Zusammenfassung
Alle tiefen somatischen Gewebe sind intensiv nozizeptiv und propriozetiv innerviert. Viele dieser Sensoren sind im Normalzustand nur auf starke mechanische Reize schmerzsensibel, können aber im Falle von persistierenden Schmerzreizen oder von lokoregionären Entzündungsvorgängen im Rahmen der Sensibilisierung niederschwellig werden und ihren Charakter ändern. Daher sind der Schmerz und die nozireaktiven Veränderungen stark vom Sensibilisierungsgrad und auch von der zeitlichen Dauer eines Reizes oder der Dysfunktion abhängig. Zwar existieren einige Unterschiede in der Anlage von Gelenk- und Muskelafferenzen, generell gibt es aber keine gewebespezifischen Rezeptoren und keine spezifische spinale bzw. zentrale Verarbeitung. In diesem Sinne „verhalten“ sich die verschiedenen tiefen somatischen Afferenzen nicht unterschiedlich. Die afferente multisensible Konvergenz der ersten Neuronen aller tiefen somatischen Afferenzen am spinalen Hinterhorn führt zum Reizsummenprinzip. Dies bedeutet, dass verschiedene Afferenzen summativ eine verstärkte motorische Reaktion und Schmerzempfindung zur Folge haben können. Gleichzeitig wird die zentrale Verarbeitung bezüglich Reizquellen (Nozigeneratoren) unspezifisch. Konvergenz bedeutet immer auch Informationsverlust bezüglich Diskriminierbarkeit. Die zentralen reflektorischen Verarbeitungsmuster wie auch der Muskeltonus sind komplexen Mechanismen mit multiplen spinalen und supraspinalen Einflüssen unterworfen. Es gibt keinen isolierten γ-gesteuerten Muskeltonus. Der „psychomotorische Link“ funktioniert über die Formatio reticularis, die retikulospinalen Bahnen wirken über den spinalen Interneuronenpool auf die α-/γ-Motoneuronen-Aktivität, die immer als α-/γ-Koaktivierung erfolgt.
Abstract
All deep somatic tissues are intensively innervated by nociceptive and proprioceptive fibers. Under normal conditions many of these sensors are only sensitive to pain by strong mechanical stimuli, but the threshold can be lowered and the character changed in cases of persistent pain stimuli or locoregional inflammatory processes due to sensitization. Therefore, the pain and nociceptive alterations are strongly dependant on the degree of sensitization and also on the duration of a stimulus or the dysfunction. There are some differences in the predisposition of joint and muscle afferent fibers but generally there are no tissue-specific receptors and no specific spinal or central processing. In this sense the various deep somatic afferent fibers do not“behave” differently. The afferent multisensitive convergence of the primary neurons of all deep somatic afferent fibers in the posterior spinal horn leads to the stimulus summation principle. This means that different afferent impulses can result in a stronger motor reaction and pain perception due to summation. Simultaneously, the central processing with respect to the source of the stimuli (nocigenerators) becomes unspecific. Convergence always means loss of information with respect to discrimination. The central reflex processing pattern and also muscle tonus are complex mechanisms subject to multiple spinal and supraspinal influences. There is no isolated γ-driven muscle tonus. The „psychomotor link“ functions via the reticular formation and the reticulospinal tracts function via the spinal interneuronal pool on the α-/γ-motor neuron activity, which is always by α-/γ-coactivation.
Literatur
Arendt-Nielsen L, Laursen RJ, Drewes AM (2000) Referred pain as an indicator for neural plasticity. In: Sandkühler J, Bromm B, Gebhart GF (eds) Nervous system plasticity and chronic pain. Prog Brain Res, vol 129. Elsevier, Amsterdam, pp 343–356
Arendt-Nielsen L, Nie H, Laursen MB et al (2010) Sensitization in patients with painful knee osteoarthritis. Pain 149:573–581
Basmajian JV, Nyberg R (1993) Rational manual therapies. William & Wilkins, Baltimore
Benarroch E (2012) Periaqueductal gray: an interface for behavioral control. Neurology 78:210–217
Blair S, Djupsöbacka M et al (2003) Neuromuscular mechanisms behind chronic work-related myalgias: an overview. In: Johansson H, Windhorst U, Djupsöbacka M et al (eds) Chronic work-related myalgia. Gävle University Press, Gävle, pp 5–46
Böhni Ulrich W, Lauper M, Locher H (2014) Manuelle Medizin 1: Fehlfunktion und Schmerz am Bewegungsorgan verstehen und behandeln. Thieme, Stuttgart
Crameri RM, Aagaard P, Qvortrup K et al (2007) Myofibre damage in human skeletal muscle: effects of electrical stimulation versus voluntary contraction. J Physiol 583:365–380
Dommerholt J, Bron C, Franssen J (2006) Myofacial trigger points: an evidence-informed review. J Man Manip Ther 14:203–221
Ferrell WR, Wood L, Baxendale RH (1988) The effect of acute joint inflammation on flexion reflex excitability in the decerebrate, low spinal cat. Q J Exp Physiol 373:353–365
Freiwald J (2009) Optimales Dehnen: Sport – Prävention – Rehabilitation. Spitta, Balingen
Graven-Nielsen T (2010) Reorganized motor control due to muscle pain. In: Mense S, Gerwin R (eds) Muscle pain – understanding the mechanisms. Springer, Berlin Heidelberg New York, pp 251–268
Hägg GM (1991) Static work load and occupational myalgia – a new explanation model. In: Anderson P, Hobart D, Danoff J (eds) Electromyographical kinesiology. Elsevier, Amsterdam, pp 141–144
Hägg GM (2003) The cinderella hypothesis. In: Johansson H, Windhorst U, Djupsöbacka M et al (eds) Chronic work-related myalgia. Gävle University Press, Gävle, pp 127–132
Headley BJ (1990) EMG and myofascial pain. Clin Manag 10:43–46
Henneman E, Somjen G, Carpenter DO (1965) Excitability and inhibitability of motoneurons of different sizes. J Neurophysiol 28:599–620
Hoheisel U, Mense S, Simons DG, Yu XM (1993) Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain? Neurosci Lett 153:9–12
Hoheisel U, Koch K, Mense S (1994) Functional reorganization in the rat dorsal horn during an experimental myositis. Pain 59:111–118
Hoheisel U, Unger T, Mense S (2005) Excitatory and modulatory effects of inflammatory cytokines and neurotrophins on mechanosensitive group IV muscle afferents in the rat. Pain 114:168–176
Hoheisel U, Unger T, Mense S (2007) Sensitization of rat dorsal horn neurons by NGF-induced subthreshold potentials and low-frequency activation. A study employing intracellular recordings in vivo. Brain Res 1169:34–43
Hostens I, Ramon H (2005) Assessment of muscle fatigue in low level monotonous task performance during car driving. J Electromyogr Kinesiol 15:266–274
Krauspe R, Schmidt M, Schaible H-G (1992) Sensory innervation of the anterior cruciate ligament: an electrophysiological study of the response properties of single identified mechanoreceptors in the cat. J Joint Bone Surg 7:390–397
Kumazawa T, Mizumura K (1976) The polymodal C-fiber receptor in the muscle of the dog. Brain Res 101:589–593
Kumazawa T, Mizumura K (1977) Thin-fibre receptors responding to mechanical, chemical, and thermal stimulation in the skeletal muscle of the dog. J Physiol 273:179–194
Lucas KR, Polus B, Rich (2004) Latent myofascial trigger points: their effects on muscle activation and movement efficiency. J Bodyw Mov Ther 8:160–166
Lund JP, Donga R, Widmer CG, Stohler CS (1991) The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 69:683
Malm C, Sjödin TL, Sjöberg B (2004) Leukocytes, cytokines, growth factors and hormones in human skeletal muscle and blood after uphill or downhill running. J Physiol 556:983–1000
McHugh MP, Connolly DAJ, Easton RG, Gleim GW (1999) Exercise-induced muscle damage and potential mechanisms for the repeated out effect. Sports Med 27(3):151–170
Mense S, Stahnke M (1983) Responses in muscle afferent fibres of slow conduction velocity to contractions and ischaemia in the cat. J Physiol 342:383–397
Mense S (1997) Pathophysiologic basis of muscle pain syndromes. Myofasc pain. Update in diagnosis and treatment. Phys Med Rehabil Clin North Am 82:23–53
Mense S (1999) Neurobiologische Grundlagen von Muskelschmerz. Schmerz 13:3–17
Mense S (2007) Sensorische Nervenendigungen, Mechanorezeptoren. In: Benninghoff A, Drenckhahn D (Hrsg) Anatomie. Bd 2, 16. Aufl. Urban & Fischer, München
Mense S (2009) Protokoll der Wissenschaftstagung der European Scientific Society of Manual Medicine ESSOMM, Bad Horn (beim Verfasser)
Mense S (2009) Algesic agents exciting muscle nociceptors. Exp Brain Res 196:89–100
Mense S (2010) Muscle pain: understanding the mechanisms. Springer, Berlin Heidelberg New York
Mense S (2013) Basics mechanisms of muscle pain. In: Koltzenburg M, McMahon S, Tracey I, Turk D (eds) Textbook of pain, 6. edn. Saunders, Philadelphia
Mitchell LF Jr (1995, 1998, 1999) The muscle energy manual. Vol 1 – 3. MET Press Michigan, East Lancing
Murase S, Terazawa E, Queme F, Mizumura K et al (2010) Bradykinin and nerve growth factor play pivotal roles in muscular mechanical hyperalgesia after exercise (delayed-onset muscle soreness). J Neurosci 30:3752–3761
Myers JB, Hwang JH, Pasquale MR et al (2009) Rotator cuff coactivation ratios in participants with subacromial impingement syndrome. J Sci Med Sport 12:603–608
Neugebauer V, Lücke T, Schaible H-G (1993) N -Methyl- d -aspartate [NMDA] and non-NMDA receptor antagonists block the hyperexcitability of dorsal horn neurons during development of acute arthritis in rat’s knee joint. J Neurophysiol 70:1365–1377
Peck C, Murray G, Gerzina T (2008) How does pain affect jaw muscle activity? The integrated pain adaptation model. Aust Dent J 53:201–207
Schaible H-G, Grubb BD (1993) Afferent and spinal mechanisms of joint pain. Pain 55:5–54
Schaible H-G, Schmidt RF (1988) Time course of mechanosensitivity changes in articular afferents during a developing experimental arthritis. J Neurophysiol 60:2180–2195
Schaible HG (2013) Joint pain – basic mechanisms. In: Koltzenburg M, McMahon S, Tracey I, Turk D (eds) Textbook of pain, 6. edn. Saunders, Philadelphia
Svensson P, Cairns BE, Wang K et al (2003) Injection of nerve growth factor into human masseter muscle evokes long-lasting mechanical allodynia and hyperalgesia. Pain 104:241–247
Hu J, Milenkovic N, Lewin GR (2006) The high threshold mechanotransducer: a status report. Pain 120:3–7
Travell J, Rinzler S, Herman M (1942) Pain and disability of the shoulder and arm. Treatment by intramuscular infiltration with procain hydrochloride. JAMA 120:417–422
Treede RD (2010) Das somatosensorische System. In: Schmidt R (Hrsg) Physiologie des Menschen, 31. Aufl. Springer, Berlin Heidelberg New York
Yu XM, Sessle BJ, Vernon H et al (1995) Effects of inflammatory irritant application to the rat temporomandibular joint on jaw and neck muscle activity. Pain 60:143–149
Einhaltung ethischer Richtlinien
Interessenkonflikt. U. Böhni und R. Gautschi geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Böhni, U., Gautschi, R. Schmerz aus Muskeln und anderen tiefen somatischen Geweben. Manuelle Medizin 52, 190–202 (2014). https://doi.org/10.1007/s00337-014-1109-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00337-014-1109-1