A new method of isometric dynamometry for the craniocervical flexor muscles

Background and Purpose. A new method of dynamometry has been developed to measure the performance of the craniocervical (CC) flexor muscles by recording the torque that these muscles exert on the cranium around the CC junction. This report describes the method, the specifications of the instrument, and the preliminary reliability data. Subjects and Methods. For the reliability study, 20 subjects (12 subjects with a history of neck pain, 8 subjects without a history of neck pain) performed, on 2 occasions, maximal voluntary isometric contraction (MVIC) tests of CC flexion in 3 positions within the range of CC flexion and submaximal sustained tests (20% and 50% of MVIC) in the middle range of CC flexion (craniocervical neutral position). Reliability coefficients were calculated to establish the test-retest reliability of the measurements. Results. The method demonstrated good reliability over 2 sessions in the measurement of MVIC (intraclass correlation coefficient [ICC] =.79-.93, SEM=0.6-1.4 N-m) and in the measurement of steadiness (standard deviation of torque amplitude) of a sustained contraction at 20% of NMC (ICC=.74-.80, SEM=0.01 N-m), but not at 50% of MVIC (ICC=.07-.76, SEM=0.04-0.13 N-m). Discussion and Conclusion. The new dynamometry method appears to have potential clinical application in the measurement of craniocervical flexor muscle performance.

Effects of menthol on rat tail artery mediated by TRPM8 and voltage-gated calcium channels

Transient receptor potential melastatin 8 (TRPM8) is the principal cold and menthol receptor channel. Characterized primarily for its cold sensing role in sensory neurons, it is expressed and functional in several non-neuronal tissues, including vasculature. We previously demonstrated that menthol causes vasoconstriction and vasodilatation in isolated arteries, depending on vascular tone. Here we investigated calcium's role in responses mediated by TRPM8 ligands in rat tail artery myocytes using patch-clamp electrophysiology and ratiometric Ca2+ recording. Isometric contraction studies examined actions of TRPM8 ligands in the presence/absence of L-type calcium channel blocker. Menthol (300 μM), a concentration typically used to induce TRPM8 currents, strongly inhibited L-type voltage-dependent Ca2+ current (L-ICa) in myocytes, especially it's sustained component, most relevant for depolarisation-induced vasoconstriction. In contraction studies, with nifedipine present (10 μM) to abolish L-ICa contribution to phenylephrine (PE)-induced vasoconstrictions of vascular rings, a marked increase in tone was observed with menthol. Menthol-induced increases in PE-induced vasoconstrictions were mediated predominantly by Ca2+-release from sarcoplasmic reticulum, since they were significantly inhibited by cyclopiazonic acid. Pre-incubation of vascular rings with a TRPM8 antagonist strongly inhibited menthol-induced increases in PE-induced vasoconstrictions, thus confirming specific role of TRPM8. Finally, two other common TRPM8 agonists, WS-12 and icilin, inhibited L-ICa. Thus, TRPM8 channels are functionally active in rat tail artery myocytes and play a distinct direct stimulatory role in control of vascular tone. However, indirect effects of TRPM8 agonists, which are unrelated to TRPM8, are mediated by inhibition of L-type Ca2+ channels, and largely obscure TRPM8-mediated vasoconstriction.

Comparison between maximal lengthening and shortening contractions for biceps brachii muscle oxygenation and hemodynamics

Eccentric contractions (ECC) require lower systemic oxygen (O2) and induce greater symptoms of muscle damage than concentric contractions (CON); however, it is not known if local muscle oxygenation is lower in ECC than CON during and following exercise. This study compared between ECC and CON for changes in biceps brachii muscle oxygenation [tissue oxygenation index (TOI)] and hemodynamics [total hemoglobin volume (tHb) = oxygenated-Hb + deoxygenated-Hb], determined by near-infrared spectroscopy over 10 sets of 6 maximal contractions of the elbow flexors of 10 healthy subjects. This study also compared between ECC and CON for changes in TOI and tHb during a 10-s sustained and 30-repeated maximal isometric contraction (MVC) task measured immediately before and after and 1–3 days following exercise. The torque integral during ECC was greater (P < 0.05) than that during CON by ∼30%, and the decrease in TOI was smaller (P < 0.05) by ∼50% during ECC than CON. Increases in tHb during the relaxation phases were smaller (P < 0.05) by ∼100% for ECC than CON; however, the decreases in tHb during the contraction phases were not significantly different between sessions. These results suggest that ECC utilizes a lower muscle O2 relative to O2 supply compared with CON. Following exercise, greater (P < 0.05) decreases in MVC strength and increases in plasma creatine kinase activity and muscle soreness were evident 1–3 days after ECC than CON. Torque integral, TOI, and tHb during the sustained and repeated MVC tasks decreased (P < 0.01) only after ECC, suggesting that muscle O2 demand relative to O2 supply during the isometric tasks was decreased after ECC. This could mainly be due to a lower maximal muscle mass activated as a consequence of muscle damage; however, an increase in O2 supply due to microcirculation dysfunction and/or inflammatory vasodilatory responses after ECC is recognized.

Attenuation of muscle damage by preconditioning with muscle hyperthermia

This study investigated the hypothesis that muscle damage would be attenuated in muscles subjected to passive hyperthermia 1 day prior to exercise. Fifteen male students performed 24 maximal eccentric actions of the elbow flexors with one arm; the opposite arm performed the same exercise 2-4 weeks later. The elbow flexors of one arm received a microwave diathermy treatment that increased muscle temperature to over 40°C, 16-20 h prior to the exercise. The contralateral arm acted as an untreated control. Maximal voluntary isometric contraction strength (MVC), range of motion (ROM), upper arm circumference, muscle soreness, plasma creatine kinase activity and myoglobin concentration were measured 1 day prior to exercise, immediately before and after exercise, and daily for 4 days following exercise. Changes in the criterion measures were compared between conditions (treatment vs. control) using a two-way repeated measures ANOVA with a significance level of P < 0.05. All measures changed significantly following exercise, but the treatment arm showed a significantly faster recovery of MVC, a smaller change in ROM, and less muscle soreness compared with the control arm. However, the protective effect conferred by the diathermy treatment was significantly less effective compared with that seen in the second bout performed 4-6 weeks after the initial bout by a subgroup of the subjects (n = 11) using the control arm. These results suggest that passive hyperthermia treatment 1 day prior to eccentric exercise-induced muscle damage has a prophylactic effect, but the effect is not as strong as the repeated bout effect. © Springer-Verlag 2006.

Effects of whole-body cryotherapy (-110 degrees C) on proprioception and indices of muscle damage

The purpose of this study was to investigate the effects of whole-body cryotherapy (WBC) on proprioceptive function, muscle force recovery following eccentric muscle contractions and tympanic temperature (TTY). Thirty-six subjects were randomly assigned to a group receiving two 3-min treatments of −110 ± 3 °C or 15 ± 3 °C. Knee joint position sense (JPS), maximal voluntary isometric contraction (MVIC) of the knee extensors, force proprioception and TTY were recorded before, immediately after the exposure and again 15 min later. A convenience sample of 18 subjects also underwent an eccentric exercise protocol on their contralateral left leg 24 h before exposure. MVIC (left knee), peak power output (PPO) during a repeated sprint on a cycle ergometer and muscles soreness were measured pre-, 24, 48 and 72 h post-treatment. WBC reduced TTY, by 0.3 °C, when compared with the control group (P<0.001). However, JPS, MVIC or force proprioception was not affected. Similarly, WBC did not effect MVIC, PPO or muscle soreness following eccentric exercise. WBC, administered 24 h after eccentric exercise, is ineffective in alleviating muscle soreness or enhancing muscle force recovery. The results of this study also indicate no increased risk of proprioceptive-related injury following WBC.

Effect of cold water immersion after exercise in the heat on muscle function, body temperatures, and vessel diameter

Cold water immersion (CWI) is a popular recovery modality, but actual physiological responses to CWI after exercise in the heat have not been well documented. The purpose of this study was to examine effects of 20-min CWI (14 degrees C) on neuromuscular function, rectal (T(re)) and skin temperature (T(sk)), and femoral venous diameter after exercise in the heat. Ten well-trained male cyclists completed two bouts of exercise consisting of 90-min cycling at a constant power output (216+/-12W) followed by a 16.1km time trial (TT) in the heat (32 degrees C). Twenty-five minutes post-TT, participants were assigned to either CWI or control (CON) recovery conditions in a counterbalanced order. T(re) and T(sk) were recorded continuously, and maximal voluntary isometric contraction torque of the knee extensors (MVIC), MVIC with superimposed electrical stimulation (SMVIC), and femoral venous diameters were measured prior to exercise, 0, 45, and 90min post-TT. T(re) was significantly lower in CWI beginning 50min post-TT compared with CON, and T(sk) was significantly lower in CWI beginning 25min post-TT compared with CON. Decreases in MVIC, and SMVIC torque after the TT were significantly greater for CWI compared with CON; differences persisted 90min post-TT. Femoral vein diameter was approximately 9% smaller for CWI compared with CON at 45min post-TT. These results suggest that CWI decreases T(re), but has a negative effect on neuromuscular function.

Architectural changes of the biceps femoris after concentric or eccentric training

Purpose To determine i) the architectural adaptations of the biceps femoris long head (BFlf) following concentric or eccentric strength training interventions; ii) the time course of adaptation during training and detraining. Methods Participants in this randomized controlled trial (control [n=28], concentric training group [n=14], eccentric training group [n=14], males) completed a 4-week control period, followed by 6 weeks of either concentric- or eccentric-only knee flexor training on an isokinetic dynamometer and finished with 28 days of detraining. Architectural characteristics of BFlf were assessed at rest and during graded isometric contractions utilizing two-dimensional ultrasonography at 28 days pre-baseline, baseline, days 14, 21 and 42 of the intervention and then again following 28 days of detraining. Results BFlf fascicle length was significantly longer in the eccentric training group (p<0.05, d range: 2.65 to 2.98) and shorter in the concentric training group (p<0.05, d range: -1.62 to -0.96) after 42 days of training compared to baseline at all isometric contraction intensities. Following the 28-day detraining period, BFlf fascicle length was significantly reduced in the eccentric training group at all contraction intensities compared to the end of the intervention (p<0.05, d range: -1.73 to -1.55). There was no significant change in fascicle length of the concentric training group following the detraining period. Conclusions These results provide evidence that short term resistance training can lead to architectural alterations in the BFlf. In addition, the eccentric training-induced lengthening of BFlf fascicle length was reversed and returned to baseline values following 28 days of detraining. The contraction mode specific adaptations in this study may have implications for injury prevention and rehabilitation.

Biceps femoris architecture and strength in athletes with a prior ACL reconstruction

Purpose To determine if limbs with a history of anterior cruciate ligament (ACL) injury reconstructed from the semitendinosus (ST) display different biceps femoris long head (BFlh) architecture and eccentric strength, assessed during the Nordic hamstring exercise, compared to the contralateral uninjured limb. Methods The architectural characteristics of the BFlh were assessed at rest and at 25% of a maximal voluntary isometric contraction (MVIC) in the control (n=52) and previous ACL injury group (n=15) using two-dimensional ultrasonography. Eccentric knee-flexor strength was assessed during the Nordic hamstring exercise. Results Fascicle length was shorter (p=0.001; d range: 0.90 to 1.31) and pennation angle (p range: 0.001 to 0.006: d range: 0.87 to 0.93) was greater in the BFlh of the ACL injured limb when compared to the contralateral uninjured limb at rest and during 25% of MVIC. Eccentric strength was significantly lower in the ACL injured limb than the contralateral uninjured limb (-13.7%; -42.9N; 95% CI = -78.7 to -7.2; p=0.021; d=0.51). Fascicle length, MVIC and eccentric strength were not different between the left and right limb in the control group. Conclusions Limbs with a history of ACL injury reconstructed from the ST have shorter fascicles and greater pennation angles in the BFlh compared to the contralateral uninjured side. Eccentric strength during the Nordic hamstring exercise of the ACL injured limb is significantly lower than the contralateral side. These findings have implications for ACL rehabilitation and hamstring injury prevention practices which should consider altered architectural characteristics.

Electron tomography of cryofixed, isometrically contracting insect flight muscle reveals novel actin-myosin interactions.

BACKGROUND: Isometric muscle contraction, where force is generated without muscle shortening, is a molecular traffic jam in which the number of actin-attached motors is maximized and all states of motor action are trapped with consequently high heterogeneity. This heterogeneity is a major limitation to deciphering myosin conformational changes in situ. METHODOLOGY: We used multivariate data analysis to group repeat segments in electron tomograms of isometrically contracting insect flight muscle, mechanically monitored, rapidly frozen, freeze substituted, and thin sectioned. Improved resolution reveals the helical arrangement of F-actin subunits in the thin filament enabling an atomic model to be built into the thin filament density independent of the myosin. Actin-myosin attachments can now be assigned as weak or strong by their motor domain orientation relative to actin. Myosin attachments were quantified everywhere along the thin filament including troponin. Strong binding myosin attachments are found on only four F-actin subunits, the "target zone", situated exactly midway between successive troponin complexes. They show an axial lever arm range of 77°/12.9 nm. The lever arm azimuthal range of strong binding attachments has a highly skewed, 127° range compared with X-ray crystallographic structures. Two types of weak actin attachments are described. One type, found exclusively in the target zone, appears to represent pre-working-stroke intermediates. The other, which contacts tropomyosin rather than actin, is positioned M-ward of the target zone, i.e. the position toward which thin filaments slide during shortening. CONCLUSION: We present a model for the weak to strong transition in the myosin ATPase cycle that incorporates azimuthal movements of the motor domain on actin. Stress/strain in the S2 domain may explain azimuthal lever arm changes in the strong binding attachments. The results support previous conclusions that the weak attachments preceding force generation are very different from strong binding attachments.

Efeitos imediatos da mobilização com movimento na dor, Amplitude de movimento e actividade electromiográfica dos músculos da cintura escapular em indivíduos com síndrome do conflito subacromial

Introdução: A síndrome do conflito subacromial (SCSA) é a causa mais frequente de dor no ombro. Alterações na cinemática escapuloumeral e na activação dos músculos escapulares têm sido identificadas em pessoas com SCSA. A mobilização com movimento (MWM) é uma técnica de terapia manual, desenvolvida por Mulligan, que visa normalizar a cinemática articular. Objectivos: Determinar os efeitos imediatos da MWM na dor, na amplitude de movimento (ADM) de abdução no plano da escápula (APE), e na amplitude do sinal electromiográfico (EMG) do trapézio e grande dentado (GD), em pessoas com SCSA. Métodos: Foram incluídas no estudo 24 pessoas com SCSA, divididas de forma aleatória em 2 grupos de 12, MWM e Placebo. As medidas de resultados avaliadas foram: a dor nos testes de Neer e Hawkins-Kennedy; o limiar de dor à pressão; a ADM de APE até ao início da dor; e a percentagem da contracção isométrica voluntária máxima dos músculos trapézio (superior, médio e inferior) e GD. Resultados: A aplicação da MWM resultou numa significativa diferença, com redução da dor, no teste de Hawkins-Kennedy (p=0,028), num aumento do limiar de dor à pressão (p=0,002) e da ADM de APE até ao início da dor (p=0,010), e numa diminuição da actividade EMG do trapézio superior (TS), na fase concêntrica, abaixo dos 90˚ (p=0,028), comparativamente ao grupo Placebo. Foi, ainda, identificada uma diminuição estatisticamente significativa da actividade EMG do TS, nas restantes fases do movimento (p<0,05), um aumento do limiar de dor à pressão (p<0,001) e da ADM até ao início da dor (p=0,006) entre, antes e após a intervenção com MWM. Conclusão: A MWM poderá ser uma técnica efectiva em indivíduos com SCSA, pelos seus efeitos na redução de dor, aumento de ADM até ao início da dor e diminuição da actividade EMG do TS.

Comparação do efeito da técnica de facilitação neuromuscular proprioceptiva com a técnica de músculo energia no alongamento muscular dos isquiotibiais a curto prazo

Introdução: A aplicação das técnicas de Contrair-Relaxar com Contracção do Antagonista (CRCA) e de Músculo Energia (TME) promovem um aumento da flexibilidade muscular, contudo poucos estudos comparam a eficácia de ambas. Apresentam aspectos comuns como a contracção prévia do músculo a alongar sendo esta máxima na CRCA e uma percentagem da máxima na TME. Contudo, alguma evidência sugere que não existe correspondência entre a força produzida e a desejada pelo que este aspecto da TME carece de explicação. Objectivos: Confirmar se a técnica CRCA e a TME são efectivas no alongamento muscular dos isquiotibiais a curto prazo, caso sejam determinar qual a mais efectiva. Pretende-se ainda avaliar se a percepção ao esforço durante a aplicação da TME corresponde à força efectivamente realizada. Métodos: Efectuou-se um estudo experimental com 45 voluntários distribuídos aleatoriamente pelos grupos CRCA, TME e Controlo. Avaliou-se a amplitude articular passiva de extensão do joelho antes e depois de aplicar as técnicas, utilizando um goniómetro. Nos participantes submetidos à TME avaliou-se a percepção ao esforço, solicitando uma contracção submáxima isométrica de 40% medida através do dinamómetro de mão. Resultados: Verificou-se um efeito das técnicas entre as avaliações (Teste ANOVA medidas repetidas factor tempo: p<0,001) e entre os grupos (tempo*grupo: p<0,001). Comparando os grupos dois a dois, verificaram-se diferenças entre o grupo CRCA e o grupo Controlo (Teste Post Hoc Games-Howell: p=0,001) e entre o grupo TME e o grupo Controlo (p=0,009), não existindo diferenças entre os grupos CRCA e TME (p=0,376). Os grupos CRCA e TME obtiveram um ganho de 10,7º e de 11,4º respectivamente, não havendo diferenças significativas entre os ganhos (Teste T-Student Independente: p=0,599). Existiram diferenças significativas entre os 40% CMVI produzida e desejada (Teste Wilcoxon: p=0,018). Conclusão: Ambas foram efectivas no aumento da flexibilidade muscular dos isquiotibiais a curto prazo. Os efeitos foram comparáveis, mas dada a menor complexidade e menor solicitação a TME foi considerada mais eficiente. A percepção ao esforço durante a aplicação da TME não correspondeu ao esforço desejado, existindo uma tendência para a produção de intensidades de contracções maiores.

Proposition de combinaisons optimales de contractions volontaires maximales isométriques pour la normalisation de 12 muscles de l'épaule

Afin d’être représentatif d’un niveau d’effort musculaire, le signal électromyographique (EMG) est exprimé par rapport à une valeur d’activation maximale. Comme l’épaule est une structure articulaire et musculaire complexe, aucune contraction volontaire isométrique (CVMi) proposée dans la littérature ne permet d’activer maximalement un même muscle de l’épaule pour un groupe d’individus. L’objectif de ce mémoire est de développer une approche statistique permettant de déterminer les CVMi optimales afin de maximiser les niveaux d’activation d’un ensemble de muscles de l’épaule. L’amplitude du signal EMG de 12 muscles de l’épaule a été enregistrée chez 16 sujets alors qu’ils effectuaient 15 CVMi. Une première approche systématique a permis de déterminer les 4 CVMi parmi les 15 qui ensemble maximisent les niveaux d’activation pour les 12 muscles simultanément. Ces 4 contractions ont donné des niveaux d’activation supérieurs aux recommandations antérieures pour 4 muscles de l’épaule. Une seconde approche a permis de déterminer le nombre minimal de CVMi qui sont nécessaires afin de produire un niveau d’activation qui n’est pas significativement différent des valeurs d’activation maximales pour les 16 sujets. Pour 12 muscles de l’épaule, un total de 9 CVMi sont requises afin de produire des valeurs d’activation qui sont représentatives de l’effort maximal de tous les sujets. Ce mémoire a proposé deux approches originales, dont la première a maximisé les niveaux d’activation qui peuvent être produits à partir d’un nombre fixe de CVMi tandis que la deuxième a permis d’identifier le nombre minimal de CVMi nécessaire afin de produire des niveaux d’activation qui ne sont pas significativement différentes des valeurs d’activation maximales. Ces deux approches ont permis d’émettre des recommandations concernant les CVMi nécessaires à la normalisation de l’EMG afin de réduire les risques de sous-estimer l’effort maximal d’un ensemble d’individus.

Modulation of event-related desynchronization during kinematic and kinetic hand movements

Background Event-related desynchronization/synchronization (ERD/ERS) is a relative power decrease/increase of electroencephalogram (EEG) in a specific frequency band during physical motor execution and mental motor imagery, thus it is widely used for the brain-computer interface (BCI) purpose. However what the ERD really reflects and its frequency band specific role have not been agreed and are under investigation. Understanding the underlying mechanism which causes a significant ERD would be crucial to improve the reliability of the ERD-based BCI. We systematically investigated the relationship between conditions of actual repetitive hand movements and resulting ERD. Methods Eleven healthy young participants were asked to close/open their right hand repetitively at three different speeds (Hold, 1/3 Hz, and 1 Hz) and four distinct motor loads (0, 2, 10, and 15 kgf). In each condition, participants repeated 20 experimental trials, each of which consisted of rest (8–10 s), preparation (1 s) and task (6 s) periods. Under the Hold condition, participants were instructed to keep clenching their hand (i.e., isometric contraction) during the task period. Throughout the experiment, EEG signals were recorded from left and right motor areas for offline data analysis. We obtained time courses of EEG power spectrum to discuss the modulation of mu and beta-ERD/ERS due to the task conditions. Results We confirmed salient mu-ERD (8–13 Hz) and slightly weak beta-ERD (14–30 Hz) on both hemispheres during repetitive hand grasping movements. According to a 3 × 4 ANOVA (speed × motor load), both mu and beta-ERD during the task period were significantly weakened under the Hold condition, whereas no significant difference in the kinetics levels and interaction effect was observed. Conclusions This study investigates the effect of changes in kinematics and kinetics on resulting ERD during repetitive hand grasping movements. The experimental results suggest that the strength of ERD may reflect the time differentiation of hand postures in motor planning process or the variation of proprioception resulting from hand movements, rather than the motor command generated in the down stream, which recruits a group of motor neurons.

Melatonin inhibits LPS-induced NO production in rat endothelial cells

Endothelial cells produce NO by activation of constitutive nitric oxide synthase (NOS) and transcription of inducible NOS (iNOS). We have previously shown that melatonin, in the nanomolar range, inhibits activation of constitutive NOS, and in the present paper, we evaluated whether it could interfere with the expression of iNOS, which is activated by lipopolysaccharide (LPS), a major component of gram-negative bacteria cell walls. Primary cultures of rat endothelial cells were loaded with fluorescent probe for NO detection. Nuclear factor kappa B (NF-kappa B) translocation in endothelial cells elicited by LPS was measured by electromobility shift assay, and the vasodilation of aortic rings was accessed by recording isometric contraction. Melatonin in a micromolar but not in a nanomolar range inhibits the NO production induced by LPS. This effect is not dependent on the activation of G protein-coupled melatonin receptors. The nuclear NF-kappa B translocation is a process necessary for iNOS transcription, and melatonin also inhibits its translocation. LPS induced vasodilation only in endothelium-intact aortic rings, and melatonin (10 mu m) inhibits the vasodilation. Here, we show that concentrations compatible with nocturnal melatonin surge (nm) did not interfere with the activity of iNOS. Considering that micromolar melatonin concentrations could be locally achieved through production by activated immune competent cells, extra-pineal melatonin could have a protective effect against tissue injury. We propose that melatonin blocked the LPS-induced vasodilation by inhibiting the NF-kappa B pathway. Finally, we propose that the effect of melatonin on vascular reactivity is one of the mechanisms that underlies the protective effect of this indolamine against LPS.

Differences in muscle activity during hand dexterity tasks between women with arthritis and a healthy reference group

Background. Impaired hand function is common in patients with arthritis and it affects performance of daily activities; thus, hand exercises are recommended. There is little information on the extent to which the disease affects activation of the flexor and extensor muscles during these hand-dexterity tasks. The purpose of this study was to compare muscle activation during such tasks in subjects with arthritis and in a healthy reference group. Methods. Muscle activation was measured in m. extensor digitorium communis (EDC) and in m. flexor carpi radialis (FCR) with surface electromyography (EMG) in women with rheumatoid arthritis (RA, n = 20), hand osteoarthritis (HOA, n = 16) and in a healthy reference group (n = 20) during the performance of four daily activity tasks and four hand exercises. Maximal voluntary isometric contraction (MVIC) was measured to enable intermuscular comparisons, and muscle activation is presented as %MVIC. Results. The arthritis group used a higher %MVIC than the reference group in both FCR and EDC when cutting with a pair of scissors, pulling up a zipper and—for the EDC—also when writing with a pen and using a key (p < 0.02). The exercise “rolling dough with flat hands” required the lowest %MVIC and may be less effective in improving muscle strength. Conclusions. Women with arthritis tend to use higher levels of muscle activation in daily tasks than healthy women, and wrist extensors and flexors appear to be equally affected. It is important that hand training programs reflect real-life situations and focus also on extensor strength.