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Fatigue in the forearm resulting from low-level

repetitive ulnar deviation.
ARTICLE in AIHA JOURNAL NOVEMBER 2003
DOI: 10.1202/515.1 Source: PubMed

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AIHA Journal

64:799805 (2003)

AUTHORS
Jack Tigh Dennerleina
Vincent M. Ciriellob
Kirsty J. Kerina,c
Peter W. Johnsond
Department of Environmental
Health, Harvard University,
School of Public Health, 665
Huntington Ave., Boston, MA
02115;
b
Liberty Mutual Research
Institute for Safety, 71 Frankland
Road, Hopkinton, MA 01748;
c
Circadian Technologies Inc., 24
Hartwell Ave., Lexington, MA
02421;
d
Department of Environmental
Health, University of
Washington, School of Public
Health and Community
Medicine, Seattle, WA 98195
a

Ms. #515

Fatigue in the Forearm Resulting

From Low-Level Repetitive
Ulnar Deviation

This project was funded

in part by The Kresge
Center for Environmental
Health (ES00002) at the
Harvard School of Public
Health; the Liberty
Mutual Harvard Program
in Occupational Health
and Safety; and the
Liberty Mutual Research
Institute for Safety.

ince the middle of the 1980s, chronic

musculoskeletal disorders of the upper
extremity associated with repetitive work
have increased in both prevalence and incidence.(1) These disorders are especially evident
in the food packing industry, where workers repeatedly use ulnar deviation movements during
meat, poultry, or seafood cutting tasks.(2,3) Although the injury mechanisms of chronic musculoskeletal disorders are not well understood,
studies have identified several physical risk factors
including repetition rate,(4) force,(5) posture,(6) vibration,(7) and the patterns of the work. The
question that remains, however, is what levels of
force and repetition are acceptable.
The methods of Snook et al.(810) and Ciriello
et al.(1113) used psychophysical methods to determine acceptable workloads for tasks involving
repetitive motions of the wrist at various repetition rates over an 8-hour day. Subjects worked
for extended periods of time7 hours per day,

Copyright 2003, American Industrial Hygiene Association

5 days per week, up to a total of 23 days in some

cases. They performed repetitive movements
against a load. Each subject defined an individual
maximum acceptable force operationally, as the
maximum force he or she could tolerate without
developing unusual self-reported upper extremity discomfort, such as soreness, stiffness, or
numbness. From these experiments, Snook et
al.(810) and Ciriello et al.(1113) developed acceptable limits on repetitive work; however, these
studies lack the support of physiological data.
Muscle fatigue when measured before, during, and after exercise is a measure of physiological change of a muscle and may provide a biomarker for cumulative exposure to repetitive
work. The primary risk factors for work-related
musculoskeletal disordersforce, duration of
force, repetition, and patterns of workare also
causes of fatigue. Muscle fatigue and muscle pain
syndromes are common in the workplace and
may precede more serious disorders.(1416) For

AIHA Journal (64)

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799

APPLIED STUDIES

This study measured low-frequency fatigue (LFF) in the extensor carpi ulnaris (ECU) muscle
while workers completed a repetitive ulnar deviation task. Using a repeated measures design,
10 healthy women participated in three conditions, each lasting 2 consecutive days: a control
condition in which subjects remained inactive, and two repetitive work conditions involving
repeated ulnar deviation of the wrist at 20 and 25 repetitions per minute at individual
workloads deemed acceptable for 8 hours through a psychophysical protocol. LFF of the ECU
muscle and self-reported levels of fatigue were recorded eight times throughout the control and
workdays before (time 0), during (2, 4.25, 6.75, 8 hours), and after (9, 10, and 11 hours)
exposure. The ratio of the isometric force produced by electrical stimulus at 20 pulses per
second (pps) to the isometric force produced by 50 pps provided the measure of LFF. The
ratios were lower on workdays compared with the control days, indicating the presence of LFF
during repetitive work. During repetitive work the ratios decreased during the day, indicating the
muscles fatigued as the day progressed. The psychophysically determined workloads, although
not creating noticeable discomfort to the subjects, were high enough to create low levels of
muscle fatigue.
Keywords: extensor carpi ulnaris, low-frequency fatigue, muscle, musculoskeletal
disorders, repetitive work

TABLE I. Subject Daily Work and Experimental Procedures

Monday
Week
Week
Week
Week
Week

1
2
3
4
5

Tuesday
setup
training
PP @ 15 RPM
PP @ 25 RPM
FMP @ 25 RPM

training
PP @ 25 RPM
FMP @ 25 RPM

Wednesday
control
PP @ 15 RPM

Thursday
control
training
PP @ 20 RPM
FMP @ 20 RPM

Friday
training
PP @ 20 RPM
FMP @ 20 RPM

APPLIED STUDIES

Note: PP 5 psychophysical protocol; FMP 5 fatigue measurement protocol

example, a relationship between muscle tissue damage and increased fatigability during occupational work has been shown using electromyographic zero-crossing techniques in the trapezius
muscle.(17,18) Given the low force levels, the long hours of repetitive work, and the fact that motor units are recruited and used at
low frequencies in everyday life,(19) low-frequency fatigue (LFF) is
likely to be the most common type of muscle fatigue in the modern workplace.(20)
LFF is a transient decrement in the force from a muscle in
response to low-frequency (120 Hz) stimulation. Edwards et
al.(21) electrically stimulated the abductor pollicis brevis muscle and
measured the resultant force output at the thumb. The measurement of LFF involves stimulating the muscle at both low (120
pulses per second [pps]) and high frequencies (50100 pps); the
fatigue measure is based on a ratio of the force output of the
muscle resulting from the low- and high-frequency stimulation.
The force response of the muscle to high-frequency stimulation
recovered rapidly, whereas the force response to the low-frequency
stimulation was suppressed and took a longer time to recover.
Hence, recovery from LFF generally takes hours(20,22) and can even
persist more than a day.(19,23) For these measurements the electrical
stimulation recruits the same muscle fibers within a muscle synchronously, unlike a voluntary contraction, which recruits different fibers throughout the muscle asynchronously.
To date, the development of muscle fatigue during repetitive
work has not been investigated over the course of a full workday.
The goal of this study was to repeat the ulnar deviation tasks of
Snook et al.(9) for a set of female participants executing a repetitive
ulnar deviation wrist movement for 8-hour days at two repetition
rates, and concurrently measure muscle fatigue in the extensor
carpi ulnaris muscle. Because the workloads are set by the participants to be acceptablethat is, not creating any unnecessary discomfort, soreness, or painthe null hypothesis was that no muscle
fatigue would occur during the workday and across 2 consecutive
workdays.

METHODS
en female participants between the ages of 19 and 52 (mean
35 years, SD 15 years) were recruited from the general public
using newspaper advertisements. Screening ensured that subjects
were not routinely overly exposed to repetitive motion in their
daily activities, and each participant was examined by a nurse practitioner for symptoms associated with musculoskeletal disorders of
the upper extremity. Each participant read and signed an experimental informed consent form. Both the Harvard School of Public
Health Human Subjects Committee and the Liberty Mutual Research Institute for Safety Internal Review Committee approved
experimental protocols and the participant consent and recruitment forms. These subjects were a subset of a larger group undergoing repetitive ulnar deviation tasks reported elsewhere.(11,24)

800

AIHA Journal (64)

November/December 2003

Subjects entered a 17-day protocol dispersed over 4 weeks (Table I). The first day was devoted to subject orientation and maximal strength measurements. On the second and third days control
(no-exposure) baseline muscle fatigue measurements were recorded throughout the day. Subjects then entered a 1-week training
protocol and then a 1.5-week psychophysical protocol to determine their self-selected acceptable workloads (see Snook et al.(9)
and Ciriello et al.(11) for details) for ulnar deviation at 15, 20, and
25 repetitions per minute (RPM). After a day of rest, fatigue measurements were recorded during 8 hours of repetitive work at 20
RPM for 2 consecutive days and then again, after a weekend
break, as subjects performed 8 hours of repetitive work at 25 RPM
for 2 consecutive days. Randomization of conditions was not possible due to the psychophysical protocol of gradually increasing
the subjects up to the higher repetition rates.
The participants completed the repetitive ulnar deviation tasks
at a set of workstations consisting of an adjustable chair and footrest with a visual display monitor mounted at eye level (see Snook
et al.(9) for details). The workstation contained a magnetic particle
brake with a force and angle transducer attached to the shaft. The
shape of the handle, attached to the shaft, was rectangular and
similar to knife handles used in meat-packing activities (152 mm
long, 29 mm wide, 22 mm deep with curved edges for comfort).
Subjects sat at the workstation, placed their right forearm horizontally on the armrest, and grasped the handle with a power grip.
The handle length was adjusted so that the point of rotation of
the equipment was in line with the axis of the wrist joint. The
chair and footrest were adjusted such that the angle between the
upper arm and the forearm was approximately 1208 and the legs
were firmly supported by footrests. At the sound of an audible
tone, subjects moved the handle through 808 of rotation using a
combination of forearm movement and ulnar deviation of the
wrist. As mentioned previously, handle resistance was determined
during the psychophysical test days. To simulate a full workday,
subjects worked for seven 55-minute segments. There were 5-min
breaks after segments 1, 3, and 5; 15-min work breaks after segments 2 and 6; and a 30-min lunch break after segment 4. Work
ceased after segment 7, and subjects entered a 3-hour recovery
period.
Fatigue measurements of the extensor carpi ulnaris (ECU)
muscle, a primary muscle associated with ulnar deviation,(25) were
obtained at the beginning of the day (0 hour) and then throughout the day at 2, 4:15, 6:45, 8, 9, 10, and 11 hours thereafter.
During workdays work would cease at hour 8, and the additional
measures monitored recovery (hours 9, 10, and 11).
Electrically stimulating the ECU muscle and measuring the resulting isometric force output at the wrist provided the measure
of muscle fatigue. Each measurement was obtained by having the
subjects sit with their right forearms in wrist force measurement
apparatuses especially designed to measure isometric force of the
wrist in the direction of ulnar deviation (Figure 1). The apparatus

FIGURE 1. The wrist-restraining jig to measure the isometric

force of the ECU muscle from the electrical stimulation. The
apparatus kept the wrist steady and measured the resulting
isometric force produced at the distal end of the fifth
metacarpalphalangeal joint.

RESULTS
able II lists the workload torque values selected by the 10 subjects as being acceptable for completing 8 hours of repetitive
work at the two repetition rates. The torque levels were within
the ranges reported in previous psychophysical protocols (see Ciriello et al.(11) for a summary) and were a subset of a larger group
of participants presented in Bennie et al.(24) No subject reported
signs of upper extremity symptoms and subjective discomfort
above 1 (a little sore) at any point during the experiment. The
incidence of level 1 symptom reporting was less than 1% of the
recorded levels.
The ratio of the force produced by the 20 pps to the force
produced by the 50 pps decreased with exposure to repetitive
work, hence, the muscles exhibited LFF. The ratios on the workdays were on average significantly lower (p,.01) than the ratios
on the control days, on average by 3 and 4% for the 20 RPM and
25 RPM days, respectively (Figure 2). The difference between the
20 RPM and 25 RPM days was small, roughly 1% smaller on the
25 RPM exposure. Significance was not observed between the
consecutive days within each condition (p5.4).

AIHA Journal (64)

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801

APPLIED STUDIES

secured the forearm just proximal to the wrist allowing for articulation of the wrist joint only. The forearm was in a neutral pronation-supination posture with the thumb pointing upward. The
hand was placed on a platform which had a 25 lb (112 N) load
cell (Omega Engineering LCCA-25, Stamford, Conn.) mounted
underneath. The hand was positioned so the metacarpalphalangeal
joint of the fifth digit was directly above the load cell. The study
participants sat upright with feet on the floor, knees at 908, shoulders parallel to the floor, and the arm relaxed forming a 908 angle
at the elbow with the forearm parallel to the floor.
The ECU muscle was stimulated through two surface electrodes 1 cm in diameter placed along the belly of the muscle with
the anode distally with respect to the cathode.(26) To ensure consistent electrode placement across days, henna tattoos, which remain for at least 1 to 2 weeks, marked the position of the electrodes on the skin. Photographs and sketches of the forearm also
documented the electrode placement. The electrodes were connected to a Grass Electronics S48 muscle and nerve stimulator
(West Warwick, R.I.) through a stimulus isolation unit (Grass
SIU5) and a constant current unit (Grass CCU1). The S48 stimulator controlled the frequency and the duration of the stimulus
(100 ms). The constant current unit controlled the stimulus to
ensure a constant current was always applied to the muscle. The
electrode placement and stimulation intensity were determined on
the orientation day (day 1). Electrode placement was determined
by repeatedly positioning the cathode electrode over the ECU
muscle until the muscle response, based on visual observation,
appeared to be maximal with minimal recruitment of other muscles. Once this site was determined, the stimulus intensity was
increased to the subjects maximal level of acceptable tolerance.
Three subjects from the larger study(11) (N513) had low tolerance
levels to the stimulation such that a reliable muscle response could
not be obtained. Hence, they were not included in this portion
of the study. The current settings remained constant throughout
the experiment.
The fatigue measurements consisted of recording the force produced by electrically stimulating the ECU muscle for 2 sec at 50
pulses per second (pps) and then after a 2-sec rest another 2-sec
stimulus at 20 pps. This was repeated after 2 sec of rest providing

two sets of contractions. The force signal was recorded through

an analogue-to-digital converter (PCMIO16E-4, National Instruments, Austin, Texas) and stored on a personal computer at 1000
samples per second. The 20 to 50 pps ratios were calculated for
the two sets of contractions and averaged to produce the single
measure for each time period. The ratio of the force produced by
20 pps to the force produced by the 50 pps indicated the amount
of muscle fatigue.(20)
Signs of upper extremity symptoms and subject discomfort
were also monitored throughout the workday through a self-administered symptom-survey form.(8,9,12) Subjects completed the
form each hour, recording any soreness, stiffness, or numbness
(rated 0 to 3: 05no soreness, 15a little sore, 25moderately or
somewhat sore, 35very sore) that they experienced in their hands,
wrists, or forearms. The protocol called for the experimenter to
intervene when a subject reported a level 2 symptom at the beginning of the day (prework), a level 3 at any time, or three consecutive level 2 scores. Intervention consisted of a private review
of the instructions with the subject and an examination of the
forearm for any signs of pain, inflammation, or discomfort. In
addition, the subjects perceptions of fatigue were measured with
a modified Borg Scale. The Borg Scale was presented visually on
a 10-cm line with Borgs verbal anchors spaced proportionally
with respect to their numerical score. Subjects were asked to mark
the position on the line that corresponded to their perceived levels
of fatigue. Subjects were asked to rate their perceptions of fatigue
localized to the forearm and their general overall levels of perceived fatigue.
Due to technical problems and late arrival of one subject on 1
day, there were some missing repeated measures; therefore, the
PROC MIXED regression analysis procedure in SAS (SAS V 8.2
SAS Computing Software, Cary, N.C.) was used to determine
whether there were any significant differences and trends within
the data over the experimental days and between conditions. The
independent variables were Condition: control (no exposure), 20
RPM (exposure), or 25 RPM (exposure); Day within condition:
day 1 or 2; and Hour of Measurement: 0, 2, 4.25, 6.75, 8, 9, 10,
11. The dependent variables were the ratio of the force produced
by 20 pps stimulation to the force produced by the 50 pps
stimulation.

TABLE II. Subject Parameters Including Strength and the Individually Selected Workload Torques
Subject No.

Age
(Years)

MVC
(N-m)

Torque @ 20 RPM
(N-m)

Torque @ 25 RPM
(N-m)

20 RPM
Torque Product
(N-m/min)

25 RPM
Torque Product
(N-m/min)

0
4
5
6
7
8
9
10
12
13
Mean (SD)

52
48
46
21
21
19
24
51
49
23
35 (15)

6.8
8.5
6.9
7.0
9.5
9.9
7.1
4.1
3.9
8.6
7.23 (2.03)

1.77
1.31
1.97
0.37
0.21
1.52
2.94
0.76
0.94
2.28
1.41 (0.86)

1.38
0.94
1.53
0.19
0.22
1.38
2.85
0.8
0.58
1.39
1.13 (0.78)

35.4
26.2
39.4
7.4
4.2
30.4
58.8
15.2
18.8
45.6
28 (5.8)

34.5
23.5
38.3
4.8
5.5
34.5
71.3
20.0
14.5
34.8
28 (6.5)

APPLIED STUDIES

Note: MVC 5 maximum voluntary contraction torque applied to the handle; RPM 5 repetitions per minute.

The ratios decreased during the workdays but not on the control days (Figure 3). For the control condition the ratios remained
relatively constant with respect to the time of day, with hour not
being a significant factor (p..5). For the work conditions, however, the ratios significantly decreased throughout the day with
respect to hours of exposure (p,.005).
LFF did not appear to last into the next day of testing during
the exposure conditions. Although the ratios did tend to be about
1% smaller on the second day of testing, this decline was not significant (p5.4, Figure 2). The ratio at the beginning of day 2 of
the 20 RPM condition appeared to be lower, as shown in Figure
3, the measures of the LFF ratio at the beginning of the day (H0)
were not significantly different across conditions (p5.82) or across
days (p5.4) of testing.
The ratings of perceived fatigue in the forearm were unaffected
by condition (p5.15, Figure 4). However, the perceived fatigue
did increase as the day progressed (p,.001) even on the control

FIGURE 2. The fatigue values of the ratios over the three

conditions and the 2 days of testing. The ratios are lower on the
workdays, indicating a low level of LFF present in the muscles
resulting from the repetitive workloads.

802

AIHA Journal (64)

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days. These levels of perceived fatigue were quite small, with terminal ratings at hour 8 ranging between very slight to slight. Responses to the general overall fatigue question were similar in that
there were no differences observed over the day, and the values
did increase as the day progressed.

DISCUSSION
hen the workload of a repetitive task of the wrist was determined using a psychophysical protocol, LFF was observed in
these 10 women. These physiological data support the hypothesis
that a full workday of repetitive work creates a physiological
change, rejecting the stated null hypothesis. These data indicate
that the range of psychophysical protocol levels reported by
Snook(810) and Ciriello(1113) were high enough to create fatigue
during the day, but low enough that subjects were almost fully
recovered by the next day. The decreases in the ratio of the forces
produced by the 20 and 50 pps stimulations indicate that the muscles of the forearm fatigued during the 20 and 25 RPM conditions, even when subjects worked at their self-selected workloads.
As indicated by the pain symptom responses, these workloads

FIGURE 3. The ratio of the force produced by the 20 and the

50 pps stimulus before (H0) and after exposure (H8) and after a
3-hour recovery (H11). The ratios decrease during the exposure;
however, they remain relatively constant on the control days.

FIGURE 4. The perceived levels of forearm fatigue measured

through the day and the corresponding verbal anchors. The
levels of self-reported fatigue were very small (maximum of 1.6
on a 10-point scale) and increased only significantly with the
time of day. The self-reported fatigue levels did not correspond
with the measurement of LFF.

whose work load exceeded 10% of their maximum voluntary contraction (MVC) values, the LFF ratio was lower compared with
that of subjects whose work load was less than 10% MVC. The
fatigue measured at the end of the exposure showed a slight relationship (p5.02) with absolute workload (work expressed in Nm) and a stronger (p5.001) relationship with relative workload
(work expressed as a %MVC), suggesting that fatigue may be more
a measure of relative exposure rather than absolute exposure.
However, within the group with workloads above 10% the increasing fatigue with workload was not observed (p5.5). Measurement
of objective physiological changes in muscle behavior can provide
information on how to better design the work environment and/
or the tools used to evaluate tasks that are repetitious and/or
monotonous in nature. However, the question remains whether
the fatigue that accumulates over time creates a situation for cumulative damage to the soft tissues of the musculoskeletal system.
The results indicated that fatigue occurred when subjects were
exposed to the repetitive work; however, there were no observed
differences in the level of fatigue at the two different exposures.
One explanation is that there may not have been the statistical
power to detect these differences. The other is that the exposure
between the two conditions, 20 RPM and 25 RPM were not that
different. Others have suggested, especially for isometric types of
tasks, a force-time integral as the exposure factor for fatigue.(23)
The force-time integral can be estimated from the product of the
torque and the repetition rate, assuming that the time to turn the
handle remained constant between conditions. Indeed, when both
the self-selected force levels and the repetition rate were accounted
for, there was little difference between the protocols (Table II).
During the psychophysical protocol used here, the subjects selected a nearly constant force-time workload over the two repetition rates. Therefore, it is not possible to determine the individual roles of force or repetition in the onset and development of
low frequency fatigue.
AIHA Journal (64)

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803

APPLIED STUDIES

caused negligible soreness, pain, or discomfort in the forearm.

Hence, the physiology of the muscle was changing as the repetitive
task was completed during the day without causing any pain to
the worker.
For these submaximal workloads there was no significant evidence that the fatigue remained into the next workday. However,
for both the 20 and 25 RPM conditions the ratio at the beginning
of the second day was lower (Figure 3). Low frequency muscle
fatigue has also been referred to as fatigue of long duration, because it has been observed to last for more than 24 hours and
even after submaximal exertions.(23) Therefore, these self-selected
workloads at the specific repetition rates were low enough so that
the muscles recovered for the most part from the LFF resulting
from the previous days work. However, this exposure was over
only 2 days, and it is possible that for exposure lasting longer than
2 days fatigue may start to carry over to the following days. Further investigations examining fatigue over multiple days are
merited.
The workloads determined in this protocol were within the
range of previous studies presented by Ciriello et al.,(11) and the
additional fatigue measure provided further physiological data for
these psychophysical methods. The study participants judged and
selected a workload that resulted in LFF, but for the most part
the fatigue and resultant cumulative physiological change in muscle did not carry over into the next day. As a result, these levels
of workloads selected by the subjects may help reduce the workers
chances of developing long-term muscle fatigue and possibly
chronic injury. Fatigue is thought to be a protective response of
the muscle to work and to be acceptable when the recovery times
are short and allow enough time for damaged tissue to repair itself.(2729)
Electrical muscle stimulation as used in these experiments can
be a tool to explore the relationship between exposure in terms
of force, repetitions, work, or force-time integral, and muscle/
tissue response. As demonstrated in Figure 5, for the subjects

FIGURE 5. The ratios measured at the end (H8) of the 20 and

25 RPM exposures relative to the workload normalized to the
subjects strength (n540). The wide range of workloads added
to the variation in the fatigue levels. In general, the fatigue
increased as the workload increased across subjects (p5.001).
However, fatigue levels clustered into two groups: those subjects
with a workload below 10% and those with a workload above
10% when the increasing fatigue with workload was not
observed (p5.5).

APPLIED STUDIES

A large source of variation within the results of this study was

the exposure of the participants to different workloads in terms of
both absolute crank torques and a torque normalized to the participants strength. The relative torques range from 2 to 41%
MVC, with an average of 19% for the 20 RPM and 15% for the
25 RPM tasks. This lack of experimental control could have reduced the power of procedures testing for differences between the
exposures and the accumulation of fatigue to the next day. Nonetheless, significant fatigue was observed in the exposure conditions
even though the workloads were self-selected.
The limitations of this laboratory-based study include generalizing these conclusions to the actual work settings, nonrandomization of conditions, limitation associated with electrical stimulation of the muscle, and the small levels of fatigue observed. A
real job may have a natural variability in terms of force and workload. Exposure assessment of repetitive work in the actual workplace is needed for designing real work-like laboratory experiments. Characterizing the workplace exposures and measuring the
resultant fatigue in the lab would help extend the results of these
types of studies to the real work force. In this study, force was the
variable the participants were able to self-select; often it is not the
force, but the frequency that workers can select when controlling
workload. Furthermore, the order of the conditions was not randomized, allowing the effects of training and strengthening to
potentially introduce a systematic bias into the results. However,
although this bias would be toward the null, fatigue was still observed. The exclusively female study population also limits the
ability, to a certain degree, to generalize conclusions.
During the administration of the electrical stimulation, the
stimulus intensity was limited by the subjects ability to tolerate
the discomfort associated with the electrical stimulation. The researchers were not able to adequately recruit the muscle in 3 of
the 13 subjects who participated in the full protocol. Higher stimulus intensities typically result in a greater force output from the
muscle. If the force response of the muscle increases while sources
of measurement error remain constant (i.e., measurement errors
associated with passive contributions from muscle and tendons),
then the overall experimental variability could be reduced. Also,
only one muscle was examined that creates ulnar deviation at the
wrist; therefore, conclusions drawn are limited to this muscle.
Other muscles may be acting in synergy, sharing the load and
reducing the effect on the ECU muscle.
Muscle fiber recruitment of and induced fatigue by electrical
stimulation may be of concern. In this context the goal of the
electrical stimulation was to repeatedly recruit the same portion
of a muscle within the day to measure changes within and over
that cross-section of the muscle. The changes measured are then
representative of the condition of the fibers contained in that cross
section and may be representative of the other fibers comprising
the rest of the muscle. Another concern is that electrical stimulation may cause fatigue. The electrical stimulation protocol in this
study was very brief, four 2-sec trains. The exposure resulting from
the repetitive work was much greater than from the brief bouts of
electrical stimulation administered to the muscle. In addition,
there was not a consistent decrease in the ratios over the day for
the control conditions, indicating any systematic fatigue affects
resulting from the electrical stimulation.
In conclusion, even though the study participants did not report any substantial levels of perceived forearm fatigue, low frequency muscle fatigue was observed in the extensor carpi ulnaris
muscle after exposure to a repetitive wrist task designed to simulate 2 full workdays. The torque levels of the repetitive task, which
were determined as acceptable through a psychophysical protocol,
804

AIHA Journal (64)

November/December 2003

did create a temporary state of fatigue, indicating that psychophysical acceptable levels may not prevent the onset and development of LFF.

ACKNOWLEDGMENTS
he authors wish to thank the following individuals for their
assistance from data collection to statistical analysis: Mary
Dionne, Joanne Gouin, Peter Teare, Eric Jones, and Rick Holihan
of Liberty Mutual Research Institute for Safety; Steve Lehman and
Tom Hruska of the University of California, Berkeley; and Louise
Ryan at the Harvard School of Public Health.

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