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Association Between Clinical and Neurophysiological Outcomes in Patients With Mechanical Neck Pain and Whiplash-associated Disorders

Castaldo, Matteo PT*,†,‡; Catena, Antonella PT*; Chiarotto, Alessandro PT, MSc§; Villafañe, Jorge H. PT, PhD, MSc; Fernández-de-las-Peñas, César PT, PhD, Dr Med Sci†,¶; Arendt-Nielsen, Lars PhD, Dr Med Sci

doi: 10.1097/AJP.0000000000000532
Original Articles

Objectives: To investigate the association between pain, disability, trigger points (TrPs), and pressure pain thresholds (PPTs) in patients with mechanical neck pain (MNP) or whiplash-associated disorders (WAD).

Materials and Methods: In total, 46 MNP and 51 WAD patients underwent a physical examination consisting of cervical range of motion, PPTs in the upper trapezius and tibialis anterior muscles, TrPs examination in the upper trapezius, and collection of clinical data including disability, pain intensity, and spontaneous symptomatic pain area.

Results: A significantly moderate positive association between pain and disability was found in both groups (P<0.01). Significantly negative associations between pain intensity and PPT in the upper trapezius (P=0.008 and 0.041), pain and PPT in tibialis anterior (P=0.015 and 0.038), disability and PPT in upper trapezius (both, P=0.006) were also found in both MNP and WAD groups. Individuals with MNP showed significantly positive association between pain area and disability (P=0.034) and negative association between disability and PPT in the tibialis anterior (P=0.003). Patients with active TrPs in the upper trapezius exhibited higher intensity of neck pain, higher neck disability, and lower PPTs than those with latent TrPs in upper trapezius in both groups.

Discussion: The association between pain, disability, and PPTs is common in patients with neck pain regardless of the origin of neck pain. The presence of active TrPs was related to higher pain intensity and related-disability and lower PPTs.

*Poliambulatorio FisioCenter, Collecchio, Parma

University of Siena, Siena

IRCCS Don Gnocchi Foundation, Milan, Italy

SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark

§Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO+ Institute for Health and Care Research, VU University, Amsterdam, The Netherlands

Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain

The authors declare no conflict of interest.

Reprints: Lars Arendt-Nielsen, PhD, Dr Med Sci, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D3, DK-9200 Aalborg, Denmark (e-mail:

Received December 15, 2016

Received in revised form June 8, 2017

Accepted June 16, 2017

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