Department of Physical
Medicine and Rehabilitation, Tri-Service General
Hospital, Taipei, Taiwan
We describe a 44-year-old female patient
with unusually severe muscle tightness in upper
trapezius, levator scapulae, scalenes and the
suboccipital extensors pain, which are
ascribable to subcutaneous posterior cervical
and thoracic trigger points. She was referred to
our department for further rehabilitation
therapy because of the muscle pain, which was in
accordance with marked hyperesthesia, but
without referred (distant) pain. She had no
history of hypertension, diabetes mellitus,
dyslipidemia or cardiac arrhythmia. There were
no specific illnesses in her family
background.
Results of all laboratory tests were within
normal limits. A possible contribution might
come from the preexisting degenerative change of
cervical spine found on the plain films.
Maneuver of self-myofascial release (SMR)
together with stretching exercise learned from
our therapist was used to improve myofascial
restrictions and to restore soft-tissue
extensibility.
Interestingly, several days later, excessive
yawning developed when- ever she was performing
SMR in our physiotherapy room (Fig). The patient
signed informed consent for the publication of
her photographs for the purposes of this
research report.
Discussion
Myofascial pain syndrome (MPS), a kind of
non-articular musculoskeletal problem, is a
painful condition associated with regional pain
and muscle tenderness depicted by the presence
of myofascial trigger points (MTPs) with
hypersensitive nodules. The signs and symptoms
associated with MPS include taut muscular bands,
palpable nodules, pain are exacer- bated by
stress and referred pain patterns.
There has been no consensus to diagnose the
criteria of MPS, but it is commonly agreed that
pain is a significant manifestation arising from
MTPs. MTPs are manifested as focal muscle
contracture on which pressure induces pain and
twitching responses.
With regard to the treatment of MTPs, the
therapeutic effect on the muscle contractions
has been suggested to be due to stretch and
relaxation of the involved deep muscle fibers
possibly resolving the local ischemia postulated
as underlying cause of the pain. Considering
another treatment, the SMR is a technique used
to mitigate myofascial restrictions and restore
the extensible structure of soft-tissue.
Niddam et al. have recently provided
evidence that the intervention of MTP at least
partially involves supraspinal pain control via
midbrain periaquaduct gray (PAG). In addition,
van der Plas et al. suggested the PAG involving
in the hypotensive pathway can be activated by
the electrical stimulation of hypothalamic
areas. The above points of view imply that the
central modulation of pain evoked from MTP
might be connected to excessive yawning via
spinothalamic tract, PAG and
hypothalamus.
Regarding the relationship between excessive
yawning and thermoregulation, excessive yawning
has been noted as a symptom of abnormal
thermoregulation influenced by hypothalamus.
However, further research should be performed to
identify the possible connection between
specific thermal responsiveness of ventromedial
hypothalamic neurons and yawning induced by the
stimulation of MTPs in addition to the
nonthermal-related excessive yawning.
Excessive yawning shown in the patients
series of photos obtained whenever she is
performing self-myofascial release.
When she yawned, she squeezed her eyes
tightly shut with her jaw tightened, nostrils
flared as her mouth stretches open wide followed
by a satisfied sigh with her eyes watered.
Isbir CA.
Treatment of a Patient with Glossopharyngeal
Neuralgia by the Anterior Tonsillar Pillar
Method.Case Rep Neurol. 2011;3(1):27&endash;31.
