Symptoms

Question 1

FLEXOR HALLUCIS BREVIS

Answer 1

intolerably sore feet, deep and aching at rest. The patients have a limited walking range and their friends may note that they tend to limp

Question 2

QUADRATUS PLANTAE

Answer 2

TrPs in this muscle will cause sharp pain in the heel that feels like you have bruised it stepping on a stone or it may even feel like a nail from a shoe is being driven in to the foot.
This pain may prevent the heel from being placed on the ground and the patient may have to walk on their toes

Question 3

Quadratus Lumborum

Answer 3

The pain from TrPs of the QL muscle causes immobilising back pain, continued pain on rest but is worse on movement or in positions where the lumbar spine is unsupported and the QL has to function, such as standing.

Question 4

Flexor Hallucis Longus

Answer 4

Patients with these trigger points commonly complain that they experience pain on walking.

Question 5

Lumbar Paraspinals – Iliocostalis Lumborum and Lx and Sx Multifidus

Answer 5

Lower back pain will be the most common complaint for these 2 muscles
Patient’s may feel like they need to crack their backs for relief
Mostly restricted in trunk flexion
May feel a stitch in the side of their lower back

Question 6

EXTENSOR DIGITORUM BREVIS

Answer 6

Pain

Question 7

ABDUCTOR HALLICIS

Answer 7

Pain

Question 8

Flexor Digitorum Longus

Answer 8

Patients with these trigger points commonly complain that they experience pain on walking.

Question 9

Gluteus Maximus

Answer 9

• Walking uphill, especially in the forward bent posture
• Vigorous contraction when in the shortened position such as when swimming. Patients have been known to have intense gluteus maximus cramps particularly when in cold water
• Sitting is uncomfortable and reproduces pain and tenderness due to direct pressure on the MTrPs

Question 10

Gluteus Medius

Answer 10

Low back pain and pain when walking.
Difficulty and pain when lying on your back, slouching in a chair or sleeping on the affected side due to compression of the MTrPs.

Question 11

Gluteus Minimus

Answer 11

“Pseudo-sciatica”
Pain when walking and running which may cause a limp, pain when getting in & out of a chair, pain when sleeping on the affected which frequently disturbs sleep. Pain when sleeping on the opposite side due to a stretch of the posterior fibres.
The pain can be constant and excruciating. The patient may not be able to find a stretching position that relieves pain and usually cannot lie down comfortably or walk normally.

Question 12

Piriformis

Answer 12

“Piriformis Syndrome” involving sciatic radiation, lumbago, and low back pain due the following contributing factors: piriformis MTrPs, sciatic nerve compression and SIJ dysfunction.
Symptoms are usually aggravated by sitting and a prolonged combination of hip flexion, adduction and medial rotation.

Question 13

Iliopsoas

Answer 13

• Low back pain that runs vertically up and down the spine when unilateral iliopsoas MTrPs are involved
• When there are bilateral iliopsoas MTrPs, the patient complains of pain running across the low back region
• Pain is worse when the patient is standing but there may be slight nagging pain when seated
• Thigh pain and tightness with associated low back pain
• Difficulty when rising from a chair and an inability to perform sit-ups
• The most comfortable positions in bed are side-lying in an almost foetal position or supine with the hips and knees flexed
• Loss of full hip extension

Question 14

Tensor Fascia Latae

Answer 14

Pain may feel like the sensation associated with trochanteric bursitis
Pain is more severe during hip movements
The pain prevents walking rapidly or lying comfortably on the affected side.
It may even interfere with the ability to sit with the hip fully flexed.
Patient’s prefer to stand with the hip in slight flexion and do not like to lean backward or extend the thigh.
Contracture in this muscle is associated with ‘snapping hip’

Question 15

Sartorius

Answer 15

Sharp superficial tingling pain that is only felt along the anteromedial thigh and not deep within the knee.
Entrapment (in the proximal fibres close to the ASIS) of the lateral femoral cutaneous nerve may produce symptoms of dysthesia or numbness on the anterolateral aspect of the thigh.

Question 16

Rectus Femoris

Answer 16

Knee pain and weakness when walking down stairs
Patients may be awakened at night by pain in front of the knee cap and just above it on the anterior thigh
Side-lying with the knee extended and the hip flexed is usually a painful position.
A buckling hip syndrome may present with the high rectus femoris TrP and a high Vastus Intermedius TrP

Question 17

Vastus Lateralis

Answer 17

• Lateral thigh and knee pain that is worse during walking or when lying on the involved side and that often disturbs sleep.
• Locking stiff patella
• Difficulty straightening or bending the knee particularly after getting up from a chair

Question 18

Vastus Medialis

Answer 18

ROM may be only minimally restricted, pain may not be present but dysfunction is common.
Initial symptoms are a pain feeling as though it is deep in the joint and it may interrupt sleep.
VM is known to be associated with ‘buckling’ knee episodes and a weakness in knee extension.

Question 19

Biceps Femoris

Answer 19

Patients may complain of pain on walking and may present with a limp due to compromised hip stability from TrPs.
When sitting, patients experience pain in the buttock, upper thigh and back of the knee due to pressure on the TrPs.
Pain is commonly experienced when getting out a chair particularly if they were sitting with crossed legs.
TrPs in the biceps femoris often wake patients at night with patients complaining of disturbed or non-restful sleep.

Question 20

Semitendinosus

Answer 20

Patients may complain of pain on walking and may present with a limp due to compromised hip stability from MTrPs.

When sitting, patients experience pain in the buttock, upper thigh and back of the knee due to pressure on the MTrPs.

Pain is commonly experienced when getting out of a chair particularly if they were sitting with crossed legs.

Question 21

Semimembranosus

Answer 21

Patients may complain of pain on walking and may present with a limp due to compromised hip stability from MTrPs.
When sitting, patients experience pain in the buttock, upper thigh and back of the knee due to pressure on the MTrPs.
Pain is commonly experienced when getting out a chair particularly if they were sitting with crossed legs.

Question 22

Adductor Longus & Brevis

Answer 22

Patients are usually aware of pain in the groin and medial thigh only during vigorous activity or muscular overload, rather than at rest. The pain is increased by weight bearing and by sudden twisting movements of the hip. Sometimes patients notice restricted lateral rotation of the thigh.

Question 23

Adductor Magnus

Answer 23

MTrP 1 – patients may complain of anteromedial thigh and groin pain
MTrP 2 – patients will complain of intrapelvic pain that may be specifically localised to the genitalia and rectum or may be described as somewhere deep inside

Patients frequently have difficulty positioning the lower limb comfortably at night and usually prefer to lie on the opposite side with the thigh horizontal and slightly flexed at the hip.

Question 24

Pectineus

Answer 24

Persistent, deep seated groin pain especially during weight bearing activities. Patients are likely to experience pain on abduction of the thigh especially if this occurs whilst weight-bearing. Patients may also demonstrate a limited range of motion when sitting cross-legged.

Question 25

Gracilis

Answer 25

The chief complaint is usually superficial, hot, stinging pain in the medial thigh. The pain is usually constant at rest and no change of position reduces the pain. Walking tends to relieve the pain present at rest.

Question 26

Gastrocnemius

Answer 26

Symptoms are usually pain in the back of the knee especially when carrying out tasks such as climbing steep slopes, walking on rocks, or slanted surfaces.
There is not usually weakness or restricted ROM. When the TrPs become active there is normally pain in the calf and sometimes in the back of the knee or the instep of the foot.
The two distal MTrPs are commonly associated with nocturnal calf cramps.

Question 27

Soleus

Answer 27

Heel pain and tenderness with restricted dorsiflexion
Pain that may be severe enough to cause restriction in walking especially uphill or up and down stairs
The heel may ache at night
Calf & foot pain with swelling of the ankle
Soleus MTrPs are one cause of growing pains in children.
The MTrPs in the soleus do not cause calf cramp, as do the MTrPs of gastrocnemius.
Patients develop back pain due to the restriction of ankle dorsiflexion which leads them to lean over and lift improperly.

Question 28

Peroneus Longus

Answer 28

Pain & tenderness in the ankle behind and over the lateral malleolus especially after an inversion sprain injury
Unstable ankles that are frequently and easily sprained
Entrapment of the peroneal nerve may cause foot drop and neural symptoms
Prone to ankle fractures

Question 29

Peroneus Brevis

Answer 29

Pain & tenderness in the ankle behind and over the lateral malleolus especially after an inversion sprain injury
Unstable ankles that are frequently and easily sprained
Entrapment of the peroneal nerve may cause foot drop and neural symptoms
Prone to ankle fractures

Question 30

Tibialis Anterior

Answer 30

Weakness of dorsiflexion when walking
Falls, dragging of the foot, tripping and balance problems
General weakness of the ankle
Painful motion and loss of function of the ankle joint
Patients usually don’t complain of night pain

Question 31

Extensor Hallucis Longus

Answer 31

Pain on the top of the foot that may extend to the MTP joints
Intermediate severity of dorsiflexion weakness
Nights cramps
Growing pains in children