The prevalence of myofascial trigger points in spinal disorders: a systematic review and meta-analysis

Chiarotto, Alessandro and Clijsen, Ron and Fernandez-de-Las-Penas, Cesar and Barbero, Marco (2015) The prevalence of myofascial trigger points in spinal disorders: a systematic review and meta-analysis. In: World Confederation for Physical Therapy Congress 2015, 1-4 May, Singapore.

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Background. Active and latent myofascial trigger points (MTrPs) can be clinical signs present in subjects with spinal disorders. Expert-based definitions of MTrPs identify these as hypersensitive spots within taut bands of skeletal muscles that are painful on compression and that evoke a referred pain. A latent MTrP point does not cause spontaneous pain, while active MTrP contributes to patient’s symptomatology. Purpose. The aim of this study was to perform a systematic review with meta-analysis to synthesise the literature on the prevalence of active and latent MTPs in subjects with spinal disorders. Methods. Medline, Embase and CINAHL were searched up to October 15, 2014; additional search in Google Scholar, and forward and backward citation tracking were performed. Observational studies reporting on the prevalence of MTrPs in at least one group of subjects with a spinal disorder were included. Two reviewers screened title/abstract and full-text independently, and assessed risk of bias of included studies. Proportions of subjects with a spinal disorder and healthy controls with active and/or latent MTPs in each muscle were extracted. Meta-analyses were performed when at least two studies assessed active or latent MTPs on the same muscle for the same spinal disorder. Results. Twelve cross-sectional studies met eligibility criteria and four of them were included in meta-analyses. Overall, the studies presented a high risk of bias with only four studies meeting at least 50% of the applicable quality criteria. Meta-analyses were performed for subjects with chronic neck pain (CNP), resulting in pooled point prevalence for active MTrPs of 38.5% (95% CI: 29.1-48.9) on the right upper trapezius, 29.8% (21.3-40.0) on left trapezius, 16.9% (10.4-26.2) on right levator scapulae, 14.8% (7.7-26.7) on left levator scapulae, 22.0% (14.5-32.1) on right sternocleidomastoid, 19.8% (12.6-29.6) on left sternocleidomastoid. 11.9% (1.0-63.6) on right temporalis, and 11.2% (1.2-56.9) on left temporalis. These pooled estimates were characterised by lack of precision, high risk of bias and/or substantial heterogeneity. The prevalence of active and latent MTrPs for several muscles could be extracted from seven single studies with small samples and/or high risk of bias conducted in subjects with CNP, whiplash associated disorders, cervical radiculopathy and non-specific low back pain. No significant differences were found for the prevalence of latent MTrPs between subjects with spinal disorders and healthy controls. Three studies with high risk of bias assessed MTrPs in subjects with other spinal disorders, but two of them did not make a distinction between active and latent MTrPs. Conclusions. Pooled estimates and results extracted from individual studies showed that active MTrPs can be present in all muscles of subjects with different spinal disorders. The point prevalence of active MTrPs in subjects with CNP seems higher in the upper trapezius than in the other muscles. However, the results of this review should be taken cautiously due to small samples and high risk of bias of the included studies. Implications. Future studies assessing the prevalence of MTrPs in spinal disorders with large sample sizes and low risk of bias are likely to change the results summarized in this review. Funding acknowledgements. Supported by a grant from the Thim van der Laan Foundation.

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