Trigger points in the adductor longus and brevis.

These muscles are located in the groin. The longus originates on the pubic body just below the pubic crest and inserts on the middle third of the linea aspera.The brevis muscle originates on the inferior ramus and body of the pubis and has its attachment to the lesser trochanter and linea aspera of the femur. Trigger points in these muscles are the most common muscular cause of groin pain. Distal trigger points refer pain to the upper medial knee and down the tibia. Proximal trigger points refer into the anterior hip area.

A weak lateral chain will stop you in your tracks.

One very important job of your hip muscles is to maintain the alignment of your leg when you move. One of the primary hip muscles, the gluteus medius, plays an especially important stabilizing role when you walk, run, or squat. The gluteus medius attaches your thigh bone to the crest of your hip. When you lift your left leg, your right gluteus medius must contract in order to keep your body from tipping toward the left. And when you are standing on a bent leg, your gluteus medius prevents that knee from diving into a “knock knee” or “valgus” position.
Weakness of the gluteus medius allows your pelvis to drop and your knee to dive inward when you walk or run. This places tremendous strain on your hip and knee and may cause other problems too. When your knee dives inward, your kneecap is forced outward, causing it to rub harder against your thigh bone- creating a painful irritation and eventually arthritis. Walking and running with a relative “knock knee” position places tremendous stress on the ligaments around your knee and is a known cause of “sprains”. Downstream, a “knock knee” position puts additional stress on the arch of your foot, leading to other painful problems, like plantar fasciitis. Upstream, weak hips allow your pelvis to roll forward which forces your spine into a “sway back” posture. This is a known cause of lower back pain. Hip muscle weakness seems to be more common in females, especially athletes.

You should avoid activities that cause prolonged stretching of the hip abductors, like “hanging on one hip” while standing, sitting crossed legged, and sleeping in a side-lying position with your top knee flexed and touching the bed. Patients with fallen arches may benefit from arch supports or orthotics. Obesity causes more stress to the hip muscles, so overweight patients may benefit from a diet and exercise program. The most important treatment for hip abductor weakness is strength training. Hip strengthening is directly linked to symptom improvement. Moreover, people with stronger hip muscles are less likely to become injured in the first place. The exercises listed below are critical for your recovery.

What is knee tendonitis?

Tendons are strong bands of fibrous tissue that connect your muscles to your bones. Your “patellar tendon” connects your kneecap (patella) to your shin bone (tibia). “Patellar tendonopathy” results from repetitive straining and micro-tearing of this connection, resulting in pain and inflammation. The condition is referred to as “jumper’s knee,” since damage is thought to often result from repetitive jumping.

The condition should probably be called “landing knee,” since forces on the patellar tendon are twice as great during landing as compared to those created during take off.

Patellar tendinopathy is common, affecting almost 20% of all athletes with a rate as high as 50% in sports that require repetitive forceful jumping, like basketball and volleyball. The condition may affect one or both knees and may be slightly more common in males.

Weakness in the quadriceps muscle of your thigh can allow excessive bending of your knee when you land following a jump. This places your patellar tendon at a greater risk for injury. Having strong quadriceps muscles protects your knee from excessive flexion and injury.

Symptoms of patellar tendinopathy include pain or swelling just below your kneecap. This may begin without an identifiable injury and may come and go for months or years. Symptoms are usually aggravated by activity, but most athletes have been able to continue playing through the pain. Pain often increases during activities that require strong quadriceps contraction, like jumping, squatting, arising from a seated position, stair climbing, or running. Walking down stairs or running down hill seems to be more bothersome than going up.

Some athletes may have unconsciously learned to protect their knee by developing unnatural jumping mechanics. This could include landing with a more rigid knee, or allowing too much hip flexion. You may need to become more conscious of landing with the right amount of knee flexion with your foot in a neutral position and avoiding excessive hip flexion. Your doctor would be able to answer any questions you have about good jumping mechanics.

Patellar tendon straps, like a Cho-pat, can help reduce stress on your patellar tendon and relieve pain. Three fourths of the people who use patellar tendon straps for patellar tendinitis report improvement.

Patellar tendinopathy is treatable. Patients who follow a well-planned strengthening program show similar outcomes to those who have undergone surgery for the problem. Initially, you may need to decrease your training intensity to help protect your knee. You should stay away from activities that produce more than mild pain. You should avoid complete rest, as this could actually increase your risk of recurrence. Using ice packs or ice massage for 10-15 minutes at a time, especially following activity, may help to reduce inflammation.

Trigger points in the serratus anterior

The serratus anterior muscle is located along the sides of the ribs. It originates on the outer surface of the upper 8-9ribs, and inserts on the medial border of the scapula. This muscle acts on the scapula in several different ways. First it rotates the scapula to turn the glenoid fossa upward. It also protracted and elevates the scapula. And lastly it helps to prevent wining. This muscle is often shortened from prolonged sitting and work on a computer. Active trigger points in this muscle refer pain locally around the trigger point with spillover down the inside of the arm. Pain can also radiate into the inferior angle of the scapula.

Trigger points in the piriformis muscle

The piriformis muscle is a small muscle deep to glute max and lies over top of the sciatic nerve. It originates on the anterior sacrum, and inserts on the greater trochanter of the femur. It’s main action is to laterally rotate the femur. When trigger points developed in this muscle they will refer pain into the sacro-iliac region, across the posterior hip and down the leg. This muscle can also be a cause of sciatic nerve irritation if it gets tight, causing “sciatica” symptoms.

Trigger points in the gluteus minimus

The gluteus minimus is a small but important muscle that lies deep to the gluteus medius. It originates on the gluteal surface of the ilium, and attaches on the greater trochanter of the femur. It’s main actions are to abduct and medically rotate the hip. Trigger points in this muscle refer pain into the buttock and down the lateral and posterior leg, mimicking sciatica. This muscle should be the first to be examined if a straight leg test turns out negative.

Trigger points in the gluteus medius muscle

The gluteus medius muscle plays an important role in hip and pelvic stability. It originates on the gluteal surface of the ilium, deep to the gluteus Maximus. It inserts on the greater trochanter of the femur. It’s main actions are to abduct the hip and to assist in internal rotation of the hip. It also maintains pelvic stability during walking and running. Trigger points in this muscle will refer pain into the sacrum, the iliac crest, and down the lateral hip and into the thigh. This muscle is often a cause of lower pack pain.

Trigger points in the infraspinatus

The infraspinatus muscle is one of the muscles that makes up the rotator cuff. It originates on the infraspinous fossa of the scapula, and inserts on the middle facet of the greater tubercle of the humerus. It functions to externally rotate the humerus and to stabilize the head of the humerus in the glenoid cavity during upward movement of the arm. Trigger points in this muscle refer pain deep into the anterior shoulder joint and down the anterior arm. Trigger points near the lower medial border refer pain into the rhomboids. This muscle is often injured during throwing motions.

What is a trigger point

Dr Janet travel coined the term trigger point in 1942 to describe clinical findings with characteristics of pain related a discrete irritable point in muscle or fascia that was not caused by acute trauma, inflammation, degeneration, neoplasm or infection. The painful point can be palpated as a nodule or tight band in the muscle that can produce a local twitch response when stimulated. Palpation of the trigger point reproduces the pain and symptoms of the patient and the pain radiates in a predictable referral pattern specific to the muscle harbouring the trigger point.

Our Condition of the Month: ITB Syndrome

Iliotibial Band Syndrome

Your iliotibial band is a fibrous band of tissue running from the crest of your hip, down to your knee. A muscle near the crest of your hip called the tensor fascia lata, attaches to this band to help control movements of your leg. Your iliotibial band passes over the point of your hip and over another bony bump on the outside of your knee called the lateral epicondyle. When the band is too tight, it can become painfully inflamed as it repeatedly rubs over the top of either of these bony projections. Irritation at the bony bump near the knee is called iliotibial band friction syndrome.

The condition usually presents as pain on the outside of your knee that becomes worse with repetitive knee flexion or extension. This condition is the leading cause of lateral knee pain in runners, especially slower “joggers.” The pain usually develops 10-15 minutes into the workout. You may sometimes feel or hear a click during movement. Symptoms generally ease at rest. Running on slick “wintry” surfaces may aggravate the condition. Excessively worn running shoes may be a culprit.

This problem is commonly caused by weakness in your gluteal muscles. When these muscles are weak, the muscle that attaches to your iliotibial band must contract harder to stabilize your hip. Having one leg longer than another is a known aggravating factor.

Runners should minimize downhill running and avoid running on a banked surface like the crown of a road or indoor track, as well as wet or icy surfaces. Runners should reverse directions on a circular track at least each mile. Bicyclists may need to adjust seat height and avoid “toe in” pedal positions. Avoid using stair climbers or performing squats and dead lifts. Sports cream and home ice massage may provide some relief of symptoms.