Pain

Pain Guide

Under each subheading of each part of the body, muscles are listed in order with the muscles listed first being the ones most frequently found by Travell and Simons to be the cause of the specific pain. This information is based on Travell and Simons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, by D. Simons, J. Travell and L. Simons, Volume I, 1999; Volume II, 1993. [Information in colored italics indicates additional muscles and sub-groupings, mentioned by other authors, that may not be included in the Trigger Point Manual. I am still checking these.]

Abdominal pain:

general: rectus abdominis, external oblique, transversus abdominis,

iliocostalis thoracis, multifidi, quadratus lumborum, pyramidalis

pubic bone: rectus abdominis, adductor magnus

Ankle pain:

Achilles tendon (often called tendinitis): soleus, tibialis posterior

anterior: tibialis anterior, peroneus tertius, extensor digitorum longus,

extensor hallucis longus

anteromedial: tibialis anterior

arthritis of the ankle: peroneal muscles

bone pain, anterior tibia: extensor hallucis longus

lateral: peroneus longus, peroneus brevis, peroneus tertius

medial: abductor hallucis, flexor digitorum longus, gastrocnemius, soleus

posterior: soleus, tibialis posterior

Arm pain, upper arm: (for lower arm, see Forearm pain)

anterior: scalene muscles, infraspinatus, biceps brachii, brachialis, triceps

brachii, supraspinatus, deltoid, sternalis, scalenus minimus,

subclavius

lateral: infraspinatus

oppressive ache on the outside of the upper arm near elbow: brachialis

posterior: scalene muscles, triceps brachii, deltoid, subscapularis,

supraspinatus, teres major, teres minor, latissimus dorsi, serratus

posterior superior, coracobrachialis

medial: latissimus dorsi

Back pain:

arthritis of the back: deep spinal muscles, quadratus lumborum

low back: hamstrings (treat both legs), gluteus medius, iliopsoas, rotatores,

longissimus thoracis, quadratus lumborum, gluteus maximus, rectus

abdominis, iliopsoas, soleus

low back horizontal pain pattern: lowest portion of rectus abdominis

low back immobilized, can’t bend forward or to side: hamstrings (treat both

legs), quadratus lumborum

low back sharp pain with small movement: quadratus lumborum, multifidi at

base of spine on sacrum

low back stiff, difficult to turn over in bed: hamstrings (treat both legs),

quadratus lumborum

lower-thoracic back: iliocostalis thoracis, multifidi, serratus posterior

inferior, rectus abdominis, intercostals, latissimus dorsi, iliopsoas

lumbar: longissimus thoracis, iliocostalis lumborum, iliocostalis

thoracis, multifidi, rectus abdominis, iliopsoas, gluteus medius,

quadratus lumborum, hamstrings

lumbosacral: gluteus maximus, anterior cervical muscles, soleus

mid-back oppressive or burning: trapezius (points 3, 4)

mid-back pain centered on inferior angle of scapula: latissimus dorsi

mid-thoracic back: scalene muscles, latissimus dorsi, levator scapulae,

iliocostalis thoracis, multifidi, rhomboid muscles, serratus posterior superior,

infraspinatus, trapezius (points 4, 5), anterior cervical muscles,

serratus anterior, serratus posterior inferior, rectus abdominis,

intercostals, iliocostalis lumborum

sacral and gluteal: longissimus thoracis, iliocostalis lumborum, multifidi,

quadratus lumborum, piriformis, gluteus medius, gluteus maximus,

levator ani, obturator internus, gluteus minimus, sphincter ani,

coccygeus, soleus

sacroiliac joint: gluteus medius, gluteus maximus, piriformis, quadratus

lumborum, longissimus thoracis, multifidi, soleus

upper-thoracic back: scalene muscles, levator scapulae, supraspinatus,

trapezius (point 2, 3, 5), multifidi, rhomboid muscles, splenius cervicis,

triceps brachii, biceps brachii, superficial spinal muscles, serratus

posterior superior, infraspinatus, serratus anterior

upper sacral: bilateral quadratus lumborum (cephalad, deep)

Breast pain:

general: serratus anterior, scalene muscles, pectoralis major, pectoralis minor

nipple: pectoralis major, serratus anterior

Buttock pain: (see also Hip pain)

any pain: piriformis almost always involved due to nerve entrapments as

well as trigger points

buttock: gluteus medius, quadratus lumborum, gluteus maximus, iliocostalis

lumborum, longissimus thoracis, semitendinosus, semimembranosus,

piriformis, gluteus minimus, rectus abdominis, soleus

lower buttock: quadratus lumborum (caudal, deep)

coccyx: levator ani, coccygeus, gluteus maximus

Chest pain:

front: pectoralis major, pectoralis minor, scalene muscles, sternalis,

intercostals, iliocostalis cervicis, subclavius, sternocleidomastoid,

external abdominal oblique, diaphragm, rectus abdominis

lower ribcage: abdominal obliques

mid-clavicular: sternocleidomastoid

side: serratus anterior, intercostals, latissimus dorsi, diaphragm

Ear pain, see Head pain

Elbow pain:

back or olecranon: triceps brachii (attachment tendon), serratus

posterior superior

front or antecubital: brachialis, biceps brachii

lateral (thumb side): supinator, brachioradialis, extensor carpi radialis

longus, triceps brachii, supraspinatus, fourth and fifth finger

extensors, anconeus

medial (little finger side): triceps brachii, pectoralis major,

pectoralis minor, serratus anterior, serratus posterior superior, flexor

carpi ulnaris

Eye pain, see Head pain.

Facial pain, see Head pain.

Finger pain:

arthritis of the fingers: flexor digitorum, interossei

arthritis of the knuckles: extensor digitorum, interossei

dorsal (back-of-hand side) fingers: extensor digitorum, interossei,

scalene muscles, abductor digiti minimi, pectoralis major, pectoralis

minor, latissimus dorsi, subclavius, triceps brachii

fourth and fifth fingers: latissimus dorsi, triceps brachii, pectoralis major,

pectoralis minor, serratus anterior

index finger: scalene muscles

little finger: serratus posterior superior

thumb, at base, and radial-side hand: supinator, scalene muscles, brachialis,

infraspinatus, extensor carpi radialis longus, brachioradialis,

opponens pollicis, adductor pollicis, subclavius, first dorsal

interosseus, flexor pollicis longus

sharp pain to palm side of fingers, misinterpreted as arthritis or carpal tunnel

syndrome: flexor digitorum

volar (palm side) fingers: flexores digitorum superficialis and

profundus, interossei, latissimus dorsi, serratus anterior, abductor

digiti minimi, subclavius, triceps brachii

Foot pain: (see also Toe pain)

arch and mid-foot: gastrocnemius, soleus, flexor digitorum longus, adductor

hallucis, abductor hallucis, interossei, tibialis posterior

dorsal forefoot: extensors digitorum longus and brevis, extensors

hallucis longus and brevis, flexor hallucis brevis, interossei, tibialis

anterior

dorsal (top) foot pain: tibialis anterior, peroneus tertius, extensor digitorum

longus, extensor hallucis longus

heel pain, general: soleus, quadratus plantae, abductor hallucis, tibialis

posterior

heel pain, lateral: peroneus tertius

heel pain, medial: abductor hallucis

heel pain, posterior: soleus, tibialis posterior

heel pain, plantar (bottom): soleus, tibialis posterior, quadratus plantae,

abductor hallucis

lateral plantar foot pain: abductor digiti minimi

metatarsal heads (ball of foot): flexor hallucis brevis, flexor digitorum brevis,

adductor hallucis, flexor hallucis longus, interossei, abductors digiti

minimi longus and brevis, flexor digitorum longus, tibialis posterior

plantar mid-foot: gastrocnemius, flexor digitorum longus, adductor hallucis,

soleus, interossei, abductor hallucis, tibialis posterior

Forehead pain, see Head pain or Headache.

Forearm pain:

achiness and oppressive pain in forearm and back of upper arm: triceps brachii

dorsal (extensor) side burning, tightness, aching: extensor carpi radialis brevis,

extensor carpi radialis longus, brachioradialis, supinator

dorsal (extensor) side: triceps brachii, teres major, extensors carpi radialis

longus and brevis, coracobrachialis, scalenus minimus,

brachioradialis, brachialis

radial aspect (thumb side) pain: infraspinatus, scalene muscles,

brachioradialis, supraspinatus, subclavius

radial aspect (thumb-side) burning pain: extensor carpi radialis longus,

brachioradialis, supinator

ulnar aspect (little finger side): latissimus dorsi, pectoralis major, pectoralis

minor, serratus posterior superior, serratus anterior

volar (flexor) side: palmaris longus, pronator teres, serratus anterior, triceps

brachii, latissimus dorsi, pectoralis major, pectoralis minor, serratus

posterior superior

Genital pain: (see also Groin pain and Pelvic pain)

both genders: rectus abdominis, abdominal obliques, intrapelvic muscles,

adductor magnus, iliopsoas, piriformis

labia: psoas major

prostate pain: posterior intrapelvic muscles

pubic bone: rectus abdominis, adductor magnus

rectal fullness sensation: obturator internus, piriformis

testicular: psoas major, anterior intrapelvic muscles, external oblique,

internal oblique, transversus abdominis

vaginal: anterior intrapelvic muscles, levator ani, obturator internus,

adductor magnus

Groin pain:

deep pain, below inguinal ligament: adductor magnus (mid-thigh)

general: quadratus lumborum, iliopsoas, adductor longus, adductor brevis,

adductor magnus, rectus abdominis, external and internal obliques,

transversus abdominis

shooting pain inside pelvis: adductor magnus (proximal)

with restricted extension at the hip: pectineus, tensor fasciae latae

Hand pain:

arthritis in the knuckles: extensor digitorum, interossei

burning pain, wrist and hand: extensor carpi radialis longus, brachioradialis,

supinator

dorsal (back side) hand and wrist: extensors carpi radialis brevis and

longus, extensor digitorum, extensor indicis, extensor carpi ulnaris,

subscapularis, coracobrachialis, scalenus minimus, latissimus dorsi,

serratus posterior superior, first dorsal interosseus

palm of hand and wrist: flexor carpi radialis, flexor carpi ulnaris,

opponens pollicis, pectoralis major, pectoralis minor, latissimus dorsi,

palmaris longus, pronator teres, serratus anterior

radial (thumb side) hand and base-of-thumb: supinator, scalene muscles,

brachialis, infraspinatus, extensor carpi radialis longus,

brachioradialis, opponens pollicis, adductor pollicis, subclavius, first

dorsal interosseus, flexor pollicis longus

ulnar (little finger side): latissimus dorsi

Head pain: (see also Headache)

above eye to bridge of nose: orbicularis oculi

back (can’t bear weight of back of head on pillow): occipitalis

cheek: sternocleidomastoid (sternal), masseter, lateral pterygoid, trapezius

(point 1), digastric, medial pterygoid, buccinator, platysma,

orbicularis oculi, zygomaticus major

chin and jaw, prickling pain: platysma

crown or top of head: sternocleidomastoid (sternal), splenius capitis

ear: lateral pterygoid, masseter, sternocleidomastoid (clavicular), medial

pterygoid, digastric, suprahyoid group, infrahyoid group, longus colli

eye and eyebrow: sternocleidomastoid (sternal), temporalis, splenius

cervicis, masseter, suboccipital muscles, occipitalis, orbicularis oculi,

trapezius (point 1)

forehead: sternocleidomastoid (sternal), masseter, zygomaticus major,

frontalis

gum, upper gum: buccinator

jaw: sternocleidomastoid (sternal), masseter, lateral pterygoid, trapezius

(point 1), digastric, medial pterygoid, buccinator, platysma,

orbicularis oculi, zygomaticus major

jaw, upper, aggravated by chewing: buccinator

occiput: digastric (posterior), occipitalis, semispinalis capitis, semispinalis

cervicis

mouth, diffuse ache in pharynx, tongue, hard palate: medial pterygoid

nose: orbicularis oculi, zygomaticus major

posterior head: trapezius (point 1), sternocleidomastoid, semispinalis capitis,

semispinalis cervicis, splenius cervicis, suboccipital muscles,

occipitalis, digastric, temporalis

sinus: sternocleidomastoid, masseter, lateral pterygoid

temple: trapezius (point 1), sternocleidomastoid (sternal), temporalis,

splenius cervicis, suboccipital muscles, semispinalis capitis

temporomandibular joint: temporalis, lateral pterygoid, masseter,

sternocleidomastoid (clavicular), medial pterygoid

tongue: sternocleidomastoid, medial pterygoid, digastric, mylohyoid

toothache, lower incisors: digastric (anterior)

toothache, lower molars: trapezius (point 1), masseter

toothache, upper teeth: temporalis

Headache:

behind the ear: sternocleidomastoid (sternal), longissimus capitis

behind the eye: occipitalis, temporalis, splenius cervicis

cervicogenic: masseter, trapezius (points 1, 2), temporalis, suboccipital

muscles, posterior cervical muscles, scalene muscles

deep, diffuse pain on one side, from occiput to forehead: suboccipital

muscles, semispinalis capitis

eyebrow area: temporalis, masseter, sternocleidomastoid (sternal),

orbicularis oculi

frontal: sternocleidomastoid (clavicular), semispinalis capitis, frontalis,

zygomaticus major

front and sides: sternocleidomastoid, temporalis, masseter

forehead: sternocleidomastoid, masseter, zygomaticus major, frontalis

hangover: sternocleidomastoid

migraine, inside head from back to front: suboccipital muscles,

semispinalis capitis, trapezius

pressure in back of head (lying face-up) causes headache: suboccipital

muscles

side, toward the back: occipitalis

spinal tap headache: sternocleidomastoid

stabbing pain, “straight through the head:” splenius cervicis

temple: trapezius (point 1), sternocleidomastoid (sternal), temporalis,

splenius cervicis, suboccipital muscles, semispinalis capitis

tension type: trapezius (point 1), sternocleidomastoid (sternal), suboccipital

muscles, temporalis, masseter, orbicularis oculi, buccinator,

zygomaticus major, occipitofrontalis, posterior cervical muscles

top of head: splenius capitis, sternocleidomastoid (sternal)

vascular: sternocleidomastoid

Hip pain:

ache in hip, deep, between iliotibial band (ITB) and greater trochanter:

tensor fasciae latae

back, hip, and/or tailbone: posterior intrapelvic muscles

coccyx: levator ani, coccygeus, gluteus maximus

greater trochanter region: quadratus lumborum, tensor fasciae latae

groin and hip: pectineus

“growing pains” in hips and thighs: adductors, hamstrings

hip, with pain down back of leg: piriformis, hamstrings, vastus lateralis,

gastrocnemius, iliopsoas, quadratus lumborum, gluteus minimus,

gluteus medius (with associated points in: thoracic paraspinal

muscles, rectus abdominis, shoulder and posterior cervical muscles)

iliac crest: gluteus medius, longissimus thoracis, quadratus lumborum

iliosacral area: levator ani and coccygeus, gluteus medius, quadratus

lumborum, gluteus maximus, multifidi, rectus abdominis, soleus

lateral hip and thigh: gluteus minimus, vastus lateralis, piriformis, quadratus

lumborum, tensor fasciae latae, vastus intermedius, gluteus maximus,

rectus femoris

sacral and gluteal: longissimus thoracis, iliocostalis lumborum, multifidi

quadratus lumborum, piriformis, gluteus medius, gluteus maximus,

levator ani, obturator internus, gluteus minimus, sphincter ani,

coccygeus, soleus

sacroiliac joint: gluteus maximus, gluteus medius, piriformis, quadratus

lumborum, soleus

sitting or lying supine causes pain in hip: quadratus lumborum (due to small

hemipelvis)

Jaw pain, see Head pain.

Knee pain:

ache deep in knee joint, often interrupting sleep: vastus medialis

ache in front of and above kneecap: rectus femoris

anterior: rectus femoris, vastus medialis, adductor longus, adductor brevis

anteromedial: vastus medialis, gracilis, rectus femoris, sartorius, adductor

longus, adductor brevis

behind the knee upon straightening leg: popliteus, plantaris, biceps femoris

behind the knee when crouching: popliteus, plantaris

dull ache in back of knee: vastus lateralis

dull ache at head of fibula: biceps femoris

“growing pains” in leg and knee: vastus lateralis, other quadriceps

lateral: vastus lateralis, biceps femoris, gluteus minimus, fibular

collateral ligament

lateral while walking downhill: popliteus

medial: vastus medialis, gracilis

posterior knee: gastrocnemius, biceps femoris, popliteus, semitendinosus,

semimembranosus, soleus, plantaris, gluteus minimus, vastus lateralis

posterior pain in knee with pain in hip and posterior thigh: hamstrings,

vastus lateralis, gastrocnemius, iliopsoas, quadratus lumborum,

gluteus minimus, thoracic paraspinal muscles, rectus abdominis

sharp pain to posterior medial knee: semimembranosus, semitendinosus

Lower leg pain: (see “Thigh pain” for upper leg)

anterior: tibialis anterior, adductor longus, adductor brevis

cramping at night, calf: gastrocnemius

lateral: gastrocnemius, gluteus minimus (anterior section), peroneus longus,

peroneus brevis, vastus lateralis

medial: flexor digitorum longus

posterior: soleus, gluteus minimus (posterior section), gastrocnemius,

semitendinosus, semimembranosus, tibialis posterior, plantaris

Neck pain:

anterior neck or throat pain: sternocleidomastoid (sternal), digastric, medial

pterygoid, longus colli

base of skull: trapezius (points 2, 3), multifidi

lateral, below ear: digastric, splenius cervicis, longissimus capitis

nodding and tilting head, painful in posterior neck: suboccipital muscles

posterior neck pain: trapezius (points 1, 2, 3), multifidi, levator scapulae,

splenius cervicis, infraspinatus, anterior cervical muscles, rotatores

posterolateral, with temporal headache: trapezius (point 1)

posterolateral, without headache: trapezius (point 2)

stiff and painful: levator scapulae

turning head to the side causes pain: trapezius (point 2, 3), levator scapulae,

splenius capitis, splenius cervicis, posterior cervical muscles

Pelvic pain:

general: coccygeus, levator ani, obturator internus, adductor magnus,

piriformis, internal oblique

due to spreading legs (as for women during intercourse): piriformis

Shoulder pain:

acromion (tip of shoulder): trapezius (points 3, 4, 6)

anterior: infraspinatus, deltoid, scalene muscles, supraspinatus,

pectoralis major, pectoralis minor, biceps brachii, coracobrachialis,

sternalis, subclavius, latissimus dorsi

lateral: deltoid, scalene muscles, supraspinatus, infraspinatus

posterior: deltoid, levator scapulae, scalene muscles, supraspinatus,

teres major, teres minor, subscapularis, serratus posterior superior,

latissimus dorsi, triceps brachii, trapezius (points 3, 6), iliocostalis

thoracis, multifidi, serratus anterior

posterior axilla, at rest and in motion, especially if accompanied by pain at

wrist: subscapularis

scapula, deep ache underneath (especially with pain in back of shoulder,

point of elbow, and ulnar side of wrist and hand): serratus posterior

superior

scapula, medial edge pain: scalene muscles, multifidi, rhomboid muscles, serratus

posterior superior, trapezius, infraspinatus, latissimus dorsi, serratus

anterior, levator scapulae

Thigh pain:

anterior medial, high in groin: pectineus; lower, with burning, numbness, or

tingling just under the skin: sartorius

anterior: adductor longus, adductor brevis, iliopsoas, adductor magnus,

vastus intermedius, pectineus, sartorius, quadratus lumborum, rectus

femoris

anterior, quadriceps pain: hamstrings, soleus, quadriceps femoris (release

hamstrings first)

lateral, to top of hip: gluteus minimus, vastus lateralis, piriformis, quadratus

lumborum, tensor fasciae latae, vastus intermedius, gluteus maximus,

rectus femoris, biceps femoris

medial: pectineus, vastus medialis, gracilis, adductor magnus, sartorius

medial, with superficial stinging sensation: gracilis

medial thigh with groin pain: adductor longus, adductor brevis, adductor

magnus

posterior: gluteus minimus, semitendinosus, semimembranosus, biceps

femoris, piriformis, obturator internus, gluteus maximus, gluteus

medius

Toe pain:

base extending to ends, along the sides of toes: interossei

big toe, dorsal (top) and medial surfaces: tibialis anterior

big toe, dorsal (top) over first metatarsal head: extensor hallucis longus

big toe, plantar (bottom): flexor hallucis longus, flexor hallucis brevis

lesser toes, dorsal (top): interossei, extensor digitorum longus, extensor

digitorum brevis, extensor hallucis brevis

lesser toes, plantar (bottom): flexor digitorum longus, tibialis posterior,

flexor digitorum brevis

littlest toe, plantar pain near head of fifth metatarsal: abductor digiti minimi

Wrist pain:

Dorsal (back-side) hand and wrist pain: extensors carpi radialis brevis and

longus, extensor digitorum, extensor indicis, extensor carpi ulnaris,

subscapularis, coracobrachialis, scalenus minimus, latissimus dorsi,

serratus posterior superior, first dorsal interosseus

Volar (palm-side) hand and wrist pain: flexor carpi radialis, flexor carpi

ulnaris, opponens pollicis, pectoralis major, pectoralis minor,

latissimus dorsi, palmaris longus, pronator teres, serratus anterior