TrP Location

Question 1

FLEXOR HALLUCIS BREVIS

Answer 1

The TrPs may be found in the centre of each of the two heads of this muscle.

Question 2

QUADRATUS PLANTAE

Answer 2

There is normally only one trigger point in this muscle which is in the belly of the muscle and proximal to the heel

Question 3

Quadratus Lumborum

Answer 3

There are 4 TrPs in this muscle, 2 are superficial and laterally located and 2 are deep and medially located. Each pair are horizontally parallel to their counterparts, with one TrP being superficial or inferior to the other in that pair.

Question 4

Flexor Hallucis Longus

Answer 4

One trigger point in approximately the muscle mid-belly.

Question 5

Lumbar Paraspinals – Iliocostalis Lumborum and Lx and Sx Multifidus

Answer 5

Iliocostalis Lumborum – In the lateral portion of the fibres in line with L1 just inferior to the costal margin and in line with T9-10
Multifidus – Adjacent to S4, S1 and L1

Question 6

EXTENSOR DIGITORUM BREVIS

Answer 6

1 in the proximal portion of the muscle

Question 7

ABDUCTOR HALLICIS

Answer 7

3 in a line along the length of the muscle

Question 8

Flexor Digitorum Longus

Answer 8

Trigger points in this muscle are found just distal to its origin

Question 9

Gluteus Maximus

Answer 9

There are three major MTrP sites in a C-shape along the sacrum to the ischial tuberosity:
MTrP 1 – most superior next to the sacrum
MTrP 2 – most common one located just above the ischial tuberosity
MTrP 3 – lower most medial aspect of the muscle close to the coccyx

Question 10

Gluteus Medius

Answer 10

Three main sites – all located just inferior to the illiac crest - posterior, middle and anterior

The patient is side-lying with the hips and knees flexed. A pillow is placed under the hip & between the knees.

MTrP 1 (posterior) is palpated via flat palpation

MTrPs 2 & 3 are palpated by rolling the muscle fibres against the underlying bone

Question 11

Gluteus Minimus

Answer 11

Anteriorly – usually 2 MTrPs medial to the border of TFL
Posteriorly – approximately 5 MTrPs along the muscles attachment to the ilium.

MTrPs in the gluteus medius muscle usually lie deep to the gluteus maximus and gluteus medius muscles. Therefore, taut bands are difficult to palpate, however, MTrP spot tenderness can be clearly located and frequently produce strong twitch responses.

Anterior MTrPs – patient is supine with the thigh extended. MTrPs are explored by palpating deeply anterior and then posterior to the TFL muscle just distal to the level of the ASIS.

Posterior MTrPs – Patient is side-lying with the uppermost thigh adducted and flexed to about 30 degrees. Flat or strumming palpation is used above the level of the piriformis line.

Question 12

Piriformis

Answer 12

1 Lateral TrP – just lateral to the junction of the middle & lateral 1/3 of the muscle closer to the greater trochanter
1 Medial TrP – just lateral to the lateral border of the sacrum over the region of the greater sciatic foramen

Question 13

Iliopsoas

Answer 13

Superior – in the psoas major/minor near the lumbar transverse of L3

Middle – in the iliacus muscle along the superior iliac fossa.

Inferior – in the iliospoas muscle along the lateral wall of the femoral triangle just above the muscles attachment to the lesser trochanter

Question 14

Tensor Fascia Latae

Answer 14

The trigger point in this muscle will normally be found in the centre of the muscle belly.

Question 15

Sartorius

Answer 15

Three MTrPs found superficially along the muscle belly in the proximal one-third, middle one-third and distal one-third of the muscle.

Question 16

Rectus Femoris

Answer 16

Proximally close to the AIIS

Question 17

Vastus Lateralis

Answer 17

5 MTrP zones in total located in 3 clusters:
Inferior part of the muscle (MTrPs 1 & 2) just above the insertion to the patella
Mid belly (MTrPs 3 & 4)
Superior part of the muscle (MTrP 5) just inferior to the greater trochanter

For MTrP palpation, the patient is supine with the leg relaxed in slight extension. The majority of the MTrPs can be found only by flat palpation directly against the underlying bone. The most distal MTrP responsible for patella locking is often found by depressing the patella inferiorly and medially.

Question 18

Vastus Medialis

Answer 18

Distal MTrP – above the medial superior border of the patella

Mid belly MTrP – approximately the mid-point of the muscle

Question 19

Biceps Femoris

Answer 19

Multiple in the distal portion of the muscle

Question 20

Semitendinosus

Answer 20

Multiple in the distal portion of the muscle

Question 21

Semimembranosus

Answer 21

Multiple in the distal portion of the muscle

Question 22

Adductor Longus & Brevis

Answer 22

1 trigger point found in the mid belly in both the adductor longus and brevis

Question 23

Adductor Magnus

Answer 23

Trigger point 1 is located in the mid-belly of the muscle and 2 is located more proximally closer to the ischial tuberosity (2 trigger points can be found here)

Question 24

Pectineus

Answer 24

1 trigger point found just distal to the superior ramus of the pubis.

Question 25

Gracilis

Answer 25

2 trigger points located about 1/3 and 2/3 along the muscle

Question 26

Gastrocnemius

Answer 26

There are four MTrPs in this muscle: 
Distal MTrPs (1 & 2) – located a few centimetres distally in the belly of the muscle
Proximal MTrPs (3 & 4) – located proximally behind the posterior knee near where the lateral and medial heads attach to the femoral condyle.

Question 27

Soleus

Answer 27

MTrP 1 – the most common TrP is situated 2-3cm to the distal end of the gastrocnemius belly and slightly medial to the midline of the leg.
MTrP 2 – less common and more proximal trigger point is situated high on the lateral side of the calf.
MTrP 3 – rarely found and lies slightly more proximal and lateral to the most common trigger point.

Palpation for the distal TrPs requires pincer palpation to both sides of the Achilles tendon with the patient in a prone or side-lying position with the ankle slightly elevated. The proximal TrPs require flat palpation against the underlying bone. These TrPs should be palpated with the knee flexed to about 90 degrees to release tension in the gastrocnemius and thus minimizing the likelihood of mistaking a TrP in the overlying gastrocnemius for a soleus TrP. This position allows gentle dorsiflexion of the ankle by the therapist to stretch the soleus and increase the sensitivity of the soleus TrPs.

Question 28

Peroneus Longus

Answer 28

2-4cm below the head of the fibula in the muscle’s proximal belly

Question 29

Peroneus Brevis

Answer 29

This trigger point lies distal to that of peroneus longus in the same line. TrPs usually lie at the junction of the middle and lower thirds of the muscle and can be found either side of the peroneus longus tendon.

Question 30

Tibialis Anterior

Answer 30

A MTrP occurs approximately one-third of the way down the leg from the knee and often lies deep in the muscle

Question 31

Extensor Hallucis Longus

Answer 31

Trigger points in this muscle tend to be in the belly of the muscle