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FLASHCARDS

for Palpation,
Trigger Points,

and Referral
Patterns

JOSEPH E. MUSCOLINO, DC
Instructor, Connecticut Center for Massage Therapy

Westport, Connecticut
Owner, The Art and Science of Kinesiology

Redding, Connecticut

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Page 2

Copyright ©
2009 M

osby, Inc., an affi liate of Elsevier, Inc.
PART 1: Muscle Palpation

Section 1: Palpation of the Muscles of the Shoulder Girdle

Trapezius
Starting Position:
• Client prone with arm resting on the table at the side of the body
• Therapist standing to the side of the client
• Palpating hand placed just lateral to the lower thoracic spine (on the

lower trapezius)
Palpation Steps:
1. Ask the client to abduct the arm at the shoulder joint to 90 degrees

with the elbow joint extended, and to slightly retract the scapula at
the scapulocostal joint by pinching the shoulder blade toward the
spine (Figure A). Adding gentle resistance to the client’s arm abduc-
tion with your support hand might be helpful.

2. Palpate the lower trapezius. To locate the lateral border, palpate per-
pendicular to it (Figure A). Once located, palpate the entirety of the
lower trapezius.

3. Repeat for the middle trapezius between the scapula and the spine.
Strum perpendicular to the direction of the fi bers (i.e., strum verti-
cally) (Figure B).

4. Repeat for the upper trapezius.
5. To further engage the upper trapezius, ask the client to do slight ex-

tension of the head and neck at the spinal joints. Then palpate the
entirety of the upper trapezius (Figure C).

6. Once the trapezius has been located, have the client relax it and pal-
pate to assess its baseline tone.

Palpation Note:
1. Abducting the arm at the shoulder joint requires an upward rotation

force by the upper and lower trapezius to stabilize the scapula. Re-
tracting the scapula engages the entire trapezius, especially the mid-
dle trapezius.

CARD # 1

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Page 12

Copyright ©
2009 M

osby, Inc., an affi liate of Elsevier, Inc.
PART 1: Muscle Palpation

Section 8: Palpation of the Pelvic Muscles

Piriformis
Starting Position:
• Client prone with the leg fl exed to 90 degrees at the knee joint
• Therapist standing to the side of the client
• Palpating hand placed just lateral to the sacrum, halfway between

the posterior superior iliac spine (PSIS) and the apex of the sacrum
• Support hand placed on the medial surface of the distal leg, just

proximal to the ankle joint
Palpation Steps:
1. Begin by fi nding the point on the lateral sacrum that is halfway be-

tween the PSIS and the apex of the sacrum. Drop just off the sacrum
laterally at this point and you will be on the piriformis.

2. Resist the client from laterally rotating the thigh at the hip joint and
feel for the contraction of the piriformis. Note: Lateral rotation of the
client’s thigh involves the client’s foot moving medially toward the
midline (and opposite side) of the body.

3. Continue palpating the piriformis laterally toward the superior border
of the greater trochanter of the femur by strumming perpendicular to
the fi bers as the client alternately contracts (against resistance) and
relaxes the piriformis.

4. Once the piriformis has been located, have the client relax it and pal-
pate to assess its baseline tone.

Palpation Notes:
1. It can be challenging to discern the borders between the piriformis

and the gluteus medius superiorly and superior gemellus inferiorly.
2. When giving resistance to the client’s lateral rotation of the thigh at

the hip joint, do not let the client contract too forcefully, or the more
superfi cial gluteus maximus (also a lateral rotator) may be engaged,
blocking palpation of the deeper piriformis.

CARD # 101

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Copyright ©
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osby, Inc., an affi liate of Elsevier, Inc.
Piriformis

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Palpation Key: Find the midpoint of the lateral border of the sacrum.
Then draw a line from there to the greater trochanter.

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TrP � Trigger Point

Copyright ©
2009 M

osby, Inc., an affi liate of Elsevier, Inc.
PART 3: Trigger Points

Section 7: Pelvis

Piriformis

CARD # 232 A

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Posterior view of common piriformis TrPs and their corresponding referral
zones.

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TrP � Trigger Point

Copyright ©
2009 M

osby, Inc., an affi liate of Elsevier, Inc.

A B

PART 3: Trigger Points

Section 8: Thigh

Hamstring Group

CARD # 232 B

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Posterior views of common lateral and medial hamstring TrPs and their
corresponding referral zones. A, Lateral hamstring (biceps femoris).
B, Medial hamstrings (semitendinosus and semimembranosus).

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