Myofascial Pain and Dysfunction: The Trigger Point Manual :Volume 2: The Lower Extremities

576 Pages·2007·23.42 MB·English

by  Janet G. Travell

Pain Patterns
PAGE PAGE
Abductor Digiti Minimi 505 Long Flexors of Toes 490
Abductor Hallucis 504 Obturator Internus 112
Adductor Hallucis 524 Pectineus 237
Adductor Longus and Adductor Pelvic Floor Muscles 112
Peroneus Longus and Peroneus
Brevis 291
Adductor Magnus 292 Brevis 372
Peroneus Tertius 372
Biceps Femoris 317
Coccygeus 112 Piriformis 188
Deep Intrinsic Foot Plantaris 430
Muscles 523, 524, 525 Popliteus 340
Quadratus Lumborum 30
Extensor Digitorum Brevis 503
Quadratus Plantae 523
Extensor Digitorum Longus 474
Quadriceps Femoris
Extensor Hallucis Brevis 503
Group 250,251,252,253
Extensor Hallucis Longus 474
Rectus Femoris 250
Flexor Digitorum Brevis 505
Sartorius 227
Flexor Digitorum Longus 490
Semimembranosus and
Flexor Hallucis Brevis 524
Semitendinosus 317
Flexor Hallucis Longus 490
Soleus 429
Gastrocnemius 399
Sphincter Ani 112
Gluteus Maximus 133
Superficial Intrinsic Foot
Gluteus Medius 151
Muscles 503,504,505
Gluteus Minimus (Anterior part) 169
Tensor Fasciae Latae 218
Gluteus Minimus (Posterior part) 169
Tibialis Anterior 356
Gracilis 293
Tibialis Posterior 461
Hamstring Muscles 317
Vastus Intermedius 252
Iliopsoas 90
Interossei (of the Foot) 525 Vastus Lateralis 253
Levator Ani 112 Vastus Medialis 251
Long Extensors of Toes 474
Lower Torso
Pain-and-Muscle Guide
Chapter 3
Hip, Thigh, and Knee
Pain-and-Muscle Guide
Chapter 11
BACK FRONT
VIEW VIEW
Leg, Ankle, and Foot
Pain-and-Muscle Guide
Chapter 18
Pictorial index. The muscles that are likely to refer pain to an illustrated region of
the body are listed in the Pain-and-Muscle Guide to the corresponding Part of the
Manual. A Guide is found at the beginning of each Part, which is marked by red
thumb tabs.
VOLUME 2
Myofascial Pain
and Dysfunction
The Trigger Point Manual
THE LOWER EXTREMITIES
This is the second of two volumes, and contains information
relating to the "lower half" of the body. Volume 1 deals with
the "upper half" of the body. The contents and indices for both
volumes are included in this book for the reader's convenience.
VOLUME 2
Myofascial Pain
and Dysfunction
The Trigger Point Manual
THE LOWER EXTREMITIES
JANET G. TRAVELL, M.D.
Honorary Clinical Professor of Medicine
The George Washington University School of Medicine
Washington, D.C.
DAVID G. SIMONS, M.D.
Clincial Professor
Department of Physical Medicine and Rehabilitation
University of California, Irvine
Irvine, California
Illustrations by Barbara D. Cummings
Editor: John P. Butler
Managing Editor: Linda Napora
Copy Editor: Shelley Potler
Designer: JoAnne Janowiak
Illustration Planner: Wayne Hubbel
Production Coordinator: Charles E. Zeller
Lippincott Williams & Wilkins
530 Walnut Street
Philadelphia, PA 19106
All rights reserved. This book is protected by copyright. No part of this book may be reproduced
in any form or by any means, including photocopying, or utilized by any information storage
and retrieval system without written permission from the copyright owner. However, this book
may be reproduced royalty free for United States Governmental purposes.
Accurate indications, adverse reactions, and dosage schedules for drugs are provided
in this book, but it is possible that they may change. The reader is urged to review
the package information data of the manufacturers of the medications mentioned.
Made in the United States of America
Library of Congress Cataloging-in-Publication Data
(Revised for volume 2)
Travell, Janet, 1901-1997
Myofascial pain and dysfunction.
Includes bibliographies and indexes.
1. Myalgia—Handbooks, manuals, etc. 2. Muscles—Diseases—Handbooks, manuals, etc. 3.
Fasciae (Anatomy)—Diseases—Handbooks, manuals, etc. 4. Myofascial pain syndrome. 5. Mus
cles. I. Simons, David G. II. Trigger point manual. III. Title.
RC925.5.T7 1983 616.7'4 82-8555
ISBN 0-683-08366-X (v. 1)
ISBN 0-683-08367-8 (v. 2)
00 01
10 11 12
TO
Lois Statham Simons
whose contributions enriched this book
and
with whom it became a rewarding way of life
Foreword
John V. Basmajian
Superlatives come easily in considering tors. This volume goes beyond and opens
what Drs. Travell and Simons have done up new ground in sensitizing clinicians
in rounding out their epoch-making and to the important interfaces between myo
highly successful Trigger Point Manual fascial pain syndromes and articular (so
with this Volume 2. Many must have matic) dysfunctions on the one hand and
thought that producing the excellent Vol fibromyalgia (fibrositis) on the other
ume 1 was so exhausting that the authors hand. I applaud the wise manner in
were not going to be able to produce a fit which these issues are addressed, as
ting sequel. Such fans will be as delighted sessed, and integrated.
as I (who was impatient, not pessimistic). When I first began to learn that Fluori-
The pessimists were completely wrong. Methane spray had a deleterious effect on
I believe this volume is even better than the ozone layer, I was dismayed and dis
the other because it reflects an enormous heartened for both my two friends and the
new recharging of energy that further ex many patients who would be denied the
perience, interaction, and thought have spray-and-stretch treatments. It is so
stimulated. Thus, Volume 2 has become heartwarming and exciting to see these
much more than it originally promised to innovators fully recognizing the environ
be; i.e., it was to be a rounding out of mental risks and acting with firmness. In
practical considerations in the anatomical stead of making excuses and persisting in
sense of dealing with the lower half of the the use of fluorocarbons, they have found
body. Volume 1, indeed, dealt with the up adequate alternative techniques and are
per half of the body, but it also laid out actively seeking adequate substitutes. My
the important principles of the myofascial instincts assure me that they will suc
pain syndromes (MPS) and hands-on ceed. Meanwhile, it is important that the
techniques that were state-of-the-art then. chemical coolants are only the means to
This new volume has the distinction of an end that can be achieved by following
going considerably beyond those areas to the lessons to be learned in Volume 2.
discuss rationale, new principles arising There are a multitude of clinically valu
from a ground-swell of experience, and able gems throughout this volume. Some
the unique place of MPS in the spectrum are boldly displayed (e.g., postisometric
of musculoskeletal disorders. No book, relaxation and cautions for patients with
not even Volume 1, has attempted this hypermobility); others are scattered liber
broad view before, and probably no other ally throughout the text and may be over
authors now could do it as well-if at all. looked by the inexperienced reader.
Myofascial trigger points and their sig Of course, on seeing the eloquent illus
nificance in painful conditions are no trations, casual browsers will be deeply
longer the rather controversial subject impressed. I predict that they will soon be
they were before Volume 1 appeared, nor at risk of becoming serious and devoted
are the treatment methods taught by Drs. readers. The drawings are not approxi
Travell and Simons. These are firmly es mate renderings by a clever artist of what
tablished and are increasingly being vali the authors "want." They are exactly what
dated by once skeptical clinical investiga the authors require, carefully integrated
vii
viii Foreword

with  the  text  by  a  close  author‐artist  rela‐ In short, I am greatly honored and pleased 
tionship.  Rarely  have  I  seen  such  a  perfect  to  have  had  the  opportunity  to  write  this 
match.  Foreword. It is a volume that has set a very 
The chapters on individual muscles ʺbelow  high mark for all authors in this field to try to 
the waistʺ were, of course, supposed to be the  reach. It is the book for its time, and an instant 
reason for Volume 2. Alone, they could make the  classic for many years to come. 
book an important aid for clinicians. But once 
again, they go far beyond the ʺHow Toʺ ap‐ John V. Basmajian, M.D., FRCPC, 
proach  implied  by  the  title  Manual. They  FACA, FACRM (Australia), FSBM, 
embody  the  state‐of‐the‐art  of  dealing  with 
FABMR 
pain in and around the individual muscles in a 
Professor Emeritus, McMaster 
way that I have never before seen for those 
University 
muscles.  Morphology,  function,  and 
Hamilton, Ontario 
common‐sense  approaches  are  melded  with 
great style and clarity.  Canada