Original article| Volume 93, ISSUE 11, P2042-2048, November 2012

Current Pain and Fear of Pain Contribute to Reduced Maximum Voluntary Contraction of Neck Muscles in Patients With Chronic Neck Pain

  • René Lindstroem
    Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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  • Thomas Graven-Nielsen
    Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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  • Deborah Falla
    Reprint requests to Deborah Falla, PhD, Dept of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology (BFNT) Göttingen, Bernstein Center for Computational Neuroscience University Medical Center Göttingen, Georg-August University, Von-Siebold-Str. 4,37075, Göttingen, Germany
    Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany

    Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology Göttingen, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
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Published:April 30, 2012DOI:


      Lindstroem R, Graven-Nielsen T, Falla D. Current pain and fear of pain contribute to reduced maximum voluntary contraction of neck muscles in patients with chronic neck pain.


      To assess a range of physical and psychological factors and determine which factors contribute the most to reduced strength in patients with neck pain.






      Women with chronic neck pain (n=34) and healthy controls (n=14).


      Not applicable.

      Main Outcome Measures

      Neck flexion, extension, and lateral flexion maximum voluntary contractions (MVC) were measured in patients and healthy controls. Additional parameters were collected for the patient group including: (1) questionnaires measuring general health (Medical Outcomes Study 36-Item Short-Form Health Survey), pain intensity, disability (Neck Disability Index [NDI]; Patient Specific Functional Scale), and fear of movement (Fear-Avoidance Beliefs Questionnaire [FABQ]), (2) pressure pain thresholds, (3) cross-sectional area of selected neck muscles, and (4) surface electromyography from selected neck muscles during a multidirectional isometric task. Univariate and multivariate regression analyses were applied with the average MVC (average of flexion, extension, and lateral flexion MVC) as the dependent variable.


      The average MVC was significantly lower in patients (mean ± SD, 130.0±6.0N) compared with controls (166.9±11.7N; P<.01). Univariate regression of the average MVC with the FABQ, NDI, or pain experienced during the MVC gave R2 values of 13.4%, 13.8%, and 21.1%, respectively. Collectively, the FABQ and pain experienced during the MVCs resulted in an R2 of 26.6% and the FABQ, contraction pain, and NDI, an R2 of 28.2%.


      The average maximum voluntary force produced in neck flexion, extension, and lateral flexion is inversely and moderately correlated with the pain experienced during maximal contraction, fear of movement, and aspects of neck disability in patients with chronic neck pain.

      Key Words

      List of Abbreviations:

      ARV (average rectified value), CSA (cross-sectional area), EMG (electromyogram), FABQ (Fear-Avoidance Beliefs Questionnaire), MVC (maximum voluntary contraction), NDI (Neck Disability Index), PPT (pain pressure threshold), PSFS (Patient-Specific Functional Scale), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), VAS (visual analog scale)
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