Trigger Point Therapy for Myofascial Pain by L.M.T. L.Ac. Donna Finando Page A
Authors: L.M.T. L.Ac. Donna Finando
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the course of the acromion posteriorly and medially along the spine of the scapula to the root of the spine of the scapula, a flattened, triangular surface at the medial border of the scapula. The root of the spine of the scapula is located on a horizontal line with the spinous process of T3.
Deltoid tuberosity of the humerusâThe bony prominence located approximately midway down the lateral aspect of the humerus.
Palpate the deltoid from its attachments on the shoulder girdle to its attachment on the humerus. Palpate anteriorly, noting the area where the deltoid lies adjacent to the pectoralis at the lateral concavity of the clavicle. Note the deltopectoral groove formed by the junction of the deltoid and pectoralis major muscles. Palpate the medial fibers, noting the attachment of the deltoid muscle to the acromion; palpate posteriorly, noting the attachment to the spine of the scapula. Note how the three aspects of the muscle converge to insert onto the deltoid tuberosity of the humerus.
Deltoid pain pattern
Pain pattern: Anterior fibers: Pain is experienced in the anterior and medial deltoid; the patient may experience weakened abduction of the externally rotated arm. Posterior fibers: Pain is experienced in the posterior and medial deltoid; the patient may experience weakened abduction of the internally rotated arm.
Causative or perpetuating factors: Direct trauma due to impact, overexertion, or sudden overload.
Satellite trigger points: Anterior fibers: pectoralis major, biceps brachii, posterior deltoid. Posterior fibers: long head of the triceps, latissimus dorsi, teres major.
Affected organ systems: Anterior fibers: respiratory system. Posterior fibers: digestive system.
Associated zones, meridians, and points: Anterior fibers: ventral zone; Hand Tai Yin Lung meridian; LU 1, 2, and 3. Posterior fibers: dorsal and lateral zones; Hand Yang Ming Colon meridian, Hand Shao Yang Triple Warmer meridian; CO 14 and 15, SI 10; TW 13 and 14.
Stretch exercises:
Anterior fibers : Place the palms firmly on each side of a doorway at approximately ear level. Stretch the body through the outstretched arms, opening the chest and anterior shoulder region.
Posterior fibers: Pull the affected arm across the chest, using the other arm placed proximal to the elbow to guide the action.
Strengthening exercises: Both strengthening exercises should be performed in a standing position with the arms at the sides.
Flex the affected armsâkeeping the elbows straight, bring the arm to shoulder level. Perform this flexion to a count of two; return to the starting position to a count of four. Repeat eight to ten times, increasing the number of repetitions as strength allows. Hand weights may be used to increase the work effort of the muscle.
Abduct the affected arm, keeping the elbows straight; bring the arm to shoulder level. Abduct to a count of two; return to the starting position to a count of four. Repeat eight to ten times, increasing the number of repetitions as strength allows. Hand weights may be used to increase the work effort of the muscle.
Stretch exercise 1: Anterior deltoid
Stretch exercise 2: Posterior deltoid
Latissimus dorsi and trigger points
L ATISSIMUS D ORSI
Proximal attachment: Latissimus dorsi fuses with teres major to attach at the medial edge of the bicipital groove, on the anterior aspect of the humerus.
Distal attachment: Spinous processes of T6âT12, L1âL5 and the sacrum, iliac crest via the thoracolumbar aponeurosis, lower 3â4 ribs, inferior angle of the scapula.
Action: Extension, adduction, and internal rotation of the arm at the shoulder.
Palpation: The latissimus dorsi and the teres major together form the posterior wall of the axilla. The tendon of the latissimus dorsi twists upon itself before fusing with teres major at the attachment on the bicipital groove.
To locate latissimus dorsi, identify the following structures:
Spinous processes of T6 through T12 and L1 through
Deltoid tuberosity of the humerusâThe bony prominence located approximately midway down the lateral aspect of the humerus.
Palpate the deltoid from its attachments on the shoulder girdle to its attachment on the humerus. Palpate anteriorly, noting the area where the deltoid lies adjacent to the pectoralis at the lateral concavity of the clavicle. Note the deltopectoral groove formed by the junction of the deltoid and pectoralis major muscles. Palpate the medial fibers, noting the attachment of the deltoid muscle to the acromion; palpate posteriorly, noting the attachment to the spine of the scapula. Note how the three aspects of the muscle converge to insert onto the deltoid tuberosity of the humerus.
Deltoid pain pattern
Pain pattern: Anterior fibers: Pain is experienced in the anterior and medial deltoid; the patient may experience weakened abduction of the externally rotated arm. Posterior fibers: Pain is experienced in the posterior and medial deltoid; the patient may experience weakened abduction of the internally rotated arm.
Causative or perpetuating factors: Direct trauma due to impact, overexertion, or sudden overload.
Satellite trigger points: Anterior fibers: pectoralis major, biceps brachii, posterior deltoid. Posterior fibers: long head of the triceps, latissimus dorsi, teres major.
Affected organ systems: Anterior fibers: respiratory system. Posterior fibers: digestive system.
Associated zones, meridians, and points: Anterior fibers: ventral zone; Hand Tai Yin Lung meridian; LU 1, 2, and 3. Posterior fibers: dorsal and lateral zones; Hand Yang Ming Colon meridian, Hand Shao Yang Triple Warmer meridian; CO 14 and 15, SI 10; TW 13 and 14.
Stretch exercises:
Anterior fibers : Place the palms firmly on each side of a doorway at approximately ear level. Stretch the body through the outstretched arms, opening the chest and anterior shoulder region.
Posterior fibers: Pull the affected arm across the chest, using the other arm placed proximal to the elbow to guide the action.
Strengthening exercises: Both strengthening exercises should be performed in a standing position with the arms at the sides.
Flex the affected armsâkeeping the elbows straight, bring the arm to shoulder level. Perform this flexion to a count of two; return to the starting position to a count of four. Repeat eight to ten times, increasing the number of repetitions as strength allows. Hand weights may be used to increase the work effort of the muscle.
Abduct the affected arm, keeping the elbows straight; bring the arm to shoulder level. Abduct to a count of two; return to the starting position to a count of four. Repeat eight to ten times, increasing the number of repetitions as strength allows. Hand weights may be used to increase the work effort of the muscle.
Stretch exercise 1: Anterior deltoid
Stretch exercise 2: Posterior deltoid
Latissimus dorsi and trigger points
L ATISSIMUS D ORSI
Proximal attachment: Latissimus dorsi fuses with teres major to attach at the medial edge of the bicipital groove, on the anterior aspect of the humerus.
Distal attachment: Spinous processes of T6âT12, L1âL5 and the sacrum, iliac crest via the thoracolumbar aponeurosis, lower 3â4 ribs, inferior angle of the scapula.
Action: Extension, adduction, and internal rotation of the arm at the shoulder.
Palpation: The latissimus dorsi and the teres major together form the posterior wall of the axilla. The tendon of the latissimus dorsi twists upon itself before fusing with teres major at the attachment on the bicipital groove.
To locate latissimus dorsi, identify the following structures:
Spinous processes of T6 through T12 and L1 through
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