Trigger Point muscle

O: Medial ½ of clavicle, sternum, & cartilage of ribs 1 thru 6
I: Lateral lip of bicipital grove
A: Adduction, flexion, medial rotation, horizontal adduction.
Lower fibers; extension of arm and shoulder
Nerve Innervation: Medial & Lateral Pectoral
Nickname; Heart attack

Perpetuating Factors
• Poor posture
• Heavy lifting
• Arm adduction (trimming hedges)
• Immobilization (sling position)
• Stress

O: Anterior surface of 3 thru 5 ribs
I: Coracoid Process
A: Protraction of scapula; depression of scapula
Nerve Innervation: Medial Pectoral
Nickname: Neurovascular entrapper
Note: Brachial artery & nerve pass under
Perpetuating Factors
• Crutches
• Rifle shooting
• Poor posture
• Satellite Trigger Point of Pectoralis Major
• Book bag w/tight straps
• Severe Coughing

O: Upper 8 or 9 Ribs
I: Vertebral border of scapula
A: Protraction of the shoulder
Nerve Innervation: Long Thoracic
Nickname: Stitch in side & Pushup muscle
Perpetuating Factors
• Running
• Pushups
• Heavy coughing
• Anxiety

O: External occipital protuberance, medial portion of superior nuchal line of occiput, ligamentum nuchae, & spinous processes of c7 thru T12
I: Lateral 1/3 of clavicle, acromion process, & spine of the scapula
Nerve Innervation: Spinal Accessory & Cervical plexus
Nick name: Coat hanger
A: Upper fibers
Bilaterally; extend the head & neck
Unilateral; laterally flex the head & neck to same side
Rotate the head & neck to the opposite side
Elevate the scapula
Upwardly rotate the scapula
Middle fibers
Adduct the scapula
Retract the scapula
Stabilize the scapula
Lower Fibers
Depress the scapula
Upwardly rotate the scapula
Perpetuating factors
• Sudden trauma
• Falling off horse for down steps
• Reaching up and holding arms overhead
• Fashion trauma – heavy coat, book bag
• Large breast
• Holding shoulders in ear
• Playing violin
• Holding head to a rotated position to one side or sleeping
• Quick repetitive movements
• Flipping hair out of face
• Lower limb length inequality LLLI

O: Spinous process of last six thoracic vertebrae, last three or four ribs, thoracolumbar aponeurosis & posterior iliac crest
I: Crest of the lesser tubercle of the humerus (bicipital grove of humerus)
A: Extend the shoulder
Adducts the shoulder
Medially rotates shoulder
Nerve Innervation: Thoracodorsal
Nickname: Pernicious mid-thoracic backache
Perpetuating factors:
• “Same as Teres Major”
• Driving a car w/o power steering
• Throwing a baseball or softball
• Hanging from a rope or swing
• Wearing a tight bra
• Swimming butterfly strokes
• Sleeping on your side

O: Lateral side of inferior angle & lower half of lateral border of scapula
I: Crest of the lesser tubercle of the humerus
A: Extend the should & arm
Adducts the shoulder
Medially rotates the shoulder
Nerve Innervation: Lower Subscapular
Nickname: Twin to lats
Perpetuating factor
• Driving car w/o power steering
• Throwing a baseball
• Wearing a tight bra
• Swimming butterfly strokes
• Sleeping on your side

O: Spinous process of vertebrae C6 thru T5
I: Vertebrae border of scapula from inferior angle
A: Adducts the scapula; elevates the scapula, downwardly rotates the scapula
Nerve Innervation: Dorsal scapular from brachial plexus
Nicknames: Superficial backache – rounded shoulders
Perpetuating factors
• Adduction w/arms @ 90 degrees (spackling, painting ceiling)
• Leaning forward w/rounded shoulders (sitting at desk writing)
• Scoliosis
• Chest surgery
• Shortened pectoralis major or minor
• Large breast

O: Supraspinatus fossa of scapula
I: Greater tubercle of humerus
A: Abducts the shoulder (initiator)
Stabilizes the head of the humerus (glenoid cavity)
Nerve Innervation: Suprascapular
Nickname: Sub-Deltoid Bursitis mimikas
Perpetuating factors:
• Carrying heavy on side
• Large dog pulling on leash

O: Infraspinous fossa
I: Greater tubercle of humerus
A: Laterally rotates the shoulder
Adducts the shoulder
Extends the shoulder
Horizontally abducts the shoulder
Stabilizes head of humerus in the glenoid cavity
Nerve Innervation: Suprascapular
Nickname: Shoulder joint pain
Perpetuating factors:
• Grasping Rail during a fall or ski pole during a fall
• Hitting a tennis ball off balance or mishitting a ball
• Reaching back to a bedside lamp

O: Subscapular fossa of the scapula
I: Lesser tubercle of the humerus
A: Medially rotate the shoulder
Stabilize head of humerus in glenoid cavity
Nerve Innervation: Upper & Lower Subscapular
Nickname: Frozen shoulder
Perpetuating factors:
• Freestyle swimming
• Swinging a child
• Spiking a volleyball
• Dislocating a shoulder
• Immobilization (sling position)

O: Superior half of lateral border of scapula
I: Greater tubercle of humerus
A: Laterally rotates the shoulder
Adducts the shoulder
Extends the shoulder
Horizontally abducts the shoulder
Stabilizes head of humerus in glenoid cavity
Nerve Innervation: Axillary
Nickname: Silver dollar muscle
Perpetuating factors
• (same as Infraspinatus)
• Grasping Rail during a fall or ski pole during a fall
• Hitting a tennis ball off balance or mishitting a ball
• Reaching back to a bedside lamp
• + Holding on to steering wheel during accident
• +Working in cramped area or overhead

O: E.S. Thoracolumbar aponeurosis, Posterior sacrum, iliac crest, lumbar & vertebrae
I: Posterior surface of ribs, thoracic and cervical vertebrae, mastoid process, nuchal line
A: Extend vertebral column; laterally flex vertebral column to same side
Nerve Innervation: Dorsal primary divisions of spinal nerves
O: QL; Posterior Iliac crest
I: 12 Ribs transverse process L1 thru L4
A: Lateral flexes vertebral column to same side
Elevate Hip (hip Hiker)
Nerve Innervation: Branches of 1st Lumbar & 12th Thoracic
Nickname: Lumbago or low back pain
Perpetuating factors
• Trauma (ex. Whiplash)
• Heavy lifting & holding and bending
• Carrying or sitting on thick wallet
• Immobility/Sitting
• Postural & structural asymentry
• Pelvis symmetry disturbance
• Flat feet
• LLLI Lower Leg Length Inequality
• Walking in cast
• Scoliosis, Lordosis (Swayback), Kyphosis (hunchback)
Note: Spasms in QL usually affect iliopsoas, so work on both
**Onset is like a lightning bolt
Due to referral pain to greater trochanter, client may not be able to lie on effected side.
Trigger points in QL often cause secondary in back & Abs & satellite trigger points in Gluteus medius and minimus

O/I Connects lumbar vertebrae to iliac crest
A: stabilization of said articulation
Nerve Innervation: Subcostal
Nickname: Joker of low back pain
Perpetuating factors
• Rising from a deep seated chair
• Putting on pants
• Major vehicle accident (mva)
• Gardening and scrubbing floor
• Vacuuming
• Walking or running on a slant
• Soft bed with a sag
• Leaning over with poor lumbar support
• Weak abdominal muscles
• Weak hip adductors

O: Anterior lateral of the scapula, lateral 1/3 of clavicle, acromion
I: Deltoid tuberosity
Action: All fibers; Abduct the shoulder
Anterior; Flex the shoulders
Medial rotate shoulder
Horizontally adduct shoulder
Posterior; Extend the shoulder
Laterally rotate the shoulder
Horizontally abduct
Nerve Innervation: Axillary from brachial plexus
Nickname: Doll Actor
Perpetuating factors:
• Gun Recoil
• Injections
• Excessive ski polling

O: Long head; supraglenoid tubercle of scapula
Short head; Coracoid process of scapula
I: Racial tuberosity
Bicipital aponeurosis
A: Flex supinated elbow
Supinate forearm
Flex shoulder
Nerve Innervation: Musculocutaneous
Nickname: Three Joint Motor
Perpetuating factors:
• Tennis backhand w/top spin
• Lifting w/arms extended
• Shoveling snow
• Elbow flexion
• Trigger point in supraspinatis
• Playing guitar