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Trigger Points and Pressure Pain Hypersensitivity in People With Postmeniscectomy Pain

Torres-Chica, Bárbara PT, PhD*; Núñez-Samper-Pizarroso, César MD; Ortega-Santiago, Ricardo PT, PhD*,‡,§; Cleland, Joshua A. PT, PhD∥,¶,#; Salom-Moreno, Jaime PT, PhD*,‡,§; Laguarta-Val, Sofía PT, PhD*; Fernández-de-las-Peñas, César PT, PhD, DMSc*,‡,§

doi: 10.1097/AJP.0000000000000109
Original Articles

Objectives: The objectives of this study are (1) to assess the presence of myofascial trigger points (TrPs) and widespread pressure hyperalgesia; and (2) to assess the relationship between the presence of active TrPs, pain intensity, and widespread pressure hypersensitivity in individuals with postmeniscectomy pain.

Methods: Thirty-three patients with postmeniscectomy pain, 46 to 60 years of age, and 33 matched controls participated. TrPs were explored bilaterally within the tensor fasciae latae, rectus femoris, vastus lateralis, vastus medialis, adductor magnus, adductor longus, semitendinosus, biceps femoris, and gastrocnemius muscles in a blinded manner. TrPs were considered active if the referred pain reproduced knee symptoms. Pressure pain thresholds (PPT) were also assessed bilaterally over the vastus medialis, vastus lateralis, patellar tendon, second metacarpal, and tibialis anterior. Pain was collected with a numerical pain rate scale (0 to 10).

Results: Patients with postmeniscectomy pain showed a greater (P<0.001) number of active TrPs (mean: 2±1) and a similar number (P=0.611) of latent TrPs (mean: 4±4) than pain-free controls (mean latent TrP: 4±1). A greater number of active TrPs was associated with higher pain intensity (r=0.352; P=0.045). Patients also exhibited reduced PPT over the affected vastus medialis and patellar tendon (P<0.05) and bilaterally over the tibialis anterior muscle (P=0.001). A greater the number of active muscle TrPs was also associated with widespread pressure pain hyperalgesia.

Conclusions: The referred pain elicited by active TrPs reproduced knee symptoms in patients with postmeniscectomy pain. Patients also showed localized reduction of PPT. The number of TrPs was associated with the intensity of pain and pressure hyperalgesia. Our findings suggest the presence of peripheral sensitization in patients with postmeniscectomy pain could be associated with the presence of active TrPs.

*Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation

Esthesiology Laboratory

§Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón

Cirugía Ortopédica y Traumatológica del Hospital Quirón San Camilo, Madrid, Spain

Department of Physical Therapy, Franklin Pierce University

Rehabilitation Services, Concord Hospital, Concord, NH

#Manual Therapy Fellowship Program, Regis University, Denver, CO

The authors declare no conflict of interest.

Reprints: César Fernández-de-las-Peñas, PT, PhD, DMSc, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, Madrid 28922, Spain (e-mail:

Received February 19, 2014

Received in revised form May 2, 2014

Accepted April 7, 2014

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