HUMAN + MUSCLES + PAIN

ADDUCTOR MUSCLES

ACTION: hip adductor REFERRAL: thigh and knee

COMMENTS: These muscle groups- the adductor magnus, longus, brevis and the pectineus, make up the adductor group. Groin

pulls are a strain at the attachment of the adductors to the pubic bone. An upslipped hip may have tight adductors on the same side. Test the length of the adductors with clients who have lower back pain. Always drape appropriately and be gentle. This area is sensitive and can often be sore.

TRICEPS BRACHII AND ANCONEUS

ACTION: extends the elbow REFERRAL: posterior arm and elbow

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

This muscle also is rarely injured. Static pressure to the muscle belly with a fingerpoint while flexing and extending the elbow is an effective and safe way to soften the muscle.

HAMSTRINGS: Biceps Femoris, Semitendinosus, Semimembranosus

ACTION: Flexes the knee, extends the hip REFERRAL: Posterior knee

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

TALOFIBULAR AND CALCANEOFIBULAR LIGAMENTS

ACTION: Lateral ankle support REFERRAL: Lateral ankle

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

DELTOID MUSCLE

ACTION: humeral abduction, internal rotation, external rotation REFERRAL: shoulder

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

ERECTOR SPINAE MUSCLES (SPINALIS, LONGISSIMUS,

ILIOCOSTALIS)

ACTION: extends spine REFERRAL: back, ilium, sacrum

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

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

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

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

EXTENSOR CARPI RADIALIS LONGUS, EXTENSOR CARPI RADIALIS BREVIS, EXTENSOR CARPI ULNARIS

ACTION: wrist extension REFERRAL: posterior wrist

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

EXTENSOR DIGITORUM

ACTION: finger extension REFERRAL: posterior fingers

COMMENTS: The muscle of finger extension is the extensor digitorum. This muscle refers pain into the fingers. Always

work the opposing muscle group when you are working on the forearm and hand. In this case, make sure to work on the finger flexors and well as the extensors. This will decrease tone evenly and provide longer lasting results.

FLEXOR CARPI RADIALIS, FLEXOR CARPI ULNARIS, PALMARIS LONGUS

ACTION: wrist flexion REFERRAL: wrist and palm

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

ABDUCTOR POLLICIS, EXTENSOR POLLICIS BREVIS

ACTION: thumb extension and abduction REFERRAL: thumb and medial wrist

COMMENTS: Assess these muscles for health by having your client forcefully extend their thumb against your resistance.

POPLITEUS & GASTROCNEMIUS

ACTION: Flexes the kneeREFERRAL: Posterior knee

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

DEEP EXTERNAL ROTATORS (GEMELLI, OBTURATOR, QUADRATUS FEMORIS)

ACTION: externally rotates the hip REFERRAL: themselves

COMMENTS: These muscles are just under and inferior to the piriformis. People sometimes have a hard time distinguishing deep hip pain from sacroiliac joint pain(lower back pain). These muscles are best worked with a thumb or elbow (you have to get through the gluteus maximus), then add some internal and external rotation to the joint. The abbreviation of these muscles is GOGO's. Gemellus superior,

Obturator internus, Gemellus inferior, Obturator Externus(not shown). The Quadratus femoris is not included in the GOGOs acronym. The Gemelli muscle have a high concentration of spindle cells, which leads researchers to view them as sensors for the position of the hip joint rather than prime mover muscles.

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

GLUTEUS MAXIMUS MUSCLE

ACTION: externally rotates & extends the hipREFERRAL: posterior hip and leg

COMMENTS: Skin roll this muscle before working on the deeper structures. This will make the muscle plyable, and allow you to reach the other deeper external rotators easily.

GLUTEUS MEDIUS MUSCLE 

ACTION: abducts and internally rotates hip REFERRAL: sacrum and crest of ilium

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

TENSOR FASCIA LATAE MUSCLE

ACTION: flexes and internally rotates the hip REFERRAL: into itself and the lateral hip

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

THE TORSO MUSCLES

FLEXORS: rectus abdominus, psoas(depending on position) EXTENSORS: spinalis, longissimus, iliocostalis, multifidusSIDE BENDERS (LATERAL FLEXION): quadratus lumborum

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

PSOAS AND ILIACUS MUSCLES

ACTION: flexes the hip, increases lordosis REFERRAL: anterior thigh and lower back

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

INFRAHYOID AND SUPRAHYOID MUSCLES

ACTION: Infrahyoids: flex the neck, Suprahyoids: open the jaw. REFERRAL: Anterior neck

COMMENTS: The infrahyoids are made up of three muscles, the omohyoid, the sterno hyoid, and the thyrohyoid. They lie right over the trachea. The infrahyoids can be damaged in whiplash cases. To release these muscles apply gentle frictioning with the tips of your fingers. Be careful not to put pressure on the internal jugular veins, which are just lateral to the trachea. See also the longus colli and capitis, which lie deep, right over the anterior part of the cervical vertebrae, and can also be important to work on in cases of whiplash.

The suprahyoid group hardly ever has any problems, except maybe after a thanksgiving eating marathon.

INFRASPINATUS MUSCLE

ACTION: external rotation of humerus REFERRAL: upper back, anterior shoulder

COMMENTS: This muscle can also refer pain into the vertebral border of the scapula. This muscle has a large attachment and is fairly thin. Because of this, it is normal for it to be a little tender when compressed against the scapula. The lateral trigger point shown refers pain to the anterior shoulder. In sports this muscle

becomes strained because its action of decelerating a throwing motion, or racquet swing. It is one of the 4 rotator cuff muscles.

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

LEVATOR SCAPULA MUSCLE

ACTION: Neck rotation REFERRAL: top of shoulder

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

 

LONGUS COLLI AND LONGUS CAPITIS MUSCLES

ACTION: Neck flexion REFERRAL: Anterior neck

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

If you want to learn to work these muscles, the DVD Deep Tissue & Neuromuscular Therapy: The Torso, has this information.

MULTIFIDUS MUSCLE

ACTION: extends and rotates the spine REFERRAL: itself

COMMENTS: This muscle is located under the erector group, and is often missed. However, it is one of the most important muscles regarding lower back pain. It is the only muscle that has fibers that actually attach to the posterior part of the sacrum.

OPPONENS POLLICIS, ABUCTOR POLLICIS BREVIS, ADDUCTOR POLLICIS

ACTION: thumb flexion, adduction & abduction REFERRAL: thumb and wrist

COMMENTS: These three muscles control much of the movement of the thumb. Specifically trigger points in the opponens pollicis can refer pain into the lateral wrist and thumb itself.

PECTORALIS MAJOR MUSCLE

ACTION: internally rotates and laterally flexes the humerus REFERRAL: chest, ulnar side of the arm

COMMENTS: This muscle is involved in forward shoulder position. Include it when you work on the pectoralis minor.

PECTORALIS MINOR MUSCLE

ACTION: depresses and rotates the scapula forward REFERRAL: shoulder, chest, ulnar side of the arm

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

PERONEUS LONGUS AND BREVIS

ACTION: Everts the ankle REFERRAL: Lateral ankle

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

PIRIFORMIS MUSCLE

ACTION: externally rotates the hip REFERRAL: sacroiliac joint and leg

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

When working the piriformis muscle, also include the quadratus femoris, obturators and gemelli.

PRONATOR TERES AND PRONATOR QUADRATUS

ACTION: forearm pronation REFERRAL: anterior/medial wrist

COMMENTS: These two pronator muscles, the pronator teres and quadratus, both pronate the forearm. The pronator teres is more of a trouble maker, because it does the majority of the work . Whenever someone has wrist pain, check this muscle for tension and tenderness. Also evaluate for range of motion and pain on resistance.

QUADRATUS LUMBORUM MUSCLE

ACTION: hip hiker, side bender REFERRAL:sacro-iliac joiont, lateral hip, gluteal area.

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

RECTUS ABDOMINIS MUSCLE

ACTION: torso flexor REFERRAL: mid and lower back

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

RECTUS FEMORIS AND VASTUS MEDIALIS

ACTION: Extends the kneeREFERRAL: Anterior and medial knee

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

RHOMBOID MUSCLE

ACTION: retracts the scapula REFERRAL: itself

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

SCALENES: SCALENE MEDIUS, ANTERIOR AND

POSTERIOR MUSCLES

ACTION: Neck lateral flexion, helps raise ribs REFERRAL: Anterior chest, radial side of arm, and upper back(not shown)

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

Our DVD, Nerve Mobilization shows techniques to evalute the nerves as they move through the scalenes and other muscles, and shows how to free them.

SERRATUS ANTERIOR MUSCLE

ACTION: upward rotation & protraction of scapulaREFERRAL: lateral torso

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

STERNOCLEIDOMASTOID MUSCLES

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

COMMENTS: This muscle can cause headaches. Be wary of the carotid artery nearby, and don't apply pressure directly onto the muscle. Instead use pincer palpation (squeeze the muscle between your fingers and thumb).

SUBOCCIPITALS

ACTION: extends and rotates head REFERRAL: posterior skull and temples

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

SUPINATOR

ACTION: forearm supination REFERRAL: lateral elbow and wrist

COMMENTS: Strain in this muscle can be involved in Tennis elbow. The referral pattern is split, sometimes referring into the lateral elbow(tennis elbow), and other times into the

lateral wrist. This muscle is under the brachioradialis, so it takes some maneuvering to get at it. It is almost always a little sore on people, since the radial nerve pierces the muscle. To work this muscle- first find it, then supinate and pronate the client's wrist while you apply pressure. They will thank you later.

SUPRASPINATUS MUSCLE

ACTION: abducts the humerus (lifts the arm)

REFERRAL: lateral shoulder and arm

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

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

SUBSCAPULARIS MUSCLE

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

COMMENTS: This "rotator cuff" muscle attaches to the anterior part of the scapula. It lies between the scapula and the rib cage. Distally it attaches to the anterior part of the humerus, just next to the pectoralis major attachment. This attachment is normally a little tender. You can evaluate if this muscle is strained by internally rotating the arm

against resistance. Note that this muscle refers pain to the back of the shoulder. When evaluating the rotator cuff, include this muscle.

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

TERES MAJOR AND TERES MINOR MUSCLES

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

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

The teres major attaches to the posterior scapula, then straight across to the anterior (front) of the shoulder, attaching to the front

of the humerus. This muscle along with the latissimus dorsi, forms the back part of your armpit. This muscle refers pain into the lateral shoulder and sometimes into the lateral forearm.

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

TRAPEZIUS MUSCLE

ACTION: multiple actions involves pulling the scapula towards the body. Also involved in neck extension. REFERRAL: temples and occiput (headaches)

COMMENTS: This muscle has numerous referral patterns. The one pictured here is a common one. Another very common trigger point not shown is on the very lateral edge of the trapezius, which refers to the temples.

VASTUS LATERALIS

ACTION: Extends the kneeREFERRAL: Lateral knee pain

COMMENTS: This is a side view of the leg, the white band is the Iliotibial band. Trigger points in this muscle run up and down its length. There may also be trigger points in the iliotibial band. Also test and check the lateral collateral (fibular collateral) ligament in the knee.

HAMSTRINGS: BICEPS FEMORIS, SEMITENDINOSUS,

SEMIMEMBRANOSUS

ACTION: Flexes the knee, extends the hip REFERRAL: Posterior knee

COMMENTS: These three muscles, the biceps femoris, the semitendinosus and the semimembranosus muscles control the pull on

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

SPLENIUS CAPITIS, SPLENIUS CERVSI, SEMISPINALIS CAPITIS MUSCLES

ACTION: Splenius: neck rotation. Semispinalis: neck flexion. REFERRAL: occiput, neck, upper shoulder

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

The splenius capitis can be palpated directly by finding the space between the trapezius and the sternocleidomastoid at the top of the

neck. Both splenius muscles are a potent source of headaches.

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

TRICEPS BRACHII AND ANCONEUS

ACTION: extends the elbow REFERRAL: posterior arm and elbow

COMMENTS: The triceps muscle is not injured very often, but it can feel really

good to work it. When working the attachment near the elbow, be aware of the ulnar nerve that goes between the medial epicondyle of the humerus and the olecranon process of the ulna. The triceps gets its name because it has three heads superiorly. One that attaches to the humerus, and two others that attach to the scapula. The brachii part of the name refers to being on the arm.

AREA:

NECK MUSCLES

MUSCLES:FLEXORS: longus colli & capitis, infra hyoids

EXTENSORS: splenius capitis, semispinalis capitis, suboccipitals, trapezius

ROTATORS: splenius capitis, sternocleidomastoid, levator scapula, suboccipitals

LATERAL FLEXORS: scalenes

COMMENTS: The motion of the neck can be divided into rotation (looking side to side), lateral flexion (ear to shoulder), flexion (chin to sternum) and hyperextension (looking up).

Knowing which muscles do each motion will take you a long way towards proper evaluation and treatment.

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

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

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

SHOULDER MUSCLES  

HUMERUS MOVER MUSCLES: supraspinatus, infraspinatus, teres minor, subscapularis

SCAPULA MOVERS MUSCLES:PROTRACTORS:pectoralis majorpectoralis minorserratus anteriorRETRACTORS:trapeziusrhomboidsELEVATORS:levator scapulatrapezius

CONDITIONS:pectoralis minor entrapment

COMMENTS: The shoulder can be divided into two functional groups. One group is the

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

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

 

THE ELBOW MUSCLES:

FLEXORS: biceps, brachialis, brachioradialisEXTENSORS: triceps, anconeus

ELBOW INJURIES: golfers elbow, tennis elbow

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

THE HAND MUSCLES:

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

FINGER FLEXORS: flexor digitorum superficialis and profundusFINGER EXTENSORS: extensor digitorum

THUMB FLEXORS: flexor pollicis longus & brevis THUMB EXTENSORS: extensor pollicis longus & brevis,

FOREARM SUPINATOR: supinator FOREARM PRONATOR: pronator teres & quadratus

WRIST INJURIES: carpal tunnel syndrome

COMMENTS: All the muscles in the forearm operate the hand. The easiest way to grasp these muscles is to divide them into function, as we have done here. Think of the hand as 3 major joints- the wrist, fingers and thumb. The muscles can easily be divided into these groups and then it makes evaluation and treatment really easy. For detailed evaluation on yourself, our DVD Heal Your Wrist Pain

is great! If you want to learn to evaluate all these muscles on a client, our DVD Deep Tissue and NMT, the Extremities is what you want.

THE TORSO MUSCLES

FLEXORS: rectus abdominus, psoas(depending on position) EXTENSORS: spinalis, longissimus, iliocostalis, multifidusSIDE BENDERS (LATERAL FLEXION): quadratus lumborum

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

THE HIP MUSCLES

EXTERNAL ROTATORS: piriformis, GOGOs, quadratus femoris

FLEXORS: psoas, iliacus, rectus femorisADDUCTORS: adductor magnus, adductor longus &

brevis, pectineus, gracilisINTERNAL ROTATORS: gluteus medius, gluteus

minimus, tensor fascia lataeEXTENSORS: semiteninosus & semimembranosus,

biceps femoris, gluteus maximusABDUCTORS: gluteus medius, gluteus minimus

COMMENTS: The hips are the foundation of our lower bodies. They are the bowl that carries our

deepest selves, our organs. The hips are balanced upon each femur, and then support the spine where the

lumbar vertebrae meet the sacrum. The shape of the hip bones create an arch, with the top being the

sacrum, and the sides coming down onto the femurs. This arched structure allows the hips to transfer the

weight of the body to the femur bones.

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

With each distortion, there will be a diagonal pattern of tension through the body. For example, with posterior rotation the hamstrings and rectus abdominis will be tight. In an anterior rotation the rectus femoris and ilio-

psoas on the front and the back erectors on the back will be tight. When the movement of the hips is exaggerated one way or another, it can result in lower back pain.

THE KNEE MUSCLES

FLEXORS:Hamstrings (semi membranosus, semiteninosus, biceps femoris)gastrocnemiuspopliteus

EXTENSORS:vastus medialisvastus lateralisvastus intermediusrectus femoris

LIGAMENTS: medial and lateral collateralanterior and posterior cruciateinfrapatellarcoronary

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

THE ANKLE MUSCLES:

EVERTERS: peroneus longus & brevis, ligments PLANTER FLEXORS: gastrocnemius, soleus DORSI FLEXORS: tibialis anterior

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

INJURY: The ankle joint can respond in two ways to a strain. The ankle ligaments could be stretched, causing the ankle to be unstable and to feel looser than the healthy side. When someone has a loose ankle they should perform exercises to strengthen the ankle. The main muscles of stabilization of the ankle joint are the peroneus brevis, peroneus longus, and the deep ankle flexor such as the tibialis posterior. Trigger points in the muscles will also make the

muscles weak and unable to support the joint. The other response is a buildup of scar tissue that causes limited range of motion in the ankle. Ankles that have a restricted range of motion should be loosened by massage, cross-fiber frictioning and stretching.

ASSESSMENT: In order to test the ankle the client should be supine. Take both feet in your hands and turn them towards each other (inversion). This can tell you if the ligaments on the outside have been torn or stretched. Notice which foot is restricted. Use slow stretches to release the restriction.

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