Trigger Point Therapy for Myofascial Pain

Trigger Point Therapy for Myofascial Pain by L.M.T. L.Ac. Donna Finando Page B

Book: Trigger Point Therapy for Myofascial Pain by L.M.T. L.Ac. Donna Finando Read Free Book Online
Authors: L.M.T. L.Ac. Donna Finando
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L5—Note the difference in the size and shape of the spinous processes of the thoracic vertebrae versus the lumbar vertebrae.
Iliac crests—Lying on a horizontal line with the junction of L4–L5.
Inferior angle of the scapula—The sharp, triangular, distal aspect of the scapula. In most cases the inferior angle of the scapula lies on a horizontal line with T7.
Bicipital groove of the humerus (intertubercular groove)—Identify the greater and lesser tuberosities of the humerus, just distal to the lateral aspect of the acromion. (These are best palpated with the arm externally rotated.) The bicipital groove lies medial to the greater tuberosity and lateral to the lesser tuberosity. Note that the tendon of the long head of the biceps brachii runs through the bicipital groove.
    Palpate latissimus dorsi with the patient in the prone position, arms resting at his sides, palms up. Use a pincer grasp at the posterior axillary fold, gently lifting the muscle off the thoracic wall. Grasp the muscle along its lateral placement, proximal to the inferior angle of the scapula, at approximately the midpoint of the lateral edge of the scapula; follow the muscle toward the iliac crest, where the muscle fibers become increasingly indistinct.
    Latissimus dorsi pain pattern
    Pain pattern: Pain is located at the inferior angle of the scapula and the surrounding midthoracic region, possibly extending to the back of the shoulder and down the medial aspect of the arm, forearm, and hand, including the ring and little fingers. The nature of the pain is an ache that shows neither aggravation nor relief with activity or change of position.
    Causative or perpetuating factors: Depressor movements that overload, as in pulling something down from above or holding a heavy, bulky object.
    Satellite trigger points: Teres major, triceps brachii, rectus abdominis, iliocostalis thoracis, and iliocostalis lumborum.
    Affected organ system: Digestive system.
    Associated zones, meridians, and points: Dorsal and lateral zones; Foot Tai Yang Bladder meridian, Hand Tai Yang Small Intestine meridian; BL 23, SI 9.
    Stretch exercise: Reach both arms above the head. Grasp the wrist of the hand on the affected side with the opposite hand. Pull the wrist and arm toward the unaffected side, bending the torso to that side. Hold this position for a count of ten to fifteen.
    Strengthening exercise: Standing with the legs shoulder-width apart, bend from the waist so that the upper body is parallel to the floor. Reach the arm of the affected side toward the opposite foot. Bend the elbow to make a 90-degree angle and retract the scapula, extending the upper arm, bringing it to a position alongside the torso. The final position is one in which both the torso and the upper arm are parallel to the floor while the forearm is perpendicular to the floor. Draw the arm to the side to a count of two. Reach for the opposite foot to a count of four.
    Repeat eight to ten times, increasing repetitions as the strength of the muscle allows. Do not allow the torso to move during the course of the exercise.
    Stretch exercise: Latissimus dorsi
    Teres major and trigger points

T ERES M AJOR
    Proximal attachment: Teres major fuses with latissimus dorsi to attach at the medial edge of the bicipital groove, on the anterior aspect of the humerus.
    Distal attachment: Inferior angle of the scapula.
    Action: Internal rotation, adduction, and extension of the arm.
    Palpation: Teres major and latissimus dorsi are fused at their insertion into the bicipital groove. The tendon of latissimus dorsi twists upon itself before fusing with teres major at the attachment at the bicipital groove.
    To locate teres major, identify the following structures:
Inferior angle of the scapula—The sharp, triangular, distal aspect of the scapula. In most cases the inferior angle of the scapula lies on a horizontal line with T7.
Bicipital groove of the humerus (intertubercular groove)—Identify the

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