Myofascial Trigger Points in Patients with Whiplash-Associated Disorders and Mechanical Neck Pain
Matteo Castaldo PT
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
Search for more papers by this authorHong-You Ge MD, PhD
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
Search for more papers by this authorAlessandro Chiarotto PT, PGCert
Research Office, A.I.FI. Piemonte Valle d' Aosta, Torino, Italy
Search for more papers by this authorJorge H. Villafane PT, MSc, PhD
IRCCS Don Gnocchi Foundation, Milan, Italy
Search for more papers by this authorCorresponding Author
Lars Arendt-Nielsen Med. Sci., PhD
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
Reprint requests to: Lars Arendt-Nielsen, Med. Sci., PhD, Center For Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D3, Aalborg 9200, Denmark. Tel: +45-99408830; Fax: +45-98154008; E-mail: [email protected].Search for more papers by this authorMatteo Castaldo PT
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
Search for more papers by this authorHong-You Ge MD, PhD
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
Search for more papers by this authorAlessandro Chiarotto PT, PGCert
Research Office, A.I.FI. Piemonte Valle d' Aosta, Torino, Italy
Search for more papers by this authorJorge H. Villafane PT, MSc, PhD
IRCCS Don Gnocchi Foundation, Milan, Italy
Search for more papers by this authorCorresponding Author
Lars Arendt-Nielsen Med. Sci., PhD
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
Reprint requests to: Lars Arendt-Nielsen, Med. Sci., PhD, Center For Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D3, Aalborg 9200, Denmark. Tel: +45-99408830; Fax: +45-98154008; E-mail: [email protected].Search for more papers by this authorAbstract
Objective
The aim of this study was to investigate pain patterns and the distribution of myofascial trigger points (MTPs) in whiplash-associated disorders (WADs II and III) as compared with mechanical neck pain (MNP).
Methods
Manual examination of suboccipital, upper trapezius, elevator scapula, temporalis, supraspinatus, infraspinatus, deltoid, and sternocleidomastoid muscles, was done to search for the presence of both active or latent MTPs in 49 WAD patients and 56 MNP patients. Local pain and referred pain from each active MTP was recorded on an anatomical map.
Results
The mean number of active MTPs was significantly greater in the WAD group (6.71 ± 0.79) than in the MNP group (3.26 ± 0.33) (P < 0.001), but this was not found for the latent MTPs (3.95 ± 0.57 vs 2.82 ± 0.34; P > 0.05). In the WAD group, the current pain intensity (visual analogue scale) of the patients was significantly correlated with the number of active MTPs (rs = 0.03, P = 0.03) and the spontaneous pain area (rs = 0.25, P = 0.07), and the number of active MTPs was significantly correlated with the spontaneous pain area (rs = 0.3, P = 0.03). In the MNP group, significant correlation was found only between pain duration and spontaneous pain area (rs = 0.29, P = 0.02).
Conclusions
Active MTPs are more prominent in WAD than MNP and related to current pain intensity and size of the spontaneous pain distribution in whiplash patients. This may underlie a lower degree of sensitization in MNP than in WAD.
References
- 1 Yadla S, Ratliff JK, Harrop JS. Whiplash: diagnosis, treatment, and associated injuries. Curr Rev Muscoloskelet Med 2008; 1(1): 65–68.
- 2 Eck JC, Hodges SD, Humphreys SC. Whiplash: A review of a commonly misunderstood injury. Am J Med 2001; 110(8): 651–656.
- 3 Bannister G, Amirfeyz R, Kelley S, Gargan M. Whiplash injury. J Bone Joint Surg Br 2009; 91(7): 845–850.
- 4 Dommerholt J. Persistent myalgia following whiplash. Curr Pain Headache Rep 2005; 9(5): 326–330.
- 5 Barnsley L, Lord S, Bogduk N. Whiplash Injury. Pain 1994; 58(3): 283–307.
- 6 Kamper SJ, Rebbeck TJ, Maher CG, McAuley JH, Sterling M. Course and prognostic factors of whiplash: A systematic review and meta-analysis. Pain 2008; 138: 617–629.
- 7 Sterling M, Jull G, Vicenzino B, Kenardy J. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain 2003; 104(3): 509–517.
- 8 Koelbaek Johansen M, Graven-Nielsen T, Schou Olesen A, Arendt-Nielsen L. Generalized muscular hyperalgesia in chronic whiplash syndrome. Pain 1999; 83(2): 229–234.
- 9 Curatolo M, Petersen-Felix S, Arendt-Nielsen L, et al. Central hypersensitivity in chronic pain after whiplash injury. Clin J Pain 2001; 17(4): 306–315.
- 10 Moog M, Quintner J, Hall T, Zusman M. The late whiplash syndrome: A psychophysical study. Eur J Pain 2002; 6(4): 283–294.
- 11 Banic B, Petersen-Felix S, Andersen OK, et al. Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain 2004; 107(1–2): 7–15.
- 12 Curatolo M, Arendt-Nielsen L, Petersen-Felix S. Evidence, mechanisms, and clinical implications of central hypersensitivity in chronic pain after whiplash injury. Clin J Pain 2004; 20(6): 469–476.
- 13 van Wilgen CP, Keizer D. The sensitization model to explain how chronic pain exists without tissue damage. Pain Manag Nurs 2012; 13(1): 60–65.
- 14 Curatolo M, Bogduk N, Ivancic PC, et al. The role of tissue damage in whiplash-associated disorders: Discussion paper 1. Spine (Phila Pa 1976) 2011; 36(suppl 25): S309–315.
- 15 Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain 1993; 55(1): 99–106.
- 16 Bogduk N, Marsland A. The cervical zygopophysial joints as a source of neck pain. Spine (Phila Pa 1976) 1988; 13(6): 610–617.
- 17 Winkelstein BA. How can animal models inform on the transition to chronic symptoms in whiplash? Spine (Phila Pa 1976) 2011; 36(suppl 25): S218–225.
- 18 Fricton JR. Myofascial pain and whiplash. Spine: State of the Art Reviews 1993; 7(3): 403–422.
- 19 Gerwin RD, Dommerholt J. Myofascial trigger points in chronic cervical whiplash syndrome. J Musculoskeletal Pain 1998; 6(suppl 2): 28.
- 20 Ge HY. Prevalence of myofascial trigger points in fibromyalgia: The overlap of two common problems. Curr Pain Headache Rep 2010; 14(5): 339–345.
- 21
Freeman MD, Nystrom A, Centeno C. Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation. J Brachial Plex Peripher Nerve Inj 2009; 23(4): 2.
10.1186/1749-7221-4-2 Google Scholar
- 22 Xu YM, Ge HY, Arendt-Nielsen L. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects. J Pain 2010; 12: 1348–1355.
- 23 Herren-Gerber R, Weiss S, Arendt-Nielsen L, et al. Modulation of central hypersensitivity by nociceptive input in chronic pain after whiplash injury. Pain Med 2004; 5: 366–376.
- 24 Ettlin T, Schuster C, Stoffel R, Brüderlin A, Kischka U. A distinct pattern of myofascial findings in patients after whiplash injury. Arch Phys Med Rehabil 2008; 89(7): 1290–1293.
- 25 Ge HY, Arendt-Nielsen L. Latent myofascial trigger points. Headache Rep 2011; 15(5): 386–392.
- 26
Lucas KR, Polus BI, Rich PA. Latent myofascial trigger points: their effects on muscle activation and movement efficiency. Journal of Bodywork and Movement Therapies 2004; 8: 160–166.
10.1016/j.jbmt.2003.12.002 Google Scholar
- 27 Ge HY, Arendt-Nielsen L, Madeleine P. Accelerated muscle fatigability of latent myofascial trigger points in humans. Pain Med 2012; 13(7): 957–964.
- 28 Fernández-de-las-Peñas C, Caminero AB, Madeleine P, et al. Multiple active myofascial trigger points and pressure pain sensitivity maps in the temporalis muscle are related in women with chronic tension type headache. Clin J Pain 2009; 25(6): 506–512.
- 29 Fernández-de-las-Peñas C, et al. Myofascial trigger points in the suboccipital muscles in episodic tension-type headache. Man Ther 2006; 11: 225–230.
- 30 Fernández-de-las-Peñas C, et al. Myofascial trigger points, neck mobility and forward head posture in episodic tension-type headache. Headache 2007; 47: 662–672.
- 31 Fernàndez-Carnero J, Fernández-de-las-Peñas C, de la Llave-Rincòn AI, Ge HY, Arendt-Nielsen L. Prevalence of and referred pain from myofascial trigger points in the forearm muscles in patients with lateral epicondylalgia. Clin J Pain 2007; 23(4): 353–360.
- 32
Fernández-de-Las-Peñas C, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility and forward head posture in unilateral migraine. Cephalalgia 2006; 26(9): 1061–1070.
10.1111/j.1468-2982.2006.01162.x Google Scholar
- 33 Giamberardino MA, Tafuri E, Savini A, et al. Contribution of myofascial trigger points to migraine symptoms. J Pain 2007; 8(11): 869–878.
- 34 Bron C, Dommerholt J, Stegenga B, Wensing M, Oostendorp RA. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskelet Disord 2011; 28(12): 139.
- 35 Hidalgo-Lozano A, Fernández-de-las-Peñas C, Alonso-Blanco C, et al. Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: A blinded, controlled study. Exp Brain Res 2010; 202(4): 915–925.
- 36 Ge HY, Wang Y, Fernández-de-las-Peñas C, et al. Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients. Arthritis Res Ther 2011; 13(2): R48.
- 37 Fernández-de-las-Peñas C, Alonso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study. Man Ther 2007; 12(1): 29–33.
- 38 Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinations of neck pain in the general population: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 2008; 33(suppl 4): S39–51.
- 39 Fernández-Pérez AM, Villaverde-Gutiérrez C, Mora-Sánchez A, et al. Muscle trigger points, pressure pain threshold, and cervical range of motion in patients with high level of disability related to acute whiplash injury. J Orthop Sports Phys Ther 2012; 42(7): 634–641.
- 40 Fernández-Pérez A, Fernández-de-Las-Peñas C, Fernández-Carnero J, et al. Myofascial trigger points in subjects with whiplash syndrome: a pilot study. Eur J Pain 2009; 13(1): 5158–5159.
- 41 Fernández-de-Las-Peñas C, Alonso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain; A blinded, controlled study. Man Ther 2007; 12(1): 29–33.
- 42 Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine (Phila Pa 1976) 1995; 20(suppl 8): 1S–73S.
- 43 Häuser W, Wolfe F. Diagnosis and diagnostic tests for fibromyalgia (syndrome). Reumatismo 2012; 64(4): 194–205.
- 44 Simon DG, Travell JG, Simons LS. Travell & Simon's Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1, 2nd edition. Baltimore: Williams e Wilkins; 1999.
- 45 Gerwin RD, Shannon S, Hong CZ, Hubbard D, Gevirtz R. Interrater reliability in myofascial trigger point examination. Pain 1997; 69: 65–73.
- 46 Tough EA, White AR, Richards SH, Campbell JL. Myofascial trigger points needling for whiplash associated pain—a feasibility study. Man Ther 2010; 15(6): 529–535.
- 47 Falla D, O'Leary S, Farina D, Jull G. The change in deep cervical flexor activity after training is associated with the degree of pain reduction in patients with chronic neck pain. Clin J Pain 2012; 28(7): 628–634.
- 48 Stone AM, Vicenzino B, Lim EC, Sterling M. Measures of centra hyperexcitability in chronic whiplash associated disorder—A systematic review and meta-analysis. Man Ther 2013; 18(2): 111–117. [Epub ahead of print].
- 49 Scott D, Jull G, Sterling M. Widespread sensory hypersensitivity a feature of chronic whiplash -associated disorder but not chronic idiopathic neck pain. Clin J Pain 2005; 21: 175–181.
- 50 La Touche R, Fernández-de-Las-Peñas C, Fernández-Carnero J, et al. Bilateral mechanical-pain sensitivity over the trigeminal region in patients with chronic mechanical neck pain. J Pain 2010; 11(3): 256–263.
- 51 Fernandez-de-Las-Penas C, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache 2007; 47(5): 662–672.
- 52 Finan PH, Buenaver LF, Bounds SC, et al. Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis Rheum 2013; 65(2): 363–372.
- 53 Ortega-Santiago R, de-la-Llave-Rinvon AI, Laguarta-Val S, et al. Neurophysiological avances in carpal tunnel syndrome: Process of central sensitisation or local neuropathy. Rev Neurol 2012; 54(8): 490–496.
