Abstract
BackgroundMyofascial trigger points (MTrPs) are hyperirritable areas in the fascia of the affected muscle, possibly related to mitochondrial impairment. They can result in pain and hypoxic areas within the muscle. This pilot study established a minimally invasive biopsy technique to obtain high-quality MTrP tissue samples to evaluate mitochondrial function via high-resolution respirometry. Secondary objectives included the feasibility and safety of the biopsy procedure.MethodsTwenty healthy males participated in this study, 10 with a diagnosis of myofascial pain in the musculus (m.) trapezius MTrP (TTP group) and 10 with a diagnosis of myofascial pain in the m. gluteus medius (GTP group). Each participant had 2 muscle biopsies taken in one session. The affected muscle was biopsied followed by a biopsy from the m. vastus lateralis to be used as a control. Measurements of oxygen consumption were carried out using high-resolution respirometry.ResultsMitochondrial respiration was highest in the GTP group compared to the TTP group and the control muscle whereas no differences were observed between the GTP and the control muscle. When normalizing respiration to an internal reference state, there were no differences between muscle groups. None of the participants had hematomas or reported surgical complications. Patient-reported pain was minimal for all 3 groups. All participants reported a low procedural burden.ConclusionsThis pilot study used a safe and minimally invasive technique for obtaining biopsies from MTrPs suitable for high-resolution respirometry analysis of mitochondrial function. The results suggest that there are no qualitative differences in mitochondrial function of MTrPs of the trapezius and gluteus medius muscles compared to the vastus lateralis control muscle, implying that alterations of mitochondrial function do not appear to have a role in the development of MTrPs.Trial registrationRegistered as No. 20131128–850 at the Coordinating Center for Clinical Studies of the Medical University of Innsbruck, trial registration date: 28th November 2013 and retrospectively registered on 11th of October 2018 at ClinicalTrials.gov with the ID NCT03704311.
Highlights
Myofascial trigger points (MTrPs) are hyperirritable areas in the fascia of the affected muscle, possibly related to mitochondrial impairment
Study design and participants In this prospective cohort pilot study using high-resolution respirometry to evaluate mitochondrial function in MTrPs, the primary endpoints were mitochondrial function expressed as oxygen flux (JO2; pmol O2.s− 1.mg− 1) and flux control ratios (FCR)
complex I (CI) + maximal electron transfer capacity (ETC) of CI and Complex II (CII) (IIE) of the trapezius myofascial trigger point (TTP) was lower compared to the control m. vastus lateralis (131.5 ± 55.5 vs 100.5 ± 30.8 pmol.s− 1.mg− 1, p < 0.05)
Summary
Myofascial trigger points (MTrPs) are hyperirritable areas in the fascia of the affected muscle, possibly related to mitochondrial impairment. They can result in pain and hypoxic areas within the muscle. Myofascial pain syndrome is a leading cause of chronic musculoskeletal pain [1] with a lifetime incidence estimated to be up to 85% [2, 3] It is characterized by local and referred pain, weakness, and restricted mobility [2]. MTrPs are palpable, taut bands found in stiff muscle that cause spontaneous pain (active MTrPs) or pain provoked by compression of the nodule (latent MTrPs) [2, 6] This pain is often referred to other parts of the body, even in the absence of persisting nerve damage. Paresthesia, muscle weakness without primary atrophy, restricted mobility, proprioceptive disorders with impaired coordination, and autonomic reactions can be caused by MTrPs [2, 6]
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