Introduction

Attachment and Innervation

Relative Location

Palpation

Actions

Arthrokinematics

Fascial Integration

Behavior in Postural Dysfunction

Techniques and Ending Info

Trapezius Muscles

WITS

NYPT

CIMSPA

ProCert

PACE

AFAA

TPTA

CanFitPro

REPSI

ACSM

NCBTMB

YOGA

AUSPHYSIO

PTAGlobal

AUSactive

REPS

NASM

ISSA

AOTA

Trapezius Muscles: Upper, Middle and Lower Trapezius 

Trapezius

This course describes the anatomy and <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> function of the trapezius muscles. The trapezius muscles are also known as the traps, trap muscles, shoulder blade muscles, upper back muscles, and/or are referred to individually as the upper trapezius (upper trap), middle trapezius (mid trap), and lower trapezius (lower trap). This <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> is the most superficial <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> of the upper back and is composed of more type I <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> fibers; however, the percentage of type I and type II <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> fibers are close to even. This <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> crosses the scapulothoracic joint, influencing motion of the sternoclavicular joint and acromioclavicular joint. The upper trapezius is an elevator, upward rotator, and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipper of the scapula, the middle trapezius is a retractor and downward rotator of the scapula, and the lower trapezius is a depressor, upward rotator, and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tipper of the scapula. Additionally, the upper trapezius is innervated by the accessory <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> (along with the sternocleidomastoid) and plays an important role in <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> and motion of the neck (cervical spine). This course also describes the role of the trapezius muscles in scapulothoracic <a id="arthrokinematics" data-tip="1859" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematics</a>, fascial <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> (thoracolumbar fascia), <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">postural</a> dysfunction, and subsystem <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a>. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the trapezius muscles for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. neck pain, thoracic pain, AC and SC joint pain, trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> pain and <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, cervicogenic headache, thoracic outlet syndrome, accessory <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> dysfunction, trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strain, scapular winging), synergistic function and motor control (e.g. trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> and rotator cuff <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment during arm elevation), and trapezius exercises and techniques for enhancing sports performance (e.g. upper body (arm) <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, strength, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>, hypertrophy, etc.).
<h4>Brookbush Institute&#x2019;s most recommended techniques for the Trapezius Muscles (see videos below):</h4>
<ul>
 <li>Release: <a href="https://brookbushinstitute.com/video/upper-trapezius-sa-static-release">Self-Administered Upper Trapezius Manual Release&#xA0;</a></li>
 <li>Manual: <a href="https://brookbushinstitute.com/video/upper-trapezius-static-manual-release-soft-tissue-mobilization">Upper Trapezius Static Manual Release</a></li>
 <li>Manipulation: <a href="https://brookbushinstitute.com/video/thoracic-spine-self-administered-mobilization">Thoracic Spine</a></li>
 <li>Activation: <a href="https://brookbushinstitute.com/video/trapezius-isolated-activation">Trapezius Isolated Activation</a></li>
 <li>Subsystem Integration: <a href="https://brookbushinstitute.com/video/static-lunge-to-row-posterior-oblique-subsystem-integration-progressions">Static Lunge to </a><a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> Row</li>
</ul>
<img alt="The trapezius muscle in a cadaver dissection" title="A cadaver dissection of the trapezius muscle in relation to the latissimus dorsi" src="https://www.datocms-assets.com/25800/1642476687-trapezius_muscle.jpg">

 Course Description: Trapezius Muscles

<h4>What&#x2019;s in a name:</h4>
<ul>
 <li><a href="http://www.etymonline.com/index.php?term=trapezius&amp;allowed_in_frame=0" target="_blank" rel="noopener">trapezius (n.)</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> over the back of the neck, 1704, from Modern Latin trapezius (musculus), masc. adjective from trapezium (see <a href="http://www.etymonline.com/index.php?term=trapezium&amp;allowed_in_frame=0" target="_blank" rel="noopener">trapezium</a>). (<a href="http://www.etymonline.com/index.php?allowed_in_frame=0&amp;search=Trapezius&amp;searchmode=none" target="_blank" rel="noopener">Etymology Online</a>)
 <ul>
 <li>So-called from the shape they <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a>, as in trapezoid</li>
 <li><a href="http://www.etymonline.com/index.php?term=trapezoid&amp;allowed_in_frame=0" target="_blank" rel="noopener">trapezoid (n.)</a> 1706, &quot;a trapezium,&quot; from Modern Latin trapezoides, from Late Greek trapezoeides, noun use by Euclid of Greek trapezoeides &quot;trapezium-shaped,&quot; from trapeza, literally &quot;table&quot; (see <a href="http://www.etymonline.com/index.php?term=trapezium&amp;allowed_in_frame=0" target="_blank" rel="noopener">trapezium</a>), + -oeides &quot;shaped&quot; (see <a href="http://www.etymonline.com/index.php?term=-oid&amp;allowed_in_frame=0" target="_blank" rel="noopener">-oid</a>). Technically, a plane four-sided figure with no two sides parallel. But in English, since c.1800, often confused with trapezium in its sense of &quot;a quadrilateral figure having only two sides parallel and two not.&quot; (Etymology Online)</li>
 </ul>
 </li>
</ul>
<img src="https://www.datocms-assets.com/25800/1643486862-trapezius-muscle.png" width="383" height="384" title="An image of the trapezius muscle with upper, middle, and lower fibers highlighted" alt="The trapezius muscles split into upper, middle, and lower fibers">
This image was content published in a BodyParts3D/Anatomography website

Introduction to the Trapezius Muscles

<h4>Origin:</h4>
<ul>
 <li>Upper: External occipital protuberance, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> 1/3 of <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> nuchal line, ligamentum nuchae, and spinous process of the seventh cervical vertebrae (8, 11, 18).</li>
 <li>Middle: Spinous processes and interspinous ligaments of C6 through T5 (8, 11).</li>
 <li>Lower: Spinous processes and interspinous ligaments of the 6th thought 12th thoracic vertebrae (11).
 <ul>
 <li>Note: the vertebrae from which the middle and lower trapezius originate vary slightly between texts, for example, the most <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> attachment of the middle trap may be listed as C5, C6, or C7, and the most <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> attachment of the lower trap from T5, T6 or T7. This is likely due to a lack of physical division between segments and some disagreement between which fibers contribute to which joint actions. The origins are simply an attempt to group motor units with similar functions together. The most <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> and <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> attachments of the trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> are consistent between texts - listed as the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> nuchal line and the spinous process of T12.</li>
 </ul>
 </li>
</ul>
<h4>Insertion:</h4>
<ul>
 <li>Upper: <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> 1/3rd of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> clavicle, <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> acromioclavicular ligament, and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> margin of the acromion.</li>
 <li>Middle: <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> margin of the acromion and <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> lip of the spine of the scapula (11).</li>
 <li>Lower: From root of the spine of the scapula to a tubercle at the apex of the spine of scapula, extending laterally to the insertion of the middle trapezius via fibrous attachment (11).</li>
</ul>
<h4>Nerve:</h4>
<ul>
 <li>Spinal portion of <a id="cephalad" data-tip="1559" target="_blank" href="/glossary-term/cephalad" class="glossary">cranial</a> <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> XI (accessory <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>) with the trapezius portion of the motor <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> arising from the first 5 cervical segments, ascending through the foramen magnum and exiting the jugular foramen to supply and sometimes pierce the sternocleidomastoid before inserting into the trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>. Some accessory fibers may be supplied by the <a id="ventral" data-tip="1553" target="_blank" href="/glossary-term/ventral" class="glossary">ventral</a> rami of C3 - C4 and sometimes C2; however, it has not been determined what the functional significance of these separate neural innervations are. (8,11, 18 - 20).</li>
</ul>

Attachments & Innervation: Upper, Middle, and Lower Trapezius

<ul>
 <li>The trapezius is the most superficial <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> of the cervical spine, thoracic spine, and much of the scapula. In this way the trapezius could be viewed similar to the&#xA0;<a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>, the &quot;big house,&quot; as both the largest <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> of the cervical and thoracic spine and in that it &quot;covers&quot; many muscles of the cervical and thoracic spine. The upper trapezius originates on the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> 1/3 of the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> nuchal line by investing in a fascial sheath that is shared by the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> fibers of the sternocleidomastoid and may potentially continue superiorly to the occipitalis muscles. In the space between the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> border of the upper trapezius and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> border of the sternocleidomastoid (the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> triangle of the neck - pictured below) the splenii, the levator scapulae, and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> scalenes may be palpated (listed in order from <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a>). Deep to the uppermost fibers of the trapezius, at the <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a> of the occiput, are two additional layers of <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> - the semispinalis capitis is just deep to the upper trapezius and the suboccipital muscles are deep to the semispinalis capitis. As the trapezius muscles course down the spine, they also cover the semispinalis cervicis, the cervical and thoracic&#xA0;<a href="https://brookbushinstitute.com/course/erector-spinae" target="_blank" rel="noopener">erector spinae</a>, and the deeper extensors of the spine: the&#xA0;multifidus,&#xA0;rotatores, interspinalis, and intertransversarii. As the upper trapezius courses laterally toward the clavicle and acromion it envelops the levator scapulae and the lower portions of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> and middle scalenes, covering the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> portions of the 1st and 2nd rib, as well as, a portion of the brachial plexus.</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1642477073-250px-trapezius_gray409.png" title="The superficial trapezius muscles on the posterior side of the upper body" alt="The three trapezius muscles">
<ul>
 <li>The middle trapezius includes the fibers originating from vertebrae C6 to T5 and inserting from the middle 1/3 of the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> lip of the spine of the scapula to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> margin of the acromion. The middle trapezius courses over many muscles (listed from <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> to <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a>): as mentioned above, the trapezius muscles cover the cervical and thoracic&#xA0;<a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a>, and the deeper extensors of the spine: the&#xA0;multifidus,&#xA0;rotatores, interspinales and intertransversarii, the middle trap continues to course over the&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>&#xA0;(and the deeper serratus <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a>), then the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> angle and root of the spine of the scapula, the origin of the&#xA0;<a href="https://brookbushinstitute.com/courses/levator-scapulae" target="_blank" rel="noopener">levator scapulae</a>, and finally completely envelope the supraspinatus (lying in the supraspinous fossa). Palpation of the supraspinatus and origin of the levator scapulae may be achieved, but only through the fibers of the middle trapezius. At its origin, the middle trapezius invests in a cervicothoracic fascial sheath that may be worth further investigation - studies have noted a relationship between thoracic spine stiffness, middle trapezius, and&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboid</a>&#xA0;trigger points with lasting treatment only occurring after addressing <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">postural</a> issues and thoracic spine stiffness (8).</li>
</ul>
<ul>
 <li>The lower trapezius include those fibers originating from T6 - T12 and inserting from the root of the spine of the scapula medially to the insertion of the middle trapezius on the middle 1/3 of the spine of the scapula laterally. The <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> portion of the lower trapezius lies superficial to the&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>&#xA0;and the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> portions lie superficial to the serratus <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a>. A small portion of the&#xA0;<a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">latissimus dorsi</a>&#xA0;originates from underneath the tail end of the lower trapezius, just as a small portion of the&#xA0;<a href="https://brookbushinstitute.com/courses/infraspinatus-and-teres-minor" target="_blank" rel="noopener">infraspinatus</a>&#xA0;lies underneath the most <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> fibers. As with the upper and middle trapezius, the lower trapezius covers the thoracic&#xA0;<a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a>, and the deeper extensors of the spine: the&#xA0;multifidus,&#xA0;rotatores, interspinalis, and intertransversarii.
 <ul>
 <li>Although more <a id="relevance" data-tip="1505" target="_blank" href="/glossary-term/relevance" class="glossary">relevant</a> to manual therapists, it is worth noting that reaching the subscapularis via palpation from the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> side involves palpating through and stretching the&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>&#xA0;and lower trapezius around the vertebral border of the scapula - unless getting under the scapula is first achieved at the triangle of auscultation.</li>
 </ul>
 </li>
</ul>
<img src="https://www.datocms-assets.com/25800/1642477005-250px-vhm_triangle_of_auscultation.png" title="Posterior upper body dissection with the teres major, infraspinatus, latissimus dorsi and trapezius muscles showing" alt="Cadaver dissection of the posterior upper body muscles">
Triangle of Auscultation - By Daniel G. Bates - Visible Human Male, dissection created using the VH Dissector and further editted, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11375322

Where are the Traps Located?

<ul>
 <li>Upper Trapezius: The surprisingly slender upper trap may be palpated from the <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a> of the skull to the <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a> of the neck and across the top of the shoulder girdle. With your partner in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a>, gently squeeze the most superficial layer of <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> at the upper cervical spine. Have your partner lift their head - you should feel the density of this layer quickly increase as the upper trap contracts - follow those same fibers down across the top of the scapula. Having your partner gently elevate and relax their shoulder girdle as you palpate may help you trace the fibers from the <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a> of the neck to <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> clavicle (14). Note: if you feel too deep when palpating the traps at the cervical spine you will be palpating the splenii. These muscles are easy to identify, they feel like two near-vertical bars or cylinders of <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>. They course up and down the back of the neck and do not course over the shoulder girdle.</li>
 <li>Middle Trapezius: With your partner still in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a>, find the spine of the scapula. Move your hand <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> to the spine of the scapula; asking your partner to retract should &quot;pop&quot; the middle trapezius into your fingers. Remember these are superficial fibers, if you dig too deep you may palpate through the middle trap to the deeper&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>,&#xA0;<a href="https://brookbushinstitute.com/courses/erector-spinae">erector spinae</a>&#xA0;or&#xA0;<a href="https://brookbushinstitute.com/courses/levator-scapulae" target="_blank" rel="noopener">levator scapulae</a>&#xA0;(14). To inhibit the&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>&#xA0;and levator scapulae, have your partner start with their hands by their forehead. Retracting in this position (scapular upward rotation) will result in less activation of the&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>&#xA0;and levator scapulae.</li>
</ul>
<img src="https://www.musclesused.com/wp-content/uploads/2012/08/Trapezius-Muscle-3.jpg" alt><img alt="Image showing the separations between upper, middle, and lower trapezius" title="The location and fiber direction of the upper, middle, and lower traps" src="https://www.datocms-assets.com/25800/1632844348-trapeziusanimationsmall2.gif">
<ul>
 <li>Lower Trapezius: Palpate the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> border of the very superficial lower trap with your partner in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> (try to visualize the shape of the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> - &quot;Trapezoid or Kite Shaped&quot;). You may be able to get your fingers underneath the lower trap and gently lift it from the underlying musculature. If you are having a difficult time locating the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> border of the lower trapezius, have your partner raise their hand out in front of their head while cueing depression, as pictured below (same position as a lower trapezius manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> (MMT)) - this should result in a strong contraction of the lower trapezius (14). Make sure to palpate the border of the lower trapezius all the way to its origin on the spinous process of T12. Many new students, and professionals alike, are surprised at just how low the lower traps go.</li>
</ul>
<img src="https://i.ytimg.com/vi/-mJlHb_9_xs/hqdefault.jpg" alt="Palpation of the lower trap" title="A manual therapist palpating the lower trapezius muscle in a patient">
Palpating the Lower Trap - http://i.ytimg.com/vi/-mJlHb_9_xs/hqdefault.jpg

Palpating the Trapezius Muscles

<ul>
 <li>Upper: Elevation, upward rotation, and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping of the scapula. <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">Ipsilateral</a> flexion, extension, and <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> rotation of the cervical spine (3,8,11, 20).</li>
 <li>Middle: Retraction of the scapula (3,8,11).</li>
 <li>Lower: Depression, upward rotation, and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tipping of scapula.
 <ul>
 <li>Note: Some texts note the potential for all portions of the trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to contribute to retraction and upward rotation, and potentially combined contraction of all segments of the trapezius to contribute to head, neck, and thoracic spine extension (8, 11, 20).</li>
 </ul>
 </li>
</ul>
<img src="https://www.datocms-assets.com/25800/1642477314-image10.png" title="Image of the upper body posterior muscles, nerves, and boney landmarks" alt="The posterior muscles of the upper body including the traps and delts">
Note how the accessory <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> (CN XI) continues inferiorly to invest in the lower portions of the trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> - http://drkamaldeep.files.wordpress.com/2011/05/image10.png
<h3>Integrated Function:</h3>
<ul>
 <li>Stabilization:&#xA0;AC Joint (10), reinforcement of the acromioclavicular ligament, stabilization of the scapula (acromioclavicular and sternoclavicular joints respectively), stabilization of the atlantooccipital joint, cervical spine, and thoracic spine.</li>
 <li>Eccentrically Decelerates:&#xA0;All segments of the trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> may eccentrically decelerate protraction and downward rotation. Additionally, the lower trap may eccentrically decelerate elevation and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping, and the upper trap may decelerate depression and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tipping.</li>
 <li>Synergists:
 <ul>
 <li>The upper trapezius,&#xA0;<a href="https://brookbushinstitute.com/courses/levator-scapulae" target="_blank" rel="noopener">levator scapulae</a>,&#xA0;and&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>&#xA0;work synergistically during elevation.</li>
 <li>The middle trapezius (with some assistance from the upper and lower trapezius) and rhomboids act synergistically during retraction.</li>
 <li>The lower trapezius and&#xA0;<a href="https://brookbushinstitute.com/courses/pectoralis-minor" target="_blank" rel="noopener">pectoralis minor</a>&#xA0;act synergistically during depression.</li>
 <li>The upper trapezius, lower trapezius, and&#xA0;<a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a>&#xA0;work synergistically during upward rotation of the scapula, with increasing contribution by the middle trapezius the more the arm is elevated.</li>
 <li>The upper trapezius may aid the pectoralis minor and levator scapulae in <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping of the scapula (this synergy plays a major role in&#xA0;<a href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction (UBD))</a>.</li>
 <li>The lower trapezius and serratus <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> act synergistically to posteriorly tip the scapula (this synergy plays a major role in&#xA0;<a href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction (UBD).</a></li>
 </ul>
 </li>
</ul>
<img src="https://www.datocms-assets.com/25800/1642477545-istock-1354901798.jpg" title="An image of the traps running from the skull, spine, ribcage and scapula" alt="The trapezius muscle on the posterior side of the skeletal system">

Trapezius Muscle Actions

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing <a id="tone" data-tip="1639" target="_blank" href="/glossary-term/tone" class="glossary">tone</a> of invested musculature via reflex arcs formed between mechanoreceptors embedded in the <a id="connective-tissue-cell" data-tip="1368" target="_blank" href="/glossary-term/connective-tissue-cell" class="glossary">connective tissue</a> and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature&apos;s &#x201C;motherboard.&#x201D; A place for mechanical information to be communicated to the <a id="nervous-system" data-tip="1690" target="_blank" href="/glossary-term/nervous-system" class="glossary">nervous system</a> for more efficient recruitment of the <a id="muscular-system" data-tip="1691" target="_blank" href="/glossary-term/muscular-system" class="glossary">muscular system</a>. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.
<img title="Image of the fascial system of the body connecting muscles" src="https://www.datocms-assets.com/25800/1649100927-fascia-web-in-body.jpg" alt="The fascial web connecting two muscle fascicles">
<ul>
 <li>Superficial/Investing Cervical Fascia and the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> Nuchal Line: An interesting relationship to explore would be the shared fascia of the sternocleidomastoid (SCM) and upper trapezius. This sheath of the fascia extends just <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> to the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> nuchal line and expanding from external occipital protuberance medially to mastoid process laterally. This fascia is an expansion of the superficial cervical fascia, is invested by the ligamentum nuchae, and may extend <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> to invest in the fascial origin of the occipitalis. As the sternocleidomastoid is often over-active and the upper trapezius under-active the relationship is puzzling, although in the extremes of forward head <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> and cervical dysfunction the upper trap, SCM and the investing muscles of the ligamentum nuchae may all present with <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> and increased <a id="tone" data-tip="1639" target="_blank" href="/glossary-term/tone" class="glossary">tone</a>.
 <ul>
 <li>As I combed through pictures and texts researching potential relationships, I did come to an interesting conclusion. The occipitalis and galea aponeurotica likely have fascial continuity with the structures mentioned above - despite all of the illustrations of the occipitalis and galea aponeurotica implying a fascial connection with the deeper splenii and sub-occipitals. The splenii and sub-occipitals are actually enveloped by a deeper layer of cervical fascia (prevertebral layer). How do fascial lines bypass the superficial fascia, the upper trapezius, and the ligamentum nuchae to affect <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> in the prevertebral fascia? - Somebody e-mail Tom Myers, this one has me scratching my head.</li>
 </ul>
 </li>
</ul>
<img src="https://www.datocms-assets.com/25800/1642477846-nuchal_lines.png" title="The nuchal lines acting as attachment points for the trapezius and deep cervical flexor muscles" alt="Attachment of the trapezius on the skull">
http://en.academic.ru/pictures/enwiki/78/Nuchal_lines.png
<ul>
 <li>Ligamentum Nuchae: The ligamentum nuchae in quadrupedal animals is known as the paddy-whack - fun fact of the day ;-) Four muscles insert into the strong ligamentous expansion of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> cervical spine known as the ligamentum nuchae (pictured above). This includes the superficial upper trapezius, as well as, the <a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a> minor, splenius capitis, and serratus <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a>. This fascial sheath has also been found to have direct fibrous attachments with the spinal dura between the occiput and C1, and between C1 and C2 (17), which may have clinical significance in the treatment of cervicogenic headache. The splenius capitis and <a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a> minor have a tendency toward over-activity, and the upper trapezius may present as over-active (although less often) with <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>. The same may be true of the serratus <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> (although difficult to determine due to the muscle&apos;s small cross-section, function and depth). Forward head <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> would result in increased <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> in the ligamentum nuchae - Could this increase in fascial <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> stimulate receptors that facilitate the activity of investing musculature, and potentially the hypertonicity in cervical extensors noted clinically?</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1642477888-cervical-fascia.png" title="The trapezius, levator scapulae, scalenes, and deep cervical flexors attachment to the boney landmarks of the skull" alt="Cross-sectional view of the muscles attaching to the skull">
By <a href="//en.wikipedia.org/wiki/Henry_Vandyke_Carter" target="_blank" rel="noopener">Henry Vandyke Carter</a> - <a href="//en.wikipedia.org/wiki/Henry_Gray" target="_blank" rel="noopener">Henry Gray</a> (1918) Anatomy of the Human Body (See &quot;Book&quot; section below)<a href="//en.wikipedia.org/wiki/Bartleby.com" target="_blank" rel="noopener">Bartleby.com</a>: <a href="http://www.bartleby.com/107/" target="_blank" rel="noopener">Gray&apos;s Anatomy</a>, <a href="http://www.bartleby.com/107/illus384.html" target="_blank" rel="noopener">Plate 384</a>, Public Domain, https://commons.wikimedia.org/w/index.php?curid=561537
<ul>
 <li>Thoracocervical Fascia: Certainly more research is needed investigating the complex relationship between the fascia and investing musculature at the cervicothoracic junction. The upper and middle trapezius share some common fascial tissue at their origin on the spinous process and ligamentum nuchae with the <a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>, splenius capitis, and serratus <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a>, but what about deeper layers of the cervicothoracic fascia. The prevertebral layer of the cervical spine must extend inferiorly to envelop the extensors of the thoracic spine, but how intimate is this fascial layer with the more superficial cervicothoracic fascia. As this segment of the spine and the associated ribs have a complex role to play in the <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> motion of the scapula and shoulder, there could be a functional purpose for complex synergies. It has already been mentioned several times throughout this article that <a id="dyskinesis" data-tip="1693" target="_blank" href="/glossary-term/dyskinesis" class="glossary">dyskinesis</a> of the cervical and thoracic spine may result in altered activity and <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development in the trapezius muscles. Could there be synergistic subsystems at the cervicothoracic junction, analogous to those found crossing the lumbar spine and investing in the thoracolumbar fascia?</li>
 <li>Trapezius and Deltoids: Fascial continuity between the insertion of the trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> and the origin of the deltoids is actually one of the simpler relationships and stronger arguments for fascial lines if you consider these muscles relative to the scapulohumeral rhythm. Consider how elevation of the arm includes both activation of the deltoids and the trapezius to initiate upward rotation of the scapula. The strongest fascial connection is likely from the upper trapezius to <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> AC ligament to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> deltoid (10). A relationship that is highlighted every time we reach for something - shoulder flexion via the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> deltoid accompanied by upward rotation of the scapula via the upper trapezius.</li>
</ul>

The&#xA0;lower and middle trapezius&#xA0;have been noted as&#xA0;long and under-active&#xA0;by many clinicians, texts, and studies (1, 2, 4, 7, 8, 11, 15, 21). The&#xA0;upper trapezius&#xA0;has been noted as&#xA0;both under-active&#xA0;(3, 7, 15, 21)&#xA0;and over-active&#xA0;(1, 2, 5, 8) leading to some confusion on the effect this <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> may have on the&#xA0;<a href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">upper body dysfunction/impairment</a>.
In&#xA0;<a href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction (UBD):</a>
The&#xA0;lower trapezius&#xA0;is most often long and under-active leading to excessive elevation, downward rotation, and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping of the scapula in both static and dynamic <a id="posture" data-tip="1661" target="_blank" href="/glossary-term/posture" class="glossary">postures</a>. Manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> testing (MMT) will often highlight marked weakness in those with shoulder, shoulder girdle, and thoracic spine pathology. Occasionally <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> are noted, but these are relatively rare when compared and/or differentiated from&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboid</a>&#xA0;trigger points and/or <a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic</a> dysfunction of the lower thoracic spine resulting in facilitation of the lower traps.
The&#xA0;middle trapezius&#xA0;plays a similar role in <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">postural</a> dysfunction/movement impairment as the lower trapezius, resulting in a decrease in end range upward rotation during arm elevation and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping during <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">postural</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>. Careful attention should be given to the relationship between the thoracic spine and middle trapezius. Dysfunction of one is often a sign of dysfunction in the other.
It is my <a id="hypothesis" data-tip="1446" target="_blank" href="/glossary-term/hypothesis" class="glossary">hypothesis</a> that the&#xA0;upper trapezius may be over-active&#xA0;in those with the extremes of shoulder girdle and cervical dysfunction, contributing to both extension of the upper cervical spine and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping of the scapula. However, it is&#xA0;more common to find the upper trapezius long and under-active, leading to a decrease in scapular upward rotation and clavicular <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> rotation during arm elevation. Evidence of under-activity in the upper trapezius has been noted in a study by&#xA0;Scovazzo, who examined the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity of freestyle swimmers with a painful shoulder - trapezius activity was shown to be reduced during all phases of the swimming stroke (15). In <a id="posture" data-tip="1659" target="_blank" href="/glossary-term/posture" class="glossary">postural</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> (for example, the&#xA0;<a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat Assessment</a>), under-activity of the upper trap generally results in elevation of the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> angle of the scapula (shoulder girdle elevation) around a fixed glenoid fossa - relative downward rotation. The elevation is actually due to the activity of the levator scapulae and&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>, acting as&#xA0;overactive synergists&#xA0;for an inhibited upper trapezius. If the upper trapezius was the cause of the observable elevation of the shoulder girdle during <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> it would be accompanied by upward rotation.
Brent&apos;s HMS Rule #3:&#xA0;Every joint motion is relative. That is one bone moves relative to the other.
Why do you keep referring to downward rotation of the scapula in UBD, when I clearly see the scapula elevate during an assessment?
It&#x2019;s an optical illusion, kind-of&#x2026; What you see is the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> angle (superior/medial corner) of the scapula elevate, but the glenoid fossa remains fixed. That is to say, downward rotation of the scapula can occur as it is traditionally taught &#x2013; glenoid fossa moving inferiorly, or as elevation of the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> angle of the scapula around a fixed glenoid fossa.
The diagram below depicts a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> view of the right scapula and humerus. The image on the left depicts downward rotation as it is &#x201C;traditionally&#x201D; taught, while the diagram on the left depicts relative downward rotation around a fixed glenoid fossa (downward rotation masquerading as elevation).
Note: scapular downward rotation around a fixed humerus is relative humeral abduction indicating a decrease in length of the supraspinatus and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid.
<img src="https://www.datocms-assets.com/25800/1642477950-scapula.png" title="A depiction of the upward and downward motions of the scapula" alt="Upward and downward rotation of the scapula">
In a similar fashion to the example above, the forward motion often noted as protraction may be viewed as <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping and protraction of the upper scapula alone around a fixed <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> angle.
The Upper Trapezius is one of the few &quot;Jekyll and Hyde&quot; muscles. That is, most muscles that have a propensity toward over-activity are almost always over-active, and those muscles with a propensity toward under-activity are almost always under-active. It would seem that despite my inclination to label this <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> long/underactive, the upper trapezius may play both roles. This is not unheard of, as some of the muscles of the core may also play both roles (for example, the&#xA0;Psoas).
Travell and Simons note the upper trapezius may be the most common site for <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development (8). In light of this evidence, it may be easiest to simply lump the upper trap in with the other over-active, <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> laden muscles, but we cannot forget that long muscles can have <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> too. What if the upper trap is acting like the&#xA0;<a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>&#xA0;in Lumbo-Pelvic Hip Complex Dysfunction (LPHCD) - Long and Over-active. Consider how changing <a id="lengthtension-relationship" data-tip="1685" target="_blank" href="/glossary-term/lengthtension-relationship" class="glossary">length/tension</a> relationships results in decreased force production and efficiency, and the effect that may have on a long upper trap trying to resist gravity&apos;s pull on the entire shoulder girdle. Could <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> be a compensation to overcome the loss in force production and maintain some level of scapular stability?
Last, there may be some confusion related to the source of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>. If you return to the &quot;Relative Location&quot; section of this article you may note that the upper trapezius lies over several muscles that are commonly over-active. Namely, the levator scapulae,&#xA0;<a href="https://brookbushinstitute.com/courses/rhomboids" target="_blank" rel="noopener">rhomboids</a>,&#xA0;and supraspinatus, and that many clinicians have noted a resolution of <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> with cervical and thoracic mobilization. Before one advocates <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and stretching for a <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> that may be either under-active or over-active, it may be prudent to check other structures that may contribute to dysfunction.
In Lumbo Pelvic Hip Complex Dysfunction (LPHCD) and&#xA0;Sacroiliac Joint Dysfunction (SIJD),&#xA0;the trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> plays no significant role.
In&#xA0;<a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Leg Dysfunction (LLD)</a>&#xA0;the trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> plays no significant role.
In Short, all segments of the trapezius <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> may have a propensity toward under-activity and an adaptive increase in length. This implies that activation, <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a>, and strengthening techniques should be part of a human movement professional&apos;s repertoire. The upper trapezius may be over-active in those individuals with the extremes of cervical and&#xA0;<a href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction (UBD)</a>&#xA0;and additional techniques used to reduced <a id="tone" data-tip="1639" target="_blank" href="/glossary-term/tone" class="glossary">tone</a> and increase length (<a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and stretching) will be necessary for this segment of the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>. Last, knowledge of cervical and thoracic mobilization techniques may be useful for long-term resolution of altered activity and length (see videos below).
<img src="https://www.datocms-assets.com/25800/1643486988-trapezius-cadaver.jpeg" title="The latissimus dorsi and trapezius muscles in a cadaver dissection" alt="Cadaver dissection of the trapezius and latissimus dorsi">
http://www.rvuanatomy.com/uploads/1/3/4/5/13457421/sb4a-edited.gif
<h4>Clinical Implications:</h4>
<ul>
 <li>Trapezius trigger points</li>
 <li>Cervical Pain</li>
 <li>Thoracic Pain</li>
 <li>AC Joint Pain</li>
 <li>SC Joint Pain</li>
 <li>Cervicogenic Headache</li>
 <li>Cervical Radiculopathy</li>
 <li>Shoulder impingement</li>
 <li>Bursitis</li>
 <li>Thoracic Outlet Syndrome</li>
 <li>Scapular winging</li>
 <li><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> shoulder laxity</li>
 <li>Osteoarthritis
 <ul>
 <li>Thoracic Spine</li>
 <li>AC Joint</li>
 <li>SC Joint</li>
 <li>Glenohumeral Joint</li>
 </ul>
 </li>
</ul>
<h3>Signs of Altered Length/Tension and Tone:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat:</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-10-arms-fall" target="_blank" rel="noopener">Arm Fall - Long/Under-active</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-11-shoulders-elevate" target="_blank" rel="noopener">Shoulder Girdle Elevation - Long/Under-active</a></li>
 </ul>
 </li>
 <li>Goniometric Assessment:</li>
 <li><a id="goniometry" data-tip="1524" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometric</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> of the scapula is unreliable, although observation of scapular movement during arm elevation may provide valuable information.
 <ul>
 <li><a href="https://brookbushinstitute.com/video/cervical-lateral-flexion-goniometry" target="_blank" rel="noopener">Cervical </a><a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Flexion:&#xA0;&lt; 35&#xB0; (Upper Trapezius Only)</li>
 </ul>
 </li>
 <li>Special Tests:
 <ul>
 <li><a href="https://brookbushinstitute.com/video/apleys-scratch-test" target="_blank" rel="noopener">Apley&apos;s Scratch Test</a></li>
 </ul>
 </li>
 <li></li>
 <li>Manual <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/lower-trapezius-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Lower Trapezius Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> (MMT)</li>
 </ul>
 </li>
</ul>
<h4>Tapezius Trigger Points:</h4>
It is my humble opinion that many <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> believed to be trapezius <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, are actually levator scapulae, supraspinatus, and rhomboid <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>. Further, some <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> in the trapezius are nothing more than satellite sites originating from the cervical and thoracic spine dysfunction (<a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic</a> facilitation).
<ul>
 <li>Palpation results in tenderness and may result in radiating symptoms.</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1642478097-upper-trapezius-trp-combined.jpeg" title="The trigger points and referral pain patterns of the trapezius muscles " alt="Common trigger points of the traps">
David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons&#x2019; Myofascial Pain and Dysfunction, The <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">Trigger Point</a> Manual, Volume 1. Upper Half of Body: Second Edition,&#xA9; 1999 Williams and Wilkens
<img src="https://www.datocms-assets.com/25800/1642478161-upper-body-trigger-points.jpeg" title="Comparison between the upper trapezius, levator scapulae, and rhomboid trigger points" alt="Common trigger points of the upper body">
Comparison of Upper Trapezius,&#xA0;<a href="https://brookbushinstitute.com/article/levator-scapulae" target="_blank" rel="noopener">Levator Scapulae</a>&#xA0;and&#xA0;<a href="https://brookbushinstitute.com/article/rhomboids" target="_blank" rel="noopener">Rhomboid</a>&#xA0;trigger points (listed from <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a>) with <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> deltoid <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> marked on male subject:

Postural Dysfunction and the Trapezius Muscles

Exercises and Techniques for Trapezius Muscles:

Prone Trapezius Activation on Stability Ball

<ul>
 <li>Note: As a <a id="exercise-regression" data-tip="1179" target="_blank" href="/glossary-term/exercise-regression" class="glossary">regression</a>, it may be appropriate to start with <a href="https://brookbushinstitute.com/video/external-rotator-reactive-activation" target="_blank" rel="noopener">External Rotator Reactive Integration</a> and <a href="https://brookbushinstitute.com/video/serratus-anterior-reactive-activation">Serratus </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Reactive Integration - These exercises require less coordination, but still require some trap activation</li>
</ul>
<iframe src="https://player.vimeo.com/video/76730344" frameborder="0" allowfullscreen="allowfullscreen"></iframe>
<h4>Eccentric PNF Catch and Throw:</h4>
<ol>
 <li>Having your client/patient start in a kneeling position is more convenient for the clinician throwing the ball, but is not essential to the exercise itself. The ball should be caught during its descent.</li>
 <li>Pay careful attention to your client/patient&apos;s upper body <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> including <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> position of the cervical, thoracic and lumbar spine. The arm should start at the end range of a D2 Flexion PNF Pattern (abduction of between 100 - 130&#xBA;, end range horizontal abduction, and end range external rotation) with the scapula depressed and retracted (13).</li>
 <li>A ball should be thrown across the front of the client/patient&apos;s body so that it falls obliquely from the outstretched hand toward the opposing hip.</li>
 <li>The objective of this exercise is for the patient/client to catch the ball with an &quot;overhand grip&quot; as it passes; evenly decelerating the ball from the point it is caught near the outreached hand down to the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> hip (as if following a PNF D2 Flexion Pattern). Pay careful attention to scapular motion; do not allow elevation or <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tipping.</li>
 <li>Once the ball reaches the hip, you may cue your patient/client to pause to emphasize stabilization and <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> or cue an immediate reversal of the pattern to throw the ball back.</li>
</ol>
<ul>
 <li>Common Mistake:
 <ul>
 <li>Focusing so much on the catch and throw that the original intent of the exercise is forgotten - <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> scapular motion must be achieved and maintained throughout the entirety of the set.</li>
 </ul>
 </li>
</ul>

 Eccentric PNF Catch and Throw

Upper Trapezius (Self-Administered) Static Release

Upper Trap Static Stretch

Self-administered Sternocostal Mobilization: Anterior to Posterior

<h3><iframe src="https://player.vimeo.com/video/100511589" frameborder="0" allowfullscreen="allowfullscreen"></iframe></h3>
<h4>Self-administered Thoracic Spine Mobilization: Rotation:</h4>
<h4>Thoracic Spine Rotational Mobilization and Strengthening</h4>
<ol>
 <li>Assume <a href="https://brookbushinstitute.com/video/latissimus-dorsi-and-erector-spinae-static-stretch-childs-pose" target="_blank" rel="noopener">child&apos;s pose</a> position (on knees with buttock resting on heels).
 <ul>
 <li>The feet may hang beyond the end of a table if the pressure on the feet and ankles is uncomfortable.</li>
 <li>Individuals with knee pain may place a towel, pillow, bolster or foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> between the heels and buttock to reduce the amount of knee flexion in this position.</li>
 </ul>
 </li>
 <li>Place one elbow down on the floor between your knees, and then <a id="compression" data-tip="1597" target="_blank" href="/glossary-term/compression" class="glossary">compress</a> the elbow by bringing the knees together.</li>
 <li>Place the other hand behind the head, lightly palming the occiput.
 <ul>
 <li>Note: This technique may be modified for shoulder pain or shoulder restriction by placing the hand that was on the occiput on the opposite shoulder with arm across the chest.</li>
 </ul>
 </li>
 <li>Keeping the elbow downside on the floor, rotate your torso and attempt to &quot;point&quot; the elbow of the side holding the occiput toward the ceiling.</li>
 <li><a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">Optimal</a> range of motion (ROM) would allow for both arms to be in line, perpendicular to the floor, with one elbow pointing vertically toward the ceiling. It is likely that full ROM will not be achieved during initial attempts; however, practice should result in significant improvement over a couple of weeks.</li>
 <li>Hold the end range position for 2 - 5 seconds and slowly return your elbow to the ground.</li>
 <li>Repeat 10-15 times.</li>
 <li>Repeat on the other side if indicated by <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>.</li>
 <li>Reassess.</li>
</ol>

Self-administered Thoracic Spine Mobilization: Rotation

Self-administered Spine Mobilization: Rotation (Open Books)

<ol>
 <li>Phillip Page, Clare Frank, Robert Lardner, Assessment and Treatment of Muscle Imbalance: The Janda Approach &copy; 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner</li>
 <li>Dr. Mike Clark &amp; Scott Lucette, &ldquo;NASM Essentials of Corrective Exercise Training&rdquo; &copy; 2011 Lippincott Williams &amp; Wilkins</li>
 <li>Donald A. Neumann, &ldquo;Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation &ndash; 2nd Edition&rdquo; &copy; 2012 Mosby, Inc.</li>
 <li>Michael A. Clark, Scott C. Lucett, NASM Essentials of Personal Training: 4th Edition, &copy; 2011 Lippincott Williams and Wilkins</li>
 <li>Leon Chaitow, Muscle Energy Techniques: Third Edition, &copy; Elsevier 2007</li>
 <li>Tom Myers, Anatomy Trains: Second Edition. &copy; Elsevier Limited 2009</li>
 <li>Shirley A Sahrmann, Diagnoses and Treatment of Movement Impairment Syndromes, &copy; 2002 Mosby Inc.</li>
 <li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons&rsquo; Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,&copy; 1999 Williams and Wilkens</li>
 <li>Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry &ndash; Third Edition. &copy; 2003 by F.A. Davis Company</li>
 <li>Cynthia C. Norkin, Pamela K. Levangie, Joint Structure and Function: A Comprehensive Analysis: Fifth Edition &copy; 2011 F.A. Davis Company</li>
 <li>Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani, Muscles: Testing and Function with Posture and Pain: Fifth Edition &copy; 2005 Lippincott Williams &amp; Wilkins</li>
 <li>Karel Lewit. Manipulative Therapy: Musuloskeletal Medicine &copy; 2007 Elsevier</li>
 <li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization &ndash; A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
 <li>Andrew Biel, Trail Guide to the Human Body: 4th Edition, &copy; 2010</li>
 <li>Scovazzo ML, Browne A, Pink M, et. al.: The Painful shoulder during freestyle swimming. Am J Sports Med 19(6):577-582, 1991</li>
 <li>Lawrence, R. L., Braman, J. P., Laprade, R. F., &amp; Ludewig, P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. journal of orthopaedic &amp; sports physical therapy, 44(9), 636-A8.</li>
 <li>Dean, N.A. and B.S. Mitchell 2002. Anatomic relation between the nuchal ligament (ligamentum nuchae) and the spinal dura mater in the craniocervical region. Clin. Anat. 15:182-185.</li>
 <li>Lind CS, et al. (2015). Quantification of trapezius muscle innervation during neck dissections: cervical plexus versus the spinal accessory nerve. Annals of Otology, Rhinology, &amp; Laryngology. 124(11): 881-885.</li>
 <li>Canella C, Demondion X, Abreu E, et al. (2013). Anatomical study of the spinal accessory nerve using ultrasonography. European Journal of Radiology. 82:56-61.</li>
 <li>Tubbs RS, Shoja MM, Loukas M, et al. (2011). Study of the cervical plexus innervation of the trapezius muscle. J. Neurosurg Spine. 14: 626-629.</li>
 <li>Choi W, Cynn H, Lee C, et al. Shrug exercises combined with shoulder abduction improve scapular upward rotator activity and scapular alignment in subjects with scapular downward rotation impairment. Journal of Electromyography and Kinesiology. 25: 363-370.</li>
 <li>Lindman, R., Eriksson, A., &amp; Thornell, L. E. (1990). Fiber type composition of the human male trapezius muscle: Enzyme‐histochemical characteristics.&nbsp;American Journal of Anatomy,&nbsp;189(3), 236-244.</li>
 <li>
 Lindman, R., Eriksson, A., &amp; Thornell, L. E. (1990). Fiber type composition of the human female trapezius muscle: Enzyme‐histochemical characteristics. American Journal of Anatomy,&nbsp;190(4), 385-392.
 </li>
</ol>

Bibliography

<html><head></head><body>© 2016 Brent Brookbush
Questions, comments, and criticisms are welcome and encouraged</body></html>

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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