Trigger Point Pain Referral Patterns
These photos are adapted from the works of Janet Travell, MD, an American physician who pioneered the study of myofascial pain syndromes and dry needling. She served as the personal physician to John F. Kennedy, the first female doctor to do so.
How to Understand These Photos
These charts are based off were research subjects felt pain when a trigger point in the muscle was compressed. The black dots are the area of the most common sites of a trigger point in the muscle. The areas in red are where subjects felt pain symptoms spreading to. Areas of darker red are places where subjects more frequently reported their pain sensations.
Head & Neck Pain
Patient with headaches and/or neck pain, often have trigger points in these muscles. If you press on the general area of the black dots and experience a referred pain to these areas, it is likely there is an active trigger point. Of note, I typically find many headaches are the result of trigger points at the sternocleidomastoid muscle.
Suboccipital Muscles
Sternocleidomastoid Muscle
Splenius Cervicis
Upper Trapezius Muscle
Shoulder Pain
These are the most common muscles I dry needle in the shoulder. Many patients are very surprised by the exquisite tenderness at the infraspinatus muscles. Often patients only feel the referred pain. Also, most patients that have "upper trap tightness" (see above), don't actually have a trigger point there. The supraspinatus, which sits immediately under the trapezius is often the culprit.
Infraspinatus Muscle (front)
Infraspinatus Muscle (back)
Supraspinatspinatus Muscle
Spine/Hip/Thigh Pain
I grouped these areas together as there is significant overlap. What I find to be the most interesting is the sheer area of referral the gluteal muscles have! The Gluteus Minimus refers all the way down the leg and even into the calf area! The glutes are big muscles and they can hide big trigger points.
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Another interesting finding is looking at the referral pattern of Vastus Lateralis, the most lateral of the quadricep muscles. I find that patients that have been diagnosed with "IT Band Syndrome" actually have trigger points in this muscle. The Vastus Lateralis muscle actually dives under and wraps around to attach to the back portion of the femur. Patient will foam roll their IT Band, but what they are doing is desensitizing a trigger point at this muscle.
Spinal Multifidii
Gluteus Minimus
Vastus Lateralis 1
Gluteus Medius
Piriformis
Vastus Lateralis 2
Knee Pain
I don't dry needle many muscles around the knee aside from a few exceptions. I have found that most inside knee pain, especially after an MCL strain, benefit greatly from needling the Vastus Medialis and Adductor Magnus (not shown). What is interesting is the far away referral of the Rectus Femoris. It is entirely possible that it become affected by breakdown of the patellofemoral joint.
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Once again, at the lower portion of the Vastus Lateralis, we continue to see referral along the IT Band.
Vastus Medialis
Vastus Lateralis 3
Rectus Femoris
Elbow Pain
Patients with outer and inner elbow pain often benefit greatly from dry needling. I find that both tennis and golfer's Elbow respond quite well. Trigger points often sit right at the junction of the muscle and tendon. There are other muscles in the forearm that cause these symptoms, but here are a few examples.
Supinator Muscle
Brachioradialis Muscle
Lower Leg/Ankle/Foot Pain
I commonly see calf and heel pain in the clinic. The muscles of the lower leg are had working muscles and can have significant trigger point activity, especially in runners. What I find interesting are some of the referral patterns that move into the area where patients experience plantarfascitiis. Once the mechanics behind the breakdown of the plantar fascia are resolved, it is important to look for possible trigger point contributors.
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Another interesting muscle is the Flexor Hallicus Brevis. Often patients will be diagnosed with sesmoiditis, but in reality, they are experiencing trigger points at the muscle that acts on them
Soleus Muscle
Adductor Hallicus Muscle
Peroneus Longus Muscle
Flexor Hallicus Brevis Muscles
