The occipitofrontalis

The occipitofrontalis muscle consists of two parts:

The occipital parts is the occipitalis muscle. This is the muscle that covers parts of the skull at the back of the head. It arises from the upper neck along the base of the skull (occipital bone) and innervated by the facial nerve. Its contraction draws the skull back and contributes to the headaches. 

The frontal parts are called frontalis muscle. These two muscles are connected by epicranial aponeurosis. The frontalis is continuing from the aponeurosis and is inserted in the fascia of the facial muscle and in the skin above the eyes and nose. This muscle is facial expression muscle and it draws the scalp back to raise eyebrows and wrinkles the forehead.

The temporal muscle

The temporal muscle is a broad fan shaped muscle on each side of the head covering much of the temporal bone. It is one of the muscles involved in jaw movement and is the most powerful chewing muscle of the temporomandibular joint. You can see and feel the muscle contracting while the jaw is clenching and unclenching. The muscle is innervated by a branch of trigeminal nerve. This muscle is likely to be involved in jaw pain, teeth pain, facial pain ,migraines and headaches. Dental work and chewing gum can lead to trigger points in the temporal muscle. These trigger points can cause pain in the side of the face in temple region and the pain can radiate to the face, eye brow, jaw, upper teeth, head and neck. 

Masseter muscle

One of the strongest mastication muscles is masseter muscle. It consists of two heads: superficial head starts from the maxillary process of the zygomatic bone and the anterior two thirds of the inferior border of the zygomatic arch and inserts into the angle of the mandible and inferior half of the lateral surface of the ramus of the mandible; the deep head starts from the posterior third of the lower border and from the whole of the medial surface of the zygomatic arch and inserts into the upper half of the ramus of the mandible. This muscle involves jaw movement. It could be a source of toothache and tooth hypersensitivity to stimuli such as heat and cold. Also the pain over the eyebrow, ear and sinusitis can be caused by masseter muscle.

The trapezius muscle

Trapezius muscle: the muscle can cause you headache, neck and shoulder pain.

You may experience headache, neck and shoulder pain and feel aching and burning from the base of your skull to between your shoulder blades. One of the first muscles to cause this pain is trapezius. This is a broad triangular muscle at neck and upper back, one of the largest superficial muscles at the back. It attaches to the base of the skull and extends down to the neck, the upper back until mid back; laterally it inserts to the shoulder blades. There are three functional regions to the muscle: the Upper, middle, and lower trapezius, and each region has its own function: upper region moves the shoulder blades and support the arms; the middle region retracts the shoulder blades and the lower region rotates and depresses the shoulder blades.

Latissimus dorsi

Latissimus dorsi is the largest flat muscle at the back. This muscle is involved in adducting the arms, extending the shoulders and rotating shoulder joints medially. It also plays a role in extension and lateral flexion of the lumbar spine. The latissimus dorsi originated from the lumbodorsal fascia of the lower back, arising from the inferior thoracic and lumbar vertebrae, sacrum, iliac crest, and the four most inferior ribs, it runs laterally up through the back, inferior part of shoulder blades and insert on the humerus at the upper front of the upper arm. Tight latissimus dorsi and the trigger points on the muscles could be one of the causes of chronic mid back pain, shoulder pain, forearm pain, pain between shoulder blades, shoulder blades and pain in front of shoulder. The characteristic of pain is at lower shoulder blade and mid back and also the pain can go down the backside of the arm or the inner side of the arm and reach the hand and 4th and 5th fingers. Pain can be present at the front of the shoulder and to the side of the body just above the hip.

Rotator cuff

Rotator cuff comprises four muscles which are supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle. They all originate from the scapula and insert into humerus. They connect scapula to the head to humerus , stabilize shoulder joint and contribute to shoulder joint movement including abduction, internal rotation, and external rotation of the shoulder. Rotator cuff disorder is one of the problems that cause shoulder pain. The main symptoms are pain around the shoulder and reduced shoulder joint movement.

 

Teres major muscle

Teres major muscle is the muscle that connects shoulder blades to the upper arms. It starts from lower angle of the shoulder blade and ends at the upper arm in the front of the shoulder. The teres major muscle adducts the arm, extends the shoulder and rotates it inwardly. It also helps stabilize the humeral head. The pain caused in the teres major trigger is the back of your shoulder and also this pain can radiate to the front and side of the shoulder and down the backside of the arm. The trigger points for this muscle can be found at the lower angle of shoulder blades. 

Pectoralis major and minor muscles and shoulder pain

The perctoralis major muscle is a muscle located at the chest. Underneath the pectoralis major is the pectoralis minor muscle- a small triangular muscle.

The pectoralis muscle originated from inner half of the clavicular bone, sternum as well as the cartilage of the sixth or seventh rib and the aponeurosis of the abdominal muscle. The muscle run laterally and insert into the upper humerus. It adducts the arm and rotates the shoulder inwardly, pull down the shoulder joint and elevated the arm to the front. The muscle trigger points contribute to the shoulder pain and upper and inner side of the forearm.

Pectoralis minor originates from the third, fourth and fifth ribs and it runs upward and laterally and inserts to the surface of the coracoids process of the scapula. It pulls the shoulder blade downward, forward and inward towards the ribs, stabilizes the shoulder, prevents the shoulder blade from being pushed backwards. The trigger point of themuscle contributes to the pain in front of the shoulder, that could radiate to the chest and all the way down the inner arm.

The deltoid muscle

The deltoid muscle is a triangular muscle located on the uppermost part of the arm and the top of the shoulder. Tendons attach the deltoid to the collarbone, shoulder blade, and upper arm. The deltoid is widest at the top of the shoulder and has three origins: the lateral end of the clavicle, the acromion of the scapula at the top of the shoulder, and the spine of the scapula. Each origin gives rise to its own band of muscle fibers. The fibers merge together as they approach the insertion point on the deltoid tuberosity of the humerus and narrows to its apex as it travels down the arm. The deltoid is responsible for lifting the arm and giving the shoulder its range of motion. Contraction of the anterior fibers flexes and medially rotates the arm by pulling the humerus forwards towards the collar bone. The lateral fibers abduct the arm by pulling the humerus toward the acromion, moving the arm away from the body laterally. Contraction of the posterior fibers extends and laterally rotates the arm by pulling the humerus backwards.

 

Like many other muscles, the deltoid can be sore for a variety of reasons, including overuse and tendon injuries. When the deltoid muscle is injured, one may feel pain or tenderness at the front, side, or back of the shoulder, especially when lifting the arm. The injury can be from mild with tightness and slight pain without restriction of movement to severe pain, swelling and severe restriction of shoulder and arm movements.

Biceps 

In the upper arm, there is a muscle called biceps brachii or biceps. This muscle is two headed lies on the upper arm between the shoulder and the elbow. The two heads start from the scapular of the shoulder and join together to one muscle on the upper arm (humarus) and attach to the bones radius and ulnar in the front of the elbow. The biceps turn the arm outward, turn the palm upward, flex the elbow and flex the shoulder (bring the shoulder forward and upwards). The biceps can contribute to the pain on the front of the arm, the elbow and the shoulder. Also it contributes to the medial rotation of the shoulder.

Triceps

The triceps brachii muscle or three headed muscle of the arm is the large muscle on the back of the upper limb. The three heads include long head, medial head and lateral head. The long head originates from the top of the scapula (the infraglenoid tubercle of the scapula). The medial head originates from the upper part of the limb (the groove of the radial nerve, the dorsal surface of the humerus, the medial intermuscular septum and the lateral intermuscular septum). The lateral head originates from the back of the upper limb (the dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve, the greater tubercle down to the region of the lateral intermuscular septum. The three heads join together, form a tendon and attach to the elbow (the olecranon process of the ulna). The triceps extend the elbow and shoulder joint to straighten the elbow and move the arm backwards and also pull the arm towards the body. If the triceps contain trigger points, you can experience pain on the shoulder, arm, elbow or the pain can radiate to the forearm.

The Gluteal muscles

The gluteal muscles are a group of three muscles making up the buttocks: the glutes maximus, gluteus medius and the gluteus minimus. They originate from the back of the pelvic bone ilium and sacrum and end on the thigh (femur).

The largest and the most superficial of the three gluteal muscles is the gluteus maximus. It makes up a large portion of the shape and appearance of the hips. The functions of the muscles are extenson, abduction, external and internal rotation of the hip joint.

Gluteus maximus starts from the posterior gluteal line of the inner upper ilium crest, the posterior surface of the lower part of the sacrum and the side of the coccyx, aponeurosis of the erector spinae, sacrotuberous ligament and the fascia covering the gluteus medius. The gluteal maximus go downward and lateralward and insert into iliotibial band and glutealtuberosity. It extends and laterally rotates the hip and extends the trunk. Gluteus maximus injury is a common source of the low back pain. Trigger points are often presents at the originated fibers. The pain can radiate to the thigh, knee and even foot like sciatic pain.

The erector spinae muscles

The erector spinae muscles are a group of muscle and tendons lying along the side of the spine. They arise from the anterior surface of the tendon attached to the medial crest of the sacrum, spinous processes of the lumbar and last two thoracic vertebrae, the supraspinous ligament, the innerpart of the iliac crest and the lateral crest of the sacrum. They extend up through lumbar, thoracic and cervical regions. This group of muscle include iliocostalis, longissimus and spinalis. The erector spinae makes the back straight and rotate the back from side to side. Injury, strain chronic inflammation to these muscles may cause back spasm, pain and stiffness. 

The quadratus lumborum

The quadratus lumborum is a deep muscle at the back that runs from the last ribs and transverse processes of lumbar vertebrae to the top of the pelvis. It is quadrilateral in shape and forms posterior abdominal wall. When one side of the muscle contract, it flexes the spine laterally; when both side of the muscles contract, it extends the spine; it helps expiration and inhalation; and when it contracts on one side, it elevates pelvic bone. If trigger points are present in this muscle, it is a common source of low back pain. This is often caused by overuse, poor posture, stress, strain and tension from twisting, bending or lifting improperly etc.

 

The psoas major muscles

The psoas major muscles are the deep muscles by the sides of the spinal column. They go downwards to the pelvic bone and end at lesser trochanter of the femur. Illacus muscles start from the interior side of the pelvic bone. The psoas major and the illacus muscles join together and form the iliopsoas. These muscles connect the core and lower limbs and they flex the hip joint, bend the spine forward and laterally and raise the spine from supine position. The pain and trigger points related to iliopsoas is at the low back and upper thigh. Walking and standing upright can be painful, if there are trigger point present in these muscles.

 

Abdominal muscles

The rectus abdominis muscles are a pair of long flat muscles lie vertically along the middle line of abdomen. Each muscle is divided by narrow bands of tendon into four muscular bodies. It originates from the edge of the pubis bone and thepubic symphysis in the pelvis and ends at the inferior edges of the costal cartilages of the fifth through seventh ribs and at the xiphoid process of the sternum. The rectus sheath is a covering connective tissue surrounding the rectus abdominis muscles where the internal and external oblique muscles attach. The linea alba a thick mass of white fibrous connective tissue is in the mid line of the abdomen and joins the two rectus abdominis together. The important function of rectus abdominis muscles is to flex the spine when they contract. Contraction of the abdomen results in increased pressure within the abdominopelvic cavity and is useful to push substances out of the body during exhalation, defecation, and urination. It helps delivering a baby. If there are trigger points present in these muscles, you could feel the pain at the abdomen, lower and mid back region. The symptoms include pain at the low abdomen, period pain, stomach cramping, heart burn chest pain, indigestion, nauseas, vomiting bloating, genital pain, bladder problem, low and mid back pain etc. 

 

Transverse abdominis muscle is the deepest muscle on the front and side abdominal wall. It lies between the rib cage and pelvic bone. It starts from the back thoracolumbar fascia, from the top inner surface of the lower six ribs, from the bottom front of the iliac crest and inguinal ligament and it ends at the front abdominal midline called linea alba. It is a very important core muscle in compressing the abdomen, providing thoracic and pelvic stability and supporting abdominal visera. It maintains good posture and help to deliver a baby for pregnant women. Trigger points in transverse abdominis could contribute to the abdominal pain and low back pain. 

 

The external abdominal oblique muscles are a pair of muscles that lie on the lateral and anterior sides of the abdominal wall. They are broad, thin and on the top layer of the abdominal muscles. They start from ribs 5-12 and end at the midline of the abdomen, pubis and iliac crest of the hip bones. Contraction of this muscle makes lateral bend and rotation of the spine, flexes the spine and also pulls the chest downwards and compress the abdominal cavity.

 

The internal abdominal oblique muscles lie on the lateral and anterior sides of the abdominal wall just underneath the external abdominal oblique muscles and above the transverse abdominal muscle. It bends the spine forward and bring the shoulder of the side forward and it also bend the spine sideway and rotates it. It compresses abdominal contents and assists digestive process and breathing. If trigger points are present in these muscles, the pain can be felt in following area, in the side, the waist area, the groin area, the low abdomen, across the upper back below shoulder blades, across the low back just above hips, stomach pain, testicle pain, pelvis pain bladder pain. 

Muscles attached to the pelvic bone and low back pain. 

The pelvic bone has a few groups of muscles attached as follows

The abdominal muscles include the abdominal external oblique muscle (attaches to the iliac crest) , the abdominal internal oblique muscle (ataches to the pectin pubis) and the transverses abdominis muscle (ataches to the pubic crest and the pectin pubis),

 

The back muscles include the multifidus muscle (attaches to the medial surface of the posterior superior iliac spine, the posterior sacroiliac ligaments and part of the sacrum)

 

The gluteal muscles include three gluteal muscles: gluteal maxmus muscle, gluteal medium muscle and gluteal mininus muscle. They all arise from the outer surface of the hip bone and

 

The lateral rotator group of muscles include piriformis muscle, superior gemellos muscle, obturator internus muscle , inferior gemellos muscle and obturator externus muscle.

 

Adductor group of muscles include adductor brevis, adductor longus, adductor magnus, adductor minimus, pectineus, gracilis and obturator externus.

 

Hamstrings include long head biceps femoris, semitendinous and semimembranosus

Two muscles at the anterior of the thigh rectus femoris muscle and sarturius muscle

One shoulder muscle--- the latissimus dorsi muscle (attaches to the iliac crest ).

Low back pain and tenderness around the pelvic bone very common.

 

Muscle aging

Skeletal muscle is responsible for voluntary movement control of the human body. Aging process leads to a decrease in muscle mass and strength.

In age 20-30, the muscles are in their maximum of physical capacity. In age 30-50 changes in muscle mass, power and strength are small. After age 50, muscle changes with aging process are pronounced which is more than 15% of strength loss per decade. In some research this could start from 40s.

Aging muscles with   

Declined muscle fibers

muscle Type II fast twitch fibers appeared smaller and flatter.  This results in reduced muscle power

Reduced muscle mass

Muscle mass loss is caused by reduced numbers of muscle fibers. This reduction in muscle cross-sectional area associated with decreases in contractile structures muscle fibers accompanied by increases in non contractile structures such as fat and connective tissue.

Decreased motor units

There were fewer motor unites and muscles are denervated.

Reduced muscle strength

Loss of muscle fibers and innervation reduces strength capacities, decreases muscle metabolism and increase risk of muscle damage. Synthesis rate of muscle protein decreases with aging process. muscle repair capacities are reduced with increased age.

The major cause of strength and muscle mass loss with aging process is endocrine changes, including increased insulin resistant, decreased growth hormone, reduction in oestrogen and testosterone, vitamin D deficiency, increased parathyroid hormone.

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