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Excessive yawning induced by stimulation of myofascial trigger point – case report

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 whenever she was performing SMR in our physiotherapy room (Fig. 1). The patient signed informed consent for the publication of her photographs for the purposes of this research report.