Trigger Point Guide

Trigger Point Guide
Theory
Karri Koivula
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Disclaimer
Huge effort is made that this book represents generally accepted medical practises and that this information doesnt pose a risks for anybody who uses it. But it is very important that you realize that you read this book at your own risk. All material provided in this e-book is for informational and educational purposes only, and not to be construed as medical advice. No action should be taken solely based on this e-book
Absolutely consult you physician before you take any actions related to your you health By downloading/reading this book You understand and agree that in no event shall the author nor the publisher of this e-book be liable to you or any other user of this e-book for the use of the information.
Statements mentioned within this e-book are not intended to diagnose, treat, cure or prevent any disease. The statements made within this e-book have not been evaluated by the Food and Drug Administration. If you dont understand or agree these terms then please quit reading this book right now and delete this book from your computer. Thanks. Copyright notice Its illegal to copy any material from this book and distribute it. I regularly search the internet for illegal copies. And I will press criminal charges against those who illegally distribute it. Copyright. 2004 Karri Koivula
Start here
Foreword The focus here is in practical advice. The bottom line, And all that matters, Is that trigger points cause referred pain, And that they relax trough massage. And that the pain symptoms they cause will vanish along them
Call to action Read some theory below then go to the pain patterns section and Look at the body part pictures and try to pin point your pain, then look at the muscle pain index and see which muscles are generally involved. Then go to work, use the side menu to easily jump to what ever muscles you need to massage, and use the pictures and written guidelines if any to get the job done.
Theory section starts

Trigger points are hyper contracted bundles of muscle cells. Also because of this contraction there are taut bands of stretched muscle attached to these contraction knots that run to both directions and end up in the muscles attachments points. Putting pressure on the trigger point will eventually make them relax. Even pressing at the taut band can make this happen as it forces a stretch to the contracted knots that are in the center. But for best effect you want to aim center. youll locate the center/trigger point by its pressure tenderness, pressing it moderate/hard force should cause noticeable pain both ate the spot and in the pain referral zone. You can test this by pressing a spot few centimetres of the spot, and see that you can barely feel the pressing. Normal muscle tissue can take a lot of force applied to it; until you start to feel even slight discomfort.
Trigger point identification -important

Pressure tender spot Spot that hurts to press Twitch reaction When you press the spot or taut band you can feel the taut band to twitch violently. Its good indicator from trigger points, but it doesnt happen, or you cant always feel it. Reappearing of referred pain symptom When you press the tp you feel something on the actual pain zone were the symptom that bothers you exists. Sometimes its the exact feeling of the pain but most cases you just feel some weird sensations in the general area of you pain zone.
Brief massage guide lines

Find the spot and the direction of applying pressure massage that hurts the most. Massage multiple short session though out the day. As long as it takes for the spots to become none-tender, or as long as it takes to get relief. This will in most cases take weeks. Ways to massage Repetitive stroke massage or continuous pressure Il like the best from continuous pressure applied by tool and using bodyweight for applying the pressure. Its the lazy persons way to do it and works just perfect. Continuous pressure Hold 8-15 seconds pressure move to another spot come back later repeat about 2-3 per spot 2-5 times per day Massage Massage 10 strokes move to another spot come back repeat 2-3 times per spot 6-10 times per day There are no rules once you get the hang of it youll make you own system.
Case example
Acute pain phase Massages points in many sessions a day for two weeks Holy smoke I am full of these buggers it seems that every inc of my body is is a tender spot. Pain symptoms regress backwards old injuries start to feel again maybe resulting in more pain. My muscles are twitching like there no tomorrow. Where is this all going to lead.. Then every other day for couple of weeks Things start to normalize I got to tell everybody about this. This is pretty cool, why the doctors didnt tell me about this. Upkeep/ maintenance Then once a week, or when needed. Massage is getting boring but some of the points are still a bit tender, although generally it gets harder and harder to find them Then once a moth, one session holding for 5 seconds,per spot. Im so lazy I should do the massage more often. Some spots may get tender but they dont seem to cause those old referred pain symptoms, strange Where I ever in pain? It seems so distant
Pain shift - important

What you get is a pain shift or the pain gets worse. You can aggravate the current tp and your pain symptom worsens this is common although it doesnt seem to postpone the relaxation of the tp. Which is bit odd, but thats the practice of things. And thus some use very rough methods from the beginning to get things handled as quickly as possible and suffer a little extra pain. Pain shift can be like going back in time. Pain shift happens when the pull of the muscles changes and it flares old latent trigger points. For example if you hurt you foot and got longstanding knee pain that eventually settled in you hip. You can experience the same knee pain again as the trigger point will flare upp again as the balance between the pull of the muscles changes as you massage tps. But at this point dont call me and get angry at me but continue to massage the points that are responsible of this newly appeared symptom. They should vanish eventually. I dont know a case where this pain shift or regression back to old symptoms havent vanishedI dont see any logic reasons for this but realize that there is a risk for this.
Trigger Point Guide
Pain patterns
Karri Koivula
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Index
1. Head and neck pain 2. Upper back, shoulder, upper arm pain 3. Middle back, lower back ,hip and buttock pain 4. Chest, abdominal and groin pain , 5. hip, thigh, knee pain 6. Leg and ankle pain 7. Foot pain
Head and Neck pain
Eye area pain

Sternocleidomastoid Temporalis slpenius cervicis massater occipitalis orbicularis oculi suboccipital group trapezius
I pain/muscle index
Top of head
sternocleidomastoid splenius capitis
Back of head pain

Trapezius sternocleidomastoid semispinalis capitis semispinalis cervicis splenius cervicis suboccipital group occipitalis digastric temporalis
Ear and chin joint pain

sternocleidomastoid massater lateral pterygoid trapezius buccinator Platysma orbicularis oculi zygomataticus major digastric medial pterygoid
Side of head
Trapezius sternocleidomastoid temporalis splenius cervicis suboccipital group semispinalis capitis
Tooth pain
temporalis massater digastric
Back of neck
Trapezius multifidi levator scapulae splenius cervicsis
Front of head
sternocleidomastoid Frontalis zygomaticus major semispinalis capitis
Front of neck
korva ja leuka nivel srky

lateral pterygoid massater sternocleidomastoid medial pterygoid 4
sternocleidomastoid digastric medial pterygoid
Trapezius
Use Stick and tennis ball against the wall. Picture: For trigger points, lower down in the trapezius, lye down in the floor and use tennis ball and use it to apply the pressure and find the right spots. picture:
Sternocleidomastoid
Just grab the muscle like in I am doing, bend the head to the side you are pinching the muscle to give it some slack and make it easier to grab. Just go trough the whole muscle pinch gripping it and find the trigger points. The muscle two branches on top of each others, you can see them divide in the lower attachment point. But for the most part of the muscle you dont have to distinguish them.
Temporalis
Use your knuckles or some hard tool to locate temporal trigger points. But go easy on them. Its really spooky kind of pain that they can make and reappear when pressed.
massater
I find it helpful to press little towards ears to hit the muscle in right direction. Use fingers, knuckles or tool
Splenius Capitis
Splenius Cervcis
Tool against wall or against floor.
Semispinalis Capitis
Tool against wall or against floor.
multifidi , rotatores
Tennis ball is too big to hit the trigger points but some tool that is smaller works fine. Be little extra careful when applying pressure near vertebrae, use common sense. To be extra cautious use tool with your hands not against floor or wall-
Buccinator
It refers pain to the teeth near the muscle Use your fingers for pressure
Lateral pterygoid
The x is the trigger point spot and grey areas on both side it the referred pain areas. use fingers to locate and hit the spot.
Medial pterygoid
To reach this muscle you need to press it from below your chin. It is on the x spot
orbicularis oculi
No its not the Frankensteins bride wearing an eye patch, even thou it kind of a looks like it. The pain pattern is the grey shadow that seems to sculpt the nose and the trigger point is the small x just in the eye brow line or little below, like it is in this case. Just track down the bones around the eye looking for tender points. The black patch describes the muscle.
zygomaticus, levator labii
Indian war painting, or maybe not. Use fingers to locate and aply pressure
digastric
Again you need to venture to the underneath of the chin. Use fingers an to search tender spots and referred pain.
frontalis
occipital
Move your eyebrows and try to wiggle your ear can you feel the occipital muscle in the back of your head. Fingers, knuckles or a tool there arent any rules.
suboccipitalis
Use a tool to reach the muscle easily, against wall if necessary.
Upper back, shoulder, upper arm
Index II
Upper back pain
Scaleni levatorscapulae trapezius multifidi splenius cervicis supraspinatus rhombodei triceps brachii biceps brachii
teres minor subscapularis serratus posterior superior triceps brachii trapezius scaleni lats erector spinae
Shoulder front
infraspinatus deltoid scaleni supraspinatus pectoralis major pectoralis minor biceps brachii coracobrachialis sternalis subclavius scaleni biceps brachii triceps brachii subclavius supraspinatus sternalis infraspinatus Deltoid brachialis latissimus dorsi
Back of shoulder
levator scapulae supraspinatus teres major latissimus dorsi
deltoid
Back of upper arm
scaleni teres major triceps brachii deltoid subscapularis supraspinatus teres minor latissimus dorsi serratus posterior superioir coracobrachialis scalenus minimus
Front of upper arm
scalanes
Locate your collar bone use your fingers o pull to the collar bone.
trapezius
Tennis ball or similar tool against the floor is the way to go, just lye on it and move it to the tenderest spots and hold for awhile.
Levator Scapulae
Latissimus Dorsi
Rhomboid
Serratus posterior superior
supraspinatus
Stick as a tool is great to reach this, tennis ball on the floor can work also.
infraspinatus
Teres Minor
Teres Major
Subscapularis
coracobrachialis
deltoid
Triceps
Biceps
Middle back, lower back, hip and buttocks/sacral pain
Index III
Middle back pain
spinae erectors multifidi rotatores rectus abdomis serratus anterior serratus posterior inferior latissimus dorsi intercostals
hamstrings soleus
Buttock/sacral pain
quadratus lumborum erector spinae gluteus minimus gluteus medius gluteus maximus piriformis hamstring soleus
Lower back pain

gluteus medius gluteus maximus gluteus minimus psoas multifidi rotators (syvt elklihakset) spinae erectors ( pinnalliset selklihakset) quadratus lumborum rectus abdomis obiliques
Hip pain
quadreceps vastus lateralis gluteus minimus gluteus maximus. piriformis quadratus lumborum tensor fasciae latae
Gluteus maximus
Gluteus medius
Gluteus minimus
piriformis
Quadratus lumborum
Spinae erectors & multifidi ja rotatores
Rectus abdomis
liopsoas
obiliques
Hamstring
Chest, abdominal, genital pain
latissimus dorsidiaphgram
Index IV
Chest pain pectorals scalenes sternocleidomastoid sternalis intercostals superficial spinal muscles subclavius rectus abdomis diaphgram Side pain serratus anterior abdominal obiliques intercostals
Abdominal pain rectus abdomis abdominal obliques superficial spinal muscles deep spinal muscles quadratus lumborum Groin pain Rectus abdomis Abdominal obiliques intrapelvic muscles adductor magnus psoas piriformis
Pectorals
Serratus anterior
Latissimus Dorsi
Rectus abdomis
Obiliques
Hip, thigh, knee pain
Index V
Groin Pain
pectineus abductor longus abductor magnus rectus abdominis abdominal obiliques psoap intrapelvi muscles
rectus femoris vastus medialis abductor longus
Inner knee
vastus medialis gracilis rectus femoris sartorius adductor longus
Outer knee
Hip pain
vastus lateralis
gluteus minimus vastus lateralis piriformis qiadratus lumborum tensor fasciae latae vastus intermedialis gluteus maximus
Back of thigh
gluteus minimus semitendinosus biceps femoris piriformis intrapelvi muscles
Inner thigh
Front thigh pain
Abductor longus psoas abducto magnus vastus intermedialis pectineus sartorius quadratus lumborum rectus abdominis
pectineus vastus medialis grazilis adductor magnus
Back of knee
gastrocnemius biceps femoris popliteus semiteninosus semimembranus soleus plantaris
Front of knee
Tensor latia fascae
Vastus intermedialis
Vastus medialis
Rectus femoris
vastus lateralis
Pectineus
Abductor brevis
Abductor longus
49
Abductor magnus
Gracialis
Hamstrings
plantaris
Popliteus
Leg and ankle pain
Side of leg
Index VI
Front of leg
Tibialis anterior adductor longus
Gastrocnemius gluteus minimus peroneus longus peroneus brevis vastus lateralis
Front of foot
inner ankle
tibialis anterior peroneus tertius extensor digitorum longus
Abductor hallucis flexor digitorum lonngus
outer ankle
peroneus peroneus peroneus abductoe
Back of leg
Soleus gluteus minimus gastronomicus semitendinosus semimembranus flexor digitorum longus tibialis posterior Plantaris
longus brevis tertius digiti minimi
back of ankle
soleus tibialis posterior
tibialis anterior
extensor hallucis longus
&
extensor digitorum
peroneus longus
&
Peroneus brevis
peroneus tertius
gastrocnemius
soleus
tibialis posterior
Flexor digitorum longus & flexor hallucis longus
Foot pain
Index VII
Top of foot Bottom of the foot Front
flexor hallucis brevis flexor digitorum brevis adductor hallucis flexor hallucis longus interosseus abductor digiti minimi flexor digitorum longus tibialis posterior flexor digigti minimi brevis
extensor digitorum brevis extensor hallucis brevis extensor digitorum longus extensor hallucis longus flexor hallucis brevis interosseus tibialis anterior
Big toe
top tibialis anterior extensor hallucis longus flexor hallucis brevis under flexor hallucis longus flexor hallucis brevis tibialis posterior
Bottom of the foot middle

gastrocnemius flexor digitorum longus adductor hallucis soleus interoseus tibislis posterior
Other toes
top interosseus extensor digitorum longus under flexor digitorum longus tibialis posterior
Heel pain
soleus quadratus palnatae abductor hallucis tibialis posterior abductor digiti minimi
Extensor digitorum brevis & extensor hallucis brevis
introsseus
Abductor hallucis
abductor digiti minimi
flexor digitorum brevis
quadratus plantae
Abductor hallucis & flexor hallucis brevi
Flexor digiti mininmi brevis
Elbow, arm, wrist, hand pain
Index VIII
Elbow
supinator brachioradialis extensor anconeus triceps brachii supraspinatus pectoralis major serratus anterior serratus posterior superior
Wrist outer arm
extensors subsscapulari sascalenes latissimus dorsi serratus posterior superior coracobrachialis
Wrist inner hand pain

flexors palmaris longus pronator teres opopnens pollicis pectorals latissimus dorsi serratus anterior
Outer elbow
trticeps scalanes extensors brachioradialis brachialis flexors infraspinatus teres major cocabrachialis supraspinatus subclavius
Inner finger pain

flexores digitorum superficialis and profundus introssei abductor digiti minimi lats serratus subclavius
Inner elbow pain

palmaris longus pronator teres serratus anterior triceps brachii latissimus dorsi pectoralis major serratus posterioer superior
Top of finger pain

extensor digitorum introssei scalene abductor digiti mininimi pectorals
lats subclavius
Thumb pain
supinator scalene brachialis brachioradialis opponenns pollicis abductor pollicis extensor carpi radialis longus first dorsal introsseus flexor pollicis longus subclavius infraspinatus brachialis
extensor carpi radialis longus
brachioradialis
supinator
extensor carpi radialis brevis
extensor carpi ulnaris
anconeus
extensor digitorum
Extensor indicis
flexor carpi radialis
flexor carpi ulnaris
palmaris longus
flexor digitorum
pronator teres & pronator quadratus
flexor pollicis longus
opponens pollicis & abductor pollicis
introsseus

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Trigger Point Guide

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Theory section starts

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Trigger point identification -important

Brief massage guide lines

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Pain shift - important

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Trigger Point Guide

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Head and Neck pain

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Eye area pain

Back of head pain

Ear and chin joint pain

Trapezius sternocleidomastoid temporalis splenius cervicis suboccipital group semispinalis capitis

sternocleidomastoid Frontalis zygomaticus major semispinalis capitis

korva ja leuka nivel srky

sternocleidomastoid digastric medial pterygoid

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Tool against wall or against floor.

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Tool against wall or against floor.

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zygomaticus, levator labii

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Use a tool to reach the muscle easily, against wall if necessary.

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Upper back, shoulder, upper arm

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Back of upper arm

Front of upper arm

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Serratus posterior superior

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Middle back, lower back, hip and buttocks/sacral pain

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Lower back pain

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