Adaptations to neck/shoulder fatigue and injuries

Muscle fatigue during assisted violin performance

Muscle fatigue is a primary risk factor in developing musculoskeletal disorders, which affect up to 93% musicians, especially violinists. Devices providing dynamic assistive support (DAS) to the violin-holding arm can lessen fatigue. The objective was to assess DAS effects on electromyography median frequency and joint kinematics during a fatiguing violin-playing task. Fifteen university-level and professional violinists were equipped with electromyography sensors and reflective markers to record upper-body muscle activity and kinematics. They played G scales with and without DAS until exhaustion. Paired t-tests assessed DAS effects on delta (final-initial) electromyography median frequencies and joint kinematics. DAS prevented the median frequency decrease of left supraspinatus, superior trapezius, and right medial deltoid, and increases in trunk rotation, left-wrist abduction, and right arm-elevation plane. DAS effects on kinematics were marginal due to retention of musical performance despite fatigue. However, DAS reduced fatigue of several muscles, which is promising for injury prevention.Practitioner summary: Violinists are greatly affected by musculoskeletal disorders. Effects of a mobility assistive device on muscle fatigue during violin playing was investigated. The assistive technology slowed down the development of fatigue for three neck/shoulder muscles, making assisted musical performance a promising avenue to prevent violinists' injuries.

Few sex-specific effects of fatigue on muscle synergies in a repetitive pointing task

Previous studies have identified some sex differences in how individual muscles change their activation during repetitive multi-joint arm motion-induced fatigue. However, little is known about how indicators of multi-muscle coordination change with fatigue in males and females. Fifty-six (29 females) asymptomatic young adults performed a repetitive, forward-backward pointing task until scoring 8/10 on a Borg CR10 scale while surface electromyographic activity of upper trapezius, anterior deltoid, biceps brachii, and triceps brachii was recorded. Activation coefficient, synergy structure, and relative weight of each muscle within synergies were calculated using the non-negative matrix factorization method. Two muscle synergies were extracted from the fatiguing task. The synergy structures were mostly preserved after fatigue, while the activation coefficients were altered. A significant Sex × Fatigue interaction effect showed more use of the anterior deltoid in males especially before fatigue in synergy 1 during shoulder stabilization (p = 0.04). As for synergy 2, it was characterized by variations in the relative weight of biceps, which was higher by 16 % in females compared to males (p = 0.04), and increased with fatigue (p = 0.03) during the elbow flexion acceleration phase and the deceleration phase of the backward pointing movement. Findings suggest that both sexes adapted to fatigue similarly, using fixed synergy structures, with alterations in synergy activation patterns and relative weights of individual muscles. Results support previous findings of an important role for the biceps and anterior deltoid in explaining sex differences in patterns of repetitive motion-induced upper limb fatigue.

The effects of hand dominance, fatigue, and sex on muscle activation during a repetitive overhead fatiguing task

Previous studies have shown that the dominant arm is generally stronger and more resistant to fatigue. However, whether there are side differences in shoulder muscle activation during a fatiguing upper limb task, and whether this varies according to sex, is unknown. Thirty right-handed adults (15 females) were recruited to complete two sessions of an overhead repetitive fatiguing task (shoulder flexion between 90 and 135° at 1 Hz), performed in two separate sessions with their dominant arm (DA) and non-dominant arm (NDA) until exhaustion. Electromyographic (EMG) data was collected from 11 shoulder muscles of the moving arm, and their activation amplitude (RMS) and activation variability (SD) were assessed. Results show that time to exhaustion was not affected by arm or by sex. There were some main arm effects on EMG activity amplitude, with higher activity on the DA's pectoralis major (p < 0.001), and on the NDA's middle (p = 0.009) and posterior deltoid (p = 0.001) and infraspinatus (p < 0.001). The pectoralis major was affected by arm and fatigue mostly in males. Their DA's pectoralis major activity amplitude was higher, and the amplitude variability was lower, compared to the NDA, with both parameters showing fatigue-dependent decreases at the NDA only (arm x sex x fatigue: RMS: p = 0.007; SD: p = 0.001). As for females, the DA variability of their lower trapezius was smaller, and that of their subscapularis was higher, compared to the NDA (sex x arm, p = 0.028, p = 0.05). There was also more EMG variability on the supraspinatus' dominant side, and on the posterior deltoid and infraspinatus ND side. Results show an overhead shoulder flexion task dependency on pectoralis major control in males, and on lower trapezius and shoulder girdle stabilizers in females, which could be related to both sex- and gender-based factors. This knowledge can help identify side-specific injury risk factors due to overhead work in males and females, and help determine the appropriateness of implementing sex-specific workplace protocols, including alternating arms as fatigue compensatory and recovery strategies.

Data-Driven Approach for Upper Limb Fatigue Estimation Based on Wearable Sensors

Muscle fatigue is defined as a reduced ability to maintain maximal strength during voluntary contraction. It is associated with musculoskeletal disorders that affect workers performing repetitive activities, affecting their performance and well-being. Although electromyography remains the gold standard for measuring muscle fatigue, its limitations in long-term work motivate the use of wearable devices. This article proposes a computational model for estimating muscle fatigue using wearable and non-invasive devices, such as Optical Fiber Sensors (OFSs) and Inertial Measurement Units (IMUs) along the subjective Borg scale. Electromyography (EMG) sensors are used to observe their importance in estimating muscle fatigue and comparing performance in different sensor combinations. This study involves 30 subjects performing a repetitive lifting activity with their dominant arm until reaching muscle fatigue. Muscle activity, elbow angles, and angular and linear velocities, among others, are measured to extract multiple features. Different machine learning algorithms obtain a model that estimates three fatigue states (low, moderate and high). Results showed that between the machine learning classifiers, the LightGBM presented an accuracy of 96.2% in the classification task using all of the sensors with 33 features and 95.4% using only OFS and IMU sensors with 13 features. This demonstrates that elbow angles, wrist velocities, acceleration variations, and compensatory neck movements are essential for estimating muscle fatigue. In conclusion, the resulting model can be used to estimate fatigue during heavy lifting in work environments, having the potential to monitor and prevent muscle fatigue during long working shifts.

Size and structure of motor variability in young and old adults performing a rhythmic, repetitive tapping task

The size of motor variability increases with fatigue in repetitive upper limb tasks, and the structure of variability differs with old age. However, the combined influences of old age and fatigue on the size and structure of movement-to-movement variability are unclear. Eighteen young and sixteen old adults performed a fatiguing repetitive tapping task while seated using their dominant arm. Optoelectronic motion capture served to measure upper body angles via forward kinematics. Movement-to-movement variability was measured by the size at joints (standard deviation: SD) and by the structure of the uncontrolled manifold (variance: V_UCM, V_ORT; synergy index: ΔV_z) in the first and final minutes of the task for the early, middle, and late forward movement phases. Outcomes were analyzed by Age*Condition*Phase general estimating equations. Old adults had lower humerothoracic abduction/adduction and flexion/extension SD, wrist flexion/extension SD, V_UCM, and V_ORT, mainly in the early movement phase (p < 0.014). With fatigue, humerothoracic flexion/extension SD increased in young adults only and humerothoracic abduction/adduction SD, wrist pronation/supination SD, wrist flexion/extension SD, and V_UCM increased in both groups. ΔV_z was positive and did not differ with age or fatigue (p > 0.014). Results indicate that fatigue adjustments were mainly in the frontal plane, old age did not affect the ratio of good vs. bad variability, and motor synergy was preserved during fatigue despite less motor flexibility in old age.

Power Spectrum of Acceleration and Angular Velocity Signals as Indicators of Muscle Fatigue during Upper Limb Low-Load Repetitive Tasks

Muscle fatigue is a risk factor for developing musculoskeletal disorders during low-load repetitive tasks. The objective of this study was to assess the effect of muscle fatigue on power spectrum changes of upper limb and trunk acceleration and angular velocity during a repetitive pointing task (RPT) and a work task. Twenty-four participants equipped with 11 inertial measurement units, that include acceleration and gyroscope sensors, performed a tea bag filling work task before and immediately after a fatiguing RPT. During the RPT, the power spectrum of acceleration and angular velocity increased in the movement and in 6-12 Hz frequency bands for sensors positioned on the head, sternum, and pelvis. Alternatively, for the sensor positioned on the hand, the power spectrum of acceleration and angular velocity decreased in the movement frequency band. During the work task, following the performance of the fatiguing RPT, the power spectrum of acceleration and angular velocity increased in the movement frequency band for sensors positioned on the head, sternum, pelvis, and arm. Interestingly, for both the RPT and work task, Cohens' d effect sizes were systematically larger for results extracted from angular velocity than acceleration. Although fatigue-related changes were task-specific between the RPT and the work task, fatigue systematically increased the power spectrum in the movement frequency band for the head, sternum, pelvis, which highlights the relevance of this indicator for assessing fatigue. Angular velocity may be more efficient to assess fatigue than acceleration. The use of low cost, wearable, and uncalibrated sensors, such as acceleration and gyroscope, in industrial settings is promising to assess muscle fatigue in workers assigned to upper limb repetitive tasks.

The Effect of Vibration Massage on Fatigue of the Upper Trapezius Muscle during Different Tasks

Background: Vibratory massage is now widely used to alleviate muscle fatigue. The effects of different vibration massage intensities on left and right upper trapezius (UT) fatigue have not been examined. Therefore, the present study first examined whether a vibration massage intervention had an effect on UT muscles and second compared the effects of 2 different levels (36 Hz and 46 Hz) of vibratory massage on the right and left oblique muscles under 3 different fatigue conditions. Methods: A total of 23 participants (12 female, 11 male; age: 26.5 ± 3.9 year, height: 170.5 ± 1.6 cm, mass: 57.5 ± 1.5 kg, BMI: 24.3 ± 1.6 kg/m2) were randomly divided into intervention and control groups. The 2 groups of subjects completed isometric contraction fatigue tasks of 30 s of fatigue, 60 s of fatigue and 90 s of fatigue in turn. The specific task of isotonic contraction was performed by subjects holding a 1 kg dumbbell in each hand and performing a straight arm weighted lateral supination exercise. After each exercise, the intervention group was randomized to apply a massage device with a vibration intensity of 36 Hz or 46 Hz on the left and right UT muscles for 5 min each. The control group did not receive any treatment. Both groups then repeated the same fatigue task as before. Then, the effects of different vibration massage interventions on UT muscles were derived by analyzing the changes in maximal voluntary contraction percentage (MVC%) of surface electromyography (sEMG) signals before and after the intervention, and the most effective vibration massage program for relieving left and right UT fatigue was summarized. Then, four classification algorithms were used to label and classify the collected sEMG data, and finally a UT muscle fatigue identification and vibration massage model was constructed. Results: After using the vibration massage level 1 (36 Hz) intervention, the MVC% of the right UT muscle showed significant reductions in the 30 s fatigue task, the 60 s fatigue task and the 90 s fatigue task (R1: p = 0.022, R2: p = 0.005, R3: p = 0.049). After using the vibration massage level 3 (46 Hz) intervention, the MVC% of the right UT muscle showed a significant decrease in both the 60 s fatigue task and the 90 s fatigue task (R2: p = 0.033, R3: p = 0.028). Significant decreases in MVC% for the left UT muscle were found only in the 90 s fatigue task (L3: p = 0.040). Then, by comparing the different performances of four commonly used classification algorithms, it was found that the bagging (accuracy = 0.860) algorithm had higher accuracy. Therefore, the bagging algorithm was used for the UT fatigue identification and vibration massage models. Conclusions: This was the first study to show the impacts of different levels of vibration massage on fatigue alleviation in the left and right UT muscles. Furthermore, the bilateral UT fatigue identification and vibration massage model developed in this study can help people to choose the most appropriate massage protocol for quick relief and relaxation of the UT muscles under three different fatigue tasks.

Uncontrolled Manifold Analysis of the Effects of Different Fatigue Locations on Kinematic Coordination During a Repetitive Upper-Limb Task

Fatigue at individual joints is known to affect interjoint coordination during repetitive multijoint tasks. However, how these coordination adjustments affect overall task stability is unknown. Twelve participants completed a repetitive pointing task at rest and after fatigue of the shoulder, elbow, and trunk. Upper-limb and trunk kinematics were collected. Uncontrolled manifold framework was applied to a kinematic model to link elemental variables to endpoint fingertip position. Mixed and one-way analysis of variances determined effects (phase and fatigue location) on variance components and synergy index, respectively. The shoulder fatigue condition had the greatest impact in causing increases in variance components and a decreased synergy index in the late phase of movement, suggesting more destabilization of the interjoint task caused by shoulder fatigue.

Sex-specific muscle activation and oxygenation kinetics during a repetitive forward pointing task

We compared the minute-by-minute muscle activity and oxygenation responses to a repetitive arm motion-induced fatiguing task between the sexes in order to address the literature gap on these time-dependent fatigue responses. Twenty-six (13 females) healthy adults performed a repetitive pointing task (RPT) with the arm moving forward/backward at shoulder height until reaching 8/10 (Borg CR10) for neck/shoulder perceived exertion (RPE). Neck/shoulder RPE, oxygenation and electromyography were recorded every minute and compared between first and second half of the task and between the sexes. Greater changes in oxygen supply and activation amplitude occurred during the second half of the task. Despite similar time to fatigue-terminal (p > 0.05), females showed greater anterior deltoid activation amplitude at all time points than males, and only the males showed increases in anterior and posterior deltoid activation amplitudes. In females, middle (ρ = -0.34, p = 0.04) and posterior (ρ = -0.44, p = 0.01) deltoid amplitudes were negatively correlated with perceived exertion during the first half of the task. Results suggest that reduced modulation of anterior deltoid activation amplitude in females may reflect a sub-optimal fatigue-mitigation mechanism compared with males and may help explain their greater susceptibility to neck/shoulder musculoskeletal disorders. Novelty: Despite similar fatigability and trapezius oxygenation, females showed greater deltoid activation throughout the task. Deltoid activation increased in males but not in females. The results support the important role of the deltoid in sex-specific neck/shoulder injury mechanisms.

Changes in muscle activation, oxygenation, and morphology following a fatiguing repetitive forward reaching task in young adult males and females

We sought to evaluate sex-specific 1) muscle activation patterns, hemodynamics, and swelling responses to short-cycle repetitive fatigue; 2) relationships between muscular responses and perceived fatigability. Asymptomatic participants (N = 26, 13 females) completed a repetitive pointing task until 8/10 on the Borg CR10 scale. Upper trapezius (UT), supraspinatus (SUPRA), and biceps brachii (BIC) muscle activation, activation variability (CV), median power frequency (MdPF) and thickness, and UT oxygenation were recorded. Males had higher BIC CV, UT and SUPRA MdPF, and UT and BIC thickness. Longer time to fatigue-terminal was correlated to greater SUPRA activation increase (ρ = 0.624) and BIC MdPF decrease (ρ = -0.674) in males, while in females it was correlated to greater (ρ = -0.657) and lower (ρ = 0.683) decrease of SUPRA and BIC CV, respectively. Male's greater increase in SUPRA thickness correlated to greater increase in UT thickness and tissue oxygenation index, and to lower increase of UT deoxyhemoglobin. Females' greater decrease of SUPRA MdPF correlated to greater decrease of UT MdPF, while greater UT activation increase was related to lower UT thickness increase. Results suggest that despite comparable time to fatigue-terminal, males have greater force-generating capacity and neuromuscular reliance on recruitment and excitation rates, while females have greater reliance on activation variability. Further, there are relationships between hemodynamic and swelling patterns in males, while there are relationships between activation and swelling patterns in females. Although there were no differences in experimental task-induced changes, there are sex-specific relationships between muscular patterns and perceived fatigability, which may help explain sex-specific mechanisms of musculoskeletal disorders.

Relative variability in muscle activation amplitude, muscle oxygenation, and muscle thickness: Changes with dynamic low-load elbow flexion fatigue and relationships in young and older females

In repetitive upper limb activities, variability of muscle activity (a feature of motor variability) is linked to upper limb fatigability. Prior studies suggest that the variability response may change with age and could be related to the oxygen saturation of hemoglobin within the muscle. We determined, in female adults, how age affects adjustments in movement-to-movement variability of electromyograph (EMG) amplitude (RMS), oxygenation, and thickness with fatigue, and explored how these responses were related. Fifteen young (23.3 ± 3.1 years) and ten older (62.8 ± 6.9 years) females completed repeated trials of low-load, isokinetic, concentric/eccentric elbow flexion until maximal torque ≤ 70% of baseline. Movement-to-movement variability of EMG RMS in concentric phases of movement was quantified by the coefficient of variation (EMG CV), and muscle oxygenation and thickness (MTH) were quantified using near-infrared spectroscopy, and B-mode ultrasonography. Age*Time and Spearman ρ analyses were conducted. Age did not affect fatigability or Time-related changes in muscular measures (p > 0.05). Biceps brachii and brachialis EMG CV decreased, biceps brachii HbO₂ decreased and did not fully recover, and biceps brachii and brachialis MTH increased. Higher initial brachialis EMG CV was related to less blunted oxygenation in young females (p = 0.021). Oxygenation responses were related to altered anterior deltoid EMG CV in young females but altered biceps brachii and brachialis EMG CV in older females. Age was not associated with changes in EMG CV, oxygenation, or thickness at similar performance fatigability in the concentric/eccentric elbow flexion task studied. Adjustments in biceps brachii oxygenation were linked to changes in EMG CV more local to the site of fatigue with older age.

Similar effects of fatigue induced by a repetitive pointing task on local and remote light touch and pain perception in men and women

Background

Women involved in repetitive, fatiguing, jobs develop more neck and/or shoulder musculoskeletal disorders than men. Sex differences in the pain response to exercise could contribute to the higher prevalence of neck/shoulder musculoskeletal disorders in women. The objective of this study was to assess sex differences in pain sensitivity following a fatiguing upper limb task. Relationships between measures of fatigue and of the sensitivity to nociceptive and to non-nociceptive stimulations were also explored.

Methods

Thirty healthy adults (15 women) performed a fatiguing repetitive pointing task with their dominant arm. Upper limb electromyography was recorded from the dominant upper trapezius, anterior deltoid and bicep brachii and from the contralateral tibialis anterior. Before and immediately after the repetitive pointing task, pressure pain and light touch sensitivity thresholds were measured over the same muscles.

Results

Electromyographic signs of fatigue were observed only in the anterior deltoid and biceps brachii muscles. Pressure pain thresholds over both muscles increased slightly (effect size ≤ 0.34), but no changes occurred over the upper trapezius and the tibialis anterior. Light touch thresholds increased moderately to importantly after the repetitive pointing task over all four muscles (effect sizes = 0.58 to 0.87). No sex differences were observed in any sensory variable. Moreover, no or weak correlations (r = -0.27 to 0.39) were observed between electromyographical signs of fatigue, light touch threshold and pressure pain threshold variables.

Conclusions

We observed sex-independent effects of a repetitive upper limb task on the sensitivity to painful and to nonpainful stimuli. Moreover, the hypoalgesia induced by the repetitive pointing task was weak and localized, and did not directly correlate with the induced muscle fatigue. Results suggest that fatigue-related changes in the sensitivity to noxious and innocuous stimuli could not explain women’s greater prevalence of neck/shoulder musculoskeletal disorders.

Consistent Hand Dynamics Are Achieved by Controlling Variabilities Among Joint Movements During Fastball Pitching

This study aimed to determine whether covariations among joint movements are utilized to stabilize hand orientation and movement and to determine which of the upper or lower extremities make effective use of the covariation. Joint angles during pitching were measured in 12 skilled baseball pitchers, using a motion capture system. The joint angles in 10 successful trials were used for the reconstructed motions. The reconstructed motion in the first condition was the same as for the measured motion. In the second condition, the reconstructed motion was generated with joint angles that were pseudo-randomly selected to artificially break off covariation in the measured joint-angle combination. In the third and fourth conditions, the reconstructed motions were generated with the same joint-angle combinations as the measured angles in the throwing arm and the stride leg, respectively, but pseudo-randomly selected in the other joint angles. Ten reconstructed motions were generated for each condition. Standard deviations (SDs) of hand orientation and movement direction were calculated and compared among the conditions. All SDs for the first condition were the smallest among the conditions, indicating that the movements in the measured condition used the covariation in joint angles to make the hand movement stable. The results also illustrated that some SDs in the fourth condition were smaller than those in the third condition, suggesting that the lower extremity made effective use of the covariation. These results imply that it is necessary not only to reduce variability in each joint but also to regulate joint movements to stabilize hand orientation and movement.

Is sex a proxy for mechanical variables during an upper limb repetitive movement task? An investigation of the effects of sex and of anthropometric load on muscle fatigue

BACKGROUND

Women report more work-related pain and neck/shoulder musculoskeletal disorders than men. For the same absolute workload, due to lower strength, females generally work at a higher relative intensity, which could induce more fatigue. However, the arm's anthropometric load (AL) of men is higher. Therefore, simply lifting their arm could be more fatiguing. Sex as a variable is formed of many constructs, and analyses can become muddied by their differing responses to fatigue. No studies have considered AL, when comparing how fatigue affects men and women. The purpose was to determine if including the arm's AL in the statistical analysis would impact findings of sex-specific effects of shoulder fatigue on muscle EMG.

METHODS

Fifty-five (29m/26f) participants completed a repetitive pointing task (RPT) at shoulder height until they reported fatigue of 8+ on the BORG CR-10 scale. Muscle activities were measured using surface electrodes placed over the anterior deltoid (AD) and upper trapezius (UT) muscles. Muscle activity amplitude was quantified using root mean square (RMS). First- and last-minute data were used to assess change from no-fatigue (NF) to fatigue-terminal (FT) conditions. AL was calculated using sex-specific body parameter equations. General estimating equations (GEE) were used to determine the effects of sex and fatigue on RMS values, while including AL in the GEE.

RESULTS

There was no sex difference in time to reach fatigue. A significant main effect of sex on RMS was observed (χ²(1) = 4.17, p = 0.04) when including AL as a covariate. Females displayed a significantly higher percentage change in AD RMS from NF to FT, compared to males (p = 0.03), when AL was included in the GEE. No sex differences in UT were observed.

CONCLUSIONS

This sex difference emerged when AL was included as a covariate, suggesting that sex-associated anthropometric differences may contribute to sex differences in the fatigue response. Differences in the impact of AL on AD compared to UT could be explained by differences in their respective mechanical roles or muscle fiber content. Anthropometrics may be useful to include as covariates in future research to separate individual anthropometric differences from sex differences.

Fatigue-Related and Timescale-Dependent Changes in Individual Movement Patterns Identified Using Support Vector Machine

The scientific and practical fields-especially high-performance sports-increasingly request a stronger focus be placed on individual athletes in human movement science research. Machine learning methods have shown efficacy in this context by identifying the unique movement patterns of individuals and distinguishing their intra-individual changes over time. The objective of this investigation is to analyze biomechanically described movement patterns during the fatigue-related accumulation process within a single training session of a high number of repeated executions of a ballistic sports movement-specifically, the frontal foot kick (mae-geri) in karate-in expert athletes. The two leading research questions presented for consideration are (1) Can characteristics of individual movement patterns be observed throughout the entire training session despite continuous changes, i.e., even as fatigue-related processes increase? and (2) How do intra-individual movement patterns change as fatigue-related processes increase throughout a training session? Sixteen expert karatekas performed 606 frontal foot kicks directed toward an imaginary target. The kicks were performed in nine sets at 80% (K-80) of the self-experienced maximal intensity. In addition, six kicks at maximal intensity (K-100) were performed after each of the nine sets. Between the sets, the participants took a 90-s break. Three-dimensional full-body kinematic data of all kicks were recorded with 10 infrared cameras. The normalized waveforms of nine upper- and lower-body joint angles were classified using a supervised machine learning method (support vector machine). The results of the classification revealed a disjunct distinction between the kinematic movement patterns of individual athletes. The identification of unique movement patterns of individual athletes was independent of the intensity and the degree of fatigue-related processes. In other words, even with the accumulation of fatigue-related processes, the unique movement patterns of an individual athlete can be clearly identified. During the training session, changes in intra-individual movement patterns could also be detected, indicating the occurrence of adaptations in individual movement patterns throughout the fatigue-related accumulation process. The results suggest that these adaptations can be modeled in terms of changes in patterns rather than increasing variance. Practical consequences are critically discussed.

Age-Dependent Control of Shoulder Muscles During a Reach-and-Lift Task

Aging affects fatigability and is a risk factor for incurring a fatigue-related injury in the neck/shoulder region. Age-related changes in the electromyographical features of motor control may be partly responsible. Young (N = 17) and older (N = 13) adults completed a reach-and-lift task at their self-selected speed, before and after a fatiguing task targeting the neck/shoulder. Electromyography amplitude (root mean square), amplitude variability (root mean square coefficient of variation [CV]), functional connectivity (normalized mutual information [NMI]), and functional connectivity variability (NMI CV) were extracted from several muscles and analyzed for effects and interactions of age using general estimating equation models. Root mean square CV and deltoid NMI CV increased from pre- to postfatigue (ps < .05). Upper trapezius-deltoid NMI decreased for young, but increased for older adults, while the opposite response was found for lower trapezius-deltoid NMI (ps < .05). Older adults seem to adapt to fatigue in reach-and-lift movement with a cranial shift in control of the scapula.

Effects of Trunk Motion, Touch, and Articulation on Upper-Limb Velocities and on Joint Contribution to Endpoint Velocities During the Production of Loud Piano Tones

Piano performance involves several levels of motor abundancy. Identification of kinematic strategies that enhance performance and reduce risks of practice-related musculoskeletal disorders (PRMD) represents an important research topic since more than half of professional pianists might suffer from PRMD during their career. Studies in biomechanics have highlighted the benefits of using proximal upper-limb joints to reduce the load on distal segments by effectively creating velocity and force at the finger-key interaction. If scientific research has documented postural and expressive features of pianists' trunk motion, there is currently a lack of scientific evidence assessing the role of trunk motion in sound production and in injury prevention. We address this gap by integrating motion of the pelvis and thorax in the analysis of both upper-limb linear velocities and joint angular contribution to endpoint velocities. Specifically, this study aims to assess kinematic features of different types of touch and articulation and the impact of trunk motion on these features. Twelve pianists performed repetitive loud and slow-paced keystrokes. They were asked to vary (i) body implication (use of trunk and upper-limb motion or use of only upper-limb motion), (ii) touch (struck touch, initiating the attack with the fingertip at a certain distance from the key surface, or pressed touch, initiating the attack with the fingertip in contact with the key surface), and (iii) articulation (staccato, short finger-key contact time, or tenuto, sustained finger-key contact time). Data were collected using a 3D motion capture system and a sound recording device. Results show that body implication, touch, and articulation modified kinematic features of loud keystrokes, which exhibited not only downward but also important forward segmental velocities (particularly in pressed touch and staccato articulation). Pelvic anterior rotation had a prominent role in the production of loud tones as it effectively contributed to creating forward linear velocities at the upper limb. The reported findings have implications for the performance, teaching, and research domains since they provide evidence of how pianists' trunk motion can actively contribute to the sound production and might not only be associated with either postural or expressive features.

Chronic neck pain and depression: the mediating role of sleep quality and exercise

Previous researches have found that chronic neck pain was closely related to depression. However, the relation between chronic neck pain, sleep quality, exercise and depression remains unclear. This study aims to evaluate the association between these factors, based on the assumption that sleep quality and exercise are potential mediators in the relationship between chronic neck pain and depression. This cross-sectional study enrolled 231 patients with chronic neck pain who were referred to outpatient clinics in department of neurology between July and December 2016. Data analysis was performed using a structural equation model to evaluate the mediating effects of sleep quality and exercise frequency on the relation between chronic neck pain intensity and depression. A positive correlation between neck pain intensity and depression was unveiled. In addition, sleep quality was identified as a significant positive mediator between neck pain intensity and depression, and exercise can help relieve depression. Poor sleep quality leads to an increase of the symptoms of depression for people with high neck pain intensity which can be effectively relieved via additional exercise.

Sex differences in perceptual responses to experimental pain before and after an experimental fatiguing arm task

BACKGROUND

The incidence and prevalence of musculoskeletal disorders (MSDs) is about twice as high in women compared to men, and those of the neck/shoulder region are particularly high among women. Fatigue and responses towards pain are known risk factor for MSDs. However, women have been shown to be less fatigable than men, but more sensitive to experimental pain. From a general standpoint, sex differences in the relationships between the fatigue and pain pathways are poorly understood. This may be due to differences in how men and women conceptually define the sensations of fatigue and pain. The objective of this study was to compare physical and verbal descriptors of fatigue and pain between men and women undergoing an experimental protocol where fatigue and pain were manipulated.

METHODS

Healthy adult volunteers (14 men and 14 women) underwent experimental pain tests to identify pressure pain threshold (PPT) at biceps brachii (BIC), anterior deltoid (AD), and upper trapezius (UT) followed by the Short-form McGill Pain Questionnaire (SF-MPQ) and Pain Catastrophizing Scale (PCS) before and after a repetitive arm task performed at shoulder height until reaching a rating of neck/shoulder perceived exertion, using the Borg Category Ratio 10 (CR10), greater than 8/10. PPT and MPQ data were analyzed using repeated measures analyses of variance (ANOVA) (time × sex). Correlational analyses were used to investigate relationships between pain measures with time and fatigue.

RESULTS

UT PPT was reduced following the fatiguing task (p ≤ 0.01). Men overall reported higher AD PPT levels compared to women (p ≤ 0.05). MPQ and PCS magnification scores were significantly higher after the fatiguing task (p ≤ 0.05), with no sex differences. Time to fatigue correlated with changes in AD PPT in men and with PCS scores in women.

CONCLUSIONS

Findings suggest that mechanisms underlying the sensation of acute pain following a repetitive shoulder height task are closely linked with PPT changes in shoulder stabilizers (UT) irrespective of sex, and more so with physical pain responses in men and in attitudes towards pain in women. Sex differences in pain perception may contribute to a better understanding of sex-specific mechanisms underlying neck/shoulder MSDs.

Sex differences in kinematic adaptations to muscle fatigue induced by repetitive upper limb movements

Background

Muscle fatigue induced by repetitive movements contributes to the development of musculoskeletal disorders. Men and women respond differently to muscle fatigue during isometric single-joint efforts, but sex differences during dynamic multi-joint tasks have not been clearly identified. Moreover, most studies comparing men and women during fatigue development assessed endurance time. However, none evaluated sex differences in kinematic adaptations to fatigue during multi-joint dynamic tasks. The objective of the study was to compare how men and women adapt their upper body kinematics during a fatiguing repetitive pointing task.

Methods

Forty men and 41 women performed repetitive pointing movements (one per second) between two targets while maintaining their elbow elevated at shoulder height. The task ended when participants rated a perceived level of fatigue of 8/10. Trunk, humerothoracic, and elbow angles were compared between the first and last 30 s of the experiment and between men and women. Linear positions of the index finger (distance from the target) and the elbow (arm elevation) as well as movement timing were documented as task performance measures.

Results

Men (7.4 ± 3.2 min) and women (8.3 ± 4.5 min) performed the repetitive pointing task for a similar duration. For both sex groups, trunk range of motion increased with fatigue while shoulder’s and elbow’s decreased. Moreover, participants modified their trunk posture to compensate for the decreased humerothoracic elevation. Movements at all joints also became more variable with fatigue. However, of the 24 joint angle variables assessed, only two Sex × Fatigue interactions were observed. Although average humerothoracic elevation angle decreased in both subgroups, this decrease was greater in men (standardized response mean [SRM] − 1.63) than in women (SRM − 1.44). Moreover, the movement-to-movement variability of humerothoracic elevation angle increased only in women (SRM 0.42).

Conclusion

Despite many similarities between men’s and women’s response to fatigue induced by repetitive pointing movements, some sex differences were observed. Those subtle differences may indicate that men’s shoulder muscles were more fatigued than women’s despite a similar level of perceived exertion. They may also indicate that men and women do not adapt the exact same way to a similar fatigue.

Electronic supplementary material

The online version of this article (10.1186/s13293-018-0175-9) contains supplementary material, which is available to authorized users.

Fatigue-related changes in technique emerge at different timescales during repetitive training

Training consisting of numerous repetitions performed as closely as possible to ideal techniques is common in sports and every-day tasks. Little is known about fatigue-related technique changes that emerge at different timescales when repeating complex actions such as a karate front kick. Accordingly, 15 karatekas performed 600 kicks (1 pre-block and 9 blocks). The pre-block comprised 6 kicks (3 with each leg) at maximum intensity (K-100%). Each block comprised 60 kicks (10 with each leg) at 80% of their self-perceived maximum intensity (K-80%) plus 6 K-100%. In between blocks, the participants rested for 90 seconds. Right leg kinematics (peak joint angles, peak joint angular velocities, peak joint linear resultant velocities, and time of occurrence of peaks) and kick duration corresponding to the K-80% were measured resulting in numerous variations with fatigue. At the timescale of tens of seconds, the changes involved variables that were related to velocity of execution (slowed down), while variables related to movement form were hardly affected. At the timescale of tens of minutes, the opposite results were observed. These findings challenge the long-standing rationale underlying repetitive training, suggesting instead that such involuntary variations in technique might play a crucial role in motor skill training.

Sex differences in the shoulder joint position sense acuity: a cross-sectional study

Background

Work-related musculoskeletal disorders (WMSD) is the most expensive form of work disability. Female sex has been considered as an individual risk factor for the development of WMSD, specifically in the neck and shoulder region. One of the factors that might contribute to the higher injury rate in women is possible differences in neuromuscular control. Accordingly the purpose of this study was to estimate the effect of sex on shoulder joint position sense acuity (as a part of shoulder neuromuscular control) in healthy individuals.

Methods

Twenty-eight healthy participants, 14 females and 14 males were recruited for this study. To test position sense acuity, subjects were asked to flex their dominant shoulder to one of the three pre-defined angle ranges (low, mid and high-ranges) with eyes closed, hold their arm in that position for three seconds, go back to the starting position and then immediately replicate the same joint flexion angle, while the difference between the reproduced and original angle was taken as the measure of position sense error. The errors were measured using Vicon motion capture system. Subjects reproduced nine positions in total (3 ranges × 3 trials each).

Results

Calculation of absolute repositioning error (magnitude of error) showed no significant difference between men and women (p-value ≥ 0.05). However, the analysis of the direction of error (constant error) showed a significant difference between the sexes, as women tended to mostly overestimate the target, whereas men tended to both overestimate and underestimate the target (p-value ≤ 0.01, observed power = 0.79). The results also showed that men had a significantly more variable error, indicating more variability in their position sense, compared to women (p-value ≤ 0.05, observed power = 0.78).

Discussion

Differences observed in the constant JPS error suggest that men and women might use different neuromuscular control strategies in the upper limb. In addition, higher JPS variability observed in men might be one of the factors that could contribute to their lower rate of musculoskeletal disorders, compared to women.

Conclusions

The result of this study showed that shoulder position sense, as part of the neuromuscular control system, differs between men and women. This finding can help us better understand the reasons behind the higher rate of musculoskeletal disorders in women, especially in the working environments.