Myofascial trigger points, pain, disability, and sleep quality in individuals with mechanical neck pain

J Manipulative Physiol Ther. 2012 Oct;35(8):608-13. doi: 10.1016/j.jmpt.2012.09.003.


Objective: The purpose of this study was to investigate the presence of active myofascial trigger points (MTrPs) in a greater number of muscles than previous studies and the relation between the presence of MTrPs, the intensity of pain, disability, and sleep quality in mechanical neck pain.

Methods: Fifteen patients with mechanical neck pain (80% women) and 12 comparable controls participated. Myofascial trigger points were bilaterally explored in the upper trapezius, splenius capitis, semispinalis capitis, sternocleidomastoid, levator scapulae, and scalene muscles in a blinded design. Myofascial trigger points were considered active if the subject recognized the elicited referred pain as a familiar symptom. Myofascial trigger points were considered latent if the elicited referred pain was not recognized as a symptom. Pain was collected with a numerical pain rate scale (0-10); disability was assessed with Neck Disability Index; and sleep quality, with the Pittsburgh Sleep Quality Index.

Results: Patients exhibited a greater disability and worse sleep quality than controls (P < .001). The Pittsburgh Sleep Quality Index score was associated with the worst intensity of pain (r = 0.589; P = .021) and disability (r = 0.552; P = .033). Patients showed a greater (P = .002) number of active MTrPs (mean, 2 ± 2) and similar number (P = .505) of latent MTrPs (1.6 ± 1.4) than controls (latent MTrPs, 1.3 ± 1.4). No significant association between the number of latent or active MTrPs and pain, disability, or sleep quality was found.

Conclusions: The referred pain elicited by active MTrPs in the neck and shoulder muscles contributed to symptoms in mechanical neck pain. Patients exhibited higher disability and worse sleep quality than controls. Sleep quality was associated with pain intensity and disability. No association between active MTrPs and the intensity of pain, disability, or sleep quality was found.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Case-Control Studies
  • Confidence Intervals
  • Disability Evaluation
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myofascial Pain Syndromes / complications
  • Myofascial Pain Syndromes / diagnosis*
  • Neck Muscles / physiopathology*
  • Neck Pain / complications
  • Neck Pain / diagnosis*
  • Neck Pain / physiopathology*
  • Pain Measurement
  • Pain, Referred / complications
  • Pain, Referred / diagnosis
  • Physical Examination / methods
  • Prognosis
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Sleep Wake Disorders / complications
  • Sleep Wake Disorders / diagnosis*
  • Trigger Points / physiopathology*