TrP Referral

Question 1

FLEXOR HALLUCIS BREVIS

Answer 1

Mainly to the medial and plantar aspects of the first metatarsal head. Occasional spill over into the great toe and second toe.

Question 2

QUADRATUS PLANTAE

Answer 2

Generally refers pain strongly to the plantar surface of the heel

Question 3

Quadratus Lumborum

Answer 3

Posteriorly to the region of the sacroiliac joint and the lower buttock, sometimes anteriorly along the crest of the ilium to the adjacent lower quadrant of the abdomen and the groin, and to the greater trochanter. The pain is usually deep and aching, but may be lancinating during movement.

Question 4

Flexor Hallucis Longus

Answer 4

To the plantar surface of the great toe.

Question 5

Lumbar Paraspinals – Iliocostalis Lumborum and Lx and Sx Multifidus

Answer 5

Iliocostalis Lumborum – Lower back pain and pain into the inferior gluteal region, occasionally lower abdominal pain may be present
Multifidus – S4 referral is concentrated locally to the lower sacrum
S1 – Locally to lower back and down into the gluteals and upper hamstring region.
L1 – Upper lumbar area and into the adjacent upper abdominal quadrant.
Both muscles may be associated with abdominal cramps/irritable bowel symptoms.

Question 6

EXTENSOR DIGITORUM BREVIS

Answer 6

Locally to the dorsum of the foot

Question 7

ABDUCTOR HALLICIS

Answer 7

Predominantly to the medial aspect of the heel with spill over to the instep of the foot.

Question 8

Flexor Digitorum Longus

Answer 8

Primarily refer pain to the plantar surface of the foot just proximal to the toes. There may also be an associated spillover pattern, which refers pain to the plantar surface of the lesser toes and superiorly along the medial malleolus and the medial side of the calf.

Question 9

Gluteus Maximus

Answer 9

MTrP 1 – crescent shaped pain to the gluteal cleft, SIJ and above gluteal fold. Spillover to posterior thigh.

MTrP 2 – entire buttock, sacrum and below illiac crest. Presents with intense pain & patients may complain that “it’s like sitting on a nail”

MTrP 3 - coccyx

Question 10

Gluteus Medius

Answer 10

Posterior/Medial MTrP 1 – lower back, sacrum & SIJ

Middle TrP 2 – lateral buttock and inferior lateral region of buttock

Anterior/Lateral TrP 3 – sacrum, lumbar & illiac crest

Question 11

Gluteus Minimus

Answer 11

Anterior MTrPs – lower lateral buttock, the lateral thigh and knee, to the lateral lower leg as far as the lateral malleolus

Posterior MTrPs – deep pain to most of the buttock, posterior thigh and proximal posterior calf

Question 12

Piriformis

Answer 12

The pain patterns for both TrPs are similar – laterally across the buttock, over hip joint posteriorly, the sacroiliac region, the lateral border of the sacrum and the proximal 2/3 of posterior thigh.

Question 13

Iliopsoas

Answer 13

Superior MTrP – vertical ipsilateral low back pain

Middle MTrP – vertical ipsilateral low back pain and sacroiliac region

Inferior MTrP – low back, anteromedial aspect of the proximal thigh and groin

Question 14

Tensor Fascia Latae

Answer 14

Concentrates over the anterolateral thigh and greater trochanter. Pain may also be felt deep in the hip and down the lateral aspect of the thigh towards the knee.

Question 15

Sartorius

Answer 15

A burst of sharp, superficial tingling pain up and down the thigh medially. Not the usual deep aching pain characteristic of MTrPs.

Question 16

Rectus Femoris

Answer 16

Lower anterior thigh and anterior knee region, in and around the patella, sometimes deep to the knee joint

Question 17

Vastus Lateralis

Answer 17

Inferior MTrPs – locally, lower lateral thigh, lateral patella

Mid belly MTrPs – locally, entire lateral thigh, lateral base of the patella, posterior lateral popliteal fossa

Superior MTrPs - near the greater trochanter

Question 18

Vastus Medialis

Answer 18

Distal MTrP – refers pain to the front of the knee

Mid belly MTrP – refers aching pain over the anteromedial aspect of the knee and lower thigh

Question 19

Biceps Femoris

Answer 19

Deep aching pain in the posterior knee. Spillover zone to the upper calf and the posterior thigh

Question 20

Semitendinosus

Answer 20

The pain patterns for both the medial hamstring muscles are the same. The pain focuses on the gluteal fold & the ischial tuberosity.

Spillover zone is downward over medial region of posterior thigh, the back of the knee & sometimes to medial posterior calf

Question 21

Semimembranosus

Answer 21

The pain patterns for both the medial hamstring muscles are the same. The pain focuses on the gluteal fold & the ischial tuberosity. Spillover zone is downward over medial region of posterior thigh, the back of the knee & sometimes to medial posterior calf.

Question 22

Adductor Longus & Brevis

Answer 22

Travell and Simons (1993) do not distinguish between pain referral patterns of adductors longus and brevis. Proximally, pain is referred deep into the groin and the anteromedial portion of the upper thigh. Distally, pain is referred to the upper, medial aspect of the knee with a spill over referral down the medial tibia. Occasionally the pain may extend down the inner thigh to the medial aspect of the knee.

Question 23

Adductor Magnus

Answer 23

Trigger point 1 refers deep pain superiorly to the groin and inferiorly over the anteromedial aspect of the thigh.

When trigger point 2 in the adductor magnus is active it refers deep severe pain within the pelvis, which may include the pubic bone, vagina, rectum, or less commonly the bladder. This pain is often sharp and shooting in nature.

Question 24

Pectineus

Answer 24

Referred pain from the pectineus is experienced deeply in the groin and may also travel a short distance down the anteriomedial aspect of thigh.

Question 25

Gracilis

Answer 25

Produces a local, hot, stinging, superficial pain that travels up and down along the inside of the thigh

Question 26

Gastrocnemius

Answer 26

Referred pain tends to be localised in three of the trigger points, but MTrP 1 will refer pain primarily to the instep of the foot and to a lesser extent the posterior medial portion of the calf

Question 27

Soleus

Answer 27

MTrP 1 – refers pain to the posterior aspect and planter surface of the heel and also the distal end of the Achilles tendon. There may also be slight local pain.
MTrP 2 – refers diffuse pain in the upper half of the calf.
MTrP 3 – refers deep pain in the ipsilateral sacro-iliac joint.

Question 28

Peroneus Longus

Answer 28

Pain concentrates over the lateral malleolus of the ankle and a short distance along the lateral aspect of the foot with a spillover pattern covering the lateral aspect of the middle third of the leg. Pain from the peroneus longus and brevis are not differentiated

Question 29

Peroneus Brevis

Answer 29

Concentrates over the lateral malleolus of the ankle and a short distance along the lateral aspect of the foot with a spillover pattern covering the lateral aspect of the middle third of the leg (indistinguishable from peroneus longus)

Question 30

Tibialis Anterior

Answer 30

Big toe and the anteromedial ankle. Spillover pattern is downward from the MTrP site over the shin

Question 31

Extensor Hallucis Longus

Answer 31

Trigger points from this muscle refer pain to the base of the large toe. This pain may occasionally may extent from the large toe back towards the ankle and may feel it is actually in the bone.