Ulyanovsk Medico-biological Journal

PHYSIOLOGY

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DOI 10.34014/2227-1848-2019-4-114-123

POSTURAL STABILITY IN PATIENTS WITH LATENT TRIGGER ZONES OF NECK MUSCULATURE

E.R. Mukhametova, A.D. Militskova, T.V. Baltina

Kazan Federal University, Kazan, Russia

 

There are many reasons for postural disorder development, but dysfunction of the cervical spine muscles is the most disputable reason.

The purpose of the study is to reveal the influence of latent myogenic trigger zones of the cervical muscles on postural resistance.

Materials and Methods. The authors used the method of computer posturography. Latent myogenic trigger zones (LMTZs) were determined by an indurated nodule or bundle in the neck muscle and by hyperesthesia in this zona. Assessment of postural resistance in subjects with LMTZs was carried out using standard posturography tests and Romberg test. Both classical and vector indicators were evaluated in a standard sample

Results. In fact, only vector indicators changed significantly in subjects with multiple LMTZs (4 or more). Thus, a decrease in the equilibrium function quality was established, as well as an increase in the average linear velocity of the pressure center and an increase in the normalized vectorogram area if compared with the indices in the control group and the group with sporadic LMTZs (from 1 to 3). The obtained results indicate a postural control decrease in individuals with multiple LMTZs. Subjects with sporadic LMTZs demonstrated a significant decrease in classical and a number of vector indicators, which shows the improvement in postural resistance in this test group. In Romberg test, all subjects with LMTZs, regardless of the zone number, showed an increasd Romberg coefficient.

Conclusion. Multiple LMTZs of cervical muscles can reduce postural stability through increased afferentation from the cervical proprioreceptors. It is more obvious during in case of eye control elimination.

Keywords: latent myogenic trigger points, postural control, posturography, Romberg test.

Conflict of interest. The authors declare no conflict of interest.

 

References

  1. Bronstein A.M. Multisensory integration in balance control. Handb. Clin. Neurol. 2016; 137: 57–66.

  2. Jones K.D., Horak F.B., Winters-Stone K., Irvine J.M., Bennett R.M. Fibromyalgia is associated with impaired balance and falls. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases. 2009; 15 (1): 16–21.

  3. Hasvold T., Johnsen R. Headache and neck or shoulder pain-frequent and disabling complaints in the general population. Scand. J. Prim. Health Care. 1993; 11 (3): 219–224.

  4. Hain T.C. Cervicogenic causes of vertigo. Curr. Opin. Neurol. 2015; 28 (1): 69–73.

  5. Oostendorp R.A.B., van Eupen A.A.J.M., Elvers J.W.H., Bernards J.A. Effects of restrained cervical mobility on involuntary eye movements. J. Man Manip. Ther. 1993; 1 (4): 148–153.

  6. Reid S.A., Rivett D.A. Manual therapy treatment of cervicogenic dizziness: a systematic review. Man Ther. 2005; 10 (1): 4–13.

  7. Reid S.A., Rivett D.A., Katekar M.G., Callister R. Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Man Ther. 2008; 13 (4): 357–366.

  8. Sola A.E., Rodenberger M.L., Gettys B.B. Incidence of hypersensitive areas in posterior shoulder muscles. A survey of two hundred young adults. Am. J. Phys. Med. 1955; 34 (6): 585–590.

  9. Sciotti V.M., Mittak V.L., DiMarco L., Ford L.M., Plezbert J., Santipadri E., Ball K. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001; 93 (3): 259–266.

  10. Wade B. Trigger points in the upper trapezius or normal subtrapezial anatomy? Physiother. Can. 2001; 53 (3): 219–222.

  11. Chen S.M., Chen J.T., Kuan T.S., Hong T.S., Hong C.Z. Decrease in pressure pain thresholds of latent myofascial trigger points in the middle finger extensors immediately after continuous piano practice. J. Musculoskelet Pain. 2000; 8 (3): 83–92.

  12. Herdman S.J., Clendaniel R. Vestibular rehabilitation. FA Davis; 2014.

  13. Ryan G.M.S., Cope S. Cervical vertigo. Lancet. 1955; 266 (6905): 1355–1359.

  14. Croft P.R., Lewis M., Papageorgiou A.C., Thomas E., Jayson I.M., Macfarlane G.J., Silman A.J. Risk factors for neck pain: a longitudinal study in the general population. Pain. 2001; 93 (3): 317–325.

  15. Scott J., Huskisson E.C. Graphic representation of pain. Pain. 1976; 2 (2): 175–184.

  16. Gerwin R.D., Shannon S., Hong C.Z., Hubbard D., Gevirtz R. Interrater reliability in myofascial trigger point examination. Pain. 1997; 69 (1-2): 65–73.

  17. Simons D.G. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J. Electromyogr Kinesiol. 2004; 14 (1): 95–107.

  18. Usachev V.I., Dotsenko V.I., Kononov A.F., Artemov V.G. Novaya metodologiya stabilometricheskoy diagnostiki narusheniya funktsii ravnovesiya tela [New methodology for stabilometric diagnosis of body balance dysfunction]. Vestnik otorinolaringologii. 2009; 3: 19–22 (in Russian).

  19. Silva A.G., Cruz A.L. Standing balance in patients with whiplash-associated neck pain and idiopathic neck pain when compared with asymptomatic participants: a systematic review. Physiother. Theory Pract. 2013; 29 (1): 1–18.

  20. Cheng C.H., Chien A., Hsu W.L., Yen L.W., Lin Y.H., Cheng H.Y. Changes of postural control and muscle activation pattern in response to external perturbations after neck flexor fatigue in young subjects with and without chronic neck pain. Gait Posture. 2015; 41 (3): 801–807.

  21. Matre D., Arendt-Neilsen L., Knardahl S. Effects of localization and intensity of experimental muscle pain on ankle joint proprioception. Eur. J. Pain. 2002; 6 (4): 245–260.

  22. Sipko T., Kuczyński M. Intensity of chronic pain modifies postural control in low back patients. Eur. J. Pain. 2013; 17 (4): 612–620.

  23. Vuillerme N., Pinsault N. Experimental neck muscle pain impairs standing balance in humans. Exp. Brain. Res. 2009; 192 (4): 723–729.

  24. Ruhe A., Fejer R., Walker B. Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder-A systematic review of the literature. Chiropr. Man Therap. 2011; 19 (1): 13.

  25. Mense S., Gerwin R.D. (ed.). Muscle pain: diagnosis and treatment. Springer Science & Business Media; 2010.

  26. Schikora N., Klunter H., Delank S., Eysel-Gosepath K. Influence of cervical spine stabilization via stiff neck on the postural system in healthy patients: compensation or decompensation of the postural system? Eur. Arch. Otorhinolaryngol. 2010; 267: 1623–1628.

  27. Pedersen J., Sjölander P., Wenngren B.I., Johansson H. Increased intramuscular concentration of bradykinin increases the static fusimotordrive to muscle spindles in neck muscles of the cat. Pain. 1997; 70 (1): 83–91.

  28. Thunberg J., Hellström F., Sjölander P., Bergenheim M., Wenngren B., Johansson H. Influences on the fusimotor-muscle spindle system from chemosensitive nerve endings in cervical facet joints in the cat: possible implications for whiplash induced disorders. Pain. 2001; 91 (1-2): 15–22.

  29. Johansson H., Sjölander P., Djupsjöbacka M., Bergenheim M., Pedersen J. Pathophysiological mechanisms behind work‐related muscle pain syndromes. Am. J. Ind. Med. 1999; 36 (S1): 104–106.

  30. Sjölander P., Johansson H., Djupsjöbacka M. Spinal and supraspinal effects of activity in ligament afferents. J. Electromyogr Kinesiol. 2002; 12 (3): 167–176.

Received 11 July 2019; Accepted 19 September 2019.

 

Information about the authors

Mukhametova El'vira Rishatovna, Junior Researcher, Research and Scientific Laboratory “Locomotor Neurorehabilitation”, Institute of Fundamental Medicine and Biology, Kazan Federal University. 420055, Russia, Kazan, K. Marx St., 76, Building № 2; Neurologist, Primary Healthcare Unit, Kazan Federal University. 420055, Russia, Kazan, Chekhov St., 1a; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0000-0003-1822-8890

Militskova Alena Dmitrievna, Junior Researcher, Research and Scientific Laboratory “Locomotor Neurorehabilitation”, Institute of Fundamental Medicine and Biology, Kazan Federal University. 420055, Russia, Kazan, K. Marx St., 76, Building № 2; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-8078-8170

Baltina Tat'yana Valer'evna, Candidate of Sciences (Biology), Assistant Professor, Chair of Human and Animal Physiology, Institute of Fundamental Medicine and Biology, Kazan Federal University. 420055, Russia, Kazan, K. Marx St., 76, Building № 2; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-3798-7665

 

For citation

Mukhametova E.R., Militskova A.D., Baltina T.V. Postural'naya ustoychivost' u lits s latentnymi triggernymi zonami sheynoy muskulatury [Postural stability in patients with latent trigger zones of neck musculature]. Ulyanovsk Medico-Biological Journal. 2019; 4: 114–123. DOI: 10.34014/2227-1848-2019-4-114-123

 

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УДК 612.829.34

DOI 10.34014/2227-1848-2019-4-114-123

ПОСТУРАЛЬНАЯ УСТОЙЧИВОСТЬ У ЛИЦ С ЛАТЕНТНЫМИ ТРИГГЕРНЫМИ ЗОНАМИ ШЕЙНОЙ МУСКУЛАТУРЫ

Э.Р. Мухаметова, А.Д. Милицкова, Т.В. Балтина

ФГАОУ ВО «Казанский (Приволжский) федеральный университет», г. Казань, Россия

 

Выделяют множество причин развития постуральных нарушений, среди которых дисфункция мышц шейного отдела позвоночника является наиболее спорной.

Цель исследования. Выявить влияние латентных миогенных триггерных зон шейной мускулатуры на постуральную устойчивость.

Материалы и методы. Использовался метод компьютерной стабилографии. Латентные миогенные триггерные зоны (лМТЗ) определялись по наличию в мышце шеи уплотненного узелка или пучка и по повышенной болевой чувствительности в этой области. Оценка постуральной устойчивости у испытуемых с лМТЗ осуществлялась с помощью стандартного стабилографического тестирования и теста Ромберга. В стандартной пробе оценивались как классические, так и векторные показатели.

Результаты. Показано, что у испытуемых с множественными лМТЗ (4 и более) достоверно изменяются только векторные показатели. Так, установлено снижение качества функции равновесия, а также повышение средней линейной скорости центра давления и увеличение нормированной площади векторограммы по сравнению показателями в группе контроля и группе с единичными лМТЗ (от 1 до 3), что указывает на снижение постурального контроля у лиц с множественными лМТЗ. У испытуемых с единичными лМТЗ отмечено достоверное снижение классических показателей и ряда векторных, что свидетельствует об улучшении постуральной устойчивости в данной группе испытуемых. В пробе Ромберга все субъекты с лМТЗ независимо от количества последних показали повышение коэффициента Ромберга.

Выводы. Множественные лМТЗ шейной мускулатуры могут снизить постуральную устойчивость через усиление афферентации от шейных проприорецепторов, что наиболее выражено при элиминации зрительного контроля.

Ключевые слова: латентные миогенные триггерные точки, постуральный контроль, стабилография, тест Ромберга.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

 

Литература

  1. Bronstein A.M. Multisensory integration in balance control. Handb. Clin. Neurol. 2016; 137: 57–66.

  2. Jones K.D., Horak F.B., Winters-Stone K., Irvine J.M., Bennett R.M. Fibromyalgia is associated with impaired balance and falls. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases. 2009; 15 (1): 16–21.

  3. Hasvold T., Johnsen R. Headache and neck or shoulder pain-frequent and disabling complaints in the general population. Scand. J. Prim. Health Care. 1993; 11 (3): 219–224.

  4. Hain T.C. Cervicogenic causes of vertigo. Curr. Opin. Neurol. 2015; 28 (1): 69–73.

  5. Oostendorp R.A.B., van Eupen A.A.J.M., Elvers J.W.H., Bernards J.A. Effects of restrained cervical mobility on involuntary eye movements. J. Man Manip. Ther. 1993; 1 (4): 148–153.

  6. Reid S.A., Rivett D.A. Manual therapy treatment of cervicogenic dizziness: a systematic review. Man ther. 2005; 10 (1): 4–13.

  7. Reid S.A., Rivett D.A., Katekar M.G., Callister R. Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Man Ther. 2008; 13 (4): 357–366.

  8. Sola A.E., Rodenberger M.L., Gettys B.B. Incidence of hypersensitive areas in posterior shoulder muscles. A survey of two hundred young adults. Am. J. Phys. Med. 1955; 34 (6): 585–590.

  9. Sciotti V.M., Mittak V.L., DiMarco L., Ford L.M., Plezbert J., Santipadri E., Ball K. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001; 93 (3): 259–266.

  10. Wade B. Trigger points in the upper trapezius or normal subtrapezial anatomy? Physiother. Can. 2001; 53 (3): 219–222.

  11. Chen S.M., Chen J.T., Kuan T.S., Hong T.S., Hong C.Z. Decrease in pressure pain thresholds of latent myofascial trigger points in the middle finger extensors immediately after continuous piano practice. J. Musculoskelet Pain. 2000; 8 (3): 83–92.

  12. Herdman S.J., Clendaniel R. Vestibular rehabilitation. FA Davis; 2014.

  13. Ryan G.M.S., Cope S. Cervical vertigo. Lancet. 1955; 266 (6905): 1355–1359.

  14. Croft P.R., Lewis M., Papageorgiou A.C., Thomas E., Jayson I.M., Macfarlane G.J., Silman A.J. Risk factors for neck pain: a longitudinal study in the general population. Pain. 2001; 93 (3): 317–325.

  15. Scott J., Huskisson E.C. Graphic representation of pain. Pain. 1976; 2 (2): 175–184.

  16. Gerwin R.D., Shannon S., Hong C.Z., Hubbard D., Gevirtz R. Interrater reliability in myofascial trigger point examination. Pain. 1997; 69 (1-2): 65–73.

  17. Simons D.G. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J. Electromyogr Kinesiol. 2004; 14 (1): 95–107.

  18. Усачев В.И., Доценко В.И., Кононов А.Ф., Артемов В.Г. Новая методология стабилометрической диагностики нарушения функции равновесия тела. Вестник оториноларингологии. 2009; 3: 19–22.

  19. Silva A.G., Cruz A.L. Standing balance in patients with whiplash-associated neck pain and idiopathic neck pain when compared with asymptomatic participants: a systematic review. Physiother. Theory Pract. 2013; 29 (1): 1–18.

  20. Cheng C.H., Chien A., Hsu W.L., Yen L.W., Lin Y.H., Cheng H.Y. Changes of postural control and muscle activation pattern in response to external perturbations after neck flexor fatigue in young subjects with and without chronic neck pain. Gait Posture. 2015; 41 (3): 801–807.

  21. Matre D., Arendt-Neilsen L., Knardahl S. Effects of localization and intensity of experimental muscle pain on ankle joint proprioception. Eur. J. Pain. 2002; 6 (4): 245–260.

  22. Sipko T., Kuczyński M. Intensity of chronic pain modifies postural control in low back patients. Eur. J. Pain. 2013; 17 (4): 612–620.

  23. Vuillerme N., Pinsault N. Experimental neck muscle pain impairs standing balance in humans. Exp. Brain. Res. 2009; 192 (4): 723–729.

  24. Ruhe A., Fejer R., Walker B. Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder-A systematic review of the literature. Chiropr. Man Therap. 2011; 19 (1): 13.

  25. Mense S., Gerwin R.D. (ed.). Muscle pain: diagnosis and treatment. Springer Science & Business Media; 2010.

  26. Schikora N., Klunter H., Delank S., Eysel-Gosepath K. Influence of cervical spine stabilization via stiff neck on the postural system in healthy patients: compensation or decompensation of the postural system? Eur. Arch. Otorhinolaryngol. 2010; 267: 1623–1628.

  27. Pedersen J., Sjölander P., Wenngren B.I., Johansson H. Increased intramuscular concentration of bradykinin increases the static fusimotordrive to muscle spindles in neck muscles of the cat. Pain. 1997; 70 (1): 83–91.

  28. Thunberg J., Hellström F., Sjölander P., Bergenheim M., Wenngren B., Johansson H. Influences on the fusimotor-muscle spindle system from chemosensitive nerve endings in cervical facet joints in the cat: possible implications for whiplash induced disorders. Pain. 2001; 91 (1-2): 15–22.

  29. Johansson H., Sjölander P., Djupsjöbacka M., Bergenheim M., Pedersen J. Pathophysiological mechanisms behind work‐related muscle pain syndromes. Am. J. Ind. Med. 1999; 36 (S1): 104–106.

  30. Sjölander P., Johansson H., Djupsjöbacka M. Spinal and supraspinal effects of activity in ligament afferents. J. Electromyogr Kinesiol. 2002; 12 (3): 167–176.

Поступила в редакцию 11.07.2019; принята 19.09.2019.

 

Авторский коллектив

Мухаметова Эльвира Ришатовна – младший научный сотрудник НИЛ «Двигательная нейрореабилитация» Института фундаментальной медицины и биологии, ФГАОУ «Казанский (Приволжский) федеральный университет». 420055, Россия, г. Казань, ул. К. Маркса, д. 76, корп. 2; врач-невролог, Медико-санитарная часть, ФГАОУ «Казанский (Приволжский) федеральный университет». 420055, Россия, ул. Чехова, г. Казань, д. 1а; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: http://orcid.org/0000-0003-1822-8890

Милицкова Алёна Дмитриевна – младший научный сотрудник НИЛ «Двигательная нейрореабилитация» Института фундаментальной медицины и биологии, ФГАОУ «Казанский (Приволжский) федеральный университет». 420055, Россия, г. Казань, ул. К. Маркса, д. 76, корп. 2; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-8078-8170

Балтина Татьяна Валерьевна – кандидат биологических наук, доцент кафедры физиологии человека и животных Института фундаментальной медицины и биологии, ФГАОУ «Казанский (Приволжский) федеральный университет». 420055, Россия, г. Казань, ул. К. Маркса, д. 76, корп. 2; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-3798-7665

 

Образец цитирования

Мухаметова Э.Р., Милицкова А.Д., Балтина Т.В. Постуральная устойчивость у лиц с латентными триггерными зонами шейной мускулатуры. Ульяновский медико-биологический журнал. 2019; 4: 114–123. DOI: 10.34014/2227-1848-2019-4-114-123