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post-exertionele "malaise"

ook nŠ neuromusculaire (in)spanning








Volgens een recente studie van Peter Rowe en anderen resulteert neuromusculaire spanning (een

15 minuten durende passieve "straight leg-test") in een langdurige toename van symptomen in CVS.


Tijdens de test nemen alle symptomen veel sterker toe dan bij gezonde proefpersonen en

na 24 uur is die toename van symptomen (o.a. pijn en "duizeligheid") nog steeds beduidend groter.


Als we patiŽnten onderling vergelijken, dan nemen met name "vermoeidheid", pijn en concentratie-problemen veel sterker toe tijdens de neuromusculaire inspanningstest

(in vergelijking met CVS-patiŽnten die niet aan de neuromusculaire inspanningstest deelnamen).


Na 24 uur zijn met name duizeligheid/"lichthoofdigheid" en de symptoom-totaalscore veel hoger.


De auteurs stellen dat het er op lijkt dat, naast een fysieke of een intellectuele inspanning of orthostatische stress, een eenmalige, relatief kortdurende neuromusculaire inspanning,

die kwa intensiteit overeenkomt in de buurt komt van de inspanning van een tijdje autorijden,

in staat is een langdurige toename van symptomen (post-exertionele "malaise") te veroorzaken.





Neuromuscular strain increases symptom intensity in chronic fatigue syndrome.

PLoS One. 2016 Jul 18;11(7):e0159386. doi: 10.1371/journal.pone.0159386. eCollection 2016.

Rowe PC, Fontaine KR, Lauver M, Jasion SE, Marden CL, Moni M, Thompson CB, Violand RL.





Chronic fatigue syndrome (CFS) is a complex, multisystem disorder

that can be disabling.


CFS symptoms can be provoked by

increased physical or cognitive activity, and by orthostatic stress.


In preliminary work, we noted that CFS symptoms also could be provoked by

application of longitudinal neural and soft tissue strain to the limbs and spine of affected individuals.


In this study we measured

the responses to a straight leg raise neuromuscular strain maneuver

in individuals with CFS and healthy controls.


We randomly assigned 60 individuals with CFS and 20 healthy controls to either

a 15 minute period of passive supine straight leg raise (true neuromuscular strain)

or a sham straight leg raise.


The primary outcome measure was the symptom intensity difference

between the scores during and 24 hours after the maneuver compared to baseline.



Fatigue, body pain, lightheadedness, concentration difficulties, and headache scores

were measured individually on a 0-10 scale, and

summed to create a composite symptom score.


Compared to individuals with CFS in the sham strain group,

those with CFS in the true strain group

reported significantly increased body pain (P = 0.04) and concentration difficulties (P = 0.02)

as well as increased composite symptom scores (all P = 0.03) during the maneuver.


After 24 hours, the symptom intensity differences were

significantly greater for the CFS true strain group

for the individual symptom of lightheadedness (P = 0.001) and

for the composite symptom score (P = 0.005).


During and 24 hours after the exposure to the true strain maneuver,

those with CFS had significantly higher individual and composite symptom intensity changes

compared to the healthy controls.


We conclude that

a longitudinal strain applied to the nerves and soft tissues of the lower limb

is capable of increasing symptom intensity in individuals with CFS for up to 24 hours.


These findings support our preliminary observations

that increased mechanical sensitivity may be a contributor to

the provocation of symptoms in this disorder.



PMID: 27428358