Learn How to Manage Your
Trigger Points
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What is a Trigger Point (TrP)?
 A trigger point is a hyperirritable spot located in a taut band of skeletal muscle. They may form
following a sudden trauma or may develop on a more gradual basis.
 Trigger points can be classified as either active or latent.
Active Trigger Points
Latent Trigger Points

Starts with some impact to the
muscle, such as injury.


Typically caused by poor posture,
poor body mechanics, repetitive
use, nerve root irritation.
Will refer pain or other
sensations, leading to decreased
range of motion
At some point, may stop referring
pain and become latent.
The more frequent and intense
pain, the greater number of active
trigger points present.
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
Can develop gradually without
being active first; often times, you
don’t even know they are there.
Present in most people, and can be
easily converted to active trigger
points.
No pain will be present, however,
may have decreased range of
motion and weakness
 The following factors are the main causes for trigger points to occur:
- Mechanical stresses caused by improper ergonomics, body mechanics, and clothing
- Injuries
- Nutritional problems
- Emotional factors
- Sleep problems
- Acute or chronic infections
- Other medical conditions
Characteristics of a Trigger Point:
 Tenderness, knots, and tight bands in the muscle
- When pressed, trigger points are very tender.
- Typically, the pain is variable, depending on the amount of stressed placed on the muscles
 Weakness, muscle fatigue, joint stiffness
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The presence of trigger points can lead to weakness and loss of coordination. May lead to
inability to use the muscle.
 Referred pain
- Pain may be evident at both the area in which the trigger point is located as well as in other
areas of the body. This is known as referral patterns.
- Approximately 55% of found trigger points are not located with the area of referred pain.
Managing Trigger Points
1. First, figure out what you are doing to aggravate or cause the TrP. Even if it was originally caused
by an injury, if that injury was more than 6 weeks ago, there must be habits or postures that
aggravate the muscle, preventing it from healing.
2. Next, don't try to strengthen the muscle, even though it might be weak. TrP are weak because of
the neuromuscular problem, not because the muscle has atrophied. Attempting to strengthen the
muscle without first treating the TrP will typically cause the muscle to stay weak, or even to get
weaker. When the TrP subsides, much of the strength will usually come back without any
strengthening exercise, and it is then safe to do more strengthening.
3. Use ice or heat. While heat always feels better when it is on, think about whether your muscle feels
better after you take the heat off; if not, consider switching to ice. While ice does not always feel as
comfortable when it is on, it often relieves the muscle spasm much more effectively than heat.
Make sure you are applying the ice or heat to the source of the pain (the TrP) rather than the
referred pain distribution. TENS can also be helpful.
4. Use pressure point treatment – sometimes called 'ischemic compression' by applying localized
pressure to the TrP for 30-90 seconds; you should feel the spasm 'melt' away. You can use your
thumbs, a special cane (e.g., a TheraCane) with knobs, tennis balls or special bumpy balls or
various knobby gadgets.
5. Stretch the muscle slowly and carefully.
6. Strengthen only after the TrP pain has resolved.
7. Physical therapists can use a variety of manual therapy techniques to help resolve TrP.
8. Finally, physicians can do trigger point injections if nothing else works. You still need to learn to
manage your TrP so that they do not keep returning.
DOs and DON’Ts for Applying Self-Pressure
DOs:
 Use a variety of equipment such as tennis balls, golf balls, baseballs, theracanes, reflex balls,
your elbows, hands, and fingers.
 Apply pressure for adequate time
 An uncomfortable pain is normal, but it should not be so painful that it would cause you to hold
your breath or tense up.
 Search entire muscle for tender points to locate areas of maximum tenderness
 Be sure to address both sides of the body to treat and relax the muscles symmetrically, but
spend the most time on the areas that need attention more.
 Work in the direction of the referral pattern. Start directly over the trigger point and work
towards location of pain.
 If only limited time is available, work on one areas thoroughly rather than rushing through
 Perform stretching after working on your trigger points
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


Try to work on your trigger points at least once per day.
If you have questions, if your symptoms worsen, or you are sore for more than one day stop
your current self-care and seek guidance from a therapist.
Have trigger point equipment readily available while traveling, as many trigger points are
irritated when sitting for long periods of time.
DON’Ts:
 Apply pressures over locations such as varicose veins, open wounds, infections, herniated
disks, blood clots
 Overdo self-help techniques. Although you may think that more is better, you can actually
worsen your symptoms by not following the basic guidelines.
Sources of more information about Trigger Points
 The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, by Clair
Davies & Amber Davies.
 When Movement Hurts: A Self-Help Manual for Treating Trigger Points, by Barbara J.
Headley.
 Pain Relief with Trigger Point Self-Help by Valerie DeLaune
Helpful I-pad Applications
 Trigger Points by Real Bodywork - $2.99 (Provides info on common trigger points, referral
patterns, recommendations on management)
 Trigger Point Charts – Free (Provides muscle specific trigger points and referral patterns)
Gadgets for working trigger points:
 TheraCane, info available at http://www.theracane.com/. The TheraCane is $39.95; the site
includes a complete manual of how to get at almost every TrP. You cannot order from them by
phone, but can contact OTPT at 1- 888- 819- 0121.
 Pressure Pointer at http://www.mypressureproducts.com/ or 1-888-729-3053. The Pressure
Pointer is $54, but the web site also has excellent information about different trigger points
under their Pain Reference Chart
 Backnobber at http://www.pressurepositive.com/ or 800-603-5107. Just the Backnobber is
$39.95. The Trigger Point Kit ($57.95) includes Davies book, cane, and hand-held knobber.
 Fenix system has paddles that you can attach knobs to and lean against; allows you to not use
your hands. At http://www.fenixstopspain.com/ or 1-888-299-6647. Basic device costs $49.95.
 Reflexball is a knobby ball you can lie on or roll into. At http://www.bodytrends.com/ or 1800-549-1667. Balls start at $7.99. Also available at www.optp.com ((888) 819-0121)
Some web pages that have useful information about TrP, such as TrP diagrams and stretches,
include:
 http://www.coventrypainclinic.org.uk/musclepain-backhipbuttockleg.htm
 TrP diagrams at www.trigger-point-injections.com/where.htm
 Pictures of using pressure point devices at www.fenixstopspain.com/finding_tps.html
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Face/Head Trigger Points
Masseter Muscles
 This muscle clenches the teeth.
 Pain located: over eyebrow, deep in the ear, over cheek and jaws. The masseter
can cause tension-type headaches.
 Other symptoms:
 Limited range of mouth-opening
 Pain in the upper and lower molar teeth
 Teeth hypersensitive to pressure and temperature
 Ringing in one ear (tinnitus), earache
 Temporomandibular (jaw) pain
 Aggravating factors:
 Clenching or grinding the teeth, or teeth not meeting
properly
 Chewing: constant gum chewing, forceful biting,
chewing pens or instrument mouthpieces
 Forward head posture
 Mouth breathing (as with sinus congestion)
 Emotional tension
 Overstretch during dental procedure; excessive jaw mobility
 Prevention
 Correct forward head posture
 Correct mouth position, with tongue on roof of mouth, teeth slightly apart
 Avoid excessive chewing, clenching teeth, using a mouth guard to prevent grinding teeth
at night
 Correct dental problems that prevent proper closing of teeth
 Decrease muscle tension due to stress
Recommended trigger point release technique:
1. Using the hand opposite to the side you are working on, insert your thumb inside your mouth but
outside your gums and relax your jaw.
2. With your index and middle fingers, press on the outside of your cheek between your fingers
and your thumb.
3. Work all the way from the bottom of the jaw to your cheek bone and up towards your ear.
Temporalis Muscles



This muscle also clenches the teeth.
Pain located: over the temple, over eyebrow, behind ear.
The temporalis can cause tension-type headaches on one or both sides of the head.
 Other symptoms:
 Pain in upper teach; sensitivity to hot/cold
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 Temporomandibular (jaw) joint pain
 Inability to open jaw far enough to fit 2 knuckles in
 Teeth do not seem to meet correctly
 Aggravating factors
 Long periods of holding jaw in one position, either open or closed, as during dental
work
 Clenching jaw (bruxism), grinding teeth at night, chewing gum, biting instrument
mouthpieces, or temporomandibular problems
 Muscle tension from stress
 Exposure to cold draft when muscle fatigued
 Posture with head forward
 Trigger points in other muscles, such as
sternocleidomastoid or upper trapezius
 Neck traction using a chin strap
 Prevention
 Same as for masseter muscle, above
Recommended Technique:
1. Use your finger tips to apply pressure to areas above
temple and the ear.
2. While pressing against the tender points, slowly open and close your jaw.
Lateral Pterygoid
This muscle is used to open the mouth; it can be overused if the clenching muscles (masseter and
temporalis) are overactive or if you use a musical instrument held down with your chin and you hold
your teeth apart. Part of this muscle attaches to the disk inside the joint and, when in spasm, pulls the
disk out of place causing clicking or locking.
 Other symptoms:
 Sinus pain or congestion
 Popping, clicking or locking in the TMJ
 Ringing in the ear
 Aggravating factors
 Tension held in the jaw
 TrP in the masseter or temporalis
 Holding the jaw open for prolonged
periods, such as dental work or playing a wind instrument
 Opening against resistance, such as holding a violin or viola under the chin
 Protruding the jaw (poking it out) playing a wind instrument
 Mouth breathing
 Prevention
 Correct forward head posture
 Correct mouth position, with tongue on roof of mouth, teeth slightly apart, jaw relaxed
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

Avoid excessive chewing, clenching teeth, using a mouth guard to prevent grinding teeth
at night
Decrease muscle tension due to stress
Recommended trigger point release technique
1. Place your finger between the cheek and the upper molars and slide it all the way to the back,
behind the last molar and press toward your nose.
2. Isolating the entire muscle is difficult, therefore, may be impossible to entirely eliminate all
trigger points.
Medial Pterygoid


This muscle is located deep inside the mouth.
Primary function: closing the mouth and jutting out the jaw
 Common symptoms:
 Pain referred to back of month, tongue and throat, around TMJ, and deep in the ear
 Difficulty swallowing
 Pain with chewing or clenching jaw
 Pain with opening jaw
 Jaw may deviate to one side
 Causes:
 Clenching or teeth grinding, chewing gum
 Improper bite alignment
 Head-forward posture
 Nutritional deficiencies
 Management:
 Learn relaxation and coping techniques to eliminate
stress
 Do not chew gum and avoid foods requiring a lot of
chewing
 Use a pillow that adequately supports the jaw
 Perform exercises to correct forward head posture
 Attend to nutritional deficiencies if applicable.
 Recommended Technique
1. Use the opposite index finger to reach inside your mouth, inside your teeth, and behind
top set of molars.
2. Sweep downward behind your molars to the floor of your mouth
3. One a tender spot is located, press and hold that spot.
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Neck/Upper Back Trigger Points
Sternocleidomastoid
Function:
1. When using only one side, rotates head and tilts head upward
2. When both sides used together, brings the head
and neck down in front
 Common Symptoms
 Tension headache
 Headaches on the forehead
 Muscle sore to the touch
 Persistent, dry cough
 Referred pain to top of head, back of
head, the cheek, behind eye
 Sinus congestion on affected side
 Tearing and reddening of the eyes, blurred vision
 Earaches
 Dizziness, disturbed balance
 Nausea, loss of appetite
 Sweating and cool sensation on forehead
 Causes
 Overhead activities
 Looking up for long periods of time
 Poor neck postures such as forward head posture
 Traumatic injuries that have caused whiplash, a fall on the head, etc.
 Improper breathing
 Chronic cough or infection
 Injury or deformity that restricts upper body movement
 Management
 Avoid overhead work and prolonged periods of looking up
 Practice good posture and body mechanics
 Seek proper breathing techniques (ex. diaphragmatic breathing)
 Prevent excessive infection
 Seek specialist if body asymmetries exist
Trapezius
Function: Moves the shoulder girdle and shoulder blade in various directions.
 Common Symptoms
Upper trapezius
 Headaches
 Facial, temple, jaw pain
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 Pain behind the eye
 Neck pain
 Dizziness
 Limited range of motion
Middle trapezius
 Mid back pain
 Headaches at base of skull
 Burning sensation near spine
 Shoulder pain
Lower trapezius
 Mid back, neck, upper shoulder pain
 Referred pain to shoulder blade, inside of arm
 Headaches at base of skull
 Ache and tenderness over top of shoulder
 Causes:
 Poor posture and ergonomics
 Clothing or anything that places constricting pressure on the muscle (ex. backpack,
purse, etc.)
 Certain sports with sudden one-sided movements
 Structural abnormalities such as asymmetrical leg length, pelvis height, etc.)
 Fatigue
 Traumatic injuries such as whiplash, fall to the head.
 Management
 Improvements in ergonomics in the workplace
 Postural alterations
 Practice relaxation techniques
 Minimize direct pressure on the muscle
 Modification or decreased participation in sports that provoke symptoms
 Address fatigue problems
Splenius Capitus and Splenius Cervicis
Function: Rotates the head and brings head back up from forward position; provide stabilization
 Common Symptoms
 Referred pain to top of head (Capitis)
 Referred pain throughout inside of head
 Pain behind the eye
 Pain in back of skull
 Pain at the junction of the neck and top of shoulder
 Decreased neck range of motion
 Blurred vision
 Causes:
 Poor posture
- Prolonged awkward positions
- Prolonged looking up
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 Poor ergonomics during work
 Forward head posture
 Structural problems (ex. kyphosis)
 Exposure to cold temperatures while muscle is fatigued
 Traumatic injuries
 Sports activities that involve rotating of the head
 Restrictive clothing
 Depression
 Management
 Practice proper posture
- Sit upright, with head held directly over trunk and back well supported
- Invest in pillows or other objects that would facilitate proper spine alignment
 Postural retraining exercises
 Correct body asymmetries
 Avoid cold drafts; try to keep neck warm
 Avoid head rotating activities, modification of sport activities as necessary
 Be aware of restrictive clothing
 Seek counseling for depression if applicable.
Levator Scapula
Function: Shrugs shoulder and helps rotate head
 Symptoms:
 Neck, shoulder, & shoulder blade pain
 Limited neck flexion or rotation
 Tension headache
 Other diagnoses with similar symptoms:
 Stiff neck
 Neck (cervical) strain
 Neck disc disease
 Causes:
 Prolonged shoulder tension
 Holding phone between ear and shoulder
 Carrying heavy purse or book bag
 Emotional stress, tension, anger, or fear
 Prolonged posture with head turned, as in typing
 Respiratory infection
 Management:
 Take breaks when working at computer; use armrests
 Face forward without head rotated
 Carry less weight
 Learn stress reduction techniques
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Scalenes
Function: Stabilizes the cervical spine and elevates the first and second ribs during inhalation
 Common symptoms:
 Referred pain to chest, mid back, and/or over the outside, back, and front of the arm and
into the wrist and hand
 Pain may interrupt sleep, relieved by sleeping sitting up
 Decrease range of motion when turning and bending the head
 Numbness, tingling, and loss of sensation in
fingers and hand
 Finger stiffness
 Causes:
 Excessive pulling or lifting activities
 Breathing in against resistance
 Poor body mechanics when carrying large objects
 Traumatic injuries
 Trigger points in SCM and levator scapula
 Improper breath techniques
 Asymmetries of body structures (legs, pelvis,
spine, ribs)
 Management:
 Avoid activities that require lifting and pulling
heavy objects
 Prevent excessive turning of the head to one side
 Learn proper breathing techniques
 Address surround trigger points
 Seek specialist if structural asymmetries exist.
Rhomboids
Functions: Stabilizes the shoulder blade and brings it toward the spine
 Common symptoms
 Localized pain in upper/mid back, between edge of shoulder blade and spine
 Discomfort is typically superficial and achy
 Symptoms aggravated by lying on the same side or by reach forward
 Snapping noises upon movement of the shoulder blade
 Rounded shoulders
 Causes
 Poor posture
- Constantly leaning forward for long periods of time
- Rounded shoulders
 Tight pectoral muscles
 Persistent discouragement or sad (leads to
slumping of the shoulders)
 Structural problems
- Scoliosis
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 Management
 Learn proper ergonomics and body mechanics
 Address additional trigger points in pectoral muscle if applicable
 Practice proper breathing techniques
 Learn ways to control degree of depression/sadness if applicable
 Address structural abnormalities with appropriate specialist
Back, Hip and Lower Extremity Trigger Points
Serratus Posterior Inferior
Function: Assists with trunk rotation and forward bending at the waist
 Common symptoms
 Achy feeling on the back near the bottom of the rib cage
 Decreased trunk rotation
 Causes
 Straining of the back during activities that involve lifting, twisting, reach overhead
 Improper ergonomics and body mechanics
 Improper breathing techniques or coughing
 One leg longer than the other
 Management
 Practice proper lifting techniques
- Bend with your knees, not with your
back
- Hold objects close to body
 Learn proper breathing techniques
(diaphragmatic breathing)
 Seek a specialist to address any structural
abnormalities
Quadratus Lumborum
Function:
1. When only one side is used, it assists with stabilization and side-bending at the waist
2. When both sides are used, assists with assuming standing from the bending position, assists
with forced breath exhalation
 Common symptoms
 Referred pain to hip joint, groin area, lower abdomen, gluteal area
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 Pain is deep and achy at rest, but can be sharp upon movement
 Pain is aggravated by climbing stairs, rotating trunk, leaning to opposite side
 Decreased forward bending
 Painful when rolling onto side, getting up, or raising from a chair
 Pain may be unbearable when standing or sitting up straight
 Causes
 Awkward movements that involves trunk
rotation (ex. lifting and object while turning
simultaneously)
 Repetitive strains from frequent bending
 Sitting with malaligned pelvis
 Activities and positions that require excessive
forward lean
 Management
 Be mindful of body positioning during heavy
lifting, assuming standing position, dressing
oneself.
 Activity modifications that would limit
excessive forward bending
 Make sure your sit with proper pelvic
alignment
 Stand up straight
Iliopsoas
Function: flexes hip
 Common symptoms:
 Referred pain to low back region close to the spine
 Referred pain to front of thigh and groin
 Pain worse standing, or standing from sitting
 Pain first standing in the morning
 Other diagnoses with similar symptoms:
 Failed low back syndrome
 Appendicitis
 Hip osteoarthritis
 Causes:
 Walking long distances
 SI malalignment,
 Prolonged sitting
 Leg length difference
 Management:
 Correct leg length difference or flat
foot;
 Correct imbalance of weak and tight low back and hip muscles
 Trigger point pressure and stretching
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Piriformis
Function: rotates hip
 Symptoms:
 Pain worse with sitting, standing, or standing from sitting
 SI dysfunction
 Possible numbness, weakness, or swelling in the involved leg
 Chronic pelvic infections
 Other diagnoses with similar symptoms:
 Sciatica, herniated disc, or
lumbago
 Sacroiliac (SI) dysfunction
 Facet syndrome
 Post-laminectomy syndrome
 Causes:
 Catching oneself while falling, or
twisting while lifting or rotating
while weight on one leg
 SI malalignment,
 Prolonged driving or sitting
 Leg length difference
 Hip joint replacement
 Car accident.
 Management:
 Correct leg length difference or flat foot;
 Avoid strong twisting motions;
 Limit driving with involved foot on accelerator
 Avoid sitting on involved leg
 Trigger point pressure and stretching
Gluteus Minimus and Medius and Tensor Fascia Latae (TFL)
Function: holds the pelvis level during walking
 Symptoms:
 Pain walking
 Limping
 Pain crossing leg over opposite
leg
 Difficulty straightening leg after
sitting (TFL)
 Other diagnoses with similar
symptoms:
 Trochanteric bursitis
 Sciatica, herniated disc, failed
low back syndrome
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Sacroiliac (SI) dysfunction
Iliotibial band friction syndrome (TFL)
 Causes:
 Falling,
 SI malalignment,
 Strenuous walking or running, especially
on soft surfaces
 Flat foot or leg length difference
 Prolonged driving,
 Sleeping on involved hip
 Sitting with wallet in back pocket.
Gluteus Medius
 Management:
 Limit standing and vigorous walking;
 Stand with feet wider apart;
 Sleep on uninvolved side with pillow between knees
 Trigger point pressure and stretching
Tensor Fascia Lata (TFL)
Shoulder, Upper Arm, and Elbow Trigger
Points
Supraspinatus
Function: Stabilizes the humerus and moves the arm away from the body
 Common symptoms:
 Deep ache in the shoulder area
 Referred pain to the elbow, outside of the arm, wrist
 Increased pain with moving arm
 Decreases range of motion when reaching behind
 Audible clicking sounds in the shoulder
 Causes
 Carrying heavy objects with arm at your side
 Carrying objects above shoulder height
 Management
 Do not life objects overhead on a continuous basis
 Decrease prevalence of carrying heavy objects
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Infraspinatus
Functions: Stabilizes end of humerus and rotates upper arm
 Common symptoms
 Referred pain to front of shoulder, forearm, and
possibly fingers
 Increased pain during sleep
 Arm may “fall asleep” at night and during the day
 Decreased mobility of shoulder
 Muscle fatigue and weakness
 Causes
 Activities that require arm to be held out in front of
you.
 Pulling activities that requires you to reach behind.
 Overload on muscle when attempting to catch a fall.
 Management
 Increased awareness of body mechanics
 Decrease activities that requires arm to be held in front for extended periods of time.
 Application of heat over the muscle.
Teres Minor and Major
Functions: Stabilizes the humerus and helps move the upper arm
 Common symptoms
 Referred pain in posterior deltoid
 Numbness and tingling of the ring and little fingers
(increased with reaching above shoulder height)
 Causes
Teres Minor
 Sudden overload of the muscle, often during traumatic accident
 Activities that require holding arms out in front or above your for prolonged periods of
tie.
 Repetitively reaching behind
 Management
 Increase awareness of body mechanics
 Decrease the prevalence of activities that
require arms to be out in front and above
you.
 Heat application at night for 15-20 minutes
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Teres major
Pectoralis Minor
Function: Pulls the shoulder blade and should girdle down and forward, and assists in forced inhalation
 Common symptoms
 Referred pain over the front of the shoulder and chest, down the inside of the arm into
the middle, ring, and little fingers
 Rounded forward shoulder
 Difficulty taking a deep breath
 Decreased range of motion when reaching forward, upward, and backward
 Causes
 Poor ergonomics and posture
 Compression the muscle with straps and clothing
 Weakness of trapezius muscle
 Trauma to the ribs or front of shoulder
 Coughing and improper breathing techniques
 Management
 Improve ergonomics and posture in the home and
at work
 Avoid carrying backpacks or using other straps that
places significant compression on the shoulder
 Manage trigger points and weakness of surrounding muscles.
 Learn proper breathing techniques
Deltoid
Function: Moves the arms in a variety of ways
 Common symptoms
 Pain located over the shoulder
 Pain is worse when the arm is move and less intense at rest
 Decreased range of motion, difficulty raising arm past 90°
 Causes
 Jerky, repetitive movements of the arm
 Trauma to the shoulder region
 Holding an object above shoulder level for a
prolonged time.
Management
Avoid lifting objects above shoulder level
 Limit repetitive movements of the arm
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Biceps Brachii
Function: flexes the shoulder and elbow; rotates the lower arm
 Common symptoms
 Refers superficial achy pain over the front
of the upper arm and front of the should
 Weakness and pain when raising hand
above head when elbow is bent.
 Causes
 Repetitive motion injuries
 Carrying heaving objects with palms facing
upward
 Trying to catch yourself from a fall
 Trigger points of the infraspinatus
 Management
 Modification of aggravating activities
 Carry items with palms face-down
 Manage trigger points of surrounding muscles
Trigger Points in the Forearm and Hand
Hand Extensors, Brachioradialis, and Finger Extensors
Function:
1. Hand extensors- extend the hand at the wrist and stabilize the wrist while the fingers are being
used for grasping.
2. Finger extensors- extend the hand at the wrist and extend the fingers.
3. Brachioradialis- bends the elbow
 Common symptoms
 Pain is worse when shaking hands, and when performing
motions that involves twisting of the wrist and forearms.
 Trigger points in the finger extensors cause finger stiffness, pain
in the back of the forearm, hand, fingers and elbow.
 Trigger points in the hand extensors and brachioradialis cause
pain outside the elbow and refers pain to the wrist and hand.
 Decreased grip strength, loss of coordination, muscle fatigue
during repetitive motions.
 Numbness and tingling over the back of the hand if the radial
nerve is involves.
 Causes
 Forcefully and repetitively griping an object.
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-
Ex. shaking a hand, turning a doorknob, writing, kayaking,
playing the violin, etc.
 Trauma of the elbow joint
 Repetitive finger movements
- Ex. playing the piano
 Referred pain form trigger points in
shoulder.
 Management
 Avoid activities that requires twisting of the
arm and grasping repeatedly
 Learn to alternate hands when performing
aggravating activities.
 Manage trigger points that may be causing
referred pain to the forearm.
twisting of the
 Use a wrist brace at night to prevent
forearm.
Finger Flexors and Pronator
Function: Finger flexors grip & type; Pronator turns
down as in typing
 Symptoms:
 Shooting pain into wrist or hand
 Finger Stiffness and painful
 Trouble with fine motor control
 Numbness into hand or fingers
 Other diagnoses with similar symptoms:
 Carpal tunnel syndrome
 Pinched nerve in neck (C5-T1)
 Ulnar nerve palsy, cubital tunnel
 Causes:
 Prolonged or forceful gripping
 Driving, especially in bad weather
 Prolonged typing/computer use, fingering an instrument
(finger flexors) playing an instrument with palms turned
away (e.g., piano, pronator)
 Management:
 Take breaks when working at computer, instrument
 Avoid excessive gripping
 Keep grip relaxed when driving, or playing an
instrument
 Relax fingers fully when not in use
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hand palm
cramping

Use devices, such as jar openers, to reduce strong
gripping
Adductor and Opponens Pollicis
Function:
1. Adductor pollicis- brings the thumb toward the index finger
2. Opponens pollicis- brings the thumb across the palm

Common symptoms
 Aching pain referred over the thumb, into the thumb and
over the wrist
 Difficulty with fine motor movements that require the
thumb to grasp
 “Trigger thumb” where the thumb locks in the closed
position
 Causes
 Grasping things with thumb and fingers
 Residual pain from a fracture
 Management
 Avoid activities requiring grasping with the thumb
 Relax thumb fully when not in use
 Alternate hands, take rest breaks
 Use a thumb brace to support thumb in static positions
Hand Interosseous Muscles and Abductor Digiti Minimi
Function: Moves the fingers from side to side

Common symptoms
 Referred pain to back of palm and hand, and down
fingers
 Finger stiffness
 Difficulty with fine motor movements (writing,
grasping objects, making a fist
 Superficial numbness on one side of the finger
 Causes
 Repetitive grasping activities with the fingers pinched
together
 Management
 Grasps items lightly
 Take frequent breaks
 Limit amount of time of any given activity
 Alternate hands
All trigger point information is adopted from the following source:
Clarkson University Physical Therapy
Delaune, V. Pain Relief with Trigger Point Self-Help. California: Lotus Publishing; 2011.
Clarkson University Physical Therapy