Latent Myofascial Trigger Points Ge, Hong-You; Arendt-Nielsen, Lars
Current pain and headache reports,
10/2011, Volume:
15, Issue:
5
Journal Article
Peer reviewed
A latent myofascial trigger point (MTP) is defined as a focus of hyperirritability in a muscle taut band that is clinically associated with local twitch response and tenderness and/or referred pain ...upon manual examination. Current evidence suggests that the temporal profile of the spontaneous electrical activity at an MTP is similar to focal muscle fiber contraction and/or muscle cramp potentials, which contribute significantly to the induction of local tenderness and pain and motor dysfunctions. This review highlights the potential mechanisms underlying the sensory-motor dysfunctions associated with latent MTPs and discusses the contribution of central sensitization associated with latent MTPs and the MTP network to the spatial propagation of pain and motor dysfunctions. Treating latent MTPs in patients with musculoskeletal pain may not only decrease pain sensitivity and improve motor functions, but also prevent latent MTPs from transforming into active MTPs, and hence, prevent the development of myofascial pain syndrome.
To examine the association between dysmenorrhea and musculoskeletal pain amongst university students aged 20–35 and the association between dysmenorrhea and the occurrence of MTrPs.
The study ...comprised two stages: a cross-sectional study evaluated the association between dysmenorrhea and musculoskeletal pain and a case-control study evaluated the association between dysmenorrhea and the occurrence of MTrPs in the abdominal and pelvic area. Initially, questionnaires such as demographics, menstruation characteristics, Numeric Pain Rating Scale (NPRS), measuring the average pain during menstruation and Nordic, were distributed to female students. Twenty subjects who suffered from menstrual pain of >3 on the NPRS (ones with the highest scores) were included in the second stage as cases. An additional 20 who had not suffered from menstrual pain (NPRS ≤3) were considered controls. All 40 subjects underwent an assessment of MTrPs by two examiners blinded to each other's results and to the group allocation of the subjects.
We found that dysmenorrhea is a very prevalent condition among young female students. Most frequent complaints were: lower abdomen and back pain, tiredness, breast tenderness, mood changes, and an increased appetite. Pain during menstruation indicated a significant positive association with neck, low back, and hip/thigh pain during the last 12 months. The results of the palpitation conclusively showed more active MTrPs in the rectus abdominis, quadratus lumborum and paraspinal muscles in women suffering from pain during menstruation than in those who were not in pain.
Our data provide an initial basis for the inclusion of a myofascial examination when evaluating women with dysmenorrhea.
Sedentary lifestyle, age-related degenerative changes or traumatic injuries leads to cervical spine structural mal-alignment, which results in neck pain and other symptoms. Various therapeutic ...exercises and manual techniques have been proven to be beneficial in terms of managing these symptoms. This study aimed to determine the combined effects of cervical mobilization and post-isometric relaxation (PIR) technique on managing neck pain, cervical side flexion range of motion, and functional limitation in participants with mechanical neck pain linked with myofascial trigger points.
This study followed a 2-arm, parallel-group, pretest-posttest randomized comparative design. Thirty participants with mechanical neck pain associated with myofascial trigger points aged 30.87 ± 4.45 years were randomly allocated to Groups 1 and 2. Group 1 received conventional intervention, PIR, and cervical mobilization techniques while Group 2 received conventional intervention and PIR technique only. Neck pain, muscle tenderness, cervical range of motion, and functional limitations were assessed using a visual analog scale, pressure pain threshold (PPT), goniometer, and neck disability index (NDI) questionnaire, respectively at baseline on day 1 and post-intervention on day 7, 14, and 21. Wilcoxon signed-rank test and the Mann-Whitney U test evaluated within-group and between-group analyses, respectively. Statistical significance was established at a 95% confidence interval, indicated by P < .05.
Significant differences (95% confidence interval CI, P < .05) were observed within each group for all the outcomes scores when compared to the baselines across multiple time points. Significant variations were observed between the groups when comparing visual analog scale and NDI scores at weeks 1, 2, and 3 post-interventions. In contrast, insignificant differences (95% CI, P > .05) were observed for side flexion range of motion and PPT compared at weeks 1, 2, and 3 post-interventions except for PPT at week 3 post-intervention (95% CI, P < .05). Additionally, Cohen d test revealed the superiority of group 1 over group 2 in reducing pain and functional limitations and improving cervical side flexion range of motion and PPT.
The combination of cervical mobilization and Post-isometric relaxation techniques was discovered to effectively alleviate neck pain and enhance functional abilities when contrasted with the application of post-isometric relaxation alone in patients with mechanical neck pain linked with myofascial trigger points.
Background: Shoulder pain is becoming problematic disorder with symptoms of mild to severe pain, restricted ranges and stiffness. Trigger points are knots in muscle fibers that show high response to ...pressure with symptoms of referred pain. Shoulder pain may be linked to trigger points and can target the impact of quality of life. However, there are limited studies that explore frequency of trigger points in non-traumatic unilateral shoulder pain. This research aims to find how many patients of non-traumatic origin of shoulder pain have trigger points. Objective(s): To measure the frequency of myofascial trigger points in patients with non-traumatic unilateral shoulder pain. Methodology: This observation based cross sectional study was held over a duration of four months, following the approval of the synopsis by the research ethics committee of the University of Lahore. In this study data was collected from 273 patients of non-traumatic unilateral shoulder pain in Aziz Bhatti Shaheed Hospital Gujrat and were analyzed using SPSS version 23.0. Frequency tables, Bar charts, and Mean ± SD were used for descriptive analysis. The Chi-square test was used to determine the p- value for the relation between categorical variables. Results: 273 patients of age 18 to 35 were examined for the presence of Myofascial trigger points out of which 67.4% patients were positive for one or more trigger points of these 50.18% were female patients and 47(17.22%) female patients that had score of <9 on myofascial pain scale were marked negative. Meanwhile in male patients 42(15.38%) had no trigger points on myofascial pain scale scoring <9 and 47(17.22%) scored ?9. Female of age between 34 and 35 were highly prevalent (21.61%) in developing trigger points. We found significant association between shoulder pain and trigger points with p-value of (<.001*). Conclusion(s): Myofascial trigger points are highly prevalent in patients of non-traumatic unilateral shoulder pain. Of all the muscles examined, Infraspinatus muscle is most likely to develop trigger points. While looking for risk factors, female is more likely to develop myofascial pain.
Background: Shoulder pain is becoming problematic disorder with symptoms of mild to severe pain, restricted ranges and stiffness. Trigger points are knots in muscle fibers that show high response to ...pressure with symptoms of referred pain. Shoulder pain may be linked to trigger points and can target the impact of quality of life. However, there are limited studies that explore frequency of trigger points in non-traumatic unilateral shoulder pain. This research aims to find how many patients of non-traumatic origin of shoulder pain have trigger points. Objective(s): To measure the frequency of myofascial trigger points in patients with non-traumatic unilateral shoulder pain. Methodology: This observation based cross sectional study was held over a duration of four months, following the approval of the synopsis by the research ethics committee of the University of Lahore. In this study data was collected from 273 patients of non-traumatic unilateral shoulder pain in Aziz Bhatti Shaheed Hospital Gujrat and were analyzed using SPSS version 23.0. Frequency tables, Bar charts, and Mean ± SD were used for descriptive analysis. The Chi-square test was used to determine the p- value for the relation between categorical variables. Results: 273 patients of age 18 to 35 were examined for the presence of Myofascial trigger points out of which 67.4% patients were positive for one or more trigger points of these 50.18% were female patients and 47(17.22%) female patients that had score of <9 on myofascial pain scale were marked negative. Meanwhile in male patients 42(15.38%) had no trigger points on myofascial pain scale scoring <9 and 47(17.22%) scored ?9. Female of age between 34 and 35 were highly prevalent (21.61%) in developing trigger points. We found significant association between shoulder pain and trigger points with p-value of (<.001*). Conclusion(s): Myofascial trigger points are highly prevalent in patients of non-traumatic unilateral shoulder pain. Of all the muscles examined, Infraspinatus muscle is most likely to develop trigger points. While looking for risk factors, female is more likely to develop myofascial pain.
This research aimed to ascertain the effects of acupuncture at myofascial trigger points (MTrPs) in combination with sling exercise therapy (SET) on the clinical recovery and cervical spine ...biomechanics in patients with cervical spondylotic radiculopathy (CRS).
Eighty patients with CSR were divided into Group A and Group B. Group A was treated with acupuncture at MTrPs, and Group B was treated with acupuncture at MTrPs combined with SET. The cervical spine function, pain level, cervical spine biomechanics and the occurrence of complications were compared between the two groups before and after treatment.
After treatment, the Japanese Orthopaedic Association scores, Clinical Assessment Scale for Cervical Spondylosis scores, cervical forward flexion angle, posterior extension angle, left lateral flexion angle, right lateral flexion angle, left lateral rotation angle, and right lateral rotation angle of the Group B were raised, and the Neck Disability index, Visual Analogue Scale scores, and Neck Pain Questionnaire scores were reduced versus those of the Group A. The difference in complication rates between the two groups was not of statistical significance.
Acupuncture at MTrPs combined with SET promotes functional recovery of the cervical spine, reduces pain, and improves cervical spine biomechanics in patients with CRS.
Background
Neck pain is frequent in patients with migraine. Likewise, evidence for inflammatory processes in the trapezius muscles is accumulating. However, non-invasive and objectively assessable ...correlates are missing in vivo.
Methods
Twenty-one subjects with episodic migraine (mean age: 24.6 ± 3.1 years, 18 females) and 22 controls (mean age: 23.0 ± 2.2 years, 17 females) without any history of headache prospectively underwent physical examination and quantitative magnetic resonance imaging of the trapezius muscles. A T2‐prepared turbo spin-echo sequence was acquired for manual segmentation of the trapezius muscles and extraction of mean T2 values.
Results
There were no statistically significant differences regarding age, sex, body mass index, or number of myofascial trigger points (mTrPs) between groups. All patients with migraine presented with mTrPs in the trapezius muscles. T2 of the entire trapezius muscles was significantly higher in the migraine group when compared to controls (31.1 ± 0.8 ms vs. 30.1 ± 1.1 ms; p = 0.002).
Conclusions
Elevated T2 values of the trapezius muscles may indicate subtle inflammatory processes within musculature among patients with migraine because T2 increase is likely to stem from edematous changes. Future work may validate this finding in larger cohorts, but muscle T2 might have potential to develop into a viable in vivo biomarker for muscular affection in migraine.
•P-FGFR1 is upregulated in the patients with myofascial trigger points.•FGF2 activate FGFR1 in the nerves around myofascial trigger points in rats.•The expression of p-FGFR1 in DRG of MTrPs group is ...higher than control group.•Intramuscular injection of FGFR1 and PI3K inhibitors alleviate myofascial pain in rats.
Myofascial pain syndrome (MPS) is a type of skeletal pain identified by myofascial trigger points (MTrPs). The formation of MTrPs is linked to muscle damage. The fibroblast growth factor receptor (FGFR1) has been found to cause pain sensitivity while repairing tissue damage. The aim of the current study was to explore the mechanism of FGFR1 in MTrPs. We used a RayBio human phosphorylation array kit to measure p-FGFR1 levels in human control subjects and patients with MTrPs. P-FGFR1 was upregulated in the patients with MTrPs. Then a rat model of MPS was established by a blunt strike on the left gastrocnemius muscles (GM) and eccentric-exercise for 8 weeks with 4 weeks of recovery. After establishing the MPS model, the morphology of the GM changed, and the differently augmented sizes of round fibers (contracture knots) in the transverse section and fusiform shapes in the longitudinal section were clearly seen in the rats with myofascial pain. The expression of p-FGFR1 was upregulated on the peripheral nerves and dorsal root ganglion neurons in the MTrPs group. The spinal Fos protein expression was increased in the MTrPs group. Additionally, the mechanical pain threshold was reduced, and the expression of FGF2, p-FGFR1, PI3K-p110γ, and p-AKT increased in the MTrPs group. PD173074 increased the mechanical pain threshold of the MTrPs group, and inhibited the expression of p-FGFR1, PI3K-p110γ, and p-AKT. Moreover, LY294002 increased the mechanical pain threshold of the MTrPs group. These findings suggest that FGFR1 may regulate myofascial pain in rats through the PI3K/AKT pathway.
Myofascial Trigger Points (MTrPs) play a significant role in the pathogenesis of Tension Type Headache (TTH). Abnormal cranio-cervical posture has been linked to various types of headaches. However, ...the correlation between MTrPs sensitivity, cervical postural alignment, and clinical measures of headache has not been extensively studied in patients with TTH.
To investigate the relationship between MTrPs sensitivity in cervical and pericranial muscles, cervical postural abnormality, and clinical headache parameters in patients with TTH. Furthermore, to investigate the effect of sex on the examined variables and their association with headache type (episodic vs chronic TTH).
A total of 72 patients with TTH of both sexes were enrolled in this study. Headache frequency and disability as clinical measures of headache, pressure pain threshold (PPT) of bilateral upper trapezius (UT) and suboccipital (SUB) muscles, cervical lordosis angle (CA), and anterior head translation (AHT) were measured.
Pericranial MTrPs sensitivity did not demonstrate any correlation with clinical headache parameters or cervical postural abnormality. However, there was a significant correlation between the frequency of headaches and the level of disability (
= 0.32,
< 0.05). In addition, episodic TTH was more prevalent in females who exhibited greater AHT and MTrPs sensitivity of both bilateral UT and right SUB muscles than males.
There was no correlation found between the frequency of headaches and the level of disability with measures of cervical posture alignment or MTrPs sensitivity in individuals with TTH.. Based on findings, Clinicians should consider sex differences when assessing patients with TTH.
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