Physiological responses to low-force work and psychosocial stress in women with chronic trapezius myalgia

<p>Abstract</p> <p>Background</p> <p>Repetitive and stressful work tasks have been linked to the development of pain in the trapezius muscle, although the underlying mechanisms still remain unclear. In earlier studies, it has been hypothesized that chronic muscle pain conditions are associated with imbalance in the autonomic nervous system, predominantly expressed as an increased sympathetic activity. This study investigates whether women with chronic trapezius myalgia show higher muscle activity and increased sympathetic tone at baseline and during repetitive low-force work and psychosocial stress, compared with pain-free controls.</p> <p>Methods</p> <p>Eighteen women with chronic trapezius myalgia (MYA) and 30 healthy female controls (CON) were studied during baseline rest, 100 min of repetitive low-force work, 20 min of psychosocial stress (Trier Social Stress Test, TSST), and 80 min recovery. The subjects rated their pain intensity, stress and energy level every 20 min throughout the experiment. Muscle activity was measured by surface electromyography in the trapezius muscle (EMGtrap) and deltoid muscle (EMGdelt). Autonomic reactivity was measured through heart rate (HR), skin conductance (SCL), blood pressure (MAP) and respiration rate (Resp).</p> <p>Results</p> <p>At baseline, EMGtrap, stress ratings, and HR were higher in MYA than in CON. Energy ratings, EMGdelt, SCL, MAP and Resp were, however, similar in the two groups. Significant main group effects were found for pain intensity, stress ratings and EMGtrap. Deltoid muscle activity and autonomic responses were almost identical in MYA and CON during work, stress and recovery. In MYA only, pain intensity and stress ratings increased towards the end of the repetitive work.</p> <p>Conclusion</p> <p>We found increased muscle activity during uninstructed rest in the painful muscle of a group of women with trapezius myalgia. The present study could not confirm the hypothesis that chronic trapezius myalgia is associated with increased sympathetic activity. The suggestion of autonomic imbalance in patients with chronic local or regional musculoskeletal pain needs to be further investigated.</p

Regional Trajectories of Entrepreneurship and Growth

The development of regions is considerably shaped by their history. We review research that finds significant persistence of regional levels of entrepreneurship over longer periods of time. It is argued that the long term persistence of regional entrepreneurship indicates the presence and effect of a culture of entrepreneurship that is conducive to new business formation and regional growth. Hence, regional development is characterized by long term trajectories of entrepreneurship. We derive a number of policy implications and propose avenues for further research.</p

A Reform Strategy for Germany

In this chapter, we outline a reform strategy to promote a more entrepreneurial society in Germany. Germany has developed a successful model of capitalism in which high productivity growth is driven by on-the-job learning and firm-specific skill accumulation. The economy is rooted in a strong and regionally embedded Mittelstand, which supports an export-oriented industry mainly based on incremental innovations, but which is less conducive to more radical innovation. We, therefore, suggest a reform agenda for Germany that encourages more entrepreneurial experimentation with the aim of facilitating radical innovation, both in incumbent and new firms. Germany’s entrepreneurial talent should be encouraged to take on more risk, the education system could promote initiative, creativity and a willingness to experiment, and a more equal playing field between dependent employment and self-employment/employer could be created