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Kaufmann P, Zweier L, Baca A, Kainz H. Muscle synergies are shared across fundamental subtasks in complex movements of skateboarding. Sci Rep 2024; 14:12860. [PMID: 38834832 DOI: 10.1038/s41598-024-63640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
A common theory of motor control posits that movement is controlled by muscle synergies. However, the behavior of these synergies during highly complex movements remains largely unexplored. Skateboarding is a hardly researched sport that requires rapid motor control to perform tricks. The objectives of this study were to investigate three key areas: (i) whether motor complexity differs between skateboard tricks, (ii) the inter-participant variability in synergies, and (iii) whether synergies are shared between different tricks. Electromyography data from eight muscles per leg were collected from seven experienced skateboarders performing three different tricks (Ollie, Kickflip, 360°-flip). Synergies were extracted using non-negative matrix factorization. The number of synergies (NoS) was determined using two criteria based on the total variance accounted for (tVAF > 90% and adding an additional synergy does not increase tVAF > 1%). In summary: (i) NoS and tVAF did not significantly differ between tricks, indicating similar motor complexity. (ii) High inter-participant variability exists across participants, potentially caused by the low number of constraints given to perform the tricks. (iii) Shared synergies were observed in every comparison of two tricks. Furthermore, each participant exhibited at least one synergy vector, which corresponds to the fundamental 'jumping' task, that was shared through all three tricks.
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Affiliation(s)
- Paul Kaufmann
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Lorenz Zweier
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Arnold Baca
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria
| | - Hans Kainz
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria.
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria.
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Zhao K, Zhang Z, Wen H, Liu B, Li J, Andrea d’Avella, Scano A. Muscle synergies for evaluating upper limb in clinical applications: A systematic review. Heliyon 2023; 9:e16202. [PMID: 37215841 PMCID: PMC10199229 DOI: 10.1016/j.heliyon.2023.e16202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/11/2023] [Accepted: 05/09/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Muscle synergies have been proposed as a strategy employed by the central nervous system to control movements. Muscle synergy analysis is a well-established framework to examine the pathophysiological basis of neurological diseases and has been applied for analysis and assessment in clinical applications in the last decades, even if it has not yet been widely used in clinical diagnosis, rehabilitative treatment and interventions. Even if inconsistencies in the outputs among studies and lack of a normative pipeline including signal processing and synergy analysis limit the progress, common findings and results are identifiable as a basis for future research. Therefore, a literature review that summarizes methods and main findings of previous works on upper limb muscle synergies in clinical environment is needed to i) summarize the main findings so far, ii) highlight the barriers limiting their use in clinical applications, and iii) suggest future research directions needed for facilitating translation of experimental research to clinical scenarios. METHODS Articles in which muscle synergies were used to analyze and assess upper limb function in neurological impairments were reviewed. The literature research was conducted in Scopus, PubMed, and Web of Science. Experimental protocols (e.g., the aim of the study, number and type of participants, number and type of muscles, and tasks), methods (e.g., muscle synergy models and synergy extraction methods, signal processing methods), and the main findings of eligible studies were reported and discussed. RESULTS 383 articles were screened and 51 were selected, which involved a total of 13 diseases and 748 patients and 1155 participants. Each study investigated on average 15 ± 10 patients. Four to forty-one muscles were included in the muscle synergy analysis. Point-to-point reaching was the most used task. The preprocessing of EMG signals and algorithms for synergy extraction varied among studies, and non-negative matrix factorization was the most used method. Five EMG normalization methods and five methods for identifying the optimal number of synergies were used in the selected papers. Most of the studies report that analyses on synergy number, structure, and activations provide novel insights on the physiopathology of motor control that cannot be gained with standard clinical assessments, and suggest that muscle synergies may be useful to personalize therapies and to develop new therapeutic strategies. However, in the selected studies synergies were used only for assessment; different testing procedures were used and, in general, study-specific modifications of muscle synergies were observed; single session or longitudinal studies mainly aimed at assessing stroke (71% of the studies), even though other pathologies were also investigated. Synergy modifications were either study-specific or were not observed, with few analyses available for temporal coefficients. Thus, several barriers prevent wider adoption of muscle synergy analysis including a lack of standardized experimental protocols, signal processing procedures, and synergy extraction methods. A compromise in the design of the studies must be found to combine the systematicity of motor control studies and the feasibility of clinical studies. There are however several potential developments that might promote the use of muscle synergy analysis in clinical practice, including refined assessments based on synergistic approaches not allowed by other methods and the availability of novel models. Finally, neural substrates of muscle synergies are discussed, and possible future research directions are proposed. CONCLUSIONS This review provides new perspectives about the challenges and open issues that need to be addressed in future work to achieve a better understanding of motor impairments and rehabilitative therapy using muscle synergies. These include the application of the methods on wider scales, standardization of procedures, inclusion of synergies in the clinical decisional process, assessment of temporal coefficients and temporal-based models, extensive work on the algorithms and understanding of the physio-pathological mechanisms of pathology, as well as the application and adaptation of synergy-based approaches to various rehabilitative scenarios for increasing the available evidence.
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Affiliation(s)
- Kunkun Zhao
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Zhisheng Zhang
- School of Mechanical Engineering, Southeast University, Nanjing, China
| | - Haiying Wen
- School of Mechanical Engineering, Southeast University, Nanjing, China
| | - Bin Liu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Jianqing Li
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Andrea d’Avella
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Alessandro Scano
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council of Italy (CNR), Milan, Italy
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Hill CE, Heales LJ, Stanton R, Kean CO. Effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy: A randomised crossover trial. Clin Rehabil 2023:2692155231152817. [PMID: 36727206 DOI: 10.1177/02692155231152817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy. STUDY DESIGN Randomised crossover trial. SETTING Biomechanics laboratory. SUBJECTS 27 participants (11 females, mean (SD) age: 48.6 (11.9) years) with clinically diagnosed lateral elbow tendinopathy of at least six weeks' duration. INTERVENTIONS Tensioned multidirectional elastic tape applied over the wrist, compared to control tape (untensioned), and no tape conditions. MAIN MEASURES Pain-free grip strength and pressure pain threshold were recorded at three timepoints for each condition: baseline, post-application, and following an exercise circuit. Change scores were calculated as the post-application or post-exercise value minus baseline. Repeated-measure analyses of variance were used to examine differences between conditions. RESULTS There were no statistically significant differences in pain-free grip strength between conditions (flexed position: F2,52 = 0.02, p = 0.98; extended position: F2,52 = 2.26, p = 0.12) or across timepoints (post-application vs post-exercise) (flexed position: F1,26 = 0.94, p = 0.34; extended position: F1,26 = 0.79, p = 0.38). Seven participants (26%) increased pain-free grip strength above the minimal detectable change following application of multidirectional elastic tape. There were no statistically significant differences in pressure pain threshold between conditions (affected lateral epicondyle: F1.51,39.17 = 0.54, p = 0.54) or across timepoints (affected lateral epicondyle: F1,26 = 0.94, p = 0.34). CONCLUSION Tensioned multidirectional elastic tape may not immediately improve pain-free grip strength or pressure pain threshold in our lateral elbow tendinopathy population; however, individual variation may exist.
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Affiliation(s)
- Caitlin E Hill
- School of Health, Medical and Applied Sciences, 6939Central Queensland University, Rockhampton, QLD, Australia
| | - Luke J Heales
- School of Health, Medical and Applied Sciences, 6939Central Queensland University, Rockhampton, QLD, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, 6939Central Queensland University, Rockhampton, QLD, Australia.,Appleton Institute, 6939Central Queensland University, Adelaide, SA, Australia
| | - Crystal O Kean
- School of Health, Medical and Applied Sciences, 6939Central Queensland University, Rockhampton, QLD, Australia
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Hill CE, Heales LJ, Stanton R, Holmes MWR, Kean CO. Effects of multidirectional elastic tape on forearm muscle activity and wrist extension during submaximal gripping in individuals with lateral elbow tendinopathy: A randomised crossover trial. Clin Biomech (Bristol, Avon) 2022; 100:105810. [PMID: 36327545 DOI: 10.1016/j.clinbiomech.2022.105810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/11/2022] [Accepted: 10/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lateral elbow tendinopathy is associated with changes to forearm muscle activity and wrist posture during gripping. Multidirectional elastic tape is thought to exert a deloading effect on underlying musculotendinous structures, which could potentially alter muscle activity or wrist posture. METHODS This single-blinded randomised crossover trial compared the immediate effects of tensioned multidirectional elastic tape, untensioned control tape, and no tape, in individuals with lateral elbow tendinopathy. Muscle activity of extensor carpi radialis longus and brevis, extensor carpi ulnaris, and extensor digitorum and wrist extension angle were recorded during a submaximal gripping task. Muscle activity was normalised to the maximum amplitude recorded during maximal grip. Change scores were calculated (post-condition minus baseline). Repeated-measure analyses of variance were used to examine between-condition differences. FINDINGS 27 participants (16 males, mean age (SD): 48.6 (11.9) years) underwent all conditions. Extensor digitorum muscle activity was reduced during the multidirectional elastic tape, compared to control tape and no tape (MD -5.6% [95%CI: -9.9 to -1.3], MD -5.8% [95%CI: -10.2 to -1.4], respectively). Extensor carpi ulnaris muscle activity was reduced during the multidirectional elastic tape, compared to the control tape (mean difference [MD] -3.2% [95%CI: -5.3 to -1.1]), but increased during the control tape, compared to the no tape (MD 2.9% [95%CI: 0.8 to 5.0]). No differences were observed in extensor carpi radialis brevis or longus muscle activity, or extension wrist angle between conditions. INTERPRETATION A decreased in extensor carpi ulnaris and extensor digitorum muscle activity during multidirectional elastic tape may be evidence of a deloading effect during submaximal gripping.
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Affiliation(s)
- Caitlin E Hill
- School of Health, Medical and Applied Sciences, Central Queensland University, Norman Gardens, QLD, Australia
| | - Luke J Heales
- School of Health, Medical and Applied Sciences, Central Queensland University, Norman Gardens, QLD, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Norman Gardens, QLD, Australia; Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Michael W R Holmes
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Crystal O Kean
- School of Health, Medical and Applied Sciences, Central Queensland University, Norman Gardens, QLD, Australia.
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Wambold M, Taylor C, Tucker CA, Paul RW, Thomas SJ. Chronic Adaptations of Shoulder Muscle Synergies in Healthy Baseball Players. Sports Health 2022; 15:97-104. [PMID: 35137607 PMCID: PMC9808840 DOI: 10.1177/19417381211069564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Previous research has demonstrated that muscle synergy structure can adapt owing to training and injury; however, muscle synergies have not been evaluated in baseball players. HYPOTHESIS The throwing arm would have a similar muscle synergy structure but different levels of individual muscle activity within each synergy, relative to the nonthrowing arm. STUDY DESIGN Cross-sectional study in a controlled laboratory setting. METHODS Fourteen healthy competitive baseball players were included. Participants were tested bilaterally during a center-out planar reaching task using the KINARM robot, where kinematic data and surface electromyography data from 14 glenohumeral and scapular muscles were synchronized. Principal component analysis was used to extract muscle synergies, the variance accounted for (VAF) of each synergy, and individual muscle coefficients. The dominant (DOM) arm was compared with the nondominant (NDOM) arm using paired t tests for all dependent variables. RESULTS The same number of muscle synergies were extracted on the DOM and NDOM arms, along with no differences in VAF. In the first synergy, the infraspinatus (DOM 0.798 vs NDOM 0.587, P = 0.038) and lower trapezius (DOM 0.872 vs NDOM 0.480, P = 0.005) muscle coefficients significantly increased on the DOM arm. The second synergy had a significantly increased anterior deltoid (DOM 0.764 vs NDOM 0.374, P = 0.003) and a significantly decreased posterior deltoid (DOM -0.069 vs NDOM 0.197, P = 0.041) muscle coefficient on the DOM arm. CONCLUSION The DOM shoulder exhibits a higher proportion of infraspinatus and lower trapezius muscle activation during the external rotation and abduction synergy. Also, the DOM shoulder has increased muscle activation of the teres major and latissimus dorsi during the internal rotation synergy, and increased muscle activation of the pectoralis major during the cross-body adduction synergy, compared with the NDOM shoulder. CLINICAL RELEVANCE By exploring these neuromuscular adaptations, the improved understanding of muscle synergy adaptations in baseball players will help optimize injury prevention and rehabilitation techniques.
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Affiliation(s)
| | - Chris Taylor
- Department of Kinesiology, Temple
University, Philadelphia, Pennsylvania
| | | | - Ryan W. Paul
- Rothman Orthopaedic Institute,
Philadelphia, Pennsylvania
| | - Stephen J. Thomas
- Department of Exercise Science,
Thomas Jefferson University, Philadelphia, Pennsylvania,Stephen J. Thomas,
PhD, ATC, Department of Exercise Science, Thomas Jefferson University,
225K Ronson Health and Applied Science Center, 4201 Henry Avenue,
Philadelphia, PA 19144 ()
(Twitter: @shoulder_nerd_)
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Hill CE, Heales LJ, Stanton R, Kean CO. Pain-free grip strength in individuals with lateral elbow tendinopathy: Between- and within-session reliability of one versus three trials. Physiother Theory Pract 2022; 39:1007-1015. [PMID: 35114892 DOI: 10.1080/09593985.2022.2030445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pain-free grip strength is an important outcome measure in lateral elbow tendinopathy (LET); yet, the reliability and minimum detectable change (MDC) in functional positions are unknown. PURPOSE The purpose of this study is to examine the between- and within-session pain-free grip strength reliability and MDC in LET. METHODS Twenty-three individuals with LET completed three pain-free grip strength trials with the elbow flexed and extended. The first trial and the mean of three trials were analyzed. Between-session data were collected 2-28 days apart. Within-session data were collected 20-30 min apart. RESULTS Between-session intraclass correlation coefficients (ICCs) were good (ICC2,1 = 0.75) for single trials (flexed), excellent (ICC2,1 = 0.89-0.94) for single trials (extended), and excellent for the mean of three trials (both positions). Within-session ICCs were excellent for single (ICC2,1 = 0.89-0.91) and the mean of three trials (ICC2,3 = 0.96-0.98) in both positions. Between-session flexed MDCs were 133 N (single) versus 90 N (mean) and extended MDCs were 118 N (single) versus 92 N (mean). Within-session flexed MDCs were 79 N (single) versus 52 N (mean) and extended MDCs were 125 N (single) versus 46 N (mean). CONCLUSIONS Using the mean of three trials is recommended, and clinicians can be confident of true change if between-session differences are >92 N and within-session differences are >52 N.
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Affiliation(s)
- Caitlin E Hill
- School of Health, Medical and Applied Sciences, Central Queensland University, Norman Gardens, Australia
| | - Luke J Heales
- School of Health, Medical and Applied Sciences, Central Queensland University, Norman Gardens, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Norman Gardens, Australia.,Appleton Institute, Central Queensland University, Wayville, Adelaide, Australia
| | - Crystal O Kean
- School of Health, Medical and Applied Sciences, Central Queensland University, Norman Gardens, Australia
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Wiebusch M, Coombes BK, Silva MF. Joint position sense, motor imagery and tactile acuity in lateral elbow tendinopathy: A cross-sectional study. Musculoskelet Sci Pract 2021; 55:102422. [PMID: 34271414 DOI: 10.1016/j.msksp.2021.102422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Impairments of sensorimotor function are evident in individuals with lateral elbow tendinopathy (LET), although understanding of the mechanisms for this is lacking. OBJECTIVES To determine if motor imagery, tactile acuity and wrist joint position sense (JPS) are impaired in participants with unilateral LET compared to controls, whether deficits are localised to the affected side, and whether deficits relate to severity of pain. DESIGN Cross-sectional study with control group. METHODS 14 participants with unilateral LET of 6 weeks or longer and 14 matched control participants were assessed bilaterally for motor imagery (left/right hand judgement task), tactile acuity (two-point discrimination test) and wrist JPS (reposition test for flexion and extension). Pain levels were measured using a numeric rating scale. RESULTS Significant differences in JPS were observed for wrist extension only, such that participants with LET adopted less extended postures with their affected side when compared to their unaffected side (MD = 2.97°; p = 0.01) and to the matched-affected side of controls (MD = 4.89°; p < 0.01). No differences in tactile acuity or motor imagery were observed. CONCLUSION Altered wrist extension JPS, but not motor imagery or tactile acuity, was found in the affected side of patients with unilateral LET when compared to non-injured side and asymptomatic controls.
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Affiliation(s)
- Matheus Wiebusch
- Post-Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, 245 Sarmento Leite Street, Postcode: 90050-170, Porto Alegre, Brazil.
| | - Brooke Kaye Coombes
- School of Allied Health Sciences, Griffith University, Postcode: 4111, Brisbane, Australia.
| | - Marcelo Faria Silva
- Post-Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, 245 Sarmento Leite Street, Postcode: 90050-170, Porto Alegre, Brazil; Faculty of Physiotherapy, Federal University of Health Sciences of Porto Alegre, 245 Sarmento Leite Street, Postcode: 90050-170, Porto Alegre, Brazil.
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Dakkak A, Krill M, Fogarty A, Krill M. Stem cell therapy for the management of lateral elbow tendinopathy: A systematic literature review. Sci Sports 2021. [DOI: 10.1016/j.scispo.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cooke N, Obst S, Vicenzino B, Hodges PW, Heales LJ. Upper limb position affects pain-free grip strength in individuals with lateral elbow tendinopathy. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1906. [PMID: 33772973 DOI: 10.1002/pri.1906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/07/2021] [Accepted: 03/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE Pain-free grip (PFG) force is commonly used to monitor treatment outcomes in lateral elbow tendinopathy (LET); however, it is unclear whether changes in forearm and elbow position affect PFG force values. This study aims to examine the effect of elbow/shoulder and forearm position on non-normalised and normalised PFG force in individuals with unilateral LET. METHODS A cohort study including 21 subjects with clinically diagnosed unilateral LET (13 females, mean [SD] age 50 [8] years) performed PFG force (symptomatic arm) and maximal grip (asymptomatic arm) tasks using four upper limb positions: (1) shoulder neutral, elbow flexed (90°), forearm pronated; (2) shoulder neutral, elbow flexed (90°), forearm neutral; (3) shoulder flexed (90°), elbow extended, forearm pronated; and (4) shoulder flexed (90°), elbow extended, forearm neutral. PFG force was normalised to the maximal grip of the asymptomatic side. Repeated-measures analyses of variance were used to compare non-normalised and PFG force normalised to maximal grip between positions. RESULTS Both non-normalised and normalised PFG forces were greater in position 2 than position 1, position 3 and position 4 (elbow-by-forearm interaction non-normalised p = 0.002, normalised p = 0.004). There were no differences between positions 1, 3 and 4 for either non-normalised or normalised PFG strength. DISCUSSION This study shows that PFG force was higher when performed with forearm neutral supination/pronation, elbow flexion and shoulder neutral than other tested positions, and irrespective of whether PFG force was normalised to the maximal grip force of the contralateral limb. This indicates that arm position should be standardised for comparison.
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Affiliation(s)
- Nikki Cooke
- College of Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Steven Obst
- College of Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Australia
| | - Bill Vicenzino
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Australia
| | - Luke J Heales
- College of Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
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Turpin NA, Uriac S, Dalleau G. How to improve the muscle synergy analysis methodology? Eur J Appl Physiol 2021; 121:1009-1025. [PMID: 33496848 DOI: 10.1007/s00421-021-04604-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/10/2021] [Indexed: 01/02/2023]
Abstract
Muscle synergy analysis is increasingly used in domains such as neurosciences, robotics, rehabilitation or sport sciences to analyze and better understand motor coordination. The analysis uses dimensionality reduction techniques to identify regularities in spatial, temporal or spatio-temporal patterns of multiple muscle activation. Recent studies have pointed out variability in outcomes associated with the different methodological options available and there was a need to clarify several aspects of the analysis methodology. While synergy analysis appears to be a robust technique, it remain a statistical tool and is, therefore, sensitive to the amount and quality of input data (EMGs). In particular, attention should be paid to EMG amplitude normalization, baseline noise removal or EMG filtering which may diminish or increase the signal-to-noise ratio of the EMG signal and could have major effects on synergy estimates. In order to robustly identify synergies, experiments should be performed so that the groups of muscles that would potentially form a synergy are activated with a sufficient level of activity, ensuring that the synergy subspace is fully explored. The concurrent use of various synergy formulations-spatial, temporal and spatio-temporal synergies- should be encouraged. The number of synergies represents either the dimension of the spatial structure or the number of independent temporal patterns, and we observed that these two aspects are often mixed in the analysis. To select a number, criteria based on noise estimates, reliability of analysis results, or functional outcomes of the synergies provide interesting substitutes to criteria solely based on variance thresholds.
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Affiliation(s)
- Nicolas A Turpin
- IRISSE (EA 4075), UFR SHE-STAPS Department, University of La Réunion, 117 Rue du Général Ailleret, 97430, Le Tampon, France.
| | - Stéphane Uriac
- IRISSE (EA 4075), UFR SHE-STAPS Department, University of La Réunion, 117 Rue du Général Ailleret, 97430, Le Tampon, France
| | - Georges Dalleau
- IRISSE (EA 4075), UFR SHE-STAPS Department, University of La Réunion, 117 Rue du Général Ailleret, 97430, Le Tampon, France
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Effects of iliotibial band syndrome on pain sensitivity and gait kinematics in female runners: A preliminary study. Clin Biomech (Bristol, Avon) 2020; 76:105017. [PMID: 32388078 DOI: 10.1016/j.clinbiomech.2020.105017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 11/22/2019] [Accepted: 04/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Runners with iliotibial band syndrome display symptoms similar to chronic tendinopathy and distinct gait patterns compared to healthy controls. Although altered pain processing has been demonstrated in chronic tendinopathies, central pain processing and its relationship to motor control has not been measured in iliotibial band syndrome. The purpose of this study was to examine pain sensitivity, hip strength, and gait kinematics in runners with and without iliotibial band syndrome. METHODS Nine female runners with iliotibial band syndrome and eight healthy controls participated. Subjective pain was reported and pressure pain threshold measured at the bilateral foot, tibialis anterior, contralateral hand. Isometric hip strength was assessed. Three-dimensional joint angles were collected while running. Differences in pain and strength were determined using 1-way ANOVAs. Discrete hip and knee joint angles during stance phase were calculated and waveform analysis performed. FINDINGS Runners with iliotibial band syndrome exhibited bilaterally diminished pain at the foot (injured-limb: 1.54 (SD = 0.51); non-injured limb: 1.54 (SD = 0.55); control: 4.01 (SD = 2.30) kg, P < .001) and ipsilateral tibialis anterior (injured-limb: 2.33 (SD = 1.10); control: 6.13 (SD = 4.89) kg, P = .03). Hip strength was not different between groups. Runners with iliotibial band syndrome had greater hip adduction at touchdown, knee internal rotation during loading, and knee abduction and flexion at toe-off than controls. INTERPRETATION Runners with iliotibial band syndrome demonstrated expanded somatic pain sensitivity without hip strength differences, but concomitant with altered gait patterns. Bilateral pain symptoms and gait deviations exist in runners with iliotibial band syndrome even with unilateral symptoms, highlighting the importance of bilateral assessment.
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Heales LJ, McClintock SR, Maynard S, Lems CJ, Rose JA, Hill C, Kean CO, Obst S. Evaluating the immediate effect of forearm and wrist orthoses on pain and function in individuals with lateral elbow tendinopathy: A systematic review. Musculoskelet Sci Pract 2020; 47:102147. [PMID: 32452393 DOI: 10.1016/j.msksp.2020.102147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lateral elbow tendinopathy is associated with pain during gripping, with forearm/wrist orthoses prescribed for treatment. OBJECTIVES To investigate the immediate effects of forearm and/or wrist orthoses on outcome measures of pain and function in individuals with lateral elbow tendinopathy. DESIGN Systematic review METHODS: Four electronic databases were searched to identify randomised controlled trials reporting the immediate effects of forearm and/or wrist orthoses on pain and function in individuals with lateral elbow tendinopathy. The quality of evidence was rated from high to very low, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) for the primary outcomes. Where possible, standardised mean difference (SMD) and 95% confidence intervals were calculated to compare post measures between forearm and/or wrist orthoses and control/placebo conditions. RESULTS The search revealed 1965 studies, of which, seven randomised crossover trials were included. Using the GRADE approach there was low quality evidence revealing a significant decrease in pain during contraction (SMD range -0.65 to -0.83) with forearm orthoses compared to a control/placebo condition. Low quality evidence revealed improvements in pain-free grip strength with the use of a forearm orthosis (SMD range 0.24-0.38), but not maximal grip strength (SMD range 0.14-0.15). Low quality evidence revealed a static wrist orthosis did not improve pain-free grip strength (SMD -0.08) or maximal grip strength (SMD -0.22). CONCLUSION There is low quality evidence that forearm orthoses can immediately reduce pain during contraction and improve pain-free grip strength but not maximal grip strength in individuals with lateral elbow tendinopathy.
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Affiliation(s)
- Luke J Heales
- Central Queensland University, School of Health, Medical and Applied Sciences, Department of Health and Exercise Science, Rockhampton, 4701, Queensland, Australia.
| | - Stacy R McClintock
- Central Queensland University, School of Health, Medical and Applied Sciences, Department of Health and Exercise Science, Rockhampton, 4701, Queensland, Australia.
| | - Sabrina Maynard
- Central Queensland University, School of Health, Medical and Applied Sciences, Department of Health and Exercise Science, Rockhampton, 4701, Queensland, Australia.
| | - Cooper J Lems
- Central Queensland University, School of Health, Medical and Applied Sciences, Department of Health and Exercise Science, Rockhampton, 4701, Queensland, Australia.
| | - Jordan A Rose
- Central Queensland University, School of Health, Medical and Applied Sciences, Department of Health and Exercise Science, Rockhampton, 4701, Queensland, Australia.
| | - Caitlin Hill
- Central Queensland University, School of Health, Medical and Applied Sciences, Department of Health and Exercise Science, Rockhampton, 4701, Queensland, Australia.
| | - Crystal O Kean
- Central Queensland University, School of Health, Medical and Applied Sciences, Department of Health and Exercise Science, Rockhampton, 4701, Queensland, Australia.
| | - Steven Obst
- Central Queensland University, School of Health, Medical and Applied Sciences, Department of Health and Exercise Science, Bundaberg, 4670, Queensland, Australia.
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George CE, Heales LJ, Stanton R, Wintour SA, Kean CO. Sticking to the facts: A systematic review of the effects of therapeutic tape in lateral epicondylalgia. Phys Ther Sport 2019; 40:117-127. [PMID: 31518778 DOI: 10.1016/j.ptsp.2019.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/17/2019] [Accepted: 08/26/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To systematically identify, appraise, and examine evidence regarding the effects of therapeutic tape on pain and function in individuals with lateral epicondylalgia (LE). METHODS Five electronic databases were systematically searched up to March 2018. Full-text, peer-reviewed, English-language studies were included if they had an LE population, a standalone tape condition, and an outcome related to pain or function. RESULTS Eight out of 2022 screened studies were included. Three studies demonstrated immediate (i.e. within 1 h) improvements in pain and pain-free grip strength following diamond deloading rigid tape. One study reported immediate improvements in proprioception following transverse rigid tape. The immediate effects of longitudinal kinesiotape were inconsistent. One study reported improvements in pain and pain-free grip strength, while another study reported no effect on pain, strength, or muscle activity. Two studies examined short-term (i.e. within six weeks) kinesiotape application. One study reported two weeks of longitudinal kinesiotape improved pain and maximum grip strength. The other study reported one week of diamond kinesiotape improved patient-reported pain and function, but not maximum grip strength. CONCLUSIONS In individuals with LE, diamond deloading rigid tape may immediately improve pain and strength. There is conflicting evidence regarding kinesiotape effects in both immediate and short-term timeframes.
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Affiliation(s)
- Caitlin E George
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Luke J Heales
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia; School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia; Appleton Institute, Central Queensland University, Adelaide, Australia
| | - Sally-Anne Wintour
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Crystal O Kean
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia.
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14
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Liew BXW, Del Vecchio A, Falla D. The influence of musculoskeletal pain disorders on muscle synergies-A systematic review. PLoS One 2018; 13:e0206885. [PMID: 30395599 PMCID: PMC6218076 DOI: 10.1371/journal.pone.0206885] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/22/2018] [Indexed: 11/21/2022] Open
Abstract
Background Musculoskeletal (MSK) pain disorders represent a group of highly prevalent and often disabling conditions. Investigating the structure of motor variability in response to pain may reveal novel motor impairment mechanisms that may lead to enhanced management of motor dysfunction associated with MSK pain disorders. This review aims to systematically synthesize the evidence on the influence of MSK pain disorders on muscle synergies. Methods Nine electronic databases were searched using Medical Subject Headings and keywords describing pain, electromyography and synergies. Relevant characteristics of included studies were extracted and assessed for generalizability and risk of bias. Due to the significant heterogeneity, a qualitative synthesis of the results was performed. Results The search resulted in a total of 1312 hits, of which seven articles were deemed eligible. There was unclear consistency that pain reduced the number of muscle synergies. There were low consistencies of evidence that the synergy vector (W weights) and activation coefficient (C weights) differed in painful compared to asymptomatic conditions. There was a high consistency that muscle synergies were dissimilar between painful and asymptomatic conditions. Conclusions MSK pain alters the structure of variability in muscle control, although its specific nature remains unclear. Greater consistency in muscle synergy analysis may be achieved with appropriate selection of muscles assessed and ensuring consistent achievement of motor task outcomes. Synergy analysis is a promising method to reveal novel understandings of altered motor control, which may facilitate the assessment and treatment of MSK pain disorders.
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Affiliation(s)
- Bernard X. W. Liew
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail: ,
| | - Alessandro Del Vecchio
- Neuromuscular Research & Technology, Department of Bioengineering, Faculty of Engineering, Imperial College London, Kensington, London, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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15
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A comparison of fine wire insertion techniques for deep finger flexor muscle electromyography. J Electromyogr Kinesiol 2018; 41:77-81. [PMID: 29807324 DOI: 10.1016/j.jelekin.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 05/01/2018] [Accepted: 05/21/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Intramuscular electromyography electrodes targeting flexor digitorum profundus (FDP) are inserted via the anterior or medial aspect of the forearm. These two methods pose different risks to neurovascular structures which overly FDP. This study aimed to compare the insertion depth and consider advantages and limitations of two different techniques to insert intramuscular electrodes into FDP. METHODS Using ultrasound imaging, neurovascular structures were identified along the path of FDP electrode insertion at the junction of the proximal and middle third of the ulna, bilaterally, in ten healthy individuals. Insertion depth was compared between the anterior and medial approaches for the mid muscle belly and targeted insertion to the index finger fascicle of FDP. RESULTS In our sample the ulnar artery was superficial to the FDP muscle when viewed anteriorly and was beyond the furthest border of FDP when viewed medially. Compared to the anterior approach, the medial insertion depth was 1.5 cm (95%CI 1.4-1.7, p < 0.001) less to the mid-belly of FDP and 0.6 cm (95%CI 0.4-0.7, p < 0.001) less to the index finger fascicle of FDP. DISCUSSION The medial approach involves less depth and lower risk for perforation of neurovascular structures when inserting intramuscular electrodes into the FDP muscle.
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Chang WJ, O'Connell NE, Beckenkamp PR, Alhassani G, Liston MB, Schabrun SM. Altered Primary Motor Cortex Structure, Organization, and Function in Chronic Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2018; 19:341-359. [DOI: 10.1016/j.jpain.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 01/14/2023]
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17
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Feasibility of Muscle Synergy Outcomes in Clinics, Robotics, and Sports: A Systematic Review. Appl Bionics Biomech 2018; 2018:3934698. [PMID: 29808098 PMCID: PMC5902115 DOI: 10.1155/2018/3934698] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 01/04/2023] Open
Abstract
In the last years, several studies have been focused on understanding how the central nervous system controls muscles to perform a specific motor task. Although it still remains an open question, muscle synergies have come to be an appealing theory to explain the modular organization of the central nervous system. Even though the neural encoding of muscle synergies remains controversial, a large number of papers demonstrated that muscle synergies are robust across different tested conditions, which are within a day, between days, within a single subject, and between subjects that have similar demographic characteristics. Thus, muscle synergy theory has been largely used in several research fields, such as clinics, robotics, and sports. The present systematical review aims at providing an overview on the applications of muscle synergy theory in clinics, robotics, and sports; in particular, the review is focused on the papers that provide tangible information for (i) diagnosis or pathology assessment in clinics, (ii) robot-control design in robotics, and (iii) athletes' performance assessment or training guidelines in sports.
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18
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Boccia G, Zoppirolli C, Bortolan L, Schena F, Pellegrini B. Shared and task-specific muscle synergies of Nordic walking and conventional walking. Scand J Med Sci Sports 2017; 28:905-918. [PMID: 29027265 DOI: 10.1111/sms.12992] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 01/08/2023]
Abstract
Nordic walking is a form of walking that includes a poling action, and therefore an additional subtask, with respect to conventional walking. The aim of this study was to assess whether Nordic walking required a task-specific muscle coordination with respect to conventional walking. We compared the electromyographic (EMG) activity of 15 upper- and lower-limb muscles of 9 Nordic walking instructors, while executing Nordic walking and conventional walking at 1.3 ms-1 on a treadmill. Non-negative matrix factorization method was applied to identify muscle synergies, representing the spatial and temporal organization of muscle coordination. The number of muscle synergies was not different between Nordic walking (5.2 ± 0.4) and conventional walking (5.0 ± 0.7, P = .423). Five muscle synergies accounted for 91.2 ± 1.1% and 92.9 ± 1.2% of total EMG variance in Nordic walking and conventional walking, respectively. Similarity and cross-reconstruction analyses showed that 4 muscle synergies, mainly involving lower-limb and trunk muscles, are shared between Nordic walking and conventional walking. One synergy acting during upper limb propulsion is specific to Nordic walking, modifying the spatial organization and the magnitude of activation of upper limb muscles compared to conventional walking. The inclusion of the poling action in Nordic walking does not increase the complexity of movement control and does not change the coordination of lower limb muscles. This makes Nordic walking a physical activity suitable also for people with low motor skill.
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Affiliation(s)
- G Boccia
- CeRiSM Research Centre for Sport, Mountain, and Health, University of Verona, Rovereto, Trento, Italy.,NeuroMuscularFunction Research Group, Department of Medical Sciences, School of Exercise and Sport Sciences, University of Turin, Torino, Italy
| | - C Zoppirolli
- CeRiSM Research Centre for Sport, Mountain, and Health, University of Verona, Rovereto, Trento, Italy.,Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - L Bortolan
- CeRiSM Research Centre for Sport, Mountain, and Health, University of Verona, Rovereto, Trento, Italy.,Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - F Schena
- CeRiSM Research Centre for Sport, Mountain, and Health, University of Verona, Rovereto, Trento, Italy.,Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - B Pellegrini
- CeRiSM Research Centre for Sport, Mountain, and Health, University of Verona, Rovereto, Trento, Italy.,Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
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Manickaraj N, Bisset LM, Devanaboyina VSPT, Kavanagh JJ. Chronic pain alters spatiotemporal activation patterns of forearm muscle synergies during the development of grip force. J Neurophysiol 2017; 118:2132-2141. [PMID: 28724779 DOI: 10.1152/jn.00210.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 02/04/2023] Open
Abstract
It is largely unknown how the CNS regulates multiple muscle systems in the presence of pain. This study used muscle synergy analysis to investigate multiple forearm muscles in individuals with chronic elbow pain during the development of grip force. Eleven individuals with chronic elbow pain and 11 healthy age-matched control subjects developed grip force to 15% and 30% of maximum voluntary contraction (MVC). Surface electromyography was obtained from six forearm muscles during force development before nonnegative matrix factorization was performed. The relationship between muscle synergies and standard clinical tests of elbow pain were examined by linear regression. During grip force development to 15% MVC the pain group had a lower number of forearm muscle synergies, increased similarity in spatial activation patterns, increased cocontraction of forearm flexors, and a greater magnitude of muscle weightings across the forearm when performing the task. During the 30% MVC grip the numbers of muscle synergies were the same for both groups; however, the pain group had lower activation and reduced variability in the timing of peak activation. The timing of peak activation was delayed in the pain group regardless of the task, and performing the grip in different wrist postures did not affect muscle synergy characteristics in either group. Although localized pain causes direct dysfunction of an affected muscle, this study provides evidence that the timing and amplitude of agonist and antagonist muscle activity are also affected with chronic pain.NEW & NOTEWORTHY Muscle activation patterns of individuals with chronic elbow pain are simplified compared with healthy individuals. This is apparent as individuals with pain exhibit fewer forearm muscle synergies, and increased similarity of activation patterns between forearm muscles, when performing pain-free isometric gripping. As such, even during pain-free tasks it is possible to observe changes in motor control in people with chronic pain.
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Affiliation(s)
- Nagarajan Manickaraj
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Leanne M Bisset
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | | | - Justin J Kavanagh
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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