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Myofascial Pain Syndrome of Low Back And MyofascialMyofascial PainPain SyndromeSyndrome ofof LowLow BackBack andand HipHip MusclesMuscles z QuadratusQuadratus lumborumlumborum z IliopsoasIliopsoas z RectusRectus abdominisabdominis z GluteusGluteus maximusmaximus z GluteusGluteus mediusmedius z GluteusGluteus minimusminimus z PiriformisPiriformis QuadratusQuadratus LumborumLumborum QuadratusQuadratus LumborumLumborum z TheThe mostmost frequentfrequent causecause ofof lowlow backback painpain OriginOrigin InferiorInferior borderborder ofof 12th12th ribrib InsertionInsertion ApicesApices ofof transversetransverse processesprocesses ofof L1L1--4,4, iliolumbariliolumbar ligamentligament andand posteriorposterior thirdthird ofof iliaciliac crestcrest ActionAction FixesFixes 12th12th ribrib duringduring respirationrespiration andand laterallateral flexesflexes trunktrunk SuperficialSuperficial TriggerTrigger PointPoint TriggerTrigger pointpoint verticalvertical layerlayer ofof musclemuscle ReferRefer painpain greatgreat trochantertrochanter ofof femurfemur ÆÆ extendextend alongalong iliaciliac crestcrest ÆÆ lowerlower abdomenabdomen DeepDeep TriggerTrigger PointPoint TriggerTrigger pointpoint diagonaldiagonal layerlayer ofof muscle,muscle, midlinemidline ReferRefer painpain sacralsacral areaarea ÆÆ lowerlower buttockbuttock areaarea ÆÆ glutealgluteal areaarea SpraySpray andand StretchStretch SpraySpray andand StretchStretch IliopsoasIliopsoas IliopsoasIliopsoas IliopsoasIliopsoas Psoas major Psoas minor Iliacus Origin Transverse Bodies of T12 Iliac fossa within processes of L1-5, and L1 and abdomen bodies of T12-L5 intervening and intervertebral intervertebral discs below bodies disc of T12-L4 Insertion Middle surface of Fascia over Lowermost lesser trochanter psoas major surface of lesser of femur and iliacus trochanter of femur Action Flexes hip Weak flexor Flexes hip of trunk TriggerTrigger PointPoint andand ReferRefer PainPain TriggerTrigger pointpoint (1)(1) laterallateral toto marginmargin ofof musclemuscle (2)(2) femoralfemoral triangletriangle (3)(3) iliaciliac crestcrest ReferRefer painpain lumbarlumbar toto sacralsacral regionregion SpraySpray andand StretchStretch SpraySpray RectusRectus AbdominisAbdominis RectusRectus AbdominisAbdominis z AlsoAlso aa causecause ofof lowlow backback painpain OriginOrigin PubicPubic crestcrest andand pubicpubic symphysissymphysis InsertionInsertion 5,5, 6,6, 77 costalcostal cartilages,cartilages, medialmedial inferiorcostalinferiorcostal marginmargin andand posteriorposterior aspectaspect ofof xiphoidxiphoid ActionAction FlexesFlexes trunk,trunk, aidsaids forcedforced expirationexpiration andand raiseraise intraintra-- abdominalabdominal pressurepressure TriggerTrigger PointPoint andand ReferRefer PainPain TriggerTrigger pointpoint (1)(1) upperupper endend ofof musclemuscle (2)(2) pubicpubic symphysissymphysis ReferRefer painpain horizontalhorizontal distributiondistribution acrossacross backback andand sacralsacral areaarea TriggerTrigger PointPoint andand ReferRefer PainPain z McBurneyMcBurney triggertrigger pointpoint SpraySpray andand StretchStretch GluteusGluteus MaximusMaximus GluteusGluteus MaximusMaximus OriginOrigin OuterOuter surfacesurface ofof iliumilium behindbehind posteriorposterior glutealgluteal lineline andand posteriorposterior thirdthird ofof iliaciliac crestcrest lumbarlumbar fascia,fascia, laterallateral massmass ofof sacrum,sacrum, sacrotuberoussacrotuberous ligamentligament andand coccyxcoccyx InsertionInsertion DeepestDeepest quarterquarter intointo glutealgluteal tuberositytuberosity ofof femur,femur, remainingremaining threethree quartersquarters intointo iliotibialiliotibial tracttract (anterior(anterior surfacesurface ofof laterallateral condylecondyle ofof tibia)tibia) ActionAction ExtendsExtends andand laterallylaterally rotatesrotates hiphip MaintainsMaintains kneeknee extendedextended viavia iliotibialiliotibial tracttract TriggerTrigger PointPoint 11 TriggerTrigger pointpoint upperupper borderborder ofof musclemuscle ReferRefer painpain bigbig archarch overover sacralsacral areaarea TriggerTrigger PointPoint 22 TriggerTrigger pointpoint ischiumischium ReferRefer painpain buttockbuttock areaarea TriggerTrigger PointPoint 33 TriggerTrigger pointpoint lowerlower fiberfiber ofof musclemuscle ReferRefer painpain coccyx,coccyx, whenwhen sitsit downdown SpraySpray andand StretchStretch GluteusGluteus MediusMedius GluteusGluteus MediusMedius GluteusGluteus MediusMedius OriginOrigin OuterOuter surfacesurface ofof iliumilium betweenbetween posteriorposterior andand middlemiddle glutealgluteal lineslines InsertionInsertion PosterolateralPosterolateral surfacesurface ofof greatergreater trochantertrochanter ofof femurfemur ActionAction AbductsAbducts andand mediallymedially rotatesrotates hiphip TiltsTilts pelvispelvis onon walkingwalking TriggerTrigger PointPoint 11 z AlongAlong posteriorposterior iliaciliac crestcrest toto thethe sacrumsacrum TriggerTrigger PointPoint 22 z PosteriorPosterior andand laterallateral aspectaspect ofof buttockbuttock TriggerTrigger PointPoint 33 SpraySpray andand StretchStretch SpraySpray andand StretchStretch GluteusGluteus MinimusMinimus GluteusGluteus MinimusMinimus GluteusGluteus MinimusMinimus OriginOrigin OuterOuter surfacesurface ofof iliumilium betweenbetween middlemiddle andand inferiorinferior glutealgluteal lineslines InsertionInsertion AnteriorAnterior surfacesurface ofof greatergreater trochantertrochanter ofof femurfemur ActionAction AbductsAbducts andand mediallymedially rotatesrotates hiphip TiltsTilts pelvispelvis onon walkingwalking TriggerTrigger PointPoint andand ReferRefer PainPain z LateralLateral andand posteriorposterior buttockbuttock TriggerTrigger PointPoint andand ReferRefer PainPain z LateralLateral andand posteriorposterior thighthigh toto thethe ankleankle SpraySpray andand StretchStretch SpraySpray andand StretchStretch PiriformisPiriformis PiriformisPiriformis PiriformisPiriformis OriginOrigin 2,2, 3,3, 44 costotransversecostotransverse barsbars ofof anterioranterior sacrum,sacrum, fewfew fibersfibers fromfrom superiorsuperior borderborder ofof greatergreater sciaticsciatic notchnotch InsertionInsertion AnteriorAnterior partpart ofof medialmedial aspectaspect ofof greatergreater trochantertrochanter ofof femurfemur ActionAction laterallylaterally rotatesrotates andand stabilizesstabilizes hiphip TriggerTrigger PointPoint andand ReferRefer PainPain SpraySpray andand StretchStretch.
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