Department of Physical Therapy, Universidad de Granada, Granada, Spain.
J Orthop Sports Phys Ther. 2012 Jul;42(7):634-41. doi: 10.2519/jospt.2012.4117. Epub 2012 Jun 7.
Cross sectional cohort study.
To analyze the differences in the prevalence of trigger points (TrPs) between patients with acute whiplash-associated disorders (WADs) and healthy controls, and to determine if widespread pressure hypersensitivity and reduced cervical range of motion are related to the presence of TrPs in patients with acute WADs.
The relationship between active TrPs and central sensitization is not well understood in patients with acute WADs.
Twenty individuals with a high level of disability related to acute WAD and 20 age- and sex-matched controls participated in the study. TrPs in the temporalis, masseter, upper trapezius, levator scapulae, sternocleidomastoid, suboccipital, and scalene muscles were examined. TrPs are defined as hypersensitive spots in a palpable taut band, producing a local twitch response and referred pain when palpated. Pressure pain threshold (PPT) was assessed bilaterally over the C5-6 zygapophyseal joints, second metacarpal, and tibialis anterior muscle. Active cervical range of motion, neck pain, and self-rated disability using the Neck Disability Index were also assessed.
The mean ± SD number of TrPs for the patients with acute WAD was 7.3 ± 2.8 (3.4 ± 2.7 were latent TrPs; 3.9 ± 2.5 were active TrPs). In comparison, healthy controls had 1.7 ± 2.2 latent and no active TrPs (P<0.01). In patients with acute WAD, the most prevalent sites for active TrPs were the levator scapulae and upper trapezius muscles. The number of active TrPs increased with higher neck pain intensity (P<0.001) and a higher number of days since the accident (P=.003). Patients had significantly lower PPTs in all tested locations and less active cervical range of motion than controls (P<.001). In the patient group, there were significant negative correlations between the number of active TrPs and PPT over the C5-C6 joints and cervical range of motion in flexion, extension, and rotation in both directions: the greater the number of active TrPs, the lower the bilateral PPT over the neck and the greater the cervical range of motion limitation.
The local and referred pain elicited from active TrPs reproduced neck and shoulder pain patterns in individuals with acute WADs with higher levels of disability. Patients with acute WADs exhibited widespread pressure hypersensitivity and reduced cervical mobility. The number of active TrPs was related to higher neck pain intensity, the number of days since the accident, higher pressure pain hypersensitivity over the cervical spine, and reduced active cervical range of motion.
横断面队列研究。
分析急性颈扭伤相关障碍（WAD）患者与健康对照组之间触发点（TrP）患病率的差异，并确定广泛性压痛敏化和颈椎活动范围减小是否与急性 WAD 患者 TrP 的存在有关。
急性 WAD 患者中，活跃 TrP 与中枢敏化之间的关系尚不清楚。
20 名因急性 WAD 而导致高度残疾的患者和 20 名年龄和性别匹配的对照者参与了这项研究。颞肌、咬肌、上斜方肌、肩胛提肌、胸锁乳突肌、枕下肌和斜角肌中的 TrP 进行了检查。TrP 定义为可触及紧张带中的敏感点，在触诊时会产生局部抽搐反应和牵涉痛。双侧 C5-6 关节突关节、第二掌骨和胫骨前肌的压痛阈值（PPT）也进行了评估。还评估了主动颈椎活动范围、颈部疼痛和使用颈部残疾指数自我评估的残疾程度。
急性 WAD 患者的平均±标准差 TrP 数为 7.3±2.8（3.4±2.7 为潜伏 TrP；3.9±2.5 为活跃 TrP）。相比之下，健康对照组的潜伏 TrP 为 1.7±2.2，无活跃 TrP（P<0.01）。在急性 WAD 患者中，活跃 TrP 最常见的部位是肩胛提肌和上斜方肌。随着颈部疼痛强度的增加（P<0.001）和事故发生后天数的增加（P=.003），活跃 TrP 的数量也会增加。与对照组相比，患者的 PPT 明显较低，颈椎活动范围也较小（P<.001）。在患者组中，活跃 TrP 的数量与 C5-C6 关节处双侧 PPT 和颈椎屈伸、旋转活动度之间存在显著负相关：活跃 TrP 数量越多，双侧颈部 PPT 越低，颈椎活动度受限越大。
在具有较高残疾水平的急性 WAD 患者中，来自活跃 TrP 的局部和牵涉痛重现了颈部和肩部疼痛模式。急性 WAD 患者表现出广泛的压痛敏化和颈椎活动度降低。活跃 TrP 的数量与较高的颈部疼痛强度、事故发生后天数、颈椎压痛敏化程度较高以及主动颈椎活动范围减小有关。
