Persistent myalgia following whiplash is commonly considered the result of poor psychosocial status, illness behavior, or failing coping skills. However, there is much evidence that persistent myalgia may be due to neurophysiologic mechanisms involving peripheral and central sensitization. Myofascial trigger points may play a crucial role in maintaining sensitization. Recent research suggests that the chemical environment of myofascial trigger points is an important factor. Several consequences are reviewed when central pain mechanisms and myofascial trigger points are included in the differential diagnosis and in the management of patients with persistent pain following whiplash.

/pdf/persistent-myalgia-following-whiplash-1ddecgl5e9.pdf

Persistent Myalgia Following Whiplash

SUMMARY The aim of this observational study from Spain was to determine the prevalence of mechanical hypersensitivity and active and latent trigger points [TrPs] in elite swimmers with and without unilateral shoulder pain. Seventeen elite swimmers with and 18 without shoulder pain were included, while 15 elite athletes acted as matched controls. The subjects were assessed for pressure pain thresholds [PPT] and the presence of active and latent TrPs in the levator scapulae, sternocleidomastoid, upper trapezius, infraspinatus, subscapularis and scalene muscles. The PPT was also assessed over the tibialis muscle. Subjects were included when aged between 18 and 30 years of age and swimming more than 6 h per week. The subjects with shoulder pain had these complaints for more than 3 months. Pain was described as pain felt in the shoulder or arm with an intensity of at least 4 on an 11-point numerical pain rating scale. They had to report a positive Neer test and Hawkins-Kennedy test at physical examination. Subjects were excluded with a history of shoulder or neck surgery, fracture of the shoulder region, bilateral shoulder symptoms, cervical radiculopathy, previous steroid injections or any type of physical intervention within the last year. The age-matched controls were right-handed elite athletes without shoulder complaints and with a negative Neer test and Hawkins-Kennedy test and the abovementioned exclusion criteria were used. A mechanical pressure algometer was used to establish PPT, which was defined as the minimal amount of pressure needed to elicit pain. The PPT was measured at predefined points within the muscles. The TrPs were explored by a blinded assessor with more than 8 years of experience in TrPs diagnosis following the guidelines described by Simons et al. (1) and by Gerwin et al. (2). The TrPs were considered active, when local and referred pain PPTs were significant reduced in the swimmers with shoulder pain group compared with the healthy controls in all muscles, but not when compared to the swimmers without shoulder pain group. Furthermore, much higher numbers of active and latent TrPs were found in swimmers with and without shoulder pain compared to healthy athletes.

/pdf/myofascial-pain-syndrome-trigger-points-453l6qsg4d.pdf

Myofascial Pain Syndrome: Trigger Points

Neue Entwicklungen im Verständnis von Triggerpunkten

The aim of this study was the scintigraphic visualization of points of segmental irritation resulting from reversible articular dysfunction. Because of increased cellular metabolism as a result of muscular hypertonus, scintigraphic visualization of these points should be possible with 99mTc-MIBI. This radiopharmaceutical is localized in cells, depending on the metabolism.

Visualization of segmental irritation points with scintigraphy

Die myofasziale Dysfunktion ist eine Storung der myofaszialen Funktionseinheit, die mit Schmerzen und/oder Bewegungskontrolldysfunktionen verbunden ist [1, 43].

Steht der Schmerz im Vordergrund der Symptomatik, wird haufig die Bezeichnung „myofasziales Schmerzsyndrom“ verwendet [63].

Die Dysfunktion der Muskulatur ist durch folgende Befunde gekennzeichnet:


eingeschrankte Verlangerbarkeit,


Abschwachung/reflektorische Hemmung,


Triggerpunkte [36, 47, 63] sowie


Storung von Bewegungsausmas und -ablauf.





Zeichen der faszialen Dysfunktion sind Spannungsveranderungen von Faszien und daraus resultierend eine Einschrankung ihrer Verschieblichkeit gegenuber angrenzenden spezifischen Strukturen [55].

Myofasziale Dysfunktion als spezifische Ursache für Kreuzschmerzen

Triggerpunkte und Myogelose

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Triggerpunkte und Myogelose