DDx

Question 1

FLEXOR HALLUCIS BREVIS

Answer 1

Flexor hallucis brevis TrPs refer pain and tenderness mainly to the region of the head of the first metatarsal with only a spillover pat-
tern to the great toe, whereas TrPs in the tibialis anterior muscle refer primarily to the great toe itself. The extensor hallucis longus TrPs refer only to the dorsal side of the head of the first metatarsal bone, and not to the medial and plantar sides as does the flexor hallucis brevis. The re- ferred pain pattern of the flexor hallucis longus TrPs usually includes only the plantar surface of both the first metatarsal head and the great toe.

Question 2

QUADRATUS PLANTAE

Answer 2

This pain is often mistaken for plantar fasciitis or falsely blamed on a heel spur. Associated trigger points may also cause similar pains.

Question 3

Quadratus Lumborum

Answer 3

TrPs from other mucles such as:
Longisimus thoracis and multifidi (buttock and SIJ)
Psoas (low back)
Lower rectus abdominus (low back)
Gluteus maximus (low back and SIJ)
Soleus (SIJ) *not common
SIJ dysfunction
Gluteus medius tendonopathy
Trochanteric bursitis
TP fracture

Question 4

Flexor Hallucis Longus

Answer 4

L5 Radiculopathy

Question 5

Lumbar Paraspinals – Iliocostalis Lumborum and Lx and Sx Multifidus

Answer 5

QL, glute med, piriformis TrPs
Lx facet sprain
Sciatica
Spondylolithesis
Spondylisis
SIJ dysfunction
Lx arthritis

Question 6

EXTENSOR DIGITORUM BREVIS

Answer 6

Plantar Faciopathy, fracture of MT, Tarsal tunnel syndrome,

Question 7

ABDUCTOR HALLICIS

Answer 7

Plantar Faciopathy

Question 8

Flexor Digitorum Longus

Answer 8

L5 Radiculopathy, Tarsal tunnel syndrome

Question 9

Gluteus Maximus

Answer 9

Sacroiliac joint displacement, radicular pathology, trochanteric bursitis, associated trigger points.

Question 10

Gluteus Medius

Answer 10

Radiculopathy, hip pathology, associated trigger points, SIJ dysfunction or disease

Question 11

Gluteus Minimus

Answer 11

Sciatic nerve entrapment.
Anterior TrP referral is similar to L5 radiculopathy.
Posterior TrP referral is similar to S1 radiculopathy.
TrP pain is dull and persistent; radiculopathic pain is sharp, electric-shock, burning in quality. Radiculopathy would also present with a neurologic deficit.

Question 12

Piriformis

Answer 12

Sciatica, pain from associated trigger points, lumbar or sacral disc herniation, spinal stenosis, facet joint syndrome or hip pathology, hip osteoarthritis.

Question 13

Iliopsoas

Answer 13

LBP from TrPs in QL, lower rectus abdominus, rotators, or gluteus maximus. Thigh or grain pain due to TrPs in lower musculature. Iliopsoas bursitis.

Question 14

Tensor Fascia Latae

Answer 14

Trochanteric bursitis, associated trigger points, hip pathology.

Question 15

Sartorius

Answer 15

• TrPs of VMO, but more superficial compared with the deep pain of VMO
• Knee pathology

Question 16

Rectus Femoris

Answer 16

Pain and weakness in the quadriceps are easily mistaken for tendonitis, bursitis, arthritis of the knee, damaged ligaments or meniscus cartilage.

Question 17

Vastus Lateralis

Answer 17

Pain and weakness in the quadriceps are easily mistaken for tendinopathy, bursitis, arthritis of the knee, damaged ligaments or meniscus cartilage. Pain from active trigger points is experienced at various locations relative to the muscle most involved.

Question 18

Vastus Medialis

Answer 18

Pain and weakness in the quadriceps are easily mistaken for tendonitis, bursitis, arthritis of the knee, damaged ligaments or meniscus cartilage, Saphenous nerve entrapment

Question 19

Biceps Femoris

Answer 19

Bursitis, sciatica, associated trigger points trigger points, osteoarthritis of the knee.

Question 20

Semitendinosus

Answer 20

Bursitis (ischial tuberosity), sciatica, associated trigger points

Question 21

Semimembranosus

Answer 21

Bursitis (ischial tuberosity), sciatica, associated trigger points trigger points.

Question 22

Adductor Longus & Brevis

Answer 22

Osteoarthritis of the hip is a common cause of hip pain in older adults and causes pain similar to that produced by TrPs, however arthritis pain is different in that it is felt more in the outer hip than in the inner thigh.

Pubic symphys pathology, adductor insertion avulsion syndrome, FAI or hip joint pathology.

Question 23

Adductor Magnus

Answer 23

Unawareness of myofascial causes of internal pelvic pain can lead to misdirected treatment including surgery. Inguinal hernia, pubic symphysitis, pubic stress fracture, adductor insertion avulsion syndrome

Question 24

Pectineus

Answer 24

Disease or surgery affecting the hip joint, such as a hip replacement.
Possible visceral or gynecological disease.
Unawareness of myofascial causes of internal pelvic pain that can lead to misdirected treatment including surgery.
Pubic symphysitis. Psoas tendinopathy.

Question 25

Gracilis

Answer 25

None

Question 26

Gastrocnemius

Answer 26

‘Tennis leg’, posterior compartment syndrome, phlebitis, popliteal synovial (Baker’s) cyst, DVT.

Question 27

Soleus

Answer 27

Popiteal synovial (Baker's) cyst, Achilles tendonitis and retrocalcaneal bursitis are likely to be confused with referred pain from the soleus muscle.
Plantar fasciitis, soleus periostalgia syndrome, stress fracture, DVT.

Question 28

Peroneus Longus

Answer 28

Anterior compartment syndrome, pain referred from associated TrPs, entrapment of the peroneal nerve, lateral compartment syndrome, ankle sprain.

Question 29

Peroneus Brevis

Answer 29

Anterior Compartment syndrome, pain referred from associated TrPs, entrapment of the peroneal nerve, lateral compartment syndrome, ankle sprain.

Question 30

Tibialis Anterior

Answer 30

Gout of the great toe, sprained ankle, anterior compartment syndrome, ‘shin splints’.

Question 31

Extensor Hallucis Longus

Answer 31

Anterior compartment syndrome, pain from synovial joints of the tarsal bones.