DiagnosticTree/UpperThoracicBackPain
{
"model": "bayesian_lr_scoring",
"version": "1.0",
"description": "Probabilistic scoring tree for upper thoracic back pain using Bayesian likelihood ratio updating with Thurstonian pairwise tiebreakers",
"thresholds": {
"early_exit_posterior": 0.55,
"early_exit_gap": 0.18,
"pairwise_trigger": 0.22
},
"muscles": {
"trapezius_trp2": {
"label": "Upper Trapezius",
"prior": 0.130435,
"page": "Muscle:Trapezius",
"key_trp_note": "Lower Trapezius TrP3 is the key TrP that most commonly induces upper trapezius satellites. Treat lower trapezius first when upper trapezius TrPs recur or respond poorly. The lower trapezius may itself be a satellite of key TrPs in the latissimus dorsi.",
"subtitle": "Upper fibres \u2014 posterolateral neck, behind ear, temple"
},
"trapezius_trp3": {
"label": "Lower Trapezius",
"prior": 0.130435,
"page": "Muscle:Trapezius",
"subtitle": "Lower fibres \u2014 cervical, mastoid, suprascapular (\"the joker\")"
},
"levator": {
"label": "Levator Scapulae",
"prior": 0.130435,
"page": "Muscle:Levator_Scapulae",
"key_trp_note": "Check Lower Trapezius TrP3 first \u2014 it is often the key TrP driving levator scapulae and upper trapezius satellites. If levator TrPs respond poorly to treatment, lower trapezius TrP3 has not been addressed. Upper trapezius TrP1/2 also drives levator as a satellite.",
"subtitle": "Neck angle stiffness, cannot look over sore shoulder"
},
"rhomboids": {
"label": "Rhomboids",
"prior": 0.086957,
"page": "Muscle:Rhomboids",
"subtitle": "Medial scapular border burning, present at rest"
},
"multifidi": {
"label": "Multifidi",
"prior": 0.086957,
"page": "Muscle:Multifidi",
"subtitle": "Deep paraspinal ache immediately beside the spine"
},
"scaleni": {
"label": "Scaleni",
"prior": 0.086957,
"page": "Muscle:Scalene",
"key_trp_note": "Scaleni drive satellite TrPs in upper trapezius, triceps long head, pectoralis major and minor, and serratus posterior superior. Treat scaleni before their satellites. SCM should be treated concurrently.",
"subtitle": "Upper back + arm/hand symptoms, nocturnal arm aching"
},
"supraspinatus": {
"label": "Supraspinatus",
"prior": 0.086957,
"page": "Muscle:Supraspinatus",
"key_trp_note": "Infraspinatus TrPs are often the key TrP source driving supraspinatus satellites. If supraspinatus TrPs recur, examine infraspinatus.",
"subtitle": "Mid-deltoid ache, painful arc on shoulder abduction"
},
"splenius": {
"label": "Splenius Cervicis",
"prior": 0.086957,
"page": "Muscle:Splenius_Cervicis",
"subtitle": "Top of shoulder, rotation restricted away from pain"
},
"triceps_trp1": {
"label": "Triceps Brachii (Long Head)",
"prior": 0.086957,
"page": "Muscle:Triceps_Brachii",
"subtitle": "Posterior arm to scapula, skips the elbow"
},
"biceps": {
"label": "Biceps Brachii",
"prior": 0.086957,
"page": "Muscle:Biceps_Brachii",
"subtitle": "Anterior shoulder primary, suprascapular spillover"
}
},
"questions": [
{
"id": "q_neck_rotation",
"text": "Is cervical rotation restricted or painful in any direction?",
"sublabel": "Can the patient NOT turn their head to look fully over one or both shoulders?",
"type": "binary",
"answers": [
{
"id": "yes",
"label": "Yes \u2014 neck rotation is restricted or painful",
"lr": {
"levator": 4.5,
"splenius": 4.0,
"trapezius_trp2": 1.4,
"trapezius_trp3": 1.2,
"rhomboids": 0.5,
"multifidi": 0.6,
"scaleni": 1.5,
"supraspinatus": 0.7,
"triceps_trp1": 0.5,
"biceps": 0.4
}
},
{
"id": "no",
"label": "No \u2014 full pain-free cervical rotation in both directions",
"lr": {
"levator": 0.15,
"splenius": 0.18,
"trapezius_trp2": 1.1,
"trapezius_trp3": 1.1,
"rhomboids": 1.4,
"multifidi": 1.3,
"scaleni": 0.8,
"supraspinatus": 1.2,
"triceps_trp1": 1.3,
"biceps": 1.4
}
}
]
},
{
"id": "q_rotation_direction",
"text": "In which direction is cervical rotation most restricted or painful?",
"sublabel": "Turn the head toward the painful side, then away \u2014 which direction is more limited?",
"type": "choice",
"condition": {
"q_neck_rotation": "yes"
},
"answers": [
{
"id": "toward",
"label": "Cannot fully turn TOWARD the painful side",
"sublabel": "Cannot look over the sore shoulder",
"lr": {
"levator": 6.0,
"splenius": 0.15,
"trapezius_trp2": 1.2,
"scaleni": 1.3,
"trapezius_trp3": 0.9,
"rhomboids": 0.6,
"multifidi": 0.7,
"supraspinatus": 0.8,
"triceps_trp1": 0.7,
"biceps": 0.6
}
},
{
"id": "away",
"label": "Cannot fully turn AWAY from the painful side",
"sublabel": "Cannot look over the opposite shoulder; OR pain at top of shoulder",
"lr": {
"splenius": 6.0,
"levator": 0.15,
"trapezius_trp2": 1.0,
"scaleni": 1.2,
"trapezius_trp3": 0.9,
"rhomboids": 0.6,
"multifidi": 0.7,
"supraspinatus": 0.7,
"triceps_trp1": 0.6,
"biceps": 0.5
}
},
{
"id": "both",
"label": "Restricted in both directions",
"lr": {
"levator": 2.0,
"splenius": 2.0,
"scaleni": 2.5,
"trapezius_trp2": 1.3,
"trapezius_trp3": 1.2,
"rhomboids": 0.5,
"multifidi": 0.8,
"supraspinatus": 0.7,
"triceps_trp1": 0.5,
"biceps": 0.4
}
}
]
},
{
"id": "q_pain_location",
"text": "Where is the upper thoracic back pain most intense?",
"sublabel": "Choose the location that best describes the dominant pain zone",
"type": "choice",
"answers": [
{
"id": "medial_border",
"label": "Along the medial border of the scapula \u2014 inner edge of the shoulder blade",
"sublabel": "A burning sensation specifically along the edge of the scapula",
"lr": {
"rhomboids": 6.0,
"trapezius_trp3": 1.5,
"scaleni": 2.0,
"levator": 1.0,
"trapezius_trp2": 0.6,
"multifidi": 0.3,
"supraspinatus": 0.5,
"splenius": 0.4,
"triceps_trp1": 0.5,
"biceps": 0.3
}
},
{
"id": "interscapular",
"label": "Between the shoulder blades \u2014 diffuse interscapular or upper thoracic",
"sublabel": "Aching or burning between or below the scapulae",
"lr": {
"trapezius_trp2": 3.5,
"trapezius_trp3": 3.0,
"rhomboids": 1.5,
"scaleni": 2.0,
"levator": 0.8,
"multifidi": 0.7,
"supraspinatus": 0.8,
"splenius": 0.6,
"triceps_trp1": 1.5,
"biceps": 1.5
}
},
{
"id": "paraspinal",
"label": "Deep unilateral paraspinal ache \u2014 beside the spine only",
"sublabel": "Strictly beside the spine, not reaching the scapula",
"lr": {
"multifidi": 5.0,
"trapezius_trp3": 2.0,
"rhomboids": 0.4,
"trapezius_trp2": 0.5,
"levator": 0.6,
"scaleni": 0.5,
"supraspinatus": 0.3,
"splenius": 0.7,
"triceps_trp1": 0.4,
"biceps": 0.3
}
},
{
"id": "top_shoulder",
"label": "Top of the shoulder or neck angle \u2014 not the scapular blade",
"sublabel": "Pain at the peak of the shoulder slope or in the neck-shoulder angle",
"lr": {
"levator": 3.5,
"splenius": 4.0,
"trapezius_trp2": 2.5,
"scaleni": 1.5,
"trapezius_trp3": 0.8,
"rhomboids": 0.4,
"multifidi": 0.3,
"supraspinatus": 0.6,
"triceps_trp1": 0.5,
"biceps": 0.4
}
},
{
"id": "posterior_arm",
"label": "Posterior arm or posterior shoulder \u2014 back of the arm is the dominant pain",
"sublabel": "Upper back aching is secondary to a posterior arm or shoulder complaint",
"lr": {
"triceps_trp1": 7.0,
"biceps": 0.3,
"supraspinatus": 0.8,
"trapezius_trp2": 0.4,
"trapezius_trp3": 0.3,
"rhomboids": 0.3,
"multifidi": 0.2,
"scaleni": 0.5,
"levator": 0.4,
"splenius": 0.3
}
}
]
},
{
"id": "q_arm_symptoms",
"text": "Are there arm or hand symptoms alongside the upper back pain?",
"sublabel": "Arm numbness, hand swelling, nocturnal arm aching, or arm heaviness",
"type": "binary",
"answers": [
{
"id": "yes",
"label": "Yes \u2014 arm, forearm, or hand symptoms present",
"lr": {
"scaleni": 5.0,
"triceps_trp1": 2.0,
"biceps": 1.5,
"supraspinatus": 1.3,
"levator": 0.7,
"splenius": 0.7,
"trapezius_trp2": 0.6,
"trapezius_trp3": 0.5,
"rhomboids": 0.4,
"multifidi": 0.3
}
},
{
"id": "no",
"label": "No \u2014 pain confined to the upper back and/or neck",
"lr": {
"scaleni": 0.25,
"triceps_trp1": 0.7,
"biceps": 0.6,
"supraspinatus": 0.9,
"levator": 1.2,
"splenius": 1.2,
"trapezius_trp2": 1.3,
"trapezius_trp3": 1.3,
"rhomboids": 1.4,
"multifidi": 1.4
}
}
]
},
{
"id": "q_nocturnal_arm",
"text": "Is the patient woken at night by arm aching or numbness?",
"sublabel": "Must hang the arm over the side of the bed or shake it for relief",
"type": "binary",
"condition": {
"q_arm_symptoms": "yes"
},
"answers": [
{
"id": "yes",
"label": "Yes \u2014 woken at night; arm hanging over bed side gives relief",
"lr": {
"scaleni": 8.0,
"triceps_trp1": 0.8,
"biceps": 0.7,
"supraspinatus": 0.6,
"levator": 0.5,
"splenius": 0.5,
"trapezius_trp2": 0.5,
"trapezius_trp3": 0.4,
"rhomboids": 0.4,
"multifidi": 0.3
}
},
{
"id": "no",
"label": "No \u2014 arm symptoms are daytime or positional only",
"lr": {
"scaleni": 0.5,
"triceps_trp1": 1.2,
"biceps": 1.3,
"supraspinatus": 1.2,
"levator": 1.0,
"splenius": 1.0,
"trapezius_trp2": 1.0,
"trapezius_trp3": 1.0,
"rhomboids": 1.0,
"multifidi": 1.0
}
}
]
},
{
"id": "q_postural",
"text": "Is the pain clearly worse during or after sustained sitting, desk work, or forward head posture?",
"sublabel": "Pain builds during a sitting work session; relieved by moving or lying down",
"type": "binary",
"answers": [
{
"id": "yes",
"label": "Yes \u2014 clearly postural; builds with sustained sitting or forward posture",
"lr": {
"trapezius_trp2": 4.0,
"trapezius_trp3": 3.5,
"levator": 2.5,
"scaleni": 2.0,
"splenius": 2.0,
"multifidi": 2.0,
"rhomboids": 1.3,
"supraspinatus": 1.0,
"triceps_trp1": 1.5,
"biceps": 1.0
}
},
{
"id": "no",
"label": "No \u2014 not clearly worse with posture or sitting",
"lr": {
"trapezius_trp2": 0.4,
"trapezius_trp3": 0.4,
"levator": 0.6,
"scaleni": 0.7,
"splenius": 0.6,
"multifidi": 0.6,
"rhomboids": 1.5,
"supraspinatus": 1.2,
"triceps_trp1": 0.9,
"biceps": 1.0
}
}
]
},
{
"id": "q_rest_pain",
"text": "Is the pain present predominantly AT REST \u2014 a burning or gnawing quality along the inner edge of the shoulder blade \u2014 not clearly worse with movement?",
"sublabel": "Burning along the medial scapular border that is present regardless of posture or arm movement",
"type": "binary",
"answers": [
{
"id": "yes",
"label": "Yes \u2014 burning along the scapular border, present at rest",
"lr": {
"rhomboids": 7.0,
"trapezius_trp3": 1.3,
"scaleni": 1.2,
"trapezius_trp2": 0.5,
"levator": 0.4,
"multifidi": 0.4,
"supraspinatus": 0.4,
"splenius": 0.4,
"triceps_trp1": 0.4,
"biceps": 0.3
}
},
{
"id": "no",
"label": "No \u2014 pain varies with posture, activity, or movement",
"lr": {
"rhomboids": 0.3,
"trapezius_trp3": 1.1,
"scaleni": 1.0,
"trapezius_trp2": 1.2,
"levator": 1.2,
"multifidi": 1.1,
"supraspinatus": 1.2,
"splenius": 1.1,
"triceps_trp1": 1.1,
"biceps": 1.1
}
}
]
},
{
"id": "q_painful_arc",
"text": "Is there a painful arc during shoulder abduction \u2014 pain appearing between about 60\u00b0 and 120\u00b0 of raising the arm, then diminishing above that?",
"sublabel": "Ask the patient to raise the arm sideways \u2014 does pain appear and then disappear as the arm reaches overhead?",
"type": "binary",
"answers": [
{
"id": "yes",
"label": "Yes \u2014 painful arc present between 60\u00b0 and 120\u00b0 of abduction",
"lr": {
"supraspinatus": 8.0,
"biceps": 1.5,
"scaleni": 0.5,
"trapezius_trp2": 0.5,
"trapezius_trp3": 0.4,
"rhomboids": 0.4,
"levator": 0.6,
"splenius": 0.5,
"multifidi": 0.3,
"triceps_trp1": 0.4
}
},
{
"id": "no",
"label": "No \u2014 shoulder abduction is pain-free or uniformly painful throughout",
"lr": {
"supraspinatus": 0.2,
"biceps": 0.9,
"scaleni": 1.1,
"trapezius_trp2": 1.2,
"trapezius_trp3": 1.2,
"rhomboids": 1.3,
"levator": 1.1,
"splenius": 1.1,
"multifidi": 1.3,
"triceps_trp1": 1.2
}
}
]
},
{
"id": "q_elbow_skip",
"text": "Is there posterior arm pain that SKIPS the elbow \u2014 pain above and/or below the elbow but NOT at the elbow itself?",
"sublabel": "The back of the upper arm and/or dorsal forearm ache, but the elbow region is not painful",
"type": "binary",
"answers": [
{
"id": "yes",
"label": "Yes \u2014 posterior arm pain skipping the elbow",
"lr": {
"triceps_trp1": 9.0,
"biceps": 0.3,
"supraspinatus": 0.5,
"scaleni": 0.6,
"trapezius_trp2": 0.4,
"trapezius_trp3": 0.3,
"rhomboids": 0.3,
"levator": 0.5,
"splenius": 0.3,
"multifidi": 0.2
}
},
{
"id": "no",
"label": "No \u2014 no posterior arm pain, or elbow IS involved",
"lr": {
"triceps_trp1": 0.15,
"biceps": 1.1,
"supraspinatus": 1.1,
"scaleni": 1.0,
"trapezius_trp2": 1.1,
"trapezius_trp3": 1.1,
"rhomboids": 1.2,
"levator": 1.1,
"splenius": 1.1,
"multifidi": 1.2
}
}
]
},
{
"id": "q_anterior_shoulder",
"text": "Is the anterior shoulder the PRIMARY pain location \u2014 and can the patient lie comfortably on the affected side?",
"sublabel": "Anterior shoulder aching (front of shoulder) is the main complaint; lying on that side does not worsen pain",
"type": "binary",
"answers": [
{
"id": "yes",
"label": "Yes \u2014 anterior shoulder primary; can lie on the affected side",
"lr": {
"biceps": 7.0,
"supraspinatus": 0.5,
"triceps_trp1": 0.2,
"scaleni": 0.7,
"trapezius_trp2": 0.5,
"trapezius_trp3": 0.4,
"rhomboids": 0.3,
"levator": 0.5,
"splenius": 0.4,
"multifidi": 0.3
}
},
{
"id": "no",
"label": "No \u2014 anterior shoulder is not the primary zone, or cannot lie on affected side",
"lr": {
"biceps": 0.2,
"supraspinatus": 1.1,
"triceps_trp1": 1.2,
"scaleni": 1.0,
"trapezius_trp2": 1.1,
"trapezius_trp3": 1.1,
"rhomboids": 1.2,
"levator": 1.1,
"splenius": 1.1,
"multifidi": 1.2
}
}
]
},
{
"id": "q_visual_blur",
"text": "Does the patient report any blurring of vision on the same side as the pain?",
"sublabel": "Ipsilateral visual blurring \u2014 not bilateral, not related to eye strain",
"type": "binary",
"answers": [
{
"id": "yes",
"label": "Yes \u2014 ipsilateral visual blurring reported",
"lr": {
"splenius": 8.0,
"levator": 0.9,
"trapezius_trp2": 0.7,
"trapezius_trp3": 0.6,
"rhomboids": 0.5,
"multifidi": 0.5,
"scaleni": 0.6,
"supraspinatus": 0.5,
"triceps_trp1": 0.5,
"biceps": 0.4
}
},
{
"id": "no",
"label": "No \u2014 no visual symptoms",
"lr": {
"splenius": 0.6,
"levator": 1.1,
"trapezius_trp2": 1.1,
"trapezius_trp3": 1.1,
"rhomboids": 1.1,
"multifidi": 1.1,
"scaleni": 1.1,
"supraspinatus": 1.1,
"triceps_trp1": 1.1,
"biceps": 1.1
}
}
]
}
],
"pairwise": [
{
"id": "pw_levator_splenius",
"pair": [
"levator",
"splenius"
],
"text": "Tiebreaker \u2014 Levator Scapulae vs Splenius Cervicis",
"question": "Where is the pain centred \u2014 at the angle of the neck and upper scapular corner, OR at the TOP of the shoulder slope?",
"answers": [
{
"id": "neck_angle",
"label": "Neck angle and upper scapular corner",
"lr": {
"levator": 4.0,
"splenius": 0.25
}
},
{
"id": "top_shoulder",
"label": "Top of the shoulder slope",
"lr": {
"levator": 0.25,
"splenius": 4.0
}
}
]
},
{
"id": "pw_trap2_trap3",
"pair": [
"trapezius_trp2",
"trapezius_trp3"
],
"text": "Tiebreaker \u2014 Trapezius TrP2 vs TrP3",
"question": "Is the burning between the shoulder blades closer to the ACROMION and mid-scapular region, or closer to the THORACIC SPINE?",
"answers": [
{
"id": "lateral",
"label": "More lateral \u2014 toward the acromion or mid-scapular area",
"lr": {
"trapezius_trp2": 3.5,
"trapezius_trp3": 0.3
}
},
{
"id": "medial",
"label": "More medial \u2014 close to the thoracic vertebrae",
"lr": {
"trapezius_trp2": 0.3,
"trapezius_trp3": 3.5
}
}
]
},
{
"id": "pw_trap_rhomboid",
"pair": [
"trapezius_trp3",
"rhomboids"
],
"text": "Tiebreaker \u2014 Trapezius TrP3 vs Rhomboids",
"question": "Is the pain clearly worse with sustained sitting or posture, OR present equally at rest regardless of posture?",
"answers": [
{
"id": "postural",
"label": "Clearly worse with sustained sitting or forward posture",
"lr": {
"trapezius_trp3": 3.0,
"rhomboids": 0.3
}
},
{
"id": "rest",
"label": "Present at rest \u2014 not clearly postural",
"lr": {
"trapezius_trp3": 0.3,
"rhomboids": 3.0
}
}
]
},
{
"id": "pw_scaleni_levator",
"pair": [
"scaleni",
"levator"
],
"text": "Tiebreaker \u2014 Scaleni vs Levator Scapulae",
"question": "Are there arm or hand symptoms (numbness, swelling, nocturnal aching) alongside the upper back pain?",
"answers": [
{
"id": "arm_yes",
"label": "Yes \u2014 arm or hand symptoms present",
"lr": {
"scaleni": 4.0,
"levator": 0.3
}
},
{
"id": "arm_no",
"label": "No \u2014 upper back and neck only",
"lr": {
"scaleni": 0.3,
"levator": 2.5
}
}
]
},
{
"id": "pw_supraspinatus_biceps",
"pair": [
"supraspinatus",
"biceps"
],
"text": "Tiebreaker \u2014 Supraspinatus vs Biceps Brachii",
"question": "Is the arm pain primarily at the LATERAL upper arm (mid-deltoid), or at the ANTERIOR shoulder (front)?",
"answers": [
{
"id": "lateral_arm",
"label": "Lateral upper arm \u2014 mid-deltoid region",
"lr": {
"supraspinatus": 4.0,
"biceps": 0.2
}
},
{
"id": "anterior",
"label": "Anterior shoulder \u2014 front of the shoulder",
"lr": {
"supraspinatus": 0.2,
"biceps": 4.0
}
}
]
},
{
"id": "pw_multifidi_trap3",
"pair": [
"multifidi",
"trapezius_trp3"
],
"text": "Tiebreaker \u2014 Multifidi vs Trapezius TrP3",
"question": "Is the paraspinal pain DEEP and immediately adjacent to the spinous processes (within 2 cm of midline), or more SUPERFICIAL and extending laterally toward the scapula?",
"answers": [
{
"id": "deep_midline",
"label": "Deep \u2014 immediately beside the spinous processes, within 2 cm of midline",
"lr": {
"multifidi": 4.0,
"trapezius_trp3": 0.3
}
},
{
"id": "superficial_lateral",
"label": "Superficial \u2014 extends laterally toward the scapular border",
"lr": {
"multifidi": 0.3,
"trapezius_trp3": 3.5
}
}
]
},
{
"id": "pw_scaleni_trap2",
"pair": [
"scaleni",
"trapezius_trp2"
],
"text": "Tiebreaker \u2014 Scaleni vs Trapezius TrP2",
"question": "Are there any arm or hand symptoms \u2014 numbness, tingling, hand swelling, or nocturnal arm aching?",
"answers": [
{
"id": "arm_yes",
"label": "Yes \u2014 arm or hand symptoms present",
"lr": {
"scaleni": 5.0,
"trapezius_trp2": 0.2
}
},
{
"id": "arm_no",
"label": "No \u2014 upper back and neck only",
"lr": {
"scaleni": 0.25,
"trapezius_trp2": 3.5
}
}
]
}
],
"treatment_dag": {
"edges": [
{
"from": "scaleni",
"to": "trapezius_trp2",
"type": "key_satellite",
"label": "Scaleni are a key TrP source for upper trapezius satellites"
},
{
"from": "scaleni",
"to": "trapezius_trp3",
"type": "key_satellite",
"label": "Scaleni are a key TrP source for mid-trapezius satellites"
},
{
"from": "scaleni",
"to": "triceps_trp1",
"type": "key_satellite",
"label": "Scaleni drive long head triceps satellite TrPs (T&S Table 3.3)"
},
{
"from": "trapezius_trp2",
"to": "levator",
"type": "key_satellite",
"label": "Upper trapezius TrP2 drives levator scapulae satellite TrPs"
},
{
"from": "trapezius_trp2",
"to": "splenius",
"type": "key_satellite",
"label": "Upper trapezius drives splenius cervicis satellite TrPs"
},
{
"from": "trapezius_trp2",
"to": "rhomboids",
"type": "key_satellite",
"label": "Upper trapezius drives rhomboid minor satellite TrPs"
},
{
"from": "levator",
"to": "trapezius_trp2",
"type": "functional_unit",
"label": "Levator scapulae and upper trapezius share functional unit \u2014 treat concurrently"
},
{
"from": "trapezius_trp2",
"to": "trapezius_trp3",
"type": "functional_unit",
"label": "Upper and mid trapezius share functional unit \u2014 treat in same session"
},
{
"from": "trapezius_trp3",
"to": "rhomboids",
"type": "functional_unit",
"label": "Mid-trapezius and rhomboids share scapular retraction function"
},
{
"from": "supraspinatus",
"to": "trapezius_trp2",
"type": "functional_unit",
"label": "Supraspinatus and upper trapezius share rotator cuff/shoulder girdle function"
},
{
"from": "multifidi",
"to": "trapezius_trp3",
"type": "functional_unit",
"label": "Multifidi and mid-trapezius share thoracic stabilisation function"
},
{
"from": "scaleni",
"to": "levator",
"type": "secondary_load",
"label": "Levator scapulae overloaded secondarily when scaleni are in protective splinting"
},
{
"from": "levator",
"to": "rhomboids",
"type": "secondary_load",
"label": "Rhomboids overloaded secondarily with chronic levator dysfunction"
},
{
"from": "triceps_trp1",
"to": "biceps",
"type": "secondary_load",
"label": "Biceps develops secondary TrPs as antagonist to triceps \u2014 treat after triceps resolves"
},
{
"from": "triceps_trp1",
"to": "biceps",
"type": "antagonist_risk",
"label": "Triceps/biceps antagonist pair \u2014 treat in alternating partial cycles, not sequentially to completion"
},
{
"from": "supraspinatus",
"to": "scaleni",
"type": "antagonist_risk",
"label": "Releasing supraspinatus may reactively cramp scaleni \u2014 treat alternately"
}
],
"edge_type_labels": {
"key_satellite": "Treat first \u2014 key TrP driving satellites",
"functional_unit": "Treat concurrently in same session",
"secondary_load": "Treat after primary resolves",
"antagonist_risk": "\u26a0 Treat in alternating cycles \u2014 reactive cramp risk"
}
}
}