CHAPTER 5

HOW TO USE THIS MANUAL

This manual provides important information in a format that can be easily and quickly accessed by both the student and the working health care practitioner, making it readily useable in the clinic or office.

In the technical body of the book an illustration of each muscle and the locations of its common trigger points is accompanied by the following information:

Proximal attachment: The cephalad (upper) attachment, that is, the attachment closest to the head.

Distal attachment: The caudad (lower) attachment, that is, the attachment farthest away from the head.¹

Action: What the muscle moves, the purpose of its action.

Palpation: Specific instructions on how to locate and palpate the muscle, including anatomical landmarks for reference.

Pain pattern: An illustration of that muscle’s essential pain pattern is accompanied by a written description that also details possible extended pain patterns. Symptoms produced by the presence of trigger points in the muscle are also described.

Causative or perpetuating factors: A description of common behaviors that either produce or perpetuate the pain.

Satellite trigger points: Additional muscles and muscle groups that commonly develop trigger points when there are trigger points in the muscle.

Affected organ systems: Due to the relationship between skeletal muscle and meridian pathway, the constriction of each muscle or muscle group will affect the meridian pathway traversing it. As each meridian exercises influence over a specific organ or system, this section may shed additional light on the interaction between skeletal muscle and viscera.

Associated zones, meridians, and points: A statement of other areas predisposed to muscular constriction when there are trigger points in a particular muscle, to guide treatment for those practicing from an Oriental medical perspective. For a review of meridian pathways and zone description, see appendices 1 and 2.

Stretch exercises: Illustrations and descriptions of stretching exercises useful for that particular muscle. Varying levels of stretch exercises may be provided to patients to accommodate their changing capacities during the healing process.

Strengthening exercises: A description of useful strengthening exercises for the muscle and associated muscle groups. A strengthening exercise is included for phasic muscles, which tend toward weakening. Tonic, or postural muscles, tend toward shortening, making strengthening exercises generally unnecessary.

Regarding the trigger point illustrations, it must be remembered that they serve only as a means to guide the initial palpation, since trigger points can present at any point in any muscle.

Most patients present with symptoms that are usually described as a particular pattern of pain. Some patients will also present with other symptoms, such as impaired range of motion, usually described as an inability to perform particular tasks. Other symptoms might seem less related, such as dizziness or menstrual problems. Two indexes are provided in an effort to help the practitioner quickly focus his or her attention on muscle groups that commonly relate to the pain pattern or symptoms presented by the patient.

The Pain Pattern Index is a graphic index in which the pain patterns for each muscle are illustrated. The pain patterns are grouped in terms of the area affected: pain patterns that affect the neck are shown together, pain patterns that affect the anterior legs are shown together, and so on. With this information ready comparisons of patterns can be made and specific information about the muscle groups quickly located.

Some patients may be vague about their pain but clear on other symptoms. The Symptom Index provides common symptoms of myofascial syndromes and the page numbers of related muscles.

Using the indexes to help narrow the focus to particular muscles involved, then turning to the summary information for each muscle, should help guide examination, treatment, and follow-up with the patient.

This manual is designed for quick access for use in clinical situations. The material is meant to supplement and guide the careful taking of case history, examination, and palpation, not to replace them.

This manual does not outline each muscle of the body. The muscles that have been included are those that we have found to be the most clinically significant in our years of practice. Pain experienced by the great majority of patients may be alleviated through the treatment of these muscle groups. For an indepth discussion of each muscle in the body, use of Myofascial Pain and Dysfunction: The Trigger Point Manual (volumes I and II) by Travell and Simons is recommended.