Abstract
Objective
A definitive diagnosis of chronic neck pain (CNP) is sometimes not possible. The aim of this study was to understand the possible role of the deep fasciae in CNP and the utility of the ultrasonography in the diagnosis of myofascial neck pain.
Methods
The morphometric and clinical data of 25 healthy subjects and 28 patients with CNP were compared. For all subjects, the active and passive cervical range of motion (ROM) was analyzed and the neck pain disability questionnaire (NDPQ) was administered. The fascial thickness of the sternal ending of the sternocleidomastoid and medial scalene muscles was also analyzed by ultrasonography.
Results
There were significant differences between healthy subjects and patients with CNP in the thickness of the upper side of the sternocleidomastoid fascia and the lower and upper sides of the right scalene fascia both at the end of treatment as during follow-up. A significant decrease in pain and thickness of the fasciae were found. Analysis of the thickness of the sub-layers showed a significant decrease in loose connective tissue, both at the end of treatment and during follow-up.
Conclusions
The data support the hypothesis that the loose connective tissue inside the fasciae may plays a significant role in the pathogenesis of CNP. In particular, the value of 0.15 cm of the SCM fascia was considered as a cut-off value which allows the clinician to make a diagnosis of myofascial disease in a subject with CNP. The variation of thickness of the fascia correlated with the increase in quantity of the loose connective tissue but not with dense connective tissue.
Similar content being viewed by others
Abbreviations
- ROM:
-
Range of motion
- SCM:
-
Sternocleidomastoid muscle
- CC:
-
Center of coordination
- HA:
-
Hyaluronic acid, hyaluronan
- NPDQ:
-
Neck Pain Disability Questionnaire
- LCT:
-
Loose connective tissue
- MRI:
-
Magnetic resonance imaging
- VAS:
-
Visual analogical scale
- MEL:
-
Massage electrotherapy Laser
- FM:
-
Fascial manipulation
References
Arokoski JP, Surakka J, Ojala T, Kolari P, Jurvelin JS (2005) Feasibility of the use of a novel soft tissue stiffness meter. Physiol Meas 26:215–228. doi:10.1088/0967-3334/26/3/007
Bell J, Holmes M (1992) Model of the dynamics of receptor potential in a mechanoreceptor. Math Biosci 110(2):139–174. doi:10.1016/0025-5564(92)90034-T
Bjordal JM, Lopes-Martins RA, Joensen J et al (2008) A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord 9:75. doi:10.1186/1471-2474-9-75
Bogduk N (2003) The anatomy and pathophysiology of neck pain. Phys Med Rehabil Clin N Am 14:455–472. doi:10.1016/S1047-9651(03)00041-X
Borghouts J, Koes B, Vondeling H, Bouter L (1999) Cost-of-illness of neck pain in the Netherlands in 1996. Pain 80:629–636. doi:10.1016/S0304-3959(98)00268-1
Ercole B, Antonio S, Julie Ann D, Stecco C (2010) How much time is required to modify a fascial fibrosis? J Bodyw Mov Ther 14(4):318–325. doi:10.1016/j.jbmt.2010.04.006
Bots ML, Mulder PG, Hofman A, van Es GA, Grobbee DE (1994) Reproducibility of carotid vessel wall thickness measurements. The Rotterdam Study. J Clin Epidemiol 47(8):921–930. doi:10.1016/0895-4356(94)90196-1
Bronfort G, Haas M, Evans R, Leininger B, Triano J (2010) Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat 18:3. doi:10.1186/1746-1340-18-3
Chytil M, Pekar M (2007) Rheological study of hyaluronan/modified hyaluronan mixtures and the structure of hyaluronic solution. Annu Trans Nord Rheol Soc 15
Côté P, Cassidy JD, Carette S, Boyle E, Shearer HM et al (2008) Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention. Trial 9:75. doi:10.1186/1745-6215-9-75
Damiano RE (1999) Late onset regression after myopic keratomileusis. J Refract Surg 15(2):160
Day JA, Copetti L, Rucli G (2012) From clinical experience to a model for the human fascial system. J Bodyw Mov Ther. 16(3):372–380. doi:10.1016/j.jbmt.2012.01.003
Day JA, Stecco C, Stecco A (2009) Application of fascial manipulation technique in chronic shoulder pain—anatomical basis and clinical implication. J Bodyw Mov Ther 13(2):128–135. doi:/10.1016/j.jbmt.2008.04.044
Frasher JRE, Laurent TC, Laurent UBG (1997) Hyaluronan: its nature, distribution, functions and turnover. J Intern Med 242:27–33. doi:10.1046/j.1365-2796.1997.00170.x
Gerwin RD (2001) Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep 5(5):412–420. doi:10.1007/s11916-001-0052-8
Giamberardino MA, Affaitati G, Fabrizio A, Costantini R (2011) Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol 25(2):185–198. doi:10.1016/j.berh.2011.01.002
Guarda-Nardini L, Stecco A, Stecco C, Masiero S, Manfredini D (2012) Myofascial pain of jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. J Craniomandib Pract 30(2)
Jensen I, Harms-Ringdahl K (2007) Neck pain. Best Pract Res Clin Rheumatol 21:93–108. doi:10.1016/j.berh.2006.10.003
Katzman BM, Klein DM, Garven TC, Caligiuri DA, Kung J (1999) Comparative histology of the annular and cruciform pulleys. J Hand Surg Br 24(3):272–274. doi:10.1054/jhsb.1999.0069
Knepper PA, Covici S, Fadel JR, Mayanil CS, Ritch R (1995) Surface-tension properties of hyaluronic acid. J Glaucoma 4(3):194–199. doi:10.1097/00061198-199506000-00009
Langevin HM, Fox JR, Koptiuch C, Badger GJ, Greenan-Naumann AC, Bouffard NA et al (2011) Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskelet Disord 12:203. doi:10.1186/1471-2474-12-203
Matteini P, Dei L, Carretti E, Volpi N, Goti A, Pini R (2009) Structural behavior of highly concentrated hyaluronan. Biomacromolecules 10(6):1516–1522. doi:10.1021/bm900108z
Melzack R, Stillwell D, Fox E (1977) Trigger points and acupuncture points for pain: correlations and implications. Pain 3:3–23. doi:10.1016/0304-3959(77)90032-X
Murphy DR, Hurwitz EL (2011) Application of a diagnosis-based clinical decision guide in patients with neck pain. Chiropr Man Therap 19(1):19. doi:10.1186/2045-709X-19-19
Pedrelli A, Stecco C, Day JA (2009) Treating patellar tendinopathy with fascial manipulation. J Bodyw Mov Ther 13(1):73–80. doi:10.1016/j.jbmt.2008.06.002 (PubMed PMID: 19118795)
Picelli A, Ledro G, Turrina A, Stecco C, Santilli V, Smania N (2011) Effects of myofascial technique in patients with subacute whiplash associated disorders: a pilot study. Eur J Phys Rehabil Med 47(4):561–568
Piehl-Aulin K et al (1991) Hyaluronan in human skeletal muscle of lower extremity: concentration, distribution, and effect of exercise. J Appl Physiol 71(6):2493–2498
Sarratia SK (1983) Anatomy of the foot and ankle: descriptive, tomographic, functional. Lippincott, New York
Sattayut S, Hughes F, Bradley P (1999) 820 nm gallium aluminium arsenide laser modulation of prostaglandin E2 production in interleukin I stimulated myoblasts. Laser Therapy 11:88–95
Scott JE, Heatley F (2002) Biological properties of hyaluronan in aqueous solution are controlled and sequestered by reversible tertiary structures, defined by NMR spectroscopy. Biomacromolecules 3(3):547–553. doi:10.1021/bm010170j
Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA (2009) Randomized trial of therapeutic massage for chronic neck pain. Clin J Pain 25(3):233–238. doi:10.1097/AJP.0b013e31818b7912
Shultz SP, Driban JB, Swanik CB (2007) The evaluation of electrodermal properties in the identification of myofascial trigger points. Arch Phys Med Rehabil 88:780–784. doi:10.1016/j.apmr.2007.03.012
Stecco A, Stecco C, Macchi V, Porzionato A, Ferraro C et al (2011) RMI study and clinical correlations of ankle retinacula damage and outcomes of ankle sprain. Surg Radiol Anat. doi:10.1007/s00276-011-0784-z
Stecco C, Stern R, Porzionato A, Macchi V, Masiero S et al (2011) Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat 33(10):891–896. doi:10.1007/s00276-011-0876-9
Stecco C, Gagey O, Belloni A, Pozzuoli A, Porzionato A et al (2007) Anatomy of the deep fascia of the upper limb. Second part: study of innervation. Morphologie 91:38–43. doi:10.1016/j.morpho.2007.05.002
Stecco L, Stecco C (2009) Fascial manipulation. Piccin, January, COD 1931461
Stecco L. (2004) Fascial manipulation for musculoskeletal pain. Piccin, April, COD 1931451
Tadmor R, Chen N, Israelachvili JN (2002) Thin film rheology and lubricity of hyaluronic acid solutions at a normal physiological concentration. J Biomed Mater Res 61(4):514–523. doi:10.1002/jbm.10215
Tesarz J, Hoheisel U, Wiedenhofer B, Mense S (2011) Sensory innervation of the thoracolumbar fascia in rats and humans. Neuroscience 194:302–308. doi:10.1016/j.neuroscience.2011.07.066
Yahia L, Rhalmi S, Newman N, Isler M (1992) Sensory innervation of human thoracolumbar fascia. An immunohistochemical study. Acta Orthop Scand 63(2):195–197. doi:10.3109/17453679209154822
Acknowledgments
We would like to thank the whole Operative Unit of Rehabilitation, of Padova University. Special thanks go to all the physiotherapists who made the research possible.
Conflict of interest
The authors declare that they have no conflict of interest. The Department of Physical Medicine and Rehabilitation provided all equipment for the project. There are no financial benefits to the authors.
Ethical standard
This clinical trial was performed in accordance with ethical standards on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983. The investigation and use of patient data for research purposes were in accordance with the Declaration of the World Medical Association. Written informed consent was obtained as required. The studies follow Good Clinical Practice. Ethics statement was not needed because it was used non-invasive conventional treatments. Patients were informed about every single treatment modality and the modes of evaluation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stecco, A., Meneghini, A., Stern, R. et al. Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up. Surg Radiol Anat 36, 243–253 (2014). https://doi.org/10.1007/s00276-013-1185-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-013-1185-2