Super ﬁ cial fascia displacement in cervical ﬂ exion: di ﬀ erentiating myofascial pain syndrome, a cross-sectional study

Context: Myofascial pain syndrome (MPS) is primarily characterized by myofascial trigger points related to fascial adhesions. MPS hinders fascial ﬂ exibility and mobility, leading to myofascial limitations, dysfunctional movement, and limitation of motion (LOM). Objectives: This study determined the association of age, sex, type of work, symptom chronicity, symptom laterality, cervical LOM, altered direction of fascial displacement, and magnitude of super ﬁ cial fascial displacement during active cervical ﬂ exion with the clinical diagnosis of MPS. Methods: A cross-sectional study selectively included MPS and non-MPS participants from di ﬀ erent workplaces from January to October 2019. The MPS group exhibited clinical symptoms like tender spots, recognized pain patterns, and local twitch response upon palpation, often accompanied by cervical LOM. The non-MPS group lacked these symptoms, and those with certain pre-existing conditions or recent physiotherapy were not part of the study. Participants performed cervical active range of motion (AROM) while a so-nographer recorded super ﬁ cial fascial displacement utilizing ultrasound, which was later analyzed by three physiotherapists with the Tracker. Aiming for a multiple regression R-squared of 0.2, the target was 384 participants to account for a 20 % dropout, resulting in 307 participants after attrition. To explore the relationships between MPS and various factors, logistic regression models, rigorously tested for reliability and validity, were utilized. Results: In the study, there were 192 participants with MPS and 137 without MPS. The median ages were 33 years for the non-MPS group and 38 years for the MPS group. The adjusted model found signi ﬁ cant links for sex (odds ratio [OR]=2.63, p<0.01), symptom chronicity (OR=8.28, p<0.01), and cervical LOM (OR=3.77, p=0.01). However, age and the presence of nodules/taut bands were not statistically signi ﬁ cant (p>0.05). Also, the type of work, the direction of fascial displacement, and the di ﬀ erence in super ﬁ cial fascial displacement during cervical ﬂ exion did not show a signi ﬁ cant association with the clinical diagnosis of MPS (p>0.05). The adjusted model had a sensitivity of 73.80 % and a speci ﬁ city of 81.34 %, correctly identifying 84.66 % of positive cases and 68.99 % of negative ones, resulting in an overall accuracy of 76.95 % in predicting MPS. Conclusions: We provided an in-depth examination of MPS, identifying sex, duration of symptoms, and cervical LOM as signi ﬁ cant predictive factors in its diagnosis. The study emphasizes the critical role of these variables in the accurate diagnosis of MPS, while delineating the comparatively minimal diagnostic value of other factors such as age, type of occupation, presence of nodules or taut bands, and variations in fascial displacement. This study underscores the imperative for further scholarly inquiry into the role of fascial involvement in musculoskeletal disorders, with the objective of enhancing both the theoretical understanding and diagnostic practices in this medical domain.