Experimental muscle pain increases trapezius muscle activity during sustained isometric contractions of arm muscles

Exercise-induced pain within endurance exercise settings: Definitions, measurement, mechanisms and potential interventions

Pain can be defined as an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage. Though consistent with this definition, different types of pain result in different behavioural and psychophysiological responses. For example, the transient, non-threatening, acute muscle pain element of exercise-induced pain (EIP) is entirely different from other pain types like delayed onset muscle soreness, muscular injury or chronic pain. However, studies often conflate the definitions or assume parity between distinct pain types. Consequently, the mechanisms through which pain might impact exercise behaviour across different pain subcategories may be incorrectly assumed, which could lead to interventions or recommendations that are inappropriate. Therefore, this review aims to distinguish EIP from other subcategories of pain according to their aetiologies and characteristics, thereby providing an updated conceptual and operational definition of EIP. Secondly, the review will discuss the experimental pain models currently used across several research domains and their relevance to EIP with a focus on the neuro-psychophysiological mechanisms of EIP and its effect on exercise behaviour and performance. Finally, the review will examine potential interventions to cope with the impact of EIP and support wider exercise benefits. HIGHLIGHTS: What is the topic of this review? Considerations for future research focusing on exercise-induced pain within endurance exercise settings. What advances does it highlight? An updated appraisal and guide of research concerning exercise-induced pain and its impact on endurance task behaviour, particularly with reference to the aetiology, measurement, and manipulation of exercise-induced pain.

Effectiveness of the Cunningham technique for shoulder dislocation reduction and its role in providing analgesia and muscle relaxation as an adjunctive method

BACKGROUND

Shoulder dislocation, particularly anterior dislocation, is a common orthopedic injury often presenting in emergency care settings, characterized by significant pain and muscle spasms. Prompt reduction is essential to alleviate symptoms and restore function. The Cunningham technique employs gentle pulling and massage motions targeted at the muscles and has emerged as a promising method for reducing anterior shoulder dislocations. However, its reported success rates vary widely across studies, and questions remain regarding its efficacy, particularly in cases of failure. This study aims to evaluate the effectiveness of the Cunningham technique for reducing anterior shoulder dislocations and its potential role in providing analgesia and muscle relaxation as an adjunctive method.

METHODS

A retrospective study was conducted on patients presenting with acute anterior shoulder dislocation at a single center. Reduction using the Cunningham technique was performed initially, followed by the external rotation technique if unsuccessful. Procedural sedation and analgesia were administered if the reduction was still not achieved, and shoulder dislocation reduction was performed again through the external rotation method. The patients' VAS scores were recorded and evaluated the Cunningham technique's effectiveness in reduction and whether it increases the effectiveness of other techniques applied for reduction by lowering the VAS score, even in cases where it is not effective.

RESULTS

A total of 61 patients were included in the study. The reduction was performed using the Cunningham technique in 34.4% (21/61) patients, the external rotation technique in 47.5% (29/61) patients, and the external rotation technique with PSA in 18% (11/61) patients. Significant differences were observed in the duration of hospital stay among the three techniques, with ER with PSA resulting in the longest stay. VAS scores showed significant improvements from initial presentation to post-reduction in all three groups. A significant decrease in pre-reduction VAS scores was observed during the transition from the Cunningham technique to other techniques.

CONCLUSION

The Cunningham technique showed effectiveness in reducing anterior shoulder dislocations, providing analgesia, and muscle relaxation. It demonstrated favorable outcomes as an initial reduction technique, with the external rotation technique used as a subsequent option. Further studies comparing the success rates and complications of the Cunningham technique with other reduction methods are warranted to establish its role in clinical practice.

Experimentally Induced Pain Results in Reduced Activity of the Rotator Cuff Muscles in Healthy Subjects

Shoulder pain is a complex, prevalent problem that is multifactorial in nature. While there are many potential causes, one common suspect is the rotator cuff musculature. The purpose of the present study was to induce pain in the supraspinatus muscle of healthy subjects and observe the resulting changes in muscle activity. Eight muscles on 23 subjects were assessed using electromyography: anterior, middle, and posterior deltoid; pectoralis major; upper trapezius; latissimus dorsi; serratus anterior; supraspinatus; and infraspinatus. It was hypothesized that the rotator cuff muscles would display reduced activity during pain, and that reductions in activity would remain after the pain had dissipated. Both of the rotator cuff muscles measured did indeed display reduced activity in a majority of the dynamic, isometric, and maximal contractions. Many of those reductions remained after the pain had subsided.

Differences in Trapezius Muscle H-Reflex between Asymptomatic Subjects and Symptomatic Shoulder Pain Subjects

In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58-75% or in 42-58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals' rehabilitation.

The effect of elevated muscle pain on neuromuscular fatigue during exercise

PURPOSE

Muscle pain can impair exercise performance but the mechanisms for this are unknown. This study examined the effects of muscle pain on neuromuscular fatigue during an endurance task.

METHODS

On separate visits, twelve participants completed an isometric time-to-task failure (TTF) exercise of the right knee extensors at ~ 20% of maximum force following an intramuscular injection of isotonic saline (CTRL) or hypertonic saline (HYP) into the vastus lateralis. Measures of neuromuscular fatigue were taken before, during and after the TTF using transcranial magnetic stimulation (TMS) and peripheral nerve stimulation.

RESULTS

The mean pain intensity was 57 ± 10 in HYP compared to 38 ± 18 in CTRL (P < 0.001). TTF was reduced in HYP (4.36 ± 0.88 min) compared to CTRL (5.20 ± 0.39 min) (P = 0.003). Maximum voluntary force was 12% lower at minute 1 (P = 0.003) and 11% lower at minute 2 in HYP (P = 0.013) compared to CTRL. Voluntary activation was 4% lower at minute 1 in HYP compared to CTRL (P = 0.006) but not at any other time point (all P > 0.05). The TMS silent period was 9% longer at 100 s during the TTF in HYP compared to CTRL (P = 0.026).

CONCLUSION

Muscle pain reduces exercise performance through the excacerbation of neuromuscular fatigue that is central in origin. This appears to be from inhibitory feedback from group III/IV nociceptors which acts to reduce central motor output.

Electrode Size and Placement for Surface EMG Bipolar Detection from the Brachioradialis Muscle: A Scoping Review

The brachioradialis muscle (BRD) is one of the main elbow flexors and is often assessed by surface electromyography (sEMG) in physiology, clinical, sports, ergonomics, and bioengineering applications. The reliability of the sEMG measurement strongly relies on the characteristics of the detection system used, because of possible crosstalk from the surrounding forearm muscles. We conducted a scoping review of the main databases to explore available guidelines of electrode placement on BRD and to map the electrode configurations used and authors’ awareness on the issues of crosstalk. One hundred and thirty-four studies were included in the review. The crosstalk was mentioned in 29 studies, although two studies only were specifically designed to assess it. One hundred and six studies (79%) did not even address the issue by generically placing the sensors above BRD, usually choosing large disposable ECG electrodes. The analysis of the literature highlights a general lack of awareness on the issues of crosstalk and the need for adequate training in the sEMG field. Three guidelines were found, whose recommendations have been compared and summarized to promote reliability in further studies. In particular, it is crucial to use miniaturized electrodes placed on a specific area over the muscle, especially when BRD activity is recorded for clinical applications.

Functional muscle group- and sex-specific parameters for a three-compartment controller muscle fatigue model applied to isometric contractions

The three-compartment controller with enhanced recovery (3CC-r) model of muscle fatigue has previously been validated separately for both sustained (SIC) and intermittent isometric contractions (IIC) using different objective functions, but its performance has not yet been tested against both contraction types simultaneously using a common objective function. Additionally, prior validation has been performed using common parameters at the joint level, whereas applications to many real-world tasks will require the model to be applied to agonistic and synergistic muscle groups. Lastly, parameters for the model have previously been derived for a mixed-sex cohort not considering the differece in fatigabilities between the sexes. In this work we validate the 3CC-r model using a comprehensive isometric contraction database drawn from 172 publications segregated by functional muscle group (FMG) and sex. We find that prediction errors are reduced by 19% on average when segregating the dataset by FMG alone, and by 34% when segregating by both sex and FMG. However, minimum prediction errors are found to be higher when validated against both SIC and IIC data together using torque decline as the outcome variable than when validated sequentially against hypothesized SIC intensity-endurance time curves with endurance time as the outcome variable and against raw IIC data with torque decline as the outcome variable.

Coordinate activity of the quadratus lumborum posterior layer, lumbar multifidus, erector spinae, and gluteus medius during single-leg forward landing

This study aimed to clarify the differences in electromyographic activity between the quadratus lumborum anterior (QL-a) and posterior layers (QL-p), and the relationship among trunk muscles and gluteus medius (GMed) activities during forward landing. Thirteen healthy men performed double-leg and single-leg (ipsilateral or contralateral sides as the electromyography measurement of trunk muscles) forward landings from a 30 cm-height-box. The onset of electromyographic activity in pre-landing and the electromyographic amplitude of the unilateral QL-a, QL-p, abdominal muscles, lumbar multifidus (LMF), erector spinae (LES), and bilateral GMed were recorded. Two-way ANOVA was used to compare the onset of electromyographic activity (3 landing leg conditions × 10 muscles) and electromyographic amplitude among (3 landing leg conditions × 2 phases). The onset of QL-p was significantly earlier in contralateral-leg landing than in the double-leg and ipsilateral-leg landings. The onset of LMF and LES was significantly earlier than that of the abdominal muscles in contralateral-leg landing. QL-p activity and GMed activity on the contralateral leg side in the pre-landing were significantly higher in contralateral-leg landing than in the other leg landings. To prepare for pelvic and trunk movements after ground contact, LMF, LES, QL-p on non-support leg side, and GMed on support leg side showed early or high feedforward activation before ground contact during single-leg forward landing.

Effects of Various Physical Interventions on Reducing Neuromuscular Fatigue Assessed by Electromyography: A Systematic Review and Meta-Analysis

Introduction: Various interventions have been applied to improve recovery from muscle fatigue based on evidence from subjective outcomes, such as perceived fatigue and soreness, which may partly contribute to conflicting results of reducing muscle fatigue. There is a need to assess the effectiveness of various intervention on reducing neuromuscular fatigue assessed by a quantitative outcome, such as electromyography (EMG). The objective of this review and meta-analysis was to evaluate the effectiveness of different interventions and intervention timing for reducing fatigue rates during exercise. Methods: The literature was searched from the earliest record to March 2021. Eighteen studies with a total of 87 data points involving 281 participants and seven types of interventions [i.e., active recovery (AR), compression, cooling, electrical stimulation (ES), light-emitting diode therapy (LEDT), massage, and stretching] were included in this meta-analysis. Results: The results showed that compression (SMD = 0.28; 95% CI = -0.00 to 0.56; p = 0.05; I ² = 58%) and LEDT (SMD = 0.49; 95% CI = 0.11 to 0.88; p = 0.01; I ² = 52%) have a significant recovery effect on reducing muscle fatigue. Additionally, compression, AR, and cooling have a significant effect on reducing muscle fatigue when conducted during exercise, whereas a non-effective trend when applied after exercise. Discussion: This meta-analysis suggests that compression and LEDT have a significant effect on reducing muscle fatigue. The results also suggest that there is a significant effect or an effective trend on reducing muscle fatigue when compression, AR, cooling, and ES are applied during exercise, but not after exercise.

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.

Experimental knee-related pain enhances attentional interference on postural control

PURPOSE

To quantify how postural stability is modified during experimental pain while performing different cognitively demanding tasks.

METHODS

Sixteen healthy young adults participated in the experiment. Pain was induced by intramuscular injection of hypertonic saline solution (1 mL, 6%) in both vastus medialis and vastus lateralis muscles (0.9% isotonic saline was used as control). The participants stood barefoot in tandem position for 1 min on a force plate. Center of pressure (CoP) was recorded before and immediately after injections, while performing two cognitive tasks: (i) counting forwards by adding one; (ii) counting backwards by subtracting three. CoP variables-total area of displacement, velocity in anterior-posterior (AP-velocity) and medial-lateral (ML-velocity) directions, and CoP sample entropy in anterior-posterior and medial-lateral directions were displayed as the difference between the values obtained after and before each injection and compared between tasks and injections.

RESULTS

CoP total area ( - 84.5 ± 145.5 vs. 28.9 ± 78.5 cm²) and ML-velocity ( - 1.71 ± 2.61 vs. 0.98 ± 1.93 cm/s) decreased after the painful injection vs. Control injection while counting forward (P < 0.05). CoP total area (12.8 ± 53.9 vs. - 84.5 ± 145.5 cm²), ML-velocity ( - 0.34 ± 1.92 vs. - 1.71 ± 2.61 cm/s) and AP-velocity (1.07 ± 2.35 vs. - 0.39 ± 1.82 cm/s) increased while counting backwards vs. forwards after the painful injection (P < 0.05).

CONCLUSION

Pain interfered with postural stability according to the type of cognitive task performed, suggesting that pain may occupy cognitive resources, potentially resulting in poorer balance performance.

Delayed-onset muscle soreness in human masticatory muscles increases inhibitory jaw reflex responses

The effects of masticatory muscles' overloading on jaw-motor control are not yet fully clarified. Therefore, it was tested whether eccentric and concentric exercises of the human masticatory muscles would influence inhibitory jaw reflex responses. Eleven participants (6 males, 5 females) performed 6, 5-minutes bouts of eccentric-concentric contractions. Before, immediately after, 24 hours, 48 hours and 1 week afterwards, visual analogue scale (VAS) scores for jaw muscle fatigue and pain, maximum voluntary bite force (MVBF) and inhibitory jaw reflexes were recorded. Reflex data were analysed with the cumulative sum control chart error box method. Immediate and delayed masticatory muscle fatigue and pain were provoked. Further, 24 hours after the exercises, MVBF tended to decrease (P = .056), suggesting that delayed-onset muscle soreness (DOMS) was provoked in the masticatory muscles. In addition, the inhibitory jaw reflex showed a delayed increase in size 24 hours after the exercise (P < .05). In conclusion, DOMS provoked in the masticatory muscles alters jaw motor control by inducing a delayed increase in the size of the inhibitory jaw reflex.

Modulation of the muscle and nerve compound muscle action potential by evoked pain

Background and aims To our knowledge there are no studies that have examined the effects of the experimental pain on muscle fibre excitability as measured by the amplitudes of the potentials evoked by direct muscle stimulation (DMS) in a muscle at rest. We hypothesized that evoked pain can modulate the muscle compound action potential (CMAP) obtained by DMS possibly due to changes in muscle fibre excitability. Methods Pain was evoked by intramuscular infusion of hypertonic saline in 50 men. Ten control subjects were infused with isotonic saline. The infusions were given distal to the motor end plate region of the dominant brachial biceps muscle (BBM) in a double-blind manner. The nerve CMAP was obtained by stimulating the musculocutaneous nerve and recording from the BBM using surface-electrodes. Muscle CMAPs were obtained by direct muscle stimulation with subdermal electrodes placed subcutaneously in the distal third of the muscle. A stimuli-response curve of the amplitudes from muscle CMAP was obtained by stimulating from 10 to 90 mA. Results There was a decrease of the nerve CMAP amplitudes after infusion of isotonic saline (from 13.78mV to 12.16 mV), p-value 0.0007 and of hypertonic saline (from 13.35 mV to 10.85 mV), p-value 0.0000. The percent decrease from before to after infusion was larger in the hypertonic saline group (19.37%) compared to the isotonic saline group (12.18%), p-value 0.025. There was a decrease of the amplitudes of the muscle CMAP after infusion of both isotonic (at 90 mA from 13.84mV to 10.32 mV, p value 0.001) and of hypertonic saline (at 90 mA from 14.01 mV to 8.19 mV, p value 0.000). The percent decrease was larger in the hypertonic saline group compared to the isotonic saline group for all the stimulations intensities. At 90 mA we saw a 42% decrease in the hypertonic saline group and 24.5% in the isotonic saline group, p value 0.005. There were no changes in conduction velocity. Conclusion We found a larger amplitude decrease of the muscle and nerve potentials following hypertonic saline infusion compared with that of isotonic saline. We suggest that this deferential outcome of hypertonic saline on muscle CMAP may be linked to the nociceptive effect on muscle fibre membrane excitability. Implications The study supplies with some evidence of the peripheral effect of muscle pain. However, further trials with other nociceptive substances such as capsaicin should be performed.

Effect of scapular function training on chronic pain in the neck/shoulder region: a randomized controlled trial

PURPOSE

Neck and shoulder complaints are common among employees in occupations characterized by intensive computer use. Treatment has varied from passive rest to active treatments and active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach. The purpose of this study was in a randomised controlled trial to investigate if intensive scapular function training (SFT)-in terms of training of the lower trapezius and the serratus anterior muscle while minimizing direct training of the upper trapezius-is effective in reducing pain in adults with chronic non-specific pain in the neck/shoulder region.

METHODS

47 office workers with chronic non-specific pain in the neck/shoulder region were randomized to 10 weeks 3 × 20 min SFT with training supervision or to a control group. At baseline and at follow-up the participants were tested for maximum isometric shoulder strength by a blinded tester. Further, once a week participants reported pain intensity of the neck/shoulder during the previous week.

RESULTS

In intention-to-treat analysis neck- and shoulder pain decreased 2.0 (95 % CI 0.35; 3.64) in SFT compared with control group (p < 0.05). Pressure Pain Threshold (PPT) increased 129 kPa in the lower trapezius in SFT compared with the control group (p < 0.01). Shoulder elevation strength increased 7.7 kg in SFT compared with the control group (p < 0.01) with no change in shoulder protraction strength.

CONCLUSIONS

SFT reduces pain intensity and increases shoulder elevation strength in adults with chronic non-specific pain in the neck/shoulder region. The magnitude of improvement in pain intensity was clinically relevant.

Eccentric muscle damage increases intermuscular coherence during a fatiguing isometric contraction

AIM

The purpose of this study was to determine the effect of eccentric muscle damage on muscle activation patterns and intermuscular coherence during a fatiguing isometric contraction involving the elbow flexor muscles.

METHODS

Ten young subjects participated in three experimental sessions that involved the performance of maximum voluntary contractions (MVCs), a constant-force task at 30% MVC, and a fatiguing isometric contraction at 30% MVC. The three sessions were performed before, 2 h after and 2 days after eccentric exercise to induce muscle damage in elbow flexor muscles. Task performance was quantified with electromyography (EMG) from the elbow flexor (biceps brachii, brachialis and brachioradialis) and extensor (triceps brachii) muscles, M-wave amplitude of biceps brachii, elbow flexor force fluctuations and endurance time of a fatiguing contraction. Intermuscular coherence during the fatiguing contraction was quantified from the rectified surface EMGs between muscle pairs.

RESULTS

Eccentric exercise resulted in several indicators of muscle damage, such as a prolonged decline in muscle strength and an increase in muscle soreness 2 days after exercise. A 29% reduction in endurance time was observed 2 h after eccentric muscle damage, which returned to baseline 2 days later. The reduced endurance time 2 h after muscle damage was accompanied by an increase in EMG-EMG coherence between biceps brachii and brachialis muscles, which was observed at the end of the fatiguing contraction.

CONCLUSION

These findings suggest that eccentric muscle damage produces a decrease in endurance time that is accompanied by an increase in intermuscular coherence in the presence of fatigue.

Effects of cyclic static stretch on fatigue recovery of triceps surae in female basketball players

Static stretch is a safe and feasible method which usually is used before exercise to avoid muscle injury and to improve muscle performance. The purpose of this study was to determine the effects of cyclic static stretch (CSS) on fatigue recovery of triceps surae (TS) in female basketball players. Nine athlete volunteers between 20 and 30 years participated in this study containing two sessions. After warm-up a pressure cuff was fastened above the knee joint and its pressure was increased to 140 mmHg. The subjects were asked to perform one maximum voluntary contraction (MVC) followed by a fatigue test including maximum isometric fatiguing contraction of TS. These steps were similar in both sessions. Then, a two-minute rest was included in the first session while 4 static stretches were performed to TS in the second session. After interventions, one MVC was done and the pressure cuff was released. During these steps, peak torque (PT) and electromyography (EMG) were recorded. The amount of lower leg pain was determined by the visual analogue scale (VAS). The value of PT increased significantly after CSS but its increase was not significant after rest. It seems that the effects of rest and CSS on the EMG parameters, PT and pain are similar.

Similar alteration of motor unit recruitment strategies during the anticipation and experience of pain

A motor unit consists of a motoneurone and the multiple muscle fibres that it innervates, and forms the final neural pathway that influences movement. Discharge of motor units is altered (decreased discharge rate and/or cessation of firing; and increased discharge rate and/or recruitment of new units) during matched-force contractions with pain. This is thought to be mediated by nociceptive (pain) input on motoneurones, as demonstrated in animal studies. It is also possible that motoneurone excitability is altered by pain related descending inputs, that these changes persist after noxious stimuli cease, and that direct nociceptive input is not necessary to induce pain related changes in movement. We aimed to determine whether anticipation of pain (descending pain related inputs without nociceptor discharge) alters motor unit discharge, and to observe motor unit discharge recovery after pain has ceased. Motor unit discharge was recorded with fine-wire electrodes in the quadriceps of 9 volunteers. Subjects matched isometric knee-extension force during anticipation of pain (anticipation: electrical shocks randomly applied over the infrapatellar fat-pad); pain (hypertonic saline injected into the fat-pad); and 3 intervening control conditions. Discharge rate of motor units decreased during pain (P<.001) and anticipation (P<.01) compared with control contractions. De-recruitment of 1 population of units and new recruitment of another population were observed during both anticipation and pain; some changes in motor unit recruitment persisted after pain ceased. This challenges the fundamental theory that pain-related changes in muscle activity result from direct nociceptor discharge, and provides a mechanism that may underlie long-term changes in movement/chronicity in some musculoskeletal conditions.

On functional motor adaptations: from the quantification of motor strategies to the prevention of musculoskeletal disorders in the neck-shoulder region

BACKGROUND

Occupations characterized by a static low load and by repetitive actions show a high prevalence of work-related musculoskeletal disorders (WMSD) in the neck-shoulder region. Moreover, muscle fatigue and discomfort are reported to play a relevant initiating role in WMSD.

AIMS

To investigate relationships between altered sensory information, i.e. localized muscle fatigue, discomfort and pain and their associations to changes in motor control patterns.

MATERIALS & METHODS

In total 101 subjects participated. Questionnaires, subjective assessments of perceived exertion and pain intensity as well as surface electromyography (SEMG), mechanomyography (MMG), force and kinematics recordings were performed.

RESULTS

Multi-channel SEMG and MMG revealed that the degree of heterogeneity of the trapezius muscle activation increased with fatigue. Further, the spatial organization of trapezius muscle activity changed in a dynamic manner during sustained contraction with acute experimental pain. A graduation of the motor changes in relation to the pain stage (acute, subchronic and chronic) and work experience were also found. The duration of the work task was shorter in presence of acute and chronic pain. Acute pain resulted in decreased activity of the painful muscle while in subchronic and chronic pain, a more static muscle activation was found. Posture and movement changed in the presence of neck-shoulder pain. Larger and smaller sizes of arm and trunk movement variability were respectively found in acute pain and subchronic/chronic pain. The size and structure of kinematics variability decreased also in the region of discomfort. Motor variability was higher in workers with high experience. Moreover, the pattern of activation of the upper trapezius muscle changed when receiving SEMG/MMG biofeedback during computer work.

DISCUSSION

SEMG and MMG changes underlie functional mechanisms for the maintenance of force during fatiguing contraction and acute pain that may lead to the widespread pain seen in WMSD. A lack of harmonious muscle recruitment/derecruitment may play a role in pain transition. Motor behavior changed in shoulder pain conditions underlining that motor variability may play a role in the WMSD development as corroborated by the changes in kinematics variability seen with discomfort. This prognostic hypothesis was further, supported by the increased motor variability among workers with high experience.

CONCLUSION

Quantitative assessments of the functional motor adaptations can be a way to benchmark the pain status and help to indentify signs indicating WMSD development. Motor variability is an important characteristic in ergonomic situations. Future studies will investigate the potential benefit of inducing motor variability in occupational settings.

Endurance time is joint-specific: a modelling and meta-analysis investigation

Static task intensity-endurance time (ET) relationships (e.g. Rohmert's curve) were first reported decades ago. However, a comprehensive meta-analysis to compare experimentally-observed ETs across bodily regions has not been reported. We performed a systematic literature review of ETs for static contractions, developed joint-specific power and exponential models of the intensity-ET relationships, and compared these models between each joint (ankle, trunk, hand/grip, elbow, knee, and shoulder) and the pooled data (generalised curve). 194 publications were found, representing a total of 369 data points. The power model provided the best fit to the experimental data. Significant intensity-dependent ET differences were predicted between each pair of joints. Overall, the ankle was most fatigue-resistant, followed by the trunk, hand/grip, elbow, knee and finally the shoulder was most fatigable. We conclude ET varies systematically between joints, in some cases with large effect sizes. Thus, a single generalised ET model does not adequately represent fatigue across joints. STATEMENT OF RELEVANCE: Rohmert curves have been used in ergonomic analyses of fatigue, as there are limited tools available to accurately predict force decrements. This study provides updated endurance time-intensity curves using a large meta-analysis of fatigue data. Specific models derived for five distinct joint regions should further increase prediction accuracy.

Muscle pain: mechanisms and clinical significance

INTRODUCTION

Muscle pain is common, but the understanding of its causes is still patchy. This article addresses the mechanisms of some important types of muscle pain.

METHODS

Selective literature review, predominantly of data derived from neuroanatomical and electrophysiological experiments on anesthetized rats.

RESULTS

Muscle pain is evoked by specialized nerve endings (nociceptors). Important stimuli for muscle pain are adenosintriphosphate (ATP) and a low tissue pH. Excitation of muscle nociceptors leads to hyperexcitability of spinal sensory neurones (central sensitization). Low frequency activity in muscle nociceptors is sufficient to induce central sensitization.

DISCUSSION

Central sensitization leads to increased excitation in the spinal cord and to referral of muscle pain. The motoneurones of a painful muscle are centrally inhibited. Muscular spasm is mostly secondary to a painful lesion in another muscle or joint. The pain of fibromyalgia is assumed to relate to a dysfunction of central nociceptive processing. Psychosocial factors also contribute to pain.

Experimental quadriceps muscle pain impairs knee joint control during walking

Pain is a cardinal symptom in musculoskeletal diseases involving the knee joint, and aberrant movement patterns and motor control strategies are often present in these patients. However, the underlying neuromuscular mechanisms linking pain to movement and motor control are unclear. To investigate the functional significance of muscle pain on knee joint control during walking, three-dimensional gait analyses were performed before, during, and after experimentally induced muscle pain by means of intramuscular injections of hypertonic saline (5.8%) into vastus medialis (VM) muscle of 20 healthy subjects. Isotonic saline (0.9%) was used as control. Surface electromyography (EMG) recordings of VM, vastus lateralis (VL), biceps femoris, and semitendinosus muscles were synchronized with the gait analyses. During experimental muscle pain, the loading response phase peak knee extensor moments were attenuated, and EMG activity in the VM and VL muscles was reduced. Compressive forces, adduction moments, knee joint kinematics, and hamstring EMG activity were unaffected by pain. Interestingly, the observed changes persisted when the pain had vanished. The results demonstrate that muscle pain modulated the function of the quadriceps muscle, resulting in impaired knee joint control and joint instability during walking. The changes are similar to those observed in patients with knee pain. The loss of joint control during and after pain may leave the knee joint prone to injury and potentially participate in the chronicity of musculoskeletal problems, and it may have clinically important implications for rehabilitation and training of patients with knee pain of musculoskeletal origin.

Impaired neck motor function and pronounced pain-related fear in helicopter pilots with neck pain - a clinical approach

There is recognition that neck pain is a significant clinical problem in military aviation. In the present trial, the objectives were to explore neck motor function and pain-related fear in pilots with differing progression of neck pain. Seventy-two military helicopter pilots were enrolled: 20 had acute ongoing neck pain, 27 had subacute pain, and 25 were pain-free controls. Neck-flexor electromyography activity (root-mean-square) during staged active craniocervical flexion, median power frequency during sustained neck-flexor contraction, cervical range of motion, rating of perceived exertion after sustained flexor contraction, and rated fear-avoidance beliefs about physical activity were estimated. Main effects emerged for flexor activity, fear-avoidance and range of motion, but not for median frequency variables or perceived exertion. Post hoc testing showed that, compared to controls, both pain groups had greater flexor activity at higher stages of craniocervical flexion while the acute group had higher fear-avoidance and less range of motion in axial rotation and flexion-extension, all P<0.01. Discriminant regression revealed a sensitivity/specificity of 87%/71% (neck-pain/controls), with the flexor activity superior. The results indicate that altered neuromotor synergies are present at different progressions of pain. The tracing of such aberrant activity and fear-avoidance beliefs is suggested in future screening and neck intervention research.

Electromyogram and perceived fatigue changes in the trapezius muscle during typewriting and recovery

The purpose of the present study was to investigate the development and recovery of muscle fatigue in the upper trapezius muscle by analyzing electromyographic signals. Six male subjects performed a simulated typewriting task for four 25-min sessions. During fatigue and the following rest periods, subjective fatigue and surface electromyography (EMG) from the trapezius muscle during isometric contraction at 30% maximum voluntary contraction (MVC) were periodically measured in the interval. We detected a significant decrease in muscle fiber conduction velocity (MFCV) (P = 0.008) and median frequency (MDF) (P = 0.026) as well as an increase in root mean square (RMS) (P = 0.039) and subjective fatigue (P = 0.0004) during the fatigue period. During the recovery period, subjective fatigue decreased drastically and significantly (P = 0.0004), however, the EMG parameters did not recover completely. Thus, physiological muscle fatigue in the trapezius developed in accordance with subjective muscle fatigue during typewriting. On the other hand, differences between the physiological and subjective parameters were found during recovery. Further studies should be necessary to reveal the discrepancy could be a major factor of a transition from temporal phenomena to serious chronic muscle fatigue and to identify the necessity of some guidelines to prevent VDT work-related chronic muscle fatigue in the trapezius.

Clinical applications of high-density surface EMG: A systematic review

High density-surface EMG (HD-sEMG) is a non-invasive technique to measure electrical muscle activity with multiple (more than two) closely spaced electrodes overlying a restricted area of the skin. Besides temporal activity HD-sEMG also allows spatial EMG activity to be recorded, thus expanding the possibilities to detect new muscle characteristics. Especially muscle fiber conduction velocity (MFCV) measurements and the evaluation of single motor unit (MU) characteristics come into view. This systematic review of the literature evaluates the clinical applications of HD-sEMG. Although beyond the scope of the present review, the search yielded a large number of "non-clinical" papers demonstrating that a considerable amount of work has been done and that significant technical progress has been made concerning the feasibility and optimization of HD-sEMG techniques. Twenty-nine clinical studies and four reviews of clinical applications of HD-sEMG were considered. The clinical studies concerned muscle fatigue, motor neuron diseases (MND), neuropathies, myopathies (mainly in patients with channelopathies), spontaneous muscle activity and MU firing rates. In principle, HD-sEMG allows pathological changes at the MU level to be detected, especially changes in neurogenic disorders and channelopathies. We additionally discuss several bioengineering aspects and future clinical applications of the technique and provide recommendations for further development and implementation of HD-sEMG as a clinical diagnostic tool.

Experimental muscle pain changes motor control strategies in dynamic contractions

This study investigated the effect of muscle pain on muscle activation strategies during dynamic exercises. Ten healthy volunteers performed cyclic elbow flexion/extension movements at maximum speed for 2 min after injection of (1) hypertonic (painful) saline in the biceps brachii, (2) hypertonic saline in both biceps brachii and triceps brachii, and (3) isotonic (nonpainful) saline in the biceps brachii muscle. Surface electromyographic (EMG) signals were collected from the upper trapezius, biceps brachii, triceps brachii, and brachioradialis muscles (to estimate EMG amplitude) and with an electrode arrays from biceps brachii (to estimate muscle fiber conduction velocity [CV]). In all conditions, the acceleration of the movement decreased throughout the exercise, and kinematic parameters were not altered by pain. With respect to the control condition, pain induced a decrease of the biceps brachii (mean +/- SE, -23+/-4%) and brachioradialis (-10+/-0.4%) integrated EMG (IEMG) in the beginning of the exercise, and an increase (45+/-3.5%) of the upper trapezius IEMG at all time points during the exercise. The biceps brachii IEMG decreased over time during the nonpainful exercises (-11+/-0.6%) while it remained constant in the painful condition. Biceps brachii CV decreased during painful conditions (-12.8+/-2.2%) while it remained constant during the nonpainful condition. In conclusion, muscle pain changes the motor control strategy to sustain the required dynamic task both in the relative contribution between synergistic muscles and in the motor unit activation within the painful muscle. Such a changed motor strategy may be highly relevant in models of occupational musculoskeletal pain conditions.