Trigger Point Location

Aka: Trigger Point Location, Trigger Area, Trigger Point Site, Trigger Zone

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II. Exam: Head and Neck Trigger Points

  1. Paraspinous Neck Muscles
    1. Refer pain to occiput
    2. Symptoms include retro-orbital Headache
    3. Muscle Components
      1. Splenius cervicis Muscle
      2. Semispinalis cervicis Muscle
      3. Rotatores cervicis Muscles
      4. Multifidus Muscle
  2. Upper Trapezius (most common region involved)
    1. Refer pain to neck and temporal forehead
  3. Sternocleidomastoid
    1. Associated with Otalgia and possibly Vertigo
    2. Associated with increased Lacrimation and Coryza
  4. Clavicle Musculature
    1. Referred pain across forehead and behind ear
  5. Sternal Musculature
    1. Referred pain into occiput, cheek and periorbital
    2. Mimics Sinusitis
  6. Splenius Capitis (cervical paraspinous Muscle)
    1. Referred Retro-orbital or temporal-orbital pain
    2. Symptoms include vertex Headache
  7. Peri-auricular Muscles
    1. Referred pain to teeth and jaw
    2. Muscle Components
      1. Temporalis Muscle
      2. Masseter Muscle
      3. Medial Pterygoid Muscle
      4. Lateral Pterygoid Muscle

III. Exam: Shoulder, Thorax, and Arm Trigger Points

  1. Anterior Serratus Muscle (lateral to Breast)
    1. Referred pain to lateral chest and Scapula border
    2. Related to decreased chest expansion
    3. May result in perceived Dyspnea
  2. Pectoralis Major Muscle and Pectoralis Minor Muscle
    1. Referred pain to Breast and ulnar arm
  3. Levator Scapulae Muscle (lateral Neck)
    1. Referred pain to base of neck
    2. Associated with neck stiffness
    3. Follows cervical Whiplash injury
    4. Associated with Mood Disorders
  4. Infraspinatus Muscle (lower Scapula)
    1. Referred pain to Shoulder joint and down upper arm
    2. Mimics Cervical Radiculopathy
  5. Supraspinatus Muscle (upper Scapula)
    1. Referred pain to middle deltoid and elbow
    2. Mimics Cervical Radiculopathy

IV. Exam: Back and Buttock Trigger Points (common source of pain)

  1. Quadratus Lumborum Muscle (above iliac crest)
    1. Referred pain to low back
  2. Iliocostalis Muscle (lateral paraspinous Muscle)
    1. Referred pain to lower quadrant of Abdomen
    2. Referred pain to buttock
  3. Gluteus Maximus Muscle
    1. Referred pain to Sacrum and inferior buttock

V. Exam: Thigh, Leg and Foot Trigger Points

  1. Quadriceps Femoris (anterior thigh quad Muscles)
    1. Rectus femoris referred to Patella and distal thigh
    2. Vastus intermedius referred to upper thigh
    3. Vastus medialis referred to medial knee
  2. Biceps Femoris (Hamstring Muscles)
    1. Referred pain to calf
  3. Gastrocnemius (superficial posterior calf)
    1. Referred pain to calf and foot instep
  4. Soleus (deep posterior calf)
    1. Referred pain to heel and to sacroiliac joint

VI. References

  1. Alvarez (2002) Am Fam Physician 65(4): 653-60 [PubMed]
  2. Fomby (1997) Phys Sportsmed 25(2):67-75 [PubMed]
  3. Shipton (2023) Am Fam Physician 107(2): 159-64 [PubMed]

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