European Journal of Applied Physiology

, Volume 111, Issue 8, pp 1725–1735

Effects of static contraction and cold stimulation on cardiovascular autonomic indices, trapezius blood flow and muscle activity in chronic neck–shoulder pain

  • David M. Hallman
  • Lars-Göran Lindberg
  • Bengt B. Arnetz
  • Eugene Lyskov
Original Article


The aim of the present study was to investigate reactions in trapezius muscle blood flow (MBF), muscle activity, heart rate variability (HRV) and systemic blood pressure (BP) to autonomic tests in subjects with chronic neck–shoulder pain and healthy controls. Changes in muscle activity and blood flow due to stress and unfavourable muscle loads are known underlying factors of work-related muscle pain. Aberration of the autonomic nervous system (ANS) is considered a possible mechanism. In the present study, participants (n = 23 Pain, n = 22 Control) performed autonomic tests which included a resting condition, static hand grip test (HGT) at 30% of maximal voluntary contraction, a cold pressor test (CPT) and a deep breathing test (DBT). HRV was analysed in time and frequency domains. MBF and muscle activity were recorded from the upper trapezius muscles using photoplethysmography and electromyography (EMG). The pain group showed reduced low frequency-HRV (LF) and SDNN during rest, as well as a blunted BP response and increased LF-HRV during HGT (∆systolic 22 mm Hg; ∆LF(nu) 27%) compared with controls (∆systolic 27; ∆LF(nu) 6%). Locally, the pain group had attenuated trapezius MBF in response to HGT (Pain 122% Control 140%) with elevated trapezius EMG following HGT and during CPT. In conclusion, only HGT showed differences between groups in systemic BP and HRV and alterations in local trapezius MBF and EMG in the pain group. Findings support the hypothesis of ANS involvement at systemic and local levels in chronic neck–shoulder pain.


Muscle pain Sympathetic Heart rate variability PPG Electromyography 


  1. Acero CO, Kuboki T, Maekawa K, Yamashita A, Clark GT (1999) Haemodynamic responses in chronically painful, human trapezius muscle to cold pressor stimulation. Arch Oral Biol 44:805–812PubMedCrossRefGoogle Scholar
  2. Andersen L, Blangsted A, Nielsen P, Hansen L, Vedsted P, Sjøgaard G, Søgaard K (2010) Effect of cycling on oxygenation of relaxed neck/shoulder muscles in women with and without chronic pain. Eur J Appl Physiol 41(6):836–844Google Scholar
  3. Andersson G, Forsberg A, Malmgren S (1997) Konditionstest på cykel. SISU Idrottsböcker, FarstaGoogle Scholar
  4. Ashina M, Stallknecht B, Bendtsen L, Pedersen JF, Galbo H, Dalgaard P, Olesen J (2002) In vivo evidence of altered skeletal muscle blood flow in chronic tension-type headache. Brain 125:320–326PubMedCrossRefGoogle Scholar
  5. Berntson G, Bigger JT, Eckberg DL, Grossman P, Kaufmann PG, Malik M, Nagaraja H (1997) Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology 34:623–648PubMedCrossRefGoogle Scholar
  6. Borg G (1998) Borg’s perceived exertion and pain scales. Human Kinetics, Champaign, ILGoogle Scholar
  7. Cohen H, Neumann L, Shore M, Amir M, Cassuto Y, Buskila D (2000) Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum 29:217–227PubMedCrossRefGoogle Scholar
  8. Ekblom-Bak E, Hellénius M-L, Ekblom Ö, Engström L-M, Ekblom B (2010) Independent associations of physical activity and cardiovascular fitness with cardiovascular risk in adults. Eur J Cardiovasc Prev Rehabil 17:175–180PubMedCrossRefGoogle Scholar
  9. Elvin A, Siösteen A-K, Nilsson A, Kosek E (2006) Decreased muscle blood flow in fibromyalgia patients during standardised muscle exercise: a contrast media enhanced colour Doppler study. Eur J Pain 10:137–144PubMedCrossRefGoogle Scholar
  10. Giske L, Vøllestad NK, Mengshoel AM, Jensen J, Knardahl S, Røe C (2008) Attenuated adrenergic responses to exercise in women with fibromyalgia—A controlled study. Eur J Pain 12:351–360PubMedCrossRefGoogle Scholar
  11. Gockel M, Lindholm H, Alaranta H, Viljanen A, Lindquist A, Lindholm T (1995) Cardiovascular functional disorder and stress among patients having neck-shoulder symptoms. Ann Rheum Dis 54:494–497PubMedCrossRefGoogle Scholar
  12. Gockel M, Lindholm H, Niemist Leena, Hurri H (2008) Perceived disability but not pain is connected with autonomic nervous function among patients with chronic low back pain. J Rehabil Med 40:355–358PubMedCrossRefGoogle Scholar
  13. Gold JE, Cherniack M, Buchholz B (2004) Infrared thermography for examination of skin temperature in the dorsal hand of office workers. Eur J Appl Physiol 93:245–251PubMedCrossRefGoogle Scholar
  14. Graven-Nielsen T, Lund H, Arendt-Nielsen L, Danneskiold-Samsøe B, Bliddal H (2002) Inhibition of maximal voluntary contraction force by experimental muscle pain: a centrally mediated mechanism. Muscle Nerve 26:708–712PubMedCrossRefGoogle Scholar
  15. Hagblad J, Lindberg LG, Kaisdotter Andersson A, Bergstrand S, Lindgren M, Ek AC, Folke M, Lindén M (2010) A technique based on laser Doppler flowmetry and photoplethysmography for simultaneously monitoring blood flow at different tissue depths. Med Biol Eng Comput 48(5):415–422PubMedCrossRefGoogle Scholar
  16. Holte KA, Westgaard RH (2002) Daytime trapezius muscle activity and shoulder-neck pain of service workers with work stress and low biomechanical exposure. Am J Ind Med 41:393–405PubMedCrossRefGoogle Scholar
  17. Johansson H, Windhorst U, Djupsjöbacka M, Passatore M (eds) (2003) Chronic work-related myalgia. Neuromuscular mechanisms behind work-related chronic muscle pain syndromes. Gävle University Press, GävleGoogle Scholar
  18. Johnston V, Jull G, Souvlis T, Jimmieson NL (2008) Neck movement and muscle activity characteristics in female office workers with neck pain. Spine 33:555–563PubMedCrossRefGoogle Scholar
  19. Kadetoff D, Kosek E (2010) Evidence of reduced sympatho-adrenal and hypothalamic-pituitary activity during static muscular work in patients with fibromyalgia. J Rehabil Med 42:765–772PubMedCrossRefGoogle Scholar
  20. Kalezic N, Åsell M, Kerschbaumer H, Lyskov E (2007) Physiological reactivity to functional tests in patients with chronic low back pain. J Musculoskelet Pain 15:29–40CrossRefGoogle Scholar
  21. Kalezic N, Noborisaka Y, Nakata M, Crenshaw AG, Karlsson S, Lyskov E, Eriksson P-O (2010) Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD). Arch Oral Biol 55:447–453PubMedCrossRefGoogle Scholar
  22. Krantz G, Forsman M, Lundberg U (2004) Consistency in physiological stress responses and electromyographic activity during induced stress exposure in women and men. Integr Psychol Behav Sci 39:105–118CrossRefGoogle Scholar
  23. Larsman P, Thorn S, Søgaard K, Sandsjö L, Sjøgaard G, Kadefors R (2009) Work related perceived stress and muscle activity during standardized computer work among female computer users. Work J Prev Assess Rehabil 32:189–199Google Scholar
  24. Larsson SE, Ålund M, Cai H, Öberg PÅ (1994) Chronic pain after soft-tissue injury of the cervical spine: trapezius muscle blood flow and electromyography at static loads and fatigue. Pain 57:173–180Google Scholar
  25. Larsson SE, Larsson R, Zhang Q, Cai H, Öberg PÅ (1995) Effects of psychophysiological stress on trapezius muscles blood flow and electromyography during static load. Eur J Appl Physiol 71:493–498CrossRefGoogle Scholar
  26. Larsson R, Öberg PÅ, Larsson SE (1999) Changes of trapezius muscle blood flow and electromyography in chronic neck pain due to trapezius myalgia. Pain 79:45–50PubMedCrossRefGoogle Scholar
  27. Leistad R, Nilsen K, Stovner L, Westgaard R, Rø M, Sand T (2008) Similarities in stress physiology among patients with chronic pain and headache disorders: evidence for a common pathophysiological mechanism? J Headache Pain 9:165–175PubMedCrossRefGoogle Scholar
  28. Lindberg L, Öberg P (1992) Photoplethysmograph from a laser source. Med Biol Eng Comput 30:568–568Google Scholar
  29. Lundberg U (2002) Psychophysiology of work: stress, gender, endocrine response, and work-related upper extremity disorders. Am J Ind Med 41:383–392PubMedCrossRefGoogle Scholar
  30. Lundberg U, Kadefors R, Melin B, Palmerud G, Hassmén P, Engström M, Elfsberg Dohns I (1994) Psychophysiological stress and emg activity of the trapezius muscle. Int J Behav Med 1:354–370PubMedCrossRefGoogle Scholar
  31. Maekawa K, Clark GT, Kuboki T (2002) Intramuscular hypoperfusion, adrenergic receptors, and chronic muscle pain. J Pain 3:251–260PubMedCrossRefGoogle Scholar
  32. Martinez-Lavin M (2007) Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther 9:216PubMedCrossRefGoogle Scholar
  33. Okifuji A, Turk DC (2002) Stress and psychophysiological dysregulation in patients with fibromyalgia syndrome. Appl Psychophysiol Biofeedback 27:129–141PubMedCrossRefGoogle Scholar
  34. Passatore M, Roatta S (2003) Sympathetic nervous system: interaction with muscle function and and involvement in motor control. In: Johansson H, Windhorst U, Djupsjöbacka M, Passatore M (eds) Chronic work-related myalgia neuromuscular mechanisms behind work-related chronic muscle pain syndromes. Gävle University Press, Gävle, pp 243–263Google Scholar
  35. Passatore M, Roatta S (2006) Influence of sympathetic nervous system on sensorimotor function: whiplash associated disorders (WAD) as a model. Eur J Appl Physiol 98:423–449PubMedCrossRefGoogle Scholar
  36. Roatta S, Arendt-Nielsen L, Farina D (2008) Sympathetic-induced changes in discharge rate and spike-triggered average twitch torque of low-threshold motor units in humans. J Physiol 586:5561–5574PubMedCrossRefGoogle Scholar
  37. Rosendal L, Larsson B, Kristiansen J, Peolsson M, Søgaard K, Kjær M, Sørensen J, Gerdle B (2004) Increase in muscle nociceptive substances and anaerobic metabolism in patients with trapezius myalgia: microdialysis in rest and during exercise. Pain 112:324–334PubMedCrossRefGoogle Scholar
  38. Sandberg M, Larsson B, Lindberg L-G, Gerdle B (2005a) Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and work-related trapezius myalgia. Eur J Pain 9:497–510PubMedCrossRefGoogle Scholar
  39. Sandberg M, Zhang Q, Styf J, Gerdle B, Lindberg LG (2005b) Non-invasive monitoring of muscle blood perfusion by photoplethysmography: evaluation of a new application. Acta Physiol Scand 183:335–343PubMedCrossRefGoogle Scholar
  40. Sharma SD, Smith EM, Hazleman BL, Jenner JR (1997) Thermographic changes in keyboard operators with chronic forearm pain. BMJ 314:118PubMedGoogle Scholar
  41. Sjörs A, Larsson B, Dahlman J, Falkmer T, Gerdle B (2009) Physiological responses to low-force work and psychosocial stress in women with chronic trapezius myalgia. BMC Musculoskelet Disord 10:63PubMedCrossRefGoogle Scholar
  42. Strøm V, Røe C, Knardahl S (2009) Work-induced pain, trapezius blood flux, and muscle activity in workers with chronic shoulder and neck pain. Pain 144:147–155PubMedCrossRefGoogle Scholar
  43. Sullivan M, Karlsson J, Ware JE (1995) The Swedish SF-36 Health Survey-I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med 41:1349–1358PubMedCrossRefGoogle Scholar
  44. Task force of the European Society of cardiology, the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Eur Heart J 17:354–381Google Scholar
  45. Thomas GD, Segal SS (2004) Neural control of muscle blood flow during exercise. J Appl Physiol 97:731–738PubMedCrossRefGoogle Scholar
  46. Vernon H, Mior S (1991) The Neck Disability Index: a study of reliability and validity. J Manip Physiol Ther 14:409–415Google Scholar
  47. Visser B, van Dieën JH (2006) Pathophysiology of upper extremity muscle disorders. J Electromyogr Kinesiol 16:1–16PubMedCrossRefGoogle Scholar
  48. Wærsted M (2000) Human muscle activity related to non-biomechanical factors in the workplace. Eur J Appl Physiol 83:151–158PubMedCrossRefGoogle Scholar
  49. Zhang Q, Lindberg L-G, Kadefors R, Styf J (2001a) A non-invasive measure of blood flow changes in the human anterior tibial muscle. Eur J Appl Physiol 84:448–452PubMedCrossRefGoogle Scholar
  50. Zhang Q, Styf J, Lindberg L-G (2001b) Effects of limb elevation and increased intramuscular pressure on human tibialis anterior muscle blood flow. Eur J Appl Physiol 85:567–571PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • David M. Hallman
    • 1
    • 4
  • Lars-Göran Lindberg
    • 2
  • Bengt B. Arnetz
    • 3
    • 4
  • Eugene Lyskov
    • 1
  1. 1.Centre for Musculoskeletal ResearchUniversity of GävleGävleSweden
  2. 2.Department of Biomedical EngineeringLinköping UniversityLinköpingSweden
  3. 3.Department of Family Medicine and Public Health Sciences, Division of Occupational and Environmental HealthWayne State UniversityDetroitUSA
  4. 4.Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden

Personalised recommendations