Musculoskeletal symptoms and perceived work strain among reindeer herders in Sweden.

BACKGROUND: There is a shortage of knowledge on the extent of musculoskeletal symptoms in reindeer husbandry. AIMS: To investigate the prevalence and relative risk for musculoskeletal symptoms and perceived psychosocial work strain among reindeer herders. METHODS: The prevalence of self-reported musculoskeletal symptoms during the last week and last year, respectively, were obtained from male reindeer herders (n=74) of northern Sweden. Prevalence ratios (PRs) were calculated using two reference groups-women of reindeer-herding families (n=53) and men in blue-collar occupations (n=194). Comparisons were made of perceived job strain between the study and reference groups. Associations between job strain factors and the occurrence of musculoskeletal symptoms from different body regions were analysed with regression statistics. RESULTS: The PRs for musculoskeletal symptoms from the hand/wrist (PR 3.48, 95% CI 1.86-6.50) and lower back (PR 1.44, 95% CI 1.06-1.95) were significantly higher among the reindeer herders in comparison with men working with other blue-collar occupations. The reindeer herders reported significantly higher work demands and decision latitude compared with both reference groups (P<0.05). Significant associations were observed between demands and prevalence of symptoms from the lower back (OR 1.42, 95% CI 1.01-2.01) and from at least one body region (OR 1.58, 95% CI 1.07-2.32). CONCLUSIONS: The relative risk for musculoskeletal symptoms, particularly from the hands/wrists and lower back, was high among reindeer herders. It is suggested that musculoskeletal symptoms constitute a considerable health problem in modern reindeer husbandry, which calls for implementation of preventive measures addressing psychosocial, physical and socio-economic risk factors.

Increased intramuscular concentration of bradykinin increases the static fusimotor drive to muscle spindles in neck muscles of the cat.

The aim of the present study was to investigate if increased intramuscular concentrations of bradykinin (BK) in one muscle influence the activity in primary and secondary muscle spindle afferents (MSAs) originating from both ipsi- and contralateral muscles, via fusimotor reflexes. The ipsilateral trapezius (TR) and the splenius (SP) muscles were subjected to sinusoidal stretches and 2-3 MSAs were simultaneously recorded from these muscles. Responses of 29 MSAs (15 SP and 14 TR) were registered in five adult cats anaesthetised with alpha-chloralose. Intramuscular injections of 0.5 ml BK (6-86 micrograms/ml) were administered to both the ipsi- and contralateral SP and TR muscles. Similar doses of BK (5-10 micrograms) have been shown to induce muscle pain when injected into the temporal muscle in man. The responsiveness of the MSAs to the injections of BK was 86% and 87.5% from the contralateral TR and SP muscles, respectively. The effects were predominantly static onto the MSAs. The duration of the effects was on average 3.5-4 min, however some effects lasted for more than 15 min. The effects were always abolished after cutting the nerve to the injected muscle. The large majority of the spindle afferents were unresponsive to i.m. Tyrode injections (23 of 29). For the afferents that were responsive to injection of Tyrode, the effects were always considerably smaller and with shorter duration than those evoked by BK injections. Thus, increased intramuscular concentrations of BK may excite primary and secondary MSAs from ipsi- and contralateral muscles, via fusimotor reflexes evoked most probably by activity in chemosensitive muscle afferents. The results are discussed in relation to a recent hypothesis on pathophysiological mechanisms behind genesis, spread and perpetuation of muscle tension and pain in chronic musculoskeletal pain syndromes.

Influences on the fusimotor-muscle spindle system from chemosensitive nerve endings in cervical facet joints in the cat: possible implications for whiplash induced disorders.

The aim of the present study was to establish if there exists reflex connections from ligamentous structures in cervical facet joints and the fusimotor system of dorsal neck muscles. In seven cats, anaesthetized with alpha-chloralose, bradykinin (BK) of concentrations between 12 and 50 microg was injected into the facet joint between C1 and C2. Recordings were made from single muscle spindle afferents (MSA) originating in contralateral trapezius and splenius muscles (TrSp). Fusimotor induced changes in the sensitivity of the muscle spindle afferents were assessed by recording the responses to sinusoidal stretches of the TrSp muscles. The mean rate of discharge and the depth of modulation of a fitted sine were taken as quantitative estimates of the response. A total of 25 MSAs were recorded, and 21 of these showed clear-cut alterations in their responses to the sinusoidal stretches following Bk. injections into contralateral facet joint. The majority of the responding afferents (13/21) showed changes in their responses indicating an increased activity of static fusimotoneurones, although responses of dynamic and mixed static and dynamic nature were also seen. Local anaesthetics applied to the intraarticular receptors abolished the effects. Injection (i.v.) of a general anaesthetic (pentobarbital) abolished the effects. The results show that there exist reflex connections between receptors in cervical facet joints and fusimotoneurones of dorsal neck muscles, and this might be of importance in the pathophysiology behind whiplash associated disorders (WAD).

Activity in receptor afferents from the anterior cruciate ligament evokes reflex effects on fusimotor neurones.

Responses from 2-4 muscle spindle afferents from triceps surae and/or posterior biceps and semitendinosus muscles were simultaneously recorded in cats anaesthetized with alpha-chloralose. It was demonstrated that stretch of the anterior cruciate ligament (ACL) of the ipsilateral knee causes changes in dynamic and/or static sensitivity of primary and secondary spindle afferents to sinusoidal stretching. The changes were due to reflex actions of stretch/tension-sensitive receptor afferents from ACL on dynamic and static fusimotor neurones. The findings support the hypothesis that ACL-afferents contribute to the regulation of muscular stiffness around the knee, and thereby also to dynamic knee joint stability.

Influences on the gamma-muscle spindle system from muscle afferents stimulated by KCl and lactic acid.

It is known that accumulation of contraction metabolites in muscles stimulates group III and IV afferents and induces excitation of gamma-efferents to the homonymous muscle. The aim of the present study was to investigate whether increased concentrations of lactic acid and KCl in one muscle may influence the activity in primary and secondary muscle spindle afferents (MSAs) from the chemically affected muscle and from surrounding muscles. The experiments were made on 7 cats anesthetized with alpha-chloralose. Recordings were made simultaneously from 2-8 single MSAs from the triceps surae (GS) and the posterior biceps and semitendinosus muscles (PBSt). The mean rate of firing and the depth of modulation of MSA responses to sinusoidal stretching of the receptor-bearing muscles were determined. Responses of 27 primary MSAs (11 from PBSt and 16 from GS) were recorded. On 24 of these clear-cut alterations in sinusoidal response were evoked by injection of 1 ml of KCl (50-600 mM) or 1 ml of lactic acid (20-200 mM) into the artery supply of the GS muscle. Also, all secondary MSAs recorded (4 from PBSt and 1 from GS) showed sizable effects to increased intramuscular concentrations of KCl and/or lactic acid. On both primary and secondary MSAs, from GS as well as from PBSt muscles, nearly all effects observed were compatible with activation of static fusimotor neurons. Effects on MSAs were completely abolished when the ipsilateral L7-L6 ventral roots were cut and when the GS nerve was anesthetized. Intravenous injections of KCl and lactic acid, as well as arterial injections of 0.9% NaCl, were ineffective in changing the MSA responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence from stretch-sensitive receptors in the collateral ligaments of the knee joint on the gamma-muscle-spindle systems of flexor and extensor muscles.

In lightly alpha-chloralose anaesthetized cats, activity was recorded simultaneously from 2-4 primary muscle spindle afferents from triceps surae and/or posterior biceps and semitendinosus muscles. Increased tension in medial or lateral collateral ligament was found to evoke changes in the responses of the primary spindle afferents to sinusoidal stretching of their parent muscles. It is concluded that these changes were due to reflex actions of stretch/tension-sensitive receptors in the collateral ligaments on fusimotor neurones. Thus, receptor afferents from the collateral ligaments may contribute to the regulation of the activity in the gamma-motor-muscle-spindle system, and thereby also be of importance for the control of muscular stiffness and knee joint stability.

Influences on the gamma-muscle-spindle system from contralateral muscle afferents stimulated by KCl and lactic acid.

The aim of the present study was to investigate whether increased concentrations of lactic acid and potassium chloride (KCl) in contralateral muscles can influence the sensitivity of primary and secondary muscle spindle afferents (MSAs) from ipsilateral extensor and flexor muscles. The experiments were performed on 7 cats anaesthetised with alpha-chloralose. Recordings were made simultaneously from 2-12 single MSAs from the triceps surae (GS) and/or the posterior biceps and semitendinosus muscles (PBSt). The mean rate of firing and the amplitude of a fitted sine curve of MSA responses to sinusoidal stretching of the receptor bearing muscles were determined. Responses of 42 primary MSAs (17 from PBSt and 25 from GS) were recorded. On 33 of these, clear-cut alterations in sinusoidal response were evoked by injection of 1 ml KCl (200-400 mM) or 1 ml lactic acid (20-50 mM) into the arterial supply of the contralateral GS or PBSt muscles. Six out of 8 secondary MSAs showed sizeable effects to increased intramuscular concentrations of KCl and/or lactic acid (3 from PBSt and 3 from GS). On both primary and secondary MSAs, from GS as well as from PBSt muscles, the large majority of effects were excitatory. All effects on secondary MSAs were compatible with reflex actions on static fusimotor neurones, whereas on primary MSAs different types of reflex responses were observed (i.e. pure static, pure dynamic and mixtures of static and dynamic fusimotor actions). Stimuli related alterations in MSA responses were completely abolished when the contralateral GS or PBSt nerves were anaesthetised.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of electrical and natural stimulation of skin afferents on the gamma-spindle system of the triceps surae muscle.

The aim of the present study was to investigate the extent to which skin receptors might influence the responses of primary muscle spindle afferents via reflex actions on the fusimotor system. The experiments were performed on 43 cats anaesthetized with alpha-chloralose. The alterations in fusimotor activity were assessed from changes in the responses of the muscle spindle afferents to sinusoidal stretching of their parent muscles (triceps surae and plantaris). The mean rate of firing and the modulation of the afferent response were determined. Control measurements were made in absence of any cutaneous stimulation. Tests were made (a) during physiological stimulation of skin afferents of the ipsilateral pad or of the contralateral hindlimb, or (b) during repetitive electrical stimulation of the sural nerve in the ipsilateral hindlimb, or of sural or superficial peroneal nerve in the contralateral hindlimb. Of the total number of 113 units tested with repetitive electrical stimulation of the ipsilateral sural nerve (at 20 Hz), 24.8% exhibited predominantly dynamic fusimotor reflexes, 5.3% mixed or predominantly static fusimotor reflexes. One unit studied in a preparation with intact spinal cord exhibited static reflexes at low stimulation intensities and dynamic ones at higher stimulation strengths. The remaining units (69%) were uninfluenced. When the receptor-bearing muscle was held at constant length and a train of stimuli (at 20 Hz) was applied to the ipsilateral sural nerve, the action potentials in the primary muscle spindle afferent could be stimulus-locked to the 3rd or 4th pulse in the train (and to the pulses following thereafter), with a latency of about 24 ms from the effective pulse. This 1:1 pattern of driving seemed to be mediated via static and/or dynamic fusimotor neurons. Natural stimulation influenced comparatively few units (3 of 65 units tested from the ipsilateral pad and 10 of 98 tested from the contralateral hindlimb), but when the effects were present they were quite large. The results are discussed in relation to previous studies on reflex control of fusimotor neurones from cutaneous afferents. It is suggested that the wide range of fusimotor effects from cutaneous afferent fibres observed in this study (from complete absence of any effect, via moderate excitatory and inhibitory effects, to the 'driving pattern', i.e. pulse-to-pulse response) may reflect that different gamma-motoneurones have individualized reflex profiles, and it may also indicate that groups of fusimotor neurones and spindle afferents play specific roles in different motor acts.

Effects of L-DOPA on fusimotor control of triceps surae muscle spindles in the cat.

The experiments were performed on lightly alpha-chloralose anaesthetised and spinalized cats. Alterations in fusimotor activity were assessed by recordings from single spindle afferents (90 primary and 12 secondary) from the triceps surae muscle, before and after i.v. administration of L-beta-3,4-dihydroxyphenylalanine (L-DOPA). The effects of L-DOPA on fusimotor reflexes from ipsi- and contralateral hind limb afferents were investigated by using extensions of the intact contralateral hind limb and tonic stretches of the ipsilateral posterior biceps and semitendinosus muscles as reflex stimuli. Prior to injection of L-DOPA, a low reflex responsiveness was found to both the ipsi- and the contralateral stimulation. After administration of L-DOPA, the reflex responsiveness as well as the resting activity of the muscle spindle afferents were increased as a result of enhanced activity in mainly dynamic fusimotor neurones. The results indicate that changes in fusimotor activity elicited after administration of L-DOPA are caused by release of transmission in interneuronal pathways mediating ipsi- and contralateral reflexes to mainly dynamic fusimotor neurones. The possible role of monoaminergic descending control of fusimotor neurones in the regulation of muscle tone, tremor and rigidity is discussed.

Bradykinin and muscle stretch alter contralateral cat neck muscle spindle output.

The objective of this study was to investigate the activity of primary and secondary muscle spindle afferents (MSAs) in neck muscles, when the contralateral splenius or trapezius muscles were (1) exposed to i.m. injection of bradykinin (BK) (6-86 microg/ml), (2) stretched, (3) stretched during exposure to BK or (4) stretched after exposure to BK. It was found that injection of BK, muscle stretch and the combination of the two stimuli significantly excited primary and secondary MSAs via reflex effects onto static fusimotor neurones. BK, alone, and in combination with muscle stretch, induced more frequent, potent and long lasting effects as compared to muscle stretch. The effects of muscle stretch was significantly increased after exposure of BK, indicating that stretch-sensitive nerve-endings within neck muscles are sensitised by BK. The results are discussed in relation to the disturbances in motor co-ordination and proprioception found in patients suffering from chronic muscle pain in the cervical region.

A method for analysis of encoding of stimulus separation in ensembles of afferents.

This paper describes a new method for the analysis of ensemble coding in populations of receptor afferents. The method is based on principal component analysis (PCA) combined with algorithms for calculation of stimulus separation (discrimination). It allows a quantification of the ability of ensembles of afferents to discriminate between stimuli of different intensity, and it can also be used to calculate to which extent each afferent in an ensemble contributes to the discrimination. Since the emphasis is put on discrimination of stimuli rather than on similarities between the representations of the stimulus in the ensemble response and the stimulus itself, it involves no implicit assumption about the unknown decoding mechanisms in the CNS. Examples of results obtained with analysis of and comparison of simultaneously recorded and pooled sequentially recorded populations of primary muscle spindle afferents are given. These results support some of the general arguments in favour of the ensemble coding theory, and indicate that the results of studies made on populations of simultaneously recorded receptor afferents may differ considerably from results obtained in studies on pooled sequentially recorded afferents. In contrast to when ensemble responses are based on parallel recordings, population responses constructed from sequential recordings will be distorted as a result of unavoidable temporal variations in physiological conditions.

Fusimotor reflexes to antagonistic muscles simultaneously assessed by multi-afferent recordings from muscle spindle afferents.

Several single agonist/antagonist primary muscle spindle afferents were simultaneously recorded in chloralose anaesthetized cats. It was shown that their dynamic and static sensitivity to sinusoidal muscle stretches could be increased or decreased via the fusimotor system by extension and flexion of the contralateral hind limb as well as by stretch of ipsilateral muscles and stimulation of ipsilateral skin nerves. The results seem to support the hypothesis that the primary muscle spindle afferents convey complex multisensory messages to the central nervous system (CNS).

Ensemble coding of muscle stretches in afferent populations containing different types of muscle afferents.

Ensemble coding of simple mechanical stimuli (small sinusoidal stretches) was studied in simultaneously recorded mixed ensembles of primary- and secondary muscle spindle afferents (MSAs), and Golgi tendon organ (GTO) afferents recorded from L7-S1 dorsal root filaments. The experiments were made on 48 recorded afferents (29 primary MSAs, 6 secondary MSAs and 13 GTO afferents) in chloralose anaesthetised cats. For the analyses, we used a combination of principal component analysis and algorithms for quantification of stimulus discrimination. Mixed ensembles of primary- and secondary MSAs, and GTO afferents, discriminated significantly better between different muscle stretches than ensembles of only one or two types of these afferents. All kinds of ensembles showed a successive increase in discriminative ability with increased ensemble size and this ability seemed to level at larger populations. However, the increase in discriminative ability was significantly greater for the mixed ensembles. It is hypothesised that the main reason for the greater discriminative ability achieved by mixed ensembles, might be that the variation in response profiles (sensitivity tuning) among the individual afferents of the mixed ensemble will be larger than that for ensembles of only one type of afferent. Finally, the results in the present study give experimental support to some of the teleological arguments in favour of the ensemble coding theory.

Fusimotor neurones can be reflexly influenced by activity in receptor afferents from the posterior cruciate ligament.

Recordings were made simultaneously from 2-4 primary muscle spindle afferents from triceps surae and/or posterior biceps and semitendinosus muscles in cats anaesthetized with alpha-chloralose. It was demonstrated that stretch of the posterior cruciate ligament of the ipsilateral knee could cause changes in dynamic and/or static sensitivity of these afferents to sinusoidal stretching. The changes were due to reflex actions of stretch/tension-sensitive receptors in the cruciate ligaments onto fusimotor neurones. It is concluded that the cruciate ligaments may play an important 'sensory' role and that they may participate, via reflex actions on the gamma-motor-muscle spindle system, in the regulation of muscular stiffness of the knee joint, and thereby of the knee joint stability.

Sensory nerve endings in the cat cruciate ligaments: a morphological investigation.

The histology of the cat anterior and posterior cruciate ligaments was studied using the modified Gairns gold chloride staining for neural elements. Ruffini endings, Pacinian corpuscles, Golgi tendon organ-like endings and free nerve endings were identified. All receptor types were most frequently found close to the tibial and femoral insertions. The results are consistent with our earlier findings that small increases in the tension of the ligaments can potently influence the fusimotor system to the muscles acting at the knee joint, and thereby participate in the regulation of their stiffness and the knee joint stability.

Elevated intramuscular concentration of bradykinin in jaw muscle increases the fusimotor drive to neck muscles in the cat.

Patients suffering from temporomandibular dysfunction exhibit clinical findings such as fatigue, painful muscles, and muscles that are tender to palpation, not only in the temporomandibular area, but also in the neck/shoulder region. The mechanisms behind this are not known, although previous studies of similar spreading phenomena have revealed a possible involvement of the fusimotor system. In the present study, we evaluated the activity of this system by recording the activity of muscle spindle afferents from dorsal neck muscles after intramuscular injections of 6 microg to 25 microg bradykinin in the ipsilateral masseter muscle. A total of 23 muscle spindle afferents from the trapezius and splenius muscles was recorded at the C3-C4 level in 7 adult cats anesthetized with alpha-chloralose. Of these 23 afferents, 17 (74%) showed significantly different responses to bradykinin injections compared with control injections (dissolving agent, Tyrode), and the majority of the effects were compatible with an increased static fusimotor drive to the muscle spindle system. Thus, the results demonstrate potent reflex connections from groups III and IV masseter muscle afferents to fusimotor neurones on the C3-C4 level. It is concluded that the fusimotor system might play a significant role in the mechanisms behind the spread of muscle pain and tension from the temporomandibular region to the neck.

Receptors in the knee joint ligaments and their role in the biomechanics of the joint.

The knee joint ligaments contain Ruffini, Pacinian, Golgi, and free-nerve endings with different capabilities of providing the CNS with information about movement and position as well as about noxious events. Skeletomotor neurons (alpha-motoneurons) are known to be influenced only very rarely and weakly from low-threshold mechanoreceptors in the ligaments, while the effects on the tau-muscle-spindle system in the muscles around the knee are so potent that even ligament stretches at very low loads may induce major changes in the responses of the muscle spindle afferents. Since the primary muscle spindle afferents participate in the regulation of muscular stiffness, the receptors in the knee joint ligaments probably contribute, via the tau-muscle-spindle system, to preparatory adjustment (pre-setting) of the stiffness of the muscles around the knee joint, and thereby to the joint stiffness and the functional joint stability.

Vertical posture and head stability in patients with chronic neck pain.

OBJECTIVE: To evaluate postural performance and head stabilization of patients with chronic neck pain. DESIGN: A single-blind comparative group study. SUBJECTS: Patients with work-related chronic neck pain (n = 9), with chronic whiplash associated disorders (n = 9) and healthy subjects (n = 16). METHODS: During quiet standing in different conditions (e.g. 1 and 2 feet standing, tandem standing, and open and closed eyes) the sway areas and the ability to maintain the postures were measured. The maximal peak-to-peak displacement of the centre of pressure and the head translation were analysed during predictable and unpredictable postural perturbations. RESULTS: Patients with chronic neck pain, in particular those with whiplash-associated disorders, showed larger sway areas and reduced ability to successfully execute more challenging balance tasks. They also displayed larger sway areas and reduced head stability during perturbations. CONCLUSION: The results show that disturbances of postural control in chronic neck pain are dependent on the aetiology, and that it is possible to quantify characteristic postural disturbances in different neck pain conditions. It is suggested that the dissimilarities in postural performance are a reflection of different degrees of disturbances of the proprioceptive input to the central nervous system and/or of the central processing of such input.

Risk factors for cardiovascular diseases among Swedish Sami--a controlled cohort study.

OBJECTIVE: To investigate the occurrence of clinical, psychosocial and behavioural risk factors for cardiovascular diseases (CVD) among reindeer herding (RS) and non-reindeer herding Sami (NRS). STUDY DESIGN: A retrospective cohort study, comparing risk factors behind CVD between Sami and non-Sami, RS and NRS, and Sami men and women. METHODS: A cohort of 611 Swedish Sami (276 men and 335 women) was constructed from national population registers. A twice as large control cohort of non-Sami was created, matched by age, gender and area of residence. Information on risk factors was obtained from a database containing clinical and psychosocial-behavioural data from a regional CVD preventive programme for the period 1990-2001. RESULTS: The Sami and the non-Sami showed similar risk factor patterns. The main differences were related to working conditions and lifestyle factors of the RS. The RS men had lower blood pressure, were more physically active and had higher job demand and decision latitude. The RS women showed more negative scores on the indices of the job strain model. CONCLUSIONS: Previously reported differences in CVD mortality between Sami and non-Sami, and Sami men and women, can only partly be explained by different exposure to the psychosocial and behaviour risk factors investigated in this study.

Fusimotor reflex profiles of individual triceps surae primary muscle spindle afferents assessed with multi-afferent recording technique.

The experiments were performed on 21 cats anaesthetized with alpha-chloralose. The aim of the study was to investigate sets of simultaneously recorded spindle afferents (2-4 in each set) from the triceps surae muscle (GS) with respect to the pattern of fusimotor reflex effects evoked by different types of ipsi- and contralateral reflex stimulation. The afferents' responses to sinusoidal stretching of the GS muscle were determined and the fusimotor reflex effects were assessed by comparing the afferent responses (i.e. the mean rate of firing and the depth of modulation) elicited during reflex stimulation with those evoked in absence of any reflex stimulus. Natural of electrical activations of ipsi- and contralateral muscle, skin and joint receptor afferents were used as reflex stimuli. The spindle afferents were influenced by several modalities and from wide areas, with a majority responding to both ipsi- and contralateral stimuli. A particular reflex stimulus often caused different effects on different afferents, and the various reflex stimuli seldom gave similar effects on a particular afferent. Multivariate analysis revealed that the variation in response profiles among simultaneously recorded afferents were as great as between afferents recorded on different occasions. This suggests that the individualized response prifiles, observed in earlier investigations, represent a very diversified reflex control of the spindle primary afferents, and are not a reflection of changes in the setting of the spinal interneuronal network, occurring during the time interval between the recordings of different units. Also, there was no relation between the conduction velocity of the afferents and the reflex profiles of the afferents, but non-linear relations were found between effects elicited by different types of stimuli. Indications were also found that it may be possible to separate the population of GS muscle spindles into subgroups, according to the fusimotor effects exhibited by activation of various categories of ipsi- and contralateral receptor afferents. It is concluded that one possible way of making the very complex reflex system controlling the muscle spindles intelligible may be a combination of multiple simultaneous recordings of spindle afferents and multivariate analysis.