Horseback riding
Sustained posture that puts muscle Differential Diagnoses
in shortened position Obturator nerve entrapment
Disease of hip joint
Symptoms/Indications Pubic symphysitis
Persistent, deep-seated groin pain
Limited abduction of the hip
Pain Patterns
Proximal, medial thigh and groin
Pelvis & Thigh
Anterior, medial views of

right hip and thigh
Pelvis & Thigh 85

Tensor Fasciae Latae
Possible Causes
Landing on feet from high jump
Walking or running on sloped surface
Immobilization in shortened position
for long periods
Referred pain in hip joint
Poor tolerance for prolonged sitting
Inability to lie on side of TP
Pain Patterns
Lateral thigh and hip
Associated TPs
Gluteus minimus
Rectus femoris
Iliopsoas
Sartorius
Gluteus medius and minimus TPs
L-4 neuropathy
Trochanteric bursitis
Lateral view of right

hip and thigh

Sartorius
Possible Causes
Secondary TPs of muscle of the thigh
Overload strain in a twisting fall
Pain along pathway of muscle
Pain Patterns
Following path of muscle down
anterior, medial thigh
Associated TPs
Rectus femoris
Vastus medialis
Vastus medialis TPs
Myogelosis
Disease of knee joint
Pelvis & Thigh
Anterior, medial view of

right hip and thigh
Pelvis & Thigh 87

Piriformis
Catching oneself in a fall Posterior, lateral buttock
Twisting sideways while bending Posterior thigh
Lifting a heavy load
Direct trauma Associated TPs
Driving a car with foot in same place Posterior aspect of the
over long period gluteus minimus
Both gemelli
Symptoms/Indications Obturator internus
Pain in low back, groin,
buttock, and hip Differential Diagnoses
Rectal pain during defecation Sacroiliac joint dysfunction
Herniated intervertebral disc
Posterior views

Iliopsoas
Surrounding muscle TPs Vertical low back pain
Prolonged sitting Pain is worse when standing up
Sleeping in a fetal position Pain in anterior thigh
Vigorous sit-ups
Rectus femoris tightness (which Pain Patterns
prevents full hip extension) Proximal, anterior thigh
Lumbar region and upper buttock
Pelvis & Thigh
Anterior view
Pelvis & Thigh 89

Iliopsoas
Associated TPs
Quadratus lumborum
Lower section of rectus abdominis
Longissimus thoracis
Rectus femoris
Tensor fasciae latae
Quadratus lumborum TPs
Lower section of rectus
abdominis TPs
Longissimus thoracis TPs
Anterior view
Posterior view

Leg & Footx
Gastrocnemius
Possible Causes Wearing high socks with a tight
Riding a bike with the seat too low elastic band
Walking along slanted surface, Sitting in a reclining chair, compro-
such as a beach mising circulation to calf muscles
Standing for prolonged
periods, leaning forward
Posterior views of right leg, .

foot plantar flexed
Leg & Foot
Leg & Foot 91

Gastrocnemius
Symptoms/Indications Associated TPs
Calf cramps Soleus and hamstrings
Pain in back of knee when
climbing up steep slope Differential Diagnoses
S-1 radiculopathy
Pain Patterns
Posterior knee
Posterior leg
Arch of foot
Posterior views of right leg, .

foot plantar flexed

Soleus
Slipping when stepping onto a curb Posterior leg
Overloading the muscle Heel of foot
Direct trauma Posterior sacrum
High heels
Compromised circulation of calf Associated TPs
Gastrocnemius
Symptoms/Indications Flexors of the ankles and toes
Tenderness in the heel
Unbearable to place weight on heel Differential Diagnoses
Nocturnal calf pain Quadratus lumborum TPs
Edema of foot and ankle Heel spur
Baker’s cyst
Achilles tendinitis
Posterior views of right thigh

and leg, foot plantar flexed
Leg & Foot
Leg & Foot 93

Plantaris
Possible Causes
Slipping when stepping onto a curb
Overloading the muscle
Direct trauma
High heels
Compromised circulation of calf
Pain in posterior knee and leg
Pain Patterns
Posterior knee and leg
Associated TPs
Gastrocnemius
Flexors of the ankles and toes
Quadratus lumborum TPs
Heel spur
Baker’s cyst
Achilles tendinitis
Posterior view of right leg, .

foot plantar flexed

Popliteus
Possible Causes
Running and twisting knee during Associated TPs
sports, such as football or soccer Both heads of gastrocnemius
Skiing downhill
Quick deceleration from running Differential Diagnoses
Tearing of posterior cruciate ligament Popliteus tendinitis
Baker’s cyst
Symptoms/Indications Thrombosis of the popliteal vein
Pain in posterior knee when Tear of meniscus
crouching or running,
especially downhill
Pain Patterns
Posterior knee
Posterior view of
right knee
Leg & Foot
Leg & Foot 95

Fibularis Longus and Brevis
Fall with twisting Lateral leg and ankle
Inversion of the ankle
Prolonged immobilization Associated TPs
by a cast Extensors of the ankle
Gluteus minimus TPs Gluteus minimus

Pain and tenderness in the ankle Neighboring muscle TPs
Foot drop Entrapment of common
Pain in feet fibular nerve
Ankle sprain
Muscle or tendon rupture
Fibularis longus
Fibularis brevis
Lateral views of
right leg and foot
Fibularis tertius

Fibularis Tertius
Lateral views of right leg and foot

showing trigger points and pain
patterns of Fibularis tertius
Leg & Foot
Leg & Foot 97

Tibialis Anterior
Ankle sprain or fracture Fibularis longus
Gross trauma
Walking on rough ground Differential Diagnoses
Symptoms/Indications L-5 radiculopathy
Pain in ankle and big toe Anterior compartment syndrome
Weakness of dorsiflexion
Dragging of foot that causes tripping
Pain Patterns
Anterior leg
Dorsal foot
Big toe
Anterior, medial views .

of right leg and foot

Extensor Digitorum Longus
Tripping or falling Fibulares
Gas pedal that puts ankle Tibialis anterior
at acute dorsiflexion
Excessive jogging or running Differential Diagnoses
Direct gross trauma Pain from synovial joints in tarsal
bones
Symptoms/Indications Neighboring muscle TPs
Pain in dorsal foot Hammertoes and claw toes
Foot drop weakness during walking Tendinitis
Night cramps in foot
Pain Patterns
Dorsal foot into dorsal toes
Extensor digitorum longus
Extensor hallucis longus
Anterior, lateral view of right

leg and foot
Leg & Foot
Leg & Foot 99

Extensor Hallucis Longus
Tripping or falling Fibulares
Gas pedal that puts ankle Tibialis anterior
at acute dorsiflexion
Excessive jogging or running Differential Diagnoses
Direct gross trauma Pain from synovial joints in tarsal
bones
Symptoms/Indications Neighboring muscle TPs
Pain in dorsal foot Hammertoes and claw toes
Foot drop weakness during walking Tendinitis
Night cramps in foot
Pain Patterns
Dorsal foot into dorsal toes
Extensor digitorum longus
Extensor hallucis longus
Anterior, lateral view of right

leg and foot

Tibialis Posterior
Running or jogging Flexor digitorum longus
on uneven ground Flexor hallucis longus
Ill-fitting footwear Fibularis muscles

Pain in foot when Shin splints
running or walking Deep posterior compartment
syndrome
Pain Patterns Posterior tibial tendon dysfunction
Posterior leg
Most intense in calcaneal tendon area
Sole of foot and heel
Posterior views of right leg,

foot plantar flexed
Leg & Foot
Leg & Foot 101

Flexor Digitorum Longus
Possible Causes
Running or jogging on uneven ground
Hyperpronation
Impaired mobility of ankle or foot
Inflexible shoe sole
Foot pain while walking
Pain on plantar surface of
forefoot and toes
Pain Patterns
Posterior leg
Most intense on plantar
surface of foot
Associated TPs
Tibialis posterior
Long and short extensors
of the toes
Tarsal tunnel syndrome
Hammertoes and claw toes Flexor
Neighboring muscle TPs digitorum
Hallux valgus longus
Flexor
hallucis
longus
Posterior view of right leg,

foot plantar flexed

Flexor Hallucis Longus
Possible Causes
Running or jogging on uneven ground
Hyperpronation
Impaired mobility of ankle or foot
Inflexible shoe sole
Foot pain while walking
Pain on plantar surface of
forefoot and toes
Pain Patterns
Plantar surface of big toe
Head of first metatarsal
Associated TPs
Tibialis posterior
Long and short extensors
of the toes
Tarsal tunnel syndrome
Hammertoes and claw toes
Neighboring muscle TPs Flexor
Hallux valgus digitorum
longus
Flexor
hallucis
longus
Posterior view of right leg,

foot plantar flexed
Leg & Foot
Leg & Foot 103

Extensor Digitorum Brevis
Tight-fitting shoe Dorsal surface of foot
Fracture of the ankle
Trauma to the foot Associated TPs
Stubbing of toes Extensor muscles of the toes
Hyperpronation Surrounding muscles

Intolerably sore feet Plantar fasciitis
Fallen arches Bunions
Limited walking range
Extensor
hallucis
brevis
Extensor
digitorum
brevis
Dorsal, lateral views

of right foot

Flexor Digitorum Brevis
Possible Causes
Tight-fitting shoe
Trauma to the foot
Stubbing of toes
Hyperpronation
Intolerably sore feet
Fallen arches
Pain Patterns
Ball of the foot
Associated TPs
Extensor muscles of the toes
Surrounding muscles Flexor
digitorum
brevis
Plantar fasciitis
Flat feet
Bunions
Plantar views of right foot Leg & Foot
Leg & Foot 105

Abductor Hallucis
Possible Causes
Tight-fitting shoe
Trauma to the foot
Stubbing of toes
Hyperpronation
Fallen arches
Pain Patterns
Medial, plantar surface of foot
Associated TPs
Surrounding muscles
Abductor
Differential Diagnoses hallucis
Plantar fasciitis
Flat feet
Bunions
Plantar views of right foot

Abductor Digiti Minimi
Possible Causes
Tight-fitting shoe
Trauma to the foot
Stubbing of toes
Hyperpronation
Fallen arches
Pain Patterns
Lateral, plantar surface of foot
Associated TPs
Surrounding muscles
Differential Diagnoses Abductor

Plantar fasciitis digiti
Flat feet minimi
Bunions
Plantar views of right foot Leg & Foot
Leg & Foot 107

Extensor Hallucis Brevis
Tight-fitting shoe Dorsal surface of foot
Stubbing of toes Extensor muscles of the toes
Hyperpronation Surrounding muscles

Intolerably sore feet Plantar fasciitis
Fallen arches Flat feet
Limited walking range Bunions
Extensor
hallucis
brevis
Dorsal, lateral views

of right foot

Flexor Hallucis Brevis
Tight-fitting shoe Medial and plantar surface
Fracture of the ankle of base of big toe
Trauma to the foot
Stubbing of toes Associated TPs
Hyperpronation Neighboring foot muscles

Limitation of walking due to pain TPs of surrounding muscles of foot
Numbness of foot Plantar fasciitis
Feet feel swollen Pain secondary to hallux valgus
Muscular imbalance Stress fracture of foot
Articular dysfunction of foot
Hammertoes
Flexor
hallucis
brevis

Leg & Foot
Leg & Foot 109

Adductor Hallucis
Tight-fitting shoe Ball of foot
Stubbing of toes Neighboring foot muscles
Hyperpronation
Symptoms/Indications TPs of surrounding muscles of foot
Limitation of walking due to pain Plantar fasciitis
Numbness of foot Pain secondary to hallux valgus
Feet feel swollen Stress fracture of foot
Muscular imbalance
Hammertoes
Adductor
hallucis

Quadratus Plantae
Tight-fitting shoe Heel of foot
Stubbing of toes Neighboring foot muscles
Hyperpronation
Symptoms/Indications TPs of surrounding muscles of foot
Limitation of walking due to pain Plantar fasciitis
Numbness of foot Pain secondary to hallux valgus
Feet feel swollen Stress fracture of foot
Muscular imbalance
Hammertoes
Quadratus
plantae
Leg & Foot
Leg & Foot 111

Recommended Texts
Chaitow, Leon and Judith DeLany, Clinical Application of Neuromuscular Techniques,

Volume 1: The Upper Body, 2nd ed., Churchill Livingstone, Edinburgh, 2008.
Chaitow, Leon and Judith Walker DeLany, Clinical Application of Neuromuscular Techniques,
Volume 2: The Lower Body, Churchill Livingstone, Edinburgh, 2002.
Niel-Asher, Simeon, The Concise Book of Trigger Points, North Atlantic Publishing,
Berkeley, 2005.
Sharkey, John, The Concise Book of Neuromuscular Therapy, North Atlantic Publishing,
Berkeley, 2008.
Simons, David, Janet Travell, and Lois Simons, Myofascial Pain and Dysfunction: The Trigger
Point Manual, Volume 1, 2nd ed., Lippincott Williams & Wilkins, Baltimore, 1999.
Travell, Janet, and David Simons, Myofascial Pain and Dysfunction: The Trigger Point
Manual, Volume 2, Williams & Wilkins, Baltimore, 1992.
Quick Reference to Trigger Points 113

Index
i denotes illustration flexor hallucis brevis, 109, 109i
flexor hallucis longus, 101, 102i, 103, 103i
A
flexor pollicis longus, 41
abductor digiti minimi, 107, 107i
abductor hallucis, 106, 106i G
adductor brevis, 84 gastrocnemius, 75, 76, 91, 92, 93, 94, 95
adductor hallucis, 110, 110i gluteus maximus, 77–78, 79
adductor longus, 84 gluteus medius, 78, 79–80, 82
adductor magnus, 75, 76, 83 gluteus minimus, 69, 70, 72, 74, 79, 81–82,
adductor pollicis, 39–40 86, 88, 96
B I
biceps brachii, 4, 11, 22, 25, 27 iliocostalis, 43–44, 55, 56
biceps femoris, 69, 70, 72, 74, 75, 75i iliopsoas, 85, 86, 89–90
brachialis, 22, 27 infraspinatus, 10, 11, 12, 14
brachioradialis, 27, 28, 29, 38
L
C lateral pterygoid, 63, 66, 67
coracobrachialis, 25 latissimus dorsi, 8, 9, 13, 19, 24, 44, 45, 46
levator scapula, 6, 14, 15, 58
D
longissimus thoracis, 45, 56, 90
deltoid, 3–4, 10, 11, 20, 25, 27
digastric, 64 M
dorsal interossei, 40, 42 masseter, 1, 6, 61–62, 63, 64
medial pterygoid, 62, 66
E
multifidi, 46, 46i
extensor carpi radialis brevis, 28, 29, 29i
extensor carpi radialis longus, 28, 29, 29i O
extensor carpi ulnaris, 30, 32 occipitofrontalis, 65
extensor digitorum, 28, 29, 30, 31i, 31–32,
P
32i, 34
palmaris longus, 34
extensor digitorum brevis, 104, 104i
pectineus, 85
extensor digitorum longus, 99, 99i, 100i
pectoralis major, 4, 6, 8, 13, 16, 17, 18–19,
extensor hallucis brevis, 104i, 108, 108i
20, 25
extensor hallucis longus, 99i, 100, 101i
pectoralis minor, 1, 1i, 6, 20
extensor indicis, 31–32, 32i
piriformis, 79, 82, 88
external oblique, 53–54, 54i
plantaris, 94
F popliteus, 95
fibularis brevis, 96, 96i pronator teres, 37
fibularis longus, 96, 96i, 98 psoas major, 52. See also iliopsoas
fibularis tertius, 96i, 97, 97i
Q
flexor carpi radialis, 33
quadratus lumborum, 44, 45, 46, 51–52, 90
flexor carpi ulnaris, 35
quadratus plantae, 111, 111i
flexor digitorum brevis, 105, 105i
flexor digitorum longus, 101, 102, 102i, 103i R
flexor digitorum profundus, 36 rectus abdominis, 52, 53i, 53–54, 55i, 90
flexor digitorum superficialis, 36, 36i rectus femoris, 69, 86, 87, 89, 90
115
rhomboids, 15, 55 suboccipitals, 50
rotatores, 46 subscapularis, 8, 13, 19
supinator, 22, 27, 29, 38
S
supraspinatus, 10, 11
sartorius, 86, 87
scalenes, 14, 20, 37, 55, 58, 59–60 T
semimembranosus, 76 temporalis, 6, 61, 62, 63, 64
semispinalis capitis, 47 tensor fasciae latae, 69, 70, 72, 74, 86, 90
semitendinosus, 76 teres major, 8, 9, 13, 19, 24
serratus anterior, 1, 16 teres minor, 11, 12, 24
serratus posterior inferior, 44, 45, 46, 56 tibialis anterior, 98, 99, 100
serratus posterior superior, 44, 46, 55 tibialis posterior, 101, 102, 103
soleus, 92, 93 trapezius, 5–6, 10, 14, 15, 58
splenius capitis, 15, 48, 60 triceps brachii, 9, 13, 22, 23–24, 38
splenius cervicis, 49
V
sternalis, 17
vastus intermedius, 74
sternocleidomastoid, 16, 17, 18, 20, 57–58,
vastus lateralis, 71–72, 75, 76, 82
60, 62, 65, 67
vastus medialis, 70, 70i, 83, 84, 87
subclavius, 21
116 Index
Trigger Point Differential
Diagnostic Index
C-5, C-6 radiculopathy, 27, 28, 60
C-6 radiculopathy, 42. See also C-5, C-6
A
radiculopathy
Achilles tendinitis, 93, 94
C-7, C-8 radiculopathy, 20, 29, 30
acromioclavicular joint dysfunction, 25
C-7radiculopathy, 32
acromioclavicular joint separation, 12
cardiac disease, 17
adhesive capsulitis, 13
carpal tunnel syndrome, 25, 27, 28, 29, 33,
angina pectoris, 19
34, 35, 36, 37, 40, 41, 60
ankle sprain, 96
carpometacarpal osteoarthritis, 40
anterior compartment syndrome, 98
cervical arthritis, 10
appendicitis, 53
cervicals, articular dysfunctions in upper
arthritis
cervicals, 50
carpometacarpal osteoarthritis, 40
cervicogenic headache, 50
cervical arthritis, 10
claw toes, 99, 100, 102, 103
facet joint osteoarthritis, 47
colitis, 53
glenohumeral joint arthritis, 4, 11, 22
common fibular nerve entrapment, 96
of wrist, 33, 35, 36, 41
compression of axillary nerve, 12
articular dysfunctions
costochondritis, 16, 17
C-2 articular dysfunction, 48, 49
cysts, Baker’s cyst, 94, 95, 96
C-4 to C-6 articular dysfunction, 60
of foot, 109, 110 D
in general, 44, 45, 46, 53, 83, 84 deep posterior compartment syndrome, 101
pain from, 82 discs, herniated intervertebral disc, 88
in upper cervicals, 50 diseased teeth, 63
atypical facial neuralgia, 58 diseases
cardiac disease, 17
B
of hip joint, 69, 70, 72, 74, 85
Baker’s cyst, 93, 94, 95
of knee joint, 87
bicipital bursitis, 22
Meniere’s disease, 58
bicipital tendinitis, 4, 8, 11, 22, 27
renal disease, 56
brachial plexus entrapment, 42
visceral disease, 44, 45, 46
brachial plexus injuries, 10
dysfunctions
broken rib, 16
bunions, 104, 105, 106, 107, 108
articular dysfunctions, in general, 44, 45,
bursitis
46, 53, 83, 84
bicipital bursitis, 22
articular dysfunctions in upper cervicals,
of hip, 52
50
olecranon bursitis, 55
C-2 articular dysfunction, 48, 49
subacromial/subdeltoid bursitis, 4, 9, 10,
C-4 to C-6 articular dysfunction, 60
12, 22, 25
occipitoatlantal dysfunction, 48, 49
trochanteric bursitis, 72, 82, 86
posterior tibial tendon dysfunction, 101
C sacroiliac joint dysfunction, 52, 79, 88
C-2 articular dysfunction, 48, 49 scapulocostal dysfunction, 14, 15
C-4 to C-6 articular dysfunction, 60 scapulohumeral dysfunction, 11
117
E disease of hip joints, 69, 70, 72, 74, 85
earache, 62 pain from surgical procedure of, 69, 70,
elbow, tennis, 24, 32, 38 72, 74
entrapments I
of brachial plexus, 42 inflammation, of periodontal ligament, 62
of common fibular nerve, 96 intercostal nerve entrapment, 16
intercostal nerve entrapment, 16
obturator nerve entrapment, 85
J
joints
of posterior interosseous nerve, 38
of radial nerve, 24
acromioclavicular joint separation, 12
of suprascapular nerve, 8, 11
disease of knee joint, 87
epicondylitis
facet joint osteoarthritis, 47
lateral epicondylitis, 24, 28, 29
medial epicondylitis, 24, 33, 35, 36, 41
pain from synovial joints in tarsal bones,
F 99, 100
facet joint osteoarthritis, 47 pain in lumbar facet joints, 79
feet sacroiliac joint dysfunction, 52, 79, 88
articular dysfunction of, 109, 110 temporomandibular joint disorder, 6, 63
bunions, 104, 105, 106, 107, 108
claw toes, 99, 100, 102, 103
L
L-4 neuropathy, 86
flat feet, 105, 106, 107, 108
L-5 radiculopathy, 98
hammertoes, 99, 100, 102, 103
lateral epicondylitis, 24, 28, 29
heel spur, 93, 94
lateral pterygoid TPs, 66
stress fracture of, 109, 110, 111
longissimus thoracis TPs, 90
fibromyalgia, 6, 14, 44, 45, 46, 47, 53
low back pain, 79
fibrosis of superficial lumbosacral fascia, 78
lower thoracic radiculopathy, 56
flat feet, 105, 106, 107, 108
lumbar facet joints pain, 79
G lumbar ligament pain, 52
gluteus maximus TPs, 79
M
masseter TPs, 66
gluteus medius TPs, 86
masticatory muscles TPs, 6
gluteus minimus TPs, 86
medial epicondylitis, 24, 33, 35, 36, 41
groin pain, 83, 84
medial pterygoid TPs, 67
H medial thigh pain, 83, 84
hallux valgus, 102, 103, 109, 110, 111 Meniere’s disease, 58
hammertoes, 99, 100, 102, 103 meniscus, tear of, 95
headaches muscle, tear of, 19
cervicogenic headache, 50 myogelosis, 87
tension-type headache, 50, 62, 63, 65
vascular headache, 58
N
nerves
heel spur, 93, 94
compression of axillary nerve, 12
herniated intervertebral disc, 88
entrapment of brachial plexus, 42
herpes zoster, 16
entrapment of common fibular nerve, 96
hip
entrapment of posterior interosseous
bursitis of, 52
nerve, 38
118 Differential Diagnostic Index

entrapment of radial nerve, 24 R
entrapment of suprascapular nerve, 8, 11 radial nerve entrapment, 24
intercostal nerve entrapment, 16 radiculopathy
obturator nerve entrapment, 85 C-5, C-6, 27, 28, 60
spurs with nerve root irritation, 10 C-6, 42
neuralgia C-7, 32
atypical facial neuralgia, 58 C-7, C-8, 20, 29, 30
occipital neuralgia, 50, 65 in general, 55
trigeminal neuralgia, 58, 67 L-5, 98
neuropathy lower thoracic radiculopathy, 56
L-4, 86 S-1, 92
ulnar neuropathy, 8, 12, 33, 35, 36, 41, 42 rectus abdominis TPs, 90
O renal disease, 56
obturator nerve entrapment, 85 rib, broken, 16
occipital neuralgia, 50, 65 rotator cuff tear, 4, 10, 13
occipitoatlantal dysfunction, 48, 49 S
olecranon bursitis, 55 S-1 radiculopathy, 92
P sacral ligament pain, 52
pain sacroiliac joint dysfunction, 52, 79, 80
of the groin, 83, 84 scapulocostal dysfunction, 14, 15
low back pain, 79 scapulohumeral dysfunction, 11
in lumbar facet joints, 79 sciatica/pseudo-sciatica, 75, 76, 82
lumbar ligament pain, 52 shin splints, 101
medial thigh pain, 83, 84 splenius cervicis TPs, 15
sacral ligament pain, 52 sprains, ankle sprain, 96
secondary to hallux valgus, 109, 110, 111 spurs with nerve root irritation, 10
from surgical procedure of hip, 69, 70, sternocleidomastoid TPs, 15, 65, 66
72, 74 stress fracture of foot, 109, 110, 111
from synovial joints in tarsal bones, 99, subacromial/subdeltoid bursitis, 4, 9, 10,
100 12, 22, 25
peptic ulcer, 53 subluxations of carpal bones, 32
periodontal ligament, inflammation of, 62 suprascapular nerve entrapment, 8, 11
plantar fasciitis, 104, 105, 106, 107, 108, 109, supraspinatus tendinitis, 9, 19, 20, 25, 27
110, 111 syndromes
popliteal vein, thrombosis of, 95 anterior compartment syndrome, 98
popliteus tendinitis, 95 carpal tunnel syndrome, 25, 27, 28, 29, 33,
posterior interosseous nerve entrapment, 34, 35, 36, 37, 40, 41, 60
38 deep posterior compartment syndrome,
posterior tibial tendon dysfunction, 101 101
pseudo-sciatica, 75, 76 tarsal tunnel syndrome, 102, 103
pubic symphysitis, 85 thoracic outlet syndrome, 9, 13, 20, 55, 60
pulpitis, 62 whiplash syndrome, 48, 49
synovial joints in tarsal bones, pain from,
Q 99, 100
quadratus lumborum TPs, 90, 93, 94
Differential Diagnostic Index 119

T thrombosis of popliteal vein, 95
tarsal tunnel syndrome, 102, 103 tinnitus, 62
tears toes
of meniscus, 95 claw toes, 99, 100, 102, 103
of muscle, 19 hammertoes, 99, 100, 102, 103
of rotator cuff, 4, 10, 13 toothache, 62
teeth, diseased, 63 trigeminal neuralgia, 58, 67
temporal tendinitis, 63 trochanteric bursitis, 72, 82, 86
temporomandibular joint disorder, 6, 63 U
tendinitis ulcer, peptic, 53
Achilles tendinitis, 93, 94 ulnar neuropathy, 8, 12, 33, 35, 36, 41, 42
bicipital tendinitis, 4, 8, 11, 22, 27
in general, 99, 100
V
vascular headache, 58
popliteus tendinitis, 95
vastus medialis TPs, 87
supraspinatus tendinitis, 9, 19, 20, 25, 27
visceral disease, 44, 45, 46
temporal tendinitis, 63
tennis elbow, 24, 32, 38 W
tension-type headache, 50, 62, 63, 65 whiplash syndrome, 48, 49
thoracic outlet syndrome, 9, 13, 20, 55, 60 wrist, arthritis of, 33, 35, 36, 41
120 Differential Diagnostic Index

Trail Guide to the Body’s Quick Reference to Trigger Points
Quickly locate common trigger points for practical application. More
than 200 illustrations include detailed drawings showing pain patterns
and point locations of 96 muscles.
This guide will help students and practitioners identify the:
• Common location of a trigger point in a particular muscle belly
• Possible causes of trigger points
• Symptoms and indications
• Pain patterns
• Associated trigger points
Check out this other Quick Reference

by Andrew Biel!
Trail Guide to the Body’s Quick Reference
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Quick-and-easy guide to 47 strengthening
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Copyright © 2012, 2019 text, illustrations by Books of Discovery.

Published by Books of Discovery

Printed in South Korea by Four Colour Print Group

Design: Jessica Xavier, Planet X Design

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 1 Flexor Carpi Ulnaris . . . . . . . . . . . . . . . . 35

Rhomboid Major and Minor . . . . . . . . . . 14 Longissimus Thoracis . . . . . . . . . . . . . . 44

Levator Scapula . . . . . . . . . . . . . . . . . . . . 15 Multifidi and Rotatores . . . . . . . . . . . . . .46

Serratus Anterior . . . . . . . . . . . . . . . . . . 16 Semispinalis Capitis . . . . . . . . . . . . . . . . 47

Sternalis . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Splenius Capitis . . . . . . . . . . . . . . . . . . . . 48

Pectoralis Major . . . . . . . . . . . . . . . . . . . . 18 Splenius Cervicis . . . . . . . . . . . . . . . . . . . 49

Pectoralis Minor . . . . . . . . . . . . . . . . . . . 20 Suboccipitals . . . . . . . . . . . . . . . . . . . . . . 50

Subclavius . . . . . . . . . . . . . . . . . . . . . . . . 21 Quadratus Lumborum . . . . . . . . . . . . . . 51

Biceps Brachii . . . . . . . . . . . . . . . . . . . . . 22 Rectus Abdominis .

Forearm & Hand 27

Extensor Carpi Ulnaris . . . . . . . . . . . . . . 30 Temporalis . . . . . . . . . . . . . . . . . . . . . . . . 63

Extensor Digitorum and . Digastric . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Leg & Foot 91 Recommended Texts . . . . . . . . . . . . . . . 113

• An “X” indicates a common location where

Shoulder & Arm

Lateral views of right shoulder and

Shoulder & Arm 3

Lateral view of right

Anterior view of right

Posterior view of right

4 Quick Reference to Trigger Points

Shoulder & Arm

Shoulder & Arm 5

6 Quick Reference to Trigger Points

Shoulder & Arm 7

Posterior views of right

8 Quick Reference to Trigger Points

Shoulder & Arm

Posterior views of right

Shoulder & Arm 9

Posterior views of right

10 Quick Reference to Trigger Points

Shoulder & Arm

Shoulder & Arm 11

Posterior views of right

12 Quick Reference to Trigger Points

Shoulder & Arm

Anterior view of right

Posterior view of right

Shoulder & Arm 13

Symptoms/Indications Differential Diagnoses

Posterior views of right

14 Quick Reference to Trigger Points

Shoulder & Arm

Shoulder & Arm 15

Lateral views of right

Anterior view of right

16 Quick Reference to Trigger Points

Shoulder & Arm

Anterior views of thorax

Shoulder & Arm 17

Anterior views of right

18 Quick Reference to Trigger Points

Shoulder & Arm

Anterior views of right

Shoulder & Arm 19

Anterior views of right

20 Quick Reference to Trigger Points