Muscle Tenderness in Women.

Ann Persson

Research output: ThesisDoctoral Thesis (compilation)


Longstanding pain experienced from the musculoskeletal system is reported by one third of the Swedish population. The underlying mechanisms are not known in the majority of cases.

In the present studies, the changes in pressure pain thresholds (PPTs) over the trapezius and deltoid muscles after a unilateral static contraction of maximal duration of one arm was measured in healthy females (n=25) and in a group of female cleaners with longstanding shoulder pain (n=17). Simultaneous measurements of EMG-related muscular fatigue were performed over both muscles, evaluating the fatigue in the trapezius muscle by an increased amplitude (root mean square) and in the deltoid by a decreased mean power frequency of the EMG signals. A paradoxical bilateral and longstanding (10-20 min) increase of PPTs was observed, while the EMG-related muscular fatigue was shortlasting with half recovery within 15 s after the end of contraction. The findings indicate that central sensory changes, maybe through descending inhibition, are important for the mechanonociceptive thresholds in muscle.

In a separate study on 24 healthy females, the test-retest reliability of PPT measurements on the trapezius and deltoid muscles bilaterally was examined with an electronic algometer (Somedic) at four experimental sessions, one day and four weeks apart, each including four consecutive measurements at 10 min intervals. Two examiners participated. The intraindividual test-retest repeatability for each point in all sessions was high, intraclass correlation coefficient (ICC): 0.70 - 0.94, mean max abs. difference 53 - 102 kiloPascal (kPa), and between points in each muscle, ICC: 0.59 - 0.90, mean max abs. difference 65 - 111 kPa. Side to side differences were small. The interindividual variation of PPTs was fivefold (trapezius 88 - 574 kPa; deltoid 91 - 529 kPa), necessitating normalization in group level studies. Inter-rater repeatability was high with no significant differences.

The effect of repeated (30) mechanocociceptive stimuli (1.5 times pain threshold; 0.4 Hz) over one trapezius muscle on PPTs in the same point was explored in a study on 27 healthy females. Two reaction types were found, either a PPT decrease of 34% (n=12) or a PPT increase of 23% (n=15), both significant and lasting 5 - 10 min. On repeated PPT measurements of nine subjects with a "decrease" reaction a strong correlation was found between sequential observations (r= 0.54; p< 0.001; Pearson). The "increase" reaction was significantly associated with the experience of childbirths.

In conclusion, central changes in sensory transmission are important for pressure pain (tenderness) sensitivity in human muscle.
Original languageEnglish
Awarding Institution
  • Neurosurgery
  • [unknown], [unknown], Supervisor, External person
Award date2003 May 13
Print ISBNs91-628-5601-4
Publication statusPublished - 2003

Bibliographical note

Defence details

Date: 2003-05-13
Time: 09:15
Place: Main Auditorium, University Hospital, Lund

External reviewer(s)

Name: Hansson, Per
Title: Professor
Affiliation: Karolinska Inst, Stockholm


Article: I. Persson AL, Hansson G-Å, Kalliomäki J, Moritz U, Sjölund BH. Pressure pain thresholds and electromyographically defined fatigue induced by a muscular endurance test in normal women. Clin J Pain 2000;16:155-63.

Article: II. Persson AL, Hansson G-Å, Kalliomäki J, Sjölund BH. Increases in local pressure pain thresholds after muscle exertion in women with chronic shoulder pain. Arch Phys Med Rehabil. In press 2003.

Article: III. Persson Al, Brogårdh C, Sjölund, BH. Tender or not tender – test-retest repeatability of pressure pain thresholds in the ttrapezius and deltoid muscles of healthy women. J Rehab Med. In press 2003.

Article: IV. Sjölund BH, Persson AL. Changes in pressure pain thresholds after repeated pressure over tyhe trapezius muscle in healthy women. Submitted 2003.

Subject classification (UKÄ)

  • Neurology
  • Surgery


  • Reliability.
  • Electronic algometer
  • Pain threshold
  • Pain measurement
  • Shoulder pain
  • Tenderness
  • Muscle
  • Nociception
  • Central processing
  • Physical medicine
  • kinesitherapy
  • revalidation
  • rehabilitation
  • Rehabilitering (medicinsk och social)


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