Introduction

Tensor Fasciae Latae (TFL) and Gluteus Minimus

Vastus Lateralis

Adductors

Tensor Fascia Latae and Gluteus Minimus Static Manual Release

Vastus Lateralis Static Manual Release

Adductor Static Manual Release

Static Manual Release: Hip Internal Rotators - TFL, Gluteus Minimus, Vastus Lateralis and Anterior Adductors

ProCert

NCBTMB

PACE

AUSPHYSIO

CPTA

TPTA

NYPT

AOTA

Static Manual Release: Hip Internal Rotators 

This course describes static manual <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques for hip internal rotator muscles that are commonly assessed as over-active and <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development. Unfortunately, it is easy to be confused by a large number of synonyms for these terms. For example, the techniques described in this course could be considered refinements of massage therapy techniques, deep tissue massage, sports massage, medical massage, <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> therapy, static <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a> techniques, soft tissue mobilization, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> inhibitory techniques, and manual therapy techniques. Even the term <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> is referred to by a variety of synonyms including <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> knots, nodules, adhesions, over-active <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> fibers, <a id="hypertonic" data-tip="1672" target="_blank" href="/glossary-term/hypertonic" class="glossary">hypertonic</a> fascicles, spasms, and acute points of hyper-contractility, and the <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> phenomenon is likely part of every reference to short muscles, tight muscles, &quot;locked&quot; muscles, stiff muscles, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strains, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> spasm, etc. Part of the reason there are so many synonyms is the rich history of scientific inquiry, from multiple disciplines and cultures, that have contributed to our understanding of these techniques and the information in this course. &#xA0;
This course includes techniques for the tensor fascia latae, gluteus minimus, vastus lateralis, and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> adductors. <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> techniques for these muscles are commonly included in an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> program designed to address knee pain including patellar femoral pain syndrome (PFPS), <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> hip joint pain, leg pain (groin or <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> thigh), lower back pain, and sacroiliac joint dysfunction. These techniques may also aid in addressing <a id="movement-impairment" data-tip="1576" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairments</a> correlated with lumbopelvic hip complex and lower extremity dysfunction including knee valgus, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt, excessive forward lean, a loss of hip <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> (restricted hip rotation), and ankle dysfunction (ankle impingement, pronation, etc.).
The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) with the intent of developing an <a id="evidence-based-practice" data-tip="1538" target="_blank" href="/glossary-term/evidence-based-practice" class="glossary">evidence-based</a>, systematic, <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a>, patient-centered, and outcome-driven approach.&#xA0;
<h3>Techniques Covered in this Course:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/video/tfl-manual-release" target="_blank" rel="noopener"> Tensor Fascia Latae and Gluteus Minimus Static Manual </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> </li>
 <li><a href="https://brookbushinstitute.com/video/vastus-lateralis-manual-release" target="_blank" rel="noopener"> Vastus Lateralis Static Manual </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> </li>
 <li><a href="https://brookbushinstitute.com/video/anterior-adductors-static-manual-release" target="_blank" rel="noopener"> </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Adductors Static Manual Release</li>
</ul>
Additional Static Manual <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Courses
<ul>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-cervical-muscles-upper-trapezius-levator-scapulae-splenii" target="_blank" title="Static Manual Release: Upper Trapezius, Levator Scapulae and Splenii" rel="noopener">Static Manual Release: Upper Trapezius, Levator Scapulae and Splenii</a></li>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-suboccipitals-sternocleidomastoid-scm-scalenes-and-deep-cervical-extensors-multifidi" title="Static Manual Release: Suboccipitals, Sternocleidomastoid (SCM), Scalenes and Cervical Extensors&#xA0;" target="_blank" rel="noopener">Static Manual Release: Suboccipitals, Sternocleidomastoid (SCM), Scalenes and Cervical Extensors</a></li>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-scapular-muscles-levator-scapulae-upper-trapezius-rhomboids-and-pectoralis-minor" title="Static Manual Release: Scapular Muscles" target="_blank" rel="noopener">Static Manual Release: Scapular Muscles</a></li>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-shoulder-muscles" title="Static Manual Release: Shoulder Muscles" target="_blank" rel="noopener">Static Manual Release: Shoulder Muscles</a></li>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-trunk-muscles" title="Static Manual Release: Trunk Muscles" target="_blank" rel="noopener">Static Manual Release: Trunk Muscles</a></li>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-hip-flexors" title="Static Manual Release: Hip Flexors" target="_blank" rel="noopener">Static Manual Release: Hip Flexors</a></li>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-hip-internal-rotators" title="Static Manual Release: Hip Internal Rotators" target="_blank" rel="noopener">Static Manual Release: Hip Internal Rotators</a></li>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-hip-external-rotators" title="Static Manual Release: Hip External Rotators" target="_blank" rel="noopener">Static Manual Release: Hip External Rotators</a></li>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-tibia-external-rotators" title="Static Manual Release: Tibia External Rotators" target="_blank" rel="noopener">Static Manual Release: Tibia External Rotators</a></li>
 <li><a href="https://brookbushinstitute.com/courses/static-manual-release-lower-leg-muscles" title="Static Manual Release: Lower Leg Muscles" target="_blank" rel="noopener">Static Manual Release: Lower Leg Muscles</a></li>
</ul>
For a review of <a id="muscle-fiber-dysfunction" data-tip="1126" target="_blank" href="/glossary-term/muscle-fiber-dysfunction" class="glossary">muscle fiber dysfunction</a> and <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> etiology:
<ul>
 <li><a href="https://brookbushinstitute.com/article/muscle-fiber-dysfunction-trigger-points" target="_blank" rel="noopener">Muscle Fiber Dysfunction and Trigger Points</a></li>
 <li><a href="https://brookbushinstitute.com/courses/trigger-point-assessment-and-palpation" title="Trigger Point &lt;a id=" assessment" data-tip="1478" target="_blank" class="glossary">Assessment</a> and Palpation&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;Trigger Point <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> and Palpation</li>
</ul>

Course Description: Hip Internal Rotator Static Manual Release

<h3>For <a href="https://brookbushinstitute.com/article/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener"> Lumbopelvic-hip Complex Dysfunction</a>:</h3>
For a complete review of <a id="muscle-fiber-dysfunction" data-tip="1126" target="_blank" href="/glossary-term/muscle-fiber-dysfunction" class="glossary">muscle fiber dysfunction</a>, <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> <a id="etiology" data-tip="1489" target="_blank" href="/glossary-term/etiology" class="glossary">etiology</a>, <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>, and intervention, please check out:
<ul>
 <li><a href="https://brookbushinstitute.com/article/muscle-fiber-dysfunction-trigger-points" target="_blank" rel="noopener"> </a><a id="muscle-fiber-dysfunction" data-tip="1126" target="_blank" href="/glossary-term/muscle-fiber-dysfunction" class="glossary">Muscle Fiber Dysfunction</a> and <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">Trigger Points</a> </li>
 <li><a href="https://brookbushinstitute.com/article/trigger-point-assessment-and-palpation" target="_blank" rel="noopener"> </a><a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">Trigger Point</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> (and Palpation) </li>
</ul>
<h3>Techniques Covered in this Course:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/video/tfl-manual-release" target="_blank" rel="noopener"> Tensor Fascia Latae and Gluteus Minimus Static Manual </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> </li>
 <li><a href="https://brookbushinstitute.com/video/vastus-lateralis-manual-release" target="_blank" rel="noopener"> Vastus Lateralis Static Manual </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> </li>
 <li><a href="https://brookbushinstitute.com/video/anterior-adductors-static-manual-release" target="_blank" rel="noopener"> </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Adductors Static Manual <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> </li>
</ul>
<h3> Signs of over-activity and/or a maladaptive decrease in length: </h3>
<ul>
 <li> <a href="https://brookbushinstitute.com/article/introduction-overhead-squat-assessment" target="_blank" rel="noopener"> Overhead Squat Assessment: </a> 
 <ul>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener"> Knees Bow In </a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-8-excessive-forward-lean" target="_blank" rel="noopener"> Excessive Forward Lean </a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener"> Asymmetrical Weight Shift</a></li>
 </ul>
 </li>
 <li> <a href="https://brookbushinstitute.com/article/introduction-to-goniometry" target="_blank" rel="noopener"> </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> 
 <ul>
 <li><a href="https://brookbushinstitute.com/video/goniometry-hip-internal-rotation-in-prone" target="_blank" rel="noopener"> Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a> &lt;40 - 50&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/video/goniometry-hip-internal-rotation-at-90-degree-of-hip-flexion-9090-hip-ir" target="_blank" rel="noopener"> Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">Supine</a> &lt;35 - 45&#xB0;
 <ul>
 <li>Although it is counter-intuitive to think that over-active internal rotators would restrict internal rotation, in practice this is not only common, it may be the norm. The most likely <a id="hypothesis" data-tip="1446" target="_blank" href="/glossary-term/hypothesis" class="glossary">hypothesis</a> is related to alterations in <a id="arthrokinematics" data-tip="1859" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematics</a>.</li>
 </ul>
 </li>
 <li><a href="https://brookbushinstitute.com/video/goniometry-hip-external-rotation-in-prone" target="_blank" rel="noopener"> Hip External Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a> &lt;40 - 50&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/video/goniometry-hip-external-rotation-at-90-degrees-of-hip-flexion-9090-hip-er" target="_blank" rel="noopener"> Hip External Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">Supine</a> &lt;35 - 45&#xB0;</li>
 </ul>
 </li>
 <li><a href="https://brookbushinstitute.com/article/introduction-manual-muscle-testing-active-population" target="_blank" rel="noopener"> Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing MMT: 
 <ul>
 <li><a href="https://brookbushinstitute.com/video/gluteus-maximus-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener"> Gluteus Maximus Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) - Weak or With Compensation (Lumbar extension and/or knee flexion)</li>
 <li><a href="https://brookbushinstitute.com/video/gluteus-medius-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener"> Gluteus Medius Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) - Weak or With Compensation (Lumbar <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> flexion and/or hip flexion)</li>
 </ul>
 </li>
</ul>
<h3>Inhibited Antagonists:</h3>
It is advised that additional <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> techniques, as well as <a href="https://brookbushinstitute.com/article/introduction-to-activation-exercise" target="_blank" rel="noopener"> activation </a> and <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> techniques, follow <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques. The over-activity of muscles in this course may be associated with under-activity of the following muscles:
<ul>
 <li><a href="https://brookbushinstitute.com/article/transverse-abdominis" target="_blank" rel="noopener"> Transverse Abdominis </a></li>
 <li><a href="https://brookbushinstitute.com/article/gluteus-maximus" target="_blank" rel="noopener"> Gluteus Maximus </a></li>
 <li><a href="https://brookbushinstitute.com/article/gluteus-medius" target="_blank" rel="noopener"> Gluteus Medius </a></li>
 <li><a href="https://brookbushinstitute.com/article/tibialis-anterior" target="_blank" rel="noopener"> Tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> </li>
 <li><a href="https://brookbushinstitute.com/article/tibialis-posterior" target="_blank" rel="noopener"> Tibialis </a><a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> </li>
</ul>
<h3>Sample Intervention</h3>
<ul>
 <li> Manual <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> 
 <ul>
 <li><a href="https://brookbushinstitute.com/video/tfl-manual-release" target="_blank" rel="noopener"> Tensor Fascia Latae and Gluteus Minimus Static Manual </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> </li>
 <li><a href="https://brookbushinstitute.com/video/vastus-lateralis-manual-release" target="_blank" rel="noopener"> Vastus Lateralis Static Manual </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> </li>
 <li><a href="https://brookbushinstitute.com/video/anterior-adductors-static-manual-release" target="_blank" rel="noopener"> </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Adductors Static Manual Release</li>
 </ul>
 </li>
 <li> Mobilization or Manipulation 
 <ul>
 <li><a href="https://brookbushinstitute.com/video/hip-joint-lateral-manual-mobilization" target="_blank" rel="noopener"> Hip Mobilization</a></li>
 </ul>
 </li>
 <li> Manual Lengthening 
 <ul>
 <li><a href="https://brookbushinstitute.com/video/manual-adductor-stretch" target="_blank" rel="noopener"> Manual Adductor Stretch </a></li>
 <li><a href="https://brookbushinstitute.com/video/manual-hip-flexor-stretch-thomas-test-position" target="_blank" rel="noopener"> Manual Hip Flexor Stretch</a></li>
 </ul>
 </li>
 <li> Activation 
 <ul>
 <li><a href="https://brookbushinstitute.com/article/gluteus-maximus-activation" target="_blank" rel="noopener"> Gluteus Maximus Activation </a></li>
 <li><a href="https://brookbushinstitute.com/article/gluteus-medius-activation-progression" target="_blank" rel="noopener"> Gluteus Medius Activation</a></li>
 </ul>
 </li>
 <li> <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">Integration</a> 
 <ul>
 <li><a href="https://brookbushinstitute.com/article/posterior-oblique-subsystem-pos" target="_blank" rel="noopener"> </a><a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Oblique Subsystem </li>
 </ul>
 </li>
</ul>

Research Corner

Several studies have demonstrated a relative increase in <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> activity, generally in conjunction with a decrease in <a href="https://brookbushinstitute.com/article/gluteus-medius" target="_blank" rel="noopener">gluteus medius</a> activity, in those exhibiting dysfunction, especially <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener">functional knee valgus </a> (5 - 12). <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> over-activity may also be implied by a study by Sutter et al., which demonstrated that abductor tendon tears ( <a href="https://brookbushinstitute.com/article/gluteus-medius" target="_blank" rel="noopener"> gluteus medius</a> and <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> tendon) were correlated with <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> hypertrophy (13). Further, we may presume that <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> over-activity is commonly observed clinically, as a study by Selkowitz et al. compared various <a href="https://brookbushinstitute.com/article/gluteus-medius" target="_blank" rel="noopener">gluteus medius</a> exercises with the intent of finding the exercise that resulted in the least <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> activity (14). There are no studies investigating the correlation between dysfunction and altered <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> activity. This is likely due to the muscle&apos;s location deep to the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL</a>, <a href="https://brookbushinstitute.com/article/gluteus-medius" target="_blank" rel="noopener"> gluteus medius</a>, and iliotibial band. Functionally, the <a href="https://brookbushinstitute.com/glossary/muscle-cell/" target="_blank" rel="noopener">muscle</a> acts much like the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL</a>, contributing to hip flexion, abduction, and internal rotation, and the <a href="https://brookbushinstitute.com/glossary/muscle-cell/" target="_blank" rel="noopener">muscle</a> is innervated by the same <a href="https://brookbushinstitute.com/glossary/nerve-cell/" target="_blank" rel="noopener">nerve </a> (<a href="https://brookbushinstitute.com/glossary/superior/" target="_blank" rel="noopener">superior</a> gluteal <a href="https://brookbushinstitute.com/glossary/nerve-cell/" target="_blank" rel="noopener">nerve</a>)(15). One notable difference is the investment of the <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> into the hip joint capsule, which may have implications relative to complaints of hip pain (16). It is the Brookbush Institute&apos;s assertion that these muscles should be treated similarly; based on the research investigating the altered activity of the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> and clinical outcomes, we may assume that both muscles have a propensity toward over-activity.
Several studies investigating the prevalence of <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development include the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> and/or <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a>. Two studies have demonstrated an increase in <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in those with <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> dysfunction (17 - 18). The study by Torres-Chica et al. demonstrated that the intensity of post-meniscectomy pain was correlated with the number of active <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> (17). Alburquerque-Garc&#xED;a et al. demonstrated that the <a id="referred-trigger-point-pain" data-tip="1709" target="_blank" href="/glossary-term/referred-trigger-point-pain" class="glossary">referral pain</a> from active <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in the lower body contributed to the area of patient complaint in individuals with <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> osteoarthritis (18). Increased prevalence of <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> and/or <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> have also been correlated with low back pain. Imamura et al. demonstrated that <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> pain pressure <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> (including <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>) was higher in low back pain patients than asymptomatic controls (21). Two interesting studies by Farasyn et al. demonstrated that pain pressure <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> for lumbar spine muscles was similar to the pain pressure <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> of <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener">hip</a> muscles (including the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> ) in low back pain patients (19, 20). In a case study and follow-up <a id="observational-study" data-tip="1400" target="_blank" href="/glossary-term/observational-study" class="glossary">observational study</a>, Skorupska et al. demonstrated that needling <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> resulted in sympathetic activity and a <a id="referred-trigger-point-pain" data-tip="1709" target="_blank" href="/glossary-term/referred-trigger-point-pain" class="glossary">referral pain</a> pattern that matched sciatic complaints in 32% of study participants with low back/sciatic pain (22, 23). Fuentes-M&#xE1;rquez et al. demonstrated an increase in <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> of the <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> in those individuals with chronic pelvic pain (24). Two additional case studies infer contributions from <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> to symptoms of <a href="https://brookbushinstitute.com/article/sacroiliac-joint-motion-and-predictive-model-of-dysfunction" target="_blank" rel="noopener">sacroiliac joint dysfunction</a> and pain in the gluteal region (25, 26). Additional research has demonstrated that the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> and/or <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> are associated with <a id="fibromyalgia" data-tip="1135" target="_blank" href="/glossary-term/fibromyalgia" class="glossary">fibromyalgia</a> pain (27, 28). Further, <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in these muscles have been noted in adolescents (29), and an increase in physical activity may be associated with an increase in the number of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> (30). Note, Farasyn et al. demonstrated a higher pain pressure threshold in <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> correlated with low back pain in physically active adults (31). This may imply that although an increase in activity increases the potential for dysfunction and <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in adolescents, that physical activity in adults is &quot;protective&quot;, reducing <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>. In summary, <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> and <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> are correlated with low back, sacroiliac joint, <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener"> hip</a>, <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener"> knee</a>, and pelvic floor pain, as well as centralized pain as exhibited by <a id="fibromyalgia" data-tip="1135" target="_blank" href="/glossary-term/fibromyalgia" class="glossary">fibromyalgia</a> patients.
Research including the <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> of <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> and <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> has been cited in previous static manual <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> courses. Although <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> is not <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> among untrained licensed professionals, good to excellent <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> may be achieved with training (32, 33). The thermography technique used in the Skorupska et al. studies mentioned above (22, 23), has also been tested specifically for <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a>, demonstrating excellent to perfect <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> (34). More research is needed to optimize <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> protocols and <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> training courses, and thermography may be helpful in validating <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> location in future research.
Several studies demonstrating the efficacy of <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> dry needling and manual therapy have included <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> and <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>. A double-blind randomized, placebo-controlled <a id="randomized-control-trial" data-tip="1407" target="_blank" href="/glossary-term/randomized-control-trial" class="glossary">trial</a> by Mayoral et al. demonstrated that a single treatment of dry-needling under anesthesia reduced pain in the first month after knee arthroplasty when reports of pain were generally the most severe (35). This may imply that this technique would be a wonderful addition to surgical protocols. In a randomized control <a id="randomized-control-trial" data-tip="1407" target="_blank" href="/glossary-term/randomized-control-trial" class="glossary">trial</a> (RCT) by Cotchet et al., dry needling several lower extremity muscles (including the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> ) demonstrated efficacy for treating heel pain when compared to sham treatment (36). In another RCT by Brennan et al., dry needling several lower extremity muscles (including the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> ), was at least as effective as cortisone injection into the trochanteric bursae for great trochanteric pain (37). A comparative study by Gunn et al. compared physical therapy to physical therapy and needling for chronic low back pain, demonstrating <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> outcomes for the dry needling group (38). Last, Mosler et al. demonstrated that manual therapy of hip musculature (including the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> and potentially the <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus </a> ) improved hip <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> and egg-beater endurance in water polo players (39). This study may suggest a potential for <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques to be used to enhance performance. Although only a few studies are currently available demonstrating the efficacy of dry needling and manual therapy, consideration should be given to the high-quality of these studies. They provide strong <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a> for the treatment of <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> and <a href="https://brookbushinstitute.com/article/gluteus-minimus" target="_blank" rel="noopener">gluteus minimus</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> with the intent of addressing trunk, pelvis, and lower extremity orthopedic issues, as well as <a id="fibromyalgia" data-tip="1135" target="_blank" href="/glossary-term/fibromyalgia" class="glossary">fibromyalgia</a>.

Several studies have demonstrated a relative increase in <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> activity in those individuals with patellofemoral pain syndrome (PFPS) (40 - 42). Further, in a study mentioned above by Mauntel et al., <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener"> vastus lateralis</a> over-activity was correlated with <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener">functional knee valgus (knees bow in) </a> (8). The <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> invests in the iliotibial band along with the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL </a> (43), implying a fascial relationship may exist. Evidence of the relationship between the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a>, <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL</a>, iliotibial band, and <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> dysfunction may be demonstrated by studies demonstrating deleterious changes in the iliotibial fascia in those exhibiting symptoms of <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> pain (44 - 46). Although the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> is not a <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener"> hip</a> internal rotator unto itself, it is included in this course due to the synergistic relationship between the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a>, <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL</a>, and iliotibial band. Clinically, it has been observed that the activity and <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development in the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> tends to mimic the behavior of the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> TFL</a>.
The body of research suggests that <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> are correlated with <a href="https://brookbushinstitute.com/article/lower-leg-dysfunction" target="_blank" rel="noopener">lower extremity dysfunction (LED)</a>, especially dysfunction of the <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a>. As mentioned above, Torres-Chica et al. demonstrated the number of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> (including <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>) was correlated with pain intensity post meniscectomy (17). A study by Alburquerque-Garc&#xED;a et al. demonstrated <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> contributed to the area of patient complaint, and a higher number of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> correlated with greater pain intensity for patients with <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> osteoarthritis (18). A study by Dippenaar et al, and two additional dissertations by Daly and Weyer-Henderson, demonstrate a correlation between <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> and PFPS (48 - 50). <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener"> Vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> have also been correlated with hip replacement (51). Further, in an interesting study by Zuil-Escobar et al., a correlation was found between increased prevalence of lower extremity <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, including the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, and a lower <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> longitudinal arch (52). Although the majority of research including investigation of <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> relates to <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> dysfunction, professionals should consider <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> developing relative to dysfunction of all lower extremity joints.
<a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">quadriceps, including the vastus lateralis</a>, has demonstrated moderate to excellent <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> (53, 54). Considering that these muscles are large and superficial, it is not surprising that <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> is relatively high, despite these studies not including a training period, as was included in the study by Gerwin et al. (33). This may imply that larger, superficial muscles are ideal for initial training. An interesting study by Botter et al. mapped the motor points of many lower extremity muscles, and these motor points appear to be similar to the common <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> locations described by Travell and Simons (4, 55). This may have implications for enhancing the <a id="validity" data-tip="1511" target="_blank" href="/glossary-term/validity" class="glossary">validity</a> of <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> studies, as motor points can be confirmed using EMG. The combination of using EMG to confirm motor point location, <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> training programs, and starting training programs with large superficial muscles like the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a>, may be ideal for enhancing the <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> of <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> for <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> across the profession.
Research has demonstrated that <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> may be effectively treated using dry needling, manual therapy, and foam rolling. In a randomized control <a id="randomized-control-trial" data-tip="1407" target="_blank" href="/glossary-term/randomized-control-trial" class="glossary">trial</a> (RCT), Sutlive et al. demonstrated that dry needling various lower extremity muscles, including <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, was more effective for reducing pain than sham treatment for PFPS (56). Yentur et al. demonstrated that <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> injections in conjunction with hyaluronic acid joint injections resulted in an increase in function and range of motion when compared to hyaluronic acid injections which only improved function for a group of participants diagnosed with <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> osteoarthritis (47). Pavkovich et al. demonstrated the efficacy of a combination of dry needling, stretching, and strengthening for reducing pain and improving function in patients with chronic <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> hip and thigh pain (57). Two studies have demonstrated the efficacy of manual therapy for lower extremity <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> for the treatment of PFPS (58, 59). In the RCT by Hains et al., 15 sessions of manual ischemic <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a> applied to muscles around the <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> for treatment of PFPS, was found to be effective both short and long-term (6 months) (58). In a randomized, controlled cross-over study by Anaya-Terroba, ice massage was shown to reduce pain pressure <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> but increase mean EMG activity post-exercise (59). This may imply that ice can be used for analgesic effects, but does not have the desired effect on <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> activity. These studies indicate that dry needling and manual therapy are effective treatments for <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> and <a href="https://brookbushinstitute.com/article/lower-leg-dysfunction" target="_blank" rel="noopener">lower extremity dysfunction (LED)</a>, and although ice may have analgesic properties, it may not be beneficial as a treatment approach.
The <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a> has been included in a number of foam rolling and roller massage studies. Research on foam rolling is trending toward the following findings; effective for increasing range of motion, no effect or a positive effect on performance, and benefits are likely enhanced when combined with other techniques. In a study by Peackock et al. foam rolling frontal plane muscles, including the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a>, was more effective than foam rolling sagittal plane <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> for increasing performance on drills, flexibility, and subjective scaling measures during the National Football League combine (61). This study may suggest that the muscles selected for foam rolling has a significant impact on the benefits attained. A study by Bradbury-Squires, also demonstrated an increase in range of motion and performance (efficiency during a lunge) when foam rolling was used as a warm-up technique (62). Most studies suggest that foam rolling is effective for improving range of motion (61, 62, 66 - 69); however, beyond increasing range of motion, the effects of foam rolling are more complex. A study by Cavanaugh et al. demonstrated that foam rolling the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">quadriceps</a> reduced <a href="https://brookbushinstitute.com/article/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> activity (63), implying a significant effect on neuromuscular reflex and <a id="reciprocal-inhibition" data-tip="1655" target="_blank" href="/glossary-term/reciprocal-inhibition" class="glossary">reciprocal inhibition</a>. Several studies have noted a decrease in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> stiffness and a decrease in EMG activity post foam rolling (64 - 67); however, Macgregor et al. demonstrated that despite a decrease in root mean square activity, excitation efficiency was maintained (64). The interaction between <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> selection, decreased stiffness, decreased mean activity, and maintenance of recruitment efficiency may be the reason why some studies show an increase in performance (61, 62), and other studies show no change in performance (65, 66). Zorko et al. demonstrated that foam rolling may not be effective for improving recovery (70); however, this contradicts other studies (71 -73). This may be due to the muscles selected for foam rolling intervention, or perhaps more research is needed on defining a standard protocol. When foam rolling is combined with other techniques, results are overwhelmingly positive. Moore et al. demonstrated that one session of Active <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Technique in conjunction with foam rolling for home therapy (including targeted intervention for the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a>) was effective for the treatment of iliotibial band syndrome (ITBS) (74). Similarly, Else et al. demonstrated the efficacy of chiropractic care and foam rolling for ITBS (75). In an interesting RCT by Jafarnezhadgero et al., an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> corrective exercise program including foam rolling was effective for improving assessed <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-7-knees-bow-out" target="_blank" rel="noopener">functional knee varus</a> in a group of adolescents (76). Last, a study by Romero-Moraleda et al. that included treatment of <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a>, suggests that adding vibration to foam rolling does not increase benefits (77); however, again this contradicts a study by Enrique et al. that demonstrated vibration enhanced benefits when foam rolling the calf musculature (78). In summary, self-administered techniques are always welcomed due to the inherent advantage for movement prep, home exercise programs, and self-management. Considering the body of research and clinical outcomes, the Brookbush Institute asserts that foam rolling is likely effective for increasing range of motion and performance, resulting in benefits similar to dry needling or ischemic <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a>. However, it is important that implementation is carefully considered. The Brookbush Institute&apos;s assertion is dependent on the technique being used on muscles assessed as short (increased stiffness), over-active, and exhibiting signs of <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development. Further, more research is needed on how these techniques may contribute to recovery; and further, whether vibration may augment benefits.

Several studies have demonstrated that over-activity of the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductors</a> is correlated with <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener">functional knee valgus </a> (6, 7, 9). Further, in a study by <a href="https://brookbushinstitute.com/article/the-effect-of-sacroiliac-joint-pain-on-muscle-recruitment" target="_blank" rel="noopener"> Hungerford</a> et al., a relative increase in <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> activity was correlated with sacroiliac joint (SIJ) pain (79). Although it may not be a direct indicator of relative changes in length or activity, the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductors </a> (and adductor tendons) are commonly associated with tendonitis and groin pain (80 - 82); the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> longus is most often affected (83). Very few studies are available investigating <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> prevalence; however, many have been published investigating treatment and will be discussed below. The study by Torres-Chica et al. included <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> and demonstrated that the intensity of post-meniscectomy pain was correlated with the number of active <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> (17). Further, a study by Stratton et al. demonstrated that individuals with chronic pelvic pain or endometriosis exhibited a greater <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> and number of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> (study included <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>) (84). The research available suggests that the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductors</a> are <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to over-activity, contribute to sacroiliac joint, pelvic and hip joint dysfunction, and may be <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development.
Studies have demonstrated effective treatment of <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> and associated dysfunction using needling, manual therapy, and foam rolling. Several of the studies mentioned above included the investigation of <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>. The randomized control <a id="randomized-control-trial" data-tip="1407" target="_blank" href="/glossary-term/randomized-control-trial" class="glossary">trial</a> (RCT) by Cotchet et al., demonstrated dry needling several lower extremity muscles was effective for treating heel pain when compared to sham treatment (36). In another RCT by Brennan et al., dry needling several lower extremity muscles were at least as effective as cortisone injection into the trochanteric bursae for greater trochanteric pain (37). Yentur et al. demonstrated that <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> injections in conjunction with hyaluronic acid joint injections resulted in an increase in function and range of motion when compared to hyaluronic acid injections which only improved function for a group of participants diagnosed with <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> osteoarthritis (47). And, a comparative study by Gunn et al. compared physical therapy to physical therapy and needling for chronic low back pain, demonstrating <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> outcomes for the dry needling group (38). Additional studies have demonstrated the efficacy of needling several muscles, including <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, for the treatment of hip replacement pain, lumbar radiculopathy, and pelvic floor pain. Imamura et al. demonstrated that dry needling several muscles, including <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, was effective for reducing post-operative pain following total hip replacement (85). Saeidian et al. demonstrated that <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> injections enhanced the treatment of lumbar radiculopathy (86). Kim et al. demonstrated that ultra-sound guided <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> injections of the <a href="https://brookbushinstitute.com/article/psoas" target="_blank" rel="noopener">iliopsoas</a>, <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener"> adductors</a>, and <a href="https://brookbushinstitute.com/article/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">abdominal muscles</a> were effective when the cause of groin pain is suspected to originate from muscles (87). Last in a cadaver study by Rha et al., needling the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">pectineus and adductor longus</a> was validated and found to be <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a>, demonstrating perfect needle placement in all 10 specimens without penetration of other muscles or adjacent neurovascular structures (88). Needling has demonstrated efficacy in multiple studies for the treatment of low back, pelvic and <a href="https://brookbushinstitute.com/article/lower-leg-dysfunction" target="_blank" rel="noopener">lower extremity dysfunction</a>, and <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> needle insertion has been validated using cadaveric dissection.
Studies investigating manual therapy of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, including <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, have demonstrated results similar to dry needling. In a study mentioned above, Mosler et al. demonstrated that manual therapy of hip musculature improved hip <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> and egg-beater endurance in water polo players (39). This study may suggest a potential for <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques to be used to enhance performance. Robb et al. demonstrated that ART was at least moderately effective for enhancing the treatment of adductor strain (89). Last, Donnelly et al. demonstrated that the combination of ischemic <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a> and neuromobilization was effective for reducing pain and increasing function for those individuals with <a id="fibromyalgia" data-tip="1135" target="_blank" href="/glossary-term/fibromyalgia" class="glossary">fibromyalgia</a>. Although fewer studies are available investigating the efficacy of manual treatment of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, initial findings suggest outcomes similar to those seen with needling.
Several foam rolling and roller massage studies have included the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductors</a>, and although <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> are not generally mentioned in these studies, it seems reasonable to consider that foam rolling may mimic manual ischemic <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a>. An interesting difference in the research on foam rolling is the common application of this technique to enhance recovery and performance. Rey et al. demonstrated that foam rolling after training had a large effect on agility and perceived <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> soreness when compared to passive recovery at 24 hours post-training in a group of professional soccer players (91). In a study by Pearcey et al., foam rolling post-workout reduced subjective complaints of delayed onset muscles soreness (DOMS), improved pressure-pain threshold, sprint speed (30-m sprint time), <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> (broad-jump distance), change-of-direction speed (T-test), and dynamic strength-endurance at 24 and 48 hours after a DOMS inducing workout (92). Fleckenstein et al. demonstrated that pre-workout and post-workout foam rolling had approximately equal effects on recovery (93). Note, combining both pre-workout foam rolling based on <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> and post-workout foam rolling for recovery may provide additional benefit, and is worth further investigation. A study by Arneby demonstrated that a dynamic stretching warm-up was more beneficial than a foam rolling warm-up for increasing <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> performance (94). However, Yildiz et al. demonstrated that a warm-up including both foam rolling and dynamic stretching resulted in better performance than dynamic stretching alone (95). This study by Yildez et al. is just one example of the benefit foam rolling can have when added to effective programming. Note, although it may be reasonable to consider foam rolling in-between sets for better efficiency, D&#x2019;Amico et al. demonstrated foam rolling had no effect on performance when used in-between sets of 800-meter runs (96). In summary, foam rolling is likely to improve performance when used as a warm-up in conjunction with other effective techniques, and foam rolling is beneficial for recovery when sport or training imposes demands 24 - 48 hours after a session.
Foam rolling studies including the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductors</a> tend to show the same level of efficacy for improving range of motion, as is seen when other muscles are the focus of the study. In a randomized control <a id="randomized-control-trial" data-tip="1407" target="_blank" href="/glossary-term/randomized-control-trial" class="glossary">trial</a> by Vijay et al., foam rolling was slightly more effective than static stretching for improving ROM of motion in healthy individuals with &quot;adductor tightness&quot;(97) Guillot et al. also demonstrated foam rolling and self-administered joint <a id="distraction" data-tip="1589" target="_blank" href="/glossary-term/distraction" class="glossary">distraction</a> with elastic bands was effective for improving range of motion (98). Again, more consideration should be given to the benefits of combining modalities. In an interesting study by Campa et al., an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> corrective exercise program including foam rolling, designed based on results from a movement <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>, was effective for reducing asymmetries during the athletic season in a group of youth elite male soccer players (99). Last, studies by Okamoto et al. and Lastova et al. investigated the effect of foam rolling on arterial function; both studies noting a decrease in blood flow during the technique (100, 101). However, Okamoto et al. demonstrated the decrease in blood flow resulted in no significant changes in concentrations (100), and Lastova et al noted a significant hypotensive effect for 30 minutes after the intervention (101). Based on these studies the use of foam rolling as a self-administered alternative to <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques is likely safe, and beneficial for increasing range of motion, recovery, and performance when combined with other techniques.

Videos

<h3><iframe src="https://player.vimeo.com/video/174886318" frameborder="0" allowfullscreen="allowfullscreen"></iframe></h3>
<h4>Differentiation</h4>
<ol>
 <li>The <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductor</a> mass comprises the entire inner-thigh from <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">quadriceps</a> to the <a href="https://brookbushinstitute.com/article/semitendinosus-and-semimembranosus" target="_blank" rel="noopener">semimembranosus and semitendinous (semi&apos;s)</a>.</li>
 <li>These muscles are easiest to palpate with the <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener">hip</a> flexed to 60-90&#xB0; of horizontal abduction, <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> at 90&#xB0; of flexion, and foot resting on your outer <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> iliac spine (ASIS) or foot resting against the patient&apos;s opposite knee (as pictured above).</li>
 <li>In this position, the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductors</a> can be located by feeling for a contraction using a broad palpation (webspace from index finger to thumb) on the inner thigh and asking the patient to adduct against manual resistance. Assuming that your palpation is at approximately mid-point of the length of the thigh. The muscles that will be felt are the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">gracilis and adductor longus</a>.</li>
 <li>The <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">pectineus and adductor brevis</a>, specifically <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in these muscles, can be felt at the bottom of the femoral triangle.</li>
 <li>The femoral triangle can be located by falling off laterally and inferiorly from the pubis, feeling for the adductor tendons, and depressing into the area just <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> and <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> these tendons.</li>
 <li>Or, the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> side of the femoral triangle can be identified by manually resisting <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener">hip</a> adduction and identifying the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">gracilis and adductor longus</a>, and the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> side of the femoral triangle can be located by manually resisting <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> extension and identifying the <a href="https://brookbushinstitute.com/article/rectus-femoris" target="_blank" rel="noopener">rectus femoris</a>.
 <ul>
 <li>Note, special care should be taken to prevent irritation of &quot;sensitive tissues (discussed below)&quot; when palpating the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">pectineus and adductor brevis</a>.</li>
 </ul>
 </li>
</ol>
<h4>Potentially Sensitive Tissues</h4>
<ul>
 <li>The inguinal lymph nodes, femoral artery and vein, femoral and saphenous <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, and additional distributions of these vessels and nerves in the femoral triangle and adductor canal may be palpated during this technique. If a pulse is felt, or the patient complains of numbness, tingling, burning or searing pain, or pain that is diffuse and uncomfortable and unlike <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> pain, adjust hand placement. Keep in mind, lymph nodes, nerves, veins, and arteries are fairly narrow, a small adjustment in finger placement should be sufficient to continue performing the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> technique without further insult to delicate structures.</li>
</ul>
<h4>Trigger Points</h4>
<ul>
 <li>Common <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> for the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">gracilis and adductor longus</a> are roughly 1/3rd and 2/3rd the length of the inner thigh.</li>
 <li>Common <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> for the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">pectineus and adductor brevis</a> can be located in approximately the middle of the floor of the femoral triangle.</li>
</ul>
<h4>Release Technique</h4>
<ol>
 <li>This technique is likely easiest to perform, the <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener">hip</a> at 90&#xB0; of horizontal abduction, <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> at 90&#xB0; of flexion, and the foot resting on your outer <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> iliac spine (ASIS) (as pictured above).</li>
 <li>These muscles are easiest to palpate with the client in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a>, and the <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener">hip</a> flexed to 60-90&#xB0; of horizontal abduction, <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> at 90&#xB0; of flexion, and foot resting on your outer <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> iliac spine (ASIS) or foot resting against the patient&apos;s opposite knee (as pictured above).</li>
</ol>
<h4>Gracilis and Adductor Longus</h4>
<ol>
 <li>In this position, feel for a contraction using a broad palpation (webspace from index finger to thumb) on the inner thigh, and asking the patient to adduct against manual resistance. Assuming that your palpation is at approximately mid-point of the length of the thigh. The muscles that will be felt are the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">gracilis and adductor longus</a>.</li>
 <li>Use a &quot;thumb over thumb&quot; or &quot;thumb in thenar groove&quot; hand position, strum fibers from <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> to identify taut bands in this tissue.</li>
 <li>Once a <a id="taut-band" data-tip="1148" target="_blank" href="/glossary-term/taut-band" class="glossary">taut band</a> is located, the length of the band is explored for a dense nodule and consistent pressure is applied.</li>
 <li>The practitioner may press down with the hands to increase abduction or add <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> pressure to take up tissue slack; aiding in controlling the amount of <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> to pin dense nodules.</li>
 <li>Consistent pressure is held until the nodule softens under the practitioner&apos;s fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).</li>
</ol>
<h4>Pectineus and Adductor Brevis</h4>
<ol>
 <li>The <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">pectineus and adductor brevis</a>, specifically <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in these muscles, can be felt at the bottom of the femoral triangle.</li>
 <li>The femoral triangle can be located by falling off laterally and inferiorly from the pubis, feeling for the adductor tendons, and depressing into the area just <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> and <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> the adductor tendons.</li>
 <li>Or, the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> side of the femoral triangle can be identified by manually resisting <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener">hip</a> adduction and identifying the <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">gracilis and adductor longus</a>, and the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> side of the femoral triangle can be located by manually resisting <a href="https://brookbushinstitute.com/article/knee" target="_blank" rel="noopener">knee</a> extension and identifying the <a href="https://brookbushinstitute.com/article/rectus-femoris" target="_blank" rel="noopener">rectus femoris</a>.</li>
 <li>Pressing into the floor of the femoral triangle should be done with care, and exploration of tissue texture should be done with small, gentle compressions. Lift the fingers out of the tissue before moving to the next point to prevent dragging <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitive</a> structures during the technique.</li>
 <li>It is unlikely that fascicles or nodules will be identifiable. Attempt to identify dense regions or <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitive</a> regions that replicate &quot;trigger point like&quot; pain.</li>
 <li>Consistent pressure is held until the nodule softens under the practitioner&apos;s fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).</li>
</ol>

Bibliography

© 2019 Brent Brookbush


 Questions, comments, and criticisms are welcomed and encouraged

Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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Static Manual Release: Hip Internal Rotators - TFL, Gluteus Minimus, Vastus Lateralis and Anterior Adductors

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