Myofascial Pain Syndrome Diagnosis and Treatment.
|
|
- Kristopher Greene
- 5 years ago
- Views:
Transcription
1 Myofascial Pain Syndrome Diagnosis and Treatment
2 Myofascial Pain Syndrome A clinical syndrome caused by myofascial trigger points (MTrPs)
3 Definition of Myofascial Trigger Point (MTrP) A highly localized and hyperirritable spot in a palpable taut band of skeletal muscle fibers.
4 Myofascial Pain Syndrome Trigger Point Referred Pain
5 局部抽 反應 Local Twitch Response (Travell & Simons, 1983)
6 Latent VS Active MTrPs Characteristics Latent Active Taut band LTR Limited ROM +/ Tenderness Referred tender +/ Pain (spontaneous) Referred pain - -/ Weakness - - -/+ + ANS disorder /+
7 Basic Units of Myofascial Trigger Point Endplate Zone Taut band LTR locus EPN locus MTrP region MTrP Locus [Hong & Simons: APMR 1998]
8 MTrP Circuit ANS ReP MTrP Circuit #1 ANS MTrP Circuit #2 ANS MTrP Circuit #3 Pain 1. (Pain) 2. (ReP) 3. (LTR) 4. (ANS) Stimulic MtrP #1 LTR MtrP #2 MtrP #3
9 Etiology of MTrPs MTrPs are usually caused by or associated with other neuromusculoskeletal disorders. and can be perpetuated or aggravated by some medical conditions (perpetuating factors).
10 BASIC PRINCIPLE of MYOFASCIAL PAIN THERAPY 1). To treat Underlying Etiological Lesion. 2). To provide Pain Control (inactivation of MTrPs). 3). To correct Perpetuating Factors. 4). To perform Patient Education. 5). To demonstrate Home Program.
11 Identification of Underlying Pathological Lesion: Latent MTrP Active MTrP Central sensitization 2 nd to: Soft tissue lesions, Neurogenic lesions Endocrine disorders (Fibromyalgia), Other factors
12 Inactivation of MTrPs General Consideration - 1: Conservative VS Aggressive Treatment: Conservative Treatment: physical medicine Any MTrPs with pain or discomfort. MTrP Injection: Poor response to conservative therapy Deeply seated MTrPs, Chronic recurrent MTrPs, Very active MTrPs, etc.
13 Commonly Applied Techniques to inactivate (immediately release) MTrPs: 1. Physical Therapy 2. Chiropractic Therapy 3. Acupuncture 4. Myofascial Trigger Point Injection 5. Others.
14 Dry Needling and Acupuncture 1). Basic Principle: a. Spinal Cord Mechanism - Effect of dry needling: LTRs = [Hong: 1994] b. Endogenous opioid system: Neurotransmitters: 5HT, etc. c. Others. Acupuncture point Vs Trigger Point. [Melzack: Arch Phys Med Rehabil 62:114-7, 1981]
15 Dry Needling & Acupuncture 2). Clinical Application: a. Dry Needling Local twitch responses. [Lewit: Pain 6:83-90, 1979] [Gunn et al: Spine 5:279-91, 1980] [Hong: Am J Phys Med Rehabil 73:256-63, 1994] [Chu J: Electromyogr Clin Neurophysiol 37: , 1997] b. Traditional acupuncture -.
16 BASIC PRINCIPLES OF MTrP INJECTION A. Before considering MTrP injection: 1. Previous conservative treatment. 2. Previous treatment for etiological lesions. 3. Pain recognition. 4. Key Trigger Points..
17 Identification of Etiological Lesions based on Clinical Presentation of Active MTrP Key MTrPs Satellite MTrPs Splenius capitis Sternocleidomastoid Upper trapezius Scaleni Supraspinatus Infraspinatus Temporalis; Semispinalis; Temporalis; Masseter; Digastrics; Temporalis; Masseter; Splenius capitis; Semispinalis; Levator scapulae; Rhomboid; Deltoid; Extensor carpi radialis; Extensor digitorum communis; Extensor carpi ulnaris; Deltoid; Extensor carpi radialis; Biceps;
18 Key MTrPs Pectoralis minor Latissimus dorsi Serratus post. Inf. L5-S1 multifidi. Quadratus lumborum Piriformis Hamstrings Satellite MTrPs Flexor carpi radialis; Flexor carpi ulnaris; First dorsal Interosseous; Triceps; Flexor carpi ulnaris; Triceps; Latissimus dorsi; Extensor digitorum communis; Extensor carpi ulnaris; Flexor carpi ulnaris; Gluteal muscles; Hamstrings; Tibialis anterior; Peroneus longus; Gastrosoleus; Gluteal muscles; Hamstrings; Peroneus longus; Gastrosoleus;
19 BASIC PRINCIPLES OF MTrP INJECTION B. During MTrP injection: 1. Localization of sharp tenderness & taut band. 2. Location of the needle tip. 3. Local twitch response (LTR). 4. Straight needle insertion - "Fast-in and fast out".
20 BASIC PRINCIPLES OF MTrP INJECTION C. After MTrP injection: 1. Hemostasis. 2. Continuing home program. 3. Continuing physical therapy as indicated.
21 INDICATION FOR MTrP INJECTION: A. Pain Relief (Pain Control): 1. For long-term pain control: 1). Primary myofascial pain syndrome (traumatic, postural) if no involvement of tissues other than muscle / fasciae. 2). Secondary myofascial pain syndrome - after appropriate treatment of etiological lesions. 3). Other special cases.
22 INDICATION FOR MTrP INJECTION: A. Pain Relief (Pain Control): 2. For short-term pain control: 1). A substitute for narcotic analgesics. 2). Some fibromyalgia patients. 3). Other special consideration.
23 INDICATION FOR MTrP INJECTION: B. Improving Functional Status: Inactivation of MTrP (reduced pain) & Relaxation of the taut bands (increased ROM) to increase mobility & function of the involved muscles
24 INDICATION FOR MTrP INJECTION: C. Facilitating Tissue Repair: Reduced muscle tightness and spasm to improve the local circulation to interrupt the vicious cycle phenomena of an MTrP, (for MTrP itself). to facilitate the resolution of inflammation, (for the etiological factor of a MTrP)
25 CONTRTRAINDICATION FOR MTrP INJECTION 1. Acute infection in the MTrP region or vicinity. 2. Bleeding tendency, or anticoagulant therapy. 3. Allergies to the specific anesthetics being injected. 4. Acute trauma. 5. Malignancy. 6. Others.
26 Materials Used for MTrP Injections: (1) 0.5% Procaine or Lidocaine, ml for each site. Minimal systemic toxicity, Least myotoxicity, Absence of local irritation, Easy sterilization, Reasonable duration of action, Low cost.
27 Materials Used for MTrP Injections: (2) Epinephrine in local anesthetic solution - not recommended. Increases hazard of accidental intravenous injection; myotoxicity. Steroid in local anesthetic solution not recommended. Myotoxicity-muscle fiber damage; MTrP is no an inflammatory lesion.
28 Materials Used for MTrP Injections: (3) Dry needling - effective to inactivate a MTrP. Post-injection soreness. Large amount of local anesthetic not provide further benefit..
29 Needle for MTrP Injection Large size needle: to "feel" tissue texture through the needle; to avoid "fracture" of needle during injection. Small size needle: to cause less pain; to avoid excessive bleeding.
30 Recommended Needle for MTrP Injection #25, 1 1 / 2 inch for large, thick, or deep muscles; for vigorous LTRs, for nervous patient; # 27, 1 1 / 4 inch for small or thin muscles; for cooperative patient; skilful technique required.
31 Recommended Needle for MTrP Injection An 1 1 / 2 -inchneedle is usually long enough for most of thick or deep muscles if the muscle is compressed with fingers during injection.
32 Syringe for MTrP Injection 5-cc or 10-cc syringe It can be held most comfortably.
33 Syringe for MTrP Injection 5-cc or 10-cc syringe It can be held most comfortably.
34 Positioning for MTrP Injection Patient: Recumbent position, or Sitting comfortably in an armchair. Physician: Comfortable sitting position, or comfortable standing, well-supported, position. Both hands well-supported.
35 Procedure of Myofascial Trigger Point Injection 1. Identification of the MTrP. 2. Skin preparation - sterilization (& anesthesia). 3. Skin penetration -to subcutaneous tissue layer.
36 Procedure of Myofascial Trigger Point Injection 4. Palpation of MTrP: Firm compression of MTrP (or taut band near MTrP) with index or middle finger of the other hand to locate taut band & minute tender sites in that MTrP region. 5. Aim the needle to the minute tender site(s)
37 Procedure of Myofascial Trigger Point Injection 6. Multiple insertions with fast-in and fast-out technique to search for MTrP loci: - Rapid insertion of needle into a LTR locus, - Injection of MTrP loci if LTR is elicited, with a drop of 0.5% Procaine (or Lidocaine). - Rapid withdrawal of needle back to subcutaneous layer, - Elimination of all LTR loci as possible.
38 Procedure of Myofascial Trigger Point Injection 7. Hemostasis - Epidermal & Intramuscular. - Firm compression to the site of injection. - Compression dressing over the site of injection. - Cold pack (with stretch) immediately after injection, for 3-5 minutes, only if arterial penetration is noticed. 8. Hot pack for several minutes after injection.
39 Frequency and Total Number of Repeated Injections -for Fibromyalgia patients. ***No fixed rule - case by case*** Frequency Total Duration Acute lesions Every 5-10 days for 1-3 weeks Chronic lesions Every 1 week, Then every 2 weeks, Then Every 3-4 weeks, Then Every 1 month, Then Every 2 months, and so forth. for few weeks, for few weeks, for few months, for few months, for 6-12 months, etc.
40 SIDE EFFECTS of MTrP INJECTION and PREVENTION (A). Injury to Muscle Fibers scar tissues (Fibrosis)? Scarring usually can be avoided by: 1. Reducing bleeding from injections. 2. Avoiding direct scratching by the needle (using fast-in and fast-out technique). 3. Avoiding injection into an area with active inflammatory process.
41 SIDE EFFECTS of MTrP INJECTION and PREVENTION (B). Injury to Nerve Fibers O.K. to penetrate the nerve (straight movement of the needle), but not to cut (side movement of the needle).
42 SIDE EFFECTS of MTrP INJECTION and PREVENTION (C). Injury to Blood Vessels: Ecchymosed / Hematoma. (D). Infection very rare. (E). Syncope or Anaphylactic Reaction probably due to intravenous injection of xylocaine. (F). Internal Organ Injury. All the complications are preventable; their prevention depends on the physician's knowledge of anatomy and the care exercised.
43 SIDE EFFECTS of MTrP INJECTION and PREVENTION Internal Organ Injury form MTrP Injection Lung: Pneumothorax Serratus (ant, post sup, post inf) muscles, Intercostal muscles, Subscapularis, Pectoralis minor, Upper quadratus lumborum, Thoracic paraspinal, Iliocostalis muscles.
44 SIDE EFFECTS of MTrP INJECTION and PREVENTION Internal Organ Injury form MTrP Injection Peritoneums: Pneumoperitonium Rectus abdominis muscles, Oblique muscles, Quadratus lumborum. Intestine or stomach: Abdominal muscles. Liver: Intercostal muscles, Serratus posterior inferior. Kidney: Quadratus lumborum.
45 CAUSES OF FAILURE IN IMMEDIATE PAIN RELIEF: A. Technical factors: 1). No precise location of loci in an MTrP region - no LTR elicited during injection. 2). Incomplete inactivation of all sensitive loci in an MTrP region. 3). Excessive damage to muscle fibers, nerve fibers or vessels.
46 CAUSES OF FAILURE IN IMMEDIATE PAIN RELIEF: B. Diagnostic factors: 1). Inappropriate determination of a primary MTrP (pain recognition) 2). Inappropriate determination of a "Key MTrP". 3). Unreliable information from patients (pain location, intensity, etc.). 4). Superimposed fibromyalgia syndrome. 5). Neurogenic pain, central pain or psychogenic pain.
47 CAUSES OF EARLY RECURRENCE: A. Technical Factors 1). Incomplete inactivation of all sensitive loci in an MTrP region. 2). Excessive damage to muscle fibers, nerve fibers or vessels. 3). Inadequate hemostasis after injection.
48 CAUSES OF EARLY RECURRENCE: B. Diagnostic Factors 1). Inappropriate diagnosis and/or treatment of the etiological lesions. 2). Inappropriate evaluation and control of perpetuating factor. 3). Long-standing or chronic myofascial pain syndrome. 4). Superimposed fibromyalgia syndrome. 5). Neuralgic pain, central pain or psychogenic pain.
49 CAUSES OF EARLY RECURRENCE: C. Aftercare Factors 1). Inappropriate medical care: (excessive, inadequate, or inaccurate). Medication, physical therapy, Alternative medicine, etc. 2). Inadequate or inappropriate home program.
50 CAUSES OF EARLY RECURRENCE: C. Aftercare Factors 3). Inappropriate physical and/or mental activity: (excessive, inadequate, or inaccurate). Posture, Daily living activity, Recreation, Exercise, Working status (body mechanics, working environment, etc),
51 1. Location of AcPs and MTrPs MTrPs are always identified in the endplate zone. Some AcPs are identified in the endplate zone. A high degree (71%) of correspondence between MTrPs and AcPs. [Melzack 1977]
52 2. Clinical Characteristics of AcPs and MTrPs (1). Tenderness All MTrPs are tender. Some AcPs (Ah-Shi points) are tender. Ah-Shi = 阿是 = Oh! Yes. (That is the spot.)
53 2. Clinical Characteristics of AcPs and MTrPs (1). Tenderness Ah-Shi points may include Myofascial trigger points (MTrPs), Subcutaneous trigger points (STrPs), Tendon trigger points (TTrPs), Ligament trigger points (LTrPs), etc.
54 TrP = trigger point M = myofascial S = subcutaneous T = tendon F = facet Sensitized Dysfunctional Nerve Endings Endplates LTR Locus EPN Locus MTrP Locus Other TrPs FTrP TTrP STrP MTrP Tender Points in Fibromyalgia Syndrome Trigger Points in Myofascial Pain syndrome
55 2. Clinical Characteristics of AcPs and MTrPs (2). Referred Pain (ReP) High-pressure stimulation to MTrP - ReP can be elicited in most of active MTrPs & some of latent MTrPs. Needling to AcP - ReP can be elicited in some AcPs. Referred pain patterns of MTrPs are similar to Channel (Meridian) connections of AcPs. (Spinal cord mechanism MTrP Circuit) [Hong 2000]
56 Trigger Point Referred Pain
57 ANS ReP Pain MTrP Circuit #1 ANS MTrP Circuit #2 ANS MTrP Circuit #3 Stimulic MtrP #1 LTR MtrP #2 MtrP #3
58 2. Clinical Characteristics of AcPs and MTrPs (3). Local Twitch Response (LTR) - High-pressure stimulation to MTrP - LTRs can be elicited in all active MTrPs & some of latent MTrPs. - Needling to AcP - Teh-Qui effects 得氣 (similar to LTRs) can be elicited in some AcPs. The best therapeutic effect after MTrP injection or acupuncture is related to the occurrence of LTRs or Teh-Qui effect. [Chu 1995, 1997; Gunn 1980; Hong 1993, 1994, 1996, 2000; Hong & Simons 1998]
59 3. Morphological Characteristics of AcPs and MTrPs MTrP: Multiple loci. = Nociceptors + Dysfunctional endplates [Hong 1993, 1994, 1996, 1999; Hong & Simons 1998]. Contraction knots in electromicroscopy [Simons 1999] or Sonography [Gerwin et al 2002]. AcP:? Nociceptors? Other sensory receptors? Related to the autonomic nervous system or others? Morphologically, it is difficult to differentiate a normal sensory receptors and an abnormal (sensitized) sensory receptors.
60 4. Pathophysiological Characteristics of AcPs and MTrPs MTrP: Spinal cord mechanism (ReP and LTR) Autonomic connection (RSD). AcP: Spinal cord mechanism? Autonomic mechanism? Endocrine system?
61 ANS ReP Pain MTrP Circuit #1 ANS MTrP Circuit #2 ANS MTrP Circuit #3 Stimulic MtrP #1 LTR MtrP #2 MtrP #3
62 5. Therapeutic Effectiveness of Acupuncture and MTrP injection MTrP Injection: MTrP injection for pain control - spinal cord mechanism (including autonomic influence in RSD) Acupuncture: Acupuncture for pain control - spinal cord mechanism Acupuncture for other therapeutic purposes - spinal cord mechanism connection with autonomic system? Autonomic influence? (to treat hypertension etc) Endocrine influence? (to treat DM etc)
Synergist Muscles. Shoulder (glenohumeral joint) Flexion Deltoid (anterior fibers) Pectoralis major (upper fibers) Biceps Brachii Coracobrachialis
Synergist Muscles Dr Gene Desepoli DrGeneLMT@gmail.com Shoulder (glenohumeral joint) Deltoid (anterior fibers) Pectoralis major (upper fibers) Biceps Brachii Coracobrachialis Deltoid (posterior fibers)
More informationDry Needling to a Key Myofascial Trigger Point May Reduce the Irritability of Satellite MTrPs
Authors: Yueh-Ling Hsieh, PhD, PT Mu-Jung Kao, MD Ta-Shen Kuan, MD, MS Shu-Min Chen, MD Jo-Tong Chen, MD, PhD Chang-Zern Hong, MD Affiliations: From the Department of Physical Therapy, Hungkuang University,
More informationDRY NEEDLING A MANUAL THERAPY STRATEGY FOR THE INJURED TENNIS PLAYER
DRY NEEDLING A MANUAL THERAPY STRATEGY FOR THE INJURED TENNIS PLAYER OBJECTIVES ü What is Dry Needling? ü What is a Triggerpoint? ü How does a Triggerpoint develop? ü What does Dry Needling do? ü Dry Needling
More informationThis Session by Simon Strauss
This Session by Simon Strauss Myofascial Pain. Part A Myofascial Pain. Part B Pain Assessment Tools. Part C Definitions and Language of Pain Allodynia- 1. A lower than normal pain threshold. 2. A clinical
More informationBiology 2401 Muscles List for CPC models
Biology 2401 List for CPC models Italicized muscles are dissect and similar in the cat = Dissect and note the differences in human and cat Major of the Human Head Facial Expression Epicranius frontalis
More information5/21/2013. Muscle Anatomy. Thursday January, 24 th, Skeletal Muscle. Smooth Muscle. Cardiac Muscle
Muscle Anatomy Thursday January, 24 th, 2013 Skeletal Muscle Cardiac Muscle Smooth Muscle 1 Smooth Muscle 1. Found in the walls of the digestive system, bladder, uterus and blood vessels 2. Involuntary
More informationEpicranius (frontal belly) Zygomaticus minor. Zygomaticus major Buccinator
Epicranius (frontal belly) Zygomaticus minor Zygomaticus major Buccinator Masseter Digastric (posterior belly) Stylohyoid Sternocleidomastoid Trapezius Scalenus Omohyoid (inferior belly) Orbicularis oris
More informationMuscle fiber (cell) Blood vessel. Perimysium. Epimysium. Fascicle (wrapped by perimysium) Endomysium (between fibers) Tendon. Bone
Figure 6.1 Connective tissue wrappings of skeletal muscle. Blood vessel Muscle fiber (cell) Perimysium Epimysium Fascicle (wrapped by perimysium) Tendon Endomysium (between fibers) Bone Figure 6.15 Superficial
More informationThe Clavicle Right clavicle Deltoid tubercle: Conoid tubercle, conoid ligamen Impression for the
The Clavicle Muscle Attachment Sites in the Upper Limb Pectoralis major Right clavicle Smooth superior surface of the shaft, under the platysma muscle tubercle: attachment of the deltoid Acromial facet
More information4/28/2017. Treatment Targets for MFDTM. Trigger Points, Fascial Lines, and Postural Syndromes. Trigger Points. Travel and Simons
Treatment Targets for MFDTM Trigger Points, Fascial Lines, and Postural Syndromes Trigger Points Travel and Simons 1 Trigger Points Lower levels of oxygen, nutrients, blood perfusion Increased levels of
More informationDISSECTION 1: SKELETAL MUSCLES
8546d_c01_1-42 6/21/02 1:34 PM Page 4 mac62 mac62:1253_ge: 4 Cat Dissection DISSECTION 1: SKELETAL MUSCLES Many skeletal muscles of the cat are similar to human muscles. This dissection will reinforce
More informationName this muscle. Name this muscle
this muscle this muscle Pectoralis Major Pectoralis Minor Serratus anterior Pectoralis minor Serratus anterior this muscle Deltoid: The major abductor of the upper limb this muscle this muscle this muscle
More informationHuman Muscles (Anterior View) Model 3-44
Human Muscles (Anterior View) Model 3-44 Temporalis Frontalis Orbicularis Occuli Orbicularis Oris Masseter Sternocleidomastoid Orbicularis Occuli Human Muscles (Anterior View) Model 3-65 Temporalis Masseter
More informationHuman Anatomy and Physiology I Laboratory
Human Anatomy and Physiology I Laboratory Gross Anatomy of the Muscular System (Two weeks) 1 This lab involves study of the laboratory exercise Gross Anatomy of the Muscular System. Complete the Review
More informationMicroAnatomy Muscle Fiber Model
MicroAnatomy Muscle Fiber Model Muscle fiber whole model (but model is only a fraction of a fiber) Sarcolemma 14 Myofibril 1 Nucleus 8 Mitochondria 2 Triad 16 Sarcoplasmic reticulum 17 T tubule 15 Thin
More informationContents. Preface xv. SECTION 1: Introduction to the Bodynamic System 1. SECTION 2: The Bodynamic Psycho-Motor Anatomy 29
Contents Preface xv SECTION 1: Introduction to the Bodynamic System 1 Definitions in the Bodynamic System 3 Ego Formation through the Coding Elements 9 Examples of Formation of Coding 17 Using This Book
More informationThe Muscular System Lab Power Point
The Muscular System Lab Power Point Myoneural Junction Sarcoplasm Nucleus Myofibrils Sarcomere (black line to black line) Sarcolemma Myoneural space Nucleus Endomysium Motor Neuron Muscles of Facial Expression
More informationUpper Cross Syndrome: Assessment & Management in Family Practice HKDU Symposium Dec 2014
Upper Cross Syndrome: Assessment & Management in Family Practice HKDU Symposium Dec 2014 Dr. Ngai Ho Yin Allen Family Medicine Specialist PGDipMusculoskeletal Medicine MBBS(HK), DCH(London), DFM(CUHK),
More informationA. All movements require muscle which are organs using chemical energy to contract.
Ch 8 Muscles Introduction: A. All movements require muscle which are organs using chemical energy to contract. B. The three types of muscle in the body are skeletal, smooth, and cardiac muscle. C. This
More informationPain Differential Diagnosis - Enrico Dellacà M.D Ph.D. Abductor pollicis brevis muscle Myofascial Pain Syndrome
Overview Abductor pollicis brevis muscle Myofascial Pain Syndrome Definition Pain Differential Diagnosis - Enrico Dellacà M.D Ph.D. The Myofascial pain syndrome (MPS) is a syndrome characterized by chronic
More informationMuscles of the Cat. N Deltoid MUSCLES OF THE CHEST. Pectoralis major. (This muscle is superior to Pectoralis minor) MUSCLES OF THE CHEST
MUSCLES OF THE CHEST Pectoralis major (This muscle is superior to Pectoralis minor) 1. MUSCLES OF THE CHEST Pectoralis minor (This muscle is inferior to Pectoralis major) 2. MUSCLES OF THE ARM Deltoid
More informationDue in Lab weeks because of Thanksgiving Prelab #10. Homework #8. Both sides! Both sides!
Lab 8 MUSCLES Due in Lab 10 2 weeks because of Thanksgiving Prelab #10 Both sides! Homework #8 Both sides! Refer to Muscles 22-23 Naming of muscles Origin Site of muscle attachment that doesn t move during
More informationWhat you should do in labs 11 & 12
Bio 101 Laboratories 11 & 12 Muscle Histology Gross Human Skeletal Muscle Cat Muscle Dissection 1 What you should do in labs 11 & 12 Lab 11 Muscle Histology (skeletal, smooth, cardiac) Human gross skeletal
More informationThe Human Muscular System Required reading before beginning this lab: Saladin, KS: Human Anatomy 5th ed (2017) Chapters 10, 11, 12 INTRODUCTION
Biology 322: Human Anatomy The Human Muscular System Required reading before beginning this lab: Saladin, KS: Human Anatomy 5 th ed (2017) Chapters 10, 11, 12 INTRODUCTION We will use a number of lab periods
More informationLEVEL II MUSCLE CHART NB: Needle length varies with tissue depth, this chart acts as a guide only. Side lye or prone.25 x 30-50mm Inferior to ilium
LUMBAR SPINE LEVEL II MUSCLE CHART NB: Needle length varies with tissue depth, this chart acts as a guide only Muscle/ Innervation Comments Position Quadratus Lumborum T12-L3/4 segmentally PSIS Comments.
More informationLectures Muscular System 10-1
Lectures 12-14 Muscular System 10-1 Properties of Muscle Ability of a muscle to shorten with force Capacity of muscle to respond to a stimulus Muscle can be stretched to its normal resting length and beyond
More informationHead & Neck The muscle names are followed by the chapter number
Head & Neck The muscle names are followed by the chapter number. Splenius capitis (9) 2. Occipitalis (2) Temporalis () 3. Temporalis () 4. Semispinalis capitis (9) Facial / Scalp (2) 5. Temporalis () Facial
More informationChapter 9. The Muscular System
1 Chapter 9 The Muscular System 2 Introduction Skeletal muscles: movement in environment Smooth muscles: intestines, ureters, veins and arteries Cardiac muscle: pumps blood through heart and blood vessels
More informationTrigger Point Injection. Objectives. What is a Trigger Point (TrP)? 3/19/2019
Trigger Point Injection Brian Shian, MD, FHM Department of Family Medicine University of Iowa Hospitals and Clinics Objectives Discuss the definition and diagnosis criterial Explore possible pathophysiology
More informationCat Muscles Flashcards Mt SAC
1. MUSCLES OF THE CHEST Pectoralis major (This muscle is superior to Pectoralis minor) 2. MUSCLES OF THE CHEST Pectoralis minor (This muscle is inferior to Pectoralis major) 3. MUSCLES OF THE ARM AD CHEST
More informationHuman Anatomy Lab #7: Muscles of the Cadaver
Human Anatomy Lab #7: Muscles of the Cadaver Table of Contents: Expected Learning Outcomes.... 1 Introduction...... 1 Identifying Muscles on Yourself.... 2 Muscles of the Anterior Trunk and Arm.. 2 Muscles
More informationMYOFASCIAL PAIN. Dr. Janet Travell ( ) credited with bringing MTrPs to the attention of healthcare providers.
Myofascial Trigger Points background info Laurie Edge-Hughes BScPT, MAnimSt (Animal Physio), CAFCI, CCRT History lesson Dr. Janet Travell (1901 1997) credited with bringing MTrPs to the attention of healthcare
More informationMuscles in the Shoulder, Chest, Arm, Stomach, and Back
Muscles in the Shoulder, Chest, Arm, Stomach, and Back Shoulder Muscles Deltoid Supraspinatus Infraspinatus Teres Major Teres Minor Subscapularis Deltoid (Delts) Function: Raises the upper arm Origin:
More informationHuman Anatomy Biology 351
1 Human Anatomy Biology 351 Upper Limb Exam Please place your name on the back of the last page of this exam. You must answer all questions on this exam. Because statistics demonstrate that, on average,
More informationTrigger Points And Muscle
Trigger Points And Muscle 1 / 6 2 / 6 3 / 6 Trigger Points And Muscle Trigger points or muscle knots are sensitive spots in soft tissue, and too many of them is myofascial pain syndrome. They are usually
More informationSpecialty Care National Program
Specialty Care National Program Mini-Residency Pain Management February 10-12, 2015 Myofascial Techniques for Back and Neck Pain Presented by: Edward S. Lee MD National Program Faculty: Edward S. Lee MD
More informationTemporalis Elevates & retracts mandible. Masseter Elevates mandible. Sternocleidomastoid Neck flexion. Trapezius Elevates & depresses shoulders
Anterior Posterior Temporalis Elevates & retracts mandible Masseter Elevates mandible Sternocleidomastoid Neck flexion Trapezius Elevates & depresses shoulders Masseter Elevates mandible Temporalis Elevates
More informationExercise Science Section 3: The Muscular System
Exercise Science Section 3: The Muscular System An Introduction to Health and Physical Education Ted Temertzoglou Paul Challen ISBN 1-55077-132-9 Major Functions of Muscles Movement Includes: breathing,
More informationWhat you should do in labs 11 & 12
Bio 101 Laboratories 11 & 12 Muscle Histology Gross Human Skeletal Muscle Cat Muscle Dissection 1 What you should do in labs 11 & 12 Today (Lab 11) Muscle Histology (skeletal, smooth, cardiac) Human gross
More informationMonday, November 13, 2017 A & P 2401
Monday, November 13, 2017 A & P 2401 Today you will complete the following handouts. Study the last part of the handout for this will be on your quiz, which will be on Wednesday. It is titled steps of
More informationModule 7 - The Muscular System Muscles of the Arm and Trunk
Module 7 - The Muscular System Muscles of the Arm and Trunk This Module will cover the muscle anatomy of the arms and trunk. We have already seen the muscles that move the humerus, so this module will
More informationTrigger Point Injections TRIGGER POINT INJECTIONS HS-184. Policy Number: HS-184. Original Effective Date: 7/1/2010
Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. Missouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,
More informationCat Dissection. Muscular Labs
Cat Dissection Muscular Labs Tibialis anterior External oblique Pectroalis minor Gastrocnemius Sartorius Pectoralis major Gastrocnemius Semitendinosis Sartorius External oblique Trapezius Latissimus dorsi
More informationPain Differential Diagnosis - Enrico Dellacà M.D Ph.D. Extensor digitorum brevis muscle of the foot Myofascial Pain Syndrome
Overview Extensor digitorum brevis muscle of the foot Myofascial Pain Syndrome Definition Pain Differential Diagnosis - Enrico Dellacà M.D Ph.D. Pain Differential Diagnosis - Enrico Dellacà M.D Ph.D. The
More informationAl-Balqa Applied University
Al-Balqa Applied University Faculty Of Medicine *You can use this checklist as a guide to you for the lab. the items on this checklist represent the main features of the models that you have to know for
More informationMuscle Anatomy Review Chart
Muscle Anatomy Review Chart BACK Superficial (5) Trapezius Transverse cervical a. Latissimus dorsi Thoracodorsal a. Rhomboideus major Dorsal scapular a. Rhomboideus minor Levator scapulae Intermediate
More informationMatch the types of muscle tissues with the words and phrases. 1) Skeletal 2) Smooth 3) Cardiac 2 Walls of blood vessels. 2 Walls of digestive tract
S T U D Y G U I D E. Types of Muscle Tissues Match the types of muscle tissues with the words and phrases. ) Skeletal ) Smooth ) Cardiac, Striated Walls of blood vessels, Single nucleus Heart muscle, Involuntary
More informationAcupuncture & Myofascial Pain
Acupuncture & Myofascial Pain Uncovering the Central Map of Physiological Homeostasis Joseph F. Audette, M.A., M.D. Spaulding Rehabilitation Hospital Department of PM&R, Harvard Medical School INTRODUCTION
More informationChiropractic Technician Class
Chiropractic Technician Class Presentation By: Dr. Kay Miller. The Role of Exercise as it Relates to Our Musculoskeletal System Introduction to the topic and Preliminary Physical exam Musculoskeletal anatomy:
More information11/15/2018. Temporalis Elevates & retracts mandible. Masseter = Prime mover of jaw closure. Levator scapulae Supraspinatus Clavicle.
Due in Lab 10 Lab 8 MUSCLES 2 weeks because of Thanksgiving Prelab #10 Both sides! Homework #8 Both sides! Refer to Muscles 22-23 Examples of Origin & Insertion Naming of muscles Origin Site of muscle
More informationLet s get to the point: Therapeutic Dry Needling
Let s get to the point: Therapeutic Dry Needling JILL THEIN-NISSENBAUM, PT, DSC, SCS, ATC ASSOCIATE PROFESSOR, UW-MADISON SMPH STAFF PT, BADGER SPORTSMEDICINE THEIN@PT.WISC.EDU No Conflict of Interest
More informationThe muscular system I Muscles of the head neck and trunk
The muscular system I Muscles of the head neck and trunk Dr. Nabil Khouri Dr. Nabil Khouri MD MSc, PhD Interactions of Skeletal Muscles Skeletal muscles work together or in opposition Muscles only pull
More informationTrigger Point Workshop NPO Conference Background. Mary Derlacki, FNP
Trigger Point Workshop NPO Conference 2015 Mary Derlacki, FNP Drs. Cassell and Braun 132 E. Broadway #830 Eugene, OR 97401 541-687-0816 mderlacki@comcast.net Background Skeletal muscle is 40% of ideal
More information2/4/2018. Identify the two reasons why muscle cells may go through muscle fatigue. Ch.7 Review. Sternocleidomastoid.
Ch.7 Review Identify the two reasons why muscle cells may go through muscle fatigue Temporalis Depressor anguli oris Sternocleidomastoid Tibialis anterior 1 Gluteus medius Deltoid Adducts & rotates scapula
More informationPrime movers provide the major force for producing a specific movement Antagonists oppose or reverse a particular movement Synergists
Dr. Gary Mumaugh Prime movers provide the major force for producing a specific movement Antagonists oppose or reverse a particular movement Synergists Add force to a movement Reduce undesirable or unnecessary
More informationDry needling as one of the methods of eliminating myofascial trigger points
Dąbrowska Maria, Lisiecki Jakub, Biernacki Maciej, Grzonkowska Magdalena, Ulenberg Agata, Ulenberg Grzegorz. Dry needling as one of the methods of eliminating myofascial trigger points. Journal of Education,
More informationPreface ORGANIZATION AND CONTENT
Preface Today s massage, bodywork, and fitness professionals are increasingly becoming members of the healthcare team. These professionals collaborate with physicians, physical therapists, occupational
More informationSummary Notes: Myofascial pain and self Myofascial release
Summary Notes: Myofascial pain and self Myofascial release Adam Floyd B.Sc (Physio) B.PE (Hons) Physiotherapist and Exercise Physiologist www.adamfloyd.com.au What is Myofascial Pain? Much of the early
More informationBiology 218 Human Anatomy. Adapted from Martini Human Anatomy 7th ed. Chapter 12 Surface Anatomy and Cross-Sectional Anatomy
Adapted from Martini Human Anatomy 7th ed. Chapter 12 Surface Anatomy and Introduction Surface anatomy is the study of anatomical landmarks on the exterior of the human body Knowledge of surface anatomy
More informationHow Muscles are Classified Muscles The three main types of muscles are,, and
7.5 Muscles: Designed for Motion How Muscles are Classified Muscles The three main types of muscles are,, and o Muscles Muscles that are generally under control (usually ) o Muscles Muscles that not under
More informationChapter 10. An Overview of the Muscle System
Chapter 10 An Overview of the Muscle System The Muscular System Superficial Deep Deep Superficial Frontalis Platysma Deltoid Pectoralis major Biceps brachii Brachioradialis Flexor carpi radialis External
More informationStrain-Counterstrain. Harmon Myers, DO and Julie Jernberg, MD
Strain-Counterstrain Harmon Myers, DO and Julie Jernberg, MD Origin of Counterstrain Lawrence Jones, DO Original Patient: 4 Months of lower back pain, sleep deprivation and high velocity therapy Jones
More informationFor Our Loved Ones. First Aid Massage
For Our Loved Ones First Aid Massage First Aid Massage Introduction Communication Anatomy Basics Care: First Aid Massage Communication Where Ask where the pain is. Determine the anatomical location. What
More informationMusculoskeletal Anatomy Coloring Book
Musculoskeletal Anatomy Coloring Book Muscolino, Joseph E. ISBN-13: 9780323057219 Table of Contents Introduction â How to Use This Book 1. The Skeletal System Bones of the Head â Anterior View Bones of
More informationGunn s Radiculopathy Model. Injured Nerves. Shortening of Muscle
1/10 BEST-KEPT SECRET FOR PAIN Sufferers - Miracles from needles Anna Lee, MD Dr. Lee s first treatment successfully relieved my pain that I had lived with for 23 years. For years, I have tried every type
More informationMuscular Nomenclature and Kinesiology - One
Chapter 16 Muscular Nomenclature and Kinesiology - One Lessons 1-3 (with lesson 4) 1 Introduction 122 major muscles covered in this chapter Chapter divided into nine lessons Kinesiology study of human
More informationThe Massage Routine. Start with your client lying face down - Prone Position. Clean YOUR HANDS and CLIENTS FEET using antibacterial wipes
The Massage Routine Start with your client lying face down - Prone Position Clean YOUR HANDS and CLIENTS FEET using antibacterial wipes!!!! GROUNDING FOR 3 BREATHS TUNE YOUR BREATHING WITH THE CLIENTS!!!
More informationManual Muscle Testing, MMT
Muscle Testing, MMT Manual This is the official list of names of all manual neuromuscular tests within Manual Muscle Testing MMT as used in Manual Kinesiology at the Swedish School of Kinesiology and the
More informationAnatomy and Physiology for Exercise and Health Level 3 A/600/9051 Mock Paper March 1 st 2015 August 31 st 2015
Anatomy and Physiology for Exercise and Health Level 3 A/600/9051 Mock Paper March 1 st 2015 August 31 st 2015 There are 40 questions within this paper. To achieve a pass you will need to score 28 out
More informationMyofascial Pain Syndrome and Trigger Points. Paul S. Sullivan, Do Trinity Health Care New England - Family Medicine
Myofascial Pain Syndrome and Trigger Points Paul S. Sullivan, Do Trinity Health Care New England - Family Medicine Objectives Discuss why this topic is pertinent to our practices Review diagnostic criteria
More informationPeripheral Nervous Sytem: Upper Body
Peripheral Nervous Sytem: Upper Body MSTN121 - Neurophysiology Session 10 Department of Myotherapy Cervical Plexus Accessory nerve (CN11 + C1-5) Motor: trapezius and sternocleidomastoid Greater auricular
More informationCOPYRIGHTED MATERIAL INDEX
abdominal muscles anatomy, 21 23 breathing and, 26, 30 exercises, 64 67 external oblique, 21, 23, 64 importance of strong, 63 internal oblique, 22, 23, 64 rectus abdominis, 22, 23, 64 stretching, 68 69
More informationThe Muscular System. Chapter 10 Part C. PowerPoint Lecture Slides prepared by Karen Dunbar Kareiva Ivy Tech Community College
Chapter 10 Part C The Muscular System Annie Leibovitz/Contact Press Images PowerPoint Lecture Slides prepared by Karen Dunbar Kareiva Ivy Tech Community College Table 10.9: Muscles Crossing the Shoulder
More informationProlotherapy Lumbar Spine Pain and Management. By Richard Hull D.O.
Prolotherapy Lumbar Spine Pain and Management By Richard Hull D.O. Lecture Points to be Covered Anatomy review Functional anatomy Muscle testing to determine a diagnoses Differential diagnosis Confirming
More informationTypes of Muscle: Skeletal- muscle involved in movement of the skeleton. Striated, has alternating bands of light and dark due to overlapping
Types of Muscle: Skeletal- muscle involved in movement of the skeleton. Striated, has alternating bands of light and dark due to overlapping filaments within the muscle cell. Skeletal muscle can be consciously
More informationMuscles of the Upper Limb
Muscles of the Upper Limb anterior surface of ribs 3 5 coracoid process Pectoralis minor pectoral nerves protracts / depresses scapula Serratus anterior Subclavius ribs 1-8 long thoracic nerve rib 1 ----------------
More informationThe Back. Anatomy RHS 241 Lecture 9 Dr. Einas Al-Eisa
The Back Anatomy RHS 241 Lecture 9 Dr. Einas Al-Eisa The spine has to meet 2 functions Strength Mobility Stability of the vertebral column is provided by: Deep intrinsic muscles of the back Ligaments
More information3 Movements of the Trunk. Flexion Rotation Extension
3 Movements of the Trunk Flexion Rotation Extension 1 TRUNK FLEXION 2 TRUNK FLEXION: Rectus Abdominalis O: Crest of Pubis & ligaments covering front of symphysis pubis. I: By «3 portions into cartilages
More informationEvaluating the Athlete Questionnaire
Evaluating the Athlete Questionnaire Prior to developing the strength and conditioning training plan the coach should first evaluate factors from the athlete s questionnaire that may impact the strength
More informationName Phone ( ) DOB. Address City State Zip. Referred by: Phone ( In case of emergency: Phone ( Occupation Male Female Physician
Client Information Name Phone ( ) DOB Address City State Zip E-mail: Referred by: Phone ( In case of emergency: Phone ( ) ) Occupation Male Female Physician Health Insurance Carrier Please take a moment
More informationThis figure (of humerus) is from Dr. Maher's newest slides. -Its added here just for consideration-
This figure (of humerus) is from Dr. Maher's newest slides. -Its added here just for consideration- Slides of Anatomy Please note : These slides are Dr. Maher Hadidi s slides of spring 2016 and were edited
More informationBRACHIAL PLEXUS. DORSAL SCAPULAR NERVE (C5) supraclavicular branch innervates rhomboids (major and minor) and levator scapulae
THE BRACHIAL PLEXUS DORSAL SCAPULAR NERVE (C5) supraclavicular branch innervates rhomboids (major and minor) and levator scapulae SCHEMA OF THE BRACHIAL PLEXUS THE BRACHIAL PLEXUS PHRENIC NERVE supraclavicular
More informationManual Therapy Techniques
Manual Therapy Techniques manual therapy: the use of hands-on techniques to evaluate, treat, and improve the status of neuromusculoskeletal conditions massage: the systematic and scientific manipulation
More informationThe importance of postural habits in perpetuating myofascial trigger point pain
The importance of postural habits in perpetuating myofascial trigger point pain Janet Edwards Summary Various structural abnormalities that contribute to the perpetuation of myofascial trigger point activity
More informationThe importance of postural habits in perpetuating myofascial trigger point pain
Introduction Pain arising from the activity of myofascial trigger points (MTrP) is extremely common. 1 When a MTrP becomes active, usually as a result of trauma or postural overload of a muscle, a small
More information9/25/2014. Ricki Loar, Ph.D., APN, FNP-BC, GNP-BC. Disclosure: No Disclosures. Strategic Nurse Practitioner Solutions, LLC
Ricki Loar, Ph.D., APN, FNP-BC, GNP-BC 1 Dr. Ricki S. Loar, Ph.D., FNP-BC, GNP-BC Clinical Director, Be Well Partners in Health Nurse Practitioner, South Naperville Family Practice Faculty, Advanced Practice
More informationExercise Science Section 3: The Muscular System
Exercise Science Section 3: The Muscular System An Introduction to Health and Physical Education Ted Temertzoglou Paul Challen ISBN 1-55077-132-9 Major Functions of Muscles Movement v Includes: breathing,
More informationOVERVIEW OF THE SIX FLEXIBILITY HIGHWAYS
A P P E N D I X O N E OVERVIEW OF THE SIX FLEXIBILITY HIGHWAYS THE ANTERIOR FLEXIBILITY HIGHWAY STRETCHING THE ANTERIOR FLEXIBILITY HIGHWAY LEVEL 1 LEVEL 2 PHOTO A1.1A AND B STRETCHING THE ANTERIOR FLEXIBILITY
More informationThe Muscular System PART C. PowerPoint Lecture Slide Presentation by Patty Bostwick-Taylor, Florence-Darlington Technical College
PowerPoint Lecture Slide Presentation by Patty Bostwick-Taylor, Florence-Darlington Technical College The Muscular System 6 PART C Five Golden Rules of Skeletal Muscle Activity Table 6.2 Muscles and Body
More information72a Orthopedic Massage: Introduction!
72a Orthopedic Massage: Introduction! 72a Orthopedic Massage: Introduction! Class Outline 5 minutes Attendance, Breath of Arrival, and Reminders 10 minutes Lecture: 25 minutes Lecture: 15 minutes Active
More information79b Orthopedic Massage: Technique Demo and Practice! Rotator Cuff and Carpal Tunnel!
79b Orthopedic Massage: Technique Demo and Practice! Rotator Cuff and Carpal Tunnel! 79b Orthopedic Massage: Technique Demo and Practice! Rotator Cuff and Carpal Tunnel! Class Outline" 5 minutes" "Attendance,
More informationTRIGGER POINT DRY NEEDLING
TRIGGER POINT DRY NEEDLING Sadie Newman PT DPT Cox Health What is it? 1 A skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points,
More informationSkeletal Muscle. Move your bones. Voluntary ( ) Over. Long. Cardiac Muscle. The muscle of the heart. Involuntary ( ) Works. Strongest. Only.
Muscular System Tour Name Hour Skeletal Muscle Move your bones. Muscular System There are more than muscles in the Human Body!!! Muscles are: Voluntary ( ) Over Needed for Needed for Needed for Needed
More informationOBJECTIVES. Unit 7:5 PROPERTIES OR CHARACTERISTICS OF MUSCLES. Introduction. 3 Kinds of Muscles. 3 Kinds of Muscles 4/17/2018 MUSCULAR SYSTEM
OBJECTIVES Unit 7:5 MUSCULAR SYSTEM Compare the three main kinds of muscles by describing the action of each Differentiate between voluntary and involuntary muscles List at least three functions of muscles
More information3/27/2012. Muscle Classification: Functional Groups. Interactions of Skeletal Muscles. Naming Skeletal Muscles. Naming Skeletal Muscles
Interactions of Skeletal Muscles Skeletal muscles work together or in opposition Muscles only pull (never push) As muscles shorten, the insertion generally moves toward the origin Whatever a muscle (or
More informationHealing Hands School of Holistic Health. Advanced Circulatory & Sports Massage Class Handouts
Class Handouts 1 Posterior Trepidations Torso Rock Torso Rock half-step Torso Rock both sides Torso Rock down body Torso Side Stretch Erector Rock Spinal Rock Lumbo Rock Cha Cha Leg Clay Snake Flop Leg
More informationLab Exercise 8. BIOPAC Exercise. Muscle Tissue. Muscles. What you need to be able to do on the exam after completing this lab exercise:
Lab Exercise 8 BIOPAC Exercise Muscle Tissue Muscles Textbook Reference: See Chapters 9 & 10 What you need to be able to do on the exam after completing this lab exercise: Be able to answer questions covering
More informationThe Muscular System. Myology the study of muscles
The Muscular System Myology the study of muscles Functions of muscles: 1. Movement 2. Stability /support posture 3. Heat production 85% of our body heat 4. Communication 5. Constriction of organs and vessels
More information80b Orthopedic Massage: Technique Review and Practice! Rotator Cuff and Carpal Tunnel!
80b Orthopedic Massage: Technique Review and Practice! Rotator Cuff and Carpal Tunnel! 80b Orthopedic Massage: Technique Review and Practice! Rotator Cuff and Carpal Tunnel! Class Outline 5 minutes Attendance,
More informationREFERENCE DIAGRAMS OF UPPER LIMB MUSCLES: NAMES, LOCATIONS, ATTACHMENTS, FUNCTIONS MUSCLES CONNECTING THE UPPER LIMB TO THE AXIAL SKELETON
REFERENCE DIAGRAMS OF UPPER LIMB MUSCLES: NAMES, LOCATIONS, ATTACHMENTS, FUNCTIONS MUSCLES CONNECTING THE UPPER LIMB TO THE AXIAL SKELETON A25LAB EXERCISES: UPPER LIMB MUSCLES Page 1 MUSCLES CONNECTING
More information