Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Cervical muscle diseases are associated with indefinite and various symptoms in the whole body



Patients with various and indefinite symptoms in the whole body occasionally have coincident with stiffness or tenderness of the cervical muscles. This prospective case series examined the effect of local modulation of the cervical muscles in patients with cervical disorders reporting indefinite whole-body symptoms.


A total of 1863 hospitalized patients with cervical disorders accompanying three or more indefinite whole-body symptoms, who were resistant to outpatient care, were enrolled in this study for 12 years. All patients underwent daily physical therapies to the cervical muscles during hospitalization. Self-rated records on the medical interview sheets documenting 30 representative symptoms including cervical/shoulder pain or stiffness and 28 representative indefinite whole-body symptoms at admission and discharge were compared across the population.


The number of symptoms decreased significantly with the local modulation of the cervical muscles during hospitalization. All of the 28 indefinite whole-body symptoms at admission showed recovery rates greater than 50% at discharge. The mean number of symptoms decreased significantly from 17.8 at admission to 7.4 at discharge (p < 0.0001). The percentages of patients reporting 10 or more symptoms were 91.1% and 29.3% at admission and discharge, respectively. Moreover, 8.2% of patients reported no residual symptoms at discharge.


Cervical muscle lesions may contribute to indefinite whole-body symptoms, possibly through dysfunction of the parasympathetic nervous system in the muscles. Local modulation of cervical muscles could lead to a breakthrough in the management of patients with indefinite whole-body symptoms.

Trial registration ID


Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


  1. 1.

    Matsui T, Ii K, Hojo S, Sano K (2012) Cervical neuro-muscular syndrome: discovery of a new disease group caused by abnormalities in the cervical muscles. Neurol Med Chir 52:75–80. https://doi.org/10.2176/nmc.52.75

  2. 2.

    Matsui T, Iwata M, Endo Y, Shitara N, Hojo S, Fukuoka H, Hara K, Kawaguchi H (2019) Effect of intensive inpatient physical therapy on indefinite whole-body symptoms in patients with whiplash-associated disorders. BMC Musculoskelet Disord 20:251–258. https://doi.org/10.1186/s12891-019-2621-1

  3. 3.

    Gockel M, Lindholm H, Niemisto L, Hurri H (2008) Perceived disability but not pain is connected with autonomic nervous system function among people with chronic low back pain. J Rehabil Med 40:355–358. https://doi.org/10.2340/16501977-0172

  4. 4.

    Martinez-Lavin M (2007) Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther 9:216–223. https://doi.org/10.1186/ar2146

  5. 5.

    Greening J, Lynn B, Leary R (2003) Sensory and autonomic function in the hands of patients with sensory and autonomic function in the hands of patients with non-specific arm pain (NSAP) and asymptomatic office workers. Pain 104:275–281. https://doi.org/10.1016/S0304-3959(03)00010-1

  6. 6.

    Wang Y, Zekveld AA, Naylor G, Ohlenforst B, Jansma EP, Lorens A, Lunner T, Kramer SE (2016) Parasympathetic nervous system dysfunction, as identified by pupil light reflex, and its possible connection to hearing impairment. PLoS ONE 11:e0153566. https://doi.org/10.1371/journal.pone.0153566

  7. 7.

    Kang DH, Jeon JK, Lee JH (2015) Effects of low-frequency electrical stimulation on cumulative fatigue and muscle tone of the erector spinae. J Phys Ther Sci 27:105–108. https://doi.org/10.1589/jpts.27

  8. 8.

    Lai CH, Leung TK, Peng CW, Chang KH, Lai MJ, Lai WF, Chen SC (2014) Effects of far-infrared irradiation on myofascial neck pain: a randomized, double-blind, placebo-controlled pilot study. J Altern Complement Med 20:123–129. https://doi.org/10.1089/acm.2013.0122

  9. 9.

    Narita A, Shirai K, Kubota N, Takayama R, Takahashi Y, Onuki T, Numakura C, Kato M, Hamada Y, Sakai N, Ohno A, Asami M, Matsushita S, Hayashi A, Kumada T, Fujii T, Horino A, Inoue T, Kuki I, Asakawa K, Ishikawa H, Ohno K, Nishimura Y, Tamasaki A, Maegaki Y, Ohno K (2014) Abnormal pupil light reflex with chromatic pupillometry in Gaucher disease. Ann Clin Transl Neurol 1:135–140. https://doi.org/10.1002/acn3.33

  10. 10.

    Ishikawa H, Onodera A, Asakawa K, Nakadomari S, Shimizu K (2012) Effects of selective-wavelength block filters on pupil light reflex under red and blue light stimuli. Jpn J Ophthalmol 56:181–186. https://doi.org/10.1007/s10384-011-0116-1

  11. 11.

    Ghasemi A, Zahediasl S (2012) Normality tests for statistical analysis: a guide for non-statisticians. Int J Endocrinol Metab 10:486–489. https://doi.org/10.5812/ijem.3505

  12. 12.

    Gordon T (2016) Electrical stimulation to enhance axon regeneration after peripheral nerve injuries in animal models and humans. Neurotherapeutics 13:295–310. https://doi.org/10.1007/s13311-015-0415-1

  13. 13.

    Wang JL, Lin YC, Young TH, Chen MH (2019) Far-infrared ray radiation promotes neurite outgrowth of neuron-like PC12 cells through AKT1 signaling. J Formos Med Assoc 118:600–610. https://doi.org/10.1016/j.jfma.2018.08.015

  14. 14.

    Illomei G (2016) Muscle elastography in multiple sclerosis spasticity. Neurodegener Dis Manag 6:13–16. https://doi.org/10.2217/nmt-2016-0048

  15. 15.

    Paluch Ł, Noszczyk BH, Walecki J, Osiak K, Kiciński M, Pietruski P (2018) Shear-wave elastography in the diagnosis of ulnar tunnel syndrome. J Plast Reconstr Aesthet Surg 71:1593–1599. https://doi.org/10.1016/j.bjps.2018.08.018

  16. 16.

    Han DG, Lee CJ (2009) Headache associated with visceral disorders is “parasympathetic referred pain”. Med Hypotheses 73:561–563. https://doi.org/10.1016/j.mehy.2009.05.047

  17. 17.

    Fredriksen TA, Antonaci F, Sjaastad O (2015) Cervicogenic headache: too important to be left un-diagnosed. J Headache Pain 16:6–9. https://doi.org/10.1186/1129-2377-16-6

  18. 18.

    Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tawfik OM (2006) Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Pract 6:89–95. https://doi.org/10.1111/j.1533-2500.2006.00068.x

  19. 19.

    Berry SM, Broglio K, Bunker M, Jayewardene A, Olin B, Rush AJ (2013) A patient- level meta-analysis of studies evaluating vagus nerve stimulation therapy for treatment-resistant depression. Med Devices (Auckl) 6:17–35. https://doi.org/10.2147/MDER.S41017

  20. 20.

    Sterling M, Hendrikz J, Kenardy J (2011) Similar factors predict disability and posttraumatic stress disorder trajectories after whiplash injury. Pain 152:1272–1278. https://doi.org/10.1016/j.pain.2011.01.056

  21. 21.

    Pollock K, Dorstyn D, Butt L, Prentice S (2017) Posttraumatic stress following spinal cord injury: a systematic review of risk and vulnerability factors. Spinal Cord 55:800–811. https://doi.org/10.1038/sc.2017.45

Download references


The authors thank Mrs. Hiroki Fujii, Tomohiko Kaneko, and Naoto Yanagi at our institutions for their invaluable technical assistance.


There was no funding associated with this study. The patients were hospitalized for intensive treatment and detailed examinations, but not for this study. The cost of treatment was borne partly by the patients and partly by the Japanese national insurance.

Author information

TM conceived the idea and conception of the performed study. Initiation of the study was done by TM, MI, YE, NS, and HK. TM and HK conducted the ethical approval. Data acquisition was performed by TM, MI, YE, NS, SH, HF, and HK. Data interpretation were carried out by TM, KH, NY and HK. NY and HK performed the statistical analysis. TM and HK were responsible for writing the initial manuscript. Figure design was undertaken by TM and HK. Proofreading was carried out by all authors. All authors gave approval of the submitted version of the manuscript.

Correspondence to Hiroshi Kawaguchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

The study was conducted with the approval of the institutional review board of Tokyo Neurological Center and Matsui Hospital. All participants provided written consent to participate in the study. All rights of the patients were protected against any kind of disadvantage and individual matters.

Consent for publication

Not applicable. We are permitted to reproduce copyrighted materials.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Matsui, T., Hara, K., Kayama, T. et al. Cervical muscle diseases are associated with indefinite and various symptoms in the whole body. Eur Spine J (2020). https://doi.org/10.1007/s00586-019-06233-5

Download citation


  • Cervical disorder
  • Indefinite symptom
  • Treatment
  • Cervical muscle
  • Parasympathetic nerve