Prevalence of Myofascial Trigger Points in Spinal Disorders: A Systematic Review and Meta-Analysis

  • Alessandro Chiarotto
    Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO+ Institute for Health and Care Research, Vrije Universiteit, Amsterdam, The Netherlands
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  • Ron Clijsen
    Department of Business, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart, Switzerland
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  • Cesar Fernandez-de-las-Penas
    Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

    Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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  • Marco Barbero
    Corresponding author Marco Barbero, PT OMT, Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Stabile Piazzetta, Via Violino 11, CH-6928 Manno, Switzerland.
    Rehabilitation Research Laboratory, Department of Business, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Published:October 14, 2015DOI:



      To retrieve, appraise, and synthesize the results of studies on the prevalence of active and latent myofascial trigger points (MTrPs) in subjects with spinal pain disorders.

      Data Sources

      The databases PubMed, Embase, and CINAHL were searched, with no date or language restrictions. Search terms included controlled and free-text terms for spinal disorders and MTrPs. Further searches were conducted in Google Scholar and by contacting 3 experts in the field. Citation tracking of eligible studies was performed.

      Study Selection

      Two reviewers independently selected observational studies assessing the prevalence of active and/or latent MTrPs in at least 1 group of adults with a spinal disorder. Twelve studies met the eligibility criteria.

      Data Extraction

      Methodologic quality was assessed by 2 reviewers independently using a modified version of the Downs and Black checklist. Two reviewers also used a customized form to extract studies and subjects' characteristics and the proportions of subjects with active and/or latent MTrPs in each muscle assessed.

      Data Synthesis

      A meta-analysis was performed when there was sufficient clinical homogeneity in at least 2 studies for the same spinal disorder. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the body of evidence in each meta-analysis. A qualitative description of the results of single studies was provided. Low-quality evidence underpinned pooled estimates of MTrPs in the upper-body muscles of subjects with chronic neck pain. The point prevalence of MTrPs in different muscles of other disorders (eg, whiplash-associated disorders, nonspecific low back pain) was extracted from single studies with low methodologic quality and small samples. Active MTrPs were found to be present in all assessed muscles of subjects diagnosed with different spinal pain disorders. Latent MTrPs were not consistently more prevalent in subjects with a spinal disorder than in healthy controls.


      The MTrPs point prevalence estimates in this review should be viewed with caution because future studies with large samples and high methodologic quality are likely to change them substantially.


      List of abbreviations:

      CI (confidence interval), CR (cervical radiculopathy), LBP (low back pain), MTrP (myofascial trigger point), NP (neck pain), NSLBP (nonspecific low back pain), OR (odds ratio), WAD (whiplash-associated disorder)
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