Ultrasonographyinmyofascialneckpain:randomizedclinicaltrialfordiagnosisandfollow-up

Chronic neck pain affects 10-24% of the population, with significant economic and personal costs. While neck pain is common, achieving a definitive diagnosis can be challenging, as the specific source of pain — whether from joints, muscles, or ligaments — is often unclear. This study investigated whether ultrasound imaging could detect changes in the deep fasciae (connective tissue layers) of the neck in people with chronic neck pain, potentially providing an objective diagnostic tool for myofascial pain conditions.

The researchers studied 25 healthy volunteers and 28 patients with chronic neck pain. They used ultrasound to measure the thickness of deep fascial layers around two key neck muscles: the sternocleidomastoid and scalene medius muscles. The ultrasound could distinguish between different layers within the fascia — dense connective tissue (appearing white) and loose connective tissue (appearing black). All participants also had their neck range of motion tested and completed pain questionnaires.

The patients with neck pain were then randomly divided into two treatment groups: one received fascial manipulation (3 sessions of targeted deep massage), while the other received a combination of massage, electrical therapy, and laser treatment (10 sessions). Researchers followed both groups for 6 months to track changes in pain, neck mobility, and fascial thickness.

Patients with chronic neck pain had significantly thicker fasciae compared to healthy controls — about 0.075cm thicker in the sternocleidomastoid muscle area and 0.175cm thicker in the scalene muscle area on the right side. The study established a cut-off value of 0.15cm fascial thickness as potentially diagnostic for myofascial neck pain. The increased thickness was primarily due to expansion of the loose connective tissue layer, not the dense fibrous layers. Both treatment groups experienced pain reduction, but the fascial manipulation group had better and more sustained improvements.

The fascial manipulation group showed pain reduction from 4.7 to 1.5 on a 10-point scale that remained stable at 6 months, while the combination therapy group's pain initially decreased from 5.2 to 2.5 but returned to 3.3 at 6 months. Ultrasound measurements confirmed that fascial thickness decreased with treatment, and this correlated with pain improvement.

This study provides the first objective evidence that chronic neck pain is associated with measurable changes in fascial tissue that can be detected with ultrasound. The 0.15cm thickness cut-off could help clinicians make more accurate diagnoses of myofascial neck pain, moving beyond the current practice of diagnosis by exclusion. The finding that increased thickness is due to loose connective tissue expansion (likely involving hyaluronic acid accumulation) provides insight into the underlying mechanisms of myofascial pain. For patients, this means that ultrasound could potentially confirm their diagnosis and track treatment progress objectively.

The superior results with fascial manipulation suggest that targeted manual therapy addressing fascial restrictions may be more effective than general physical therapy approaches for this condition.