Effects of visual feedback absence on force control during isometric contraction

Does pain influence control of muscle force? A systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

In the presence of pain, whether clinical or experimentally induced, individuals commonly show impairments in the control of muscle force (commonly known as force steadiness). In this systematic review and meta-analysis, we synthesized the available evidence on the influence of clinical and experimental pain on force steadiness.

DATABASES AND DATA TREATMENT

MEDLINE, EMBASE, PubMed, CINAHL Plus and Web of Science databases were searched from their inception to 19 December 2023, using MeSH terms and pre-selected keywords related to pain and force steadiness. Two independent reviewers screened studies for inclusion and assessed their methodological quality using a modified Newcastle-Ottawa risk of bias tool.

RESULTS

In total, 32 studies (19 clinical pain and 13 experimental pain) were included. Meta-analyses revealed reduced force steadiness in the presence of clinical pain as measured by the coefficient of variation (CoV) and standard deviation (SD) of force (standardized mean difference; SMD = 0.80, 95% CI = 0.31-1.28 and SMD = 0.61, 95% CI = 0.11-1.11). These findings were supported by moderate and low strength of evidence respectively. In the presence of experimental pain, meta-analyses revealed reductions in force steadiness when measured by the CoV of force but not by the SD of force (SMD = 0.50, 95% CI = 0.01-0.99; and SMD = 0.44, 95% CI = -0.04 to 0.92), each supported by very low strength of evidence.

CONCLUSIONS

This work demonstrates that pain, particularly clinical pain, impairs force steadiness. Such impairments likely have clinical relevance and could become targets for treatment when managing people experiencing musculoskeletal pain.

SIGNIFICANCE STATEMENT

This systematic review and meta-analyses enhances our understanding of motor impairments observed in people experiencing musculoskeletal pain. It underscores the significance of incorporating force steadiness assessment when managing individuals experiencing musculoskeletal pain. Additionally, it suggests that future research should explore the potential benefits of force steadiness training in alleviating patients' symptoms and enhancing their functional performance. This could potentially lead to the development of innovative therapeutic approaches for individuals suffering from musculoskeletal pain.

Effect of acute meal and long-term intake of a Mediterranean Diet providing different amounts of carbohydrates on physical performance and biomarkers in non-professional strength athletes

The study aims to evaluate the effect of an acute meal and long-term intake of Mediterranean Diet (MD) on different parameters such as strength, physical performance, body composition and blood markers in a group of non-professional athletes who practice a strength activity. Thirteen volunteers completed two 8-week dietary interventions in a randomised, cross-over design. Also an acute study was performed. Subjects received a MD High in carbohydrates, characterised by at least five portions of pasta/week and an average 55-60% of daily energy derived from carbohydrates, versus an MD reduced in carbohydrates, with less than two portions of pasta/week and an average of 40-45% of daily energy provided by carbohydrates. Mainly, data did not show significant differences for the parameters analysed, except for Elbow Flexor maximum voluntary contraction (p = .039). Results enlighten that increasing total carbohydrates intake, as typically in the MD, does not negatively affect physical performance, body composition and strength.

Effects of visual feedback and force level on bilateral ankle-dorsiflexion force control

This study investigated the potential effects of visual feedback and force level on bilateral force control capabilities in the lower limbs. Thirty-nine healthy young adults performed bilateral ankle-dorsiflexion isometric force control tasks for different visual feedback conditions, including continuous visual feedback (CVF) and withdrawal of visual feedback (WVF), indicating the removal of visual feedback on force outputs during the task and force level conditions (i.e., 10 % and 40 % of the maximum voluntary contraction). Bilateral force control capabilities were estimated using force accuracy, variability, regularity, and absolute power in 0-4 Hz and interlimb coordination by cross-correlation with time lag and uncontrolled manifold (UCM) variables. Correlation analyses determined the relationship between changes in bilateral force control capabilities and interlimb coordination from the CVF to WVF conditions. The findings revealed better bilateral force control capabilities in the CVF condition as indicated by less force error, variability, regularity, absolute power in 0-4 Hz, and advanced interlimb force coordination. From CVF to WVF conditions, increased bad variability correlated with greater force control deficits. These findings suggest that visuomotor processing is an important resource for successful fine motor control in the lower limbs.

The Effect of the Postural Control Strategy on the Recognition Error of Center-of-Pressure Sway

The purpose of this study was to examine the effect of postural control strategies on the recognition error (RE) of center-of-pressure (COP) sway forward based on perceived exertion. Participants were 43 middle-aged or elderly people. We measured the maximum COP sway forward (100% center-of-pressure distance(COP-D)), 60% and 30% COP-D of 100% COP-D based on perceived exertion, and participants were classified into the good balance group and bad balance group by RE. The RE and trunk and leg angles were evaluated during COP sway forward. Results showed that RE being significantly higher for 30% COP-D and the group with a larger RE had a significantly larger trunk angle. Therefore, they may have used hip strategy predominantly to perform postural control ability, not only maximum values, but also on perceived exertion.

The type of visual biofeedback influences maximal handgrip strength and activation strategies

PURPOSE

This study investigated the effects of force and electromyographic (EMG) feedbacks on forearm muscle activations and handgrip maximal isometric voluntary contraction (MIVC).

METHODS

Sixteen males performed a set of MIVC in four different feedback conditions: (1) NO-FB: no feedback is given to the participant; (2) FORCE-FB: participants received a visual feedback of the produced force; (3) AGO-FB: participants received a visual feedback of the EMG activity of two agonist grip muscles; (4) ANTAGO-FB: participants received a visual feedback of the EMG activity of two hand extensors muscles. Each feedback was displayed by monitoring the signal of either force or electrical activity of the corresponding muscles.

RESULTS

Compared to NO-FB, FORCE-FB was associated with a higher MIVC force (+ 11%, P < 0.05), a higher EMG activity of agonist and antagonist muscles (+ 8.7% and + 9.2%, respectively, P < 0.05) and a better MIVC/EMG ratio with the agonist muscles (P < 0.05). AGO-FB was associated with a higher EMG activity of agonist muscles (P < 0.05) and ANTAGO-FB was associated with a higher EMG activity of antagonist muscles (P < 0.05). MIVC force was higher in the agonist feedback condition than in the antagonist feedback condition (+ 5.9%, P < 0.05).

CONCLUSION

Our results showed that the MIVC force can be influenced by different visuals feedback, such as force or EMG feedbacks. Moreover, these results suggested that the type of feedback employed could modify the EMG-to-force relationships. Finally, EMG biofeedback could represent an interesting tool to optimize motor strategies. But in the purpose of performing the highest strength independently of the strategy, the force feedback should be recommended.

Muscle pain from an intramuscular injection of hypertonic saline increases variability in knee extensor torque reproduction

The intensity of exercise-induced pain (EIP) reflects the metabolic environment in the exercising muscle, so during endurance exercise, this may inform the intelligent regulation of work rate. Conversely, the acute debilitating effects of EIP on motor unit recruitment could impair the estimation of force produced by the muscle and impair judgement of current exercise intensity. This study investigated whether muscle pain that feels like EIP, administered via intramuscular injection of hypertonic saline, interferes with the ability to accurately reproduce torque in a muscle group relevant to locomotive exercise. On separate days, 14 participants completed an isometric torque reproduction task of the knee extensors. Participants were required to produce torque at 15% and 20% maximal voluntary isometric torque (MVIT), without visual feedback before (baseline), during (pain/no pain), and after (recovery) an injection of 0.9% isotonic saline (Control) or 5.8% hypertonic saline (Experimental) into the vastus lateralis of the right leg. An elevated reported intensity of pain, and a significantly increased variance in mean contraction torque at both 15% (P = 0.049) and 20% (P = 0.002) MVIT was observed in the Experimental compared to the Control condition. Both 15 and 20% target torques were performed at a similar pain intensity in the Experimental condition (15% MVIT: 4.2 ± 1.9; 20% MVIT: 4.5 ± 2.2; P > 0.05). These findings demonstrate that the increased muscle pain from the injection of hypertonic saline impeded accurate reproduction of knee extensor torque. These findings have implications for the detrimental impact of EIP on exercise regulation and endurance performance.NEW & NOTEWORTHY We provide novel data demonstrating that the presence of muscle pain interferes with estimations of torque produced by the knee extensors, which could impair judgment of work rate during endurance exercise. The novelty of our study is in the application of the hypertonic saline experimental model into a quadriceps muscle during short, submaximal isometric contractions at an intensity that provides a more translatable assessment of the impact of exercise-induced pain on work-rate regulation during whole body exercise.

Effects of online-bandwidth visual feedback on unilateral force control capabilities

Purpose

The purpose of this study was to examine how different threshold ranges of online-bandwidth visual feedback influence unilateral force control capabilities in healthy young women.

Methods

Twenty-five right-handed young women (mean±standard deviation age = 23.6±1.5 years) participated in this study. Participants unilaterally executed hand-grip force control tasks with their dominant and non-dominant hands, respectively. Each participant completed four experimental blocks in a different order of block presentation for each hand condition: (a) 10% of maximum voluntary contraction (MVC) with ±5% bandwidth threshold range (BTR), (b) 10% of MVC with ±10% BTR, (c) 40% of MVC with ±5% BTR, and (d) 40% of MVC with ±10% BTR. Outcome measures on force control capabilities included: (a) force accuracy, (b) force variability, (c) force regularity, and (d) the number of times and duration out of BTR.

Results

The non-dominant hand showed significant improvements in force control capabilities, as indicated by higher force accuracy, less force variability, and decreased force regularity from ±10% BTR to ±5% BTR during higher targeted force level task. For both hands, the number of times and duration out of BTR increased from ±10% BTR to ±5% BTR.

Conclusions

The current findings suggested that the narrow threshold range of online-bandwidth visual feedback effectively revealed transient improvements in unilateral isometric force control capabilities during higher targeted force level tasks.

Use of Visual Feedback During Jump-Squat Training Aids Improvement in Sport-Specific Tests in Athletes

Vanderka, M, Bezák, A, Longová, K, Krčmár, M, and Walker, S. Use of visual feedback during jump-squat training aids improvement in sport-specific tests in athletes. J Strength Cond Res 34(8): 2250-2257, 2020-This study investigated the effects of instantaneous performance feedback during the jump-squat exercise over a 6-week training period. Twenty-five strength-trained athletes were randomly divided into an instant feedback (n = 13, half-squat 3-repetition maximum (3RM)/body mass = 2.38 ± 0.19) or a nonfeedback (n = 12, half-squat 3RM/body mass = 2.03 ± 0.44) group. Both groups performed the same training program (3 × week), consisting of 4 sets of 8 repetitions (weeks 1-3) and 8 sets of 4 repetitions (weeks 4-6) using a barbell with a load that maximized the average concentric power output (Pmax) of each athlete. Subjects in the instant feedback group were given real-time data after each repetition. Pre-, mid-, and post-training testing consisted of maximum 20-, 30-, and 50-m running speed, 3RM back half-squat load, Pmax and the load that maximized average concentric power output (Pmax load), countermovement jump (CMJ), and squat jump (SJ) height. Results revealed that the feedback group significantly improved all selected tests vs. nonfeedback (time × group interaction, p < 0.01). Significant improvements after training for 20, 30, 50 m, 3RM load, Pmax load, CMJ, and SJ were observed in the feedback group only (p < 0.01). Training without instant feedback did not lead to significant performance improvements; this group actually demonstrated significant decreases in SJ and Pmax (W) and Pmax load (p < 0.05). The results of this study indicate that the use of instant feedback during jump-squat training in athletes was beneficial for improving multiple performance tasks over 6 weeks of training. Instant feedback is an important element of power training to maximize adaptations when training strength-trained athletes.

The Effects of Botulinum Toxin Injections on Spasticity and Motor Performance in Chronic Stroke with Spastic Hemiplegia

Spastic muscles are weak muscles. It is known that muscle weakness is linked to poor motor performance. Botulinum neurotoxin (BoNT) injections are considered as the first-line treatment for focal spasticity. The purpose of this study was to quantitatively investigate the effects of BoNT injections on force control of spastic biceps brachii muscles in stroke survivors. Ten stroke survivors with spastic hemiplegia (51.7 ± 11.5 yrs; 5 men) who received 100 units of incobotulinumtoxinA or onabotulinumtoxinA to the biceps brachii muscles participated in this study. Spasticity assessment (Modified Ashworth Scale (MAS) and reflex torque) and muscle strength of elbow flexors, as well as motor performance assessment (force variability of submaximal elbow flexion) were performed within one week before (pre-injection) and 3~4 weeks (3-wk) after BoNT injections. As expected, BoNT injections reduced the MAS score and reflex torque, and elbow flexor strength on the spastic paretic side. However, motor performance remained within similar level before and after injections. There was no change in muscle strength or motor performance on the contralateral arm after BoNT injections. The results of this study provide evidence that BoNT injections can reduce spasticity and muscle strength, while motor performance of the weakened spastic muscle remains unchanged.

Reduced Neuromuscular Performance in Night Shift Orthopedic Nurses: New Insights From a Combined Electromyographic and Force Signals Approach

The effect of sleep–wake rhythm disruption on neuromuscular control and muscle fatigue has received little attention. Because nurse shift work is so varied, including overnight duty, rotating shift schedules, early awakening, and interrupted nocturnal sleep, it offers an interesting model to study this paradigm. It has been investigated so far using only subjective markers. A combined approach based on the simultaneous analysis of surface electromyographic (sEMG) and force signals can objectively detect possible deficits in neuromuscular control and muscle fatigue. With this study we investigated neuromuscular activation and muscle contraction capacity at submaximum and maximum level in nurses working two night-shift schedules and compared them to levels in nurses working entirely in day shifts. Sleep quality and activity levels were also assessed. The study sample was 71 nurses grouped by their shift work schedule: night shift for 5 days (NS₅, n = 46), night shift for 10 days (NS₁₀, n = 9), and only day/swing shift (DS, n = 16). Before and after the shift-work cycle, maximum voluntary contraction (MVC) force and muscle activation, neuromuscular control, and muscle fatigability were measured in the finger flexor muscles. Activity level and sleep quality during the shift-work cycle were recorded with a wrist actigraph. After the shift-work cycles, MVC force and muscle activation were decreased (−11 ± 3% and −33 ± 3%, p < 0.001) as was neuromuscular control (−36 ± 8%, p = 0.007), whereas muscle fatigability was increased (+ 19 ± 9%, p = 0.006) in the NS₅ and the NS₁₀ group. Sleep quality was lower in the NS₅ and the NS₁₀ group (−8 ± 1.8% and −15%3, respectively, p < 0.001), while the activity level for the three groups was similar. There was a clear reduction in neuromuscular control and an increase in muscle fatigue in the nurses working the night shift. These findings may inform of work schedule planning or recommendations for devising new recovery strategies to counteract neuromuscular alterations in night shift nurses.

Plantarflexion force is amplified with sensory stimulation during ramping submaximal isometric contractions

Stimulating cutaneous nerves, causing tactile sensations, reduces the perceived heaviness of an object, suggesting that either descending commands are facilitated or the perception of effort is reduced when tactile sensation is enhanced. Sensory stimulation can also mitigate decrements in motor output and spinal cord excitability that occur with fatigue. The effects of sensory stimulation applied with coincident timing of voluntary force output, however, are yet to be examined. Therefore, the purpose of this study was to examine effects of sensory enhancement to nerves innervating opposed skin areas of the foot (top or bottom) on force production during voluntary plantarflexion or dorsiflexion contractions. Stimulation trains were applied for 2 s at either a uniform 150 Hz or a modulated frequency that increased linearly from 50 to 150 Hz and were delivered at the initiation of the contraction. Participants were instructed to perform a ramp contraction [~10% maximal voluntary contraction (MVC)/s] to ~20% MVC and then to hold ~20% MVC for 2 s while receiving real-time visual feedback. Cutaneous reflexes were evoked 75 ms after initiating the hold (75 ms after sensory enhancement ended). Force output was greater for all sensory-enhanced conditions compared with control during plantarflexion; however, force output was not amplified during dorsiflexion. Cutaneous reflexes evoked after sensory enhancement were unaltered. These results indicate that sensory enhancement can amplify plantarflexion but not dorsiflexion, likely as a result of differences in neuroanatomical projections to the flexor and extensor motor pools. Further work is required to elucidate the mechanisms of enhanced force during cutaneous stimulation.NEW & NOTEWORTHY The efficacy of behaviorally timed sensory stimulation to enhance sensations and amplify force output has not been examined. Here we show cutaneous nerve sensory stimulation can amplify plantarflexion force output. This amplification in force occurs irrespective of whether the cutaneous field that is stimulated resides on the surface that is producing the force or the opposing surface. This information may provide insights for the development of technologies to improve performance and/or rehabilitation training.

Effects of tonic muscle pain on fusimotor control of human muscle spindles during isometric ankle dorsiflexion

Studies on anesthetized animals have revealed that nociceptors can excite fusimotor neurons and thereby change the sensitivity of muscle spindles to stretch; such nociceptive reflexes have been suggested to underlie the mechanisms that lead to chronic musculoskeletal pain syndromes. However, the validity of the “vicious cycle” hypothesis in humans has yielded results contrasting with those found in animals. Given that spindle firing rates are much lower in humans than in animals, it is possible that some of the discrepancies between human experimental data and those obtained in animals could be explained by differences in background fusimotor drive when the leg muscles are relaxed. We examined the effects of tonic muscle pain during voluntary contractions of the ankle dorsiflexors. Unitary recordings were obtained from 10 fusimotor-driven muscle spindle afferents (6 primary, 4 secondary) supplying the ankle dorsiflexors via a microelectrode inserted percutaneously into the common peroneal nerve. A series of 1-min weak contractions was performed at rest and during 1 h of muscle pain induced by intramuscular infusion of 5% hypertonic saline into the tibialis anterior muscle. We did not observe any statistically significant increases in muscle spindle firing rates of six afferents followed during tonic muscle pain, although discharge variability increased slightly. Furthermore, a participant’s capacity to maintain a constant level of force, while relying on proprioceptive feedback in the absence of visual feedback, was not compromised during pain. We conclude that nociceptive inputs from contracting muscle do not excite fusimotor neurons during voluntary isometric contractions in humans.

NEW & NOTEWORTHY Data obtained in the cat have shown that muscle pain causes a marked increase in the firing of muscle spindles, attributed to a nociceptor-driven fusimotor reflex. However, our studies of muscle spindles in relaxed leg muscles failed to find any effect on spindle discharge. Here we showed that experimental muscle pain failed to increase the firing of muscle spindle afferents during weak voluntary contractions, when fusimotor drive sufficient to increase their firing is present.

Improvements in force variability and structure from vision- to memory-guided submaximal isometric knee extension in subacute stroke

We examined changes in variability, accuracy, frequency composition, and temporal regularity of force signal from vision-guided to memory-guided force-matching tasks in 17 subacute stroke and 17 age-matched healthy subjects. Subjects performed a unilateral isometric knee extension at 10, 30, and 50% of peak torque [maximum voluntary contraction (MVC)] for 10 s (3 trials each). Visual feedback was removed at the 5-s mark in the first two trials (feedback withdrawal), and 30 s after the second trial the subjects were asked to produce the target force without visual feedback (force recall). The coefficient of variation and constant error were used to quantify force variability and accuracy. Force structure was assessed by the median frequency, relative spectral power in the 0-3-Hz band, and sample entropy of the force signal. At 10% MVC, the force signal in subacute stroke subjects became steadier, more broadband, and temporally more irregular after the withdrawal of visual feedback, with progressively larger error at higher contraction levels. Also, the lack of modulation in the spectral frequency at higher force levels with visual feedback persisted in both the withdrawal and recall conditions. In terms of changes from the visual feedback condition, the feedback withdrawal produced a greater difference between the paretic, nonparetic, and control legs than the force recall. The overall results suggest improvements in force variability and structure from vision- to memory-guided force control in subacute stroke despite decreased accuracy. Different sensory-motor memory retrieval mechanisms seem to be involved in the feedback withdrawal and force recall conditions, which deserves further study. NEW & NOTEWORTHY We demonstrate that in the subacute phase of stroke, force signals during a low-level isometric knee extension become steadier, more broadband in spectral power, and more complex after removal of visual feedback. Larger force errors are produced when recalling target forces than immediately after withdrawing visual feedback. Although visual feedback offers better accuracy, it worsens force variability and structure in subacute stroke. The feedback withdrawal and force recall conditions seem to involve different memory retrieval mechanisms.

The importance of cutaneous feedback on neural activation during maximal voluntary contraction

PURPOSE

The purpose of this study was to investigate the importance of cutaneous feedback on neural activation during maximal voluntary contraction (MVC) of the ankle plantar flexors.

METHODS

The effects of cutaneous plantar anaesthesia were assessed in 15 subjects and compared to 15 controls, using a one-day pre/post-repeated measures design. Cutaneous plantar anaesthesia was induced by lidocaine injection at the centre of forefoot, lateral midfoot, and heel. Each subject performed isometric MVCs of the ankle plantar flexors. During each isometric ramp contraction, the following variables were assessed: maximal isometric torque; surface electromyography (EMG) activity of the medial gastrocnemius (MG) and tibialis anterior (TA) muscles; and co-contraction index (CCI) between the MG and TA.

RESULTS

For ankle torque, two-way ANOVA showed no significant interaction between the pre/post-measurements × group (p = 0.166). However, MG activity presented significant interactions between the pre/post-measurements × group (p = 0.014). Post hoc comparisons indicated a decrease of MG activity in the experimental group, from 85.9 ± 11.9 to 62.7 ± 30.8% (p = 0.016). Additionally, the post-anaesthesia MG activity of the experimental group differed statistically with pre- and post-MG activity of the control group (p = 0.027 and p = 0.008, respectively). For TA activity and CCI, two-way ANOVA detected no significant interactions between the pre/post-measurements × group (p = 0.605 and p = 0.332, respectively).

CONCLUSION

Our results indicate that during MVC, cutaneous feedback modulates neural activity to MG muscle, without changing the extent of MG-TA co-contraction.