Boney Landmarks

Boney Landmarks
- Describing bones: honeycomb (carpals and tarsals), prominent, more fragile, flat, round, sharp, long, irregular, etc.
Landmark Clients Position And Instructions Scripting on How to Palpate

Scapula Sitting Locate the 7 Cervical Spinous Process moving inferiorly to the 2nd - 7th Thoracic Spinous Process then moving laterally will be the Scapula marked by
th
the Superior Angle of the Scapula and the Inferior Angle of the Scapula
Spine of Scapula Sitting Locate the Clavicle, moving posteriorly and the inferiorly and stopping on the Spine of the Scapula
Instruction: Place your hand behind your back (EXPLAIN
that the Scapula is now in a state of Adduction and/or
Elevation)
Infraspinous Fossa Sitting Locate the Spine of the Scapula and moving inferiorly and stop on the Infraspinous Fossa
Instruction: Place your hand behind your back (EXPLAIN Note: The Infraspinous Fossa borders are the Spine of the Scapula, the Lateral Border of the Scapula, the Medial Border of the Scapula, and the
that the Scapula is now in a state of Adduction and/or Inferior Angle of the Scapula
Elevation)
Supraspinous Fossa Sitting Locate the Spine of the Scapula moving medially and superiorly you will stop on the Supraspinous Fossa which is deep to the trapezius and
Instruction: Place your hand behind your back (EXPLAIN supraspinatus muscles.
that the Scapula is now in a state of Adduction and/or Note: The Supraspinous Fossa border are the medial and mid Spine of the Scapula, Superior Angle of the Scapula, the Medial Border of the
Elevation) Scapula, and the Superior Border of the Scapula
Inferior Angle of the Scapula Sitting Locate the Medial Border of the Scapula and moving inferiorly until stopping on the Inferior Angle of the Scapula
Elevation)
Medial Border of the Scapula Sitting From the Spine of the Scapula moving medially and stopping on the Medial Border of the Scapula
Elevation)
Lateral Border of the Scapula Sitting Locate the Inferior Angle of the Scapula moving laterally and superiorly be on the Lateral Border of the Scapula
Elevation)
Superior Angle of the Scapula Sitting Locate the Medial Border of the Scapula moving superiorly past the spine and now superiorly and laterally you stop of the Superior Angle of the
Instruction: Place your hand behind your back (EXPLAIN Scapula
Elevation)
Superior Border of the Sitting Locate the Superior Angle of the Scapula laterally and inferiorly will be the Superior Border of the Scapula
Scapula Instruction: Place your hand behind your back (EXPLAIN
Elevation)
Acromion (a-Kro-mee-on) Sitting Locate the Spine of the Scapula following it superiorly and laterally before reaching the Clavicle or the Acromioclavicular joint you will stop on flat
part of the Acromion or the Acromion Process
Coracoid Process Sitting (Sitting, proper posture) From the Clavicle lateral end before the Acromion and the Acromioclavicular joint moving an inch inferiorly, press until you
can locate the tip of the Coracoid Process
OR
(Sitting, hands forward) From the Sternal End of the Clavicle moving laterally when the Clavicle starts to become concaved (turning inward towards
the body) stop and move an inch inferiorly and while pressing you will locate the tip of the Coracoid Process
Subscapular Fossa Sitting In the prone position and raising the arm/abduction locate the Medial Border of the Scapula with one hand with the other hand go into the armpit
Instruction: Please lie down (over the rhomboid and trapezius muscles) and move the hand posteriorly on the opposite side of where your other hand is. This is the Subscapular
Fossa
Clavicle Sitting Locate the Jugular Notch of moving laterally you be on the Clavicle
Humerus Sitting From the Acromion moving distally you will stop on the Humerus
Deltoid Tuberosity Sitting From the Acromion (lateral view) moving distally (half way) through the shaft of the Humerus (you will notice a dip from the deltoid muscles) you
will reach the Deltoid Tuberosity
Greater Tubercle Sitting Instructions [1] ***
Instruction: [1] can you please hold my hand (make sure From the Acromion (lateral view) moving distally and posteriorly/laterally slightly you will find the Greater Tubercle
it’s relaxed, shake if necessary) Instruction [2] During medial rotation (forearm towards the body) of the arm you will feel it
Lesser Tubercle Sitting Instructions [1] ***
Instruction: [1] can you please hold my hand (make sure From the Acromion (lateral view) moving distally and anteriorly slightly you will find the Lesser Tubercle
it’s relaxed, shake if necessary) Instruction [2] During lateral rotation (forearm away from the body) of the arm you will feel it
Transtubercular Sitting ^^^^^Choose either the Lesser Tubercle or the Greater^^^^^^
OR Instruction: [1] can you please hold my hand (make sure During the rotation of the forearm you will feel the groove been the Greater and Lesser Tubercle this is the Bicipital Groove
Intertrabecular/Bicipital it’s relaxed, shake if necessary)
Groove
Olecranon Fossa Sitting Locate the Olecranon
(ol-Kran-on) Instruction: [1] can you please hold my hand (make sure Instruction [2]: Flexing the forearm (moving the forearm up)
it’s relaxed, shake if necessary) Moving proximally, you will fall into the Olecranon Fossa of the Humerus
Medial and Lateral Sitting Locate the Olecranon

Epicondyles Instruction: [1] can you please hold my hand (make sure Instruction [2]: Flexing the forearm (moving the forearm up)
it’s relaxed, shake if necessary) Moving proximally, you will fall into the Olecranon Fossa of the Humerus, laterally (from in the POV of your index finger) are the bumps of the
Medial and Lateral Epicondyles of the Humerus
Ulna Sitting Locate the 5th Metacarpal (pinky finger) and moving proximally until you are on the Shaft of the Ulna (the middle)
Shaft of the Ulna Instruction: [1] can you please hold my hand (make sure
it’s relaxed, shake if necessary)
Olecranon Sitting Locate the Olecranon Fossa
(ol-Kran-on) Instruction: [1] can you please hold my hand (make sure Instruction [2]: Flexing the forearm (moving the forearm up)
it’s relaxed, shake if necessary) Moving distally, you will fall onto the Olecranon of the Ulna
Styloid Process of the Ulna Sitting Locate the 5th Metacarpal (pinky finger) and moving proximally until you are on the distal end of the Ulna
Head of the Ulna Instruction: [1] can you please hold my hand (make sure Instruction [2]: Putting the wrist in a radial deviation/abduction (moving the wrist/thumb sideways away from pinky), you will locate the Styloid
it’s relaxed, shake if necessary) Process of the Ulna before the carpals
Instruction [3]: However, putting the wrist in ulnar deviation/adduction (moving the wrist/pinky sideways away from the thumb), you will locate the
Head of the Ulna
Radius Sitting Locate the 1st Metacarpal (thumb) and moving proximally (until you are on the middle) Shaft of the Radius
Shaft of the Radius Instruction: [1] can you please hold my hand (make sure
Styloid Process of the Radius Sitting Locate the 1st Metacarpal (thumb) and moving proximally until you are on the distal end of the Radius, if you go any further proximally it will become
Instruction: [1] can you please hold my hand (make sure thinner, it’s the broad end distally that is the Styloid Process of the Radius
Lister’s Tubercle of the Radius Sitting Locate the Styloid Process of the Radius, going proximally slightly and moving (index or thumb) over the distal end of the Radius the bump is the
(Dorsal tubercle of the radius) Instruction: [1] can you please hold my hand (make sure Lister’s Tubercle of the Radius
Head of the Radius Sitting Locate the Olecranon

Instruction: [1] can you please hold my hand (make sure Instruction [2]: Flexing the forearm (moving the forearm up)
it’s relaxed, shake if necessary) Moving proximally, you will fall into the Olecranon Fossa of the Humerus, laterally (from in the POV of your index finger) is the bump of the Lateral
Epicondyle of the Humerus
While on the Lateral Epicondyle of the Humerus moving distally past the humeroradial joint you stop on the Head of the Radius (a small circular
[around the bone] bump)
Carpals Metacarpals and Phalanges Metacarpals
1. Pisiform – (palm facing towards you, pushing the fingers and palm downward: KNOW AS EXTENSION) Locate the 5 th Thumb = 1
Metacarpal (pinky) moving proximally you will locate the Pisiform (is the bump on the pinky side of the wrist) Index = 2
st
2. Scaphoid – (palm facing towards you, pushing the fingers and palm downward: KNOW AS EXTENSION) Locate the 1 Middle Finger = 3
Metacarpal (thumb) moving proximally toward the Radius you will locate the Scaphoid (is the bump on the thumb Ring Finger = 4
side of the wrist) Pinky = 5
3. Hamate – (palm facing towards you, pushing the fingers and palm downward: KNOW AS EXTENSION) Distally and
laterally to the bump of the Pisiform is the Hook of the Hamate, if you press it correctly you will see Ulnar Nerve Head = distal
protrude outward from the pressure Body/Shaft = Middle
4. Triquetrum – (palm not facing you - Putting the wrist in a radial deviation/abduction (moving the wrist/thumb Base = proximal
sideways away from pinky), you will locate the Triquetrum (distally to the Ulna and it’s Styloid Process is a gap and
then the Triquetrum) Phalanges
5. Lunate – (palm not facing you) Locate the interosseous membrane between the Radius and the Ulna, moving distally Thumb only has proximal and distal
towards the 4th Metacarpal (ring finger) you will be on the Lunate (you will fall off the Radius notice a gap and then The rest of the phalanges have proximal, middle, and distal
Lunate is towards the center)
6. Trapezium - (palm not facing you) Locate the 1st Metacarpal (thumb) and the 2nd Metacarpal (the index) moving
proximally is the Trapezium
7. Trapezoid – (palm not facing you, push hand downward: KNOWN AS FLEXION) Locate the 2nd Metacarpal and move
proximally until falling off of it (into a gap) the Trapezoid is deep to this area (warning don’t press hard)
8. Capitate – (palm not facing you) Locate the 3rd Metacarpal and move proximally (you will fall into a gap) this is the
Capitate
Bony Pelvis GET CONSENT FOR THE PELVIS, PUBIC, SACRUM AND COCCYX
Iliac Crest Standing Locate the 10th Rib moving inferiorly until stopping on the Iliac Crest
View posteriorly
Anterior Superior Iliac Spine Standing Locate the Iliac Crest moving anteriorly, medially and inferiorly along the Crest until stopping on the Anterior Superior Iliac Spine (it has a drop off)
View laterally
Anterior Inferior Iliac Spine Standing Locate the Anterior Superior Iliac Spine moving inferiorly and medially an inch (past a groove or bumpy bone region) you will stop on the bump of
Anterior view the Anterior Inferior Iliac Spine
Posterior Superior Iliac Spine Standing Locate the Iliac Crest moving inferiorly and medially along the Crest until stopping on the Posterior Superior Iliac Spine (it has a drop off)
View Posteriorly
Sacrum +Lying face down While the client is in prone locate the Iliac Crest and moving medially and inferiorly until finding the Posterior Superior Iliac Spine, moving medially
past the sacral sulcus to the 2nd Spinous Process of the Sacrum
Sacroiliac Joint Lying face down While the client is in prone locate the Posterior Superior Iliac Crest moving slightly inferiorly and medially locate the Sacroiliac Joint
(sac-RO-iliac) You will feel the gap open and close during rotation of the calf (tibia and fibula). Palpate with the base of the palm.
Sacral Hiatus upper border Lying face down While the client is in prone locate the 2nd Spinous Process of the Sacrum moving inferiorly (before the gluteal cleft) there will be a flat part of the
(lower border) Sacrum which is the upper border of the Sacral Hiatus, palpating it with the base of your palm
Ischial Tuberosity Lying face down While the client is in prone locate the Greater Trochanter of the Femur and the gluteal fold at the cross section, medially and superiorly the Ischial
Tuberosity will be there. Pushing the base of your palm into this area.
OR
While the client is prone locate the Greater Trochanter of the Femur and the Gluteal Tuberosity, between these two palpate with the base of the
palm medially slightly above the Gluteal Cleft, before reaching it you will feel the Ischial Tuberosity inferiorly or anteriorly to that is the ramus of the
ischium
Coccyx Lying face down While the client is in prone locate the 5th Spinous Process of the Sacrum, (above the gluteal cleft), moving inferiorly is the Coccyx, you can palpate
this region with the base of your palm LIGHTLY or… don’t touch it
Pubic Crest Sitting cross legged With one hand, locate the Umbilicus (belly-button) moving inferiorly they will land on the Pubic Crest (about a hand length away). The index and ring
Pubic Tubercles ALLOW THE PATIENT TO DO THIS WITH THEIR HANDs, finger are the Pubic Tubercles, between them lies the pubic symphysis. (With one or two hands) moving laterally along the Pubic Crest is the
Superior Ramus of the Pubis YOU ARE MERELY MOVING THEIR FOREARM AS A GUIDE Superior Ramus of the Pubic. Going back to the Pubic Tubercles moving inferiorly, they’d be on the Inferior Ramus of the Pubis
Inferior Ramus of the Pubis
Femur
Greater Trochanter Standing or lying down/face down Locate the Femur moving proximally you will stop on the Greater Trochanter of the Femur; you will know if you are on it if during medial rotation of
Lateral view the calf (tibia and fibula) you will feel it move
Gluteal Tuberosity Standing Locate the Greater Trochanter of the Femur, moving distally by two inches (more or less depending on height) you will feel the Gluteal Tuberosity
Posterior view OR
Locate the Iliac Crest, locate the Anterior Superior Iliac Crest, moving distally onto the Femur near the gluteal fold is the Gluteal Tuberosity
Edges of the Femoral Sitting with calf on table Locate the Patella, push the Patella laterally and/or medially and you will slightly feel the Edges of the Femoral Condyles
Condyles EXTENDED
Epicondyles of the Femur Sitting, calf off table Locate the Patella, sliding medially and/or laterally are the Epicondyles of the Femur
Adductor Tubercle Standing Locate the Patella, sliding medially to the MEDIAL Epicondyle of the Femur, sliding proximally you will stop on the Adductor Tubercle, you can strum
the adductor magnus tendon if you continue proximally.
Patella Sitting, calf off table Locate the Tibial tuberosity, move proximally and you will be on the apex Patella
Tibia Tibia is located on the medial side and most prominent anteriorly
Tibial Tuberosity Sitting Locate the apex of the Patella, moving distally you will stop on the Tibial Tuberosity
Shaft of the Tibia Sitting Locate the Tibial Tuberosity, moving distally (till the middle) you will stop on the Shaft of the Tibia
Tibial Plateaus Sitting, calf off table Locate the Patella, moving distally you will (first thing you feel) is the Tibial Plateaus (can palpate laterally and medially if you’d like)
Medial Malleoli/Malleolar Sitting, calf off table Locate the Tibial Tuberosity moving distally and medially you will stop on the prominence of the Medial Malleoli (commonly the inner ankle)
Groove (Tarsal Tunnel) From the Medial Malleoli move posteriorly and proximally about half an inch and you will be on the Medial Malleolar Groove (like a indented curve)
Fibula Fibula is located on the lateral side and most prominent laterally
Head of the Fibula Sitting, calf off table Locate the apex of the Patella, moving laterally and distally you will feel the lateral condyle of the Tibia, moving distally, laterally and (depending on
where you are) posteriorly you will feel the Head of the Fibula
Note: lateral condyle of the Tibia is a big bump, then a groove, and then a small bump which is the Head of the Fibula
Lateral Malleoli/Malleolar Sitting, calf off table Locate the Head of the Fibula moving distally to the prominence of the Lateral Malleoli (commonly the inner ankle)
Groove From the Lateral Malleoli moving posteriorly and proximally by half an inch and you will be on the Lateral Malleolar Groove (more angled than the
medial, but still indented)
Tarsus, Metatarsus and Phalanges
Calcaneus Heel of the foot
Calcaneus Tuberosity Sitting, calf off the table Locate the Achilles tendon moving distally toward the plantar surface and locate the Calcaneus Tuberosity
Held in hand
Sustentaculum Tali Sitting, calf off the table Locate the Medial Malleolus and move distally one inch to the Sustentaculum Tali (feels like a little ridge)
(sus-ten-tac-u-lum__ta-lie) Held in hand WARNING: Do not palpate too hard, hurts
Peroneal Trochlea Sitting, calf off the table Locate the Lateral Malleolus and move distally one inch to the Peroneal Trochlea (feels like a ridge as well)
Held in hand
Talus
Head & Neck of the Talus Lying face up With thumb and/or index finger on each Malleolus moving anteriorly until you feel a ditch, this is the Head of the Talus
Foot is slightly flexed (pointing), but relaxing WARNING: if the foot is flexed you will be on the neck of the Talus
Trochlea of the Talus Lying face up With thumb and/or index finger on each Malleolus moving anteriorly past the ditch (the Head of the Talus) until the thumb and index meet at the
Foot is flexed (pointing) and inverted midline. Moving distally until you feel a bony prominence, the Trochlea of the Talus
Medial Tubercle Lying face up Locate the Medial Malleolus

From the Medial Malleoli move posteriorly and proximally about half an inch and you will be on the Medial Malleolar Groove
Move distally from this posterior position and locate the Medial Tubercle (like a indented curve before the Calcaneus)
May be wise to say it is deep to these muscle
Hallux Lying face up Locate the 2nd distal phalanx (end of the 2nd toe) and move distally to the Hallux (Big Toe)
2nd 3rd 4th 5th Metatarsal – Lying face up All one bone
Head and shaft Head = distal
Shaft = middle
Base = proximal
Be cheap and just go by the phalanges
5th Metatarsal Tuberosity Lying face up Locate the Base of the 5th Metatarsal (pinky toe side) moving laterally there is a prominence and proximally there is the Tuberosity (midway through
the foot before the foot begins [or ends] to arch)
Medial (First) Cuneiform Lying face up Locate the 1st Metatarsal (the big toe one) moving proximally over the ditch (of the tarometatarsal joint) onto the Medial Cuneiform
Middle (Intermediate or Lying face up Locate the 2nd Metatarsal (the one beside the big toe) moving proximally (over the ditch of the tarometatarsal joint) onto the Middle Cuneiform
Second) Cuneiform
Lateral (Third) Cuneiform Lying face up Locate the 3rd Metatarsal (middle toe) moving proximally over the ditch (of the tarometatarsal joint) onto the Lateral Cuneiform
Navicular Lying face up Locate the 1st Metatarsal (the big toe one) moving proximally over the ditch (of the tarometatarsal joint) onto the Medial Cuneiform, continuing
And the Tuberosity proximally over a smaller ditch (the intertarsal joint) until the Navicular Tuberosity (a prominence on the side of the big toe)
Cuboid Lying face up Locate the Base of the 5th Metatarsal (pinky toe side) moving laterally there is a prominence and proximally there is the Tuberosity (midway through
the foot before the foot begins [or ends] to arch)
From the 5th Metatarsal Tuberosity continue proximally by half an inch until on the Cuboid (draw an imaginary line from the Tuberosity to the
Lateral Malleolus)
Phalanges Lying face up 1 – Big Toe/Hallux = only had two phalanges, proximal and distal
2-5 = proximal, middle, and distal
Landmark Client Position Scripting on How to Palpate

Occipital Bone Sitting 2. If you are one the Occipital Protuberance you are on the
Occipital Bone
External Occipital Sitting 1. Locate the 7th cervical vertebra by the spinous process
Protuberance (aka: Inion) - Moving superiorly until reaching the External
Occipital Protuberance
Superior and Inferior Nuchal Sitting 3. From the Occipital Protuberance you should be on the
Lines Superior Nuchal Line that spans laterally
- Moving inferiorly from the Superior Nuchal Line deep is
the Inferior Nuchal Lines
Parietal Bone (POOR-eye-et- Sitting 5. Going laterally from the Sagittal Suture is the Parietal
all) Bones
Sagittal suture Sitting 4. Going back to the Occipital Protuberance and moving
superiorly you will be on the Sagittal Suture
Temporal Bone Sitting 2. When you have located the Mastoid Process, it means you
are on Temporal Bone
Mastoid Process Sitting 1. Locate the Mastoid Process, should be just inferior and
posterior to the external auditory meatus
Styloid Process Sitting 3. When on the Mastoid Process, moving anteriorly past the
- ***can you please move external auditory meatus and before reaching the
your head (left or right) mandible
- “hurts a little doesn’t it?” - instruction: during lateral neck rotation **** you will feel
the Styloid Process appear and disappear due to muscles
Zygomatic Arch Sitting 1. Locate the Zygomatic Arch
Sphenoid Bone (Sfē— Sitting 2. Superior to the Zygomatic Arch you will feel a slight
noid) depression, the temporal muscle, temporalis muscle, deep
to that is the Sphenoid Bone
Zygomatic Bone Sitting 3. Moving inferiorly from the Sphenoid Bone/temporalis
muscle medially to the orbital cavity you will reach the
Zygomatic Bone
Suborbital Margin Sitting 4. Moving slightly superiorly and medially from the Zygomatic
Bone you will reach the orbital cavity and thus the
Supraorbital Margin and the Suborbital Margin is inferior
edge to the orbital cavity
Frontal Bone Sitting 5. If you are on the Supraorbital Margin, you are on the
Frontal Bone

Nasal Bone Sitting 1. Anteriorly locate the midsagittal plane of the body or the
midline of the body on the Frontal Bone
- Moving inferiorly, you will reach the Nasal Bone
Maxilla Sitting 2. Moving laterally slightly from the Nasal Bone you will reach
the Maxilla which expands laterally and inferiorly
Condyle Sitting 1. Locate the temporo(w)mandibular joint (TMJ)
Mandible Instruction: Can you please - Instruction *** while the Mandible is in depression move
open your mouth, keep it inferiorly and you will the locate the Condyle process and
open please… Thank you. inferiorly still is the Condyle
Coronoid Process Sitting 2. Going back to the temporo(w)mandibular joint (TMJ) until
- Instruction: can you close reaching the Zygomatic Arch.
your mouth… Thank you - Move anteriorly to the temporal process of the Zygomatic
Bone
- Move inferiorly slightly
- Instruction **** elevating the Mandible *** you will feel
the Coronoid Process
Angle Sitting 3. Going back to the temporo(w)mandibular joint (TMJ)
- Moving inferiorly, you will reach the Angle of the
Mandible
Ramus Sitting 4. Just superior and medial to the angle is the Ramus, which is
deep to masseter (mas-sah-ter)
Body Sitting 5. Moving anteriorly from the Ramus you will land on the
Body of the Mandible
Base Sitting 6. Moving inferiorly from the Body will lead you to the Base of
the Mandible
Submandibular Fossa Sitting 7. Between the tip and Angle of the Mandible is the
Submandibular Fossa
OR
Locating the submandibular gland moving anteriorly towards the
border of the mandible

Trachea Sitting 1. Locate the jugular notch
- Instruction: can you please - Instruction **** while the head is in extension/extended
tilt your head up, look up… - Moving superiorly, you will be on the Trachea
That’s it, thank you. It may
be a little hurtful, let me
know and I’ll be more
gentle.
Thyroid Gland Sitting, head still tilted 2. Moving superiorly still you will find an area that has a
different texture, it’s squishier, this is the isthmus (isth-mis)
of the Thyroid Gland
- Thyroid Gland laterally, superiorly and slightly inferiorly to
this region
Cricoid Cartilage (CRY-coid) Sitting, head stilled tiled 3. Slightly superior to the isthmus (isth-mis) of the Thyroid
Gland is the Cricoid (CRY-coid) Cartilage
- a ring that you can feel by gliding your finger inferiorly and
superiorly
Thyroid Cartilage Sitting, head stilled tiled 4. Moving superiorly from the Cricoid (CRY-coid) Cartilage is
the Thyroid Cartilage or Adams apple
Hyoid Bone Sitting, head stilled tiled 5. Moving superiorly from the Thyroid Cartilage is the Hyoid
- Instruction: could you please Bone
rest your head and swallow - Move laterally
please… Awesome - Instructions **** You should be able to feel it move when
they swallow
OR
Locating the submandibular gland and moving inferiorly, instruction
***, you should be able to feel it move when they swallow

Jugular Notch Can you please lie face up… 1. Instruction*** While in supine find the trachea and move
Thank you. inferiorly until reaching the Jugular Notch
Manubrium (man-new-bri- Face up 2. Move inferiorly from the Jugular Notch and onto the
um) Manubrium (man-new-bri-um)
Body Face up 3. From the Manubrium moving inferiorly over the sternal
Sternum angle and continuously inferiorly we arrive at the Body of
the Sternum
Xiphoid Process Face up 4. Moving inferiorly from the Body of the Sternum right before
falling into the muscles of the abdomen is the Xiphoid
Process
Costal Cartilage Face up 5. Move superiorly back to the Body of the Sternum and
proceed laterally, there you will find the Costal Cartilage
attaching the ribs to the bones
Ribs Face up 6. Continuing laterally from the Costal Cartilage exploring the
region I will find grooves OR intercostal spaces, above and
below are some Ribs
1st rib Face up 1. Locate the Sternal End of the Clavicle, moving laterally and
- Instruction: Can you breathe posteriorly past the Impression for the costoclavicular
for me. Big inhale, hold. ligament on the inferior view of the clavicle. Sinking my
- Thank you, you can exhale fingers deep past the clavicle
now - Instruction **** You should feel the rib elevate
11th and 12th Ribs Face down 1. Locate the 10th rib and moving medially and inferior, should
- Can you please turn over locate the 11th and 12th rib.

Cervical Spine Face down 1. Locate Occipital Protuberance and moving inferiorly you’ll
(7) probably feel the 2nd cervical vertebra by the spinous
Spinous Process process first
Cervical Lamina Groove Face down 2. From 7th spinous process of cervical vertebra just laterally
and anteriorly is the Cervical Lamina Groove
Transverse Processes Face down 3. In location to the spinous process is lateral and superior
Thoracic Spine Face down
(12)
- Note: The facets (superior and inferior) of a rib may fit either
into a facet on the body of a single vertebra (T1 ONLY) OR
into the demifacets of two adjoining vertebrae
o The joint called vertebrocostal joint
Spinous Processes Face down

Transverse Processes Face down
Thoracic Lamina Groove Face down
Lumbar Spine Face down 1. Locate the iliac crest, moving medially, you should locate
(5) the Lumbar Spine by the spinous process of the 4th lumbar
Spinous Processes vertebra
Transverse Process Face down 2. Once you have the spinous process of the 4th lumbar
vertebra move laterally about two inches and sink the
fingers anteriorly and medially
Lumbar Lamina Groove Face down 3. The Lumbar Lamina Groove is covered by the erector
spinea (spin-ee), but it’s anterior to where my fingers are, or
deep.

Sacrum Face down 1. Locate the iliac crest, moving medially you’ll find the 4th
Median Sacral Crest spinous process of the Lumbar vertebra, moving inferiorly
past the 5th Lumbar spinous process will lead you into the
Median Sacral Crest along the midsagittal plane and
anteriorly
OR
Locate the iliac crest and moving medially and inferiorly
until finding the posterior superior iliac spine, moving
medially past the lateral Sacral Crest, medially into the
sacral sulcus marked by dips, and medially to the which is
the 2nd Median Sacral Crest
Lateral Sacral Crest Face down 2. The Lateral Sacral Crest is just lateral to the Median Sacral
Crest and the sacral sulcus
Edge of Sacrum/Sacra Face down 3. The Edge of the Sacrum is inferior to the gluteal cleft region
Hiatus / Sacral Cornus (which
is just lateral to it)
Coccyx Face down 4. Inferior is the coccyx
Ligaments of the Body
Bursa of the Body
Specific Areas of the Body
Muscles of the Body

Definitions Beginning of Script
Origin – the attachment of a muscle tendon to a stationary bone or the end opposite the insertion Palpation is the assessment of the body using touch.
Insertion – the attachment of a muscle tendon to a movable bone or the end opposite the origin The purpose of doing this assessment is so that I can feel for texture, tone, temperature, tenderness, and tension of the
landmark I am touching so I can make a tailored treatment for you.
Innervation - the distribution of nerves to or in a part
You might feel a slight discomfort in the areas that I touch, and may experience soreness in the following days in the
Reverse Muscle Action (RMA) – during specific movements of the body the actions are reversed; therefore, the position of the
areas I touch. There are no medical risks to this assessment.
origin and insertion of a specific muscle are switched
At any time, if you feel uncomfortable, or would like to stop, we can stop or I can modify my touch to your comfort
Trigger Point Section
level.
X – Indicates a common location where a trigger point can be found in a particular muscle belly
I would like you to be dressed like _______. However, you may underdress to your comfort level, but skin to skin
Possible Causes – of trigger points include postural patterns, traumas and overuse or underuse actions contact is more beneficial for the assessment.
Symptoms/Indications – cover the types of pains or discomforts that the patient may be feeling. I would like you to be in these ______(positions) if you can tolerate it, but if not, I can modify it.
Pain Pattern – are the areas where the radiating pain of a trigger point is felt I will be touching _____ areas, some of these I am required to get special consent for such as ______.
Do I have your consent?
Associated Trigger Point (TP) – is a trigger point in one muscle that occurs simultaneously with a trigger point in another muscle.
One point may cause the other, or they both may be induced by the same neurologic or mechanical origin Do you have any questions? Do I have your consent to touch you? Do I have consent for this assessment?
Differential Diagnoses – cover other conditions or dysfunctions that may present similar signs and symptoms as a trigger points Do you need any assistance getting on or off table?
referred pain pattern
Muscle: Origin, Insertion, Action, Innervation/Nerve Palpation Trigger Point
11.4 Muscles of the Head that Produce Facial Expressions

Scalp Muscles
Occipitofrontalis
Frontal Belly Client: sitting Occipitofrontalis Frontal Belly
Origin – Epicranial aponeurosis Instruction for client: raise your eyebrows Possible Causes Frontalis
Insertion – Skin superior to supraorbital margin Sternocleidomastoid TPs
Action – Draws scalp anteriorly, raises eyebrows, and wrinkles skin of forehead “Stress”
horizontally as in look of surprize Chronically raised eyebrows
Innervation/nerve – Facial nerve 7 Symptoms/Indications
Intolerance to pressure on back of head
Pain Patterns
Directly over muscle
Differential Diagnoses
Tension-type headache
Sternocleidomastoid TPs
Posterior Belly Client: sitting Occipitofrontalis Posterior Belly

Origin – Occipital bone and mastoid process of temporal bone Therapist: locate the nuchal line go up an inch Possible Causes
Insertion – Epicranial aponeurosis Instruction for client: raise your eyebrows Decreased visual acuity
Action – Draws scalp posteriorly Posterior cervical muscles TPs
Innervation/nerve – Facial nerve 7 Symptoms/Indications
Intolerance to pressure on back of head
Pain Patterns
Parietal region and upper eyelid
Neighboring muscle TPs
Occipital Neuralgia
Mouth Muscles
Orbicularis oris
Origin – Muscle fibers surrounding opening of mouth Client: sitting
Insertion – Skin at corner of mouth Therapist: N/A
Action – Closes and protrudes lips (as in kissing); compresses lips against teeth; Instruction client to: Can you pucker
and shapes lips during speech your lips
Innervation/nerve – Facial nerve 7
Zygomaticus major
Origin – Zygomatic bone Client: sitting
Insertion – Skin at angle of mouth and orbicularis oris Therapist: N/A
Action – Draws angle of mouth superiorly and laterally, as in smiling Instruction client to: smile
Zygomaticus minor
Origin – Zygomatic bone Client: sitting
Insertion – Upper lip Therapist: N/A
Action – Elevates upper lip exposing maxillary teeth Instruction client to: Smile and bring lip to top of
Innervation/nerve – Facial nerve 7 teeth
Levator labii superioris

Origin – Superior to infraorbital foramen of maxilla Client: Sitting
Insertion – Skin at angle of mouth and orbicularis oris Therapist: N/A
Action – Raises upper lip Instruction client to: Show your eyetooth, like Elvis
Depressor labii inferioris

Origin – Mandible Client: sitting
Insertion – Skin of lower lip Therapist: N/A
Action – Depresses lower lip Instruction client to: Show your bottom teeth
Depressor anguli oris

Insertion – Angle of mouth Therapist: N/A
Action – Draws angle of mouth laterally and inferiorly, as in opening mouth Instruction client to: Pout (bottom lip out and lips to
Innervation/nerve – Facial nerve 7 the sides and down)
Levator anguli oris

Origin – Inferior to infraorbital foramen Client: Sitting
Insertion – Skin of lower lip and orbicularis oris Therapist: N/A
Action – Draws angle of mouth laterally and superiorly Instruction client to: Pretend you have whiskers and
Innervation/nerve – Facial nerve 7 move them
Buccinator
Origin – Alveolar processes of maxilla and mandible and pterygomandibular Client: Sitting
raphe Therapist: N/A
Insertion – Orbicularis oris Instruction client to: Pretend you are sucking on
Action – Presses cheeks against teeth and lips, as in whistling, blowing, and something sour
sucking; draws corner of mouth laterally; and assists in mastication by keeping
food between the teeth
Risorius
Origin – Fascia over parotid gland Client: Sitting
Insertion – Skin at angle of mouth Therapist: N/A
Action – Draws angle of mouth laterally, as in grimacing Instruction client to: Pull corners of your mouth
Innervation/nerve – Facial nerve 7 sideways
Mentalis
Insertion – Skin of chin Therapist: N/A
Action – Elevates and protrudes lower lip and pulls skin of chin up, as in Instruction client to: Wrinkle chin, kinda like pouting
pouting
Neck Muscles
Platysma
Origin – Fascia over deltoid and pectoralis major muscles Client: sitting or supine
Insertion – Mandible, and blends with skin of lower face and muscles around Therapist: N/A
angle of mouth Instruction client to: Pull back chin, pout and lift
Action – Draws outer part of lower lip inferiorly and posteriorly; depresses head
mandible
Eye, Nose and Eyebrow Muscles

Orbicularis oculi
Origin – Medial wall of orbit Client: sitting
Insertion – Circular path around orbit Therapist: N/A
Action – Closes eye Instruction client to: Close your eyes and squint
Corrugator supercilia
Origin – Medial end of superciliary arch of frontal bone Client: Sitting
Insertion – Skin of eyebrow Therapist: N/A
Action – Draws eyebrow inferiorly and wrinkles skin of forehead vertically as in Instruction client to: Can you draw your eyebrows
frowning inward and down until it’s wrinkled (WTF lines)
Procerus
Origin – Nasal bone Client: Sitting
Insertion – Skins above and between eyebrows Therapist: N/A
Action – depresses the medial corners of the eyebrows Instruction client to: Wrinkle the area between your
Innervation/nerve – Facial nerve 7 eyebrows and nose down, like your agitated (WTF
lines)
Levator Labii Superioris Alaeque Nasi (al-eq-qway naz-i)

Origin - frontal process of the maxilla Client: Sitting
Insertion - ala of the nose and skin of the upper lip Therapist: N/A
Action - elevates the upper lip and flares the nostril Instruction client to: Take a long, hard sniff
Nasalis
Origin - Maxilla above the incisor and canine teeth Client: sitting
Insertion - Ala of the nose and midline aponeurosis Therapist: N/A
Action - Compresses bridge, depresses tip of nose, elevates corners of nostrils Instruction client to: Flatten your nose and take a
Innervation/nerve – Facial nerve 7 long sniff downward
11.5 Muscles of the Head that Move the Eyeballs (Extrinsic Eye Muscles) and Upper Eyelids
Muscle Origin Insertion Action Innervation
Superior rectus Common tendinous ring Superior and central part of the eyeball Moves eyeball superior (elevates) and medially (adduction), Oculomotor nerve III
and rotates them medially
Inferior rectus Common tendinous ring Inferior and central part of eyeball Moves eyeball inferiorly (depression) and medially Oculomotor nerve III
(adduction) and rotates them laterally
Lateral rectus Common tendinous ring Lateral side of eyeball Moves eyeball laterally (abduction) Abducens nerve VI
Medial rectus Common tendinous ring Medial side of eyeball Moves eyeball medially (adduction) Oculomotor nerve III
Superior oblique Sphenoid bone, superior and medial to common tendinous Eyeball between superior and lateral recti. Muscle inserts Moves eyeball inferiorly (depression) and laterally Trochlear nerve IV
ring in orbit into superior and lateral surface of eyeball via tendon that (abduction), and rotates them medially
passes through the trochlea
Inferior oblique Maxilla in floor of orbit Eyeball between inferior and lateral recti Moves eyeball superior (elevation) and laterally (abduction) Oculomotor nerve III
and rotates them laterally
Levator palpebrae Roof of orbit Skin and tarsal plate of upper eyelids Elevates upper eyelids Oculomotor nerve 3
superioris
11.6 Muscle that Move the Mandible and Assist in Mastication and Speech
Masseter
Origin – Maxilla and zygomatic arch Client: sitting Possible Causes
Insertion – Angle and ramus of mandible Therapist: N/A Sudden, forceful contraction
Action – Elevates mandible Instruction client to: Close mouth and clench teeth Repetitive jaw habbits
Innervation/nerve – Trigeminal nerve 5 Chronic mouth breathing
Psychological stress
Symptoms/Indications
Temporomanidublar joint symptom
Tension in masseter and temporalis
Restriction of jaw opening and
unilateral tinnitus
Pain Patterns
Molars
Temporomandibular joint
Mandibular and eyebrow area
Associated TPs
Temporalis
Medial pterygoid
Sternocleidomastoid
Tinnitus
Puplpitis
Inflammation of the periodontal ligament
Earache
Toothache
Temporalis
Origin – Temporal bone Client: sitting Possible Causes
Insertion – Coronoid process and ramus of the mandible Therapist: Grinding or clenching teeth
Action – Elevates and retracts mandible Instruction client to: close mouth and Direct trauma, such as a fall
Innervation/nerve – Trigeminal nerve 5 clench teeth Forward head posture
Head pain
Toothache
Pain Patterns
Upper row of teeth
Temporal region
Over the eyebrow
Associated TPs
Masseter on same side
Temporalis on opposite side
Medial and lateral pterygoids
disorder
Diseased teeth
Temporal tendinitis
Medial pterygoid
Origin – Medial surface of lateral portion of pterygoid process of sphenoid Client: Possible Causes
bone; and maxilla Therapist: Forward head posture
Insertion – Angle and ramus of mandible Instruction client to: Lateral pterygoid TPs
Action – Elevates and protracts (protrudes) mandible and moves mandible Excessive gum-chewing
from side to side Grinding and clenching of teeth
Innervation/nerve – Trigeminal nerve 5 Symptoms/Indications
Increased pain when opening
mouth wide or chewing food
Clenching teeth
Soreness inside throat
Painful swallowing
Pain Patterns
Refers pain into temporomandibular
joint and side of jaw
Lateral pterygoid, masseter and
sternocleidomastoid TPs
Lateral pterygoid
Origin – Greater wing and lateral surface of lateral portion of pterygoid process Client: Possible Causes
of sphenoid bone Therapist: Sternocleidomastoid TPs
Insertion – Condyle of mandible; temporomandibular joint (TMJ) Instruction client to: Mechanical stress caused by poor posture
Action – Protracts mandible, depresses mandible as in opening mouth, and Excessive grinding of teeth
moves mandible from side to side Playing a wind instrument
Innervation/nerve – Trigeminal nerve 5 Symptoms/Indications
Sever pain in the temporomandibular joint
region
Shortening of muscle
Tinnitus
Pain when chewing
Pain Patterns
Front of face
Medial pterygoid TPs
Trigeminal neuralgia
11.7 Muscle of the Head that move the Tongue and Assist in Mastication and Speech
Genioglossus Mandible Undersurface of tongue and hyoid bone Depresses tongue and thrusts it anteriorly (protraction) Hypoglossal nerve 12
Styloglossus Styloid process of temporal bone Side and undersurface of tongue Elevated tongue and draws it posteriorly (retraction) Hypoglossal nerve 12
Hyoglossus Greater horn and body of hyoid bone Side of tongue Depresses tongue and draws down its sides Hypoglossal nerve 12
Palatoglossus Anterior surface of soft palate Side of tongue Elevates posterior portion of tongue and draws soft palate Pharyngeal plexus,
down on tongue contains axons from
Vagus nerve 10
11.8 Muscles of the Anterior Neck that Assist in Deglutition and Speech
Suprahyoid Muscles
Digastric
Origin – Client: supine Possible Causes
Anterior belly: from inner side of inferior border of mandible Therapist & Instruction client to: Retrusion of mandible
Posterior belly: from temporal bone Posterior belly Mouth breathing
Insertion – Body of hyoid bone via an intermediate tendon 1. Locate mastoid process and hyoid bone Excessive grinding of teeth
Action – Elevates hyoid bone. 2. Draw an imaginary line between these two points Symptoms/Indications
RMA: Depresses mandible, as in opening mouth 3. Ask client to open mouth, and against resistance feel posterior belly Difficulty swallowing
Innervation/nerve – Anterior belly Sensation of lump in throat
Anterior belly: trigeminal nerve 5 1. Locate the hyoid bone and just lateral to Difficulty turning head
Posterior belly: facial nerve 7 the midline of the chin/mandible Pain Pattern
2. Draw an imaginary line between these Lower front teeth
two points Upper, lateral neck below ear
3. Ask client to put tongue against roof of Associated TPs
mouth feel anterior belly Masseter
Temporalis
Neighboring muscle TPs
Stylohyoid
Origin – Styloid process of the temporal bone Client:
Insertion – Body of the hyoid bone Therapist:
Action – Elevates hyoid bone and draws it posteriorly Instruction client to:
Mylohyoid Mylohyoid & Geniohyoid

Origin – Inner surface of mandible Client: supine
Insertion – Body of hyoid bone Therapist & Instruction client to:
Action – Elevates hyoid bone and floor of mouth and depresses mandible 1. With your client’s jaw closed, place your finger along the underside of the
Innervation/nerve – Trigeminal nerve 5 mandible
2. Ask client to press tongue against roof of mouth. Notice the muscles at the
Geniohyoid base of the mandible
Origin – Inner surface of mandible - Should be able to feel the
Insertion – Body of hyoid bone mylohyoid (off center of
Action – Elevates hyoid bone, draws hyoid bone and tongue anteriorly. chin, but much wider) and
Depresses mandible geniohyoid (midline of the
Innervation/nerve – 1st cervical spinal nerve chin) which go to the
hyoid bone
Infrahyoid Muscles
Omohyoid
Origin – Superior border of scapula and superior transverse ligament Client:
Insertion – Body of hyoid bone Therapist:
Action – Depresses hyoid bone Instruction client to:
Innervation/nerve – Branches of 1st through 3rd cervical spinal nerves
Sternohyoid
Origin – Medial end of clavicle and manubrium of sternum Client: sitting
Insertion – Body of hyoid bone Therapist & Instruction client to:
Action – Depresses hyoid bone 1. Locate the jugular notch
Innervation/nerve – Branches of the 1st through 3rd cervical spinal nerves 2. Moving superiorly and laterally you’ll be on the Sternohyoid (before
the hyoid bone, after Thyroid cartilage)
3. Ask the client to push their chin in and pout, palpate across fibers
Sternothyroid
Origin – Manubrium Client: sitting
Insertion – Thyroid cartilage of larynx Therapist & Instruction client to:
Action – Depresses thyroid cartilage of larynx Sitting
Innervation/nerve – Branches of the 1st through 3rd cervical spinal nerves 1. Locate the jugular notch
2. Moving superiorly and laterally you’ll be on the Sternothyroid (before
the thyroid cartilage)
3. Ask the client to push their chin in and pout, palpate across fibers
Thyrohyoid
Origin – Thyroid cartilage of larynx Client: sitting
Insertion – Greater horn of hyoid bone Therapist & Instruction client to:
Action – Depresses hyoid bone. 1. Locate the greater horn of the hyoid bone
RMA: elevates thyroid cartilage 2. Moving inferiorly before the thyroid cartilage you’ll be on the
Innervation/nerve – Branches of the 1st and 2nd cervical spinal nerves and Thyrohyoid
Hypoglossal nerve 12 3. Ask the client to push their chin in and pout, palpate across fibers
11.9 Muscles of the Neck that Move the Head

Sternocleidomastoid
Sternal head: manubrium of sternum; Therapist & Instruction client to: Poor posture
Clavicular head: medial third of clavicle 1. Rotate head to OPPOSITE side Excessive forward head posture
Insertion – Mastoid process and lateral half of superior nuchal line 2. Ask C to flex head towards chest against your resistance Sitting with head turned to side for
Action – Together, flex cervical spine, extend head at atlanto-occipital joint; long period
singly, laterally flexes neck to same side, and rotates head to opposite side Protracted neck extension
RMA: elevate sternum during forced inhalation Whiplash
Innervation/nerve – Accessory nerve 11 and 2nd and 3rd cervical spinal nerves Symptoms/Indications
Soreness in the neck
“Stiff neck”
Tilting of head to same side
Tension headache
Pain Patterns
Face and cranium
Forehead, ear and occiput
Strongly around eyebrow
Associated TPs
Opposite sternocleidomastoid
Scalenes
Levator scapula
Trapezius
Vascular headache
Atypical facial neuralgia
Trigeminal neuralgia
Meniere’s disease
th
Longus colli Transverse processes of the 5 cervical vertebrae through Anterior arch of the atlas Flexes the neck and head 2 to 6th spinal
nd
the 3rd thoracic vertebrae nerves

Longus capitis Anterior tubercles of the transverse processes of the 3rd and Basilar part of the occipital bone Flexes the neck at the atlantooccipital joint 1st to the 3rd spinal
6th cervical vertebrae nerves
Suboccipital Spine
Rectus capitis posterior minor Rectus Capitis Posterior Minor, Rectus Capitis Posterior Major, and Rectus Capitis Posterior Major and Minor, and Oblique Capitis
Origin – from the posterior 1st tubercle the cervical Oblique Capitis Superior Superior and Inferior
spine Prone Possible Causes
Insertion – Medial part of the inferior nuchal line of 1. Locate the inferior nuchal line Forward head posture
the occipital bone 2. Locate Sustained forward Flexion of the head
Action – extension of the head a) Most medial, Rectus Capitis Posterior Minor Symptoms/Indications
Innervation/nerve – suboccipital nerve b) Medial to slight lateral, Rectus Capitis Posterior Major Headache
c) Most lateral, Oblique Capitis Superior Deep-seated pain in upper neck
Difficulty rotating head
Pain Patterns
Rectus capitis posterior major Temporal and occipital regions
Origin – 2nd cervical spinous process Differential Diagnoses
Insertion – lateral part of the inferior nuchal line of Tension-type headache
the occipital bone Cervicogenic headache
Action – extension and rotation of the head Occipial neuralgia
Innervation/nerve – suboccipital nerve Articular dysfunctions in upper
cervicals
Oblique capitis superior

Origin – 1st cervical transverse process
Insertion – lateral half of the inferior nuchal line
Action – extends and flexes head to one of the sides Oblique Capitis Inferior
Innervation/nerve – 1st cervical spinal nerve Prone
1. Locate the second cervical spinous process
2. Move laterally till on the lateral mass (in*verted lamina groove) origin
3. Locate the mastoid process, move inferiorly and posteriorly until on the
transverse process of atlas/C1
4. Draw an imaginary line and palpate
Oblique capitis inferior
Origin – 2nd tubercle of the cervical spine
Insertion – Along the inferior aspect of the tip of the 1st
cervical transverse process of the atlas
Action – one sided rotation of the atlantoaxial joint
Innervation/nerve – 1st cervical spinal nerve
11.10 Muscles of the Abdomen that Protect Abdominal Viscera and Move the Vertebral Column
Rectus abdominis Rectus Abdominis and External Oblique
Origin – Pubic crest and pubic symphysis Client: supine Possible Causes
Insertion – Costal cartilage of ribs 5 to 7 and xiphoid process Therapist & Instruction client to: Poor Posture
Action – Flexes spine, especially lumbar portion, and compresses the abdomen 1. Ask client (with knees flexed on table and arms crossed) Acute or chronic overload of the abdominals
aiding in defecation, urination, forced exhalation, and childbirth. to do a sit up against resistance (hand on client’s chest) Direct trauma
RMA: Flexes pelvis Toxic or emotional stress
Innervation/nerve – Thoracic spinal nerves 7 to 12 Symptoms/Indications
Pressure and bloating
Heartburn
Vomiting
Pain Patterns
Rectus Abdominis
Across midback
Across Posterior iliac crests
External Oblique
Inferior chest
Superior abdomen
Radiates down to opposite hip
Associated TPs
Surrounding abdominal muscles
Hip adductor muscles
Articular dysfunctions
Fibromyalgia
Appendicitis
Peptic ulcer
External oblique Colitis
Origin – Ribs 5 to 12 Client: supine
Insertion – Iliac crest and linea alba (xiphoid process to Therapist & Instruction client to:
the pubic symphysis) 1. Ask client (with knees flexed on table and arms crossed) to try to do a
Action – Together, flex the spine compressing the cross sit up against resistance [elbow to opposite knee] (holding the
abdomen; singly, laterally flexes spine, especially lumbar client’s chest/arm)
portion, and rotates spine (to the opposite side/towards
the midline)
Innervation/nerve – Thoracic spinal nerves 7 to 12 and
the iliohypogastric (ilio-hypo-gastric) nerve
Internal oblique
Origin – Iliac crest, inguinal ligament, and thoracolumbar fascia Client:
Insertion – Cartilage of ribs 7-10 and linea alba Therapist:
Action – Acting together, compress abdomen and flex vertebral column; singly, Instruction client to:
laterally flex vertebral column, especially lumbar portion, and rotate vertebral
column (SAME SIDE)
Innervation/nerve – Thoracic spinal nerves T8-T12, the iliohypogastric nerve,
and ilioinguinal nerve
Transversus abdominis
Origin – Iliac crest, inguinal ligament, lumbar fascia, and cartilages of ribs 5-10 Client:
Insertion – Xiphoid process, linea alba, and pubis Therapist:
Action – Compresses abdomen Instruction client to:
Innervation/nerve – Thoracic spinal nerves T8-T12, iliohyogastric nerve, and
ilioinguinal nerve
Quadratus lumborum
Origin – Iliac crest and iliolumbar ligament (which attaches to the transverse Client: prone Possible Causes
process of the 5th lumbar vertebrae) Therapist & Instruction client to: Sudden trauma
Insertion – Inferior border of the 12th rib and lumbar transverse processes 1 to 1. Ask client to hike their hip Awkward movements
4. against resistance (holding Movement vehicle accident
Action – Together, stabilizes rib 12 during respiration, and helps extend lumbar iliac crest in place) Symptoms/Indications
portion of spine; singly, laterally flexes spine, especially lumbar portion. Low back pain
RMA: Elevates hip bone, commonly on one side Chronic myofascial pain
Innervation/nerve – Thoracic spinal nerve 12 and Lumbar spinal nerves 1 to 3 syndrome
or 4 Articular dysfunction
Restricted forward bending
Difficulty leaning to the
opposite side
Difficulty climbing stairs
Pain Patterns
Lateral and posterior hip
Associated TPs
External & internal obliques
Psoas major
Erector spinae
Rectus abdominis
Sacroiliac joint dysfunction
Lumbar or sacral ligament pain
Bursitis of hip
11.11 Muscles of the Thorax that Assist in Breathing

Diaphragm Xiphoid process of sternum, costal cartilages and adjacent Central tendon Contraction of diaphragm causes it to flatten and increases Phrenic nerve, which
portions of ribs 7-12, lumbar vertebrae and their vertical dimension of thoracic cavity, resulting in inhalation; contains axons from
intervertebral discs relaxation of diaphragm causes it to move superiorly and cervical spinal
decreases vertical dimension of thoracic cavity, resulting in nerves C3-C5
exhalation
External intercostals Inferior border of rib above Superior border of rib below Elevates and depresses ribs during respiration altering the Thoracic spinal
dimensions of the thoracic cavity nerves 2 to 12
Internal Intercostals Superior border of rib below Inferior border of rib above Contraction draws adjacent ribs together to further Thoracic spinal
decrease anteroposterior and lateral dimensions of thoracic nerves 2 to 12
cavity during forced exhalation
Diaphragm External intercostals Internal intercostals
11.12 Muscles of the Pelvic Floor that Support the Pelvic Viscera and Function as Sphincters

Levator ani Muscle is divisible into three parts: pubococcygenus muscle, puborectalis muscle, and ilicoccygenus muscle
Pubococcygeus Pubis and ischial spine Coccyx, urethra, anal canadal, perineal body of perineum Supports and maintains position of pelvic viscera; resists Sacral spinal nerves
(wedge-shaped mass of fibrous tissue in center of increase in intra-abdominal pressure during forced S2-S2
perineum), and anaococcygeal ligament (narrow fibrous exhalation, coughing, vomiting, urination, and defecation;
band that extends from anus to coccyx) constrics anus, urethra, and vagina
Puborectalis Posterior surface of pubic body Forms a sling posterior to the anorectal junction Helps maintain fecal continence and assists in defecation Sacral spinal nerves
S2-S4
Iliococcygeus Ischial spine Coccyx Supports and maintains position of pelvic viscera; resists Sacral spinal nerves
increase in intra-abdominal pressure during forced S2-S4
exhalation, coughing, vomiting, urination, and defecation;
constrics anus, urethra, and vagina
Ischiococcygenus Ischial spine Lower sacrum Supports and maintains position of pelvic viscera; resists Sacral spinal nerves
increase in intra-abdominal pressure during forced S4-S5
exhalation, coughing, vomiting, urination, and defecation’
pulls coccyx anteriorly following defecation or childbirth
11.13 Muscles of the Perineum

Superficial Perineal Muscles
Superficial transverse Ischial tuberosity Perineal body of perineum Stabilizes perineal body of perineum Perineal branch of
pudendal nerve of
perineal sacral plexus
Bulbospongiosus Perineal body of perineum Perineal membrane of deep muscles of perineum, corpus Helps expel urine during urination, helps propel semen along Perineal branch of
spongiosum of penis, and deep fascia on dorsum of penis in male; urethra, assists in erection of penis in male; constricts vaginal pudendal nerve of
pubic arch and root and dorsum of clitoris in female orifice and assists in erection of clitoris in female sacral plexus
Ischiocavernosus Ischial tuberosity and ischial and pubic rami Corpora cavernosa of penis in male and clitoris in female; pubic Maintains erection of penis in male and clitoris in female by Perineal branch of
symphysis decreasing urine drainage pudendal nerve of
sacral plexus
Deep Perineal Muscles

Deep transverse perineal Ischial ramus Perineal body of perineum Helps expel last drops of urine and semen in male Perineal branch of
pudendal nerve of
sacral plexus
External urethral Ischial pubic rami Median raphe in male and vaginal wall in female Helps expel last drops of urine and semen in male and urine Sacral spinal nerve 4
sphincter in female and inferior rectal
branch of pudendal
nerve
Compressor urethrae Ischiopubic ramus Blends with same muscle of opposite side anterior to Serves as accessory sphincter of urethra Perineal branch of
urethra pudendal nerve of
sacral plexus
Sphincter Perineal body Blends with same muscle of opposite side anterior to Serves as accessory sphincter of urethra and facilitates Perineal branch of
urethrovaginalis urethra closing of vagina pudendal nerve of
sacral plexus
External anal sphincter Anococcygeal ligament Perineal body of perineum Keeps anal canal and anus closed Sacral spinal nerve
S4 and inferior rectal
branch of pudendal
nerve
11.14 Muscles of the Thorax that Move the Pectoral Girdle

Anterior Thoracic Muscles
Subclavius
Origin – Rib 1 Client: supine Symptoms/Indications
Insertion – Clavicle Therapist & Instruction client to: Thoracic outlet syndrome
Action – Depresses and moves clavicle anteriorly, and helps stabilize pectoral 1. Supine Pain Patterns
girdle 2. Bend arm and place forearm near Inferior to clavicle
Innervation/nerve – Subclavian nerve head [can adjust] (should allow you Anterior arm
deep access under the clavicle) Lateral forearm and hand
3. Put your thumb under the middle of
the clavicle (after or right when it
concaves)
Action: ask client to inhale OR depress the
shoulder and ask them to move
clavicle/chest to opposite lower side of
body against resistance
Pectoralis minor
Origin – Ribs 2-5, 3-5, or 2-4 (locate clavicle and manubrium, fall off and count Client: supine Possible Causes
ribs [won’t feel the first] and continuously move laterally and inferiorly [why? Therapist & Instruction client to: Rounded shoulders
Difference between costal rib and ribs) 1. Can you slowly draw your arm and shoulder inferiorly slightly (slight Trauma, ex., recoil from rifle
Insertion – Coracoid process of scapula and slow contraction of the Strain from overuse as a shoulder
Action – Abducts scapula and rotates it downward. individual muscle) depressor
RMA: Elevates ribs 3 through 5 during forced inhalation Strain during inspiration
Innervation/nerve – Medial pectoral nerve Symptoms/Indications
Major complain is pain over the
anterior deltoid region
Difficulty reaching forward and up
Neurovascular symptoms through
entrapment of neurovascular
bundle
Pain Patterns
Anterior chest
Concentrated in anterior shoulder
Radiates down medial side of arm
to fingertips
Associated TPs
Pectoralis major
Anterior deltoid
Scalenes
Sternocleidomastoid
Thoracic outlet syndrome
C7, C8 radiculopathy
Bicipital/supraspinatus
tendinitis
Serratus anterior
Origin – Ribs 1-8 or 9 Client: supine or seated Possible Causes
Insertion – Medial border and inferior angle of scapula Therapist & Instruction client to: Excessively fast or prolonged
Action – Abducts scapula and rotates it upward. 1. Ask client to punch outward running
Innervation/nerve – Long thoracic nerve against resistance Push-ups
Lifting heavy weights overhead
Severe coughing
Chest pain
“Stitch in side” while running
Unable to lie on affected muscle
Shortness of breath
Pain Patterns
Lateral side of thorax, below axilla
Radiating down medial side of
arm to hand
Associated TPs
Pectoralis major
Sternocleidomastoid
Middle scalene
Costochondritis
Intercostal nerve
entrapment
Herpes zoster
Broken rib
Posterior Thoracic Muscles

Trapezius
Origin – Superior nuchal line, ligamentum nuchae, and the 7th cervical spine to Upper fibers Possible Causes
the 12 thoracic 1. Client prone Sudden trauma, such as falling
Insertion – Clavicle, acromion and spine of scapula 2. Ask client to extend there head an inch off table Whiplash injury
Action – 3. Palpate across muscle fibers Walking with cane
Middle fibers adduct scapula; Middle fibers Arm rests in high positions
Inferior fibers depress scapula; together or singly; 1. Client prone Symptoms/Indications
Superior and inferior fibers rotate scapula upward; 2. Locate the spine of the scapula and move medially (falling off the spine) Sever neck pain
stabilizes scapula. 3. Ask client to adduct scapula Headache
RMA: Superior fibers can help extend head. Lower fibers “Stiff neck”
Innervation/nerve – Accessory nerve 11 and cervical spinal nerves of 3 through 1. Client prone Pain Patterns
5 2. Locate the spine above T12 and move laterally and superiorly towards Angle of mandible
scapula Temporal region
3. Ask client to do a superman pose (arms outstretched) Lateral and posterior
sides of neck
Upper back
Medial border of scapula
Associated TPs
Temporalis
Occipitalis
Masseter
Pectoralis major and minor
Levator scapula
disorder
TPs of masticatory muscles
Fibromyalgia
Levator scapulae
Origin – Cervical transverse process of 1 through 4 Client: supine Possible Causes
Insertion – Superior medial border of scapula Therapist & Instruction client to: Occupational stresses
Action – Elevates scapula and rotates it downward 1. Locate under traps Typing with head and neck
Innervation/nerve – Dorsal scapular nerve and cervical spinal nerves 3 through 2. Move anteriorly until off (don’t confused it with the scalenes) turned
5 3. Ask client to rotate head to opposite side and dip their chin into the Holding the phone between
***When the scapula is stabilized, contraction of this muscle laterally flexes hollow of their neck (jugular neck) ear and shoulder
and rotates the neck to the same side. 4. Ask client to elevate shoulder and relax shoulder Sleeping with neck in tilted
position
Walking with cane
Pain at the angle of neck
“Stiff neck”
Torticollis
Unable to turn head fully to
same side or opposite side
Pain Patterns
Posterior shoulder and neck
Medial border of scapula
Associated TPs
Trapezius
Rhomboids
Splenius capitis
Splenius cervicis TPs
Scapulocostal dysfunction
Sternocleidomastoid TPs
Rhomboids
Rhomboid major Client: prone Possible Causes
Origin – Thoracic spines of 2 through 5 Therapist & Instruction client to: Painting overhead
Insertion – Medial border of scapula inferior to spine 1. Ask client to place hand behind back and against your resistance (plus Prolonged leaning forward
Action – Elevates, adducts, and rotates scapula downward; stabilizes scapula their hand) try to adduct shoulder Rounded shoulder position, ex., writing or sewing
Innervation/nerve – Dorsal scapular nerve 2. Palpate across muscle fibers Symptoms/Indications
3. Superficial arching pain at rest
Snapping, crunching noises during movement of the scapula
Pain Patterns
Medial border and superior region of scapula
Associated TPs
Scalenes
Levator scapula
Middle trapezius
Infraspinatus
Fibromyalgia
Scapulocostal dysfunction
Rhomboid minor
Origin – 7th cervical spine to the 1st thoracic spine
Insertion – Medial border of scapula superior to spine
Action – Elevates, adducts and rotates scapula downward; stabilizes scapula
Innervation/nerve – Dorsal scapular nerve
11.15 Muscles of the Thorax and Shoulder that Move the Humerus
Axial Muscles that Move the Humerus
Pectoralis major
clavicular head: [medial half of the] clavicle Therapist & Instruction client to: Rounded shoulder posture
sternocostal head: sternum and costal cartilages of ribs 2-6 or 1-7 1. Find the outer regions of the sternum Chronic shortening of the
Insertion – Greater tubercle of humerus and lateral lip of the bicipital groove 2. Locate the middle of the clavicle and move inferiorly (not onto breast muscle
Action – area) Heavy lifting
clavicular head flexes arm; 3. Ask client to adduct arm and flex forearm and against resistance adduct Overuse of shoulder
sternocostal head extends and adducts flexed arm; the arm/forearm (hulk out) OR make a fist and place it on their hip and adduction
together, adducts and medially rotates arm at shoulder joint try to push (half superhero pose) Immobilization of arm
Innervation/nerve – Medial and lateral pectoral nerves 4. Palpate across muscle fibers Symptoms/Indications
Activation of SCM TPs
Pain in front of shoulder
Pain over the pericardium
Limited abduction at the
shoulder
Pain Patterns
Anterior shoulder
Entire pectoral region
Medial side of arm, down
to medial forearm
Associated TPs
Latissimus dorsi
Teres major
Subscapularis
Angina pectoris
Tear of muscle
Bicipital/supraspinatus
tendinitis
Latissimus dorsi
Origin – 7th thoracic spine through to the 5th lumbar spine, ribs 9 through 12 via Client: prone with arm off table Possible Causes
thoracolumbar (thora-co-lumbar) fascia, sacrum and iliac crest Therapist & Instruction client to: Repetitive shoulder
Insertion – bicipital groove 1. Ask client to bring elbow towards lower back and forearm inwards (as if extension
Action – Extends, adducts, and medially rotates arm at shoulder joint; draws turning an oar in a rowboat ***make sure an L shape is present in the Throwing a baseball
arm inferiorly. arm) against resistance Hanging from a swing
RMA: Elevates vertebral column and torso Pulling weeds
Innervation/nerve – Thoracodorsal (thora-co-dorsal) Symptoms/Indications
nerve Pain when stretching upward or fan
out in front of the body
*** Iliac crest = L4; Inferior Pain Patterns
angle of the Scapula = T7 Region inferior to scapula
Radiating and skipping
down posterior arm to
pinkie and ring finger
Associated TPs
Pectoralis major
Teres major
Subscapularis
Entrapment of suprascapular nerve
Bicipital tendinitis
Ulnar neuropathy
Scapular Muscles that Move the Humerus

Deltoid
Origin – Client: seated or supine Possible Causes
Anterior fibers: acromial extremity and clavicle Therapist & Instruction client to: Impact trauma during
[lateral third of clavicle] 1. Ask client to abduct arm/humerus along with the forearm 90° [neutral] sports
Lateral fibers: acromion 2. Go against resistance by pushing the arm/humerus down (activating the or other activities
Posterior fibers: spine of scapula lateral fibers) Repetitive strain during
Insertion – Deltoid tuberosity 3. Ask client to put forearm down/internal rotate and flex against prolonged lifting
Action – resistance (activating the anterior fibers) [hold at elbow/condyles] Excessive poling while
Lateral fibers abduct arm; 4. Ask client to external rotate and extend arm (activating the posterior skiing
Anterior fibers flex and medially rotate arm; fibers) [hold at elbow/condyles] Symptoms/Indications
Posterior fibers extend and laterally rotate arm Difficulty abducting shoulder
ALL OF WHICH IS DONE AT THE SHOULDER JOINT to a horizontal position
Innervation/nerve – Axillary nerve Pain deep in the deltoid area
Pain Patterns
Anterior, lateral and posterior
sides of the shoulder
Associated TPs
Pectoralis major
Biceps brachii
Other sections of the deltoid
Rotator cuff tear
Subacromial/subdeltoid
bursitis
Glenohumeral joint arthritis
Subscapularis
Origin – Subscapular fossa Client: supine Possible Causes
Insertion – Lesser tubercle of the humerus Therapist & Instruction client to: Repeated, forceful medial rotation
Action – Medially rotates arm at shoulder 1. With the clients arms relaxed (to the best of your abilities) locate the anterior such as swimming or pitching
joint of the scapula through the armpit (make sure the latissimus dorsi is relaxed, or Repeated overhead lifting
push it aside, along with the teres major) Dislocation of glenohumeral joint
Innervation/nerve – Subscapular nerve
Contraction of muscle Prolonged immobilization of shoulder
2. Once found lift the client’s arm to 90° neutral position (WITHOUT GETTING Symptoms/Indications
PUSHED OUT OF THE ARMPIT Pain when arm at rest and in motion
3. Ask client to internally rotate shoulder/humerus against resistance (holding the Restricted abduction of shoulder
forearm) Inability to reach across to opposite
armpit
Pain Patterns
Posterior shoulder, radiating over
scapula
Posterior arm, skipping to wrist
Associated TPs
Pectoralis major
Teres major
Latissimus dorsi
Long head of the triceps brachii
Rotator cuff tear
Adhesive capsulitis
Supraspinatus
Origin – Supraspinous fossa Client: seated or supine Possible Causes
Insertion – Greater tubercle of humerus Therapist & Instruction client to: Carrying heavy objects that pull inferiorly, ex. suitcase
Action – Assists deltoid muscle in abducting arm at shoulder joint 1. Ask client to abduct humerus against resistance Walking a big dog that pulls hard on the leash
Innervation/nerve – Suprascapular nerve Lifting heavy object above shoulder height
Pain during shoulder abduction
Severe, sleep-disturbing pain
Stiffness of the shoulder
Snapping or clicking sounds at the shoulder
Pain Patterns
Top of shoulder
Lateral arm to wrist
Associated TPs
Infraspinatus
Trapezius
Deltoid
Cervical arthritis
Spurs with nerve root irritation
Brachial plexus injuries
Subacromial/subdeltoid bursitis
Rotator cuff tear
Infraspinatus
Origin – Infraspinous fossa Client: prone with forearm off table (L shaped arm) Possible Causes
Insertion – Greater tubercle of humerus Therapist & Instruction client to: Acute stress or multiple overload
Action – Laterally rotates arm at shoulder joint 1. Ask the client to externally rotate arm and go against resistance (use stress
Innervation/nerve – Suprascapular nerve your knee or hand to stop contraction) Reaching arm behind and away
Twisting arm during a fall
Pain when brushing teeth or
combing hair
Inability to medially rotate and
adduct shoulder simultaneously
Inability to sleep on painful side
Pain Patterns
Most intense in shoulder
Lateral arm, forearm and hand
Associated TPs
Teres minor
Anterior deltoid
Supraspinatus
Biceps brachii
Suprascapular nerve entrapment
Scapulohumeral dysfunction
Teres major
Origin – Inferior angle of scapula Client: seated Possible Causes
Insertion – Medial lip of bicipital groove Therapist & Instruction Driving without power steering
Action – Extends arm, adducts and medial rotates arm at shoulder joint client to: Reaching overhead and forward
Innervation/nerve – Lower subscapular nerve 1. Place hand behind To lift heavy object
back Symptoms/Indications
2. Try to resist me Pain upon muscle activation
pushing your Slight restriction in overhead
elbow back range
Pain Patterns
Posterior shoulder
Radiates down posterior arm
and forearm
Associated TPs
Latissimus dorsi
Long head of the triceps brachii
Supraspinatus tendinitis
Teres minor
Origin – Inferior lateral border of scapula Client: seated Possible Causes
Insertion – Greater tubercle of humerus Therapist & Instruction client to: Reaching behind shoulder in extension
Action – Laterally rotates and extends arm at shoulder joint 1. Place hand behind back Motor vehicle accident
Innervation/nerve – Axillary nerve 2. Try to resist me pushing your elbow Reaching overhead, ex.,
forward volleyball
Posterior shoulder pain
Pain Patterns
Posterior shoulder and arm
Associated TPs
Infraspinatus
Compression of the axillary nerve
Ulnar neuropathy
Acromioclavicular joint separation
Coracobrachialis (kor-a-ko-brah-ke-Ah-lis)
Origin – Coracoid process of scapula Client: supine Possible Causes
Insertion – Mid-medial surface of humerus Therapist & Instruction client to: Active TPs in the anterior deltoid, biceps brachii and pectoralis major
Action – Flexes and adducts arm at shoulder joint 1. Put forearm into a 90° with arm abducted slightly Symptoms/Indications
Innervation/nerve – Musculocutaneous nerve 2. Ask client to bring arm and forearm into body going against resistance Pain with shoulder extension
Upper limb pain
Pain Patterns
Anterior shoulder, skipping down posterior arm, forearm and hand
Acromioclavicular joint dysfunction
Carpal tunnel syndrome
11.16 Muscles of the Arms that Move the Radius and Ulna
Forearm Flexors
Biceps brachii
Origin – Client: seated Possible Causes
Long head originates from the supraglenoid tubercle (CAN’T PALPATE BUT… Therapist & Instruction client to: Elevation of arm above shoulder level
SAY ‘IS DEEP’). 1. Ask client to flex arm (bring forearm to Overstress during activities, ex., tennis
Short head originates from coracoid process of the scapula arm) against resistance backhand, lifting heavy object with
palm upward
Insertion – Radial tuberosity of radius and bicipital aponeurosis
Repeated supination
Action – Flexes arm at shoulder joint, flexes forearm at elbow joint, supinates
forearm at radioulnar joint Superficial, anterior shoulder pain
Innervation/nerve – Musculocutaneous nerve Tenderness over capital tendon
Weakness raising hand above the head
Pain Patterns
Anterior shoulder down to anterior
surface of elbow
Associated TPs
Brachialis
Supinator
Triceps brachii
Bicipital bursitis
Brachialis
Origin –Mid-anterior surface of humerus Client: seated Possible Causes
Insertion – Ulnar tuberosity and coronoid process of ulna (should feel like a Therapist & Instruction client to: Overload of forearm flexion during heavy lifting
small bump) 1. Ask client to flex arm (bring forearm to arm) against resistance/relax to strum “Tennis elbow”
Action – Flexes forearm at elbow joint lateral aspect/again to go across fibers Symptoms/Indications
Innervation/nerve – Musculocutaneous and radial nerves Radial nerve entrapment
Soreness of the thumb
Pain over anterior deltoid
Pain Patterns
Anterior shoulder
Inner elbow
Thenar eminence
Associated TPs
Biceps brachii
Brachioradialis
Supinator
Brachioradialis
Origin – Distal lateral surface of humerus Client: seated Possible Causes
Insertion – Proximal to the styloid process of the radius Therapist & Instruction client to: Repetitive, forceful gripping, ex., weeding with a trowel, scraping ice off
Action – Flexes forearm at elbow joint; supinates and pronates forearm at 1. Ask client to flex arm (bring forearm to arm) while forearm is pronated a windshield
radioulnar joints into neutral position [palm facing down] and go against resistance Continual re-injury of area
Innervation/nerve – Radial nerve Symptoms/Indications
Pain in lateral epicondyle spreading to wrist and hand
“Tennis elbow”
Weakness of grip
Pain and limited movement
Pain Patterns
Lateral elbow
Lateral forearm to dorsal side of thenar
eminence
Associated TPs
Extensor carpi radialis longus and brevis
Extensor digitorum
Supinator
Lateral epicondylitis
Forearm Extensors
Triceps brachii
Origin – Client: prone with forearm off table (in a L shape) Possible Causes
Long head originates from infraglenoid tubercle. Therapist & Instruction client to: Excessive city driving with
Lateral head originates from the lateral and posterior surface of the humerus. 1. Ask client pull arms/forearm towards their back against resistance manual transmission
Medial head originates from the posterior surface of humerus inferior to the (holding arm/elbow down) Overenthusiastic exercise
radial groove 2. Palpate muscle bellies (two are noticeable, third is deep) Needlepoint without elbow
Insertion – Olecranon support
Action – Extends forearm at elbow joint and arm at shoulder joint Symptoms/Indications
Innervation/nerve – Radial nerve Difficulty to locate pain in
posterior shoulder
Inability to fully extend elbow
Pain Patterns
Posterior shoulder
Posterior arm and forearm
down to pinkie and ring
finger
Associated TPs
Latissimus dorsi
Teres major and minor
Entrapment of radial nerve
“Tennis elbow”
Lateral or medial epicondylitis
Anconeus
Origin – Lateral epicondyle of humerus Client: seated
Insertion – Olecranon and superior portion of the ulna Therapist & Instruction client to:
Action – Extends forearm at elbow joint 1. Get elbow into 90° position in front of client
Innervation/nerve – Radial nerve 2. Ask client to extend elbow against resistance (holding onto forearm)
Forearm Pronators
Pronator teres
Origin – Medial epicondyle of humerus and coronoid process of ulna Client: seated Possible Causes
Insertion – Mid-lateral surface of radius Therapist & Instruction client to: Fracture at the wrist or elbow
Action – Pronates at radioulnar joints and weakly flexes forearm at elbow joint 1. Shake hands with client Prolonged typing
Innervation/nerve – Median nerve 2. Ask client to pronate forearm (turn it downwards) Symptoms/Indications
Unable to supinate forearm
Pain Patterns
Anterior surface of forearm,
concentrated at wrist
Associated TPs
Finger flexors
Scalenes
Pronator quadratus
Origin – Distal portion of shaft of ulna Client: seated
Insertion – Distal portion of shaft of radius Therapist & Instruction client to:
Action – Pronates forearm at radioulnar joint 1. Find the radial pulse (thumb side)
Innervation/nerve – Median nerve 2. Ask client to pronate forearm (turn it downwards)
3. Although you won’t be able to access the muscle due
*** bigger portion of the ulnar side than radial side to all the tendon crossing over the carpal tunnel you
can gain slight access on the radial side and see
contraction of the muscle on the ulnar side
Forearm Supinator
Supinator
Origin – Lateral epicondyle of humerus and supinator crest Client: seated Possible Causes
Insertion – proximal lateral third of the radius Therapist & Instruction client to: Resisting unexpected pronation
Action – Supinates forearm at radioulnar joints 1. Shake client’s hand Extremely forceful supination
Innervation/nerve – Deep radial nerve 2. Ask client to supinate forearm (turn forearm upward) against resistance Forceful and repetitive supination of the forearm
Carrying heavy suitcase
Note: DO NOT CONFUSE IT WITH BRACHIORADIALIS it is deeper and lateral Symptoms/Indications
Lateral epicondylar pain
Pain in web of thumb
Pain Patterns
Lateral elbow
Dorsal surface of thenar eminence
Associated TPs
Triceps brachii
Extensors of the fingers
Brachioradialis
“Tennis elbow”
Entrapment of the posterior
interosseous nerve
11.17 Muscles of the Forearm that Move the Wrist, Hand, Thumb and Digits
Anterior (Flexors) of the Forearm
Superficial Anterior (Flexor) Compartment of the Forearm
Flexor carpi radialis
Origin – Medial epicondyle of humerus Client: seated Possible Causes
Insertion – Metacarpals II and III Therapist & Instruction client to: Acute or chronic overloading
Action – Flexes and abducts hand (radial deviation) at wrist joint 1. Ask client to flex forearm with radial deviation of the muscle
Innervation/nerve – Median nerve against resistance (bringing thumb towards elbow Excessive gripping movements,
and bring the wrist towards the body while holding ex., gripping steering wheel over load drives
this position) Symptoms/Indications
Difficulty using scissors
Or could ask to arm wrestle. Pain Patters
Palmar surface of wrist and hand
Associated TPs
Surrounding flexor muscles
Medial epicondylitis
Ulnar neuropathy
Arthritis of wrist
Palmaris longus
Origin – Medial epicondyle of humerus Client: Possible Causes
Insertion – Flexor retinaculum and palmar aponeurosis (fascia in center of Therapist: Direct trauma
palm) Instruction client to: Fall onto an outstretched hand
Action – Weakly flexes hand at wrist joint *** 10% of the population does Tool pressed into a cupped hand
Innervation/nerve – Median nerve NOT have this muscle Leaning on cane
Difficulty handling tools
Tenderness and pain in palm
Pain Patterns
Anterior forearm
Palm of hand
Associated TPs
Hand and finger flexors
Flexor carpi ulnaris

Origin – Medial epicondyle of humerus and proximal posterior border of ulna Client: seated Possible Causes
Insertion – Pisiform, hamate, and base of the 5th metacarpal Therapist & Instruction client to: Acute or chronic overloading of
Action – Flexes and adducts hand (ulnar deviation) at wrist joint 1. Ask client to bring forearm towards the muscle
Innervation/nerve – Ulnar nerve arm (RELAXED NOT FLEXED, elbow Excessive gripping movements,
can be on table, posterior surface ex., steering wheel over long drives
facing you) Symptoms/Indications
2. Ask client to perform ulnar Difficulty using scissors
deviation (bring pinky to elbow Pain Patterns
against resistance (can go back and Medial surface of wrist and hand
forth between contraction and Associated TPs
relaxation) Surrounding flexor muscles
Ulnar neuropathy
Arthritis of wrist
Flexor digitorum superficialis

Origin – Medial epicondyle of humerus, coronoid process of ulna, and ridge Client: Flexor Digitorum Superficialis and Profundus
along lateral margin or anterior surface (anterior oblique line) of the radius Therapist: Possible Causes
Insertion – Middle phalanx of each finger Instruction client to: Acute or chronic overloading
Action – Flexes middle and proximal phalanx of each finger at proximal of the muscle
interphalangeal and metacarpophalangeal joint, and hand at wrist joint Excessive gripping movements,
Innervation/nerve – Median nerve ex., gripping steering wheel
over long drives
Pain Patterns
Palmar surface of hand into
middle ring and pinkie fingers
and beyond
Associated TPs
Surrounding flexor muscles
Ulnar neuropathy
Arthritis of wrist
Deep Anterior (Flexor) Compartment of the Forearm
Flexor pollicis longus
Origin – Anterior surface of radius and interosseous membrane Client: Possible Causes
Insertion – Base of distal phalanx of thumb Therapist: Milking animals
Action – Flexes distal phalanx of thumb at interphalangeal joint Instruction client to: Excessive weeding with
Innervation/nerve – Median nerve clippers or other hand
tools
Forceful grasping joined with rocking, twisting motions
Pain in thumb
Pain Patterns
Length of thumb
Ulnar neuropathy
Arthritis of wrist
Flexor digitorum profundus

Origin – Anterior medial surface of body of ulna Client:
Insertion – Base of distal phalanx of each finger Therapist: See flexor digitorum superficialis
Action – Flexes distal and middle phalanges of each finger at interphalangeal Instruction client to:
joints, proximal phalanx of each finger at metacarpophalangeal joint, and hand
at wrist joint
Innervation/nerve – Median and ulnar nerves
See flexor digitorum superficialis
Posterior (Extensors) of the Forearm

Superficial Posterior (Extensor) Compartment of the Forearm
Extensor carpi radialis longus Extensor Carpi Radialis Longus and Brevis
Origin – Lateral supracondylar ridge of humerus Client: Possible Causes
Insertion – 2nd metacarpal Therapist: Repetitive, forceful gripping, ex., weeding with trowel, scraping ice off a
Action – Extends and abducts hand at wrist joint (radially deviates) Instruction client to: windshield
Innervation/nerve – Radial nerve Continual re-injury of area
Pain in lateral epicondyle, spreading to wrist and hand
“Tennis elbow”
Weakness of grip
Pain Patterns
Longus
Posterior elbow, forearm and hand
Dorsal thenar eminence
Brevis
Dorsal wrist and hand
Associated TPs
Extensor digitorum
Supinator
Brachioradialis
Extensor carpi radialis brevis Lateral epicondylitis
Origin – Lateral epicondyle of humerus Client: C7, C8 radiculopathy
Insertion – 3rd metacarpal Therapist: Carpal tunnel syndrome
Action – Extends and abducts hand at wrist joint (radially deviates) Instruction client to:
Innervation/nerve – Radial nerve
Extensor digitorum
Origin – Lateral epicondyle of humerus Client: seated Extensor Digitorum and Extensor Indicis
Insertion – Distal and middle phalanges of each finger Therapist & Instruction client to: Possible Cause
Action – Extends the phalanges of each finger at the interphalangeal joint and 1. Forearm on top Forceful or repetitive wrist
metacarpophalangeal joint, and hand at wrist joint 2. Put your hand over the distal area of the fingers or finger extension
Innervation/nerve – Radial nerve (excluding thumb) on a slant, pinky has the Fracture of forearm
beginning of the slope Symptoms/Indications
3. Ask client to extend fingers and wrist against Weakness of grip accompanied
resistance by pain in the elbow
Pain on lateral elbow
Stiffness and painful cramping
of the fingers
Pain Patterns
Digitorum
Posterior forearm to middle and
ring fingers
Anterior wrist
Indicis
Doral surface of wrist to index
finger
Associated TPs
Extensor carpi ulnaris
“Tennis elbow”
C7 radiculopathy
Subluxations of carpal bones
Extensor digiti minimi

Origin – Lateral epicondyle of humerus Client: seated with forearm on table
Insertion – the entire 5th phalanx Therapist & Instruction client to:
Action – Extends proximal phalanx of little finger at metacarpophalangeal joint 1. Extend little finger against resistance WITHOUT
and hand at wrist joint USING FINGERS (if used asked client to make a fist
Innervation/nerve – Deep radial nerve with those fingers)
Extensor carpi ulnaris

Origin – Lateral epicondyle of humerus and posterior border of ulna Client: Possible Causes
Insertion – Metacarpal 5 Therapist: Gross trauma, such as
Action – Extends and adducts hand at wrist joint (ulnar deviation) Instruction client to: fracture of ulna
Innervation/nerve – Deep radial nerve Prolonged immobilization
Pain in lateral epicondyle
spreading to wrist and hand
“Tennis elbow”
Weakness of grip
Pain Patterns
Ulnar surface of wrist
Associated TPs
Extensor digitorum
Arthritis
Deep Posterior (Extensor) Compartment of the Forearm

Abductor pollicis longus
Origin – Mid-posterior surface of the ulna moving distally to the interosseous Client: seated with forearm on table
(inter-ah-see-us) membrane and radius Therapist & Instruction client to:
Insertion – 1st metacarpal (the thumb) 1. Ask client to move thumb away from the fingers
Action – Abducts and extends thumb at carpometacarpal joint and abducts
(radially deviates) hand at wrist joint REPEAT BETWEEN CONTRACTION AND RELAXATION
Innervation/nerve – Deep radial nerve
Extensor pollicis brevis

Origin – Posterior surface of middle of radius and interosseous membrane Client:
Insertion – Base of proximal phalanx of thumb Therapist:
Action – Extends proximal phalanx of thumb at metacarpophalangeal joint, Instruction client to:
first metacarpal of thumb at carpometacarpal joint, and hand at wrist joint
Extensor pollicis longus

Origin – Mid-posterior surface of the ulna and interosseous (inter-ah-see-us) Client: seated
membrane Therapist & Instruction client to:
Insertion – Base of distal phalanx of thumb 1. Ask client lifts thumb brings it towards them
Action – Extends thumb at interphalangeal joint and carpometacarpal joint, (abduction and extension) against resistance
and abducts (radially deviates) hand at wrist joint. WITHOUT USING FINGERS (if other fingers are
Innervation/nerve – Deep radial nerve being used ask client to make a fist with fingers)
REPEAT BETWEEN CONTRACTION AND RELAXATION
Extensor indicis
Origin – Posterior surface of ulna and interosseous membrane Client:
Insertion – Tendon of extensor digitorum of index finger (distal and middle Therapist: See extensor digitorum
phalanges of each finger) Instruction client to:
Action – Extends distal and middle

phalanges of index finger at interphalangeal joints, proximal phalanx of index
finger at metacarpophalangeal joint, and hand at wrist joint
11.18 Muscles of the Palm that Move the Digits—Intrinsic Muscles of the Hand
Thenar (Lateral Aspect of Palm)

Abductor pollicis brevis Flexor retinaculum, scaphoid, and trapezium Lateral side of proximal phalanx of thumb Abducts thumb at carpometacarpal joint Median nerve
Opponens pollicis Flexor retinaculum and trapezium Lateral side of metacarpal 1 (thumb) Moves thumb across palm to meet any finger (opposition) at Median nerve
carpometacarpal joint
Flexor pollicis brevis Flexor retinaculum, trapezium Lateral side of proximal phalanx of thumb Flexes thumb at carpometacarpal and metacarpophalangeal Median nerve
joints
Abductor pollicis brevis Opponens pollicis Flexor pollicis brevis
Adductor pollicis
Origin – Client: Possible Causes
Oblique head originates from capitate and metacarpal 2 and 3 Therapist: Pulling weeds
Transverse head originates from metacarpal 3 Instruction client to: Milking animals
Insertion – Medial side of proximal phalanx of thumb by tendon containing Repetitive fine movements of thumb
sesamoid bone Former bone injury
Action – Adducts thumb at carpometacarpal and metacarpophalangeal joints “Trigger thumb”
Innervation/nerve – Ulnar nerve Symptoms/Indications
Thumb feels uncoordinated
Poor handwriting
Difficulty with fine movements
for specific tasks
Pain Patterns
All sides of the thumb and
thenar eminence
Associated TPs
First dorsal interossei muscle
Flexor pollicis brevis
Abductor pollicis brevis
Carpometacarpal
osteoarthritis
Hypothenar (Medial Aspect of Palm)

Abductor digiti minimi Pisiform and tendon of flexor carpi ulnaris Medial side of proximal phalanx of little finger Abducts and flexes little finger at metacarpophalangeal joint Ulnar nerve
Flexor digiti minimi Flexor retinaculum and hamate Medial side of proximal phalanx of little finger Flexes little finger at carpometacarpal and Ulnar nerve
brevis metacarpophalangeal joints
Opponens digiti minimi Flexor retinaculum and hamate Medial side of the 5th metacarpal of little finger Moves little finger across palm to meet thumb (opposition) Ulnar nerve
at carpometacarpal joint
Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi
Intermediate (Midpalmar)
Lumbricials Palmar interossei
Origin – Lateral sides of tendons and flexor digitorum Origin – Sides of shafts of metacarpals of all digits EXCEPT
profundus of each finger 3
Insertion – Lateral sides of tendons of extensor digitorum Insertion – Sides of bases of proximal phalanges of all
on proximal phalanges of each finger fingers EXCEPT 3
Action – Flex each finger at metacarpophalangeal joints Action – Adduct and flex each finger EXCEPT 3 at
and extend each finger at interphalangeal joints metacarpophalangeal joints and extend these digits at
Innervation/nerve – Median and ulnar nerves interphalangeal joints
Innervation/nerve – Ulnar nerve
Dorsal interossei
Origin – Adjacent sides of metacarpals Client: Possible Causes
Insertion – Proximal phalanx of fingers 2 through 4 Therapist: Sustained or repetitive
Action – Abducts and flexes fingers 2 through 4 at metacarpophalangeal joints, Instruction client to: pincer grasping
and extend fingers 2 through 4 at interphalangeal joints Playing the piano
Innervation/nerve – Ulnar nerve Sustained forceful finger
movements
Arthritis pain in the fingers
Stiffness in the fingers
Sore, swollen joints
Pain Patterns
First interossei
Index and pinkie fingers
Dorsal surface of hand
Second interossei
Middle finger
Associated TPs
Intrinsic thumb muscles
Long extensors and flexors
of fingers
C6 radiculopathy
Ulnar neuropathy
Nerve entrapment of brachial plexus
11.19 Muscles of the Neck and Back that Move the Vertebral Column
Splenius Group – spinous process to tvps/head
Splenius capitis Client: prone Possible Causes
Origin – Ligamentum nuchae and the 7th cervical spinous process through to Therapist & Instruction client to: Postural stress
the 4th thoracic 1. Locate the trapezius Falling asleep with neck in odd position
Insertion – Occipital bone and mastoid process of temporal bone 2. Locate the lateral edge up until occipital bone of the trapezius by having Motor vehicle accident
Action – Acting together, extend head and vertebral column; acting singly, the client extend their head slightly. Symptoms/Indications
laterally flex and/or rotate head to same side as contracting muscle 3. Ask the client to relax and palpate just medially to the trapezius which Pain at top of the head
Innervation/nerve – Middle cervical spinal nerves is the splenius capitis Pain Patterns
4. Move inferiorly Top of cranium
through the trapezius (if Associated TPs
you can) towards the 7th Erector spinae muscles
spinous process Semispinalis thoracis
C2 articular dysfunction
Occiptoatlantal dysfunction
Whiplash syndrome
Splenius cervicis Client: Possible Causes

rd th
Origin – The 3 through the 6 thoracic spinous processes Therapist: Postural stress
Insertion – 1st and 2nd OR 4th cervical transverse processes Instruction client to: Sleeping with neck in odd position
Action – Acting together, extend head; acting singly, laterally flex and/or rotate Motor vehicle accident
head to same side as contracting muscle Excessive rotation or extension of head
Innervation/nerve – Inferior cervical spinal nerves Symptoms/Indications
Pain in neck, cranium and eye
“Stiff neck”
Pain Patterns
Lateral eyebrow, radiates to temporal region
Posterior neck
Associated TPs
Erector spinae
Semispinalis thoracis
C2 articular dysfunction
Occipitoatlantal dysfunction
Whiplash syndrome
Erector Spinae
The erector spinae is a group of 3 muscle: iliocostalis (lateral), longissimus (intermediate and largest) and spinalis (medial).
Each are subdivided by their superior attachments: lumborum (lumbar), thoracis (thorax), cervicis (cervical) and capitis (head).
ALL have a common tendinous origin that arises from: iliac crest, lumbar, thoracic and cervical vertebrae, ligamentum nuchae.
Iliocostalis inserts onto all the ribs and the 6th to 4th cervical TVP.
A: maintains posture, extends the spine; singly laterally flex
Longissimus inserts onto ribs 9 &10 and the 12th T to 2nd C TVP and mastoid process of the temporal bone.
A: extends head and spine; singly, rotates head to SAME side and laterally flexes the spine
Spinalis inserts onto spinous process of the 9th T to the 2nd C, the occiput.
A: extends the spine and head
Iliocostalis Group (lateral)  Ribs

Iliocostalis cervicis Client: Possible Causes
Origin – Ribs 1 through 6 Therapist: Sudden overload of traumatic
Insertion – 4th through 6th cervical transverse processes Instruction client to: event
Action – Acting together, muscles of each region extend and maintain erect Repeated muscular contraction
posture of vertebral column of their respective regions; singly, laterally flex Quick bending and twisting
vertebral column of their regions to the same side as the contracting muscle Prolonged immobility, such as
Innervation/nerve – Cervical and thoracic spinal nerves sitting on a plane
Iliocostalis thoracis Symptoms/Indications
Origin – Ribs 7 through 12 Pain in the back
Insertion – Ribs 1 through 6 Restricted spinal movement
Action – Acting together, muscles of each region extend and maintain erect Difficulty rising from chair
posture of vertebral column of their respective regions; singly, laterally flex and/or climbing stairs
vertebral column of their regions to the same side as the contracting muscle Pain Patterns
Innervation/nerve – Thoracic spinal nerves Entire length of back next to
vertebrae, radiating into the
Iliocostalis lumborum region of scapula, lower ribs
Origin – Iliac crest
and buttocks
Insertion – Ribs 7 through 12
Associated TPs
Action – Acting together, muscles of each region extend and maintain erect
Latissimus dorsi
posture of vertebral column of their respective regions; singly, laterally flex
Quadratus lumborum
vertebral column of their regions to the same side as the contracting muscle
Serratus posterior inferior and
Innervation/nerve – Lumbar spinal nerves
superior
Articular dysfunctions
Fibromyalgia
Visceral disease
Longissimus Group (intermediate)  Transverse Processes
Longissimus capitis Client: Possible Causes
th th st th
Origin – 4 to 7 cervical articular processes through to the 1 to 4 transverse Therapist: Sudden overload or traumatic
processes of the thoracic spine Instruction client to: event
Insertion – Mastoid process of temporal bone Repeated muscular contraction
Action – Acting together, both longissimus capitis muscles extend head and Quick bending and twisting
vertebral column; single, rotate head to same side as contracting muscle Prolonged immobility, such as
Innervation/nerve – Middle and inferior cervical spinal nerves sitting on a plane
Longissimus cervicis Symptoms/Indications
Origin – 4ths and 5th thoracic transverse processes Restricted spinal movement
Insertion – Mastoid process of temporal bone Difficulty rising from chair
Action – Acting together, both longissimus cervicis and thoracis muscles extend and/or climbing stairs
vertebral column of their regions; single, laterally flex vertebral column of Pain Patterns
their regions Buttocks and low back
Innervation/nerve – Cervical and superior thoracic spinal nerves. Thoracic and Associated TPs
lumbar spinal nerves Latissimus dorsi
Longissimus thoracis Quadratus lumborum
Origin – Transverse processes of lumbar vertebrae Serratus posterior inferior
Insertion – Transverse processes of ALL thoracic and superior lumbar vertebrae Differential Diagnoses
and ribs 9 and 10 Articular dysfunctions
Action – Acting together, both longissimus cervicis and thoracis muscles extend Fibromyalgia
vertebral column of their regions; single, laterally flex vertebral column of Visceral disease
their regions
Innervation/nerve – Cervical and superior thoracic spinal nerves. Thoracic and
lumbar spinal nerves
Spinalis Group (medial)  Spinous Processes

Spinalis capitis Spinalis cervicis Spinalis thoracis
th
Origin – Often absent or very small. Arises with semispinalis Origin – Ligamentum nuchae and spinous process of the 7 Origin – 10th thoracic spinous process through the 2nd
capitis cervical vertebrae lumbar
Insertion – Occipital bone Insertion – Spinous process of axis Insertion – Spinous processes of superior thoracic vertebrae
Action – Acting together, muscles of each region extend Action – Acting together, muscles of each region extend Action – Acting together, muscles of each region extend
vertebral column of their respective regions and extend vertebral column of their respective regions and extend vertebral column of their respective regions and extend
head head head
Innervation/nerve – Cervical spinal nerves Innervation/nerve – Inferior cervical and thoracic spinal Innervation/nerve – Thoracic spinal nerves
nerves
Transversospinales
Semispinalis  4C to 10T TVPs to SPs of 1C and 4T & the sup and inf nuchal lines – extends, rotates to opposite side
Semispinalis capitis Client: Possible Causes
th th th
Origin – 4 to 6 articular process of the cervical spine through to 7 cervical Therapist: Hitting head
vertebrae to the 7th thoracic transverse process Instruction client to: Motor vehicle accidents
Insertion – Occipital bone between superior and inferior nuchal lines Acute overload
Action – Acting together, extend head and vertebral column; singly, rotate Postural stress
head to side opposite contracting muscle Symptoms/Indications
Innervation/nerve – Cervical and thoracic spinal nerves Headache
Tenderness over back of
head and neck
Numbness, tingling or
burning in the scalp
Pain Patterns
Headband pattern
around cranium
Fibromyalgia
Facet joint osteoarthritis
Semispinalis cervicis Client:

st th
Origin – 1 through 5 thoracic transverse processes Therapist:
Insertion – 1st through 5 cervical spinous processes Instruction client to:
Action – Acting together, both cervicis and thoracis muscles extend vertebral
column of their respective regions; singly, rotate head to side opposite
contracting muscle
Innervation/nerve – Cervical and thoracic spinal nerves
Semispinalis thoracis Client:

th th
Origin – 6 through 10 thoracic transverse processes Therapist:
Insertion – 6th cervical through to the 4th thoracic spinous processes Instruction client to:
Action – Acting together, both cervicis and thoracis muscles extend vertebral
column of their respective regions; singly, rotate head to side opposite
contracting muscle
Innervation/nerve – Thoracic spinal nerves
Multifidus / Multifidi – Sacrum, ilium, and TVPs stopping at C4 to SP ascending 2-4 Multifidi and Rotatores
Origin – Sacrum; ilium; the 5th lumbar to the 4th cervical transverse processes Client: prone Possible Causes
Insertion – Spinous process of a more superior vertebra, every 2 to 4 Therapist & Instruction client to: Sudden overload or traumatic event
Action – Together, extend the spine; singly, weakly laterally flex and rotates 1. Ask client to do a superman (arms Repeated muscular contraction
spine opposite to contracting muscle back) but if they are turning Quick bending and twisting
Innervation/nerve – Cervical, thoracic, and lumbar spinal nerves around a corner slightly and with Prolonged immobility, such as sitting on a plane
slight rotation (in and out, slowly) Symptoms/Indications
Pain in the back
Restricted spinal movement
Difficulty rising from chair and/or climbing stairs
Pain Patterns
Between scapulae
Sacrum
Posterior buttock region
Rotatores / Rotatore – TVP to SP 1 or 2 ascending
Origin – Transverse processes of all vertebrae Client: Associated TPs
Insertion – Spinous process of vertebrae superior to the one of origin / by 1 or Therapist: Latissimus dorsi
2 Instruction client to: Quadratus lumborum
Action – Acting together, weakly extend vertebral column; singly, weakly Serratus posterior inferior and superior
rotate vertebral column to side opposite contracting muscle Differential Diagnoses
Innervation/nerve – Cervical, thoracic, and lumbar spinal nerves Articular dysfunction
Fibromyalgia
Visceral disease
Segmental
Interspinales Intertransversarii / Intertransversarius
Origin – Superior surface of all spinous processes Origin – Transverse process of all vertebrae
Insertion – Inferior surface of spinous process of vertebra Insertion – Transverse processes of vertebra superior to
superior to the one of origin the one of origin
Action – Acting together, weakly extend vertebral column; Action – Acting together, weakly extend vertebral column;
acting singly, stabilize vertebral column during movement acting singly, weakly laterally flex vertebral column and
Innervation/nerve – Cervical, thoracic, and lumbar spinal stabilize it during movements
nerves Innervation/nerve – Cervical, thoracic, and lumbar spinal
nerves
Scalenes
Anterior scalene Client: supine Possible Causes
rd th
Origin – 3 through to the 6 cervical transverse processes Therapist & Instruction client to: Accidental trauma
Insertion – Rib 1 1. Rotate head to opposite side Carrying awkward, large objects
Action – Together, right and left anterior and middle scalene muscles elevate 2. Laterally flex Whiplash
first ribs during deep inhalation 3. Against Resistance or Inhale Symptoms/Indications
RMA: Flex cervical vertebrae; singly, laterally flexes and slightly rotate cervical Pain in shoulder, upper limb
vertebrae Venous obstruction
Innervation/nerve – Cervical spinal nerves Pain in upper back
Middle scalene Disturbed sleep
Origin – 2nd through 7th cervical transverse processes Numbness and tingling in hand
Insertion – Rib 1 Pain Patterns
Action – Together, right and left anterior and middle scalene muscles elevate Lateral shoulder, arm, forearm,
first ribs during deep inhalation index finger and thumb
RMA: Flex cervical vertebrae; singly, laterally flexes and slightly rotate cervical Upper pectoral region
vertebrae Medial border of scapula
Innervation/nerve – Cervical spinal nerves Associated TPs
Other scalenes
Posterior scalene Sternocleidomastoid
Origin – 4th through 6th cervical transverse processes
Splenius capitis
Insertion – Rib 2
Action – Together, elevate second ribs during deep inhalation
RMA: Flex cervical vertebrae; singly, laterally flex (SAME SIDE) and slightly
rotate (AWAY) cervical vertebrae
C4 to C6 articular dysfunction
Innervation/nerve – Cervical spinal nerves
C5 and C6 radiculopathy
11.20 Muscles of the Gluteal Region that Move the Femur

Iliopsoas
Psoas major 1. Partner supine, support partner’s thigh by placing your thigh Iliopsoas
Origin – Transverse processes and bodies of underneath it. Possible Causes
lumbar vertebrae 2. Umbilicus is usually at lumbar vertebrae 3 through 4 (sometimes L3-5). Surrounding muscle TPs
Insertion – Lesser trochanter of femur Locate the ASIS and between these points (McBurney’s point) place you Prolonged sitting
Action – Psoas major and iliacus act together to finger and ask partner to flex thigh. Palpate cross fibers. Sleeping in a fetal position
flex and laterally rotate thigh at the hip joint, 3. To reach lesser trochanter follow this muscle inferiorly down when it’s Vigorous sit-ups
and flex trunk on hip relaxed. Rectus femoris tightness (which
Innervation/nerve – Lumbar spinal nerves 2-3 prevents full hip extension)
Vertical low back pain
Pain is worse when standing up
Pain in anterior thigh
Pain Patterns
Proximal, anterior thigh
Lumbar region and upper buttock
Iliacus 1. Partner supine, support partner’s thigh by placing your thigh

Origin – Iliac fossa and sacrum underneath it.
Insertion – Lesser trochanter of femur 2. Locate the iliac crest more to the anterior side and place your
Action – Psoas major and iliacus act together to flex and laterally rotate thigh fingerpads hand-on-hand an inch off its ridge.
at the hip joint, and flex trunk on hip 3. Slowly curl your fingers into the iliac fossa, moving only when your
Innervation/nerve – Femoral nerve partner exhales. Your fingers might sink only a short distance into the
tissue.
4. Ask partner to flex hip slightly, and palpate across fibers.
Glutes
Gluteus maximus 1. Partner prone. Locate the iliac crest moving medially and inferiorly to Possible Causes
Origin – Iliac crest, sacrum, coccyx, and sacrospinalis aponeurosis the posterior superior iliac spine to the sacrum and coccyx (switch from Walking uphill
Insertion – Iliotibial band (of fascia lata) and gluteal tuberosity finger to palm of hand just inferior to the gluteal cleft palpate the Vigorous contraction in a shortened position
Action – Extends and laterally rotates thigh at hip joint; helps lock the knee in coccyx) and mention the sacrospinalis aponeurosis (which covers those Vigorous eccentric contraction when
extension. locations) which forms the origin preventing a fall
RMA: extends torso 2. Moving laterally and distally to the greater trochanter (if you can’t find Direct blow to buttock
Innervation/nerve – Inferior gluteal nerve it rotate the clients thigh/leg to find the prominence on the laterally Sleeping on one side with hip flexed
posterior portion of the thigh) say the insertion: iliotibial tract of fascia Swimming front crawl
lata moving distally to the gluteal tuberosity (gluteal crease or just Sitting too long in one position
medial to it) Repetitious tasks involving leaning over
3. Draw and imaginary line between these areas and ask your partner to Symptoms/Indications
lift their leg off the table and palpate across fibers. Uncomfortable and restless when seated
Pain Patterns
Posterior buttock
Posterior surface of sacrum
Gluteus medius Gluteus medius & minimus Possible Causes

Origin – Ilium 1. Side lying ask your partner to bring up their thigh with a bolster/pillow Sudden falls
Insertion – Greater trochanter of femur underneath. Sports injuries
Action – Abducts and medially rotates thigh at hip joint 2. Located the iliac crest, moving posteriorly and medially to the PSIS and Running
Innervation/nerve – Superior gluteal nerve anteriorly and medially to the ASIS but stopping before reaching each Long tennis matches
one, and slightly fall off the ridge Symptoms/Indications
3. Picture a fanning shape toward the handle of the greater trochanter of Pain when walking
the femur the insertion (if you can’t find it rotate partners thigh) Difficulty sleeping on
4. Place your hands between these two areas and ask your partner to lift affected side
their thigh off the bolster/pillow and palpate across fibers for the Uncomfortable when sitting
gluteus medius. in a slumped position
5. To palpate the gluteus minimus condense the origin and say deep to Pain Patterns
the gluteus medius. Posterior, lateral buttock
6. Ask partner to lift the leg off the bolster/pillow and palpate across Posterior surface of sacrum
fibers. Posterior iliac crest
Gluteus minimus Possible Causes

Origin – Ilium Sacroiliac joint
Insertion – Greater trochanter of femur dysfunction
Action – Abducts and medially rotates thigh at hip joint Nerve root irritation
Innervation/nerve – Superior gluteal nerve Prolonged immobility
Hip pain that may cause
limp
Pain when lying on
affected side
Difficulty rising from a
chair and standing up
straight
Pain Patterns
Posterior buttock
Lateral, posterior thigh and leg
Tensor fasciae latae
Origin – Iliac crest and anterior superior iliac spine 1. Supine (or side lying). Locate the iliac crest and move anteriorly, Possible Causes
Insertion – Gerdy’s tubercle of the tibia by way of iliotibial band medially and distally to the ASIS. Place the flat of your hand posterior Landing on feet from high jump
Action – Flexes and abducts thigh at hip joint and distal to the ASIS and iliac crest. Walking or running on sloped surface
Innervation/nerve – Superior gluteal nerve 2. Ask your partner to alternate medial rotation with relaxation of the hip. Immobilization in shortened position for long
Upon medial rotation, the TFL will contract into a solid, oval mound periods
beneath your hand. Palpate across fibers and then ask your partner to Symptoms/Indications
relax. Referred pain in hip joint
3. Follow it distally until the TFL blends into the iliotibial tract moving Poor tolerance for prolonged sitting
distally to the tibia (around the patella) to the tibial tuberosity. Inability to lie on side of TP
4. You can palpate the ITT (iliotibial tract) by asking your partner to abduct Pain Patterns
their thigh. Lateral thigh and hip
Piriformis
Origin – Anterior sacrum 1. Partner prone locate the iliac crest and move medially and inferiorly to Possible Causes
Insertion – Superior aspect of the greater trochanter of the femur the sacrum. The origin of the piriformis is on the anterior surface of the Catching oneself in a fall
Action – Laterally rotates and abducts thigh at hip joint sacrum. Twisting sideways while bending
Innervation/nerve – Sacral spinal nerves 1 (mainly) and 2 2. Locate the greater trochanter (if necessary rotate the thigh/leg to make Lifting a heavy load
sure you are on it). The piriformis is located between these sections. Direct trauma
3. Place your fingers along this line. Ask your partner to bend their knee to Driving a car with foot in the same place over long period
90° and rotate their leg inner wards against resistance. Working Symptoms/Indications
through the thick gluteus maximum (push aside) and palpate across Pain in low back, groin, buttock, and hip
fibers. Rectal pain during defecation
Pain Patterns
Posterior, lateral buttock
Posterior thigh
Quadratus femoris
Origin – Ischial tuberosity 1. Partner prone. Locate the distal, posterior aspect of the greater
Insertion – quadrate tubercle (on posterior femur) trochanter moving slightly distally and posteriorly to the quadrate
Action – Laterally rotates and stabilizes hip joint tubercle and then moving medially and distally to the ischial tuberosity
Innervation/nerve – Nerve to quadratus femoris (above the gluteal fold follow and palpate with heel of the hand). Place
your fingerpads between these two landmarks and going under the
gluteus maximus.
2. Ask your partner to flex their knee to 90 and then ask them to medially
rotate their leg against your resistance. Palpate across fibers.
Obturator internus Obturator externus Superior gemellus Inferior gemellus

Origin – Inner surface of obturator foramen, pubis, and Origin – Outer surface of obturator membrane Origin – Ischial spine Origin – Ischial tuberosity
ischium Insertion – trochanteric fossa of the femur Insertion – Medial surface of greater trochanter of femur Insertion – Medial surface of greater trochanter of femur
Insertion – Medial surface of greater trochanter of femur Action – Laterally rotates and abducts thigh at hip joint Action – Laterally rotates and abducts thigh at hip joint Action – Laterally rotates and abducts thigh at hip joint
Action – Laterally rotates and abducts thigh at hip joint Innervation/nerve – Obturator nerve Innervation/nerve – Nerve to obturator internus Innervation/nerve – Nerve to quadratus femoris
Innervation/nerve – Nerve to obturator internus
Medial (Adductor) Compartment of the Thigh
Gracilis Gracilis and adductor longus
Origin – Body and inferior ramus of pubis 1. Partner supine with the hip slightly flexed and laterally rotated. Place
Insertion – Pes anserine of the tibia the flat of your hand at the middle of the medial thigh.
Action – Flexes, adducts and medially rotates thigh at hip joint, and flexes leg 2. Ask your partner to locate their pubic crest and pubic symphysis with
at knee joint the heel of their hand being placed below their umbilicus/belly button,
Innervation/nerve – Obturator nerve noting the origin. Palpate with the heel of your palm afterward
3. Ask your partner to adduct hip slightly. While your partner contracts,
slide your fingers proximally to the pubic bone and locate the taut,
prominent tendon(s) of the gracilis and adductor longus extending off
of (or near) the pubic crest.
4. While palpating across fibers and follow it distally as it develops into
muscle tissue. If the muscle belly slowly angles into the medial thigh,
you are palpating adductor longus. If the belly is slender and continues
down the medial thigh toward the knee, you are accessing gracilis.
Adductor longus Adductor Long and Brevis

Origin – Pubic tubercle Possible Causes
Insertion – Linea aspera of the femur Sudden overload, such as slipping on ice
Action – Adducts, medially rotates, and flexes thigh at hip joint Forceful resisting hip abduction
RMA: Extends thigh Osteoarthritis of the hip
Innervation/nerve – Obturator nerve Strenuous horseback riding
Sitting for long periods of time
Pain in the groin during vigorous activity
(not at rest)
Severe restriction of abduction of thigh
Pain Patterns
Anterior thigh, radiates down anterior leg
Adductor brevis
Origin – Inferior ramus of pubis
Insertion – Superior half of linea aspera of femur
Action – Adducts, medially rotates, and flexes thigh at hip joint
RMA: Extends thigh
Innervation/nerve – Obturator nerve
Adductor magnus
Origin – Inferior ramus of pubis and ischium to ischial tuberosity 1. Partner side lying with his top hip flexed. Begin by locating the ischial Possible Causes
Insertion – Linea aspera of femur going distally to the adductor tubercle tuberosity. Sudden overload, such as slipping on ice
(proximal to the medial supracondylar) 2. Ask your partner to adduct his hip slightly. Shifting anteriorly, locate the Forceful resisting hip abduction
Action – Adducts and medially rotates thigh at hip joint; anterior part flexes prominent tendon of adductor longus or gracilis. Then slide off the Osteoarthritis of the hip
thigh at hip joint, and posterior part extends thigh at hip joint tendon posteriorly. Palpate the wide tendon of adductor magnus as it Strenuous horseback riding
Innervation/nerve – Obturator and sciatic nerves stretches to the ischial tuberosity. Sitting for long periods of time (driving)
3. Follow the fibers of adductor magnus distally by strumming your fingers Symptoms/Indications
across its belly. It is difficult to differentiate magnus fibers from Intra-pelvic pain, specifically localized to
semimembranosus fibers. Nevertheless, the thin, distal tendon of the the vagina or rectum during sexual
magnus is distinguishable and can be accessed where it attaches onto intercourse
the adductor tubercle. Groin pain
Pain Patterns
Groin area
Medial thigh
Rectum
Pectineus
Origin – Superior ramus of pubis 1. Partner supine with the hip slightly flexed and laterally rotated. Place Possible Causes
Insertion – Pectineal line of femur the flat of your hand on the middle of the medial thigh and ask your Tripping or falling
Action – Flexes and adducts thigh at hip joint partner o adduct his hip slightly. Unexpected strong resistance to adduction of thigh
(NO MEDIAL ROTATION!!!) 2. Locate the prominent tendon of the adductor longus or gracilis. Slide Horseback riding
Innervation/nerve – Femoral nerve off the tendon laterally toward the ASIS. Slowly sink into the belly of Sustained posture that puts muscle in shortened position
pectineus. You should be inferior to the superior ramus of the pubis. Symptoms/Indications
3. Ask your partner to alternately adduct and relax his hip and feel the Persistent, deep-seated groin
fibers of pectineus contract. pain
Limited abduction of the hip
Pain Patterns
Proximal, medial thigh and groin
11.21 Muscles of the Thigh that Move the Femur, Tibia, and Fibula
Anterior (Extensor) Compartment of the Thigh
Quadriceps Femoris
Rectus femoris 1. Supine with knee bolstered. Locate the AIIS (leaving one hand) and Rectus Femoris
Origin – Anterior inferior iliac spine move distally to the tibial tuberosity (inferior to the patella) Possible Causes
Insertion – tibial tuberosity via quadriceps tendon to the patellar ligament 2. Draw an imaginary line. Fall or accident that produces sudden
Action – All four heads extend leg at knee joint; rectus femoris particularly flexes thigh 3. Ask your partner to flex his hip and hold his foot off the table and eccentric contraction
at hip joint palpate across fibers Skiing accident
Innervation/nerve – Femoral nerve Siting for long time with heavy object on
lap
Recovery from hip surgery
Weakness of knee extension
Walking at night with pain in front of
patella
Weakness in knees when going
downstairs
Pain Patterns
Most intense at patellar region
Distal, anterior thigh
Vastus Lateralis
Possible Causes
Acute overload from sudden eccentric
contraction
Stumbling or unexpectedly stepping off a
curb
Exercise that includes deep knee bends
Hurts to walk, pin on lateral aspect of
knee
Pain Patterns
Lateral hip, thigh, and knee
Vastus Medialis
Possible Causes
contraction
Stumbling or unexpectedly stepped off a
curb
1. Partner side lying locate the greater trochanter moving distally and Pain deep in knee joint
Vastus lateralis
anteriorly mention the linea aspera of the femur. Buckling of knee
Origin – Greater trochanter and lateral lip of the linea aspera of femur
2. Locate the tibia tuberosity. Pain Patterns
Insertion – tibial tuberosity via quadriceps tendon to the patellar ligament
3. Draw an imaginary line between these points placing your hand on the Medial knee and thigh
Action – All four heads extend leg at knee joint
Innervation/nerve – Femoral nerve lateral side of the thigh while your partner extends their knee. Say it is Vastus Intermedius
deep to the iliotibial tract (ITT) Possible Causes
contraction
Stumbling or unexpectedly stepping off a
curb
Difficulty straightening knee
Pain Patterns
Anterior thigh
Vastus medialis 1. Supine with the knee bolstered. Locate the greater trochanter and
Origin – Medial lip of linea aspera of femur moving distally, anteriorly and medially to the linea aspera (lower third
Insertion – tibial tuberosity via quadriceps tendon to the patellar ligament of the femur).
Action – All four heads extend leg at knee joint 2. Ask your partner to fully contract his quadriceps by extending his
Innervation/nerve – Femoral nerve knee. Palpate just medial and proximal to the patella for the bulbous
shape of the medialis (like a teardrop)
3. Move distally to the insertion which is the tibial tuberosity.
Vastus intermedius 1. Supine with knee bolstered. Locate the AIIS (leaving one hand) and
Origin – Anterior and lateral surfaces of the femur move distally to the origin the anterior and lateral surface of the body
Insertion – tibial tuberosity via quadriceps tendon to the patellar ligament of femur continuing distally the tibial tuberosity (inferior to the
Action – All four heads extend leg at knee joint patella), the insertion
Innervation/nerve – Femoral nerve 2. Draw an imaginary line.
3. Ask your partner to flex his hip and resist against his foot that is going
off the table. It is deep to the rectus femoris, so push the belly of the
rectus femoris medially to palpate the vastus intermedius.
Sartorius
Origin – Anterior superior iliac spine 1. Partner supine. Locate the iliac crest and move medially and inferiorly Possible Causes
Insertion – pes anserine of the tibia to the anterior superior iliac spine and locate the tibial tuberosity and Secondary TPs of muscle of the thigh
Action – Weakly flexes leg at knee joint; move medially to the medial surface of the body of the tibia. Overload strain in a twisting fall
weakly flexes, abducts, and laterally rotates thigh 2. Ask your partner to position his foot so it is resting on his opposite Symptoms/Indications
at hip joint knee. The hip will be flexed and laterally rotated. Pain along pathway of muscle
Innervation/nerve – Femoral nerve 3. Place your hand along the middle of the medial thigh. Ask your partner Pain Patterns
to raise his knee toward the ceiling (contracting the sartorius) Following path of muscle down anterior,
4. Palpating across fibers (pretend if you can’t find it) medial thigh
Posterior (Flexor) Compartment of the Thigh

Hamstrings
Biceps femoris The popliteal fossa is a diamond-shaped space on the posterior aspect of the Biceps femoris
Origin – Long head arises from ischial tuberosity; short head arises from linea knee bordered laterally by the tendons of the biceps femoris muscle and Possible Causes
aspera of femur medially by the tendons of the semitendinosus and semimembranosus Posterior thigh compression by
Insertion – Head of fibula and lateral condyle of tibia muscles. ill-fitting chair
Action – Flexes leg at knee joint and extends thigh at hip joint Uncomfortable furniture
Innervation/nerve – Tibial and fibular nerves from the sciatic nerve Prolonged sitting
- Partner
Pain on walking
prone. When sitting, pain in buttock and
Locate
upper thigh
the Pain when getting up from a
greater
chair
Pain Patterns
Posterior thigh
Most intense at posterior knee
trochanter or the femur and move distally and medially slightly above
the gluteal crease to find the ischial tuberosity (origin of the long head
of biceps femoris, semitendinosus and semimembranosus).
- For the biceps femoris move distally and laterally for the short head on
the linea aspera of the femur. Continue distally to the head of the
fibula and lateral condyle of the tibia (which the head of the fibula is
lateral to the tibial tuberosity and moving slightly proximally epicondyle
Semitendinosus Semitendinosus and Semimembranosus
of the tibia). Ask client to flex their knee and elevate their thigh. Palpate
Origin – Ischial tuberosity Possible Causes
across fibers between these two places.
Insertion – pes anserine of the tibia Posterior thigh compression by ill-
- For the semitendinosus move distally and medially to the medial shaft
Action – Flexes leg at knee joint and extends thigh at hip joint fitting chair
of the tibia (DON’T BE ON THE EPICONDYLE it’s medial/posterior to it).
Innervation/nerve – Tibial nerve from the sciatic nerve Uncomfortable furniture
Ask client to flex their knee and elevate their thigh. Palpate across
Prolonged sitting
fibers between these two places.
- For the semimembranosus move distally and medially to the medial
Pain on walking
epicondyle of the tibia. Ask client to flex their knee and elevate their
When sitting, pain in buttock and
thigh. Palpate across fibers between these two places and SAY IT IS
upper thigh
DEEP TO THE SEMITENDINOSUS.
Pain when getting up from a chair
- NOTE: biceps femoris is on the lateral half while the semitendinosus
Pain Patterns
and semimembranosus is on the medial half of the popliteal fossa
Posterior thigh
Most intense at proximal thigh
The popliteal fossa is a diamond-shaped

Semimembranosus space on the posterior aspect of the knee
Origin – Ischial tuberosity bordered laterally by the tendons of the
Insertion – Medial condyle of the tibia biceps femoris muscle and medially by the
Action – Flexes leg at knee joint and extends thigh at hip joint tendons of the semitendinosus and semimembranosus muscles.
Innervation/nerve – Tibial nerve from the sciatic nerve
of the semitendinosus and semimembranosus muscles.
11.22 Muscles of the Leg that Move the Foot and Toes
Anterior Compartment of the Leg AKA Tom, Dick and Harry
Tibialis anterior (most medial, closest to the shaft of the tibia)
Origin – Lateral condyle and body of the 1. Partner supine/seated with pillow under the knee. Locate the apex of Possible Causes
tibia and interosseous membrane the patella and the tibial plateau (flat ridge) following it laterally to the Ankle sprain or fracture
Insertion – 1st cuneiform and 1st lateral condyle of the tibia and move distally and increasingly medially Gross trauma
metatarsal attaching to the interosseous membrane and body of the tibia. Walking on rough ground
Action – Dorsiflexes foot at ankle joint 2. Locate the hallux (big toe) and move proximally on the medial side of Symptoms/Indications
and inverts foot at intertarsal joints the foot to the base of the 1st metatarsal and 1st medial cuneiform (the Pain in ankle and big toe
Innervation/nerve – Deep fibular groove should be painful due to the tendon being there). Weakness of dorsiflexion
(peroneal) nerve 3. Between these land marks and in the middle on the lateral border of Dragging of foot that causes tripping
the tibia (just over the ridge) ask client to dorsiflex and invert their foot. Pain Patterns
Anterior leg
Dorsal foot
Big toe
Extensor hallucis longus (middle moving laterally)

Origin – Interosseous membrane and anterior middle third of fibula 1. Partner supine/seated with pillow/bolster under the knee. Locate the Possible Causes
Insertion – Distal phalanx of great toe distal phalanx of the second toe and move medially to the distal Tripping or falling
Action – Dorsiflexes foot at ankle joint and extends proximal phalanx of great phalanx of the great toe (more at the proximal portion) Gas pedal that puts ankle at acute dorsiflexion
toe at metatarsophalangeal joint 2. Mention that the extensor hallucis longus is DEEP to the tibialis Excessive jogging or running
Innervation/nerve – Deep fibular (peroneal) nerve anterior and extensor digitorum longus, so you are going to ask your Direct gross trauma
client to extend their big toe and flex their foot. Note the TENDON of Symptoms/Indications
the extensor hallucis longus and move proximally and laterally Pain in dorsal foot
3. Moving proximally and laterally through the interosseous membrane Foot drop weakness during walking
and anterior middle third of the fibula (you might notice that the Night cramps in foot
muscles are harder [denser] in the distal third between the tibia and Pain Patterns
fibula and then becomes softer where the muscle ends) Dorsal foot into dorsal toes
Extensor digitorum longus (most lateral)

Origin – Lateral condyle of tibia, anterior surface of fibula, and interosseous 1. Partner supine/seated with pillow/bolster under the knee. Locate the Possible Causes
membrane apex of the patella and follow the tibia plateau (flat ridge) laterally to Tripping or falling
Insertion – Middle and distal phalanges of toes 2,3,4 and 5 the lateral condyle of the tibia (move your thumb slightly distal, it will Gas pedal that puts ankle at acute dorsiflexion
Action – Dorsiflexes foot at ankle joint and extends phalanges at feel like a mushy groove). Excessive jogging or running
interphalangeal joints and metatarsophalangeal joint 2. Locate the distal phalanx of the great toe and move laterally to the 2nd Direct gross trauma
Innervation/nerve – Deep fibular (peroneal) nerve through 5th distal and middle phalanges Symptoms/Indications
3. Ask the client to dorsi flex their foot and extend their toes OR wiggle Pain in dorsal foot
their toes (should be able to notice the tendons, but the most proximal Foot drop weakness during walking
part of contraction to be felt is closer to origin just distal, where if you Night cramps in foot
ask them to relax and go back should be felt). Palpate across fibers. Pain Patterns
Dorsal foot into dorsal toes
Lateral (Fibular) Compartment of the Leg
Fibularis (peroneus) longus (wraps posteriorly around lateral malleolus)
Origin – Head and body of the fibula 1. Partner side lying, use a pillow/bolster to support the leg/knee. Locate Fibularis Long, Brevis and Tertius
Insertion – 1st metatarsal and 1st cuneiform the tibial tuberosity and move laterally to the head of the fibula. Possible Causes
Action – Plantar flexes foot at ankle joint and 2. Locate the lateral malleolus (which it wraps around) and move distally Fall with twisting
everts foot at intertarsal joints to the 5th metatarsal tuberosity and move medially onto the plantar Inversion of the ankle
Innervation/nerve – Superficial fibular (sole) aspect of the foot and proximally to the base of the 1st Prolonged immobilization by a cast
(peroneal) nerve metatarsal and distally onto the 1st cuneiform. (the ridge these two Gluteus minimus TPs
landmarks can be felt on the medial side) Symptoms/Indications
3. Between the head of the fibula and the 5th metatarsal tuberosity draw Pain and tenderness in the ankle
and imaginary line and ask partner evert and plantar flex their foot and Foot drop
palpate across fibers at the more proximal (half way) part. Pain in feet
Pain Patterns
Lateral leg and ankle
Fibularis (peroneus) brevis (wraps posteriorly around lateral malleolus)

Origin – Distal half of the body of the fibula 1. Partner side lying, locate the head of the fibula (move laterally from the
Insertion – Base of 5th metatarsal (or 5th metatarsal tuberosity) tibial tuberosity) and move distally to the distal half of the body of the
Action – Plantar flexes foot at ankle joint and everts foot at intertarsal joints fibula.
Innervation/nerve – Superficial fibular (peroneal) nerve 2. Locate the lateral malleolus (which the tendon wraps posteriorly
around) and move distally to the base of the 5th metatarsal (5th
metatarsal tuberosity)
3. Ask partner to evert and plantar flex their foot palpate across fibers
(below where and laterally to the hill of the gastrocnemius and soleus
are)
Fibularis (peroneus) tertius [ter-she-us] (DOES NOT wrap posteriorly around lateral malleolus, RATHER goes in FRONT)
Origin – Distal third of the fibula and interosseous membrane
Insertion – Base of metatarsal 5 (or 5th metatarsal tuberosity)
Action – Dorsiflexes foot at ankle joint and everts foot at intertarsal joints
Innervation/nerve – Deep fibular (peroneal) nerve
Superficial Posterior Compartment of the Leg

Gastrocnemius
Origin – Lateral and medial condyles of femur and capsule of the knee 1. Partner prone. Popliteal fossa going proximally to the medial and Possible Causes
Insertion – Calcaneus by calcaneal (Achilles) tendon lateral condyles of the femur and going posteriorly and distally to Riding a bike with the seat too low
Action – Plantar flexes foot at ankle joint and flexes leg at knee joint connect at the capsule of the knee. Walking along slanted surface, such as a beach
Innervation/nerve – Tibial nerve 2. Locate the medial and lateral malleolus and moving posteriorly to the Standing for prolonged periods, leaning
Achilles tendon and move distally to the calcaneus. forward
3. Asking client to straighten their foot and lift their leg up against your Wearing high socks with tight elastic band
resistance. Locate the proximal half of the of the two oval bellies (more Sitting in a reclining chair, compromising
posterior than lateral) of the gastrocnemius. Palpate across fibers. circulation to calf muscles
Calf cramps
Pain in back of knee when climbing up steep
slope
Pain Patterns
Posterior knee
Posterior leg
Arch of foot
Soleus
Origin – Head of fibula and the soleal line of the tibia 1. Partner prone. Feet off table! Possible Causes
Insertion – Calcaneus by calcaneal (Achilles) tendon 2. Locate tibial tuberosity and moving laterally and proximally to gerdy’s Slipping when stepping onto a curb
Action – Plantar flexes foot at ankle joint tubercle and laterally still to head of the fibula moving distally and Overloading the muscle
Innervation/nerve – Tibial nerve medial to the medial border of the tibia Direct trauma
3. Locate the medial and lateral malleolus and move posteriorly to the High heels
Achilles tendon and move distally to the calcaneus. Compromised circulation of calf
4. Ask your client to push your hand (which is on the plantar surface of the Symptoms/Indications
foot) against your resistance. Say “The soleus is DEEP to the Tenderness in the heel
gastrocnemius but palpable from the lateral side.” Palpate across fibers. Unbearable to place weight on heel
Nocturnal calf pain
Edema of foot and ankle
Pain Patterns
Posterior leg
Heel of foot
Posterior sacrum
Plantaris
Origin – Lateral epicondyle of femur 1. Partner prone. Locate the popliteal fossa and the knee crease, between Possible Causes
Insertion – Calcaneus medial to calcaneal (Achilles) tendon (occasionally fused these two points move laterally to the lateral epicondyle of the femur. Slipping when stepping onto a curb
with calcaneal tendon). 2. Moving obliquely (at an angle) and distally across the gastrocnemius Overloading the muscle
Action – Plantar flexes foot at ankle joint and flexes leg at knee joint and in the more medial portion of it to the medial side of the Achilles Direct trauma
Innervation/nerve – Tibial nerve tendon which it is occasionally fused with and continue distally to the High heels
medial side of the calcaneus Compromised circulation of calf
3. Asking client to straighten their foot and lift their leg up against your Symptoms/Indications
resistance. Within the popliteal fossa palpate the plantaris across fibers Pain in posterior knee and leg
(on the lateral side) Pain Patterns
Posterior knee and leg
The popliteal fossa is a diamond-shaped space on the

posterior aspect of the knee bordered laterally by
the tendons of the biceps femoris muscle and medially
by the tendons of the semitendinosus and
semimembranosus muscles. The plantaris should be in
this fossa.
Deep Posterior Compartment of the Leg with Tom, Dick And Very Anxious Harry
Popliteus
Origin – Lateral condyle of femur 1. Partner prone with knee flexed. Locate the tibial tuberosity and move Possible Causes
Insertion – Proximal tibia medially to the proximal posterior aspect of the tibia. MOVE ASIDE THE Running and twisting knee during sports, such as football or soccer
Action – Flexes leg at knee joint and medially gastrocnemius and soleus TO REACH THE POSTERIOR ASPECT. DON’T Skiing downhill
rotates tibia unlocking knee extension (the GO NEAR THE PES ANSERINE GO DISTAL TO THOSE TENDONS. Then Quick deceleration from running
key which unlocks the knee) relax the client knee. Tearing of posterior cruciate ligament
Innervation/nerve – Tibial nerve 2. With the other hand locate the popliteal fossa and the crease of the Symptoms/Indications
knee and move laterally and slightly proximally to the lateral condyle of Pain in posterior knee when crouching or
the femur. running, especially downhill
3. Say “It is deep gastrocnemius and plantaris.” Palpate across fibers. Pain Patterns
Posterior knee
Tom, Dick And Very Nervous Harry (tibialis posterior, flexor digitorum longus, artery, vein & nerve [posterior tibial] and flexor hallucis longus)
Tibialis posterior (wraps posteriorly around medial malleolus)
Origin – Proximal tibia, fibula, and interosseous membrane ALL aren’t entirely accessible HOWEVER can be felt in a certain location Possible Causes
Insertion – navicular; all cuneiforms; and metatarsals 2,3 and 4 Running or jogging on uneven ground
Action – Plantar flexes foot at ankle joint and inverts foot at intertarsal joints 1. Client SUPINE! Ill-fitting footwear
Innervation/nerve – Tibial nerve 2. Between the Achilles tendon and medial malleolus (forms the base) Symptoms/Indications
continuing proximally onto the shaft of the tibia and Achilles tendon before Pain in foot when running or walking
becoming the soleus (apex) is the TRIANGLE area where it can be felt.
Pain Patterns
3. Tibialis posterior can be felt by asking the client to INVERT the foot
Posterior leg
a. It is closest to the medial malleolus posteriorly and slightly proximally
i. Locate the MEDIAL popliteal fossa moving distally onto the proximal Most intense in calcaneal tendon area
posterior tibia continuing to moving distally where it spans laterally to Sole of foot and heel
the interosseous membrane and fibula is the ORIGIN
ii. It is deep to the superficial muscles of the posterior leg
iii. Moving medially and distally to the medial malleolus and onto plantar
surface of the foot
iv. It INSERTS onto the navicular, ALL cuneiforms and the base of the 2 nd
through 4th metatarsals.
4. Flexor digitorum longus can be felt by asking the client to flex their toes
a. It is the largest and can be felt more proximally and in between the
triangle
i. Locate the tibial tuberosity moving distally onto the shaft of the tibial
Flexor digitorum longus (wraps posteriorly around medial moving posteriorly about a middle third posterior surface of the tibia Flexor digitorum longus
malleolus) which is the ORIGIN of the flexor digitorum longus
Origin – Middle third of the posterior surface of ii. It is DEEP to the superficial muscles of the posterior leg Possible Causes
the tibia iii. Moving medially and distally to the medial malleolus and onto plantar Running or jogging on uneven ground
surface of the foot
Insertion – Distal phalanges of toes 2, 3, 4 and 5 Hyperpronation
iv. It INSERTS onto the 2nd through 5th distal phalanges
Action – Plantar flexes foot at ankle joint; flexes Impaired mobility of ankle or foot
5. Flexor hallucis longus can be felt by asking the client to flex their big toe
phalanges of toes 2, 3, 4 and 5 at interphalangeal a. It is closest to the Achilles tendon BUT more in the middle of the triangle Inflexible shoe sole
joints and metatarsophalangeal joint on the base Symptoms/Indications
Innervation/nerve – Tibial nerve i. Locate the LATERAL popliteal fossa and moving distally on to the distal Foot pain while walking
half of the fibula Pain on plantar surface of forefoot and toes
ii. It is DEEP to the superficial muscles of the posterior leg Pain Patterns
iii. Moving medially and distally to the medial malleolus and onto plantar Posterior leg
surface of the foot Most intense on plantar surface of foot
iv. It INSERTS onto the distal phalanx of the great toe
Flexor hallucis longus (wraps posteriorly around medial Flexor hallucis longus
malleolus)
Origin – Distal third of the posterior portion of the fibula Possible Causes
Insertion – Distal phalanx of the great toe Running or jogging on uneven ground
Action – Plantar flexes foot at ankle joint; flexes phalanges of great toe at Hyperpronation
interphalangeal joint and metatarsophalangeal joint Impaired mobility of ankle or foot
Innervation/nerve – Tibial nerve Inflexible shoe sole
Foot pain while walking
Pain on plantar surface of forefoot and toes
Pain Patterns
Plantar surface of big toes
Head of first metatarsal
11.23 Intrinsic Muscles of the Foot that Move the Toes

Dorsal
Extensor hallucis brevis Extensor hallucis brevis & extensor digitorum brevis
Origin – Calcaneus and inferior extensor retinaculum Possible Causes
Insertion – Proximal phalanx of great toe Tight-fitting shoe
Action – Extends great toe at metatarsophalangeal joint Fracture of the ankle
Innervation/nerve – Deep fibular (peroneal) nerve Trauma to the foot
Stubbing of toes
Hyperpronation
Intolerably sore feet
Fallen arches
Limited walking range
Pain Patterns
Dorsal surface of foot
Extensor digitorum brevis

Origin – Calcaneus and inferior extensor retinaculum 1. Side lying
Insertion – Middle phalanges of toe 2, 3 and 4 2. Locate the lateral malleolus moving distally onto the dorsal surface of the foot
Action – Extends toes 2, 3 and 4 at interphalangeal joints to the ORIGIN of the calcaneus and inferior extensor retinaculum
Innervation/nerve – Deep fibular (peroneal) nerve 3. Continuing to move distally to the INSERTION which is the middle phalanges
of the 2nd, 3rd and 4th toes
4. If I ask the client to “lift their toes toward you” I can palpate across fibers
5. It is DEEP to the extensor digitorum longus
Plantar
First Layer (Most Superficial)
Abductor hallucis
Origin – Calcaneus, plantar aponeurosis, and flexor retinaculum 1. Client prone with feet elevated Possible Causes
Insertion – Medial side of the proximal phalanx of great toe WITH the tendon 2. Locate the Achilles tendon, moving distally and medially onto the plantar Tight-fitting shoe
of flexor hallucis brevis surface of the calcaneus the origin, moving distally to the plantar aponeurosis Fracture of the ankle
Action – Abducts and flexes great toe at metatarsophalangeal joint and flexor retinaculum Trauma to the foot
3. Continuing distally to the insertion which is the medial side of the proximal
Innervation/nerve – Medial plantar nerve Stubbing of toes
phalanx of the great toes with the flexor hallucis brevis
Hyperpronation
4. Since most people can’t abduct their toe I’m going to ask the client to ‘curl
their great toe’ and there (closer to the origin) can be palpated across fibers Symptoms/Indications
Fallen arches
Pain Patterns
Medial, plantar surface of foot
Flexor digitorum brevis

Insertion – Sides of middle phalanges of toes 2, 3, 4 and 5 2. Locating the Achilles tendon moving Tight-fitting shoe
Action – Flexes toes 2, 3, 4 and 5 at proximal interphalangeal and distally on the ORIGIN which is the Fracture of the ankle
metatarsophalangeal joints calcaneus, plantar aponeurosis Trauma to the foot
(which spans the majority of the
foot), and the flexor retinaculum (on
Hyperpronation
the medial side)
3. Continuing to move distally to the Symptoms/Indications
INSERTION which is the sides of Intolerable sore feet
middle phalanx of the 2nd through Fallen arches
5th toe Limited walking range
4. If I ask the client to “curl their toes” Pain Patterns
it can be palpated across fibers Ball of the foot
Abductor digiti minimi

Insertion – Lateral side of proximal phalanx of little toe WITH tendon of flexor 2. Locating the Achilles and moving distally and laterally onto the plantar surface Tight-fitting shoe
digiti minimi brevis of the foot to the lateral side of the calcaneus is the start of the origin, moving Fracture of the ankle
Action – Abducts and flexes little toe at metatarsophalangeal joint distally to the plantar aponeurosis and flexor retinaculum Trauma to the foot
3. Continuing distally to the insertion which is the lateral side of the proximal
Innervation/nerve – Lateral plantar nerve Stubbing of toes
phalanx of the little toe with the tendon of the flexor digiti mini brevis
Hyperpronation
4. Depending on the client, they can either ‘curl or push their pinky toe outward’
and can be palpated across fibers Symptoms/Indications
Fallen arches
Pain Patterns
Lateral, plantar surface of foot
Second Layer
Quadratus plantae
Origin – Calcaneus (on either side) Possible Causes
Insertion – Tendon of flexor digitorum longus Tight-fitting shoe
Action – Assists flexor digitorum longus to flex toes 2, 3, 4 and 5 at Fracture of the ankle
interphalangeal and metatarsophalangeal joints Trauma to the foot
Hyperpronation
Limitation of walking due to pain
Numbness of foot
Feet feel swollen
Muscular imbalance
Articular dysfunction of foot
Hammertoes
Pain Patterns
Heel of foot

Lumbricals Tendons of flexor digitorum longus Tendons of extensor digitorum longus on Toes 2, 3, 4 and 5 extend at interphalangeal Medial and lateral plantar nerves
proximal phalanges of toes 2, 3, 4 and 5 joints and flexes at metatarsophalangeal
joints
Third Layer
Flexor hallucis brevis
Origin – Cuboid and 3rd (lateral) cuneiform Possible Causes
Insertion – Medial and lateral sides of proximal phalanx of the great toe via the Tight-fitting shoe
sesamoid bone Fracture of the ankle
Action – Flexes great toe at metatarsophalangeal joint Trauma to the foot
Hyprepronation
Numbness of foot
Feet feel swollen
Muscular imbalance
Hammertoes
Pain Patterns
Medial and plantar surface of base of big toe
Adductor hallucis
Origin – (Base of) Metatarsals 2, 3 and 4; ligaments of metatarsals 3, 4 and 5 at Possible Causes
metatarsophalangeal joints and tendon of fibularis (peroneus) longus Tight-fitting shoe
Insertion – Lateral side of proximal phalanx of great toe Fracture of the ankle
Action – Adducts and flexes great toe at metatarsophalangeal joint Trauma to the foot
Hyperpronation
Numbness of foot
Feet feel swollen
Muscular imbalance
Hammertoes
Pain Patterns
Ball of foot

Flexor digit minimi brevis Metatarsal 5 and tendon of fibularis Lateral side of proximal phalanx of little toe Flexes little toe at metatarsophalangeal joint Lateral plantar nerve
(peroneus) longus
Fourth Layer (Deepest)
Dorsal interossei Adjacent side of all metatarsals Proximal phalanges: both sides of toe 2 and Abduct and flexes toes 2, 3 and 4 at Lateral plantar nerve
lateral side of toes 3 and 4 metatarsophalangeal joints and extend toes at
interphalangeal joints
Plantar interossei Metatarsals 3, 4 and 5 Medial side of proximal phalanges of toes 3, 4 Adducts and flexes proximal Lateral plantar nerve
and 5 metatarsophalangeal joints and extends toes
at interphalangeal joints

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Boney Landmarks

Landmark Clients Position And Instructions Scripting on How to Palpate

Medial and Lateral Sitting Locate the Olecranon

Head of the Radius Sitting Locate the Olecranon

Medial Tubercle Lying face up Locate the Medial Malleolus

Landmark Client Position Scripting on How to Palpate

Landmark Client Position Scripting on How to Palpate

Landmark Client Position Scripting on How to Palpate

Landmark Client Position Scripting on How to Palpate

Landmark Client Position Scripting on How to Palpate

Spinous Processes Face down

Landmark Client Position Scripting on How to Palpate

Ligaments of the Body

Bursa of the Body

Specific Areas of the Body

Muscles of the Body

Muscle: Origin, Insertion, Action, Innervation/Nerve Palpation Trigger Point

11.4 Muscles of the Head that Produce Facial Expressions

Posterior Belly Client: sitting Occipitofrontalis Posterior Belly

Levator labii superioris

Depressor labii inferioris

Depressor anguli oris

Levator anguli oris

Eye, Nose and Eyebrow Muscles

Levator Labii Superioris Alaeque Nasi (al-eq-qway naz-i)

Mylohyoid Mylohyoid & Geniohyoid

11.9 Muscles of the Neck that Move the Head

the 3rd thoracic vertebrae nerves

Oblique capitis superior

11.11 Muscles of the Thorax that Assist in Breathing

Muscle Origin Insertion Action Innervation

11.13 Muscles of the Perineum

Deep Perineal Muscles

11.14 Muscles of the Thorax that Move the Pectoral Girdle

Posterior Thoracic Muscles

Scapular Muscles that Move the Humerus

Flexor carpi ulnaris

Flexor digitorum superficialis

Flexor digitorum profundus

See flexor digitorum superficialis

Posterior (Extensors) of the Forearm

Extensor digiti minimi

Extensor carpi ulnaris

Deep Posterior (Extensor) Compartment of the Forearm

Extensor pollicis brevis

Extensor pollicis longus

Action – Extends distal and middle

Thenar (Lateral Aspect of Palm)

Hypothenar (Medial Aspect of Palm)

Splenius cervicis Client: Possible Causes

Iliocostalis Group (lateral)  Ribs

Spinalis Group (medial)  Spinous Processes

Semispinalis cervicis Client:

Semispinalis thoracis Client:

11.20 Muscles of the Gluteal Region that Move the Femur

Iliacus 1. Partner supine, support partner’s thigh by placing your thigh

Gluteus medius Gluteus medius & minimus Possible Causes