DAY 1 – HEAD, FACE, THORAX AND NERVE ENTRAPMENT SYNDROMES

Day 2 – MORNING

TMD & orofacial pain

(Temporalis, lateral and medial pterygoid muscles, masseter, facial expression muscles: procerus, buccinator, corrugator, platysma)

1. Clinical overview

Why TMD and facial pain are often misdiagnosed:

• “Tooth pain” that is actually muscular
• Continuum of headache, jaw and neck
• How occlusion and posture interact with craniofacial trigger points
• Sensitization of trigeminal pathways → widespread symptoms
• Why imaging rarely helps

2. Case 1 – Unilateral jaw pain + joint noises (“Classic but misleading TMD”)

Common misdiagnoses:

• Degenerative joint disease
• “Disc displacement”
• Malocclusion

Trigger points:

• Lateral pterygoid (intra-articular pain, reproduction of joint noise)
• Medial pterygoid (sore throat, deep jaw pain)
• Masseter (“tooth pain”)

Possible muscular factors:

• Corrugator (forehead/eye pain)
• Procerus (pressure on the forehead)
• Buccinator (cheek symptoms → tooth symptoms)
• Platysma (front of throat, jaw symptoms)

Day 1 – AFTERNOON

Chest pain and nerve entrapment syndromes

(Pectoralis minor, pectoralis major, serratus anterior · pronator teres · “double-crush concepts”)

1. Clinical overview

Why 30% of “chest pain” is musculoskeletal in nature:

• Anxiety and breathing mechanics
• Referred pain from pectoralis minor to the chest wall and scapula
• Serratus anterior rib/side pain misinterpreted as visceral

Orthopedic diagnosis of exclusion:

• Red flags (cardiac, costochondritis, pulmonary)
• Simple rib springing tests

2. Case 1 – Chest tightness, anxiety, paresthesia in the arm

Common misdiagnoses:

• Costochondritis
• Cardiac workup with negative findings

Key muscles:

• Pectoralis minor (primary)
• Serratus anterior
• Pectoralis major (sternal and clavicular portions)

3. Case 2 – Median nerve entrapment (pronator teres syndrome vs. carpal tunnel)

DAY 2 – PELVIS, ABDOMEN, VISCERAL REFERRED PAIN, FOREARM AND HAND

Day 2 – MORNING

Pelvic pain (including gynecological contexts) + abdominal and viscerosomatic pain

(Adductors, GiGO complex, obturator internus; external oblique, rectus abdominis, psoas major)

1. Clinical overview

Understanding the pelvis as a neuromyofascial hub:

• Pelvic floor – hip rotator – abdominal muscle chain
• Viscerosomatic referral (colon, bladder, uterus, ovaries)
• How trigger points mimic visceral pain
• Why chronic pelvic pain is rarely caused “only by the pelvic floor”

2. Case 1 – Gynecological pain (but musculoskeletal origin)

Presenting symptoms:

• Pain during intercourse
• Deep pelvic pain
• Groin pain with hip rotation

Muscles:

• Obturator internus
• GiGO complex
• Adductors

3. Case 2 – Abdominal pain: visceral vs. myofascial

Symptoms:

• “Stabbing” in the external oblique and rectus abdominis
• Pseudo-appendicitis symptoms
• Testicular pain and PID pain
• Gynecological pain

Muscles:

• External oblique
• Rectus abdominis
• Psoas major

Neurological focus:

Viscerosomatic pathways:

• How organ irritation sensitizes the corresponding spinal segments
• Trigger points as amplification zones of the spinal cord

4. Synthesis:

The pelvis–abdomen algorithm

• Primary pelvic factors
• Abdominal factors
• Visceral mimicry
• How to sequence IMS for chronic, unresolved pelvic pain

Day 2 – AFTERNOON

Upper-extremity flexor systems and intrinsic muscles of the hands and feet

(Flexor carpi radialis, palmaris longus, flexor digitorum superficialis and profundus, hand interossei; intrinsic foot muscles)

1. Clinical overview

Why forearm flexor groups cause persistent hand symptoms:

• Grip load + repetitive strain
• Contributions from the cervical spine
• Why treating the wrist alone fails
• Hand–forearm–shoulder chain

2. Case 1 – Medial forearm pain + weak grip

Often misdiagnosed as:

• “Golfer’s elbow”
• Carpal tunnel
• Tendinopathy

Involved muscles:

• Flexor carpi radialis
• Palmaris longus
• Flexor digitorum superficialis and profundus

3. Intrinsic hands and feet (mini-module)

Applications:

• RSI syndrome (repetitive strain injury)
• Metatarsalgia
• Plantar heel pain

Muscles:

• Quadratus plantae
• Lumbricals
• Interossei
• Abductor hallucis
• Flexor hallucis brevis
• Foot interossei