{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T20:53:20Z","timestamp":1789505600637,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T00:00:00Z","timestamp":1659052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>The natural history and clinical course of tension-type headache and non-specific low back pain are reconsidered. By closer examination, these two conditions appear to share several specific clinical features. Both are muscular pain conditions along the spine, they have a preponderance in women, they may occur spontaneously or follow a trivial traumatic incident, and they both have a high risk of chronicity. The affected muscles are tender with tender points. EMG indicates diffuse hyperactivity and abnormal activation pattern, and motor control of the affected muscles and adjacent muscle groups is discoordinated. These shared features suggest analogous pathophysiology involving the neuromotor control of affected and adjacent muscle groups in the cervical and lumbar regions, respectively. As recently suggested for the whiplash disease, we suggest the term spinal dyssynergia for this specific pattern of pathology. This suggestion provides a new perspective for the understanding of these diseases by placing their cause within the central nervous system and not in the spine or spinal musculature. This perspective warrants further clinical, neurophysiological, and neuropharmacological studies of this \u2018family\u2019 of common yet poorly understood clinical muscular pain conditions along the spine.<\/jats:p>","DOI":"10.3389\/fneur.2022.912348","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T06:22:02Z","timestamp":1659075722000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Tension-type headache and low back pain reconsidered"],"prefix":"10.3389","volume":"13","author":[{"given":"Jens","family":"Astrup","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finn","family":"Gyntelberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1046\/j.1468-2982.1999.019006602.x","article-title":"Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies","volume":"19","author":"Jensen","year":"1999","journal-title":"Cephalalgia"},{"key":"B2","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1038\/s41582-019-0243-8","article-title":"Post-traumatic headache: epidemiology and pathophysiological insights","volume":"15","author":"Ashina","year":"2019","journal-title":"Nat Rev Neurol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/1471-2474-9-90","article-title":"Altered motor control patterns in whiplash and chronic neck pain","volume":"9","author":"Woodhouse","year":"2008","journal-title":"BMC Musculoskelet Disord."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1097\/BRS.0b013e3181e7fc0a","article-title":"The Fly: a new clinical assessment and treatment method for deficits of movement control in the cervical spine: reliability and validity","volume":"35","author":"Kristjansson","year":"2010","journal-title":"Spine."},{"key":"B5","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1111\/ane.13473","article-title":"Impaired neck motor control in chronic whiplash and tension-type headache","volume":"144","author":"Astrup","year":"2021","journal-title":"Acta Neurol Scand."},{"key":"B6","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1046\/j.1468-2982.1996.1602097.x","article-title":"Muscular disorders in tension-type headache","volume":"16","author":"Jensen","year":"1996","journal-title":"Cephalalgia."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.1097\/01.BRS.0000128759.02487.BF","article-title":"Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task","volume":"29","author":"Falla","year":"2004","journal-title":"Spine."},{"key":"B8","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1111\/j.1468-2982.2008.01584.x","article-title":"Cervical muscle co-activation in isometric contractions is enhanced in chronic tension-type headache patients","volume":"28","author":"Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2008","journal-title":"Cephalalgia"},{"key":"B9","doi-asserted-by":"publisher","first-page":"784","DOI":"10.2519\/jospt.2010.3405","article-title":"Altered scapular orientation during arm elevation in patients with insidious onset neck pain and whiplash-associated disorder","volume":"40","author":"Helgadottir","year":"2010","journal-title":"J Orthop Sports Phys Ther"},{"key":"B10","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1123\/jab.27.3.181","article-title":"Altered alignment of the shoulder girdle and cervical spine in patients with insidious onset neck pain and whiplash-associated disorder","volume":"27","author":"Helgadottir","year":"2011","journal-title":"J Appl Biomech"},{"key":"B11","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1093\/pm\/pnw292","article-title":"Relationship of the lateral rectus muscle, the supraorbital nerve, and binocular coordination with episodic tension-type headaches frequently associated with visual effort","volume":"18","author":"Cachinero-Torre","year":"2017","journal-title":"Pain Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/S0304-3959(02)00420-7","article-title":"Development of motor system dysfunction following whiplash injury","volume":"103","author":"Sterling","year":"2003","journal-title":"Pain."},{"key":"B13","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1097\/01.BRS.0000105535.12598.AE","article-title":"Characterization of acute whiplash-associated disorders","volume":"29","author":"Sterling","year":"2004","journal-title":"Spine (Phila Pa 1976)"},{"key":"B14","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/S1356-689X(03)00086-9","article-title":"Dall'Alba P. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients","volume":"9","author":"Jull","year":"2004","journal-title":"Man Ther."},{"key":"B15","doi-asserted-by":"publisher","first-page":"376","DOI":"10.2340\/16501977-1120","article-title":"Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain: a cross-sectional study","volume":"45","author":"Juul-Kristensen","year":"2013","journal-title":"J Rehabil Med."},{"key":"B16","doi-asserted-by":"crossref","DOI":"10.1097\/00007632-200008010-00012","article-title":"Cervical muscle dysfunction in the chronic whiplash associated disorder grade II (WAD-II)","author":"Nederhand","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s13643-019-1125-2","article-title":"Electronic measures of movement impairment, repositioning, and posture in people with and without neck pain-a systematic review","volume":"8","author":"Hesby","year":"2019","journal-title":"Syst Rev"},{"key":"B18","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1080\/15389588.2019.1601716","article-title":"Low-velocity motor vehicle collision characteristics associated with claimed low back pain","volume":"20","author":"Fewster","year":"2019","journal-title":"Traffic Inj Prev."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"Hartvigsen","year":"2018","journal-title":"Lancet"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1097\/01.BRS.0000067565.16832.B9","article-title":"Large-array surface electromyography in low back pain: a pilot study","volume":"28","author":"Finneran","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/j.jelekin.2005.08.004","article-title":"Classification of large array surface myoelectric potentials from subjects with and without low back pain","volume":"16","author":"Reger","year":"2006","journal-title":"J Electromyogr Kinesiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1007\/s00586-010-1543-2","article-title":"Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature","volume":"20","author":"Ruhe","year":"2011","journal-title":"Eur Spine J."},{"key":"B23","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.gaitpost.2012.06.013","article-title":"Low back pain and postural sway during quiet standing with and without sensory manipulation: a systematic review","volume":"37","author":"Mazaheri","year":"2013","journal-title":"Gait Posture."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1080\/09638288.2018.1433240","article-title":"Is standing balance altered in individuals with chronic low back pain? a systematic review","volume":"41","author":"Berenshteyn","year":"2019","journal-title":"Disabil Rehabil."},{"key":"B25","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s11556-021-00263-z","article-title":"Effects of low back pain on balance performance in elderly people: a systematic review and meta-analysis","volume":"18","author":"Ge","year":"2021","journal-title":"Eur Rev Aging Phys Act."},{"key":"B26","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.clinbiomech.2005.01.007","article-title":"Trunk muscle recruitment patterns in specific chronic low back pain populations","volume":"20","author":"Silfies","year":"2005","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1002\/mds.870060206","article-title":"Idiopathic cervical dystonia: clinical characteristics","volume":"6","author":"Chan","year":"1991","journal-title":"Mov Disord."},{"key":"B28","first-page":"210","article-title":"Cervical dystonia (spasmodic torticollis). Some aspects of the natural history","volume":"95","author":"Van Zandijcke","year":"1995","journal-title":"Acta Neurol Belg"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-021-00257-2","article-title":"Tension-type headache","author":"Ashina","year":"2021","journal-title":"Nat Rev Dis Primers"},{"key":"B30","doi-asserted-by":"publisher","first-page":"82","DOI":"10.3389\/fneur.2022.821097","article-title":"The whiplash disease reconsidered","volume":"13","author":"Astrup","year":"1097","journal-title":"Front Neurol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1002\/ejp.1176","article-title":"Increased pain sensitivity in migraine and tension-type headache coexistent with low back pain: A cross-sectional population study","volume":"22","author":"Ashina","year":"2018","journal-title":"Eur J Pain."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.912348\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T06:22:06Z","timestamp":1659075726000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.912348\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,29]]},"references-count":31,"alternative-id":["10.3389\/fneur.2022.912348"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2022.912348","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,29]]},"article-number":"912348"}}