Anatomy Myofascial Upper Quarter
1
,Inhoudsopgave
ANATOMY MYOFASCIAL UPPER QUARTER ....................................................................................................... 1
SHOULDER MUSCLES ........................................................................................................................................ 6
M. DELTOID .......................................................................................................................................................... 6
M. SUPRASPINATUS ......................................................................................................................................... 9
M. INFRASPINATUS ........................................................................................................................................ 11
TERES MINOR ................................................................................................................................................. 13
M. TERES MAJOR ............................................................................................................................................ 15
M. SUBSCAPULARIS ........................................................................................................................................ 17
SERRATUS ANTERIOR & LATISSIMUS DORSI ................................................................................................... 19
M SERRATUS ANTERIOR......................................................................................................................................... 19
M. LATISSIMUS DORSI ........................................................................................................................................... 22
PECTORALS AND SUBCLAVIUS ........................................................................................................................ 25
M. PECTORALIS MAJOR .................................................................................................................................. 25
M. PECTORALIS MINOR .................................................................................................................................. 27
M. SUBCLAVIUS .............................................................................................................................................. 29
CERVICAL AND SUBOCCIPITAL MUSCLES ........................................................................................................ 31
M. SPLENIUS CAPITUS .................................................................................................................................... 31
M. SPLENIUS CERVICIS .................................................................................................................................... 33
M. LEVATOR SCAPULAE .................................................................................................................................. 35
M. SUBOCCIPITAL MUSCLE GROUP ................................................................................................................ 38
M. RECTUS CAPITIS POSTERIOR MAJOR ................................................................................................................... 39
M. RECTUS CAPITIS POSTERIOR MINOR ................................................................................................................... 39
M. OBLIQUUS CAPITIS INFERIOR ............................................................................................................................. 39
M. OBLIQUUS CAPITIS SUPERIOR ............................................................................................................................ 39
GENERAL CERVICAL EXTENSORS ..................................................................................................................... 41
M. SEMISPINALIS CAPITIS ............................................................................................................................... 41
M. LONGUS CAPITIS .............................................................................................................................................. 43
M. SEMISPINALIS CERVICIS ..................................................................................................................................... 44
DYSFUNCTIONAL OF THE SHOULDER COMPLEX.............................................................................................. 45
SPENCER TECHNIQUE ............................................................................................................................................. 45
KINEMATIC RELEASE .............................................................................................................................................. 45
THEREFORE, WHERE NO EXACT MECHANISM CAN BE FOUND A GLOBAL FUNCTIONAL APPROACH MAY BE
MORE USEFUL. THIS HAS BEEN ARGUED BY A NUMBER OF AUTHORS INCLUDING (GEMMELL ET AL.
HTTPS://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/ABS/PII/S1479235411000095) .............................. 46
DIAGNOSIS 1........................................................................................................................................................ 46
‘Glenohumeral hypomobility with inhibition of the lower scapular stabilizers, stiff thoracic spine and
possible fear avoidance behavior’. ............................................................................................................. 46
DIAGNOSIS 2........................................................................................................................................................ 47
‘Scapular dyskinesis with reduced external rotation of the shoulder’ ...................................................... 47
2
, DIAGNOSIS 3........................................................................................................................................................ 47
‘Glenohumeral hypomobility, tight subscapularis with TrPs and referral pain from cervical manipulable
lesions’ ......................................................................................................................................................... 47
TRAPEZIUS MUSCLES THREE PARTS ................................................................................................................ 48
M. UPPER TRAPEZIUS ‘DESCENDING PART’ .................................................................................................... 48
M. MIDDLE TRAPEZIUS AND LOWER TRAPEZIUS ............................................................................................ 51
M. RHOMBOID MAJOR AND MINOR .............................................................................................................. 54
M. RHOMBOID MAJOR ......................................................................................................................................... 55
M. RHOMBOID MINOR ......................................................................................................................................... 55
M. SERRATUS POSTERIOR SUPERIOR .............................................................................................................. 57
M. SERRATUS POSTERIOR INFERIOR ............................................................................................................... 59
LUMBAR ERECTOR SPINAE MUSCLES.............................................................................................................. 61
M. ILIOCOSTALIS ............................................................................................................................................ 61
ILIOCOSTALIS CERVICIS ........................................................................................................................................... 62
ILIOCOSTALIS THORACIC ......................................................................................................................................... 62
ILIOCOSTALIS LUMBORUM ...................................................................................................................................... 62
LONGISSIMUS THORACIS................................................................................................................................ 63
M. SEMISPINALIS THORACIS ........................................................................................................................... 67
M. MULTIFIDUS .............................................................................................................................................. 69
M. ROTATORES .............................................................................................................................................. 72
M. QUADRATUS LUMBORUM ........................................................................................................................ 74
M. CORACOBRACHIALIS, M. BICEPS BRACHII, M. BRACHIALIS, M. TRICEPS BRACHII AND M. ANCONEUS. ..... 77
M. CORACOBRACHIALIS ......................................................................................................................................... 77
M. BICEPS BRACHII ......................................................................................................................................... 80
M. BRACHIALIS ............................................................................................................................................... 83
M. TRICEPS BRACHII AND ANCONEUS ............................................................................................................ 85
M. TRICEPS BRACHII ............................................................................................................................................. 85
M. ANCONEUS ..................................................................................................................................................... 88
M. PRONATOR TERES, M. FLEXOR CARPI RADIALIS, M. PALMARIS LONGUS AND M. FLEXOR CARPI ULNARIS.89
M. PRONATOR TERES ............................................................................................................................................ 89
M. FLEXOR CARPI RADIALIS.................................................................................................................................... 92
M. PALMARIS LONGUS .......................................................................................................................................... 94
M. FLEXOR CARPI ULNARIS .................................................................................................................................... 96
M. BRACHIORADIALIS, M. FLEXOR DIGITORUM SUPERFICIALIS, M. FLEXOR DIGITORUM PROFUNDES AND M.
FLEXOR POLLICIS LONGUS .............................................................................................................................. 98
M. BRACHIORADIALIS............................................................................................................................................ 98
M. FLEXOR DIGITORUM SUPERFICIALIS................................................................................................................... 100
M. FLEXOR DIGITORUM PROFUNDES ...................................................................................................................... 103
M. FLEXOR POLLICIS LONGUS ............................................................................................................................... 105
M. SUPINATOR AND M. PRONATOR QUADRATUS ........................................................................................ 107
M. SUPINATOR .................................................................................................................................................. 107
M. PRONATOR QUADRATUS................................................................................................................................. 110
FINGER MUSCLE RELAXATION EXERCISE TRACK ........................................................................................... 112
3
, RATIONALE ........................................................................................................................................................ 112
M. EXTENSOR CARPI RADIALIS LONGUS AND BREVIS, M. EXTENSOR DIGITORUM, M. EXTENSOR DIGITI
MINIMI AND M. EXTENSOR CARPI ULNARIS. ................................................................................................ 113
M. EXTENSOR CARPI RADIALIS LONGUS ................................................................................................................. 113
Handgrip and Compression Test ............................................................................................................... 115
M. EXTENSOR CARPI RADIALIS BREVIS ................................................................................................................... 116
M. EXTENSOR DIGITORUM ................................................................................................................................... 118
M. EXTENSOR DIGITI MINIMI ............................................................................................................................... 121
M. EXTENSOR CARPI ULNARIS .............................................................................................................................. 123
M. ABDUCTOR POLLICIS LONGUS, M. EXTENSOR POLLICIS BREVIS, M. EXTENSOR POLLICIS LONGUS AND M.
EXTENSOR INDICES. ...................................................................................................................................... 125
M. ABDUCTOR POLLICIS LONGUS .......................................................................................................................... 125
M. ABDUCTOR POLLICUS BREVIS ........................................................................................................................... 127
M. EXTENSOR POLLICIS LONGUS ........................................................................................................................... 129
M. EXTENSOR INDICIS ......................................................................................................................................... 131
M. ABDUCTOR POLLICIS BREVIS, M. FLEXOR POLLICIS BREVIS, M. OPPONENS POLLICIS AND M. ADDUCTOR POLLICIS ........... 133
M. ABDUCTOR POLLICIS BREVIS ............................................................................................................................ 133
M. EXTENSOR POLLICIS BREVIS ............................................................................................................................. 135
M. EXTENSOR POLLICIS LONGUS ........................................................................................................................... 137
M. EXTENSOR INDICIS ......................................................................................................................................... 139
M. ABDUCTOR POLLICIS BREVIS, M. FLEXOR POLLICIS BREVIS, M. OPPONENS POLLICIS AND M. ADDUCTOR
POLLICIS ....................................................................................................................................................... 141
M. ABDUCTOR POLLICIS BREVIS ............................................................................................................................ 141
M. FLEXOR POLLICIS BREVIS ................................................................................................................................. 143
M. OPPONENS POLLICIS ...................................................................................................................................... 145
M. ADDUCTOR POLLICIS ...................................................................................................................................... 147
M. ABDUCTOR DIGITI MINIMI, M. FLEXOR DIGITI MINIMI AND M. OPPONENS DIGITI MINIMI .................... 149
M. ABDUCTOR DIGITI MINIMI .............................................................................................................................. 149
M. FLEXOR DIGITI MINIMI BREVIS......................................................................................................................... 151
M. OPPONENS DIGITI MINIMI .............................................................................................................................. 153
CARPAL TUNNEL MOBILIZATIONS ................................................................................................................ 155
OPPONENS ROLL EXERCISE ................................................................................................................................... 155
CARPAL TUNNEL STRETCH 1.................................................................................................................................. 155
CARPAL TUNNEL STRETCH 2.................................................................................................................................. 155
M. PALMAR INTEROSSEI, M. DORSAL INTEROSSEI AND M. LUMBRICALS ..................................................... 156
M. PALMAR INTEROSSEI ...................................................................................................................................... 156
M. DORSAL INTEROSSEI ....................................................................................................................................... 158
M. LUMBRICALS ................................................................................................................................................. 160
M. STERNALIS, M. EXTERNAL INTERCOSTALS AND M. INTERCOSTALS .......................................................... 163
M. STERNALIS (RECTUS STERNALIS) ....................................................................................................................... 163
M. EXTERNAL INTERCOSTAL.................................................................................................................................. 165
M. INTERNAL INTERCOSTAL .................................................................................................................................. 167
M. STERNOCLEIDOMASTOID, M. LONGUS COLI AND M. SCALENES .............................................................. 169
M. STERNOCLEIDOMASTOID ................................................................................................................................. 169
M. LONGUS COLI .......................................................................................................................................... 172
M. SCALENES ANTERIOR, M. SCALENES MEDIUS, M. SCALENES POSTERIOR ................................................................. 174
M. Scalenes Anterior ................................................................................................................................. 174
M. Scalenes Medius .................................................................................................................................. 175
4
, Scalenus Posterior ..................................................................................................................................... 176
..................................................................................................................................................................... 178
DIAPHRAGM ................................................................................................................................................ 179
M. EXTERNAL OBLIQUE, M. INTERNAL OBLIQUE, M. RECTUS ABDOMINIS, M. PYRAMIDALIS AND M.
TRANSVERSE ABDOMINIS ............................................................................................................................ 182
M. EXTERNAL OBLIQUE ....................................................................................................................................... 182
Inguinal Ligament ..................................................................................................................................... 183
M. INTERNAL OBLIQUES ...................................................................................................................................... 185
M. PYRAMIDALIS ................................................................................................................................................ 187
M. RECTUS ABDOMINIS ....................................................................................................................................... 189
..................................................................................................................................................................... 191
M. TRANSVERSUS ABDOMINIS .............................................................................................................................. 192
MYOFASCIAL CONSIDERATION OF THE MUSCLES OF RESPIRATION .............................................................. 195
MUSCLES OF RESPIRATION ................................................................................................................................... 198
UPPER AND LOWER INTERCOSTAL MUSCLE TENSION RELEASE .................................................................................... 199
SYMPATHETIC INTRAFUSAL TENSION SYNDROME ....................................................................................... 200
FACTORS FEEDING INTO SITS AND USEFUL DIAGNOSTIC SIGNS AND SYMPTOMS ........................................................... 200
TREATMENT ....................................................................................................................................................... 202
INTERSCAPULAR PAIN SYNDROME ............................................................................................................... 204
THE FIVE MOST COMMON MUSCLES INVOLVED ARE: .................................................................................................. 204
M. Levator Scapulae ................................................................................................................................. 204
M. Scalenes ............................................................................................................................................... 205
M. Infraspinatus ........................................................................................................................................ 206
M. Latissimus Dorsi ................................................................................................................................... 207
M. Serratus Anterior ................................................................................................................................. 208
THE OTHER FIVE MUSCLES ARE: .............................................................................................................................. 209
M. Multifidus Thoracis .............................................................................................................................. 209
M. Rhomboids ........................................................................................................................................... 210
M. Lower Trapezius ................................................................................................................................... 211
M. Iliocostalis Thoracis ............................................................................................................................. 212
M. Serratus Posterior Superior ................................................................................................................. 213
ABDOMINAL PAIN OF MYOFASCIAL ORIGIN (APOMO) ................................................................................. 214
TREATMENT ....................................................................................................................................................... 215
BODY LANGUAGE ASSOCIATED WITH DISTORTIONS AND MYOFASCIAL THERAPY........................................ 216
TRIGGER POINTS .......................................................................................................................................... 217
PREAMBLE ......................................................................................................................................................... 217
PATHOPHYSIOLOGY OF MYOFASCIAL TRIGGER POINTS .............................................................................................. 217
ENERGY CRISIS THEORY........................................................................................................................................ 217
MOTOR END-PLATE HYPOTHESIS ........................................................................................................................... 217
TYPES OF TRIGGER POINT ..................................................................................................................................... 217
Active TrP .................................................................................................................................................. 217
Latent TrP .................................................................................................................................................. 218
TREATMENT POINT PRESSURE RELEASE .................................................................................................................. 218
COMMON MYOFASCIAL BANDS ................................................................................................................... 219
5
, Shoulder Muscles
M. Deltoid
The Deltoid muscle has three divisions: 1. Anterior Division 2. Middle Division 3. Posterior
Division and has a smooth Medial Triangular Surface.
6
,Origin
1. Anterior Division:
Anterior border and Superior surface of the third Lateral
of the Clavicle.
2. Middle Division:
The Lateral margin and Superior surface of the Acromion
3. Posterior Division:
The lower edge of the Crest of the Scapular Spine
Insertion
The fibers converge Inferiorly to a short, substantial
tendon that is attached to the Deltoid Tubercule on the
Lateral aspect of the Midshaft of the Humerus.
Nerve Supply
Axillary Nerve (C5-C6)
Actions
- Anterior Division
Vertical abduction, medial rotation and flexion
- Middle Division
Vertical abduction (agonist of M. Pectoralis
Major)
- Posterior Division
Vertical abduction, lateral rotation and extension (an agonist of M. Latissimus Dorsi
and M. Teres Major)
Muscle Test/s
- Anterior Division
The arm is raised to 90gr abduction, slightly flexed and
externally rotated and the doctor pushed down and into
extension (biceps grip).
- Middle Division
The arm is raided to 90gr abduction and the doctor p
ushes straight down on the elbow.
- Posterior Division
The arm is raised to 90gr abduction, slightly extended and internally rotated and the doctor
pushes down and into flexion.
7
, Clinical Gems
- Upper Trapezius over-involvement is
common in arm Abduction patterns.
Therefore, patients who work overhead
will often be more difficult to treat for
Upper Trapezius TrPs. This muscle test
often is a good screening for this
abnormal movement pattern (shrugging
trapezius)
8
1
,Inhoudsopgave
ANATOMY MYOFASCIAL UPPER QUARTER ....................................................................................................... 1
SHOULDER MUSCLES ........................................................................................................................................ 6
M. DELTOID .......................................................................................................................................................... 6
M. SUPRASPINATUS ......................................................................................................................................... 9
M. INFRASPINATUS ........................................................................................................................................ 11
TERES MINOR ................................................................................................................................................. 13
M. TERES MAJOR ............................................................................................................................................ 15
M. SUBSCAPULARIS ........................................................................................................................................ 17
SERRATUS ANTERIOR & LATISSIMUS DORSI ................................................................................................... 19
M SERRATUS ANTERIOR......................................................................................................................................... 19
M. LATISSIMUS DORSI ........................................................................................................................................... 22
PECTORALS AND SUBCLAVIUS ........................................................................................................................ 25
M. PECTORALIS MAJOR .................................................................................................................................. 25
M. PECTORALIS MINOR .................................................................................................................................. 27
M. SUBCLAVIUS .............................................................................................................................................. 29
CERVICAL AND SUBOCCIPITAL MUSCLES ........................................................................................................ 31
M. SPLENIUS CAPITUS .................................................................................................................................... 31
M. SPLENIUS CERVICIS .................................................................................................................................... 33
M. LEVATOR SCAPULAE .................................................................................................................................. 35
M. SUBOCCIPITAL MUSCLE GROUP ................................................................................................................ 38
M. RECTUS CAPITIS POSTERIOR MAJOR ................................................................................................................... 39
M. RECTUS CAPITIS POSTERIOR MINOR ................................................................................................................... 39
M. OBLIQUUS CAPITIS INFERIOR ............................................................................................................................. 39
M. OBLIQUUS CAPITIS SUPERIOR ............................................................................................................................ 39
GENERAL CERVICAL EXTENSORS ..................................................................................................................... 41
M. SEMISPINALIS CAPITIS ............................................................................................................................... 41
M. LONGUS CAPITIS .............................................................................................................................................. 43
M. SEMISPINALIS CERVICIS ..................................................................................................................................... 44
DYSFUNCTIONAL OF THE SHOULDER COMPLEX.............................................................................................. 45
SPENCER TECHNIQUE ............................................................................................................................................. 45
KINEMATIC RELEASE .............................................................................................................................................. 45
THEREFORE, WHERE NO EXACT MECHANISM CAN BE FOUND A GLOBAL FUNCTIONAL APPROACH MAY BE
MORE USEFUL. THIS HAS BEEN ARGUED BY A NUMBER OF AUTHORS INCLUDING (GEMMELL ET AL.
HTTPS://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/ABS/PII/S1479235411000095) .............................. 46
DIAGNOSIS 1........................................................................................................................................................ 46
‘Glenohumeral hypomobility with inhibition of the lower scapular stabilizers, stiff thoracic spine and
possible fear avoidance behavior’. ............................................................................................................. 46
DIAGNOSIS 2........................................................................................................................................................ 47
‘Scapular dyskinesis with reduced external rotation of the shoulder’ ...................................................... 47
2
, DIAGNOSIS 3........................................................................................................................................................ 47
‘Glenohumeral hypomobility, tight subscapularis with TrPs and referral pain from cervical manipulable
lesions’ ......................................................................................................................................................... 47
TRAPEZIUS MUSCLES THREE PARTS ................................................................................................................ 48
M. UPPER TRAPEZIUS ‘DESCENDING PART’ .................................................................................................... 48
M. MIDDLE TRAPEZIUS AND LOWER TRAPEZIUS ............................................................................................ 51
M. RHOMBOID MAJOR AND MINOR .............................................................................................................. 54
M. RHOMBOID MAJOR ......................................................................................................................................... 55
M. RHOMBOID MINOR ......................................................................................................................................... 55
M. SERRATUS POSTERIOR SUPERIOR .............................................................................................................. 57
M. SERRATUS POSTERIOR INFERIOR ............................................................................................................... 59
LUMBAR ERECTOR SPINAE MUSCLES.............................................................................................................. 61
M. ILIOCOSTALIS ............................................................................................................................................ 61
ILIOCOSTALIS CERVICIS ........................................................................................................................................... 62
ILIOCOSTALIS THORACIC ......................................................................................................................................... 62
ILIOCOSTALIS LUMBORUM ...................................................................................................................................... 62
LONGISSIMUS THORACIS................................................................................................................................ 63
M. SEMISPINALIS THORACIS ........................................................................................................................... 67
M. MULTIFIDUS .............................................................................................................................................. 69
M. ROTATORES .............................................................................................................................................. 72
M. QUADRATUS LUMBORUM ........................................................................................................................ 74
M. CORACOBRACHIALIS, M. BICEPS BRACHII, M. BRACHIALIS, M. TRICEPS BRACHII AND M. ANCONEUS. ..... 77
M. CORACOBRACHIALIS ......................................................................................................................................... 77
M. BICEPS BRACHII ......................................................................................................................................... 80
M. BRACHIALIS ............................................................................................................................................... 83
M. TRICEPS BRACHII AND ANCONEUS ............................................................................................................ 85
M. TRICEPS BRACHII ............................................................................................................................................. 85
M. ANCONEUS ..................................................................................................................................................... 88
M. PRONATOR TERES, M. FLEXOR CARPI RADIALIS, M. PALMARIS LONGUS AND M. FLEXOR CARPI ULNARIS.89
M. PRONATOR TERES ............................................................................................................................................ 89
M. FLEXOR CARPI RADIALIS.................................................................................................................................... 92
M. PALMARIS LONGUS .......................................................................................................................................... 94
M. FLEXOR CARPI ULNARIS .................................................................................................................................... 96
M. BRACHIORADIALIS, M. FLEXOR DIGITORUM SUPERFICIALIS, M. FLEXOR DIGITORUM PROFUNDES AND M.
FLEXOR POLLICIS LONGUS .............................................................................................................................. 98
M. BRACHIORADIALIS............................................................................................................................................ 98
M. FLEXOR DIGITORUM SUPERFICIALIS................................................................................................................... 100
M. FLEXOR DIGITORUM PROFUNDES ...................................................................................................................... 103
M. FLEXOR POLLICIS LONGUS ............................................................................................................................... 105
M. SUPINATOR AND M. PRONATOR QUADRATUS ........................................................................................ 107
M. SUPINATOR .................................................................................................................................................. 107
M. PRONATOR QUADRATUS................................................................................................................................. 110
FINGER MUSCLE RELAXATION EXERCISE TRACK ........................................................................................... 112
3
, RATIONALE ........................................................................................................................................................ 112
M. EXTENSOR CARPI RADIALIS LONGUS AND BREVIS, M. EXTENSOR DIGITORUM, M. EXTENSOR DIGITI
MINIMI AND M. EXTENSOR CARPI ULNARIS. ................................................................................................ 113
M. EXTENSOR CARPI RADIALIS LONGUS ................................................................................................................. 113
Handgrip and Compression Test ............................................................................................................... 115
M. EXTENSOR CARPI RADIALIS BREVIS ................................................................................................................... 116
M. EXTENSOR DIGITORUM ................................................................................................................................... 118
M. EXTENSOR DIGITI MINIMI ............................................................................................................................... 121
M. EXTENSOR CARPI ULNARIS .............................................................................................................................. 123
M. ABDUCTOR POLLICIS LONGUS, M. EXTENSOR POLLICIS BREVIS, M. EXTENSOR POLLICIS LONGUS AND M.
EXTENSOR INDICES. ...................................................................................................................................... 125
M. ABDUCTOR POLLICIS LONGUS .......................................................................................................................... 125
M. ABDUCTOR POLLICUS BREVIS ........................................................................................................................... 127
M. EXTENSOR POLLICIS LONGUS ........................................................................................................................... 129
M. EXTENSOR INDICIS ......................................................................................................................................... 131
M. ABDUCTOR POLLICIS BREVIS, M. FLEXOR POLLICIS BREVIS, M. OPPONENS POLLICIS AND M. ADDUCTOR POLLICIS ........... 133
M. ABDUCTOR POLLICIS BREVIS ............................................................................................................................ 133
M. EXTENSOR POLLICIS BREVIS ............................................................................................................................. 135
M. EXTENSOR POLLICIS LONGUS ........................................................................................................................... 137
M. EXTENSOR INDICIS ......................................................................................................................................... 139
M. ABDUCTOR POLLICIS BREVIS, M. FLEXOR POLLICIS BREVIS, M. OPPONENS POLLICIS AND M. ADDUCTOR
POLLICIS ....................................................................................................................................................... 141
M. ABDUCTOR POLLICIS BREVIS ............................................................................................................................ 141
M. FLEXOR POLLICIS BREVIS ................................................................................................................................. 143
M. OPPONENS POLLICIS ...................................................................................................................................... 145
M. ADDUCTOR POLLICIS ...................................................................................................................................... 147
M. ABDUCTOR DIGITI MINIMI, M. FLEXOR DIGITI MINIMI AND M. OPPONENS DIGITI MINIMI .................... 149
M. ABDUCTOR DIGITI MINIMI .............................................................................................................................. 149
M. FLEXOR DIGITI MINIMI BREVIS......................................................................................................................... 151
M. OPPONENS DIGITI MINIMI .............................................................................................................................. 153
CARPAL TUNNEL MOBILIZATIONS ................................................................................................................ 155
OPPONENS ROLL EXERCISE ................................................................................................................................... 155
CARPAL TUNNEL STRETCH 1.................................................................................................................................. 155
CARPAL TUNNEL STRETCH 2.................................................................................................................................. 155
M. PALMAR INTEROSSEI, M. DORSAL INTEROSSEI AND M. LUMBRICALS ..................................................... 156
M. PALMAR INTEROSSEI ...................................................................................................................................... 156
M. DORSAL INTEROSSEI ....................................................................................................................................... 158
M. LUMBRICALS ................................................................................................................................................. 160
M. STERNALIS, M. EXTERNAL INTERCOSTALS AND M. INTERCOSTALS .......................................................... 163
M. STERNALIS (RECTUS STERNALIS) ....................................................................................................................... 163
M. EXTERNAL INTERCOSTAL.................................................................................................................................. 165
M. INTERNAL INTERCOSTAL .................................................................................................................................. 167
M. STERNOCLEIDOMASTOID, M. LONGUS COLI AND M. SCALENES .............................................................. 169
M. STERNOCLEIDOMASTOID ................................................................................................................................. 169
M. LONGUS COLI .......................................................................................................................................... 172
M. SCALENES ANTERIOR, M. SCALENES MEDIUS, M. SCALENES POSTERIOR ................................................................. 174
M. Scalenes Anterior ................................................................................................................................. 174
M. Scalenes Medius .................................................................................................................................. 175
4
, Scalenus Posterior ..................................................................................................................................... 176
..................................................................................................................................................................... 178
DIAPHRAGM ................................................................................................................................................ 179
M. EXTERNAL OBLIQUE, M. INTERNAL OBLIQUE, M. RECTUS ABDOMINIS, M. PYRAMIDALIS AND M.
TRANSVERSE ABDOMINIS ............................................................................................................................ 182
M. EXTERNAL OBLIQUE ....................................................................................................................................... 182
Inguinal Ligament ..................................................................................................................................... 183
M. INTERNAL OBLIQUES ...................................................................................................................................... 185
M. PYRAMIDALIS ................................................................................................................................................ 187
M. RECTUS ABDOMINIS ....................................................................................................................................... 189
..................................................................................................................................................................... 191
M. TRANSVERSUS ABDOMINIS .............................................................................................................................. 192
MYOFASCIAL CONSIDERATION OF THE MUSCLES OF RESPIRATION .............................................................. 195
MUSCLES OF RESPIRATION ................................................................................................................................... 198
UPPER AND LOWER INTERCOSTAL MUSCLE TENSION RELEASE .................................................................................... 199
SYMPATHETIC INTRAFUSAL TENSION SYNDROME ....................................................................................... 200
FACTORS FEEDING INTO SITS AND USEFUL DIAGNOSTIC SIGNS AND SYMPTOMS ........................................................... 200
TREATMENT ....................................................................................................................................................... 202
INTERSCAPULAR PAIN SYNDROME ............................................................................................................... 204
THE FIVE MOST COMMON MUSCLES INVOLVED ARE: .................................................................................................. 204
M. Levator Scapulae ................................................................................................................................. 204
M. Scalenes ............................................................................................................................................... 205
M. Infraspinatus ........................................................................................................................................ 206
M. Latissimus Dorsi ................................................................................................................................... 207
M. Serratus Anterior ................................................................................................................................. 208
THE OTHER FIVE MUSCLES ARE: .............................................................................................................................. 209
M. Multifidus Thoracis .............................................................................................................................. 209
M. Rhomboids ........................................................................................................................................... 210
M. Lower Trapezius ................................................................................................................................... 211
M. Iliocostalis Thoracis ............................................................................................................................. 212
M. Serratus Posterior Superior ................................................................................................................. 213
ABDOMINAL PAIN OF MYOFASCIAL ORIGIN (APOMO) ................................................................................. 214
TREATMENT ....................................................................................................................................................... 215
BODY LANGUAGE ASSOCIATED WITH DISTORTIONS AND MYOFASCIAL THERAPY........................................ 216
TRIGGER POINTS .......................................................................................................................................... 217
PREAMBLE ......................................................................................................................................................... 217
PATHOPHYSIOLOGY OF MYOFASCIAL TRIGGER POINTS .............................................................................................. 217
ENERGY CRISIS THEORY........................................................................................................................................ 217
MOTOR END-PLATE HYPOTHESIS ........................................................................................................................... 217
TYPES OF TRIGGER POINT ..................................................................................................................................... 217
Active TrP .................................................................................................................................................. 217
Latent TrP .................................................................................................................................................. 218
TREATMENT POINT PRESSURE RELEASE .................................................................................................................. 218
COMMON MYOFASCIAL BANDS ................................................................................................................... 219
5
, Shoulder Muscles
M. Deltoid
The Deltoid muscle has three divisions: 1. Anterior Division 2. Middle Division 3. Posterior
Division and has a smooth Medial Triangular Surface.
6
,Origin
1. Anterior Division:
Anterior border and Superior surface of the third Lateral
of the Clavicle.
2. Middle Division:
The Lateral margin and Superior surface of the Acromion
3. Posterior Division:
The lower edge of the Crest of the Scapular Spine
Insertion
The fibers converge Inferiorly to a short, substantial
tendon that is attached to the Deltoid Tubercule on the
Lateral aspect of the Midshaft of the Humerus.
Nerve Supply
Axillary Nerve (C5-C6)
Actions
- Anterior Division
Vertical abduction, medial rotation and flexion
- Middle Division
Vertical abduction (agonist of M. Pectoralis
Major)
- Posterior Division
Vertical abduction, lateral rotation and extension (an agonist of M. Latissimus Dorsi
and M. Teres Major)
Muscle Test/s
- Anterior Division
The arm is raised to 90gr abduction, slightly flexed and
externally rotated and the doctor pushed down and into
extension (biceps grip).
- Middle Division
The arm is raided to 90gr abduction and the doctor p
ushes straight down on the elbow.
- Posterior Division
The arm is raised to 90gr abduction, slightly extended and internally rotated and the doctor
pushes down and into flexion.
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, Clinical Gems
- Upper Trapezius over-involvement is
common in arm Abduction patterns.
Therefore, patients who work overhead
will often be more difficult to treat for
Upper Trapezius TrPs. This muscle test
often is a good screening for this
abnormal movement pattern (shrugging
trapezius)
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