Aspects of shoulder function in relation to exposure demands and fatigue - a mini review

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

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

The Guidelines for Application of Kinesiology Tape for Prevention and Treatment of Sports Injuries

The number of kinesiology tape’s users is increasing year by year. However, the insufficiency of fundamental knowledge about the appropriate usage of kinesiology tapes can generate undesired side-effects caused by incorrect application of kinesiology tapes and/or denouncement of kinesiology tapes as an ineffective practice. Therefore, it is necessary to arrange a set of general guidelines of kinesiology taping that must be followed. If not, the treatment may have to be ceased due to the side-effects such as skin’s troubles. Another problem, which impeaches effectivity of treatment by kinesiology tapes, is focusing solely on the present area of pain or discomfort. However, such solution is only short-termed and the likelihood of reappearance of the pain is remarkably high. Therefore, it is essential to find and eliminate the origin of the problem. If these fundamentals conditions of tape’s application are satisfied, the treatment by kinesiology tapes may bring us far more better results.

Postural and muscular adaptations to repetitive simulated work

Complex repetitive tasks are common in the workplace and have been associated with upper extremity disorders. The purpose of this study was to examine the progressive effects of highly repetitive work on joint kinematics and muscle activity of the trunk and upper extremity. Fifteen healthy men performed 60 one-minute cycles of 4 simulated automotive-related tasks. Electromyography of eight muscles and kinematics of the trunk and right upper extremity were collected. Data were analysed at 12-min intervals and divided into a complete work cycle. The time to complete the work cycle decreased by 6.3 s over the trials. Peak shoulder flexion decreased and peak elbow flexion increased during the work cycle. Muscle activity magnitude and variability was influenced by time during the repetitive tasks. This study found adaptations to highly repetitive but light work in only 1 h; redistributing muscle demands within the shoulder over time may reduce muscle fatigue development. Practitioner Summary: While the work was not strenuous, we were able to demonstrate muscular and postural adaptations in a single hour of simulated work. By evaluating both the whole work cycle and the sub-tasks, we aim to develop new methods for evaluating the risk of complex tasks in prolonged repetitive work.

Thoracic adaptations for ventilation during locomotion in humans and other mammals

Bipedal humans, like canids and some other cursorial mammals, are thought to have been selected for endurance running, which requires the ability to sustain aerobic metabolism over long distances by inspiring large volumes of air for prolonged periods of time. Here we test the general hypothesis that humans and other mammals selected for vigorous endurance activities evolved derived thoracic features to increase ventilatory capacity. To do so, we investigate whether humans and dogs rely on thoracic motion to increase tidal volume during running to a greater extent than goats, a species that was not selected for endurance locomotion. We found that while all three species use diaphragmatic breathing to increase tidal volume with increasing oxygen demand, humans also use both dorsoventral and mediolateral expansions of the thorax. Dogs use increased dorsoventral expansion of the thorax, representing an intermediate between humans and goats. 3D analyses of joint morphology of 10 species across four mammalian orders also show that endurance-adapted cursorial species independently evolved more concavo-convex costovertebral joint morphologies that allow for increased rib mobility for thoracic expansion. Evidence for similarly derived concavo-convex costovertebral joints in Homo erectus corresponds with other evidence for the evolution of endurance running in the genus Homo.

External and Internal Focus of Attention Increases Muscular Activation During Bench Press in Resistance-Trained Participants

Kristiansen, M, Samani, A, Vuillerme, N, Madeleine, P, and Hansen, EA. External and internal focus of attention increases muscular activation during bench press in resistance-trained participants. J Strength Cond Res 32(9): 2442-2451, 2018-Research on the effects of instructed attentional focus during execution of strength training exercises is limited and has thus far only been performed on single-joint exercises. The aim of this study was to compare the effects of instructed internal (INT) and external (EXT) focus of attention with a baseline measurement of no instructed focus of attention (BASE) on the surface electromyographic (EMG) amplitude during a free-weight bench press exercise in resistance-trained participants. Twenty-one resistance-trained male participants performed bench press at 60% of their 3-repetition maximum, with BASE, EXT, and INT. The order of EXT and INT was randomized and counterbalanced. Electromyographic data were recorded from 13 muscles of the upper and lower body. Subsequently, mean and peak EMG amplitudes were computed. EXT and INT resulted in significantly increased mean EMG amplitude of 6 upper-body muscles as compared with BASE (p ≤ 0.05). In addition, EXT and INT also resulted in increased peak EMG amplitude of 3 upper-body muscles as compared with BASE (p ≤ 0.05). These results show that muscular activation is increased during bench press, when applying an instructed focus of attention compared with a baseline measurement with no focus instructions (BASE).

A critical review on physical factors and functional characteristics that may explain a sex/gender difference in work-related neck/shoulder disorders

The objective of this paper is to critically review recent literature on physical and functional sex/gender (s/g) differences, with focus on physical determinants associated with neck/shoulder musculoskeletal injuries. It is well known that there are s/g differences in anthropometrical and functional body characteristics (e.g. size and strength). However, s/g differences may be wrongly attributed if data analysis does not include appropriate corrections (e.g. by strength for endurance). Recent literature on motor control shows that there may indeed be s/g differences in muscle coordination and movement strategies during upper limb tasks that are not currently explained by methodological inadequacies. Moreover, recent studies have shown differences between men and women in sensory hypersensitivity characteristics associated with neck/shoulder injuries. Taken together, the literature points to the importance of accounting for possible s/g differences at all levels of the biopsychosocial system in order to better understand sex- and gender-specific issues relevant to workplace health.

PRACTITIONER SUMMARY

This article critically reviews recent literature and a conceptual model highlighting s/g differences in physical and functional characteristics related to neck/shoulder musculoskeletal disorders (NSMSD). Findings have implications on understanding how personal factors may affect NSMSD risk. With better understanding, practitioners can make more appropriate decisions to prevent work-related NSMSD.

EMG-biofeedback and load sharing problem in assistive and rehabilitation orthotic devices

Biofeedback signals have been frequently used for rehabilitation purposes, and in design and calibration of orthotic and prosthetic devices. Whenever one or a couple of muscles of a joint are chosen for rehabilitation or control of a device, it's assumed that a specific load sharing or activation pattern exists among them for each individual and for each specific joint demand. Indeterminacy or a load sharing problem arises from having more muscles crossing a joint than needed to perform all possible movements. It's proven that muscle activation patterns depend on fatigue, the task (isometric/isokinetic, concentric/eccentric), load type, mental demands, etc. The most used biofeedbacks are electromyogram of one of the muscles or the joint torque signal. An important question is if they can be used interchangeably. This study investigated if the choice of biofeedback can also change the activation pattern in the two main elbow flexors. The results of this experiment on six healthy subjects and seven activation levels, indicated that change in biofeedback type had a significant effect on the activation ratio of these two muscles.

Effects of strap support in a hand-held device on the muscular activity in female workers assessed by electromyography and subjective rating

The present study evaluates the potential mitigation of physical workload when using strap support for a portable device. The experiments were designed as consecutive sessions over a 2-h period. Electromyogram signals were recorded from four muscles of six subjects. The perceived level of fatigue on the whole body as well as in the shoulder, arm, lower back and legs was assessed using Borg's CR-10 scale. All subjects were tested under eight experimental conditions. Results indicated that the biceps brachii muscle displayed significantly lower activity with strap support than without a strap. In the experiments with and without a strap, different levels of force were imposed on the various muscles, which caused changes in the distribution of the physical load. Although the role of the strap might seem evident, using strap support did not always decrease the sensation of fatigue. However, for short-term tasks, using a strap may be recommended.

Numerical modelling of the shoulder for clinical applications

Research activity involving numerical models of the shoulder is dramatically increasing, driven by growing rates of injury and the need to better understand shoulder joint pathologies to develop therapeutic strategies. Based on the type of clinical question they can address, existing models can be broadly categorized into three groups: (i) rigid body models that can simulate kinematics, collisions between entities or wrapping of the muscles over the bones, and which have been used to investigate joint kinematics and ergonomics, and are often coupled with (ii) muscle force estimation techniques, consisting mainly of optimization methods and electromyography-driven models, to simulate muscular action and joint reaction forces to address issues in joint stability, muscular rehabilitation or muscle transfer, and (iii) deformable models that account for stress-strain distributions in the component structures to study articular degeneration, implant failure or muscle/tendon/bone integrity. The state of the art in numerical modelling of the shoulder is reviewed, and the advantages, limitations and potential clinical applications of these modelling approaches are critically discussed. This review concentrates primarily on muscle force estimation modelling, with emphasis on a novel muscle recruitment paradigm, compared with traditionally applied optimization methods. Finally, the necessary benchmarks for validating shoulder models, the emerging technologies that will enable further advances and the future challenges in the field are described.

A method to quantify frequency and duration of sustained low-level muscle activity as a risk factor for musculoskeletal discomfort

AIM

The purpose of this paper was to describe and evaluate different aspects of muscle activity patterns associated with musculoskeletal discomfort/pain.

METHOD

Surface electromyography (sEMG) of the right upper trapezius and the right extensor digitorum muscles was conducted continuously during one working day in 19 male forest machine operators driving harvesters, 20 driving forwarders and 20 researchers at the Forest Research Institute. Perceived discomfort/pain in the right side of the neck and the right forearm was rated morning, noon and afternoon with Borg's CR-10 scale. Static, median and peak levels of muscle activity were analyzed and the number and total duration of EMG gaps (muscular rest) were calculated. Sustained low-level muscle activity (SULMA) was defined as continuous muscle activity above 0.5% of the maximal EMG activity quantified into 10 periods of predetermined duration intervals from 1.6 to 5s up to above 20 min. The number of SULMA periods is presented within each interval and as cumulative periods above the already determined levels. The operators handled control levers seated in a fixed position while the researchers performed mainly PC work and other varied tasks.

RESULTS

A positive correlation was found between discomfort/pain in the right upper trapezius muscle region in the afternoon and cumulative SULMA periods above 10 min duration, and a negative correlation to cumulative SULMA periods also including the short durations. No specified patterns were found for discomfort/pain in the right extensor digitorum or for the other EMG measurements. All EMG measurements distinguished to some extent between the occupational groups, especially between machine operators driving harvesters and researchers.

CONCLUSIONS

Number of SULMA periods longer than 10 min per hour was positively correlated, and predominantly short periods were negatively correlated, to complaints in the neck region. This seems promising in order to find duration limits for sustained low-level muscle activity as a risk factor for musculoskeletal disorders.

The role of core stability in athletic function

The importance of function of the central core of the body for stabilisation and force generation in all sports activities is being increasingly recognised. 'Core stability' is seen as being pivotal for efficient biomechanical function to maximise force generation and minimise joint loads in all types of activities ranging from running to throwing. However, there is less clarity about what exactly constitutes 'the core', either anatomically or physiologically, and physical evaluation of core function is also variable. 'Core stability' is defined as the ability to control the position and motion of the trunk over the pelvis to allow optimum production, transfer and control of force and motion to the terminal segment in integrated athletic activities. Core muscle activity is best understood as the pre-programmed integration of local, single-joint muscles and multi-joint muscles to provide stability and produce motion. This results in proximal stability for distal mobility, a proximal to distal patterning of generation of force, and the creation of interactive moments that move and protect distal joints. Evaluation of the core should be dynamic, and include evaluation of the specific functions (trunk control over the planted leg) and directions of motions (three-planar activity). Rehabilitation should include the restoring of the core itself, but also include the core as the base for extremity function.

Muscular fatigue and endurance during intermittent static efforts: effects of contraction level, duty cycle, and cycle time

OBJECTIVE

To determine the effects of intermittent task parameters on muscle fatigue and endurance time during static shoulder abductions, with a long-term goal of establishing relationships between intermittent task parameters and short-term performance.

BACKGROUND

Effects of intermittent work on endurance and fatigue development have been reported, and certain combinations of contraction levels and duty cycles have been proposed as design guidelines. These findings, however, were not derived from systematic manipulations of the task parameters.

METHOD

Prolonged (1-hr maximum) intermittent shoulder abductions were performed at different combinations of contraction level (12% or 28% of muscle strength), duty cycle (.25 or .75), and cycle time (34 or 166 s). Fatigue was measured based on reductions in muscle strength and indirectly by changes in ratings of discomfort, electromyographic (EMG) amplitude, and EMG spectral distribution.

RESULTS

Contraction level and duty cycle significantly affected endurance time and muscle fatigue, and interactive effects between these parameters were observed for some of the measures. Significant effects of cycle time were found only for EMG spectral measures.

CONCLUSION

Endurance time and local fatigue were dependent on the comprehensive effects of the different task parameters.

APPLICATION

Design changes to reduce the occurrence of localized fatigue during intermittent work need to take into account all the task parameters simultaneously.

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.

Intramuscular pressure and EMG relate during static contractions but dissociate with movement and fatigue

Intramuscular pressure (IMP) and electromyography (EMG) mirror muscle force in the nonfatigued muscle during static contractions. The present study explores whether the constant IMP-EMG relationship with increased force may be extended to dynamic contractions and to fatigued muscle. IMP and EMG were recorded from shoulder muscles in three sessions: 1) brief static arm abductions at angles from 0 to 90°, with and without 1 kg in the hands; 2) dynamic arm abductions at angular velocities from 9 to 90°/s, with and without 1 kg in the hands; and 3) prolonged static arm abduction at 30° for 30 min followed by recovery. IMP and EMG increased in parallel with increasing shoulder torque during brief static tasks. During dynamic contractions, peak IMP and EMG increased to values higher than those during static contractions, and EMG, but not IMP, increased significantly with speed of abduction. In the nonfatigued supraspinatus muscle, a linear relationship was found between IMP and EMG; in contrast, during fatigue and recovery, significant timewise changes of the IMP-to-EMG ratio occurred. The results indicate that IMP should be included along with EMG when mechanical load sharing between muscles is evaluated during dynamic and fatiguing contractions.