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physioscience 2014; 10(3): 106-114
DOI: 10.1055/s-0034-1384918
Fachwissen: Myofaszialer Schmerz
© Georg Thieme Verlag KG Stuttgart · New York

Myofascial Pain: An Update

Myofaszialer Schmerz: Ein Update
F. Timmermans
Further Information

Publication History

21 May 2014

10 July 2014

Publication Date:
04 September 2014 (online)

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Abstract

Background: Myofascial pain, and its characteristic myofascial trigger points, is very common in physiotherapy practice.

Objective/Method: This article, an update from 2006, reviews the latest research and points out some potential clinical implications for daily physiotherapy practice.

Results/Conclusions: Myofascial pain is beginning to gain recognition as a neuromuscular disease and scientific studies of myofascial trigger points (MTrP) have found objective abnormalities that, together with observed changes in motor and sensory characteristics, implicate peripheral and central mechanisms in the development of myofascial pain. Beyond a primary muscle cause, predisposing and precipitating factors and remote lesions can be present, and need management as well.

Zusammenfassung

Hintergrund: Myofaszialer Schmerz und seine charakteristischen Triggerpunkte sind in der physiotherapeutischen Praxis weit verbreitet.

Ziel/Methode: Dieser Artikel – ein Update von 2006 – gibt einen Überblick über die neueste Forschung und stellt einige mögliche klinische Schlussfolgerungen für die tägliche physiotherapeutische Praxis dar.

Ergebnisse/Schlussfolgerungen: Myofaszialer Schmerz beginnt als neuromuskuläre Erkrankung Anerkennung zu finden, und wissenschaftliche Studien haben objektive Anomalien gefunden, die zusammen mit beobachteten Veränderungen motorischer und sensorischer Eigenschaften periphere und zentrale Mechanismen in die Entstehung myofaszialer Schmerzen einschließen. Neben einer primären muskulären Ursache können prädisponierende und auslösende Faktoren sowie weiter entfernte Läsionen vorkommen, die ebenso behandelt werden müssen.

Key words

myofascial pain - trigger point - physiotherapy

Schlüsselwörter

myofaszialer Schmerz - Triggerpunkt - Physiotherapie
 

  • References

  • 1 Abd Jalil N, Awang MS, Omar M. Scalene myofascial pain syndrome mimicking cervical disc prolapse: a report of two cases. Malays J Med Sci 2010; 17: 60-65
    PubMedGoogle Scholar
  • 2 Barbero M, Bertoli P, Cescon C et al. Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle. J Man Manip Ther 2013; 20: 171-177
    PubMedGoogle Scholar
  • 3 Barbero M, Bertoli P, Cescon C et al. Myofascial trigger points and innervation zone locations in upper trapezius muscles. BMC Musculoskelet Disord 2013; 8: 171-177
    PubMedGoogle Scholar
  • 4 Borg-Stein J, Iaccarino MA. Myofascial Pain Treatments. Phys Med Rehabil Clin N Am 2014; 25: 357-374
    CrossrefPubMedGoogle Scholar
  • 5 Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep 2013; 16: 439-444
    PubMedGoogle Scholar
  • 6 Cagnie B, Dewitte V, Barbe T et al. Physiologic effects of dry needling. Curr Pain Headache Rep 2013; 17: 348-356
    CrossrefPubMedGoogle Scholar
  • 7 Celik D, Kaya Mutlu E. The relationship between latent trigger points and depression levels in healthy subjects. Clin Rheumatol 2013; 31: 907-911
    PubMedGoogle Scholar
  • 8 Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep 2013; 17: 353-360
    CrossrefPubMedGoogle Scholar
  • 9 Chandola HC, Chakraborty A. Fibromyalgia and myofascial pain – a dilemma. Indian J Anaesth 2009; 53: 575-581
    PubMedGoogle Scholar
  • 10 Chou LW, Hsieh YL, Kao MJ et al. Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle. Arch Phys Med Rehabil 2009; 90: 905-912
    CrossrefPubMedGoogle Scholar
  • 11 Clewley D, Flynn TW, Koppenhaver S. Trigger point dry needling as an adjunct treatment for a patient with adhesive capsulitis of the shoulder. J Orthop Sports Phys Ther 2014; 44: 92-101
    CrossrefPubMedGoogle Scholar
  • 12 Cotchett MP, Munteanu SE, Landorf KB. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. 2014 www.ncbi.nlm.nih.gov/pubmed/24700136
    PubMedGoogle Scholar
  • 13 Desai MJ, Bean MC, Heckman TW et al. Treatment of myofascial pain. Pain Manag 2013; 3: 67-79
    CrossrefPubMedGoogle Scholar
  • 14 Doraisamy MA Anshul. Effect of latent myofascial trigger points on strength measurements of the upper trapezius: a case-controlled trial. Physiother Can 2011; 63: 405-409
    CrossrefPubMedGoogle Scholar
  • 15 Edwards J. The importance of postural habits in perpetuating myofascial trigger point pain. Acupunct Med 2005; 23: 77-82
    CrossrefPubMedGoogle Scholar
  • 16 Facco E. Myofascial pain mimicking radiculars. Acta Neurochir Suppl 2005; 92: 147-150
    PubMedGoogle Scholar
  • 17 Fernández-Carnero J, Fernández-de-Las-Peñas C, de la Llave-Rincón AI et al. Prevalence of and referred pain from myofascial trigger points in the forearm muscles in patients with lateral epicondylalgia. Clin J Pain 2007; 24: 353-360
    PubMedGoogle Scholar
  • 18 Fernández-de-las-Peñas CF, Sohrbeck Campo M, Fernandez Carnero J et al. Manual therapies in myofascial trigger point treatment: a systematic review. J Bodywork Movement Ther 2005; 9: 27-34
    CrossrefPubMedGoogle Scholar
  • 19 Fernández-de-las-Peñas C. Interaction between trigger points and joint hypomobility: a clinical perspective. J Man Manip Ther 2009; 17: 74-77
    CrossrefPubMedGoogle Scholar
  • 20 Fernández-de-las-Peñas C, Gröbli C, Ortega-Santiago R et al. Referred pain from myofascial trigger points in head, neck, shoulder, and arm muscles reproduces pain symptoms in blue-collar (manual) and white-collar (office) workers. Clin J Pain 2013; 28: 511-518
    PubMedGoogle Scholar
  • 21 Fleckenstein J, Zaps D, Rüger LJ et al. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord 2010; 11: 32
    CrossrefPubMedGoogle Scholar
  • 22 Fricton J, Meister T, Seiroe M. Scope of tenderness is best predictor of myofascial pain diagnosis. Defining diagnostic criteria for myofascial pain. J Musculoskeletal Pain [submitted]
    PubMedGoogle Scholar
  • 23 Ge HY. Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems. Curr Pain Headache Rep 2010; 14: 339-345
    CrossrefPubMedGoogle Scholar
  • 24 Ge HY, Fernandez-de-las-Penas C, Yue SW. Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med 2011; 6: 13
    CrossrefPubMedGoogle Scholar
  • 25 Gerwin RD. A review of myofascial pain and fibromyalgia – factors that promote their persistence. Acupunct Med 2005; 23: 131-134
    PubMedGoogle Scholar
  • 26 Gerwin RD. The taut band and other mysteries of the trigger point: An examination of the mechanisms relevant to the development and maintenance of the trigger point. J Musculoskeletal Pain 2008; 16: 115-131
    CrossrefPubMedGoogle Scholar
  • 27 Gerwin R. Myofascial Pain: Here we are, where must we go?. J Musculoskeletal Pain 2010; 18: 18
    PubMedGoogle Scholar
  • 28 Gerwin RD. Diagnosing fibromyalgia and myofascial pain: a guide. J Fam Pract 2013; 62 (Suppl. 01) S 19-S 25
    PubMedGoogle Scholar
  • 29 Grieve R, Barnett S, Coghill N et al. The prevalence of latent myofascial trigger points and diagnostic criteria of the triceps surae and upper trapezius: a cross-sectional study. Physiotherapy 2013; 99: 278-284
    CrossrefPubMedGoogle Scholar
  • 30 Gunn CC. The Gunn Approach to the Treatment of Chronic Pain. New York: Churchill Livingstone; 1996
    Google Scholar
  • 31 Hanten WP, Olson SL, Butts NL et al. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther 2000; 80: 997-1003
    PubMedGoogle Scholar
  • 32 Harden RN, Bruehl SP, Gass S et al. Signs and symptoms of myofascial pain: a national survey of pain management providers. Clin J Pain 2000; 16: 64-72
    CrossrefPubMedGoogle Scholar
  • 33 Hong CZ. Muscle pains. In: Braddom RL, (ed) Physical Medicine and Rehabilitation: Expert Consult – Online and Print. Toronto: Elsevier; 2011
    CrossrefGoogle Scholar
  • 34 Hubbard DR, Berkoff GM. Myofascial trigger points show spontaneous needle EMG activity. Spine 1993; 18: 1803-1807
    CrossrefPubMedGoogle Scholar
  • 35 Jarrell J, Giamberardino MA, Robert M et al. Bedside testing for chronic pelvic pain: discriminating visceral from somatic pain. Pain Res Treat 2011; 2011: 1-6
    PubMedGoogle Scholar
  • 36 Jayaseelan DJ, Moats N, Ricardo CR. Rehabilitation of proximal hamstring tendinopathy utilizing eccentric training, lumbopelvic stabilization, and trigger point dry needling: 2 case reports. J Orthop Sports Phys Ther 2014; 44: 198-205
    CrossrefPubMedGoogle Scholar
  • 37 Kietrys DM, Palombaro KM, Azzaretto E et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013; 43: 620-634
    CrossrefPubMedGoogle Scholar
  • 38 Kuan TS, Hsieh YL, Chen SM et al. The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise. Am J Phys Med Rehabil 2007; 86: 183-189
    CrossrefPubMedGoogle Scholar
  • 39 Kuan TS. Current studies on myofascial pain. Curr Pain Headache Rep 2009; 13: 365-369
    CrossrefPubMedGoogle Scholar
  • 40 Lucas KR, Rich PA, Polus BI. How common are latent myofascial trigger points in the scapular positioning muscles?. J Musculoskelet Pain 2008; 16: 279-286
    CrossrefPubMedGoogle Scholar
  • 41 Lucas N, Macaskill P, Irwig L et al. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain 2009; 25: 80-89
    CrossrefPubMedGoogle Scholar
  • 42 Lucas KR, Rich PA, Polus BI. Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of latent myofascial trigger points. Clin Biomech 2010; 25: 765-770
    CrossrefPubMedGoogle Scholar
  • 43 Luo JJ, Dun NJ. Chronic pain: myofascial pain and fibromyalgia. Int J Phys Med Rehabil 2013; 1: e102
    PubMedGoogle Scholar
  • 44 Mejuto-Vázquez MJ, Salom-Moreno J, Ortega-Santiago R et al. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2014; 44: 252-260
    CrossrefPubMedGoogle Scholar
  • 45 Mense S, Simons DG. Muscle Pain. Understanding its Nature, Diagnosis, and Treatment. Philadelphia: Lippincott Williams & Wilkins; 2001
    Google Scholar
  • 46 Mense S. Muscle pain: mechanisms and clinical significance. Dtsch Arztebl Int 2008; 105: 214-219
    PubMedGoogle Scholar
  • 47 Mense S. How do muscle lesions such as latent and active trigger points influence central nociceptive neurons?. Journal of Musculoskeletal Pain 2010; 18: 348-353
    CrossrefPubMedGoogle Scholar
  • 48 Mense S. Differences between myofascial trigger points and tender points. Schmerz 2011; 25: 93-103
    CrossrefPubMedGoogle Scholar
  • 49 Myburgh C, Larsen AH, Hartvigsen J. A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil 2008; 89: 1169-1176
    CrossrefPubMedGoogle Scholar
  • 50 Nguyen BM. Myofascial trigger point, falls in the elderly, idiopathic knee pain and osteoarthritis: an alternative concept. Med Hypotheses 2013; 80: 806-809
    CrossrefPubMedGoogle Scholar
  • 51 Niddam DM, Chan RC, Lee SH et al. Central modulation of pain evoked from myofascial trigger point. Clin J Pain 2007; 23: 440-448
    CrossrefPubMedGoogle Scholar
  • 52 Nijs J, Daenen L, Cras P et al. Nociception affects motor output – a review on sensory-motor interaction with focus on clinical implications. Clin J Pain 2013; 28: 175-181
    PubMedGoogle Scholar
  • 53 Patel N. Physiology of pain. In: Patel N, Kopf A, (eds) Guide to Pain Management in Low-resource Settings. Seattle: IASP; 2010
    Google Scholar
  • 54 Rha DW, Shin JC, Kim YK et al. Detecting local twitch responses of myofascial trigger points in the lower-back muscles using ultrasonography. Arch Phys Med Rehabil 2011; 92: 1576-1580
    CrossrefPubMedGoogle Scholar
  • 55 Russel LJ. Future perspectives in generalised musculoskeletal pains. Best Pract Res Clin Rheumatol 2011; 25: 321-331
    PubMedGoogle Scholar
  • 56 Samuel AS, Peter AA, Ramanathan K. The association of active trigger points with lumbar disc lesions. J Musculoskeletal Pain 2007; 15: 11-18
    PubMedGoogle Scholar
  • 57 Sari H, Akarirmak U, Uludag M. Active myofascial trigger points might be more frequent in patients with cervical radiculopathy. Eur J Phys Rehabil Med 2012; 48: 237-244
    PubMedGoogle Scholar
  • 58 Shah J. New frontiers in the pathophysiology on myofascial pain. Pain Practitioner 2012; 22: 26-33
    PubMedGoogle Scholar
  • 59 Simons DG, Travell JG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 1. Baltimore: Williams & Wilkins; 1999
    Google Scholar
  • 60 Simons DG. Understanding effective treatments of myofascial trigger points. Journal of Bodywork and Movement Therapies 2002; 6: 81-88
    CrossrefPubMedGoogle Scholar
  • 61 Simons DG. New views of myofascial trigger points: etiology and diagnosis (commentary). Arch Phys Med Rehabil 2008; 89: 157-159
    CrossrefPubMedGoogle Scholar
  • 62 Thomas K, Shankar H. Targeting myofascial taut bands by ultrasound. Curr Pain Headache Rep 2013; 17: 349
    CrossrefPubMedGoogle Scholar
  • 63 Though EA, Tough AR, White S et al. Variability of criteria used to diagnose myofascial trigger point pain-evidence from a review of the literature. Clin J Pain 2007; 23: 278-286
    CrossrefPubMedGoogle Scholar
  • 64 Timmermans F. Aktueller Stand der Überlegungen zum myofaszialen Schmerzsyndrom. physioscience 2006; 2: 25-32
    Article in Thieme ConnectPubMedGoogle Scholar
  • 65 Timmermans F. Een analyse van het myofasciale pijnsyndroom. Deel 2. Therapie. (Dutch). Tijdschrift voor Kinesitherapie 2008; 3: 19-27
    PubMedGoogle Scholar
  • 66 Weiner DK. Office management of chronic pain in the elderly. Am J Med 2007; 130: 306-315
    PubMedGoogle Scholar
  • 67 Wheeler AH. Myofascial pain disorders: theory to therapy. Drugs 2004; 64: 45-62
    CrossrefPubMedGoogle Scholar
  • 68 Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011; 152 (03) S2-S15
    Google Scholar
  • 69 Zusman M. Forebrain-mediated sensitization of central pain pathways: “non-specific” pain and a new image for MT. Man Ther 2002; 7: 80-88
    CrossrefPubMedGoogle Scholar