Free Trigger Point Therapy for Myofascial Pain by L.M.T. L.Ac. Donna Finando Page A

supporting it with the palms of your hands. Palpate with the pads of the second, third, and fourth fingers, moving distally from the occiput toward the lower cervical region. Place your hands with your fingers lying in the direction of the long fibers of the muscles, adjacent to the spinous processes of the cervical vertebrae. Your fingers will be covering the region under which semispinalis capitis lies beneath the more superficial trapezius and splenius muscles. Deep, flat palpation will note thickened areas of muscle approximately 2 centimeters (inch) wide. Constrictions may be noted approximately 1 to 2 inches below the occiput and at the level of C4–5.

    Semispinalis capitis

    Semispinalis cervicis
    Posterior cervicals pain pattern
    Pain pattern: Proximal trigger point refers pain that encircles the head, reaching its maximum intensity at the temple and forehead over the eye. Intermediate trigger point refers pain over the occiput and toward the vertex. Distal trigger point (C4–5 area) refers pain and tenderness to the suboccipital region and down over the neck and upper part of the shoulder girdle. Symptoms include pain in the neck; restriction of head and neck flexion, with possibly some restriction of head and neck rotation and extension; and tenderness at the back of the head and neck.
    Causative or perpetuating factors: Sustained flexion of the neck (semispinalis cervicis) and of the neck and head (semispinalis capitis); sustained extension of the neck and head.
    Satellite trigger points: Bilateral posterior cervical muscles.
    Affected organ system: Vision.
    Associated zones, meridians, and points: Dorsal zone; Foot Tai Yang Bladder meridian; BL 10–17.
    Stretch exercise: Drop the head forward, aiming the chin for the chest. Allow the weight of the head, acting with gravity, to stretch the posterior neck muscles. In doing so the chin will reach the lowest possible level on the chest. It is important to try to avoid pulling the chin in toward the throat during this stretch.
    Strengthening exercise: Isometric against mild posterior resistance. Clasp the hands behind the head at the level of the nuchal line. Press the head and neck posteriorly against the mild resistance provided by the clasped hands.
    Stretch exercise: Posterior cervicals
    Temporalis and trigger points
    Temporalis pain pattern

T EMPORALIS
    Proximal attachment: Lateral skull in front of and above the ear in the temporal fossa.
    Distal attachment: Coronoid process of the mandible.
    Action: Elevation of the mandible, closing the jaw; posterior fibers act in retraction of the mandible. Acting unilaterally: deviation of the mandible to the same side.
    Palpation : To locate the temporalis, spread the fingers across the muscle just posterior to the temples and above the ears. Gentle compression of the rear teeth will produce contraction of the muscle, which will be easily experienced under the palpating hand
    Palpate temporalis moving caudal to its attachment at the coronoid process of the mandible. With the mouth relaxed and open, identify trigger points in various portions of the belly of the muscle using a cross-fiber palpating technique. Trigger points that occur at the junction of the muscle fibers and its distal attachment may be found approximately 1 inch above the zygomatic arch.
    Pain pattern: Temporal headache and maxillary toothache. Pain extends over the temporal region to the eyebrow, the upper teeth, and occasionally to the maxilla and the temporomandibular joint (TMJ). Trigger points can refer pain, tenderness, and hypersensitivity of the upper teeth to hot, cold, and pressure. Patients rarely complain of restricted jaw movement.
    Causative or perpetuating factors: Excessive forward head posture; overuse of the muscle due to gum chewing, jaw clenching, or bruxism; chronic overuse due to an anteriorly displaced temporomandibular joint disc; direct trauma to the muscle caused from a fall or impact to the side of the head; secondary