Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1994 Sep;57(9):1106–1111. doi: 10.1136/jnnp.57.9.1106

Muscle strength, voluntary activation, twitch properties, and endurance in patients with fibromyalgia.

J Nørregaard 1, P M Bülow 1, B Danneskiold-Samsøe 1
PMCID: PMC1073137  PMID: 8089679

Abstract

Previous studies have shown decreased voluntary muscle strength and endurance in patients with fibromyalgia. The aim of this study was to determine to what extent this is due to lack of exertion. The twitch interpolation technique was used to determine the degree of central activation and estimate the "true" quadriceps muscle strength in patients with fibromyalgia and age and sex matched controls. Subjects hereafter performed an endurance test consisting of repetitive contractions at 50% of estimated "true" muscle strength of four seconds duration followed by a six second rest until exhaustion, or maximally for 40 minutes. Twitch decline and increases in mean rectified EMG were used as objective markers of fatigue. The estimated "true" muscle strength was 82 (SD 26) Nm in 20 patients with fibromyalgia compared with 133 Nm (SD 28) Nm in the 21 controls (p < 0.001). The "true" muscle strength per cm2 midthigh cross sectional area was lower 0.50 (SD 0.15) Nm/cm2 in the patients compared with 0.74 (SD 0.15) Nm/cm2 in the controls (p < 0.001). The decline over time in twitch sizes was similar in the two groups. The mean rectified EMG signal at a fixed force level of 50% of "true" muscle strength increased similarly in the two groups. Relaxation rates and contraction rates also increased equally in the two groups. In conclusion, a reduction of the estimated muscle strength per area unit of about 35% was found in the patients with fibromyalgia. This might be secondary to physical inactivity or neuroendocrine factors. No differences in changes in the neurophysiological indices associated with fatigue were found between the two groups.

Full text

PDF
1106

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Appell H. J. Muscular atrophy following immobilisation. A review. Sports Med. 1990 Jul;10(1):42–58. doi: 10.2165/00007256-199010010-00005. [DOI] [PubMed] [Google Scholar]
  2. Belanger A. Y., McComas A. J. Extent of motor unit activation during effort. J Appl Physiol Respir Environ Exerc Physiol. 1981 Nov;51(5):1131–1135. doi: 10.1152/jappl.1981.51.5.1131. [DOI] [PubMed] [Google Scholar]
  3. Bengtsson A., Henriksson K. G., Larsson J. Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis Rheum. 1986 Jul;29(7):817–821. doi: 10.1002/art.1780290701. [DOI] [PubMed] [Google Scholar]
  4. Bengtsson A., Henriksson K. G. The muscle in fibromyalgia--a review of Swedish studies. J Rheumatol Suppl. 1989 Nov;19:144–149. [PubMed] [Google Scholar]
  5. Bigland-Ritchie B., Cafarelli E., Vøllestad N. K. Fatigue of submaximal static contractions. Acta Physiol Scand Suppl. 1986;556:137–148. [PubMed] [Google Scholar]
  6. Bigland-Ritchie B., Furbush F., Woods J. J. Fatigue of intermittent submaximal voluntary contractions: central and peripheral factors. J Appl Physiol (1985) 1986 Aug;61(2):421–429. doi: 10.1152/jappl.1986.61.2.421. [DOI] [PubMed] [Google Scholar]
  7. Booth R. A., Goddard B. A., Paton A. Measurement of fat thickness in man: a comparison of ultrasound, Harpenden calipers and electrical conductivity. Br J Nutr. 1966;20(4):719–725. doi: 10.1079/bjn19660073. [DOI] [PubMed] [Google Scholar]
  8. Bülow P. M., Nørregaard J., Danneskiold-Samsøe B., Mehlsen J. Twitch interpolation technique in testing of maximal muscle strength: influence of potentiation, force level, stimulus intensity and preload. Eur J Appl Physiol Occup Physiol. 1993;67(5):462–466. doi: 10.1007/BF00376464. [DOI] [PubMed] [Google Scholar]
  9. Edwards R. H., Hill D. K., Jones D. A., Merton P. A. Fatigue of long duration in human skeletal muscle after exercise. J Physiol. 1977 Nov;272(3):769–778. doi: 10.1113/jphysiol.1977.sp012072. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Edwards R. H. Hypotheses of peripheral and central mechanisms underlying occupational muscle pain and injury. Eur J Appl Physiol Occup Physiol. 1988;57(3):275–281. doi: 10.1007/BF00635985. [DOI] [PubMed] [Google Scholar]
  11. Goldenberg D. L., Simms R. W., Geiger A., Komaroff A. L. High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis Rheum. 1990 Mar;33(3):381–387. doi: 10.1002/art.1780330311. [DOI] [PubMed] [Google Scholar]
  12. Hales J. P., Gandevia S. C. Assessment of maximal voluntary contraction with twitch interpolation: an instrument to measure twitch responses. J Neurosci Methods. 1988 Sep;25(2):97–102. doi: 10.1016/0165-0270(88)90145-8. [DOI] [PubMed] [Google Scholar]
  13. Heckmatt J. Z., Pier N., Dubowitz V. Measurement of quadriceps muscle thickness and subcutaneous tissue thickness in normal children by real-time ultrasound imaging. J Clin Ultrasound. 1988 Mar-Apr;16(3):171–176. doi: 10.1002/jcu.1870160305. [DOI] [PubMed] [Google Scholar]
  14. Jacobsen S., Danneskiold-Samsøe B. Dynamic muscular endurance in primary fibromyalgia compared with chronic myofascial pain syndrome. Arch Phys Med Rehabil. 1992 Feb;73(2):170–173. [PubMed] [Google Scholar]
  15. Jacobsen S., Danneskiold-Samsøe B. Isometric and isokinetic muscle strength in patients with fibrositis syndrome. New characteristics for a difficult definable category of patients. Scand J Rheumatol. 1987;16(1):61–65. [PubMed] [Google Scholar]
  16. Jacobsen S., Jensen K. E., Thomsen C., Danneskiold-Samsoe B., Henriksen O. 31P magnetic resonance spectroscopy of skeletal muscle in patients with fibromyalgia. J Rheumatol. 1992 Oct;19(10):1600–1603. [PubMed] [Google Scholar]
  17. Lloyd A. R., Gandevia S. C., Hales J. P. Muscle performance, voluntary activation, twitch properties and perceived effort in normal subjects and patients with the chronic fatigue syndrome. Brain. 1991 Feb;114(Pt 1A):85–98. [PubMed] [Google Scholar]
  18. Lund N., Bengtsson A., Thorborg P. Muscle tissue oxygen pressure in primary fibromyalgia. Scand J Rheumatol. 1986;15(2):165–173. doi: 10.3109/03009748609102084. [DOI] [PubMed] [Google Scholar]
  19. MERTON P. A. Voluntary strength and fatigue. J Physiol. 1954 Mar 29;123(3):553–564. doi: 10.1113/jphysiol.1954.sp005070. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. McCain G. A., Bell D. A., Mai F. M., Halliday P. D. A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia. Arthritis Rheum. 1988 Sep;31(9):1135–1141. doi: 10.1002/art.1780310908. [DOI] [PubMed] [Google Scholar]
  21. Nørregaard J., Bülow P. M., Prescott E., Jacobsen S., Danneskiold-Samsøe B. A four-year follow-up study in fibromyalgia. Relationship to chronic fatigue syndrome. Scand J Rheumatol. 1993;22(1):35–38. doi: 10.3109/03009749309095109. [DOI] [PubMed] [Google Scholar]
  22. Rutherford O. M., Jones D. A., Newham D. J. Clinical and experimental application of the percutaneous twitch superimposition technique for the study of human muscle activation. J Neurol Neurosurg Psychiatry. 1986 Nov;49(11):1288–1291. doi: 10.1136/jnnp.49.11.1288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Sallis J. F., Haskell W. L., Wood P. D., Fortmann S. P., Rogers T., Blair S. N., Paffenbarger R. S., Jr Physical activity assessment methodology in the Five-City Project. Am J Epidemiol. 1985 Jan;121(1):91–106. doi: 10.1093/oxfordjournals.aje.a113987. [DOI] [PubMed] [Google Scholar]
  24. Sandercock T. G., Faulkner J. A., Albers J. W., Abbrecht P. H. Single motor unit and fiber action potentials during fatigue. J Appl Physiol (1985) 1985 Apr;58(4):1073–1079. doi: 10.1152/jappl.1985.58.4.1073. [DOI] [PubMed] [Google Scholar]
  25. Sargeant A. J., Davies C. T., Edwards R. H., Maunder C., Young A. Functional and structural changes after disuse of human muscle. Clin Sci Mol Med. 1977 Apr;52(4):337–342. doi: 10.1042/cs0520337. [DOI] [PubMed] [Google Scholar]
  26. Stokes M. J., Cooper R. G., Edwards R. H. Normal muscle strength and fatigability in patients with effort syndromes. BMJ. 1988 Oct 22;297(6655):1014–1017. doi: 10.1136/bmj.297.6655.1014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Thomas C. K., Johansson R. S., Westling G., Bigland-Ritchie B. Twitch properties of human thenar motor units measured in response to intraneural motor-axon stimulation. J Neurophysiol. 1990 Oct;64(4):1339–1346. doi: 10.1152/jn.1990.64.4.1339. [DOI] [PubMed] [Google Scholar]
  28. Wolfe F., Smythe H. A., Yunus M. B., Bennett R. M., Bombardier C., Goldenberg D. L., Tugwell P., Campbell S. M., Abeles M., Clark P. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990 Feb;33(2):160–172. doi: 10.1002/art.1780330203. [DOI] [PubMed] [Google Scholar]
  29. Yunus M. B., Kalyan-Raman U. P. Muscle biopsy findings in primary fibromyalgia and other forms of nonarticular rheumatism. Rheum Dis Clin North Am. 1989 Feb;15(1):115–134. [PubMed] [Google Scholar]
  30. de Blécourt A. C., Wolf R. F., van Rijswijk M. H., Kamman R. L., Knipping A. A., Mooyaart E. L. In vivo 31P magnetic resonance spectroscopy (MRS) of tender points in patients with primary fibromyalgia syndrome. Rheumatol Int. 1991;11(2):51–54. doi: 10.1007/BF00291145. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES