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Aldabbas MM, Tanwar T, Iram I, Salman M, Veqar Z. A comparison of nocturnal upper trapezius muscle activity between chronic neck pain patients with sleep disturbance and healthy participants. Sleep Breath 2024; 28:95-102. [PMID: 37421519 DOI: 10.1007/s11325-023-02867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Sleep disturbances frequently occur in patients with chronic neck pain. In these patients, upper trapezius muscle dysfunction is observed during sleep. This study aimed to evaluate the trapezius muscle activity during sleep among patients with chronic neck pain and sleep disturbances for comparison with healthy subjects. STUDY DESIGN: Cross-sectional study. METHODS Patients with chronic neck pain and healthy subjects participated in the study. Two overnight polysomnography recordings were conducted for each subject. Surface electromyography was utilized to record the nocturnal activity of the right and left upper trapezius muscles throughout the night. The nocturnal upper trapezius activity recording was divided into the following parts: wakefulness, rapid eye movement sleep (REM), and non-rapid eye movement sleep (NREM). The nocturnal activity during NREM sleep was further divided into three parts (stage I NREM sleep, stage II NREM, and stage III NREM. Normalization of EMG signals was performed. The normalized value of nocturnal activity was derived for analysis. RESULTS Among 15 patients with chronic neck pain and 15 healthy subjects, statistically significant differences were observed in the nocturnal activity of the upper trapezius. Compared to healthy subjects, the nocturnal activity of the upper trapezius was significantly higher during wakefulness, REM sleep, and NREM II and III sleep in patients with chronic neck pain and sleep disturbances. CONCLUSION There was higher nocturnal upper trapezius activity in patients with chronic neck pain compared to healthy controls. The findings suggest a possible pathophysiological mechanism that may relate to chronic neck pain. TRIAL REGISTRATION CTRI/2019/09/021028.
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Affiliation(s)
- Mosab M Aldabbas
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India
| | - Tarushi Tanwar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India
| | - Iram Iram
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India
| | - Mohammad Salman
- Deen Dayal Upadhyaya Kaushal Kendra, Jamia Millia Islamia Central University, New Delhi, India
| | - Zubia Veqar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India.
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Kim D, Nicoletti C, Soedirdjo SDH, Baghi R, Garcia MG, Läubli T, Wild P, Botter A, Martin BJ. Effect of Periodic Voluntary Interventions on Trapezius Activation and Fatigue During Light Upper Limb Activity. HUMAN FACTORS 2023; 65:1491-1505. [PMID: 34875887 DOI: 10.1177/00187208211050723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The effects of diverse periodic interventions on trapezius muscle fatigue and activity during a full day of computer work were investigated. BACKGROUND Musculoskeletal disorders, including trapezius myalgia, may be associated with repeated exposure to prolonged low-level activity, even during light upper-extremity tasks including computer work. METHODS Thirty healthy adults participated in a study that simulated two 6-hour workdays of computer work. One workday involved imposed periodic passive and active interventions aimed at disrupting trapezius contraction monotony (Intervention day), whereas the other workday did not (Control day). Trapezius muscle activity was quantified by the 3-dimensional acceleration of the jolt movement of the acromion produced by electrically induced muscle twitches. The spatio-temporal distribution of trapezius activity was measured through high-density surface electromyography (HD-EMG). RESULTS The twitch acceleration magnitude in one direction was significantly different across measurement periods (p = 0.0156) on Control day, whereas no significant differences in any direction were observed (p > 0.05) on Intervention day. The HD-EMG from Intervention day showed that only significant voluntary muscle contractions (swing arms, Jacobson maneuver) induced a decrease in the muscle activation time and an increase in the spatial muscle activation areas (p < 0.01). CONCLUSION Disruption of trapezius monotonous activity via brief voluntary contractions effectively modified the ensuing contraction pattern (twitch acceleration along one axis, active epochs reduction, and larger spatial distribution). The observed changes support an associated reduction of muscle fatigue. APPLICATION This study suggests that disruptive intervention activity is efficient in reducing the impact of trapezius muscle fatigue.
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Affiliation(s)
| | - Corine Nicoletti
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Institute of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Subaryani D H Soedirdjo
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di, Torino, Turin, Italy
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Raziyeh Baghi
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Maria-Gabriela Garcia
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Department of Industrial Engineering, School of Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Thomas Läubli
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Institute of Occupational and Social Medicine and Health Services Research, University of Tübingen, Tübingen, Germany
| | - Pascal Wild
- French National Research and Safety Institute (INRS), Vandœuvre lès Nancy, France
| | - Alberto Botter
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di, Torino, Turin, Italy
| | - Bernard J Martin
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Department of Industrial and Operations Engineering, School of Engineering, University of Michigan, Ann Arbor, MI, USA
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Brambilla C, Lavit Nicora M, Storm F, Reni G, Malosio M, Scano A. Biomechanical Assessments of the Upper Limb for Determining Fatigue, Strain and Effort from the Laboratory to the Industrial Working Place: A Systematic Review. Bioengineering (Basel) 2023; 10:bioengineering10040445. [PMID: 37106632 PMCID: PMC10135542 DOI: 10.3390/bioengineering10040445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Recent human-centered developments in the industrial field (Industry 5.0) lead companies and stakeholders to ensure the wellbeing of their workers with assessments of upper limb performance in the workplace, with the aim of reducing work-related diseases and improving awareness of the physical status of workers, by assessing motor performance, fatigue, strain and effort. Such approaches are usually developed in laboratories and only at times they are translated to on-field applications; few studies summarized common practices for the assessments. Therefore, our aim is to review the current state-of-the-art approaches used for the assessment of fatigue, strain and effort in working scenarios and to analyze in detail the differences between studies that take place in the laboratory and in the workplace, in order to give insights on future trends and directions. A systematic review of the studies aimed at evaluating the motor performance, fatigue, strain and effort of the upper limb targeting working scenarios is presented. A total of 1375 articles were found in scientific databases and 288 were analyzed. About half of the scientific articles are focused on laboratory pilot studies investigating effort and fatigue in laboratories, while the other half are set in working places. Our results showed that assessing upper limb biomechanics is quite common in the field, but it is mostly performed with instrumental assessments in laboratory studies, while questionnaires and scales are preferred in working places. Future directions may be oriented towards multi-domain approaches able to exploit the potential of combined analyses, exploitation of instrumental approaches in workplace, targeting a wider range of people and implementing more structured trials to translate pilot studies to real practice.
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Affiliation(s)
- Cristina Brambilla
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy
| | - Matteo Lavit Nicora
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy
- Industrial Engineering Department, University of Bologna, 40126 Bologna, Italy
| | - Fabio Storm
- Bioengineering Laboratory, Scientific Institute, IRCCS “Eugenio Medea”, 23842 Bosisio Parini, Italy
| | - Gianluigi Reni
- Informatics Department, Autonomous Province of Bolzano, 39100 Bolzano, Italy
| | - Matteo Malosio
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy
| | - Alessandro Scano
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy
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Evaluation of Physiotherapy Impact on Neuromuscular Tension in Analog Astronauts at the LunAres Habitat. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116888. [PMID: 35682471 PMCID: PMC9180861 DOI: 10.3390/ijerph19116888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
The evaluation of manual Trigger Point Therapy (TrPt) on mandible abduction range of Analog Astronauts (AA) surviving isolation conditions during consecutive missions at the LunAres Habitat was performed. This physiotherapy method was applied to decrease stress-related neuromuscular tension. Abduction measurements were conducted on the two groups of five AA, who endured severe isolation conditions for 14 days in the limited space of the LunAres Research Station Habitat (Piła, Poland) during missions. The test group consisted of abduction measurements of AA who received TrPt and control group of abduction measurements of AA who did not receive TrPt. All measurements were noted in the TemporoMandibular Joint (TMJ) diagnosis aspect of the integrated dental examination card SZOPPDP©. The ischemic compression was performed on an active localized trigger point-resulting in cessation of pain. Maximum abduction measurements were made with an electronic caliper, and the abduction range was compared. The change of abduction range in AA with TrPt was bigger than in AA without TrPt. A larger increase in abduction range was observed in every case in the group receiving TrPt compared to the control group. TrPt effectively decreases the neuromuscular tension, which results in an increased mandibular abduction range of AA. Observations conducted in LunAres Research Station regarding stress-related neuromuscular tension can help identify effective therapeutic methods for circumstances of social isolation.
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Investigation of psychosocial factors on upper limb musculoskeletal disorders and the prevalence of its musculoskeletal disorders among nurses: a systematic review and meta-analysis. Int Arch Occup Environ Health 2021; 94:1113-1136. [PMID: 33569697 DOI: 10.1007/s00420-021-01654-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/18/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Musculoskeletal disorders are one of the most important occupational problems especially among nurses. The aim of this study was to investigate the prevalence of musculoskeletal disorders in upper limbs and its associated psychosocial factors in the workplace. METHODS A systematic review was conducted by searching the Medline/PubMed, EMBASE, Scopus, ISI/web of knowledge and Google Scholar databases. The authors classified studies into categories of psychological work stressors and musculoskeletal problems. The statistical analysis was performed using Stata software. RESULTS We found 1742 articles in our initial search. After reviewing the titles, abstracts and full texts, 66 articles were finally analyzed. Psychosocial factors affecting the prevalence of upper limb musculoskeletal disorders among nurses were identified which included boring work, inadequate staffing, job demands, insufficient support, time pressure, decision latitude, job dissatisfaction, and job stress. There was a significant relationship between these factors and prevalence of musculoskeletal disorders in the wrists, shoulders, neck and shoulders, and wrists and hands. CONCLUSION Collectively, the results of this study provide strong evidence of some psychosocial factors affecting the prevalence of upper limb musculoskeletal disorders among nurses. Thus, organizational interventions to minimize these stressors may be promising in reducing one risk factor for the development of nurses' musculoskeletal disorders. These interventions should not only consider the factors of physical ergonomics but also seek to improve the organizational aspects of the workplace.
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The effect of upper trapezius muscle dry needling treatment on sleep quality: A case report. J Bodyw Mov Ther 2018; 22:333-336. [DOI: 10.1016/j.jbmt.2017.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/23/2017] [Accepted: 05/27/2017] [Indexed: 11/24/2022]
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NICOLETTI C, LÄUBLI T. Trapezius muscle activity and body movement at the beginning and the end of a workday and during the lunch period in female office employees. INDUSTRIAL HEALTH 2017; 55:162-172. [PMID: 28090066 PMCID: PMC5383413 DOI: 10.2486/indhealth.2016-0189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 01/05/2017] [Indexed: 06/06/2023]
Abstract
The aim of this study was to analyze the activity of the trapezius muscle and the arm acceleration during the course of a workday in office employees. It was examined if there are significant changes in trapezius muscle activity in the afternoon compared to the morning work period and relationships to the level of arm acceleration during lunchtime. Nineteen female office employees were recruited. A one hour period of the work in the morning, afternoon, and lunchtime were compared. The measures of the trapezius muscle activity and muscle rest time (TR) did not significantly differ between working in the morning (TR: median 10%; range 1%-49) or working in the afternoon (TR: median 18%; range 2%-34%). The 90th percentile of arm acceleration during lunch time significantly correlated with less trapezius muscle activity in the afternoon compared to the morning values (RT: Spearman R=0.80; p<0.01). Differences in the duration and level of trapezius muscle activity were bigger between the subjects than between different work periods or between lunchtime and work. Furthermore it seems that higher arm accelerations during lunch may be beneficial in reducing trapezius activity in the afternoon compared to the morning values.
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Affiliation(s)
- Corinne NICOLETTI
- Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Thomas LÄUBLI
- Department of Health Sciences and Technology, ETH Zurich, Switzerland
- Augmented Community AID Research Center, Kyoto Institute of Technology, Japan
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Physical risk factors for developing non-specific neck pain in office workers: a systematic review and meta-analysis. Int Arch Occup Environ Health 2017; 90:373-410. [DOI: 10.1007/s00420-017-1205-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
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Ortego G, Villafañe JH, Doménech-García V, Berjano P, Bertozzi L, Herrero P. Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis. J Psychosom Res 2016; 90:70-81. [PMID: 27772562 DOI: 10.1016/j.jpsychores.2016.09.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/28/2016] [Accepted: 09/08/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To systematically review and analyze the research evidence linking stress or anxiety to chronic nonspecific neck-arm pain (NSNAP) in adults. SUBJECTS AND METHODS Data were obtained from Pubmed, Scopus, PsycInfo, Web of Science, Physiotherapy Evidence Database (PEDro) and The Cochrane library database from their inception to July 2015. Two authors independently conducted the searches, extracted data, and completed methodological quality assessments. The methodological quality of the cohort and case-control studies was evaluated using the Newcastle-Ottawa scale, whilst the quality of the Randomized Controlled Trial (RCT) was evaluated using the PEDro scale. RESULTS Twenty-eight studies involving 39,166 participants met the inclusion criteria. Four studies, including 5 pair-wise comparisons, were included in the meta-analysis: Three were cohort studies and 1 was a cross-sectional study. The meta-analysis outcome demonstrated a relationship between chronic NSNAP and psychological stress. The estimate odds ratio for all studies combined was 2.33 (95% CI, 1.04-5.18; p=0.039). A high heterogeneity of the findings appeared (Q=28.94, I2=86% p=0.00). CONCLUSION This study shows that there is a strong relationship between stress and chronic NSNAP. Despite this finding, we cannot support that stress is a risk factor for chronic NSNAP due to the low quality of the results according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). It was not possible to make a quantitative analysis comparing the relationship between anxiety and chronic NSNAP. However, according to the qualitative analysis there is a strong relationship between anxiety and chronic NSNAP.
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Affiliation(s)
- Gorka Ortego
- iPhysio Research Group, Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830, Villanueva de Gállego Zaragoza, Spain.
| | | | - Victor Doménech-García
- iPhysio Research Group, Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830, Villanueva de Gállego Zaragoza, Spain
| | | | | | - Pablo Herrero
- iPhysio Research Group, Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830, Villanueva de Gállego Zaragoza, Spain
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Marker RJ, Balter JE, Nofsinger ML, Anton D, Fethke NB, Maluf KS. Upper trapezius muscle activity in healthy office workers: reliability and sensitivity of occupational exposure measures to differences in sex and hand dominance. ERGONOMICS 2016; 59:1205-14. [PMID: 26924036 PMCID: PMC9333326 DOI: 10.1080/00140139.2015.1130860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Patterns of cervical muscle activity may contribute to overuse injuries in office workers. The purpose of this investigation was to characterise patterns of upper trapezius muscle activity in pain-free office workers using traditional occupational exposure measures and a modified Active Amplitude Probability Distribution Function (APDF), which considers only periods of active muscle contraction. Bilateral trapezius muscle activity was recorded in 77 pain-free office workers for 1-2 full days in their natural work environment. Mean amplitude, gap frequency, muscular rest and Traditional and Active APDF amplitudes were calculated. All measures demonstrated fair to substantial reliability. Dominant muscles demonstrated higher amplitudes of activity and less muscular rest compared to non-dominant, and women demonstrated less muscular rest with no significant difference in amplitude assessed by Active APDF compared to men. These findings provide normative data to identify atypical motor patterns that may contribute to persistence or recurrence of neck pain in office workers. Practitioner Summary: Upper trapezius muscle activity was characterised in a large cohort of pain-free workers using electromyographic recordings from office environments. Dominant muscles demonstrated higher activity and less rest than non-dominant, and women demonstrated less rest than men. Results may be used to identify atypical trapezius muscle activity in office workers.
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Affiliation(s)
- Ryan J. Marker
- Rehabilitation Science Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jaclyn E. Balter
- Physical Therapy Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Micaela L. Nofsinger
- Physical Therapy Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dan Anton
- Department of Physical Therapy, Eastern Washington University, Spokane WA, USA
| | - Nathan B. Fethke
- Department of Occupational and Environmental Health, University of Iowa, Iowa City IA, USA
| | - Katrina S. Maluf
- Rehabilitation Science Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Physical Therapy Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- School of Exercise and Nutritional Sciences, Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, USA
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Müller C, Nicoletti C, Omlin S, Brink M, Läubli T. Relationship between sleep stages and nocturnal trapezius muscle activity. J Electromyogr Kinesiol 2015; 25:457-62. [PMID: 25765124 DOI: 10.1016/j.jelekin.2015.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Former studies reported a relationship between increased nocturnal low level trapezius muscle activity and neck or shoulder pain but it has not been explored whether trapezius muscle relaxation is related to sleep stages. The goal of the present study was to investigate whether trapezius muscle activity is related to different sleep stages, as measured by polysomnography. METHODS Twenty one healthy subjects were measured on four consecutive nights in their homes, whereas the first night served as adaptation night. The measurements included full polysomnography (electroencephalography (EEG), electrooculography (EOG), electromyography (EMG) and electrocardiography (ECG)), as well as surface EMG of the m. trapezius descendens of the dominant arm. RESULTS Periods with detectable EMG activity of the trapezius muscle lasted on average 1.5% of the length of the nights and only in four nights it lasted longer than 5% of sleeping time. Neither rest time nor the length of periods with higher activity levels of the trapezius muscle did significantly differ between sleep stages. CONCLUSIONS We found no evidence that nocturnal trapezius muscle activity is markedly moderated by the different sleep stages. Thus the results support that EMG measurements of trapezius muscle activity in healthy subjects can be carried out without concurrent polysomnographic recordings.
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Affiliation(s)
- Christian Müller
- Occupational Health Management, SBB AG, Swiss Federal Railways, Hilfikerstrasse 1, 3000 Bern, Switzerland
| | - Corinne Nicoletti
- ETH Zürich, Department of Health Sciences and Technology, Sensory-Motor Systems Lab, Sonneggstrasse 3, ML G57, CH-8092 Zurich, Switzerland
| | - Sarah Omlin
- Umwelt und Energie, Kanton of Lucerne, 6002 Lucerne, Switzerland
| | - Mark Brink
- Swiss Federal Office for the Environment, 3003 Bern, Switzerland
| | - Thomas Läubli
- ETH Zürich, Department of Health Sciences and Technology, Sensory-Motor Systems Lab, Sonneggstrasse 3, ML G57, CH-8092 Zurich, Switzerland
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Shin SJ, Yoo WG. Effect of workstation height and distance on upper extremity muscle activity during repetitive below-the-knee assembly work. J Occup Health 2015; 57:193-6. [PMID: 25735509 DOI: 10.1539/joh.14-0168-br] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the activity of the upper trapezius, serratus anterior, anterior deltoid, biceps brachii. and lower trapezius muscles in healthy adults during below-the-knee assembly work. METHODS Fifteen right-handed male subjects participated in this study. The electrical activities, measured by EMG, of the right upper trapezius, serratus anterior, anterior deltoid, biceps brachii. and lower trapezius were measured during below-the-knee assembly work at four workstations of varying height and distance from the participant (workstation 1, below-the-knee assembly work with a height of 15 cm above the floor and a reach distance of 30 cm; workstation 2, height of 15 cm and distance of 45 cm; workstation 3, height of 30 cm and distance of 30 cm; workstation 4, height of 30 cm and distance of 45 cm). Muscle activity at the four workstations was represented as a percentage of the reference voluntary isometric contraction (RVIC). RESULTS Height: Upper and lower trapezius activity increased significantly during below the knee assembly work as height above the floor increased. The activities of the serratus anterior and biceps brachii muscles increased significantly during low-height below-the-knee assembly work. Distance: The activities of the upper trapezius, serratus anterior, anterior deltoid and biceps brachii increased significantly during below-the-knee assembly work at a far distance (45 cm). The lower trapezius muscle activity increased significantly during below-the-knee assembly work at a close distance (30 cm). CONCLUSIONS Below-knee workers should engage in work close to themselves, since distance appears to be a stronger risk factor for injury than height above the floor.
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Affiliation(s)
- Seung-Je Shin
- Department of Physical Therapy, The Graduate School, Inje University
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Toulouse G, St-Arnaud L, Duhalde D, Lévesque J, Delisle A, Comtois AS. Diagnostic ergonomique résultant de la présence de risques psychosociaux contribuant aux troubles musculo-squelettiques : le cas des centres d’appels d’urgence 9-1-1. PERSPECTIVES INTERDISCIPLINAIRES SUR LE TRAVAIL ET LA SANTÉ 2013. [DOI: 10.4000/pistes.3385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wærsted M, Hanvold TN, Veiersted KB. Perceived tension and relaxation ability in young adults. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/14038196.2012.756931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Larsman P, Kadefors R, Sandsjö L. Psychosocial work conditions, perceived stress, perceived muscular tension, and neck/shoulder symptoms among medical secretaries. Int Arch Occup Environ Health 2012; 86:57-63. [DOI: 10.1007/s00420-012-0744-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 01/19/2012] [Indexed: 12/17/2022]
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Fechir M, Schlereth T, Kritzmann S, Balon S, Pfeifer N, Geber C, Breimhorst M, Eberle T, Gamer M, Birklein F. Stress and thermoregulation: Different sympathetic responses and different effects on experimental pain. Eur J Pain 2012; 13:935-41. [DOI: 10.1016/j.ejpain.2008.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 08/30/2008] [Accepted: 11/02/2008] [Indexed: 10/21/2022]
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Nilsen KB, Sand T, Westgaard RH, Stovner LJ, White LR, Bang Leistad R, Helde G, Rø M. Autonomic activation and pain in response to low-grade mental stress in fibromyalgia and shoulder/neck pain patients. Eur J Pain 2012; 11:743-55. [PMID: 17224287 DOI: 10.1016/j.ejpain.2006.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 11/03/2006] [Accepted: 11/20/2006] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Psychosocial stress is a risk factor for musculoskeletal pain, but how stress affects musculoskeletal pain is poorly understood. We wanted to examine the relationship between low-grade autonomic activation and stress-related pain in patients with fibromyalgia and localised chronic shoulder/neck pain. METHODS Twenty-three female patients with fibromyalgia, 29 female patients with chronic shoulder-neck pain, and 35 healthy women performed a stressful task lasting 60min. With a blinded study design, we recorded continuous blood pressure, heart rate, finger skin blood flow and respiration frequency before (10min), during (60min) and after (30min) the stressful task. The physiological responses were compared with subjective reports of pain. RESULTS The increase in diastolic blood pressure and heart rate in response to the stressful task were smaller in fibromyalgia patients compared with the healthy controls. Furthermore, fibromyalgia patients had reduced finger skin blood flow at the end of the stressful task compared to healthy controls. We also found an inverse relationship between the heart rate response and development and recovery of the stress-related pain in fibromyalgia patients. CONCLUSION We found abnormal cardiovascular responses to a 60min long stressful task in fibromyalgia patients. Furthermore, we found a negative association between the heart rate response and the pain which developed during the stressful task in the fibromyalgia group, possibly a result of reduced stress-induced analgesia for fibromyalgia patients.
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Affiliation(s)
- Kristian Bernhard Nilsen
- Norwegian University of Science and Technology, Department of Neurosciences, N-7489, Trondheim, Norway.
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Cole DC, Chen C, Hogg-Johnson S, Van Eerd D, Mazumder A, Wells RP. Multivariate, longitudinal analysis of the impact of changes in office work environments on surface electromyography measures. Int Arch Occup Environ Health 2011; 85:493-503. [PMID: 21881963 DOI: 10.1007/s00420-011-0696-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/19/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To detect impacts of changes in work environment and worker-equipment interface variables upon surface electromyography (EMG) measures using multivariate, longitudinal analysis. METHODS For 33 office workers, yearly measurements (1999-2001) were taken during normal work. Independent variables were related to work environment (expert-observed equipment dimensions, work organization on questionnaire) and interface (expert-observed postures, self-reported workstation-equipment relative fit i.e. inside or outside guidelines-informed location, and 30 min video-based task analysis). Internal mechanical exposure (EMG) was recorded bilaterally from extensor carpi radialis brevis (ECRB) and upper trapezius sites, each side, also for 30 min. Dependent variables were amplitude probability distribution functions (APDF 50 and 90%) and gaptime for entire record EMG (over all tasks) and task-specific EMG (for four separate tasks). Multivariate mixed models used independent variables to predict EMG measures (4 muscle sites × (1 entire record + 4 task specific) = 20 models total). RESULTS Among EMG measures, 9/16 means and 2/16 variances were significantly different across years (p < 0.1). Environment and interface variables explained part of the variation in EMG measures in 13/20 models. The most consistent predictors included: (1) increased monitor distance predicted reduced APDFs and increased gaptimes; (2) wrist extension <20° predicted decreases in left ECRB APDFs; (3) keyboard location within guidelines predicted improvements in all right ECRB EMG measures during keyboarding; and (4) longer task duration predicted higher APDFs and lower gaptimes. CONCLUSION Longitudinal analysis with multivariate models can detect the impacts of changes in environment and interface exposures on EMG measures among office workers.
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Affiliation(s)
- D C Cole
- Institute for Work and Health, Toronto, ON, Canada.
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Fethke NB, Gant LC, Gerr F. Comparison of biomechanical loading during use of conventional stud welding equipment and an alternate system. APPLIED ERGONOMICS 2011; 42:725-34. [PMID: 21183155 DOI: 10.1016/j.apergo.2010.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 11/05/2010] [Accepted: 11/22/2010] [Indexed: 05/03/2023]
Abstract
We investigated the effect of an alternative welding system designed to reduce exposure to extreme trunk flexion on measures of trunk inclination and muscle activity. Among 10 participants, data were collected while using conventional stud welding equipment and while using the alternate system. Paired t-tests were used to compare results between the two welding systems. Mean trunk inclination angle was reduced with the alternate system (34.4° versus 9.7°, p < 0.01). Percent time with trunk inclination angles greater than 60° was also reduced (40.0% versus 4.7%, p < 0.01). In general, the alternate system resulted in less desirable upper trapezius muscle activity levels. The alternate system appears to be effective in reducing exposure to extreme trunk flexion among stud welders. Continued development of the system should explore features designed to reduce shoulder forces and improve productivity.
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Affiliation(s)
- Nathan B Fethke
- University of Iowa, Occupational and Environmental Health, UI Research Park, Iowa City, IA 52242, USA.
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20
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Effects of static contraction and cold stimulation on cardiovascular autonomic indices, trapezius blood flow and muscle activity in chronic neck-shoulder pain. Eur J Appl Physiol 2011; 111:1725-35. [PMID: 21221987 DOI: 10.1007/s00421-010-1813-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 12/24/2010] [Indexed: 10/18/2022]
Abstract
The aim of the present study was to investigate reactions in trapezius muscle blood flow (MBF), muscle activity, heart rate variability (HRV) and systemic blood pressure (BP) to autonomic tests in subjects with chronic neck-shoulder pain and healthy controls. Changes in muscle activity and blood flow due to stress and unfavourable muscle loads are known underlying factors of work-related muscle pain. Aberration of the autonomic nervous system (ANS) is considered a possible mechanism. In the present study, participants (n = 23 Pain, n = 22 Control) performed autonomic tests which included a resting condition, static hand grip test (HGT) at 30% of maximal voluntary contraction, a cold pressor test (CPT) and a deep breathing test (DBT). HRV was analysed in time and frequency domains. MBF and muscle activity were recorded from the upper trapezius muscles using photoplethysmography and electromyography (EMG). The pain group showed reduced low frequency-HRV (LF) and SDNN during rest, as well as a blunted BP response and increased LF-HRV during HGT (∆systolic 22 mm Hg; ∆LF(nu) 27%) compared with controls (∆systolic 27; ∆LF(nu) 6%). Locally, the pain group had attenuated trapezius MBF in response to HGT (Pain 122% Control 140%) with elevated trapezius EMG following HGT and during CPT. In conclusion, only HGT showed differences between groups in systemic BP and HRV and alterations in local trapezius MBF and EMG in the pain group. Findings support the hypothesis of ANS involvement at systemic and local levels in chronic neck-shoulder pain.
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Madeleine P. On functional motor adaptations: from the quantification of motor strategies to the prevention of musculoskeletal disorders in the neck-shoulder region. Acta Physiol (Oxf) 2010; 199 Suppl 679:1-46. [PMID: 20579000 DOI: 10.1111/j.1748-1716.2010.02145.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Occupations characterized by a static low load and by repetitive actions show a high prevalence of work-related musculoskeletal disorders (WMSD) in the neck-shoulder region. Moreover, muscle fatigue and discomfort are reported to play a relevant initiating role in WMSD. AIMS To investigate relationships between altered sensory information, i.e. localized muscle fatigue, discomfort and pain and their associations to changes in motor control patterns. MATERIALS & METHODS In total 101 subjects participated. Questionnaires, subjective assessments of perceived exertion and pain intensity as well as surface electromyography (SEMG), mechanomyography (MMG), force and kinematics recordings were performed. RESULTS Multi-channel SEMG and MMG revealed that the degree of heterogeneity of the trapezius muscle activation increased with fatigue. Further, the spatial organization of trapezius muscle activity changed in a dynamic manner during sustained contraction with acute experimental pain. A graduation of the motor changes in relation to the pain stage (acute, subchronic and chronic) and work experience were also found. The duration of the work task was shorter in presence of acute and chronic pain. Acute pain resulted in decreased activity of the painful muscle while in subchronic and chronic pain, a more static muscle activation was found. Posture and movement changed in the presence of neck-shoulder pain. Larger and smaller sizes of arm and trunk movement variability were respectively found in acute pain and subchronic/chronic pain. The size and structure of kinematics variability decreased also in the region of discomfort. Motor variability was higher in workers with high experience. Moreover, the pattern of activation of the upper trapezius muscle changed when receiving SEMG/MMG biofeedback during computer work. DISCUSSION SEMG and MMG changes underlie functional mechanisms for the maintenance of force during fatiguing contraction and acute pain that may lead to the widespread pain seen in WMSD. A lack of harmonious muscle recruitment/derecruitment may play a role in pain transition. Motor behavior changed in shoulder pain conditions underlining that motor variability may play a role in the WMSD development as corroborated by the changes in kinematics variability seen with discomfort. This prognostic hypothesis was further, supported by the increased motor variability among workers with high experience. CONCLUSION Quantitative assessments of the functional motor adaptations can be a way to benchmark the pain status and help to indentify signs indicating WMSD development. Motor variability is an important characteristic in ergonomic situations. Future studies will investigate the potential benefit of inducing motor variability in occupational settings.
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Affiliation(s)
- P Madeleine
- Laboratory for Ergonomics and Work-related Disorders, Department of Health Science and Technology, Aalborg University, Center for Sensory-Motor Interaction, Aalborg, Denmark.
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22
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Discharge behaviors of trapezius motor units during exposure to low and high levels of acute psychosocial stress. J Clin Neurophysiol 2010; 27:52-61. [PMID: 20087201 DOI: 10.1097/wnp.0b013e3181cb81d3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study investigated the effects of acute psychosocial stress on trapezius single motor unit discharge behaviors. Twenty-one healthy women performed feedback-controlled isometric contractions under conditions of low and high psychosocial stress in the same experimental session. Psychosocial stress was manipulated using a verbal math task combined with social evaluative threat that significantly increased perceived anxiety, heart rate, and blood pressure (P < 0.001). Motor unit discharge behaviors including the threshold and discharge rate at recruitment [7.7% (5.7%) maximal voluntary isometric contraction and 7.3 pulses per second (pps) (6.8 pps), P > 0.121, N = 103] and derecruitment [6.0% (4.4%) maximal voluntary isometric contraction and 6.5 pps (4.1 pps), P > 0.223, N = 99], the mean [11.3 pps (2.3 pps), P = 0.309, N = 106] and variability [2.5 pps (0.91 pps), P = 0.958, N = 106] of discharge rate, and the proportion of motor units exhibiting double discharges (21%, P = 0.446) did not change across stress conditions. Discharge rate modulation with changes in contraction intensity was highly variable and similar across stress conditions (P > 0.308, N = 89). Rate-rate modulation of concurrently active motor units was also highly variable (r = -0.84 to 1.00, N = 75). Estimates of DeltaF for motor unit pairs with rate-rate modulation >or=0.7 were positive and similar across stress conditions [4.7 pps (2.0 pps), P = 0.405, N = 16]. The results indicate that acute psychosocial stress does not alter trapezius motor unit discharge behaviors during a precisely controlled motor task in healthy women.
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Neck–shoulder muscle activity in general and task-specific resting postures of symptomatic computer users with chronic neck pain. ACTA ACUST UNITED AC 2009; 14:338-45. [DOI: 10.1016/j.math.2008.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 04/17/2008] [Accepted: 05/06/2008] [Indexed: 11/20/2022]
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Szeto GPY, Straker LM, O'Sullivan PB. Examining the low, high and range measures of muscle activity amplitudes in symptomatic and asymptomatic computer users performing typing and mousing tasks. Eur J Appl Physiol 2009; 106:243-51. [PMID: 19255772 DOI: 10.1007/s00421-009-1019-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2009] [Indexed: 11/29/2022]
Abstract
Past studies on work-related musculoskeletal disorders (WMSD) have reported increased median muscle activities in terms of 50th% of amplitude probability distribution function (APDF), and this was thought to be a manifestation of altered motor control--an important mechanism contributing to WMSD. The present study aimed to examine whether such altered motor control was also present in other parameters of APDF--the 10th and 90th% values, which can be considered indicators of the low and high measures of muscle activity. The difference between 10th and 90th% APDF can be considered an indicator of the variation in muscle activity amplitude (the "APDF range"). Surface electromyography was examined in female office workers as Case (n = 21) and Control (n = 18) subjects. The APDF variables were measured in cervical erector spinae (CES) and upper trapezius (UT) muscles during typing, mousing and type-and-mouse, for 20 min each. The Case Group had significantly higher CES activity in the 10th, 90th% and APDF range compared to Controls. The UT muscles showed similar trends but the between-group differences were not statistically significant. These results have demonstrated the robustness of the APDF variables as sensitive indicators of motor control variations in symptomatic subjects with musculoskeletal disorders.
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Affiliation(s)
- Grace P Y Szeto
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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25
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Huysmans MA, Hoozemans MJ, Visser B, van Dieën JH. Grip force control in patients with neck and upper extremity pain and healthy controls. Clin Neurophysiol 2008; 119:1840-1848. [DOI: 10.1016/j.clinph.2008.04.290] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 04/01/2008] [Accepted: 04/04/2008] [Indexed: 11/17/2022]
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Nilsen KB, Sand T, Borchgrevink P, Leistad RB, Rø M, Westgaard RH. A unilateral sympathetic blockade does not affect stress-related pain and muscle activity in patients with chronic musculoskeletal pain. Scand J Rheumatol 2008; 37:53-61. [PMID: 18189196 DOI: 10.1080/03009740701716850] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Chronic musculoskeletal pain is often exacerbated by mental and social stress. The association between stress and musculoskeletal pain is potentially mediated by peripheral sympathetic nerves, either directly or indirectly through muscle activity. In the present study we wanted to determine whether sympathetic blockade could affect either the pain or the muscular activity experienced during mental stress in patients with chronic musculoskeletal pain. METHODS We performed a unilateral anaesthetic blockade of the lower cervical sympathetic ganglion (ganglion stellatum) in 18 patients with chronic musculoskeletal pain (10 with fibromyalgia and eight with chronic shoulder/neck pain). After the blockade the patients performed a 60-minute stressful task with low-grade mental stress that has induced pain and muscle activity in earlier experiments. Surface electromyography (SEMG) of the forehead, temples, neck, and shoulders, and heart rate and blood pressure were recorded together with ratings of pain. RESULTS We did not find any side or sidextime effect for pain or muscular activity in any of the four muscle groups (p>0.12). CONCLUSION We investigated the potential involvement of peripheral sympathetic nerves in stress-related musculoskeletal pain. A peripheral sympathetic block did not affect pain and muscle responses to a stressful task. Other explanatory models should be implemented and tested experimentally to further investigate the clinical impression that mental stress exacerbates pain in patients with chronic musculoskeletal pain.
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Affiliation(s)
- K B Nilsen
- Department of Neurosciences, Faculty of Medicine, Norwegian University of Science and Technology, Norway.
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27
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Leistad RB, Nilsen KB, Stovner LJ, Westgaard RH, Rø M, Sand T. Similarities in stress physiology among patients with chronic pain and headache disorders: evidence for a common pathophysiological mechanism? J Headache Pain 2008; 9:165-75. [PMID: 18373156 PMCID: PMC3476196 DOI: 10.1007/s10194-008-0029-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 03/01/2008] [Indexed: 01/14/2023] Open
Abstract
One common feature of chronic musculoskeletal pain and headaches are that they are both influenced by stress. Among these, tension-type headache (TTH), fibromyalgia (FMS) and chronic shoulder/neck pain (SNP) appear to have several similarities, both with regard to pathophysiology, clinical features and demographics. The main hypothesis of the present study was that patients with chronic pain (TTH, FMS and SNP) had stress-induced features distinguishing them from migraine patients and healthy controls. We measured pain, blood pressure, heart rate (HR) and skin blood flow (BF) during (1 h) and after (30 min) controlled low-grade cognitive stressor in 22 migraine patients, 18 TTH patients, 23 FMS patients, 29 SNP patients and 44 healthy controls. FMS patients had a lower early HR response to stress than migraine patients, but no differences were found among FMS, TTH and SNP patients. Finger skin BF decreased more in FMS patients compared to migraine patients, both during and after the test. When comparing chronic pain patients (chronic TTH, FMS and SNP) with those with episodic pain (episodic TTH and migraine patients) or little or no pain (healthy controls), different adaptation profiles were found during the test for systolic and diastolic blood pressure, HR and skin BF in the chronic group. In conclusion, these results suggest that TTH, FMS and SNP patients may share common pathophysiological mechanisms regarding the physiological responses to and recovery from low-grade cognitive stress, differentiating them from episodic pain conditions such as migraine
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Affiliation(s)
- Rune Bang Leistad
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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28
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Nilsen KB, Sand T, Stovner LJ, Leistad RB, Westgaard RH. Autonomic and muscular responses and recovery to one-hour laboratory mental stress in healthy subjects. BMC Musculoskelet Disord 2007; 8:81. [PMID: 17697337 PMCID: PMC2045095 DOI: 10.1186/1471-2474-8-81] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 08/14/2007] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Stress is a risk factor for musculoskeletal pain. We wanted to explore stress related physiology in healthy subjects in order to gain insight into mechanisms of pain development which may relate to the pathophysiology of musculoskeletal pain disorders. METHODS Continuous blood pressure, heart rate, finger skin blood flow, respiration, surface electromyography together with perception of pain, fatigue and tension were recorded on 35 healthy women and 9 healthy men before, during a 60 minute period with task-related low-grade mental stress, and in the following 30 minute rest period. RESULTS Subjects responded physiologically to the stressful task with an increase in trapezius and frontalis muscle activity, increased blood pressure, respiration frequency and heart rate together with reduced finger skin blood flow. The blood pressure response and the finger skin blood flow response did not recover to baseline values during the 30-minute rest period, whereas respiration frequency, heart rate, and surface electromyography of the trapezius and frontalis muscles recovered to baseline within 10 minutes after the stressful task. Sixty-eight percent responded subjectively with pain development and 64% reported at least 30% increase in pain. Reduced recovery of the blood pressure was weakly correlated to fatigue development during stress, but was not correlated to pain or tension. CONCLUSION Based on a lack of recovery of the blood pressure and the acral finger skin blood flow response to mental stress we conclude that these responses are more protracted than other physiological stress responses.
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Affiliation(s)
- Kristian B Nilsen
- Norwegian University of Science and Technology, Faculty of Medicine, Department of Neurosciences, N-7489 Trondheim, Norway
- St. Olavs Hospital Trondheim University Hospital, N-7489 Trondheim, Norway
| | - Trond Sand
- Norwegian University of Science and Technology, Faculty of Medicine, Department of Neurosciences, N-7489 Trondheim, Norway
- St. Olavs Hospital Trondheim University Hospital, N-7489 Trondheim, Norway
| | - Lars J Stovner
- Norwegian University of Science and Technology, Faculty of Medicine, Department of Neurosciences, N-7489 Trondheim, Norway
- St. Olavs Hospital Trondheim University Hospital, N-7489 Trondheim, Norway
| | - Rune B Leistad
- Norwegian University of Science and Technology, Faculty of Medicine, Department of Neurosciences, N-7489 Trondheim, Norway
- St. Olavs Hospital Trondheim University Hospital, N-7489 Trondheim, Norway
| | - Rolf H Westgaard
- Norwegian University of Science and Technology, Faculty of Social Sciences and Technology Management, Department of Industrial Economics and Technology Management, N-7491, Trondheim, Norway
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Mork PJ, Westgaard RH. The influence of body posture, arm movement, and work stress on trapezius activity during computer work. Eur J Appl Physiol 2007; 101:445-56. [PMID: 17653757 DOI: 10.1007/s00421-007-0518-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2007] [Indexed: 11/25/2022]
Abstract
The study aimed to determine the influence of arm posture and movement on trapezius activity of computer workers, considering the full workday. A second aim was to investigate if work periods perceived as stressful were associated with elevated or more sustained muscle activity pattern. Twenty-six computer workers performing call-center (n=11), help desk (n=7), or secretarial (n=8) work tasks participated. Bilateral trapezius surface electromyographic (sEMG) activity and heart rate was recorded throughout the workday. Simultaneous inclinometer recordings from left thigh and upper arms identified periods with sitting, standing, and walking, as well as arm posture and movement. Perceived work stress and tension were recorded on visual analog scales (VAS) every hour. Trapezius sEMG activity was low in seated posture [group median 1.8 and 0.9% of activity at maximal voluntary contraction (%EMGmax) for dominant and non-dominant side] and was elevated in standing (3.0 and 2.5% EMGmax) and walking (3.9 and 3.4% EMGmax). In seated posture (mean duration 79% of workday) arm movement consistently influenced trapezius activity, accounting for approximately 20% of intra-individual variation in trapezius activity. Arm elevation was on average not associated with trapezius activity when seated; however, considerable individual variation was observed. There was no indication of increase in trapezius activity or more sustained activity pattern, nor in heart rate, in high-stress versus low-stress periods, comparing periods with seated posture for the subjects reporting contrasts of at least two VAS units in stress (n=16) or tension (n=14) score.
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Affiliation(s)
- Paul Jarle Mork
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, 7491, Trondheim, Norway
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Pape E, Brox JI, Hagen KB, Natvig B, Schirmer H. Prognostic factors for chronic neck pain in persons with minor or moderate injuries in traffic accidents. ACCIDENT; ANALYSIS AND PREVENTION 2007; 39:135-46. [PMID: 16934210 DOI: 10.1016/j.aap.2006.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 06/05/2006] [Accepted: 06/22/2006] [Indexed: 05/11/2023]
Abstract
Prognostic factors for chronic neck pain were identified in a prospective Norwegian insurance cohort comprising 636 persons with minor or moderate traffic injuries. One questionnaire was used at baseline and another at 3 years post-injury. Daily severe or very severe neck pain at three years follow up was defined as chronic neck pain. Eight significant independent prognostic factors for chronic neck pain were identified: (1) rear-end or frontal and rear-end collision, odds ratio (OR): 4.10 (95% confidence interval (CI): 1.72-10.82); (2) neck and/or shoulder pain before the accident, OR: 2.38 (95% CI: 1.07-5.37); (3) post-accident (a) memory and concentration problems, OR: 4.62 (95% CI: 1.99-11.20), (b) bodily tension, OR: 3.43 (95% CI: 1.49-8.42), (c) difficulties to climb stairs, OR: 5.03 (95% CI: 1.77-14.95), (d) difficulties to bend forward, OR: 4.85 (95% CI: 2.06-11.79), (e) difficulties to do heavy labour, OR: 3.70 (95% CI: 1.24-11.64); (4) beliefs in future work disability, OR: 2.64 (95% CI: 1.11-6.48). The results indicate that development of chronic neck pain is influenced by pre-accident neck and/or shoulder pain, the impact of the collision, as well as post-accident symptoms, perceived impaired function and pessimism for the future ability to work.
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Affiliation(s)
- Eivind Pape
- Expert Services Medicine, If P and C Insurance Company Ltd., P.O. Box 240, 1326 Lysaker, Norway
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31
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Voerman GE, Vollenbroek-Hutten MMR, Hermens HJ. Upper trapezius muscle activation patterns in neck–shoulder pain patients and healthy controls. Eur J Appl Physiol 2006; 102:1-9. [PMID: 16845552 DOI: 10.1007/s00421-006-0215-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2006] [Indexed: 11/25/2022]
Abstract
This study aimed at investigating whether patients with neck-shoulder complaints from different aetiologies (work-related musculo-skeletal disorders, WMSD; whiplash associated disorders, WAD) show comparable muscle activation patterns, characterised by higher activation and lower relaxation levels of the trapezius muscles compared to healthy controls. Twenty healthy controls, 21 WMSD and 20 WAD patients with non-acute neck-shoulder pain were recruited for this cross-sectional study. Surface electromyography (sEMG) recordings were performed at the upper trapezius muscles during reference contractions, standardised computer tasks (typing and unilateral stress task), and rest measurements. sEMG was continuously recorded during these measurements. Outcome measures were root mean square (RMS) to study muscle activity, and relative rest time (RRT) to study muscle relaxation. Statistical analysis comprised the bootstrap technique and Kruskall-Wallis tests. Results showed no clear evidence for abnormal muscle activation patterns in WMSD and WAD patients compared to healthy controls. However, a tendency was observed for higher RMS levels during the reference contractions and computer tasks in both patient groups compared to healthy controls, and lower RRT levels at the non-dominant side during stress. Both patient groups also showed larger variability in RMS and RRT values. This variability has more often been reported in literature and may suggest the existence of subgroups of pain patients with corresponding different muscle activation patterns not related to aetiology. Future research may focus on identifying these subgroups of patients with neck-shoulder pain.
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Affiliation(s)
- G E Voerman
- Roessingh Research and Development, Enschede, The Netherlands.
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Mork PJ, Westgaard RH. Low-amplitude trapezius activity in work and leisure and the relation to shoulder and neck pain. J Appl Physiol (1985) 2006; 100:1142-9. [PMID: 16322372 DOI: 10.1152/japplphysiol.01111.2005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study is to obtain evidence supporting or negating the hypothesis that muscle pain is associated with sustained activation of low-threshold motor units. Long-term surface electromyographic (EMG) recordings of trapezius activity pattern were related to subjectively reported shoulder and neck pain in work and leisure. Recordings from 118 female subjects (73 recorded both during work and leisure) were analyzed. Computer operators, secretaries, and health care and retail workers were represented in the material. The recordings were calibrated by the root-mean-square-detected response at maximal voluntary contraction (%maximum EMG). The analysis was performed by quantifying duration and amplitude of surface EMG activity exceeding 2% maximum EMG (“EMG bursts”). Three response categories were defined by duration of the burst periods during work: low- (<50%), intermediate- (50–70%), and high-response (>70%) groups. Shoulder and neck pain was assessed by hourly visual analog score throughout work and leisure and by pain score for the last 6 mo. Shoulder and neck pain was higher at work than leisure for subjects with long-term pain in both the high- and the low-response groups. Persistent pain, defined by the 6-mo score, was more prevalent in the high- than the low- and intermediate-response groups (73 vs. 37%); relative risk was 2.0. Trapezius activity was reduced from work to leisure for the high- but not the low-response group. The activity pattern is consistent with low-threshold motor unit overexertion for the high- but not the low-response group. We speculate that different mechanisms of muscle pain causation, dependent and independent of motor activity pattern, coexist.
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Airaksinen MK, Kankaanpää M, Aranko O, Leinonen V, Arokoski JPA, Airaksinen O. Wireless on-line electromyography in recording neck muscle function: A pilot study. PATHOPHYSIOLOGY 2005; 12:303-6. [PMID: 16256323 DOI: 10.1016/j.pathophys.2005.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 09/16/2005] [Accepted: 09/16/2005] [Indexed: 11/29/2022] Open
Abstract
AIM The surface electromyography (SEMG) records muscle activity without causing pain and therefore it can be used in the on-line kinetic evaluation of rehabilitation methods. The cables are a problem in the clinical work. The aim of this pilot study was to introduce a wireless on-line SEMG method in the measurements of neck muscle activity and preliminarily evaluate its usability in dynamic exercises in a healthy and a neck pain subject. METHOD The bilateral wireless on-line SEMG measurements were performed at the level C4-C5 of the cervical spine. The subjects (one healthy 32-year-old female and one neck pain patient, 35-year-old female) were performing slow cervical flexions with eyes open. The angle of the flexion was measured with inclinometer. RESULTS In healthy subjects, the SEMG curve demonstrated clear flexion-relaxation rhythm whereas in the patient the rhythm was blurred. The SEMG signal quality was, however, good in both cases. CONCLUSION Wireless on-line SEMG method seems promising in daily clinical work for the measurements of neck muscle activity.
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Affiliation(s)
- Minna K Airaksinen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, 70200 Kuopio, Finland.
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Mork PJ, Westgaard RH. Long-term electromyographic activity in upper trapezius and low back muscles of women with moderate physical activity. J Appl Physiol (1985) 2005; 99:570-8. [PMID: 15817722 DOI: 10.1152/japplphysiol.00198.2005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The habitual activity patterns of trapezius and postural back muscles (multifidus, iliocostalis, longissimus) of 23 female subjects with moderate physical activity were studied. Bilateral surface electromyographic (sEMG) recordings from start of work until bedtime were analyzed. The activity level was calibrated as percentage of root mean square-detected muscle activity at maximal voluntary contraction (EMGmax). Sixty-six previous trapezius recordings of women with moderate physical activity were included in some analyses to pursue the full range of variation in trapezius activity. Twenty-six of these were recorded twice, separated by 16–28 mo. Median activity level and duration of periods with sEMG activity of <0.5% EMGmax (“rest time”; only trapezius) and exceeding 2 (“burst time”), 10, 30, and 50% EMGmax was determined. The trapezius median activity level ranged from 0.6 to 8.8% EMGmax, burst time from 9 to 84%, and rest time from 2 to 84%. The activity patterns of the back muscles showed similar large interindividual variation. Repeated trapezius recordings of the same subject showed high consistency; intraclass correlation coefficients ranged from 0.62 to 0.79 for different sEMG variables. Periods with high sEMG amplitude were of short duration; 7% of the trapezius recordings did not present time intervals (0.2-s duration) above 50% EMGmax. The activity patterns of the postural muscles, despite large interindividual variability, were distinctly different from activity patterns of upper and lower limb muscles reported by others (e.g., mean burst time 40–50 vs. 10–20%). We conclude that postural trunk muscles show idiosyncratic activity patterns with large interindividual variation. High-threshold motor units are activated to a very minor extent.
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Affiliation(s)
- Paul Jarle Mork
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
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Westad C, Westgaard RH, De Luca CJ. Motor unit recruitment and derecruitment induced by brief increase in contraction amplitude of the human trapezius muscle. J Physiol 2004; 552:645-56. [PMID: 14561844 PMCID: PMC2343389 DOI: 10.1113/jphysiol.2003.044990] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The activity pattern of low-threshold human trapezius motor units was examined in response to brief, voluntary increases in contraction amplitude ('EMG pulse') superimposed on a constant contraction at 4-7 % of the surface electromyographic (EMG) response at maximal voluntary contraction (4-7 % EMGmax). EMG pulses at 15-20 % EMGmax were superimposed every minute on contractions of 5, 10, or 30 min duration. A quadrifilar fine-wire electrode recorded single motor unit activity and a surface electrode recorded simultaneously the surface EMG signal. Low-threshold motor units recruited at the start of the contraction were observed to stop firing while motor units of higher recruitment threshold stayed active. Derecruitment of a motor unit coincided with the end of an EMG pulse. The lowest-threshold motor units showed only brief silent periods. Some motor units with recruitment threshold up to 5 % EMGmax higher than the constant contraction level were recruited during an EMG pulse and kept firing throughout the contraction. Following an EMG pulse, there was a marked reduction in motor unit firing rates upon return of the surface EMG signal to the constant contraction level, outlasting the EMG pulse by 4 s on average. The reduction in firing rates may serve as a trigger to induce derecruitment. We speculate that the silent periods following derecruitment may be due to deactivation of non-inactivating inward current ('plateau potentials'). The firing behaviour of trapezius motor units in these experiments may thus illustrate a mechanism and a control strategy to reduce fatigue of motor units with sustained activity patterns.
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Affiliation(s)
- C Westad
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
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Wahlström J, Hagberg M, Toomingas A, Wigaeus Tornqvist E. Perceived muscular tension, job strain, physical exposure, and associations with neck pain among VDU users; a prospective cohort study. Occup Environ Med 2004; 61:523-8. [PMID: 15150392 PMCID: PMC1763657 DOI: 10.1136/oem.2003.009563] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine whether perceived muscular tension, job strain, or physical exposure are associated with increased risk of developing neck pain among VDU users. METHODS A baseline questionnaire was answered by 1283 respondents, of whom 671 were free from neck pain at baseline. Perceived muscular tension, job strain, and physical exposure were assessed at baseline. Information about newly developed neck pain was collected in 10 follow up questionnaires and the case definition was the first report of such pain in any of the follow up questionnaires. Median follow up time was 10.9 months. RESULTS Both men and women who perceived muscular tension at least a few times per week, compared to those who had not perceived muscular tension the preceding month, had an incidence rate ratio (IRR) of 1.9 (95% CI 1.25 to 2.93) for developing neck pain, when stratifying for sex. High perceived muscular tension was associated with an increased risk (IRR 1.6, 95% CI 1.02 to 1.91), even when controlling for job strain, physical exposure, and age in the model stratified by sex. CONCLUSIONS Perceived muscular tension was associated with an increased risk of developing neck pain among VDU users. The combination of high job strain and high perceived muscular tension was associated with higher risk of developing neck pain than the combination of high physical exposure and high perceived muscular tension. There was an indication of an excess risk due to interaction between high physical exposure and high job strain.
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Affiliation(s)
- J Wahlström
- Department of Occupational Medicine at the Sahlgrenska Academy at Göteborg University, Sweden.
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Eriksen W. Linking work factors to neck myalgia: the nitric oxide/oxygen ratio hypothesis. Med Hypotheses 2004; 62:721-6. [PMID: 15082096 DOI: 10.1016/j.mehy.2003.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2003] [Accepted: 12/04/2003] [Indexed: 02/05/2023]
Abstract
The pathophysiological link between work-related exposures and neck myalgia remains a puzzle. According to the hypothesis presented here, neck myalgia is evoked when low-level contractions in the trapezius muscle are combined with sympathetic vasoconstriction due to psychological stress or prolonged head-down neck flexion at work. These ischemic contractions increase nitric oxide/oxygen concentration ratio in the muscle fibres, enhancing herewith the reversible inhibition of mitochondrial cytochrome oxidase by nitric oxide. The result is depletion of adenosine triphosphate, which elicits production/efflux of lactic acid, in turn activating and sensitising proton-sensitive nociceptive fibres in the connective tissue, causing myalgic pain and tenderness. High estrogen-level, which gives a high expression of nitric oxide synthase in the muscle, accentuates the situation. During episodes of sustained inhibition of cytochrome oxidase by nitric oxide, peroxynitrite may be produced and cause irreversible inactivation of several enzymes in the mitochondrial electron-carrier chain. With repeated episodes, an increasing part of the enzymatic capacity for cellular respiration is inactivated. Even if this process only takes place within a small portion of the muscle fibres, it may contribute to frequent exacerbations of pain. Effects of peroxinitrite may also explain the mitochondrial abnormalities found in the trapezius muscle of many neck myalgia patients. Adrenergic antagonists and nitric oxide synthase inhibitors could reduce symptoms. Ascorbic acid, alpha tocopherol, and flavonoids, which are safe and effective scavengers of peroxynitrite, could prevent chronicity. The most effective non-pharmacological measure may be to reduce exposure to prolonged head-down neck flexions and psychosocial stress at work.
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Affiliation(s)
- Willy Eriksen
- Department of General Practice and Community Medicine, University of Oslo, P.O. Box 1130, Blindern, 0318 Oslo, Norway.
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Bonato P, Mork PJ, Sherrill DM, Westgaard RH. Data mining of motor patterns recorded with wearable technology. IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE : THE QUARTERLY MAGAZINE OF THE ENGINEERING IN MEDICINE & BIOLOGY SOCIETY 2003; 22:110-9. [PMID: 12845827 DOI: 10.1109/memb.2003.1213634] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Paolo Bonato
- Motion Analysis Laboratory, Dept. of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 125 Nashua Street, Boston, MA 02114, USA.
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Holte KA, Westgaard RH. Further studies of shoulder and neck pain and exposures in customer service work with low biomechanical demands. ERGONOMICS 2002; 45:887-909. [PMID: 12519522 DOI: 10.1080/0014013021000034867] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The aim of the study was to establish insight into work exposures that cause shoulder and neck pain among occupational groups that have low biomechanical exposure and experience work stress from client/customer contact, among other exposures. Four occupational groups were studied, in health care (n = 20), retail (n = 22), banking (n = 26), and university secretaries (n = 26), a total of 94 volunteers. Thirty-nine were classified as pain-afflicted in the shoulder and neck, while 55 were pain-free. The subjects' perceptions of biomechanical and psychosocial exposures were established by use of quantitative questionnaires and by explorative interviews with open-ended questions, covering the same themes. Heart rate and trapezius EMG were recorded over a full workday and the following leisure period. Trapezius median and static activity during work were 3.3% and 0.3% EMG(max), only marginally higher than trapezius activity in the leisure period (2.7% and 0.2% EMG(max)). The quantitative questionnaire did not identify any variable that correlated with shoulder and neck pain except perceived general tension. The interviews established that the interaction with clients or customers was an important source of work stress. Such stress appeared to be a complex entity not easily characterized by established psychosocial questionnaires. The physiological variables were at most weakly elevated in periods with high stress as compared to periods with low stress. The authors caution against relying on standardized quantitative questionnaires and/or physiological recordings to characterize work stress in occupations with emotional stress through client/customer service work.
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Affiliation(s)
- Kari Anne Holte
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
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Biobehavioral Mechanisms of Work-Related Upper Extremity Disorders. Proceedings of a symposium. 6-7 November 2000, Washington, DC, USA. Am J Ind Med 2002; 41:293-455. [PMID: 12405103 DOI: 10.1002/ajim.10060] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Epidemiological studies provide support for the role of organizational and individual psychosocial stressors in work-related upper extremity disorders (WRUEDs). Despite this evidence, the biological plausibility of a relationship between exposure to various psychosocial and work organizational stressors and WRUEDs remains unclear METHODS The Georgetown Symposium on Biobehavioral Mechanisms of Work-Related Upper Extremity Disorders was held in Washington D.C. on November 6-7, 2000 to improve the understanding of potential biobehavioral mechanisms, identify future areas for research and discuss the implications of this body of knowledge for intervention. This meeting involved presentations and discussions by researchers and clinicians from a number of disciplines (epidemiology, occupational medicine, rheumatology, orthopedics, surgery, internal medicine, psychoneuroimmunology, occupational health psychology, behavioral medicine, psychophysiology and experimental and organizational psychology). RESULTS The symposium generated several papers addressing the following topics: definitions and job stress models; epidemiological foundations; musculoskeletal and biomechanical models; central nervous system models of recurrent and persistent clinical pain; psychophysiology of work; and implications for intervention. These papers comprise this special issue. DISCUSSION The present paper summarizes the various contributions to this special issue and provides direction for future research on potential biobehavioral pathways.
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