Myofascial Trigger Points, Pain, Disability, and Sleep Quality in Patients with Chronic Nonspecific Low Back Pain

Authors

  • Juan J. Iglesias-González PT,

    1. Department of Physical Therapy, Universidad de Salamanca, Salamanca, Spain
    Search for more papers by this author
  • María T. Muñoz-García PT,

    1. Department of Physical Therapy, Mutua de Accidentes de Trabajo y Enfermedades de la Seguridad Social (FREMAP), Avila, Spain
    Search for more papers by this author
  • Daiana P. Rodrigues-de-Souza PT, MSc,

    1. Department of Human Anatomy and Histology, Universidad de Salamanca, Salamanca, Spain
    Search for more papers by this author
  • Francisco Alburquerque-Sendín PT, PhD,

    1. Department of Physical Therapy, Universidad de Salamanca, Salamanca, Spain
    Search for more papers by this author
  • César Fernández-de-las-Peñas PT, PhD

    Corresponding author
    1. Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
    • Reprint requests to: César Fernández de las Peñas, PT, PhD, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón (Madrid) 28922, Spain. Tel: +34-91-488-88-84; Fax: +34-91-488-89-57; E-mail: cesar.fernandez@urjc.es.

    Search for more papers by this author

  • Disclosures: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.
  • 1) No funds were received for this study; 2) no financial benefits are derived to the authors from this study; 3) data from this study have not been presented in any other form.

Abstract

Objective

To investigate the difference in the presence of trigger points (TrPs) between patients with chronic nonspecific low back pain (LBP) and healthy people, and to determine the relationship of TrPs with the intensity of ongoing pain, disability, and sleep quality.

Design

A cross-sectional study.

Setting

The role of TrPs in LBP has not been determined.

Patients

Forty-two patients with nonspecific LBP (50% women), aged 23–55 years old, and 42 age- and sex-matched controls participated.

Outcome Measures

TrPs were bilaterally explored within the quadratus lumborum, iliocostalis lumborum, psoas, piriformis, gluteus minimus, and gluteus medius muscles in a blinded design. TrPs were considered active if the subject recognized the local and referred pain as familiar symptoms, and TrPs were considered latent if the pain was not recognized as a familiar symptom. Pain measures were collected with a numerical pain rate scale, disability was assessed with the Roland–Morris questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index.

Results

Patients with nonspecific LBP exhibited a greater disability and worse sleep quality than healthy controls (P < 0.001). Patients with nonspecific LBP exhibited a mean of 3.5 ± 2.3 active TrPs. Further, patients with nonspecific LBP showed a greater (P < 0.001) number of latent TrPs (mean: 2.0 ± 1.5) than healthy controls (mean: 1.0 ± 1.5). Active TrPs in the quadratus lumborum, iliocostalis lumborum, and gluteus medius muscles were the most prevalent in patients with nonspecific LBP. A greater number of active TrPs was associated with higher pain intensity (rs = 0.602; P < 0.001) and worse sleep quality (rs = 0.338; P = 0.03).

Conclusions

The local and referred pain elicited by active TrPs in the back and hip muscles contributes to pain symptoms in nonspecific LBP. Patients had higher disability and worse sleep quality than controls. The number of active TrPs was associated with pain intensity and sleep quality. It is possible that a complex interaction among these factors is present in patients with nonspecific LBP.

Ancillary