Experimental muscle pain increases normalized variability of multidirectional forces during isometric contractions

Pain elicits complex adaptations of motor strategy, leading to impairments in the generation and control of steady forces, which depend on muscle architecture. The present study used a cross-over design to assess the effects of muscle pain on the stability of multidirectional (task-related and tangential) forces during sustained dorsiflexions, elbow flexions, knee extensions, and plantarflexions. Fifteen healthy subjects performed series of isometric contractions (13-s duration, 2.5, 20, 50, 70% of maximal voluntary force) before, during, and after experimental muscle pain. Three-dimensional force magnitude, angle and variability were measured while the task-related force was provided as feedback to the subjects. Surface electromyography was recorded from agonist and antagonist muscles. Pain was induced in agonist muscles by intramuscular injections of hypertonic (6%) saline with isotonic (0.9%) saline injections as control. The pain intensity was assessed on an electronic visual analogue scale. Experimental muscle pain elicited larger ranges of force angle during knee extensions and plantarflexions (P < 0.03) and higher normalized fluctuations of task-related (P < 0.02) and tangential forces (P < 0.03) compared with control assessments across force levels, while the mean force magnitudes, mean force angle and the level of muscle activity were non-significantly affected by pain. Increased multidirectional force fluctuations probably resulted from multiple mechanisms that, acting together, balanced the mean surface electromyography. Although pain adaptations are believed to aim at the protection of the painful site, the current results show that they result in impairments in steadiness of force.