Levator Scapulae Muscle

Levator Scapulae

Action: Unilaterally

– Elevates the scapula

– Downwardly roatates the scapula

– rotates the head and neck simultaneously

Bilaterally

– Extend the head and neck

Origin: C1 – C4 Transverse Processes

Insertion: Medial Border of scapula

Nerve: cervical nerve (C3-C4) and dorsal scapular nerve (C5)

The levator scapulae muscle is a key player in the complex network of muscles that support the neck and shoulder region. Originating from the upper cervical vertebrae (C1-C4), it extends down diagonally to attach onto the superior angle of the scapula (shoulder blade).

As its name suggests, the primary action of the levator scapulae is to elevate the scapula, or shoulder blade. This muscle is often involved in movements such as shrugging the shoulders or tilting the head to the side. Additionally, it assists in lateral flexion and rotation of the neck.

Despite its importance in providing stability and mobility to the neck and shoulders, the levator scapulae is prone to tightness and overuse, often leading to symptoms like neck pain, stiffness, and restricted range of motion.

In the clinic we often see people come in with a stiffness feeling in the angle of the neck and down to the attachment with head turning and side bending. This usually a tell tale sign that the levator scapulae is involved.

Stretching, strengthening and self treatment exercises targeting this muscle are commonly prescribed to alleviate discomfort and improve overall function in the neck and shoulder region.

Stretch

To stretch the left side, sit up tall, turn your head to the right. Anchor your left hand by sitting on it or let it hang.
With your right hand on the back of your head, pull your head forward and down on the angle so your nose is close to your armpit.
Hold for 15-20secs and repeat on the opposite side to stretch the right side.

You want to feel the stretch but it shouldn’t be painful.

Self Treatment

Equipment needed: long towel folded up to about 10cm wide and massage ball.

Take the folded up towel and put one end on the seat with the rest of it draping over the back of the seat.
Sit on the towel on the chair to anchor it.
Reach back and bring the towel over your shoulder to the front of you.
Place the ball on your upper trap and under the towel.
Using your hand on the opposite side the ball is, pull down on the towel to create some pressure with the ball.
You can either hold the ball in one spot and not move or add in a head movement to move the muscle.
Hold for 15-20secs, you should feel the discomfort lessen, then move the ball onto the next tender spot. Repeat on the opposite side.

Strengthening

Setup:

Stand on the middle of a resistance band with your feet shoulder-width apart.
Hold one end of the resistance band in each hand, allowing the band to hang down by your sides.

Grip:

Hold onto the resistance band with a neutral grip, palms facing your body.

Positioning:

Keep your back straight, chest up, and shoulders relaxed.
Position your hands so that they’re directly below your shoulders, with the resistance band taut but not stretched.

Shrug Movement:

Lift your shoulders straight upward toward your ears in a controlled motion.
Squeeze your shoulder blades together at the top of the movement to maximize contraction.

Hold and Squeeze:

Hold the top position of the shrug for a brief moment, focusing on contracting your trapezius muscles.

Lowering Phase:

Slowly lower your shoulders back down to the starting position, maintaining tension on the resistance band throughout the movement.
Avoid letting the band snap back down; control the descent to keep tension on your muscles.

Breathing:

Inhale as you lower your shoulders back down.
Exhale as you lift your shoulders up into the shrug position.

Before using any of these techniques, it’s safest to consult your local Myotherapist to see if they are suitable for your situation.

Gluteus Minimus

Action – abduction of hip
flexion and medial rotation of hip (anterior fibres)
extension and lateral rotation of hip (posterior fibres)
stabilises the pelvis and prevents the free limb from sagging during gait

Origin – outer ilium (between anterior and inferior gluteal lines)

Insertion – greater trochanter on the femur (anterior surface)

Nerve – Superior gluteal nerve (L4-S1)

Gluteus minimus lies below gluteus medius and is therefore difficult to feel. It has essentially the
same function as gluteus medius. (which is why we have included the medius videos below.)

The muscle plays a key role in normal gait (walking or running) by stabilising the pelvis when the
opposite leg is off the ground. If weak, the pelvis can drop towards the opposite side in what is
known as a ‘Trendelenburg gait’.

Gluteus minimus can be injured from falling, blunt trauma such as those experienced in contact
sports, repetitive stress from hip extension activities or long periods sitting or sleeping in one
position. Pain in the region should be differentiated from other pathologies such as trochanteric
bursitis, lumbar, sacroiliac or hip joint dysfunction, or trigger point referral from muscles in the low
back.

Trigger points in gluteus minimus have a large referral pattern, and the discomfort caused is often
called ‘pseudo-sciatica’ because of the similar sensation and location of the pain. Anecdotally we have found that clients would usually describe the sensation as an ache (tooth ache) feeling rather than a sharp shooting pain if it was muscular rather than impingement of the sciatic nerve at the spine.

If you think you may have an issue with your gluteus minimus, consult your local Myotherapist for an assessment of your specific situation.

Strengthening

Stretching

Lie on your back, knees bent and feet on the ground. Place the ankle of the side to be stretched to
just above the knee of the opposite leg, then use your hands to pull this opposite leg towards your
chest. You should feel the stretch on the side/back of the hip that is being stretched.

Self Treatment

Laying on the side you want to work on. Propped up on your forearm with your bottom knee bent and your top foot on the floor just behind your bent knee.

Place the ball on the floor underneath your gluteus minimus and lower yourself onto the ball. Roll on the ball until you find a tender spot. Once on a tender spot, hold there. Do some nice breathing into the belly. Let your body sink onto the ball. (You can adjust the pressure using your forearm and the foot on the floor) After about 20 secs or so you should feel the discomfort start to subside. Once this happens, move onto the next tender spot.

Contributors: Ben Lewis & Jesse Kingsbury

Semimembranosus

Action – flexion of knee, extension of hip
medial rotation of knee (tibia) when knee is flexed

Origin – ischial tuberosity

Insertion – medial tibial condyle (posterior medial aspect)

Nerve – sciatic nerve, tibial division (L5, S1, S2)

Semimembranosus is one of three hamstring muscles. It is medial (towards the inside of your thigh) and lies below another hamstring muscle – semitendinosus. It can be felt when tensing the hamstrings deep to the semitendinosus tendon.

Semimembranosus is the largest hamstring muscle. In some people the distal fibres blend into the proximal fibres of the gastrocnemius medial head.

The hamstring group are used when walking, running or lifting from the ground with straight legs. Semimembranosus also plays an important role in knee stability.

Injury or dysfunction in the semimembranosus muscle can cause pain or discomfort in the back of the thigh, lower buttock or inner knee regions, and sometimes can be associated with low back pain. Common injuries include hamstring strains/tears, particularly when performing ballistic activity (sprinting, kicking, hurdling) without proper warm-up.

Hip or knee joint pain referral or nerve related pain, may need to be differentiated from injury to the hamstrings. Consult your local Myotherapist to help with differentiating.

Strengthening

Standing upright with feet shoulder width apart, hold a barbell, kettlebell or pair of dumbbells of an appropriate weight with an overhand grip in front of your thighs with straight arms. With knees slightly bent and keeping a straight back, hinge forward at the hips and lower the weights while keeping them close to your legs until about the mid shin level. Pause, then squeeze your glutes to bring the hips forward and return to the starting upright position.

Stretching

Rotate legs outwards to favour the medial hamstrings (semitendinosus and semimembranosus). You can use a towel to make the stretch stronger.

Self Treatment

Sitting on a firm table or chair with your legs hanging off the edge. Place a ball under your right hamstring, where you feel it is tight. Slowly lift your foot, extending your knee a few times. Then move the ball onto the next tender spot along the muscle. Alternatively, not extending the knee, you can use your hands and body weight to push your thigh onto the ball with more pressure. When you feel the discomfort dissipate, move onto the next spot.

Semitendinosus

Action – flexion of knee, extension of hip
medial rotation of knee (tibia) when knee is flexed

Origin – ischial tuberosity

Insertion – proximal anterior medial tibia (pes anserine)

Nerve – sciatic nerve, tibial division (L5, S1, S2)

Semitendinosus is one of three hamstring muscles. It is medial (towards the inside of your thigh) and lies on top of another hamstring muscle – semimembranosus. It has quite a long tendon to the insertion which can be easily felt when tensing the hamstrings, toward the inner part of the lower half on the back of the thigh.

Pes anserine is latin for goose foot. The area that semitendinosus inserts into is often called this because three muscles (semitendinosus, gracilis and sartorius) insert here together, in a way that resembles the shape of a goose’s foot.

The hamstring group are used when walking, running or lifting weight from the ground with straight legs.

Injury or dysfunction in the semitendinosus muscle can cause pain or discomfort in the back of the thigh, lower buttock or inner knee regions, and sometimes can be associated with low back pain. Common injuries include hamstring strains/tears, particularly when performing ballistic activity (sprinting, kicking, hurdling) without proper warm-up.

Symptoms may need to be differentiated from injury to the other hamstrings, hip or knee joint pain referral or nerve related pain (disc herniation, sciatica)

Strengthening

Stretching

Rotate legs outwards to favour the medial hamstrings (semitendinosus and semimembranosus). You can use a towel to make the stretch stronger.

Self Treatment

Biceps Femoris

Action – flexion of knee (both long and short head)
extension of hip (long head only)
lateral rotation of knee (tibia) when knee is flexed

Origin – long head: ischial tuberosity
short head: lateral lip of liner aspera

Insertion – head of fibula

Nerve – sciatic nerve (long head – tibial division (L5, S1, S2), short head – common perineal division (S1, S2))

Biceps femoris is one of three hamstring muscles. It is lateral (towards the outside of your thigh) and consists of two heads – a long head and a short head. It can be felt when tensing the hamstrings on the outside of the back the thigh, most easily close to the knee where the tendon is more prominent.

The hamstring group are used when walking, running or lifting from the ground with straight legs. Biceps femoris also plays a large role in providing knee stability.

Injury or dysfunction in the biceps femoris muscle can cause pain or discomfort in the back of the thigh, lower buttock or inner knee regions, and sometimes can be associated with low back pain. Common injuries include hamstring strains/tears, particularly when performing ballistic activity (sprinting, kicking, hurdling) without proper warm-up.

As you can see in the above picture, the pain referral pattern can be higher up into the bottom of the glutes or lower into the back of the knee. Looking at the referral pattern, all hamstrings should be considered when working out the source of an issue.

Symptoms of hamstring muscle tension can feel similar to referred joint pain or disc related pain. Consult your local Myotherapist to help with diagnosis.

Strengthening

Stretching

Sitting on the ground with one leg out in front and the other bent out to the side. With your foot on the inside of the straight legs knee. Lean forward (keeping a straight/neutral back) to feel a nice stretch down the back of the straight leg. Rotate legs inwards to favour biceps femoris over the medial hamstrings. You can use a towel to make the stretch stronger.

Self Treatment

Gluteus Medius

Origin – outer ilium (between anterior and posterior gluteal lines)

Insertion – greater trochanter on the femur (superior and lateral surface)

Nerve – superior gluteal nerve (L4, L5, S1)

Gluteus medius fans out across the hip in a similar way, as the deltoid muscle does to the shoulder. As a result it has many actions on the movement of the hip. It is partially covered by gluteus maximus, but can be felt on the side below the hip bone when moving your straight leg to the side away from the opposite leg.

The muscle plays a key role in normal gait (walking or running) by stabilising the pelvis when the opposite leg is off the ground. If weak, the pelvis can drop towards the opposite side in what is known as a ‘Trendelenburg gait’.

Gluteus medius can be injured from falling, blunt trauma such as those experienced in contact sports, repetitive stress from hip extension activities or long periods sitting or sleeping in one position. Pain in the region should be differentiated from other pathologies such as trochanteric bursitis, lumbar, sacroiliac or hip joint dysfunction, or trigger point referral from muscles in the low back.

Pictured above you can see the typical referral pattern of the gluteus medius trigger points. There are generally 3 points that can have an affect on different regions. Ranging from the muscled itself, sacroiliac joint (SIJ), upper hamstring (sometimes to the side of the leg more) and over the sacrum.

That feeling of general stiffness or tightness across the upper glutes and sacrum on both sides, could be caused by trigger points in the gluteus medius.

Strengthening

Lie on your side with the lower leg slightly bent, top leg straight with toes pointed slightly towards the floor. Raise the straight top leg as far as possible (it may only be 20-30 degrees) without rocking through the hips, pause for 2 seconds and slowly lower back down. As you continue you should start to feel your gluteus medius fatigue.

Stretching

Lie on your back, knees bent and feet on the ground. Place the ankle of the side to be stretched to just above the knee of the opposite leg, then use your hands to pull this opposite leg towards your chest. You should feel the stretch on the side/back of the hip that is being stretched.

Self Treatment

Laying on the side you want to work on. Propped up on your forearm with your bottom knee bent and your top foot on the floor just behind your bent knee.

Place the ball on the floor underneath your gluteus medius and lower yourself onto the ball. Roll on the ball until you find a tender spot. Once on a tender spot, hold there. Do some nice breathing into the belly. Let your body sink onto the ball. (You can adjust the pressure using your forearm and the foot on the floor) After about 20 secs or so you should feel the discomfort start to subside. Once this happens, move onto the next tender spot.

As always, consult your local Myotherapist to make sure the above techniques are suitable for your situation.

Contributors: Ben Lewis & Jesse Kingsbury

Tibialis Posterior

Action – plantar flexion and inversion of the foot

– Plantar flexion – pointing the foot and toes away from the knee

– Inversion – the foot moves towards the side of the big toe

Origin – posterior proximal 2/3 of tibia, fibula and interosseous membrane

Insertion – fans out over the plantar surface of foot (navicular, all 3 cuneiforms, 2nd-4th metatarsals, cuboid and calcaneus)

Nerve – tibial nerve (L4-S1)

Tibialis posterior is located on the back of the lower leg deep to the main ‘calf’ muscles (gastrocnemius and soleus), so it can be difficult to feel.

It helps to stabilise the ankle and prevents over-pronation while walking, as well as supporting the arch of the foot. Playing an important role in running for both ankle stability and spring in the foot. For those with ‘flat feet’ and/or wearing orthotics, tibialis posterior strengthening is recommended for the support of the arch.

If you stand on your toes or use your foot to press on the pedals in your car, then you are engaging tibialis posterior.

Dysfunction in the muscle, similar to tibialis anterior, can cause pain around the shin bone (Medial Tibial Stress Syndrome), in the front of the ankle or the big toe (shown in the above referral pattern image). Shin splints are an overuse or overload injury that can involve inflammation and pain in tibialis posterior and along the Tibia where the muscle inserts. Weakness can lead to the arch of the foot collapsing, resulting in pain and increased stress on the muscle.

When inflamed it can be extremely painful to massage. Dry needling is a good option if this is the case.

As usual, consult your local Myotherapist on what strategy may work best for your situation.

Strengthening

Stand with feet hip width apart. Place a tennis ball (or yoga block, foam roller) between both ankles and squeeze the heels together to hold on to it. While keeping the squeeze, raise the heels off the ground as high as you can, hold for 1-2 seconds and slowly lower back down. Repeat 10-15 times.

Stretching

Sit on the floor with the affected leg straight out in front of you, placing a rolled up towel under the knee so that it is slightly bent. Use another towel, belt or strap looped around the foot (or simply your outstretched hand on the same side), pull the top of the foot towards the knee while everting the foot (so the small toe side comes a little further than the big toe side). You should feel a stretch deep in your calf. Hold for 20-30 seconds.

Self Massage

Sitting in a chair, place your ankle of the affected leg on your opposite knee. Place your thumbs on the inside edge of the tibia. Anywhere in the top 2/3 of your tibia. Push in and around to the back of your tibia with your thumbs.

Flex and extend your foot as you push in. You will be able to feel the muscle contract if you are on the correct spot. If you feel a pulse move onto another spot.

As always, consult your local Myotherapist to make sure the above techniques are suitable for your situation.

Contributors: Ben Lewis & Jesse Kingsbury

Peroneus (Fibularis) Longus

Action – Eversion and plantarflexion of the foot

– Eversion – the foot moves towards the side of the smallest toe

– Plantarflexion – pointing the toes downwards

Origin – head and proximal shaft of the fibula

Insertion – medial cuneiform and base of the 1st metatarsal (plantar surfaces)

Nerve – superficial peroneal (fibular) nerve L5, S1

Peroneus longus is located on the outer part of the lower leg, along with peroneus brevis (short) and peroneus tertius (third). These peroneal muscles may also be known as fibularis longus, brevis and tertius. The name changed to fibularis in the international standard for human anatomy as the muscles are attached to the fibula bone (perónē in Ancient Greek), and also to avoid confusion with the perianal region – important for treatment purposes! Most people still use the term peroneus though, as old habits die hard.

The three muscles are often grouped together because they evert the foot. Peroneus longus is also a key stabiliser of the ankle joint, balancing against the ankle invertors (move the foot towards the big toe side). It is a strong muscle that can withstand the forces of running and jumping.

Injury or dysfunction in the peroneus longus muscle may cause pain or discomfort in the lower leg, ankle or foot (especially on the outside, refer to above picture). This can cause difficulty with walking and running. The muscle may become weakened or strained following the most common ankle injury, an inversion sprain. Symptoms may need to be differentiated from dysfunction of peroneus brevis and tertius, hip or knee joint dysfunction referral or nerve entrapment or irritation from the lower back.

Strengthening

Tie a resistance band to a sturdy object. Place your foot in a loop at the other end of the band, keep your lower leg still and rotate your foot outwards, stretching the band using only your foot. Hold for 2-3 seconds then rest. Repeat 10-15 times.

Stretching

Invert the ankle with gentle over pressure. Note, stretching of the peroneal muscles is generally NOT indicated as over stretching can lead to chronic recurrent ankle sprains.

Self Massage

Lie on your side with a foam roller under the outside of your lower leg. Pressure can be modified by adjusting your bodyweight on your arms and other leg. Slowly move the affected leg along the foam roller, pausing for around 30 seconds on any tender spots.

Tibialis Anterior

Action – Dorsiflexion and inversion of the foot

– Dorsiflexion – pulling the foot upwards towards the knee

– Inversion – the foot moves towards the side of the big toe

Origin – anterior proximal tibia

Insertion – medial cuneiform and base of the first metatarsal (the same as peroneus longus)

Nerve – deep peroneal (fibular) nerve L4-S1

Tibialis anterior is located on the front part of the lower leg and is the main dorsiflexor of the foot. Together with peroneus longus, tibialis anterior forms the anatomical stirrup of the foot. They form a balance between inversion and eversion, plantarflexion and dorsiflexion.

It is easy to locate tibialis anterior when it contracts – find the upper half of your shin bone, then move your fingers just to the outside of this and pull your toes upwards to feel it activate.

Tibialis anterior helps with walking, running, kicking a ball, anything that involves moving the leg or stabilising the ankle.

Dysfunction in the muscle can cause pain around the shin bone, in the front of the ankle or the big toe. Shin splints are an overuse injury that can involve inflammation and pain in tibialis anterior. Damage to the nerve supply to the muscle can result in what is known as ‘foot drop’ where the front of the foot is unable to be lifted up.

It’s not too often that this muscle has issues. Hyper extending the ankle, stubbing your toe or tripping on something can cause this muscle to tense up and become protective. If this happens here are some ways to Strengthen, Stretch and Self Massage the area.

Strengthening

Tie a resistance band to a sturdy object. Sit on a chair with your leg out straight in front of you, heel on the ground. Place your foot in a loop at the other end of the band, then pull your foot towards your knee (dorsiflex) against the resistance of the band, stretching the band using only your foot. Hold for 2-3 seconds then rest. Repeat 10-15 times.

Stretching

Kneel with the top of your foot on the ground (toes pointed, foot plantarflexed). Sit back on your heels and feel the stretch in the front of your shin. The amount of stretch can be controlled by adjusting your bodyweight with your hands on the ground.

Self Massage

Sitting on a chair, bring your knee up towards your chest. Grab onto your shin with both hands. Using your fingers from both hands, put pressure on your tibilias anterior and strum across the muscle, side to side.

You can increase or decrease the amount of pressure by pulling your finger tips in towards you or relaxing your arms, respectively.

Work your way up and down the muscle. If the muscle is tight, it is common to feel a pain referral down the front of the shin and into the foot.

As always, consult your local Myotherapist to make sure the above techniques are suitable for your situation.

Contributors: Ben Lewis & Jesse Kingsbury

Posture is something that we usually associate with being the cause of our neck or lower back pain. For a long time there has been a focus on sitting up straight, shoulders back etc. While aesthetically it looks like the pictures in an anatomy book, it’s not always the most comfortable position.

Most people like to be in a relaxed, slouched position when they are sitting. Feet up on the ottoman, reading their phone or book. Or leaning forward to read their computer screen. Is sitting in these relaxed ‘poor postures’ going to increase our chances of being in pain?

In more recent times Myotherapists have learnt that posture isn’t as important as we once thought. Rather the amount of time we are in any given posture is where it can have an impact. It still does play a role but not to the same effect as we had been led to believe. Let’s have a look at an example.

An office worker is chained to their desk for hours on end at work to meet a deadline. Slumped forward in their chair, head forward, rounded shoulders etc. After 3hrs straight at the computer they start to get some discomfort through the upper back and neck.

If that same person was to hold a “perfect” posture for the same amount of time they would be experiencing discomfort in their body as well. Perhaps not in the exact same area but still experiencing some discomfort. So maybe we can assume that the posture that we usually hold when working is not as important as the amount of movement that we do throughout the day?

When can posture have an impact?

There are certain postures that can be more straining on the body for any given task. Where your body is under some postural stress for an extended period of time, this is when we start to feel some discomfort or pain. However, if we have the opportunity to change postures regularly, this should help reduce the amount of ongoing discomfort people can experience when operating a task over time.

Posture can have an impact depending on the task you are doing and for how long. Or maybe you are just in an awkward position that your body isn’t used to.

What can we do to try and prevent postural stress from turning into pain?

Move more often throughout the day.

Our body is telling us that something needs to change when we feel discomfort. It takes some body awareness to pick up on these signals before they turn into pain. Sometimes we miss these signals because we are distracted. Too engrossed in a conversation, head deep in work, listening to a podcast etc.

The invent of the sit-stand desk has been a wonderful addition to the humble workplace. Giving people the opportunity to change their positions throughout the day and break up people’s time in one posture. Even standing we need to be aware that we aren’t caught in one posture for too long. Which can have a negative impact as well.

Set yourself a timer for every hour. A reminder that you need to get up and have a quick stretch or do something to make a change.

Do some mindful movement, like Yoga, Pilates or Qi Gong. Movement where you are connecting your mind and body can help with your body awareness. Noticing when your body is under postural stress can reduce the time you are in an unfavourable position. Which should reduce the impact on you.

Hopefully this has armed you with some more knowledge on how posture can affect you and what you can do to manage it. As always, consult your local Myotherapist to make sure this advice is right for you.

Levator Scapulae Muscle