Stretching of muscles with cervical osteochondrosis

Headaches due to the pathology of the cervical spine and neck muscles are united under the general term "cerogenic" headache. It includes various cranialgic syndromes, differing in the mechanisms of origin and features of the clinical picture.

The source of nociceptive impulses can be the structures of the craniovertebral transition (PDS C0-C1 C1-C2) with so-called functional blockades and arthroses of the junction surfaces, other cervical PDS, as well as muscular, fascial and ligament trigger points, especially in the extensor muscles of the head and neck, upper third of the sternocleidomastoid muscle, etc.

A number of muscles (large and small pectoral, ladder, sternocleamus-mastoid, sternum, iliacus muscle of the neck, subclavian) initiate pain in the anterior thoracic region.

Stretching of the affected muscles, we recommend that you enter into the massage procedure immediately after preparing the appropriate muscle with massage techniques (stroking, rubbing, kneading, vibration).

[1], [2], [3]

Method of stretching muscles in cervical osteochondrosis

Trapezius muscle

According to many authors, the trapezius muscle is obviously most often affected by myofascial CT and yet it is often ignored as a likely source of headache in the temporal region.

In the upper, middle and lower parts of the muscle, six TT can be located (two in each department), from which different pain patterns are transmitted.

Symptoms

• Turns of the head and neck are minimally limited (if only the trapezius muscle is affected);
• limited (up to 45 ° and less) inclination of the head to the side opposite to the affected upper muscle bundles;
• neck flexion and arm diversion are limited to a minor extent;
• active, the maximum possible turning of the head in the opposite direction causes pain, since the muscle contracts from the shortened state;
• the active turn of the head towards the affected muscle is not accompanied by painfulness, if the muscle lifting the scapula on the same side or the upper tufts of the trapezius muscle do not contain TT;
• if active TT is affected and the muscle that lifts the scapula, the turn of the head and neck into the affected side is significantly limited and the patient prefers to "keep the neck still".

Technique of stretching the trapezius muscle

The upper muscle beams (TT, and TT ₂ ): TTj. The starting position of the patient - sitting on a chair, holding hands for sitting (fixing the shoulders). To stretch the muscle fibers, the doctor (masseur) tilts the patient's head in the opposite side of the affected muscle (ear to shoulder). To maximize the stretching of the muscle, the patient's head is tilted forward.

The doctor at this time exerts pressure on the head and shoulder of the patient, thereby strengthening the flexion of the spine and lateral displacement of the scapula.

TT ₂. To inactivate TT _{2, the} muscle is stretched, tilting the patient's head somewhat more forward than with TT1.

ATTENTION! The stretching procedure should be subjected to a trapezoidal muscle and on the other side in order to prevent the activation of any TT in it at the usual shortening during stretching to the maximum length of the affected muscle.

Breast-clavicular-mastoid muscle

Painful patterns and accompanying symptoms are specific for each head of the muscle (medial and lateral). Pain and autonomic or proprioceptive disorders caused by TT muscles are evaluated by dentists as an important component of the most common disease - myofascial pain dysfunctional MDD syndrome. H. Williams and E. Elkins (1950) noted that myalgia of the head is accompanied by pains in the neck muscles at the places where they attach to the skull.

Symptoms

A. Medial head of the muscle.

• Active TT, localized at the lower end of the medial head, reflects pain in the area above the upper part of the sternum. Pain in the upper part of the sternum is a hallmark of the sternocleidomastoid myofascial syndrome from neuralgia of the trigeminal nerve.
• TT, affecting the medial level of the medial head, reflect pain on the ipsilateral side of the face. The zone of this pain in the form of an arc passes through the cheek, upper jaw, above the eyebrow and ends deep in the orbit.
• TTs localized along the inner edge of the middle section of the medial head transmit pain to the pharynx and to the back of the tongue when swallowed (Brody S.), which causes the sensation of a "sore throat," as well as a small area on the top of the chin.
• The pain reflected from the TT, localized at the upper end of the medial head, extends into the region of the occipital crest.

B. The lateral head of the muscle.

• Pain from the TT, located in the middle of this head, is reflected in the forehead; severe pain extends to both sides of the forehead.
• TTs located in the upper part of the lateral head cause pain deep in the ear and in the behind-the-ear region, in a number of cases - in the cheek and molars on the ipsilateral side.

Proprioceptive disorders caused by TT in the lateral head lead mainly to spatial disorientation. Patients complain of postural dizziness in the form of a mismatch of motion or a sense of movement "inside the head" (H.Kraus). Dizzy spells that last from a few seconds to several hours develop with a change in the posture caused by contraction of the sternocleidomastoid muscle or unexpected stretching.

Technique of stretching of the sternocleidomastoid muscle

The patient's starting position - sitting on a chair, grasping his hands with the sitting (fixing the muscles of the shoulder girdle). In the presence of TT in many muscles of the neck, the stretching procedure is performed first for the trapezius muscle and the muscle that lifts the scapula, as a result of which the amplitude of movement in the cervical region increases, which is absolutely necessary for complete passive stretching of the medial head of the sternocleidomastoid muscle. To achieve the full volume of movements and the maximum lengthening of the muscle, you can alternate the treatment of this muscle with the stretching of the staircases (H.Kraus).

Gradual stretching of the lateral head of the muscle is done by tilting the patient's head back and then turning her face into the opposite stretchable muscle side.

With a passive stretching of the medial head of the muscle, the patient's head gently turns toward the stretched muscle. Then, with a full turn of the head, the chin is lowered onto the foreleg. In this movement, the nape and mastoid process are elevated, ensuring maximum muscle stretching. The head in this position should be held only for a few seconds, because in the presence of atherosclerosis of the vertebral artery, it compresses at the base of the skull, which can lead to vision impairment and dizziness (J.Travell).

ATTENTION! During these procedures, the muscles of the neck and shoulder girdle should be relaxed.

The stretching procedure is always performed for both the right and left muscles. An increased volume of head rotation as a result of effective muscle therapy on one side can cause a reactive spasm of the abruptly shortened muscle on the other side. Such an unusual shortening of the muscle can activate its latent TT, which again will cause pain and dizziness. After the procedure, it is recommended to apply hot compresses to the muscles.

[4]

Deep muscles of the posterior region of the neck (semi-oedemic muscle of the head, semi-ovoid neck muscle, multivariate muscle)

Symptoms

Each region of localization of trigger points (TT) corresponds to a certain pattern of reflected pain.

The region of localization of TT1 lies somewhat higher than the base of the neck at the level of the vertebral bodies C ₄, C ₅. These points cause pain and soreness in the suboccipital region, sometimes the pain spreads down the posterior region of the neck right up to the upper part of the medial edge of the scapula. These TT can lie at the depth of the semi-oval muscle of the neck and the dividing muscle.

• Active TT ₂, localized 2-4 cm below the occiput, causes pain throughout the neck until the crown.
• TT ₃ is located directly under the occipital crest in the area of attachment of the semi-oval head muscle to the occipital bone. The pain from this TT in the form of a semibore is distributed in the ipsilateral half of the head, maximally manifesting in the temporal region and in the frontal part above the eye (EJakson). Often, TT, localized in the posterior cervical muscles under the occiput, causes pain in both arms and legs or in the trunk (below the shoulder strap on the ipsilateral side).

Method of stretching the muscles

Stretching, as a rule, is first of all subjected to those muscles that maximally restrict movement. Provided that all head movements are limited, it is best to first restore the head inclination forward, then lateral inclinations and turns of the head, and only lastly, extension of the head. The patient should therefore be evaluated for the degree of damage to individual muscle groups, taking into account the overlapping functions of these muscles (D.Zohn et al.).

Due to the fact that a certain movement in the cervical region is provided by several muscles, the procedure of stretching in only one direction usually only partially solves this problem. Therefore, adjacent almost parallel muscle fibers must be subjected to the stretching procedure. To eliminate the restriction of movements in different planes in the cervical region, the stretching procedure is often necessary to repeat 2-3 times with the obligatory application of a hot compress to the affected muscles.

To eliminate the limitations of the inclination forward and laterally in the cervical region, the stretching procedure is first subjected to the sublingual and upper neck muscles, then the long-fiber lower muscles of the neck and muscles of the upper half of the trunk and finally the muscles of the thoracic spine. With this procedure, mainly the near-vertebral muscles are stretched, including the small posterior rectus muscle of the head, the semimineral muscle of the head, and the longest muscles.

• A. Muscles of the posterior region of the neck.

The patient's starting position is sitting, his head tilted, his hands lowered.

The doctor (masseur) gently presses the patient's head, gradually tilting it along with the shoulder girdle closer to the knees.

• B. Muscles of the anterior region of the neck.

If, with maximum bending of the head, the patient's chin does not reach the sternum by the thickness of the finger, the cause of this may be the muscles of the anterior region of the neck that participate in this movement.

I.p. Patient sitting on a chair. The doctor slowly unbends his head.

ATTENTION! The presence of TT in these muscles and their shortening leads to an overload of the posterior group of neck muscles.

The stretching procedure should be subjected to the sternocleidomastoid muscle (on both sides).

It is recommended to finish the procedure by applying a hot compress to the affected muscle.

[5], [6], [7],

Muscle lifting shoulder blade

The muscle that lifts the scapula is one of the most frequently affected CT muscles of the shoulder girdle (A.Sola et al.).

Symptoms

The main pain from the TT, regardless of localization, is projected into the corner of the neck (the area of the neck's transition to the forehead), and the spilled pain from the TT is distributed along the medial edge of the scapula and on the posterior deltoid region. The lower TT can cause pain in the area of the lower angle of the scapula. The pain caused by TT significantly limits the turn of the neck (H.Kraus).

Technique of stretching the muscle

The starting position of the patient is sitting on a chair, holding hands by the seat (fixing the shoulder blade in the lowered position). The doctor (masseur) gently rotates the patient's head about 30 ° from the affected muscle, then tilts the head forward (to stretch more vertical muscle fibers) and in the contralateral side.

Stair Muscles

Active TT, localized in any of the staircases (anterior, middle or posterior) can cause pain in the chest, arm, medial border of the scapula and in the interblade area.

Symptoms

1. When viewed from patients:
   • flexion of the head to the contralateral side is limited;
   • when the head turns, soreness is absent;
   • the hand is sideways to the side is limited.
2. Sample for muscle spasm. The patient is asked to turn his head to the side of pain localization, then lower his chin into the supraclavicular fossa.

These movements cause a significant reduction of the stair muscles, activate the TT localized in them and cause a pattern of reflected pain characteristic for these points.

3. Try to relax the muscles. The patient's starting position is sitting on a chair. The patient applies the forearm of the affected hand to the forehead and simultaneously lifts and pushes forward the shoulder, thus eliminating the pressure of the clavicle on the stair muscles located under it and the brachial plexus. The pain in this movement takes place in a fairly short time.

ATTENTION! The test is based on the fact that lifting the arm and collarbone removes the reflected pain in the syndrome of the anterior staircase.

4. Finger bending test. The patient must fully unbend his fingers in the metacarpophalangeal joints. Normally, when performing a test consisting of maximum bending of the fingers in interphalangeal joints, the fingertips touch the palmar surface of the hand.

This test is considered positive if active TT is localized in the stair muscles. In this case, four fingers do not bend completely.

5. The Adson test is as follows: the patient takes a long breath, lifts his chin and turns it to the affected side.

During this movement, the maximal rise of the 1st rib occurs, which starts to press the neurovascular bundle to the contracted muscle.

The sample is considered positive if it leads to a weakening or disappearance of the pulse on the radial artery or to a change in blood pressure.

Method of stretching the muscle.

The patient's starting position is sitting, holding with one hand (on the side of the muscle lesion) to fix the shoulder blade for sitting chair.

• A. Front staircase. In order to stretch the front staircase, the doctor (masseur) first asks the patient to tilt the head in the opposite side of the stretched muscle and then turns it in the posterolateral direction.
• B. When the middle stair is stretched, the patient's starting position is the same. The doctor (masseur) exercises the inclination of the head in the direction of the contralateral shoulder.
• B. When the back stair is stretched, the patient's initial position is sitting on a chair, fixing the hands behind the chair. The doctor (masseur), without turning the patient's head, exerts pressure on her in the anterior-contralateral direction along the axial line of this muscle. At the same time, it is possible to conduct vertical traction of the cervical spine (for the purpose of muscle relaxation).

Immediately after the procedure, it is recommended to apply a hot compress.

Muscular muscle

Localized in the supraspinus muscle trigger points cause deep pain in the shoulder and shoulder: the pain in the middle deltoid region is particularly pronounced.

Symptoms

• When the muscle is damaged, the test to get the scapula from behind the back is limited;
• in the standing position the patient is not able to completely withdraw the shoulder, as this shortens and loads the muscle;

ATTENTION! The same movement in the IS. Lying on the back of the patient performs more freely, since the weight of the hand does not counteract the activity of the muscle.

• when palpation, a pronounced tenderness of the tendon of the lateral end of the muscle is revealed.

ATTENTION! Tendon attachment of the lateral end of the muscle is much more accessible for palpation, if the hand from the side of the examined muscle is turned inwards and its hand is wound behind the waist.

The technique of stretching the supraspinatus

I.p. Patient - sitting on a chair, the hand is wound behind the waist. The doctor brings the hand of this hand to the shoulder blade.

I.p. Patient sitting on a chair. The doctor helps raise the patient's arm in front of the chest.

Musculoskeletal

Most researchers believe that with the defeat of this muscle, the primary target for reflected pain is the anterior region of the shoulder joint. The pain is also projected down into the anterior-lateral region of the shoulder, into the radial part of the wrist and sometimes into the fingers.

Symptoms

Patients with such a lesion usually complain that they can not get a shoulder blade on the opposite side. The patient's inability to turn the shoulder to the inside and at the same time to withdraw it indicates the presence of an active TT in the subacute muscle. Reflected pain does not allow patients to sleep on the affected side.

Recommended tests for the detection of lesions of the muscles of the shoulder girdle:

• getting your mouth over your head and
• getting a shoulder blade from behind.

The method of stretching the muscle: for stretching the muscle, you can use one of three methods:

• sample to get the shoulder blade from behind. I.p. Patient - sitting;
• i.p. Patient - sitting. The doctor produces in the horizontal direction the traction of the hand on the croup;
• i.p. Patient - lying on the opposite side of the affected muscle. The doctor turns the patient's hand behind his back.

Subscapular muscle

Trigger points localized in this muscle cause severe pain both at rest and during movement. The area of the underlying pain is projected in the posterior projection of the shoulder joint. Zones of diffuse pain cover the scapula and spread down the posterior region of the shoulder to the elbow.

Clinical picture: in the early stages of muscle damage, patients can raise their arm forward and up, but they can not tilt it back (throwing the ball). With the progression of TT activity, shoulder leaning becomes possible only by 45 °, patients complain of pain both at rest and under stress. Often such patients are diagnosed with a "frozen shoulder".

The technique of stretching the muscle: ip. The patient - lying on his back, fixing the scapula is carried out by the mass of his body. The doctor carefully withdraws his shoulder to the border of tolerable pain, holding it in a neutral position between turns outside and inside. Then the doctor should gently rotate the shoulder outward. The doctor gradually strengthens the passive stretching of the muscle, moving the patient's brush first under the head, then under the pillow, and finally at the head end of the couch, thereby increasing the volume of such movements of the shoulder as retraction and turning outwards.

The widest back muscle

Myofascial CT is usually localized in that part of the muscle that forms the posterior wall of the axillary fossa. Constant dull pain is reflected in the lower angle of the scapula and into the surrounding area at the level of the middle of the thorax. Reflex pain can also spread to the posterior region of the shoulder and down the medial surface of the forearm and hand, including the ring finger and little finger.

It should be remembered that the latissimus muscle of the back is a long relaxed muscle, which, therefore, rarely causes pain under loads that only partially stretch it, but it irradiates the pain in the actions associated with lowering the load when it has a heavy load.

Such patients are often prescribed a whole series of diagnostic procedures (bronchoscopy, coronary angiography, myelography, computed tomography), which do not reveal any pathology.

The method of stretching the muscle: stretching the muscle is carried out in the i.p. Patient - lying on his back and on his side.

Large round muscle

Trigger points (points) are localized in two areas of the muscle: the medial points are in the region of the posterior surface of the scapula; lateral - in the field of the back wall of the axillary fossa, where the latissimus muscle of the back "wraps" this muscle. The TT of both regions causes pain in the posterior deltoid region and over the long head of the triceps brachii muscle. TT, localized in a large circular muscle, can cause reflected pain in the posterior region of the shoulder joint.

The method of stretching the muscle: the muscle can be stretched in the patient in the p. Lying on his back and on his side. At the same time, the patient's arm should be maximally withdrawn and bent in the shoulder joint, which allows to rotate the shoulder inside or out. The doctor should gradually bring the patient's hand to his head, while the blade angle is fixed by the body weight.

The clinical picture consists of a painful phenomenon and when the blade moves, the patient may experience a click and a crunch.

The method of stretching the muscles. i.p. Patient - sitting on a chair, inclination of the trunk and head forward, hands lowered. At this position, the round back and the downwardly downward arms pull the scapula in the anterolateral direction. To increase stretching, the doctor must press the patient's shoulder forward and down.

Large pectoralis muscle

Myofascial CT of the anterior pectoral muscles can simulate typical heart pain in terms of intensity, nature and localization. The final diagnosis of active TT, based on their characteristic signs and symptoms and the elimination of their medicamentous treatment, does not exclude heart disease. The complexity in diagnosis is also evidenced by the fact that pains of non-cardiac origin can cause transient changes in the T wave on the ECG. Complaints of unilateral pain in a clearly delineated parasternal zone make one suspect the existence of TT, localized in the muscle.

The most frequent somatosceral manifestations are episodes of supraven-tricular tachycardia and extrasystole or ventricular extrasystole without other heart lesions. The somatic area of reflected pain causes drilling pain in myocardial ischemia. An example of myofascial viscero-somatic manifestation may be the failure of the coronary arteries or another intrathoracic disease, reflecting pain from the affected organ on the anterior chest wall. The result is the development of satellite-lithotransplant in the somatic pectoral muscles.

In addition to pain along the front surface of the shoulder and in the subclavian area, patients with active TT in the clavicle portion of the large pectoral muscle may complain about limiting the shoulder abscess.

Method of stretching the muscle. When stretching the muscle, it is important to remember that it covers three joints: a crudo-clavicular, clavicular-acromial and humeral. It also covers an area that functions like a joint that moves the blade along the ribs.

Most effectively all portions of the large pectoral muscle are stretched in the p. Patient sitting on a chair, since this position allows the free movement of the scapula and arms (the need for the participation of three joints).

The doctor holds the traction by the hand, the withdrawal in the shoulder joint and the movement of the shoulder in such a way as to dislodge the scapula.

For passive stretching of the clavicular portion of the muscle, the physician performs external rotation and horizontal retraction of the shoulder.

To stretch the intermedial groove fibers, the doctor raises his arm by about 90 °, then performs an external rotation and retracts back to the maximum possible extension position.

To stretch the lowest rib portion is recommended. Patient sitting or lying on his back. The doctor flexes the patient's arm in the shoulder joint, performing an external rotation. In this case, the doctor should apply a measured resistance to a possible reverse movement of the hand.

After elimination of tension in the large pectoral muscle in the muscles-antagonists (the posterior group of muscles covering the shoulder joint, rhomboid and trapezoid), pain and activation of shortening are usually noted. They can also activate TT (latent) due to excessive strengthening during the stretching of the pectoralis major muscle. Therefore, as a mandatory procedure, it is necessary to stretch them.

In order to stretch the large pectoral muscle, exercises are recommended, which should be included in exercises of therapeutic gymnastics.

Deltoid

Active TT, localized in the anterior part of the muscle, causes pain in the anterior and middle deltoid regions. Active TT, localized in the back of the muscle, causes pain in the middle and posterior deltoid areas and sometimes in adjacent shoulder areas.

Method of stretching the muscle.

I.p. Patient - sitting.

1. Stretching the anterior portion of the muscle. The doctor directs the straightened hand of the patient to the side by 90 °, rotates the shoulder outside and pulls it backward.
2. Stretching of the back portion of the muscle. The doctor rotates the patient's shoulder to the inside and then withdraws to the contralateral side. With this movement, there is a stretching of two more muscles - supraspinatus and subacute.

[8]

The biceps brachialis muscle

Active TT is localized in the distal part of the muscle. The pain caused by these TTs is superficial and spreads in the region of the upper part of the biceps arm muscle, in the anterior deltoid region.

Technique of stretching the muscle

1. I.p. Patient - sitting on a chair, the shoulder blades are pressed to the back of the chair, the hand is unbent at the elbow joint. The doctor slowly turns the patient's shoulder outward, pulls it 90 ° and then pierces the brush. With this movement, both the long and short heads of the biceps brachium muscle are stretched. The physician must hold the patient's hand in this position (20-40 seconds).
2. I.p. The patient - lying down, the hand is rotated to the outside, a pads are placed under the shoulder, the brush is punctured. The doctor extends the patient's arm simultaneously in the elbow and shoulder joints. In order to hold his hand in this position, the doctor fixes the patient's elbow to the couch or to his knee. To ensure the full extension of the arm in the elbow joint, stretch the shoulder and triceps muscles.

The triceps brachialis muscle

Long head of the muscle. The pain caused by active TT1 extends upward from the localization zone along the posterior surface of the shoulder and the upper layer, seizing the zones of the upper trapezoid muscle bundles (near the neck).

Medial head of the muscle. TT2 is localized in the lateral edge of the medial head. Reflected pain is projected onto the lateral over-condyles and is a common component of epicondylitis.

Lateral head of muscle. TT3 causes pain in the area of the posterior surface of the shoulder. A tight muscular tract, in which it is localized, can squeeze the radial nerve.

Technique of stretching the muscle

1. I.p. Patient - sitting on a chair, arm bent at the elbow joint. The doctor flexes the arm in the shoulder joint with the subsequent pressure on the elbow area (putting the arm behind the back), while pressing the forearm.
2. I.p. Patient - lying on his back. The doctor flexes the patient's arm in the elbow and shoulder joints, then the supine brush is placed under the shoulder area. At the same time, the physician's arm presses onto the elbow (downwards), thereby strengthening the flexion in the shoulder joint and, as a consequence, increases the stretching of the muscle (especially its long head).

Extensors of the wrist and the brachial muscle

Trigger points localized in the long radial extensor of the wrist cause pain and soreness in the lateral epicondyle and in the area of the anatomical snuffbox. Pain from TT localized in the short radial extensor of the wrist is projected into the back region of the wrist and hand. These TTs are the main source of myofascial pain in the back of the wrist.

The technique of stretching the extensors of the wrist

I.p. Patient sitting or lying on his back. The stretching of the long and short radius extensors of the wrist is performed by flexing the penetrated hand of the straightened arm in the elbow joint. When stretching the elbow extensor of the wrist, the wrist is flexed in the wrist joint and its supination.

Technique of stretching of the humerus muscle

I.p. Patient - sitting, the arm is straight, a small pillow is placed under the elbow joint. As the muscle crosses the forearm, then for stretching it is carried out pronation of the forearm.

After the stretching procedure, the arm is covered with hot compresses.

[9], [10], [11]

Extensors of fingers

Trigger points (TT) of extensor fingers project pain onto the outer surface of the forearm, the back surface of the hand and fingers. Pain can spread to the distal parts of the fingers, but it never appears in the area of the terminal phalanges and nails.

Technique of stretching the extensor of the fingers of the hand

I.p. The patient is sitting, the arm is straight, a small pillow is placed under the elbow.

The doctor should bend all the fingers of the patient with the simultaneous bending of the hand.

[12]

Supinator ("tennis elbow")

The trigger points of the instep support the pain in the area of the external epicondyle and the outer surface of the elbow. They also project pain in the tissue of the gap between the forefinger and the thumb, and with considerable intensity, the pain can capture part of the posterior surface of the forearm.

Cyriax distinguishes four varieties of "tennis elbow":

1. Tendon-periosteal, which is explained as a partial detachment of the muscle and its tendons from the attachment sites, resulting in a painful scar.
2. Muscular, which is close in clinical picture to the described activity of TT, located in the long radial extensor of the wrist and transmitting painful sensations to the area of the external epicondyle.
3. Tendon, which is described as damage to the "tendon body". Obviously, we are talking about the tendon of the common extensor at the level of the head of the radius. Morphological examination revealed microscopic ruptures of the short radial extensor of the wrist with the phenomena of abortive regeneration.
4. Supracondylar, which reveals a TT, localized in the triceps muscle of the shoulder and transmits pain to the internal epicondyle.

Technique of stretching the muscle

I.p. The patient is sitting, the hand is straightened, a small pillow is placed under the elbow. This position allows you to completely unbend the arm in the area of the elbow joint and with complete pronation of the brush prevent internal rotation of the shoulder.

Long palm muscle

Trigger points are localized in the long palmar muscle and reflect superficial stabbing pain unlike most other muscles that transmit deep dull pain. The pattern of reflected pain is focused on the palmar surface of the hand.

Technique of stretching the muscle

I.p. Patient - sitting, under the elbow joint area a small pillow is brought, fingers of the hand are unbent. The doctor stretches the patient's arm. Stretching can alternate with ischemic compression to inactivate TT, after which it is recommended to stretch the entire group of flexor muscles of the forearm, especially wrist and finger flexors to inactivate myofascial TT, the involved parallel muscles.

Brush flexors

Active CT of the wrist flexor of the wrist, the pain focused on the radial surface of the palmar fold of the wrist, reflects on the foreleg and palm. An active TT of the elbow flexor of the wrist transmits a similar pain pattern on the ulnar side of the palmar surface of the wrist.

[13], [14]

Folders of fingers

Differences in patterns of reflected pain of superficial and deep flexor flexors were not noted. TT, localized in the muscles of the flexor of any finger, reflects pain in this finger.

[15]

The long flexor of the thumb

When there is a myofascial TT in the muscle, pain spreads over the palmar surface of the finger to its tip.

Round pronator

TT, localized in the muscle, reflect pain in the depth of the wrist along the palmar surface and in the forearm.

Method of stretching the muscles

I.p. The patient - lying down, the arm is unbent, a small pillow is placed under the area of the elbow joint. The doctor extends the wrist and fingers of the patient.

The muscle that leads the thumb of the hand

Active TT causes dull pain along the outer surface of the thumb at its base, distal to the wrist of the skin fold. The zone of diffuse soreness includes the palmar surface of the first metacarpophalangeal joint, and can also extend to the thumb, the rise of the tenar and the dorsal surface of the interdigital membrane.

The muscle that opposes the thumb of the hand

The pain from the TT localized in that muscle is reflected on the palmar surface of the thumb and onto the radial palmar surface of the wrist, to which the patient usually presses the finger to localize the pain.

Method of stretching the muscles

I.p. The patient - sitting or lying down, the brush is supined and placed on the cushion, which allows a full extension, and then a significant retraction of the thumb.

The patient should also be trained in the stretching exercise of these muscles, which is performed in a warm bath.

The interosseous muscles

Trigger points of the 1st back interosseous muscle reflect the pain clearly over the radial surface of the index finger, deep into the back surface of the hand and across the palm. Myofascial CTs of the other rear and palmar interosseous muscles reflect pain on the side of the finger to which the muscle is attached. The pain extends to the distal interphalangeal joint. The presence of active TT in the interosseous muscle is often combined with the Geberden node located in the zone of reflected pain of myofascial TT and pain.

Method of stretching the muscles

With the exception of the 1st back interosseous muscle, stretching treatment is usually ineffective, since stretching them is difficult. These TTs are also inaccessible for ischemic compression. The first back interosseous muscle is stretched out by means of strong retraction of the thumb and reduction of the index finger.

The patient is offered daily at home to perform exercises to stretch the interosseous muscles of the hand. It is important that the forearms are one straight line.