1945 Pugh

This is a short article about trigger points and fibrositic nodules (also known as back mice) from 1945 signed by Pugh and Christie. They studied the back, the shoulders and the buttocks of 522 healthy soldiers in Holland.

They explain the two theories about trigger points and the nodules: the Eliott’s theory and the Copeman’s theory. They related the nodules to the past history of rheumatic pain.

Although they performed the study in spring, the soldiers related the rheumatic pain to the humid winter.

Commenting on:

A study of rheumatism in a group of soldiers with reference to the incidence of trigger points and fibrositic nodules.

Pugh, L. G. and Christie, T. A.

Ann Rheum Dis. 1945 Sep; 5:8-10.

PubMed PMID: 21006920

About L.G.C.E. Pugh:

Lewis Griffith Cresswell Evans Pugh (1909-1994) was a British physiologist researcher and mountaineer, known to have been to the first ascent of Mount Everest in 1953. He studied medicine in St Thomas’ Hospital in London.

fibrositic nodules and trigger points

In this article, A study of rheumatism in a group of soldiers with references to the incidence of trigger points and fibrositic nodules, Pugh and Christie present a study done in 1945 where they studied the back, the shoulders and the buttocks of 522 healthy soldiers, aged between 19 and 42. It was performed in Holland during a dried and warm spring.

fibrositic nodules and trigger points

They explored them to find trigger points or nodules and they asked them about history of rheumatic pain (stiffness and pain of muscles and joints, characteristic of fibrositis). 146/512 (28%) gave a previous history of pain considered of rheumatic origin.

In the introduction they explain two theories about the nature of trigger points and fibrositic nodules: on the one hand, Elliott’s theory explains subclinical spasm of the muscle, and on the other hand, Copeman believes that they probably arise in the fibro-fatty tissue involving oedema and, in some cases, herniation of discrete lobules of fat.

fibrositic nodules and trigger points                  At the moment of the study, only 6 soldiers presented rheumatic pain, but the majority among the other 143 cases were associated particularly with changes of weather, periods of cold and damp, wet clothes or sleeping under damp blankets at some point in the past. The majority (45%) complained about back symptoms, whereas 35% complained about shoulders and upper limbs.

fibrositic nodules and trigger points

fibrositic nodules and trigger points

They found palpable nodules (fibrositic nodules) present in 16% of rheumatic and 15% of non-rheumatic individuals, but they noticed that the tender nodules as opposed to non-tender nodules were present four times more often in rheumatic than in non-rheumatic subjects. Therefore, the quality of tenderness appears to be associated with a history of rheumatic pain. The tender ones were always located in iliac region.

fibrositic nodules and trigger points

They found trigger points in 30% of the rheumatic and 3% of the non-rheumatic subjects. The distribution of these trigger points coincided with the areas of basic fat pads defined by Copeman (1944). The trigger points were situated in regions previously affected by symptoms.

The authors mentioned that they thought it unlikely that such symptoms in those soldiers could be regarded as psychogenic, considering that it had led to doubt the existence of a physical basis for fibrositis. Copeman adduced that fibrositic nodules are the result of pathological changes in fibro-fatty tissues, and not in muscle or fibrous tissue. Nevertheless, they could be associated to muscle spasm by reflex irritation.

Published in March 2018 By Marta Cañis Parera   ORCID iD icon
  • Copeman, W.S.C. and Ackerman, W. (1944) . Quart.J.Med. 13,37.
  • Elliott FA. Aspects of “Fibrositis”. Annals of the Rheumatic Diseases. 1944;4(1):22-25.