Trigger Point Guide                                    Theory
Karri Koivula
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       Disclaimer
       Huge effort is made that this book represents generally accepted medical practises and that
       this information doesn’t pose a risks for anybody who uses it.
       But it is very important that you realize that you read this book at your own risk.
       All material provided in this e-book is for informational and educational purposes only, and not
       to be construed as medical advice.
       No action should be taken solely based on this e-book
       Absolutely consult you physician before you take any actions related to your you health
       By downloading/reading this book
       You understand and agree that in no event shall the author nor the publisher of this e-book be liable
       to you or any other user of this e-book for the use of the information.
       Statements mentioned within this e-book are not intended to diagnose, treat, cure or prevent
       any disease.
       The statements made within this e-book have not been evaluated by the Food and Drug
       Administration.
       If you don’t understand or agree these terms then please quit reading this book right now and
       delete this book from your computer.
       Thanks.
       Copyright notice
       It’s illegal to copy any material from this book and distribute it.
       I regularly search the internet for illegal copies.
       And I will press criminal charges against those who illegally distribute it.
       Copyright. 2004 Karri Koivula
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       Start here
       Foreword
       The focus here is in practical advice.
       The bottom line,
       And all that matters,
       Is that trigger points cause referred pain,
       And that they “relax” trough massage.
       And that the pain symptoms they cause will vanish along them…
       Call to action
       Read some theory below then go to the pain patterns section and…
       Look at the body part pictures and try to pin point your pain, then look at the muscle pain index and
       see which muscles are generally involved.
       Then go to work, use the side menu to easily jump to what ever muscles you need to massage, and
       use the pictures and written guidelines if any to get the job done.
       Theory section starts
       Trigger points are hyper contracted bundles of muscle cells. Also because of this contraction there
       are taut bands of stretched muscle attached to these contraction knots that run to both directions and
       end up in the muscles attachments points.
       Putting pressure on the trigger point will eventually make them relax.
       Even pressing at the taut band can make this happen as it forces a stretch to the contracted knots
       that are in the center.
       But for best effect you want to aim center.
       you’ll locate the center/trigger point by its pressure tenderness, pressing it moderate/hard force
       should cause noticeable pain both ate the spot and in the pain referral zone.
       You can test this by pressing a spot few centimetres of the spot, and see that you can barely feel the
       pressing.
       Normal muscle tissue can take a lot of force applied to it; until you start to feel even slight
       discomfort.
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       Trigger point identification -important
       Pressure tender spot
       Spot that hurts to press
       Twitch reaction
       When you press the spot or taut band you can feel the taut band to twitch violently.
       It’s good indicator from trigger points, but it doesn’t happen, or you can’t always feel it.
       Reappearing of referred pain symptom
       When you press the tp you feel something on the actual pain zone were the symptom that bothers
       you exists.
       Sometimes it’s the exact feeling of the pain but most cases you just feel some weird sensations in
       the general area of you pain zone.
       Brief massage guide lines
       Find the spot and the direction of applying pressure massage that hurts the most.
       Massage multiple short session though out the day.
       As long as it takes for the spots to become none-tender, or as long as it takes to get relief.
       This will in most cases take weeks.
       Ways to massage
       Repetitive stroke massage or continuous pressure
       Il like the best from continuous pressure applied by tool and using bodyweight for applying the
       pressure. It’s the lazy person’s way to do it and works just perfect.
       Continuous pressure
       Hold 8-15 seconds pressure move to another spot come back later repeat about 2-3 per spot 2-5
       times per day
       Massage
       Massage 10 strokes move to another spot come back repeat 2-3 times per spot 6-10 times per day
       There are no rules once you get the hang of it youll make you own system.
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       Case example
       Acute pain phase
       Massages points in many sessions a day for two weeks
       Holy smoke I am full of these buggers it seems that every inc of my body is is a tender spot.
       Pain symptoms regress backwards old injuries start to feel again maybe resulting in more pain.
       My muscles are twitching like there no tomorrow.
       Where is this all going to lead..
       Then every other day for couple of weeks
       Things start to normalize
       I got to tell everybody about this.
       This is pretty cool, why the doctors didn’t tell me about this.
       Upkeep/ maintenance
       Then once a week, or when needed.
       Massage is getting boring but some of the points are still a bit tender, although generally it gets
       harder and harder to find them
       Then once a moth, one session holding for 5 seconds,per spot.
       I’m so lazy I should do the massage more often.
       Some spots may get tender but they don’t seem to cause those old referred pain symptoms,
       strange…
       Where I ever in pain? It seems so distant…
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       Pain shift - important
       What you get is a pain shift or the pain gets worse.
       You can aggravate the current tp and your pain symptom worsens this is common although it
       doesn’t seem to postpone the relaxation of the tp.
       Which is bit odd, but that’s the practice of things.
       And thus some use very rough methods from the beginning to get things handled as quickly as
       possible and suffer a little extra pain.
       Pain shift can be like going back in time.
       Pain shift happens when the pull of the muscles changes and it flares old latent trigger points.
       For example if you hurt you foot and got longstanding knee pain that eventually settled in you hip.
       You can experience the same knee pain again as the trigger point will flare upp again as the balance
       between the pull of the muscles changes as you massage tps.
       But at this point don’t call me and get angry at me but continue to massage the points that are
       responsible of this newly appeared symptom.
       They should vanish eventually.
       I don’t know a case where this pain shift or regression back to old symptoms haven’t vanished-
       I don’t see any logic reasons for this but realize that there is a risk for this.
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       Trigger Point Guide                                    Pain patterns
                                                              Karri Koivula
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       Index
       1. Head and neck pain
       2. Upper back, shoulder, upper arm pain
       3. Middle back, lower back ,hip and buttock pain
       4. Chest, abdominal and groin pain ,
       5. hip, thigh, knee pain
       6. Leg and ankle pain
       7. Foot pain
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       Head and Neck pain
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                                                      Eye area pain
                                                      Sternocleidomastoid
                                                      Temporalis
       I pain/muscle index                            slpenius cervicis
                                                      massater
                                                      occipitalis
       Top of head                                    orbicularis oculi
       sternocleidomastoid                            suboccipital group
       splenius capitis                               trapezius
       Back of head pain                              Ear and chin joint pain
       Trapezius                                      sternocleidomastoid
       sternocleidomastoid                            massater
       semispinalis capitis                           lateral pterygoid
       semispinalis cervicis                          trapezius
       splenius cervicis                              buccinator
       suboccipital group                             Platysma
       occipitalis                                    orbicularis oculi
       digastric                                      zygomataticus major
       temporalis                                     digastric
                                                      medial pterygoid
       Side of head
       Trapezius                                      Tooth pain
       sternocleidomastoid                            temporalis
       temporalis                                     massater
       splenius cervicis                              digastric
       suboccipital group
       semispinalis capitis
                                                      Back of neck
                                                      Trapezius
       Front of head                                  multifidi
       sternocleidomastoid                            levator scapulae
       Frontalis                                      splenius cervicsis
       zygomaticus major
       semispinalis capitis                           Front of neck
                                                      sternocleidomastoid
                                                      digastric
       korva ja leuka nivel                           medial pterygoid
       särky
       lateral pterygoid
       massater
       sternocleidomastoid
       medial pterygoid
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       Trapezius
       Use Stick and tennis ball against the wall.
       Picture:
       For trigger points, lower down in the trapezius, lye down in the floor and use
       tennis ball and use it to apply the pressure and find the right spots.
       picture:
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       Sternocleidomastoid
       Just grab the muscle like in I am doing, bend the head to the side you are
       pinching the muscle to give it some slack and make it easier to grab.
       Just go trough the whole muscle pinch gripping it and find the trigger points.
       The muscle two branches on top of each others, you can see them divide in the
       lower attachment point.
       But for the most part of the muscle you don’t have to distinguish them.
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       Temporalis
       Use your knuckles or some hard tool to locate temporal trigger points.
       But go easy on them.
       Its really spooky kind of pain that they can make and reappear when pressed.
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       massater
       I find it helpful to press little towards ears to hit the muscle in right direction.
       Use fingers, knuckles or tool
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       Splenius Capitis                       Splenius Cervcis
       Tool against wall or against floor.
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       Semispinalis Capitis
       Tool against wall or against floor.
                                                 10
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       multifidi , rotatores
       Tennis ball is too big to hit the trigger points but some tool that is smaller
       works fine.
       Be little extra careful when applying pressure near vertebrae, use common
       sense.
       To be extra cautious use tool with your hands not against floor or wall-
       Buccinator
                                                 11
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       It refers pain to the teeth near the muscle
       Use your fingers for pressure
       Lateral pterygoid
                                                 12
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       The x is the trigger point spot and grey areas on both side it the referred pain
       areas.
       use fingers to locate and hit the spot.
       Medial pterygoid
       To reach this muscle you need to press it from below your chin.
       It is on the x spot
       orbicularis oculi
                                                 13
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       No it’s not the Frankenstein’s bride wearing an eye patch, even thou it kind of
       a looks like it.
       The pain pattern is the grey shadow that seems to sculpt the nose and the
       trigger point is the small x just in the eye brow line or little below, like it is in
       this case.
       Just track down the bones around the eye looking for tender points.
       The black patch describes the muscle.
       zygomaticus, levator labii
                                                 14
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       Indian war painting, or maybe not.
       Use fingers to locate and aply pressure
                                                 15
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       digastric
       Again you need to venture to the underneath of the chin.
       Use fingers an to search tender spots and referred pain.
                                                 16
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       frontalis                       occipital
       Move your eyebrows and try to wiggle your ear can you feel the occipital
       muscle in the back of your head.
       Fingers, knuckles or a tool there aren’t any rules.
       suboccipitalis
       Use a tool to reach the muscle easily, against wall if necessary.
                                                 17
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       Upper back, shoulder, upper arm
                                                 18
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                                                      teres minor
       Index II                                       subscapularis
                                                       serratus posterior superior
                                                      triceps brachii
       Upper back pain                                trapezius
                                                      scaleni
       Scaleni                                        lats
       levatorscapulae                                erector spinae
       trapezius
       multifidi                                      Shoulder front
       splenius cervicis
       supraspinatus                                  infraspinatus
       rhombodei                                      deltoid
       triceps brachii                                scaleni
       biceps brachii                                 supraspinatus
                                                      pectoralis major
       Back of shoulder                               pectoralis minor
                                                      biceps brachii
       deltoid                                        coracobrachialis
       levator scapulae                               sternalis
       supraspinatus                                  subclavius
       teres major
       latissimus dorsi                               scaleni
                                                      biceps brachii
       Back of upper arm                              triceps brachii
       scaleni
       teres major                                    subclavius
       triceps brachii                                supraspinatus
       deltoid                                        sternalis
       subscapularis                                  infraspinatus
       supraspinatus                                  Deltoid
       teres minor                                    brachialis
       latissimus dorsi                                latissimus
       serratus posterior superioir                   dorsi
       coracobrachialis
       scalenus minimus
       Front of upper arm
                                                 19
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       scalanes
       Locate your collar bone use your fingers o pull to the collar bone.
                                                 20
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       trapezius
       Tennis ball or similar tool against the floor is the way to go, just lye on it and
       move it to the tenderest spots and hold for awhile.
                                                 21
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       Levator Scapulae
       Tennis ball or similar tool against the floor is the way to go, just lye on it and
       move it to the tenderest spots and hold for awhile.
                                                 22
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       Latissimus Dorsi
       Tennis ball or similar tool against the floor is the way to go, just lye on it and
       move it to the tenderest spots and hold for awhile.
                                                 23
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       Rhomboid
       Tennis ball or similar tool against the floor is the way to go, just lye on it and
       move it to the tenderest spots and hold for awhile.
       Serratus posterior superior
                                                 24
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       supraspinatus
       Stick as a tool is great to reach this, tennis ball on the floor can
       work also.
       infraspinatus
       Tennis ball or similar tool against the floor is the way to go, just lye on it and
       move it to the tenderest spots and hold for awhile.
                                                 25
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       Teres Minor
       Teres Major
                                                 26
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       Subscapularis
       coracobrachialis
                                                 27
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       deltoid
                                                 28
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       Triceps
       Biceps
                                                 29
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       Middle back, lower back, hip and buttocks/sacral pain
                                                 30
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       Index III                                      hamstrings
                                                      soleus
       Middle back pain
                                                      Buttock/sacral pain
       spinae erectors
       multifidi rotatores                            quadratus lumborum
       rectus abdomis                                 erector spinae
       serratus anterior                              gluteus minimus
       serratus posterior inferior                    gluteus medius
       latissimus dorsi                               gluteus maximus
       intercostals                                   piriformis
                                                      hamstring
       Lower back pain                                soleus
       gluteus medius
       gluteus maximus                                Hip pain
       gluteus minimus
       psoas                                          quadreceps vastus lateralis
       multifidi rotators (syvät                      gluteus minimus
       elkälihakset)                                  gluteus maximus.
       spinae erectors (                              piriformis
       pinnalliset selkälihakset)                     quadratus lumborum
       quadratus lumborum                             tensor fasciae latae
       rectus abdomis
       obiliques
                                                 31
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       Gluteus maximus
                                                 32
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       Gluteus medius
       Gluteus minimus
                                                 33
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       piriformis
       Quadratus lumborum
                                                 34
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       Spinae erectors & multifidi ja rotatores
        Rectus abdomis
                                                 35
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       liopsoas
       obiliques
                                                 36
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       Hamstring
                                                 37
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       Chest, abdominal, genital pain
                                                 38
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                                                      latissimus dorsidiaphgram
       Index IV                                       Abdominal pain
       Chest pain                                     rectus abdomis
       pectorals                                      abdominal obliques
       scalenes                                       superficial spinal muscles
       sternocleidomastoid                            deep spinal muscles
       sternalis                                      quadratus lumborum
       intercostals
       superficial spinal muscles                     Groin pain
       subclavius
       rectus abdomis                                 Rectus abdomis
       diaphgram                                      Abdominal obiliques
                                                      intrapelvic muscles
       Side pain                                      adductor magnus
       serratus anterior                              psoas
       abdominal obiliques                            piriformis
       intercostals
                                                 39
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       Pectorals
                                                 40
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       Serratus anterior
       Latissimus Dorsi
                                                 41
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       Rectus abdomis
       Obiliques
                                                 42
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       Hip, thigh, knee pain
                                                 43
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       Index V                                        rectus femoris
                                                      vastus medialis
                                                      abductor longus
       Groin Pain
       pectineus                                      Inner knee
       abductor longus                                vastus medialis
       abductor magnus                                gracilis
       rectus abdominis                               rectus femoris
       abdominal obiliques                            sartorius
       psoap intrapelvi muscles                       adductor longus
                                                      Outer knee
                                                      vastus lateralis
       Hip pain
       gluteus minimus
                                                      Back of thigh
                                                      gluteus minimus
       vastus lateralis
                                                      semitendinosus
        piriformis
                                                      biceps femoris
       qiadratus lumborum
                                                      piriformis
       tensor fasciae latae
                                                      intrapelvi muscles
       vastus intermedialis
       gluteus maximus                                Inner thigh
                                                      pectineus
                                                      vastus medialis
                                                      grazilis
       Front thigh pain                               adductor magnus
       Abductor longus
                                                      Back of knee
       psoas
                                                      gastrocnemius
       abducto magnus
                                                      biceps femoris
       vastus intermedialis                           popliteus
       pectineus                                      semiteninosus
       sartorius
                                                      semimembranus
       quadratus lumborum                             soleus
       rectus abdominis                               plantaris
       Front of knee
                                                 44
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       Tensor latia fascae               Vastus intermedialis
                                                 45
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       Vastus medialis
                                                 46
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       Rectus femoris
       vastus lateralis
                                                 47
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       Pectineus
                                                 48
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       Abductor brevis               Abductor longus
                                                 49
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       Abductor magnus
       Gracialis
                                                 50
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       Hamstrings
                                                 51
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       plantaris                                      Popliteus
                                                 52
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       Leg and ankle pain
                                                 53
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                                                      Side of leg
       Index VI                                       Gastrocnemius
                                                      gluteus minimus
                                                      peroneus longus
       Front of leg
                                                      peroneus brevis
       Tibialis anterior
                                                      vastus lateralis
       adductor longus
                                                      inner ankle
       Front of foot
                                                      Abductor hallucis
       tibialis anterior
                                                      flexor digitorum lonngus
       peroneus tertius
       extensor digitorum longus
                                                      outer ankle
                                                      peroneus     longus
       Back of leg
                                                      peroneus     brevis
       Soleus
                                                      peroneus     tertius
       gluteus minimus
                                                      abductoe     digiti minimi
       gastronomicus
       semitendinosus
       semimembranus                                  back of ankle
                                                      soleus
       flexor digitorum longus                        tibialis posterior
       tibialis posterior
       Plantaris
                                                 54
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       tibialis anterior
       extensor hallucis longus            &      extensor digitorum
                                                 55
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       peroneus longus           &       Peroneus brevis
       peroneus tertius
                                                 56
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       gastrocnemius
                                                 57
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       soleus
       tibialis posterior
                                                 58
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       Flexor digitorum longus & flexor hallucis longus
                                                 59
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       Foot pain
                                                 60
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       Index VII
       Top of foot                                    Bottom of the foot Front
       extensor digitorum brevis                      flexor hallucis brevis
       extensor hallucis brevis                       flexor digitorum brevis
       extensor digitorum longus                      adductor hallucis
       extensor hallucis longus                       flexor hallucis longus
       flexor hallucis brevis                         interosseus
       interosseus                                    abductor digiti minimi
       tibialis anterior                              flexor digitorum longus
                                                      tibialis posterior
       Big toe                                        flexor digigti minimi brevis
       top
       tibialis anterior
       extensor hallucis longus                       Bottom of the foot
       flexor hallucis brevis                         middle
       under                                          gastrocnemius
       flexor hallucis longus                         flexor digitorum longus
       flexor hallucis brevis                         adductor hallucis
       tibialis posterior                             soleus
                                                      interoseus
       Other toes                                     tibislis posterior
       top
       interosseus                                    Heel pain
       extensor digitorum longus                      soleus quadratus palnatae
       under                                          abductor hallucis
       flexor digitorum longus                        tibialis posterior
       tibialis posterior                             abductor digiti minimi
                                                 61
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       Extensor digitorum brevis & extensor hallucis brevis
       introsseus
       Abductor hallucis
                                                 62
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       abductor digiti minimi
       flexor digitorum brevis
       quadratus plantae
                                                 63
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       Abductor hallucis & flexor hallucis brevi
       Flexor digiti mininmi brevis
                                                 64
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       Elbow, arm, wrist, hand pain
                                                 65
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       Index VIII
       Elbow                                          Wrist outer arm
                                                      extensors
       supinator                                      subsscapulari
       brachioradialis                                sascalenes
       extensor                                       latissimus dorsi
       anconeus                                       serratus posterior superior
       triceps brachii                                coracobrachialis
       supraspinatus
       pectoralis major                               Wrist inner hand pain
       serratus anterior
       serratus posterior superior                    flexors
                                                      palmaris longus
       Outer elbow                                    pronator teres
                                                      opopnens pollicis
       trticeps                                       pectorals
       scalanes                                        latissimus dorsi
       extensors                                      serratus anterior
       brachioradialis
       brachialis                                     Inner finger pain
       flexors
       infraspinatus                                  flexores digitorum
       teres major                                    superficialis and profundus
       cocabrachialis                                 introssei abductor digiti
       supraspinatus                                  minimi
       subclavius                                     lats
                                                      serratus
       Inner elbow pain                               subclavius
       palmaris longus                                Top of finger pain
       pronator teres
       serratus anterior                              extensor digitorum
       triceps brachii                                introssei
       latissimus dorsi                               scalene
       pectoralis major                               abductor digiti mininimi
       serratus posterioer superior                   pectorals
                                                 66
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       lats
       subclavius
                                                      Thumb pain
                                                      supinator
                                                      scalene brachialis
                                                      brachioradialis
                                                      opponenns pollicis
                                                      abductor pollicis
                                                      extensor carpi radialis longus
                                                      first dorsal introsseus
                                                      flexor pollicis longus
                                                      subclavius
                                                      infraspinatus
                                                      brachialis
                                                 67
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       extensor carpi radialis longus
       brachioradialis
                                                 68
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       supinator
       extensor carpi radialis brevis
                                                 69
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       extensor carpi ulnaris
       anconeus
                                                 70
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       extensor digitorum
       Extensor indicis
                                                 71
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       flexor carpi radialis
       flexor carpi ulnaris
                                                 72
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       palmaris longus
       flexor digitorum
                                                 73
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       pronator teres & pronator quadratus
       flexor pollicis longus
                                                 74
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       opponens pollicis & abductor pollicis
                                                 75
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       introsseus
                                                 76
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