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TRIGGER POINT THERAPY BOOK

MYOFASCIAL SYNDROMES

DIAGNOSIS

Patients with chronic myofascial pain are people who have suffered more than just pain for many months or longer. The severity and chronicity of their "untreatable" pain has often reduced their physical activity, limited participation in social activities, impaired sleep, induced a major or minor degree of depression, caused loss of role in the family, led to loss of employment, and deprived them of control of their lives. Many have been depersonalized by the ultimate indignity-the conviction that their pain is not "real," but psychogenic. Well- meaning practitioners sometimes have also convinced the patients' families and friends that the pain is not real, leaving many patients nowhere to turn for help. The patients come to the clinician seeking relief from their suffering, which they may present only in terms of pain. When examining the patient who has presented with chronic enigmatic pain, the diagnostician must first conduct a thorough, time- consuming history and physical examination to identify what conditions are contributing to the patient's pain and to determine whether there is a significant myofascial component. If it appears likely that the patient does have chronic myofascial pain syndrome, the diagnostic task becomes twofold. In addition to identifying which TrPs, in which muscles, are causing what portion of the patient's total pain complaint, the examiner must determine what perpetuating factors converted the initial acute myofascial pain syndrome to a chronic one. Myofascial TrPs may be perpetuated by mechanical (structural or postural) factors, by systemic factors, by associated medical conditions, and by psychological stress. The central nervous system powerfully modulates pain input from the muscles in ways that can explain referred pain and altered sensation from TrPs. In phase 1 (constant pain from severely active TrPs), patients may already have such intense pain that they do not perceive an increase and cannot distinguish what makes it worse. Phase 2 (pain from less irritable TrPs that is perceived only on movement and not at rest) is ideal for educating the patient as to which muscles and movements are responsible for the pain, and how to manage it. In phase 3 (latent TrPs that are causing no pain), the patient still has some residual dysfunction and is vulnerable to reactivation of the latent TrPs.

Myofascial Physical Examination

Specific myofascial examination of the muscles is undertaken following a complete general physical examination. When searching for active TrPs that are responsible for the patient's pain, it is essential to know the precise location of the pain and to know which specific muscles can refer pain to that location. Muscles that could be causing the pain are tested for restriction of passive stretch range of motion and for pain at the shortened end of active range of motion, as compared with uninvolved contralateral muscles. Suspected muscles are also tested for mild to moderate weakness either by conventional isometric strength testing or during a lengthening contraction. Such weakness is not associated with atrophy of the muscle. The muscles showing abnormalities in these tests are the ones most likely to have the taut bands and spot tenderness of the TrP. The taut bands are located by palpation and then tested for a local twitch response and reproduction of the patient's pain complaint by digital pressure on the TrP. One must try to distinguish active TrPs from latent ones, which can also respond positively to the tests described but are not responsible for a pain complaint. Active TrPs are more irritable than latent TrPs and show greater responses on examination. If inactivation of the suspected TrP does not relieve the pain, it may either have been a latent TrP or it may not have been the only active TrP referring pain to that area. Examination for mechanical perpetuating factors requires careful observation of the patient's postures, body symmetry, and movement patterns. Common mechanical factors that can influence many muscles are the round-shouldered, head-forward posture with loss of normal lumbar lordosis, and body asymmetries including a lower limb-length inequality and a small hemi-pelvis. Tightness of the iliopsoas and hamstring muscles can also seriously disrupt balanced posture.

DIFFERENTIAL DIAGNOSIS

Two variants of myofascial pain syndromes should be recognized: the myofascial pain modulation disorder, which leads to diagnostic

confusion, and the post-traumatic hyperirritability syndrome, which complicates management. In addition, either fibromyalgia or articular dysfunction can confusingly mimic a chronic myofascial pain syndrome. Each requires an additional specific examination technique and its own treatment approach.

Myofascial Pain Modulation Disorder

It appears that the aberrant referral patterns are caused by a distortion of sensory modulation in the central nervous system. Many of these patients had previously experienced trauma or painful impact at the focus of pain, but often not of such severity that it would be expected to cause structural damage to the central nervous system. The mechanism behind this sensory nervous system dysfunction is not clear, but possible mechanisms are being explored in current neurosensory research.

Post-traumatic Hyperirritability Syndrome

This syndrome follows a major trauma, such as an automobile accident, a fall, or a severe blow to the body that is apparently sufficient to injure the sensory modulation mechanisms of the spinal cord or brain stem. The patients have constant pain, which may be exacerbated by the vibration of a moving vehicle, by the slamming of a door, by a loud noise (a firecracker at close range), by jarring (bumping into something or being jostled), by mild thumps (a pat on the back), by severe pain (a TrP injection), by prolonged physical activity, and by

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emotional stress (such as anger). Recovery from such stimulation is slow. Even with mild exacerbations, it may take the patient many minutes or hours to return to the baseline pain level. Severe exacerbation of pain may require days, weeks, or longer to return to baseline. These patients almost always give a history of having coped well in life prior to their injury, having paid no more attention to pain than did their friends and family. They were no more sensitive to these stimuli than other persons. From the moment of the initial trauma, however, pain suddenly became the focus of life. They must pay close attention to the avoidance of strong sensory stimuli; they must limit activity because even mild to moderate muscular stress or fatigue intensifies the pain. Efforts to increase exercise tolerance may be self- defeating. Such patients, who suffer greatly, are poorly understood and, through no fault of their own, are difficult to help. In these patients, the sensory nervous system behaves much as the motor system does when the spinal cord has lost supraspinal inhibition. In the latter, a strong sensory input of almost any kind can activate non-specific motor activity for an extended period of time. Similarly, in these patients, a strong sensory input can increase the excitability of the nociceptive system for long periods. In addition, these patients may show lability of the autonomic nervous system with skin temperature changes and swelling that resolve with inactivation of regional TrPs. Since routine medical examination of these suffering patients fails to show any organic cause for their symptoms, they are often relegated to "crock" status. Any additional fall or motor vehicle accident that would ordinarily be considered minor can severely exacerbate the hyperirritability syndrome for years. Unfortunately, with successive traumas, the individual may become increasingly vulnerable to subsequent trauma. A frequent finding is a series of motor vehicle accidents over a period of several years.

Fibromyalgia

Patients with fibromyalgia are predominantly female (73-88%). Men and women are nearly equally likely to have myofascial pain syndromes. The patient with an acute myofascial pain syndrome typically can identify the onset precisely as to time and place. Usually the muscle was subjected to momentary overload, e.g. an automobile accident, a near fall, a sudden and vigorous movement (sports activity), moving a heavy box, reaching over to pick something up from the floor, or getting into an automobile, although there may be a lag of several hours to a day after the initiating event before pain appears. Patients with chronic myofascial pain may have difficulty identifying the onset so clearly. These patients are likely to have more than a single myofascial pain syndrome. In contrast, the symptoms of fibromyalgia typically develop insidiously; these patients usually can identify no specific moment in time when their symptoms began. Thus, the onset of myofascial pain characteristically relates much more strongly to muscular activity and specific movements than does fibromyalgia. The orientation of the patient examination is quite different for the two conditions. For the diagnosis of myofascial pain, the clinician painstakingly identifies precisely the distribution of each pain complaint, looks for dysfunctional postures and asymmetries, and examines the muscles to determine which ones show a restricted stretch range of motion. Restriction of motion is not a part of the diagnosis of fibromyalgia. The myofascial examination includes palpation of the suspected muscles for tender spots in taut bands, which, when compressed, refer pain to the area of the patient's pain complaint and, when snapped transversely, produce a local twitch response. To examine for fibromyalgia, the prescribed tender point locations are examined only for tenderness; a relationship between the location of the tender points and the distribution of the patient's pain is not an issue. On palpation, the diffusely tender muscles of patients with fibromyalgia feel soft and doughy (except in specific areas, if they ateo have TrPs in taut bands), whereas the muscles of patients with myofascial pain feel tense and are non-tender except at TrPs and in reference zones. Muscles that exhibit TrPs also exhibit some weakness without atrophy, but they are not particularly fatigable. Generalized severe fatigue, rather than weakness, is characteristic of fibromyalgia. The chronicity of myofascial pain syndromes is caused by perpetuating factors that usually are correctable; the chronicity of fibromyalgia is inherent to the disease. This distinction is not evident at initial evaluation. Some features are confusingly common to both conditions. Disturbed, non-restful sleep may occur in either, but is not required for diagnosis. Over half of the designated tender point locations are also common muscle TrP sites. By definition, a latent or an active TrP at one of those tender point sites would be counted as a tender point. Recent studies indicate that taut bands may be found not only in patients with myofascial pain and in patients with fibromyalgia, but also in "normal" subjects. This finding may have unexplored implications as to the relationship between the taut band and its TrP. Many patients with fibromyalgia also have active myofascial TrPs. At this time, no specific cause of either fibromyalgia or myofascial TrPs has been established. However, clinically, myofascial pain caused by TrPs is primarily a focal dysfunction of muscle, whereas fibromyalgia is a systemic disease that also affects the muscles.

Articular Dysfunction

We think of articular dysfunction either as joint hypomobility (including loss of joint play) that requires manual. movement, mobilization, or manipulation to restore normal function, or as hypermobility that requires stabilization. The term somatic dysfunction is now commonly used and includes skeletal dysfunctions that are often treated by mobilization and manipulation, as well as myofascial dysfunctions that are frequently treated with myofascial release techniques. An understanding of the interface between myofascial pain syndrome and articular dysfunction is one of the great voids in our current knowledge of manual medicine.

TREATMENT

A chronic myofascial pain syndrome became chronic because of perpetuating factors that were unrecognized or were inadequately managed. An identifying characteristic of a chronic myofascial pain syndrome is the initially unsatisfactory response to specific myofascial therapy. Relief is usually only temporary, lasting a few hours or days. However, with correction of the perpetuating factors, the involved muscles become increasingly responsive to therapy. Occasionally, severe perpetuating factors render the TrPs so irritable that even the most gentle attempts at therapy cause more distress than relief. As progress is made in resolving the perpetuating factors, the

involved muscles become increasingly treatable.

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If one starts by correcting obvious mechanical perpetuating factors, myofascial TrP therapies that were previously ineffective are then likely to provide significant relief and to encourage the patient. Each component myofascial pain syndrome should be analyzed and managed as a single-muscle syndrome in the context of other TrPs in the same region. For patients with chronic pain, a home program of stretch exercises is extremely important, probably even more so than for patients with a myofascial pain syndrome of only one or two muscles. Setting specific goals as described by Materson34 is critical for patients with chronic myofascial pain. The primary goal is to teach patients how to recognize specific TrP syndromes, how to employ appropriate body positioning, and which stretch techniques to use for relief. This puts the patients in control. If they want more relief, they know how to obtain it. If they prefer to trade a given level of pain for the time and effort required to relieve it, that is their decision. They learn that control of the pain is in their hands. They come to understand what constitutes abuse of their muscles (that will aggravate the pain) and what measures will reduce unnecessary overload of the muscles. They learn to converse with and listen to their muscles.

Mechanical Perpetuating Factors

If the clinician selects for initial treatment a myofascial pain syndrome that is a major source of pain, is likely to respond to TrP therapy, and has a mechanical perpetuating factor that is readily correctable (such as sitting posture or lower limb-length inequality), the patient will see immediate benefits and will develop confidence in the treatment. Additional mechanical perpetuating factors relevant to the patient's pain should also be corrected promptly. Faulty posture is a mechanical perpetuating factor that is becoming increasingly common and serious with the proliferation of computer terminals and computerized work stations. Postural training should be one of the first parts, if not the first part, of the treatment program. Faulty posture can aggravate TrPs in many regions of the body and can also increase the tenderness of fibromyalgia tender points. In the seated individual, the "slumped posture," or fatigue posture, is characterized by a flattened lumbar spine (loss of normal lordosis), sometimes by an increased dorsal kyphosis, by protracted scapulae, and usually by a flattened cervical spine with the head forward. This posture leads to multiple muscle and joint problems in the trunk, upper limbs, neck, and head, as well as limited respiratory function. For the seated slumped position, the patient can improve postural alignment by consciously raising the top of the head upward, keeping it slightly forward. This simple maneuver lifts the chest to an optimum position for respiratory function. A comparable alignment can be accomplished by "putting a hollow" in the low back. Since this erect posture (sitting "tall") cannot be actively held for long periods, the individual can achieve this without effort by positioning the buttocks against the back of the chair and then placing a small roll behind the lumbar spine (waist level). "Reaching" upward with the top of the head can be done several times a day as an exercise. The prin ciple of raising the top of the head away from the shoulders should also be applied when leaning forward to bathe or eat, thereby avoiding rolling the shoulder up and forward and dropping the head. For good seated posture, one's feet must reach the floor; when a person's legs are short or a seat is too high, a flexible footrest (small firm pillow, bean bag, or sand bag] may be used to support the feet. A hard telephone book is less desirable, but can be temporarily useful. The arms should be supported on armrests that are high enough to allow the individual to sit erect with the elbows supported. Forearm support extensions can be adapted for desk work when typing. When one sits on a sofa or at a desk, arm support can be provided by using a lap board placed on a pillow. An alternate sitting position is one of sitting toward the front edge of a chair seat, placing one foot back under the chair and the other foot forward. This balanced position promotes an erect posture with a natural, but not excessive, lumbar curve. Another way to promote good sitting alignment with little effort is to place a pad at the back of the chair seat, directly under the ischial tuberosities (not under the thighs). The padding tilts the pelvis forward slightly to induce normal lumbar lordosis, which, in turn, facilitates good upper body alignment. Having two ways of sitting with good posture can be particularly useful for someone working at a desk. Frequent changes of position are needed to promote health of the muscles and intervertebral discs. Most important is patient awareness of the problem, understanding of its significance, and willingness to practice sitting and standing erect. Following appropriate postural training (both "static" and dynamic), the patient can take responsibility for the management of the pain that results from chronic postural strain and many activities of daily living. As patients exercise increasing control, they improve both physically and emotionally.

Description of the myofascial syndromes

o

semispinalis capitis

o

semispinalis cervicis

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o multifundi • upper muscles of the neck rectus capitis p. et a. obliquus capitis o
o
multifundi
upper muscles of the neck
rectus capitis p. et a.
obliquus capitis
o
o
levator scapule
scalenus
supraspinatus
infraspinatus
teres minor
latissimus dorsi
teres major
subscapularis
rhomboideus
deltoideus
coracobrachialis
biceps brachii
brachialis
triceps brachii
anconeus
extensores carpi
carpi radialis longus
extensor carpi radialis brevis
extensor carpi ulnaris
brachioradialis
o
o
o
o
extensor digitorum
supinator
palmaris longus
flexores carpi-digitorum
flexor carpi radialis
flexor carpi ulnaris
flexor digitorum superficialis
flexor digitorum profundus
flexor policis longus
pronator teres
o
o
o
o
o
o
opponens-adductor policis
interossei
interossei
adductor digiti minimi
o
o
pectoralis major and subclavicularis
sternalis
serratus superior posterior
serratus anterior
serratus inferior posterior
paravertebralis
iliocostalis
semispinalis
multifundi
rotatores
o
o
o
o
regio abdominalis
obliquus abdominis
transversus abdominis
rectus abdominis
pyramidalis
Quadratus Lumborum
o
o
o
o
Iliopsoas
Pelvic Floor Muscles
o Bulbospongiosus
o Ischiocavernosus
o
Transversus Perinei
o
Sphincter Ani
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o

Levator Ani

o

Coccygeus

o

Obturator Internus

o

Quadratus Femoris

o

Obturator Internus

o

Obturator Externus

o

Quadriceps Femoris Group

o

o

o

o

Adductor Longus

o

o

o

o

Adductor Brevis

Adductor Magnus

Gracilis

Biceps Femoris

o

o Semitendinosus o Semimembranosus

Peroneus Longus

o

o

o

Peroneus Brevis

Peroneus Tertius

Extensor Digitorum Longus

o

o

Extensor Hallucis Longus

Flexor Digitorum Longus

o

o

Flexor Hallucis Longus

Extensor Digitorum Brevis

o

o

o

o

o

Extensor Hallucis Brevis

Abductor Hallucis

Flexor Digitorum Brevis

Abductor Digiti Minimi

o

Quadratus Plantae

o

Lumbricals

o

Flexor Hallucis Brevis

o

Adductor Hallucis

o

Flexor Digiti Minimi Brevis

o

Interossei

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DIGASTRICUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 6
DIGASTRICUS
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
6
SPLENIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 7
SPLENIUS
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
7
SEMISPINALIS; MULTIFUNDI; ROTATORES Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 8
SEMISPINALIS; MULTIFUNDI; ROTATORES
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
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RECTUS CAPITIS POSTERIOR MAJOR & MINOR; OBLIQUUS CAPITIS SUPERIOR & INFERIOR Anatomy Reflected pain Palpation and
RECTUS CAPITIS POSTERIOR MAJOR & MINOR; OBLIQUUS CAPITIS SUPERIOR & INFERIOR
Anatomy
Reflected pain
Palpation and massage
Home therapy
Function and PIR
9
 

LEVATOR SCAPULE

 
 

Anatomy

 

Reflected pain

 
LEVATOR SCAPULE Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 10
   
LEVATOR SCAPULE Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 10
 

Palpation and massage

 

Function and PIR

LEVATOR SCAPULE Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 10
LEVATOR SCAPULE Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 10
 

Home therapy

 
 
LEVATOR SCAPULE Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 10
 
LEVATOR SCAPULE Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 10
 
 

10

SCALENUS Anatomy Reflected pain Function and PIR Home therapy 11
SCALENUS
Anatomy
Reflected pain
Function and PIR
Home therapy
11
 

SUPRASPINATUS

 
 

Anatomy

 
SUPRASPINATUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 12
 
 

Reflected pain

 
 
SUPRASPINATUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 12
 
SUPRASPINATUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 12
 

Palpation and massage

 

Function and PIR

SUPRASPINATUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 12
SUPRASPINATUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 12
 

Home therapy

 
 
SUPRASPINATUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 12
   
 

12

INFRASPINATUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 13
INFRASPINATUS
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
13
 

TERES MINOR

 

Anatomy

Reflected pain

 
TERES MINOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 14
 
TERES MINOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 14
 

Palpation and massage

 
TERES MINOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 14
 

Function and PIR, home therapy

 
TERES MINOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 14
TERES MINOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 14
 

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LATISSIMUS DORSI Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 15
LATISSIMUS DORSI
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
15
 

TERES MAJOR

 

Anatomy

 

Reflected pain

TERES MAJOR Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 16
 
TERES MAJOR Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 16
 

Palpation and massage

 

Function and PIR

TERES MAJOR Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 16
TERES MAJOR Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 16
 

Home therapy

 
 
TERES MAJOR Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 16
 
 

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SUBSCAPULARIS

 
 

Anatomy

 

Reflected pain

 
SUBSCAPULARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 17
 
SUBSCAPULARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 17
 

Palpation and massage

 

Function and PIR

SUBSCAPULARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 17
SUBSCAPULARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 17
 

Home therapy

 
 
SUBSCAPULARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 17
 
 

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RHOMBOIDEUS MAJOR & MINOR

 

Anatomy

Reflected pain

 
RHOMBOIDEUS MAJOR & MINOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 18
 
RHOMBOIDEUS MAJOR & MINOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 18
 

Palpation and massage

Function and PIR, home therapy

 
RHOMBOIDEUS MAJOR & MINOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 18
RHOMBOIDEUS MAJOR & MINOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 18
 

18

DELTOIDEUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 19
DELTOIDEUS
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
19
 

CORACOBRACHIALIS

 
 

Anatomy

 

Reflected pain

 
CORACOBRACHIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 20
   
CORACOBRACHIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 20
 
 

Palpation and massage

 

Function and PIR, home therapy

CORACOBRACHIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 20
CORACOBRACHIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 20
 

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BICEPS BRACHII

 
 

Anatomy

 

Reflected pain

 
BICEPS BRACHII Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 21
 
BICEPS BRACHII Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 21
 

Palpation and massage

 

Function and PIR

BICEPS BRACHII Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 21
BICEPS BRACHII Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 21
 

Home therapy

 
 
BICEPS BRACHII Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 21
 
 

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BRACHIALIS

 

Anatomy

Reflected pain

 
BRACHIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 22
 
BRACHIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 22
 

Palpation and massage

Function and PIR, home therapy

BRACHIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 22
BRACHIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 22
 

22

TRICEPS BRACHII Anatomy Reflected pain Palpation and massage Function and PIR, home therapy Home therapy 23
TRICEPS BRACHII
Anatomy
Reflected pain
Palpation and massage
Function and PIR, home therapy
Home therapy
23
 

ANCONEUS

 
 

Reflected pain

 
 
ANCONEUS Reflected pain Palpation and massage Function and PIR, home therapy 24
 

Palpation and massage

 

Function and PIR, home therapy

ANCONEUS Reflected pain Palpation and massage Function and PIR, home therapy 24
ANCONEUS Reflected pain Palpation and massage Function and PIR, home therapy 24
 

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EXTENSORES CARPI EXTENSOR CARPI RADIALIS LONGUS, BREVIS

 
 

Anatomy

Reflected pain

 
EXTENSORES CARPI EXTENSOR CARPI RADIALIS LONGUS, BREVIS Anatomy Reflected pain Palpation and massage Function and PIR,
 
EXTENSORES CARPI EXTENSOR CARPI RADIALIS LONGUS, BREVIS Anatomy Reflected pain Palpation and massage Function and PIR,
EXTENSORES CARPI EXTENSOR CARPI RADIALIS LONGUS, BREVIS Anatomy Reflected pain Palpation and massage Function and PIR,
 

Palpation and massage

Function and PIR, home therapy

EXTENSORES CARPI EXTENSOR CARPI RADIALIS LONGUS, BREVIS Anatomy Reflected pain Palpation and massage Function and PIR,
EXTENSORES CARPI EXTENSOR CARPI RADIALIS LONGUS, BREVIS Anatomy Reflected pain Palpation and massage Function and PIR,
 

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EXTENSOR CARPI ULNARIS

 
 

Anatomy

 

Reflected pain

 
EXTENSOR CARPI ULNARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 26
   
EXTENSOR CARPI ULNARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 26
 

Palpation and massage

 

Function and PIR

EXTENSOR CARPI ULNARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 26
EXTENSOR CARPI ULNARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 26
 

Home therapy

 
 
EXTENSOR CARPI ULNARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 26
 
 
 

26

 

BRACHIORADIALIS

 
 

Anatomy

 

Reflected pain

 
BRACHIORADIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 27
   
BRACHIORADIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 27
 

Palpation and massage

 

Function and PIR

BRACHIORADIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 27
BRACHIORADIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 27
 

Home therapy

 
 
BRACHIORADIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 27
 
 

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EXTENSOR DIGITORUM Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 28
EXTENSOR DIGITORUM
Anatomy
Reflected pain
Palpation and massage
Function and PIR, home therapy
28
 

SUPINATOR

 

Anatomy

Reflected pain

 
SUPINATOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 29
 
SUPINATOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 29
 

Palpation and massage

Function and PIR, home therapy

SUPINATOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 29
SUPINATOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 29
 

29

 

PALMARIS LONGUS

 

Reflected pain

 
PALMARIS LONGUS Reflected pain 30
 
 

30

 

FLEXOR CARPI RADIALIS

 

Anatomy

Reflected pain

 
FLEXOR CARPI RADIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 31
 
FLEXOR CARPI RADIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 31
 

Palpation and massage

Function and PIR, home therapy

FLEXOR CARPI RADIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 31
FLEXOR CARPI RADIALIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 31
 

31

 

FLEXOR CARPI ULNARIS

 

Anatomy

Reflected pain

 
FLEXOR CARPI ULNARIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 32
 
FLEXOR CARPI ULNARIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 32
 

Palpation and massage

Function and PIR, home therapy

FLEXOR CARPI ULNARIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 32
FLEXOR CARPI ULNARIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 32
 

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FLEXOR DIGITORUM SUPERFICIALIS

 

Anatomy

Reflected pain

 
FLEXOR DIGITORUM SUPERFICIALIS Anatomy Reflected pain Function and PIR, home therapy 33
 
FLEXOR DIGITORUM SUPERFICIALIS Anatomy Reflected pain Function and PIR, home therapy 33
 

Function and PIR, home therapy

 
FLEXOR DIGITORUM SUPERFICIALIS Anatomy Reflected pain Function and PIR, home therapy 33
 

33

 

FLEXOR DIGITORUM PROFUNDUS

 

Anatomy

Reflected pain

 
FLEXOR DIGITORUM PROFUNDUS Anatomy Reflected pain Function and PIR, home therapy 34
 
FLEXOR DIGITORUM PROFUNDUS Anatomy Reflected pain Function and PIR, home therapy 34
 

Function and PIR, home therapy

 
FLEXOR DIGITORUM PROFUNDUS Anatomy Reflected pain Function and PIR, home therapy 34
 

34

 

FLEXOR POLICIS LONGUS

 

Anatomy

Reflected pain

 
FLEXOR POLICIS LONGUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 35
 
FLEXOR POLICIS LONGUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 35
 

Palpation and massage

Function and PIR, home therapy

FLEXOR POLICIS LONGUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 35
FLEXOR POLICIS LONGUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 35
 

35

 

PRONATOR TERES

 

Anatomy

 

Reflected pain

PRONATOR TERES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy Home therapy 36
 
PRONATOR TERES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy Home therapy 36
 

Palpation and massage

Function and PIR, home therapy

PRONATOR TERES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy Home therapy 36
PRONATOR TERES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy Home therapy 36
 
 

Home therapy

 
 
PRONATOR TERES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy Home therapy 36
 
 

36

ADDUCTOR POLICIS

Anatomy

 

Reflected pain

ADDUCTOR POLICIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 37
 
ADDUCTOR POLICIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 37
 

Palpation and massage

 

Function and PIR, home therapy

ADDUCTOR POLICIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 37
 
ADDUCTOR POLICIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 37
 

37

 

OPPONENS POLICIS

 
 

Anatomy

 

Reflected pain

 
OPPONENS POLICIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 38
 
OPPONENS POLICIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 38
 

Palpation and massage

 

Function and PIR, home therapy

OPPONENS POLICIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 38
 
OPPONENS POLICIS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 38
 
 

38

INTEROSSEI Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 39
INTEROSSEI
Anatomy
Reflected pain
Palpation and massage
Function and PIR, home therapy
39
 

PECTORALIS MAJOR

 
 

Anatomy

 
PECTORALIS MAJOR Anatomy Reflected pain Palpation and massage Function and PIR 40
 
 

Reflected pain

 
PECTORALIS MAJOR Anatomy Reflected pain Palpation and massage Function and PIR 40
PECTORALIS MAJOR Anatomy Reflected pain Palpation and massage Function and PIR 40
 
PECTORALIS MAJOR Anatomy Reflected pain Palpation and massage Function and PIR 40
PECTORALIS MAJOR Anatomy Reflected pain Palpation and massage Function and PIR 40
PECTORALIS MAJOR Anatomy Reflected pain Palpation and massage Function and PIR 40
 
 

Palpation and massage

 

Function and PIR

PECTORALIS MAJOR Anatomy Reflected pain Palpation and massage Function and PIR 40
PECTORALIS MAJOR Anatomy Reflected pain Palpation and massage Function and PIR 40
 

40

 

SUBCLAVIUS

 
 

Anatomy

 

Reflected pain

SUBCLAVIUS Anatomy Reflected pain Function and PIR Home therapy 41
 
SUBCLAVIUS Anatomy Reflected pain Function and PIR Home therapy 41
 
 

Function and PIR

 
 
SUBCLAVIUS Anatomy Reflected pain Function and PIR Home therapy 41
 
 
 

Home therapy

 
 
SUBCLAVIUS Anatomy Reflected pain Function and PIR Home therapy 41
   
SUBCLAVIUS Anatomy Reflected pain Function and PIR Home therapy 41
 

41

 

STERNALIS

Anatomy

 

Reflected pain

STERNALIS Anatomy Reflected pain 42
 
STERNALIS Anatomy Reflected pain 42
 
 

42

SERRATUS SUPERIOR POSTERIOR Anatomy Reflected pain Palpation and massage 43
SERRATUS SUPERIOR POSTERIOR
Anatomy
Reflected pain
Palpation and massage
43
 

SERRATUS ANTERIOR

 

Anatomy

Reflected pain

 
SERRATUS ANTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 44
 
SERRATUS ANTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 44
 

Palpation and massage

Function and PIR, home therapy

SERRATUS ANTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 44
SERRATUS ANTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 44
 

44

SERRATUS INFERIOR POSTERIOR Anatomy Reflected pain Palpation and massage 45
SERRATUS INFERIOR POSTERIOR
Anatomy
Reflected pain
Palpation and massage
45
 

ILIOCOSTALIS

Anatomy

ILIOCOSTALIS Anatomy Reflected pain 46

Reflected pain

ILIOCOSTALIS Anatomy Reflected pain 46
ILIOCOSTALIS Anatomy Reflected pain 46
ILIOCOSTALIS Anatomy Reflected pain 46
 
 

46

SEMISPINALIS, MULTIFUNDI, ROTATORES Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 47
SEMISPINALIS, MULTIFUNDI, ROTATORES
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
47
OBLIQUUS ABDOMINIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 48
OBLIQUUS ABDOMINIS
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
48
 

TRANSVERSUS ABDOMINIS

 

Anatomy

Reflected pain

 
TRANSVERSUS ABDOMINIS Anatomy Reflected pain Palpation and massage Function and PIR 49
 
TRANSVERSUS ABDOMINIS Anatomy Reflected pain Palpation and massage Function and PIR 49
 

Palpation and massage

Function and PIR

TRANSVERSUS ABDOMINIS Anatomy Reflected pain Palpation and massage Function and PIR 49
TRANSVERSUS ABDOMINIS Anatomy Reflected pain Palpation and massage Function and PIR 49
 

49

RECTUS ABDOMINIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 50
RECTUS ABDOMINIS
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
50
 

PYRAMIDALIS

 
 

Anatomy

 

Reflected pain

 
PYRAMIDALIS Anatomy Reflected pain 51
   
PYRAMIDALIS Anatomy Reflected pain 51
 
 

51

 

QUADRATUS LUMBORUM

 
 

Anatomy

 
 
QUADRATUS LUMBORUM Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 52
 
 

Reflected pain

 
QUADRATUS LUMBORUM Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 52
 
QUADRATUS LUMBORUM Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 52
 

Palpation and massage

 

Function and PIR

QUADRATUS LUMBORUM Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 52
QUADRATUS LUMBORUM Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 52
 

Home therapy

 
 
QUADRATUS LUMBORUM Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 52
 
 

52

 

ILIOPSOAS

 
 

Anatomy

 

Reflected pain

 
ILIOPSOAS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 53
 
ILIOPSOAS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 53
 

Palpation and massage

   

Function and PIR

ILIOPSOAS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 53
ILIOPSOAS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 53
 

Home therapy

 
 
ILIOPSOAS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 53
 
 

53

 

PELVIC FLOOR MUSCLES

 

Reflected pain

 
PELVIC FLOOR MUSCLES Reflected pain Home therapy 54
 
 
PELVIC FLOOR MUSCLES Reflected pain Home therapy 54
 
 

Home therapy

 
PELVIC FLOOR MUSCLES Reflected pain Home therapy 54
 
 

54

 

GLUTEUS MAXIMUS

 
 

Anatomy

 
 
GLUTEUS MAXIMUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 55
 
 

Reflected pain

 
 
GLUTEUS MAXIMUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 55
   
GLUTEUS MAXIMUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 55
 

Palpation and massage

 

Function and PIR

GLUTEUS MAXIMUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 55
GLUTEUS MAXIMUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 55
 

Home therapy

 
 
GLUTEUS MAXIMUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 55
 
 

55

 

GLUTEUS MEDIUS

 
 

Anatomy

 
 
GLUTEUS MEDIUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 56
 
 

Reflected pain

 
GLUTEUS MEDIUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 56
 
GLUTEUS MEDIUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 56
 
GLUTEUS MEDIUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 56

Palpation and massage

 

Function and PIR, home therapy

GLUTEUS MEDIUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 56
GLUTEUS MEDIUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 56
 

56

 

GLUTEUS MINIMUS

 
 

Anatomy

 
GLUTEUS MINIMUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 57
 
 

Reflected pain

 
 
GLUTEUS MINIMUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 57
   
GLUTEUS MINIMUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 57
 

Palpation and massage

Function and PIR, home therapy

GLUTEUS MINIMUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 57
GLUTEUS MINIMUS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 57
 

57

SHORT LATERAL ROTATORS

 

Anatomy

 

Reflected pain

SHORT LATERAL ROTATORS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 58
 
SHORT LATERAL ROTATORS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 58
 

Palpation and massage

 

Function and PIR, home therapy

SHORT LATERAL ROTATORS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 58
SHORT LATERAL ROTATORS Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 58
 

58

 

TENSOR FASCIAE LATAE SARTORIUS

 

Anatomy

 

Reflected pain

   
TENSOR FASCIAE LA TAE SARTORIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy
 
TENSOR FASCIAE LA TAE SARTORIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy
 

Palpation and massage

 

Function and PIR

TENSOR FASCIAE LA TAE SARTORIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy
TENSOR FASCIAE LA TAE SARTORIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy
 

Home therapy

 
TENSOR FASCIAE LA TAE SARTORIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy
 
 

59

 

PECTINEUS

Anatomy

 

Function

PECTINEUS Anatomy Function Palpation and massage Function and PIR, home therapy 60
 
PECTINEUS Anatomy Function Palpation and massage Function and PIR, home therapy 60
 

Palpation and massage

 

Function and PIR, home therapy

PECTINEUS Anatomy Function Palpation and massage Function and PIR, home therapy 60
PECTINEUS Anatomy Function Palpation and massage Function and PIR, home therapy 60
 

60

 

RECTUS FEMORIS

 

Anatomy

 

Reflected pain

 
RECTUS FEMORIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 61
 
RECTUS FEMORIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 61
 

Palpation and massage

 

Function and PIR

 
RECTUS FEMORIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 61
RECTUS FEMORIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 61
 

Home therapy

 
 
RECTUS FEMORIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 61
 
 

61

 

VASTUS MEDIALIS

 
 

Anatomy

 

Reflected pain

 
VASTUS MEDIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 62
 
VASTUS MEDIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 62
VASTUS MEDIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 62
 

Palpation and massage

   

Function and PIR

VASTUS MEDIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 62
VASTUS MEDIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 62
 

Home therapy

 
 
VASTUS MEDIALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 62
 
 

62

 

VASTUS INTERMEDIUS

 
 

Anatomy

 

Reflected pain

 
VASTUS INTERMEDIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 63
   
VASTUS INTERMEDIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 63
 

Palpation and massage

   

Function and PIR

VASTUS INTERMEDIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 63
VASTUS INTERMEDIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 63
 

Home therapy

 
 
VASTUS INTERMEDIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 63
 
 

63

 

VASTUS LATERALIS

Anatomy

 

Reflected pain

   
VASTUS LATERALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 64
VASTUS LATERALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 64
VASTUS LATERALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 64
 

Palpation and massage

 

Function and PIR

VASTUS LATERALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 64
 
VASTUS LATERALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 64
 

Home therapy

 
VASTUS LATERALIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 64
 
 

64

ADDUCTOR Anatomy Reflected pain Longus Brevis Magnus Palpation and massage Function and PIR Home therapy 65
ADDUCTOR
Anatomy
Reflected pain
Longus
Brevis
Magnus
Palpation and massage
Function and PIR
Home therapy
65
 

HAMSTRING MUSCLES

 

Anatomy

 

Reflected pain

   

Biceps femoris

Semitendinosus

HAMSTRING MUSCLES Anatomy Reflected pain Biceps femoris Semitendinosus Palpation and massage Function and PIR, home therapy
 
HAMSTRING MUSCLES Anatomy Reflected pain Biceps femoris Semitendinosus Palpation and massage Function and PIR, home therapy
 
HAMSTRING MUSCLES Anatomy Reflected pain Biceps femoris Semitendinosus Palpation and massage Function and PIR, home therapy
 

Palpation and massage

 
HAMSTRING MUSCLES Anatomy Reflected pain Biceps femoris Semitendinosus Palpation and massage Function and PIR, home therapy
 

Function and PIR, home therapy

 
HAMSTRING MUSCLES Anatomy Reflected pain Biceps femoris Semitendinosus Palpation and massage Function and PIR, home therapy
 
HAMSTRING MUSCLES Anatomy Reflected pain Biceps femoris Semitendinosus Palpation and massage Function and PIR, home therapy
 

66

 

POPLITEUS

Anatomy

Reflected pain

POPLITEUS Anatomy Reflected pain 67
POPLITEUS Anatomy Reflected pain 67
 

67

 

TIBIALIS ANTERIOR

 

Anatomy

Reflected pain

 
TIBIALIS ANTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 68
 
TIBIALIS ANTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 68
 

Palpation and massage

Function and PIR, home therapy

TIBIALIS ANTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 68
TIBIALIS ANTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 68
 

68

 

PERONEAL MUSCLES

 

Anatomy

 

Reflected pain

PERONEAL MUSCLES Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 69
 
PERONEAL MUSCLES Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 69
 
PERONEAL MUSCLES Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 69

Palpation and massage

 

Function and PIR

PERONEAL MUSCLES Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 69
 
PERONEAL MUSCLES Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 69
 

Home therapy

 
 
PERONEAL MUSCLES Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 69
 
 

69

 

GASTROCNEMIUS

 

Anatomy

 

Reflected pain

 
       
GASTROCNEMIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 70
 
GASTROCNEMIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 70
 
     

Palpation and massage

 

Function and PIR

 
GASTROCNEMIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 70
GASTROCNEMIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 70
 

Home therapy

 
 
GASTROCNEMIUS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 70
 
 

70

SOLEUS PLANTARIS Anatomy Reflected pain Palpation and massage Function and PIR Home therapy 71
SOLEUS PLANTARIS
Anatomy
Reflected pain
Palpation and massage
Function and PIR
Home therapy
71
 

TIBIALIS POSTERIOR

 

Anatomy

Reflected pain

 
TIBIALIS POSTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 72
 
TIBIALIS POSTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 72
 

Palpation and massage

Function and PIR, home therapy

TIBIALIS POSTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 72
TIBIALIS POSTERIOR Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 72
 

72

 

LONG EXTENSORS OF TOES

 
 

Anatomy

 

Reflected pain

 
LONG EXTENSORS OF TOES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 73
 
LONG EXTENSORS OF TOES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 73
LONG EXTENSORS OF TOES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 73
 

Palpation and massage

Function and PIR, home therapy

 
LONG EXTENSORS OF TOES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 73
LONG EXTENSORS OF TOES Anatomy Reflected pain Palpation and massage Function and PIR, home therapy 73
 

73

LONG FLEXOR MUSCLES OF TOES 74
LONG FLEXOR MUSCLES OF TOES
74
SUPERFICIAL INTRINSIC FOOT MUSCLES Reflected pain 75
SUPERFICIAL INTRINSIC FOOT MUSCLES
Reflected pain
75

EXTENSOR DIGITORUM BREVIS, EXTENSOR HALLUCIS BREVIS

 

Anatomy

 
 
EXTENSOR DIGITORUM BREVIS, EXTENSOR HALLUCIS BREVIS Anatomy Palpation and massage Function and PIR, home therapy 76
 

Palpation and massage

 

Function and PIR, home therapy

EXTENSOR DIGITORUM BREVIS, EXTENSOR HALLUCIS BREVIS Anatomy Palpation and massage Function and PIR, home therapy 76
EXTENSOR DIGITORUM BREVIS, EXTENSOR HALLUCIS BREVIS Anatomy Palpation and massage Function and PIR, home therapy 76
 

76

ABDUCTOR HALLUCIS, ABDUCTOR DIGITI MINIMI

 
 

Anatomy

 
 
ABDUCTOR HALLUCIS, ABDUCTOR DIGITI MINIMI Anatomy Palpation and massage Function and PIR, home therapy 77
 

Palpation and massage

 

Function and PIR, home therapy

ABDUCTOR HALLUCIS, ABDUCTOR DIGITI MINIMI Anatomy Palpation and massage Function and PIR, home therapy 77
ABDUCTOR HALLUCIS, ABDUCTOR DIGITI MINIMI Anatomy Palpation and massage Function and PIR, home therapy 77
 

77

 

FLEXOR DIGITORUM BREVIS

 

Anatomy

Function and PIR, home therapy

 
FLEXOR DIGITORUM BREVIS Anatomy Function and PIR, home therapy 78
 
FLEXOR DIGITORUM BREVIS Anatomy Function and PIR, home therapy 78
 

78

 

DEEP INTRINSIC FOOT MUSCLES

 
 

Reflected pain

 
 
DEEP INTRINSIC FOOT MUSCLES Reflected pain 79
   
DEEP INTRINSIC FOOT MUSCLES Reflected pain 79
DEEP INTRINSIC FOOT MUSCLES Reflected pain 79
 
DEEP INTRINSIC FOOT MUSCLES Reflected pain 79
 
 

79

 

QUADRATUS PLANTAE

 

Anatomy

 
QUADRATUS PLANTAE Anatomy 80
 
 

80

 

LUMBRICALS

 
 

Anatomy

 
 
LUMBRICALS Anatomy Palpation and massage Function and PIR, home therapy 81
 

Palpation and massage

 

Function and PIR, home therapy

LUMBRICALS Anatomy Palpation and massage Function and PIR, home therapy 81
LUMBRICALS Anatomy Palpation and massage Function and PIR, home therapy 81
 

81

 

FLEXOR HALLUCIS BREVIS

 
 

Anatomy

 
 
FLEXOR HALLUCIS BREVIS Anatomy Palpation and massage Function and PIR, home therapy 82
 

Palpation and massage

 

Function and PIR, home therapy

FLEXOR HALLUCIS BREVIS Anatomy Palpation and massage Function and PIR, home therapy 82
FLEXOR HALLUCIS BREVIS Anatomy Palpation and massage Function and PIR, home therapy 82
 

82

 

ADDUCTOR HALLUCIS

 

Anatomy

 
ADDUCTOR HALLUCIS Anatomy Function and PIR, home therapy 83
 
 

Function and PIR, home therapy

 
ADDUCTOR HALLUCIS Anatomy Function and PIR, home therapy 83
 

83

 

FLEXOR DIGITI MINIMI BREVIS, INTEROSSEI

 

Anatomy

 
FLEXOR DIGITI MINIMI BREVIS, INTEROSSEI Anatomy 84
 
 

84