A comparison of peak vs cumulative physical work exposure risk factors for the reporting of low back pain in the automotive industry

Linear time delay methods and stability analyses of the human spine. Effects of neuromuscular reflex response

Linear stability methods were applied to a biomechanical model of the human musculoskeletal spine to investigate effects of reflex gain and reflex delay on stability. Equations of motion represented a dynamic 18 degrees-of-freedom rigid-body model with time-delayed reflexes. Optimal muscle activation levels were identified by minimizing metabolic power with the constraints of equilibrium and stability with zero reflex time delay. Muscle activation levels and associated muscle forces were used to find the delay margin, i.e., the maximum reflex delay for which the system was stable. Results demonstrated that stiffness due to antagonistic co-contraction necessary for stability declined with increased proportional reflex gain. Reflex delay limited the maximum acceptable proportional reflex gain, i.e., long reflex delay required smaller maximum reflex gain to avoid instability. As differential reflex gain increased, there was a small increase in acceptable reflex delay. However, differential reflex gain with values near intrinsic damping caused the delay margin to approach zero. Forward-dynamic simulations of the fully nonlinear time-delayed system verified the linear results. The linear methods accurately found the delay margin below which the nonlinear system was asymptotically stable. These methods may aid future investigations in the role of reflexes in musculoskeletal stability.

How long is long enough? Evaluating sampling durations for low back EMG assessment

Few ergonomic measurement tools explicitly state when and how to sample exposures. Traditional ergonomic sampling has used short, task-based or worst-case measurements, but these may misrepresent exposures, since they neglect the temporal variations throughout the workday. Understanding the representativeness of data from shorter measurement durations compared with full-shift measurements allows for optimization of measurements resources. This study compared a variety of low back electromyography (EMG) exposure metrics measured over a full-shift with the same metrics sampled over shorter durations to identify whether shorter durations provide representative measures of exposure. Portable EMG devices were used to measure low back EMG for 138 full work shifts in a range of jobs in heavy industry. Using a random start time, each full shift of data was resampled for 4 hr, 2 hr, 1 hr, 10 min, and 2 min. Exposure metrics from each duration were compared with the full shift using absolute and percent error, bias, and limits of agreement. Comparisons between one full shift and two full shifts were made for the subset of 35 workers with two measured workdays. Compared with full-shift data, bias is very low at all sampling durations. However, as sampling durations decreased from a full-shift to a few min, the absolute error, percentage error, and limits of agreement for exposure estimates show more deviation from full-day estimates. Estimates of mean and 90th percentile exposure averaged 8% error for 4-hr durations and 14% error for 2-hr durations. The errors for 4-and 2-hr measurement durations may be acceptable for many applications, particularly if the trade-off is measuring more subjects. Sampling durations of 1 hr or less seem likely to produce very large errors over all exposure metrics, particularly for the range and peak exposures. Depending on the purpose of measurement and the detail required, 4 hr or even 2 hr appears to be long enough to reasonably estimate full-shift exposure.

Effect of ship motion on spinal loading during manual lifting

This study investigated the effects of ship motion on peak spinal loading during lifting. All measurements were done on a ship at sea. In 1-min trials, which were repeated over a wide range of sailing conditions, subjects lifted an 18 kg box five times. Ship motion, whole body kinematics, ground reaction forces and electromyography were measured and the effect of ship motion on peak spinal moments and compression forces was investigated. To investigate whether people time their lifts in order to reduce the effect of ship motion on back loading, trials were performed at a free and at a constrained (lifting every 10s) work pace. With increase of the (local) vertical ship acceleration, increased moments and compression forces were found. Furthermore, lifting at a free work pace did not result in smaller effects of ship motion on spinal moments and compression forces than working at a constrained work pace.

Utilization of a Hybrid Neuro-Fuzzy Engine to Predict Trunk Muscle Activity for Sagittal Lifting

The ability to assess the loads on the spine in industry using biologically-assisted models has been limited by the current capability to obtain accurate muscle activities that could be entered into an EMG-assisted model. One crucial aspect of EMG-assisted models is the capability to capture the antagonistic coactivity in dynamic lifting conditions. However, limitations of electromyography equipment make it difficult to assess the muscle activity in industry. The overall project developed a complex engine using fuzzy average with fuzzy cluster distribution techniques in combination with neural network structure. The objective of the current study was compare the predicted spine loads for the actual and predicted muscle activities during sagittal lifting conditions. The model fidelity of the EMG-assisted spine load model was actually improved with the predicted EMG as compared to the actual EMG with improved r-square and average absolute error values. Furthermore, the three-dimensional spine loads were almost identical for the predicted EMG as compared to the actual EMG (within 35 N in each plane). The compression forces predicted within 1% while shear forces were within 11%. Overall, the new neuro-fuzzy engine provides an accurate estimation of the coactivity pattern during lifting that can now be applied in industrial settings where traditional muscle activity assessment methods are subjected to noise or are difficult to administer.

Fatigue influences the dynamic stability of the torso

Fatigue in the extensor muscles of the torso affects neuromuscular recruitment and control of the spine. The goal of this study was to test whether fatigue influences stability of dynamic torso movements. A controlled laboratory experiment measured the change in the maximum finite-time Lyapunov exponent, lambda(max), before and after fatigue of the extensor muscles. Non-linear analyses were used to compute stability from the embedding dimension and Lyapunov exponent recorded during repetitive dynamic trunk flexion tasks. Torso extensor muscles were fatigued to 60% of their unfatigued isometric maximum voluntary exertion force then stability was re-measured. Independent variables included fatigue, task asymmetry and lower-limb constraint. lambda(max) values increased with fatigue suggesting poorer dynamic stability when fatigued. Embedding dimension declined with fatigue indicating reduced dynamic complexity when fatigued. Fatigue-related changes in spinal stability may contribute to the risk of low-back injury during fatiguing occupational lifting tasks. The findings reported here indicate that one mechanism by which fatigue contributes to low back disorders may be spinal instability. This information may contribute to the development of ergonomic countermeasures to help prevent low back disorders.

Effect of lifting height and load mass on low back loading

The objective of this study was to quantify the effect of lifting height and mass lifted on the peak low back load in terms of net moments, compression forces and anterior-posterior shear forces. Ten participants had to lift a box using four handle heights. Low back loading was quantified using a dynamic 3-D linked segment model and a detailed electromyographic driven model of the trunk musculature. The effects of lifting height and lifting mass were quantified using a regression technique (GEE) for correlated data. Results indicate that an increase in lifting height and a decrease in lifting mass were related to a decrease in low back load. It is argued that trunk flexion is a major contributor to low back load. For ergonomic interventions it can be advised to prioritise optimisation of the vertical location of the load to be lifted rather than decreasing the mass of the load for handle heights between 32 cm and 155 cm, and for load masses between 7.5 and 15 kg. Lifting height and load mass are important determinants of low back load during manual materials handling. This paper provides the quantitative effect of lifting height and mass lifted, the results of which can be used by ergonomists at the workplace to evaluate interventions regarding lifting height and load mass.

Gluteus medius muscle activation patterns as a predictor of low back pain during standing

BACKGROUND

Low back pain is a primary source of disability and economic costs. Altered trunk muscle activation in people with low back pain, specifically agonist/antagonist co-activation, has been previously demonstrated. Prevailing theory considers this muscle activation pattern to be adaptive to low back pain. Muscle activation patterns prior to, and during, the development of low back pain in asymptomatic individuals, have not been well studied.

METHODS

Participants, without a history of low back pain, stood in a constrained area for 2 h. Continuous surface electromyography was collected from trunk and hip muscles. Participants rated their discomfort level on visual analog scale every 15 min. Cross-correlation analyses were used to determine co-activation patterns. Blind predictions were made to categorize participants into low back pain and non-low back pain groups, and comparisons made to visual analog scale scores.

FINDINGS

65% of previously asymptomatic participants developed low back pain during the protocol. Co-activation of the bilateral gluteus medius muscles was found to be prevalent in the low back pain group (P= .002). 76% of the participants were correctly classified into low back pain and non-low back pain groups based on presence or absence of gluteus medius co-activation, with sensitivity= .87 and specificity= .50.

INTERPRETATION

Agonist-antagonist co-activation may not be entirely adaptive, and may in fact predispose some individuals to develop low back pain. Muscle activation patterns at the hip may be a useful addition for screening individuals to identify those at risk of developing low back pain during standing.

Role of Trunk Muscles in Generating Follower Load in the Lumbar Spine of Neutral Standing Posture

Recently, experimental results have demonstrated that the load carrying capacity of the human spine substantially increases under the follower load condition. Thus, it is essential to prove that a follower load can be generated in vivo by activating the appropriate muscles in order to demonstrate the possibility that the stability of the spinal column could be maintained through a follower load mechanism. The aim of this study was to analyze the coordination of the trunk muscles in order to understand the role of the muscles in generating the follower load. A three-dimensional finite element model of the lumbar spine was developed from T12 to S1 and 117 pairs of trunk muscles (58 pairs of superficial muscles and 59 pairs of deep muscles) were considered. The follower load concept was mathematically represented as an optimization problem. The muscle forces required to generate the follower load were predicted by solving the optimization problem. The corresponding displacements and rotations at all nodes were estimated along with the follower forces, shear forces, and joint moments acting on those nodes. In addition, the muscle forces and the corresponding responses were investigated when the activations of the deep muscles or the superficial muscles were restricted to 75% of the maximum activation, respectively. Significantly larger numbers of deep muscles were involved in the generation of the follower load than the number of superficial muscles, regardless of the restriction on muscle activation. The shear force and the resultant joint moment are more influenced by the change in muscle activation in the superficial muscles. A larger number of deep trunk muscles were activated in order to maintain the spinal posture in the lumbar spine. In addition, the deep muscles have a larger capability to reduce the shear force and the resultant joint moment with respect to the perturbation of the external load or muscle fatigue compared to the superficial muscles.

Does musculoskeletal discomfort at work predict future musculoskeletal pain?

The objective of this prospective cohort study was to evaluate if peak or cumulative musculoskeletal discomfort may predict future low-back, neck or shoulder pain among symptom-free workers. At baseline, discomfort per body region was rated on a 10-point scale six times during a working day. Questionnaires on pain were sent out three times during follow-up. Peak discomfort was defined as a discomfort level of 2 at least once during a day; cumulative discomfort was defined as the sum of discomfort during the day. Reference workers reported a rating of zero at each measurement. Peak discomfort was a predictor of low-back pain (relative risk (RR) 1.79), neck pain (RR 2.56), right or left shoulder pain (RR 1.91 and 1.90). Cumulative discomfort predicted neck pain (RR 2.35), right or left shoulder pain (RR 2.45 and 1.64). These results suggest that both peak and cumulative discomfort could predict future musculoskeletal pain.

Inter-rater reliability of output measures for a posture matching assessment approach: a pilot study with food service workers

Despite the ongoing health problem of repetitive strain injuries, there are few tools currently available for ergonomic applications evaluating cumulative loading that have well-documented evidence of reliability and validity. The purpose of this study was to determine the inter-rater reliability of a posture matching based analysis tool (3DMatch, University of Waterloo) for predicting cumulative and peak spinal loads. A total of 30 food service workers were each videotaped for a 1-h period while performing typical work activities and a single work task was randomly selected from each for analysis by two raters. Inter-rater reliability was determined using intraclass correlation coefficients (ICC) model 2,1 and standard errors of measurement for cumulative and peak spinal and shoulder loading variables across all subjects. Overall, 85.5% of variables had moderate to excellent inter-rater reliability, with ICCs ranging from 0.30-0.99 for all cumulative and peak loading variables. 3DMatch was found to be a reliable ergonomic tool when more than one rater is involved.

The effect of on-body lift assistive device on the lumbar 3D dynamic moments and EMG during asymmetric freestyle lifting

BACKGROUND

A new on-body personal lift assistive device was developed to reduce force requirements of back muscles during lifting and static holding tasks.

METHODS

Nine male subjects participated in the study. Twelve Fastrak sensors were used to record positions and rotations of the segments. Trunk muscles were normalized to maximum and integrated electromyographic amplitudes of the left and right thoracic erector spinae, lumbar erector spinae, external obliques, and rectus abdominalis were compared in asymmetrical lifting for three different loads (5 kg, 15 kg, 25 kg) using free style under two conditions: with and without a lift assistive device.

FINDINGS

The assistive device significantly reduced the required muscular effort of the lumbar and thoracic erector spinae (P=0.001) with no significant differences in the level of abdominal muscular activity. Average integrated electromyography amplitudes were reduced across all subjects by 23.9% for lumbar erector spinae, 24.4% for thoracic erector spinae, and 34.9% for the contralateral external oblique muscles. The assistive device had its greatest impact on smaller moments with 30% reduction in lateral bending, and 24% reduction in rotational moments, with only 19.5% a reduction in larger flexion-extension moments. To investigate whether the lift assistive device affected lifting kinematics, the device tensions were zeroed mathematically. No kinematic differences in lifting technique would explain this magnitude of moment reduction.

INTERPRETATION

The on-body assistive device reduced the required muscular effort of the lumbar and thoracic erector spinae without adversely affecting the level of abdominal muscle activity. These reductions were mirrored by similar 3D moment reductions.

A validation of a posture matching approach for the determination of 3D cumulative back loads

The purpose of this project was to investigate the amount of error in calculating cumulative lumbar spine kinetics using a posture matching approach (3DMatch) compared to a 3D coordinate electromagnetic tracking approach (FASTRAK). Six subjects were required to perform five repeats each of two symmetrical and two asymmetrical lifts while being simultaneously recorded from 4 camera views at viewing angles of 0 degrees , 45 degrees , 60 degrees and 90 degrees to the sagittal plane while wearing eight FASTRAK sensors to define an 8 segment rigid link model (RLM) of the head, arms, and trunk. Four hundred and eighty lifts (6 subjects x20 lifts x4 camera views) were analyzed using the 3DMatch posture-matching program to calculate the following cumulative loads at the L4/L5 joint: compression, anterior shear, posterior shear, reaction shear and extension moment. The errors in cumulative load calculation were determined as the difference between the values calculated for the same lifts using a 3D RLM that used electromagnetic motion tracking sensors (FASTRAK) positioned at the segment center of masses as model inputs. No significant difference (p<0.05) in the relative error for any of the cumulative loading variables between the four camera views and the 3D RLM approach was found. Furthermore the relative errors for cumulative compression, joint anterior shear, reaction anterior shear and extension moment were all below 12%. These results suggest that posture matching by trained users can provide reasonable 3D data to calculate cumulative low back loads with a biomechanical model.

Computation of trunk equilibrium and stability in free flexion–extension movements at different velocities

Velocity of movement has been suggested as a risk factor for low-back disorders. The effect of changes in velocity during unconstrained flexion-extension movements on muscle activations, spinal loads, base reaction forces and system stability was computed. In vivo measurements of kinematics and ground reaction forces were initially carried out on young asymptomatic subjects. The collected kinematics of three subjects representing maximum, mean and minimum lumbar rotations were subsequently used in the kinematics-driven model to compute results during the entire movements at three different velocities. Estimated spinal loads and muscle forces were significantly larger in fastest pace as compared to slower ones indicating the effect of inertial forces. Spinal stability was improved in larger trunk flexion angles and fastest movement. Partial or full flexion relaxation of global extensor muscles occurred only in slower movements. Some local lumbar muscles, especially in subjects with larger lumbar flexion and at slower paces, also demonstrated flexion relaxation. Results confirmed the crucial role of movement velocity on spinal biomechanics. Predictions also demonstrated the important role on response of the magnitude of peak lumbar rotation and its temporal variation.

An examination of shoulder kinematics and kinetics when using a commercial trunk harness while sheep shearing

Sheep shearing is a very physically demanding occupation, especially on the low back, such that many commercial harnesses have been developed to help reduce the load on the back. Such harnesses have been shown to significantly reduce peak and cumulative low back loads; however, the effect that these harnesses have on the shoulders, which are also highly involved during sheep shearing, has not been previously examined. The purpose of this study was to examine the shoulder postures and cumulative shoulder moments of 12 New Zealand sheep shearers. The use of the trunk harness reduced the percentage of time spent in shoulder flexion greater than 90 degrees and the time spent in shoulder abduction greater than 45 degrees as well as reduced the cumulative net joint flexor, abductor, and adductor shoulder moments by a minimum of 21%, 14%, and 42%, respectively. Therefore, the use of a commercial trunk harness to reduce low back injury may also help to reduce the risk of shoulder injury while sheep shearing.

Estimation of compressive forces on lumbar spine from categorical posture data

To combine estimates of trunk posture and force into an integrated measure of load on the low back, continuous variables for body angles were estimated by assuming specified distributions within corresponding posture categories with Monte-Carlo (MC) simulation. The estimated posture angles were compared with reference measurements from the Lumbar Motion Monitor and inclinometers. The lumbar compression estimates, generated from simulated posture angles and from direct measurement, were compared. Trunk flexion showed high correlation between direct measurements and simulated angles, as did L5/S1 compression. The MC approach to extracting continuous posture angles from categorized observations did not appear to introduce large error in the variables used to estimate spinal compressive forces. When instrumentation methods of postural assessment are not feasible, a simulation approach combined with biomechanical modelling could be used to integrate multiple external exposure variables into estimates of compressive forces acting on the low back.

Time--a key issue for musculoskeletal health and manufacturing

Time is a key issue for both ergonomists and engineers when they engage in production system interventions. While not their primary purpose, the actions of engineers have major effects on biomechanical exposure; possibly of much greater magnitude than many ergonomics interventions. This paper summarises the aims, actions and tools of engineers and ergonomists, emphasising time-related outcomes. Activities of the two groups when attempting to manipulate time aspects of work may be contradictory; engineers wishing to improve production and ergonomists aiming at better health as well as contributing to production. Consequently, tools developed by ergonomists for assessing time aspects of work describe rest patterns, movement velocities or daily duration of exposures, while engineering tools emphasise time-efficient production. The paper identifies measures that could be used to communicate time-relevant information between engineers and ergonomists. Further cooperation between these two stakeholders as well as research on the topic are needed to enable ergonomists to have a larger impact on the design of production systems.

Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations

Much discussion exists about which is the most effective technique to improve spine stability. The purpose of this study was to evaluate the effectiveness of abdominal bracing and abdominal hollowing maneuvers to control spine motion and stability against rapid perturbations. Eleven healthy males were posteriorly loaded in different experimental conditions: resting with no knowledge of the perturbation timing; performing each of the stabilization maneuvers at 10%, 15% and 20% of internal oblique maximum voluntary contraction with no knowledge of the perturbation timing; and naturally coactivating the trunk muscles when perturbation timing was known. An EMG biofeedback system was used to control the pattern and intensity of abdominal coactivation. The muscular preactivation of seven trunk muscles (bilaterally registered), the applied force, and the torso muscular and kinematic responses to loading were measured; and the spine stability and compression were modeled. The hollowing maneuver was not effective for reducing the kinematic response to sudden perturbation. On the contrary, the bracing maneuver fostered torso cocontraction, reduced lumbar displacement, and increased trunk stability, but at the cost of increasing spinal compression. When the timing of the perturbation was known, the participants were able to stabilize the trunk while imposing smaller spine compressive loads.

Muscular and postural demands of using a massage chair and massage table

OBJECTIVE

The aim of this study was to determine the difference in muscular and postural demands of performing manual therapy using a massage chair and a massage table.

METHODS

Twelve female senior massage therapy students performed two 10-minute regional back massages on a fully clothed client using both a massage chair and massage table. The root mean square was used to determine the mean activation from the electromyographic signal collected from 8 upper extremity muscles. Integrated electromyography was used to compare activation between the 14 massage techniques used. Eight electromagnetic motion capture sensors were attached: the head, trunk, and upper arm, forearm, and hand bilaterally to track segment kinematics and determine total time spent in different postures.

RESULTS

There was higher activation in lumbar erector spinae when using the table and anterior deltoid when using the chair. The anterior deltoid showed a significant condition x period interaction for mean muscle activation for 6 of the 14 massage techniques. The therapists spent significantly more time in mild trunk flexion when using the massage table and significantly more time in severe radial deviation and mild shoulder flexion when using the massage chair.

CONCLUSIONS

The chair and table were more demanding of the anterior deltoid and lumbar erector spinae, respectively. Therapists adopted trunk and wrist postures that would increase the risk of upper extremity injury while using either the massage chair or table.

The effects of ergonomic interventions on low back moments are attenuated by changes in lifting behaviour

This study investigated the effects of ergonomic interventions involving a reduction of the mass (from 16 to 11 and 6 kg) and an increase in the initial lifting height (from pallet height to 90 cm above the ground) of building blocks in a mock-up of an industrial depalletizing task, investigating lifting behaviour as well as low back moments (calculated using a 3-D linked segment model). Nine experienced construction workers participated in the experiment, in which they removed building blocks from a pallet in the way they normally did during their work. Most of the changes in lifting behaviour that were found would attenuate the effect of the investigated interventions on low back moments. When block mass was reduced from 16 to 6 kg, subjects chose to lift the building block from a 10 (SD 10) cm greater distance from the front edge of the pallet and with a 100 (SD 66) degrees/s(2) higher trunk angular acceleration. When initial lifting height was increased, subjects chose to shift the building blocks less before actually lifting them, resulting in a 10.7 (SD 10) cm increase in horizontal distance of the building blocks relative to the body at the instant of peak net total moment. Despite these changes in lifting behaviour, the investigated ergonomic interventions still reduced the net total low back moment (by 4.9 (SD 2.0) Nm/kg when block mass was reduced and 53.6 (SD 41.0) Nm when initial lifting height was increased).

Methodological considerations for the calculation of cumulative compression exposure of the lumbar spine: a sensitivity analysis on joint model and time standardization approaches

Cumulative lumbar spine loading has attracted much attention as a factor associated with the development of low back pain. While evidence supports cumulative loading to be a plausible mechanism in explaining several workplace injuries, research establishing a threshold limit value (TLV) for cumulative spine loading has been challenging. The lack of a TLV or even a trend towards harmful cumulative load values may suggest that methodological considerations are greatly influencing the results. This paper examines the impact of different joint models (single muscle equivalent, an electromyography-based third order polynomial, a modified version of the polynomial and a hybrid approach) to determine cumulative spine compression, as well as the importance of time standardization in the calculation of a daily cumulative loading dose. Findings demonstrated that the polynomial predicted cumulative compression values were 43-53% higher than those with all other models tested and the single muscle equivalent predicted loads 18% higher than loads predicted using a modified polynomial. Profound differences between modelling approaches suggest that caution should be taken when selecting a muscle model to determine cumulative spine compressive loading. Time standardized cumulative compression values were found to be 28.3% greater than non-standardized estimates, illustrating the importance of selecting a standard time frame in the calculation of cumulative spine compression.

Exposure and dose modelling in occupational epidemiology

Complex and dynamic physiologic processes underlie the exposure-response relations that occupational and environmental epidemiologists study. Simple summary measures of exposure such as the average, cumulative exposure, or duration of exposure, can be applied suitably in exposure-response analyses in many instances. However, there are situations where these metrics may not be directly proportional to risk, in which case their use will result in misclassification and biased estimates of exposure-response associations. We outline methods for developing exposure or dose metrics which may reduce misclassification, as illustrated with some recent examples. Selecting better exposure or dose metrics can be thought of as a problem of choosing appropriate weights on the exposure history of each cohort member. Dosimetric modeling involves choosing exposure weights based on formal hypotheses about underlying physiologic or pathogenetic processes. Dosimetric modeling is still not widely used in epidemiology, and so the forms of mathematical models and the criteria for choosing one model over another are not yet standardized. We hope to stimulate further applications through this presentation.

Effectiveness of a participatory ergonomics intervention in improving communication and psychosocial exposures

A participatory ergonomics programme was implemented in an automotive parts manufacturing factory in which an ergonomics change team was formed, composed of members from management, the organized labour union and the research team. It was hypothesized that the participatory nature of this change process would result in enhanced worker perceptions of workplace communication dynamics, decision latitude and influence, which in conjunction with anticipated mechanical exposure reductions would lead to reduced worker pain severity. Utilizing a sister plant in the corporation as a referent group, a quasi-experimental design was employed with a longitudinal, repeat questionnaire approach to document pre-post intervention changes. Nine participatory activities (psychosocial interventions) were implemented as part of the process. Communication dynamics regarding ergonomics were significantly enhanced at the intervention plant compared to the referent plant. However, there were no significantly different changes in worker perceptions of decision latitude or influence between the two plants, nor did pain severity change. Possible explanations for these results include limited intervention intensity, context and co-intervention differences between the two plants, high plant turnover reducing the statistical power of the study and lack of sensitivity and specificity in the psychosocial measures used. Further research should include the development of psychosocial tools more specific to participatory ergonomic interventions and the assessment of the extent of change in psychosocial factors that might be associated with improvements in pain.

The effect of camera viewing angle on posture assessment repeatability and cumulative spinal loading

Video-based task analysis in the workplace is often limited by equipment location and production line arrangement, therefore making it difficult to capture the motion in a single plane. The purpose of this study was to investigate the effects of camera placement on an observer's ability to accurately assess working postures in three dimensions and the resultant influence on the reliability and repeatability of calculated cumulative loading variables. Four video cameras were placed at viewing angles of 0 degrees, 45 degrees, 60 degrees and 90 degrees to the frontal plane, enabling the simultaneous collection of views of four lifting tasks (two symmetric and two asymmetric). A total of 11 participants were trained in the use of the 3DMatch 3-D posture matching software package (developed at the University of Waterloo) and were required to analyse 16 lifting trials. Four of the participants were randomly selected to return within 72 h and repeat the analysis protocol to test intra-observer repeatability. Posture matching agreement between camera views was higher when the body segments had a minimal range of motion during the task. There was no significant participant main effect; however, there was a significant (p < 0.05) task main effect. Intraclass correlation coefficients (ICC) were calculated to assess the between day reliability. Compression, reaction anterior shear and extension moment were all found to have excellent reliability (ICC > 0.75). Joint anterior shear and joint posterior shear both provided fair to good reliability (0.4 > ICC < 0.75). Overall, the impact of the camera viewing angle on an observer's ability to match working postural exposure was found to be small.

The effect of reducing the number of EMG channel inputs on loading and stiffness estimates from an EMG-driven model of the spine

Electromyography (EMG)-driven models of the spine routinely require between ten and 14 EMG channels to estimate joint load and stiffness variables. This study was designed to determine the sensitivity of common EMG-driven model outputs to the removal of individual EMG channels, and to test two adapted models driven from eight channels. A total of 11 male participants performed a variety of static exertions designed to resist either an applied trunk flexion or right side trunk lateral bend moment. In this study, 14 channels of EMG were recorded and used to drive a biomechanical model of the spine to predict L4-L5 joint load and stiffness values. The model was subsequently re-run after the removal of individual pairs of bilateral EMG channels, and again with eight-channel models in which the rectus abdominus, latissimus dorsi and multifidus EMG-channels were eliminated. Results showed that the eight-channel model provided estimates for the majority of output variables that did not differ substantially from the 14-channel model, except in instances in which muscle force output was ramped to resist flexion moments. Estimates of the output variables were, in general, improved when multifidus fascicles were re-added to the model and driven from the lumbar erector spinae EMG sites.

Rest break interventions in stoop labor tasks

Hand cultivation and harvest of agricultural products constitute strenuous physical tasks. Working with labor-management ergonomics committees in agricultural settings, the UC Agricultural Ergonomics Research Center (AERC) tested an experimental rest and recovery protocol for its impact on symptoms and productivity during two types of work tasks. The experimental condition consisted of adding a 5 min rest break to every working hour in which there was no other scheduled break (e.g., lunchtime). This resulted in an additional 20 min of rest per workday. We tested the intervention in two trials: Trial one compared workers (n=66) randomly assigned to an experimental or a control group during the harvest of commercial strawberries. Trial two utilized a cross-over design (n=16 pairs of workers) to compare experimental and control conditions while workers inserted bud grafts into young 18'' high citrus trees. For both trials, workers under the experimental condition reported significantly less severe symptoms than workers under control conditions. The order in which the intervention was given, however, appeared to result in variations in productivity. We conclude that the introduction of frequent, brief rest breaks may improve symptoms for workers engaged in strenuous work tasks.

Changes in trunk muscle activation and lumbar-pelvic position associated with abdominal hollowing and reach during a simulated manual material handling task

The purpose of this study was to investigate the effect of abdominal hollowing (AH) on trunk muscle activation and lumbar-pelvic motion during a controlled lift and replace task. Surface electromyograms were recorded from five abdominal and two back muscle sites. Sagittal lumbar-pelvic motion was recorded by video. Subjects lifted a 3.8 kg load in normal, maximum and extreme reaches, first while performing their preferred lifting style (PLS) and then maintaining an AH technique. The external oblique muscle site activities were significantly higher (p < 0.05) for the AH technique (ranging from 7-20% of maximal voluntary activation (MVIC)) than at any of the abdominal sites for the PLS (ranging from 2-10% MVIC). Differences were found among abdominal sites for the AH, but not for the PLS. The back muscle site activities (ranging from 9-30% MVIC) were significantly higher (p < 0.05) than for any of the abdominal muscles for all conditions, except for the anterior external oblique for AH. The pelvic and lumbar angles changed significantly (p < 0.05) between normal and maximal reaches and between techniques. The AH technique altered abdominal muscle activation amplitudes, with minimal differences in trunk extensors compared to the PLS. The AH resulted in more posterior pelvic tilt.

Trunk muscle activation and associated lumbar spine joint shear forces under different levels of external forward force applied to the trunk

High anterior intervertebral shear loads could cause low back injuries and therefore the neuromuscular system may actively counteract these forces. This study investigated whether, under constant moment loading relative to L3L4, an increased externally applied forward force on the trunk results in a shift in muscle activation towards the use of muscles with more backward directed lines of action, thereby reducing the increase in total joint shear force. Twelve participants isometrically resisted forward forces, applied at several locations on the trunk, while moments were held constant relative to L3L4. Surface EMG and lumbar curvature were measured, and an EMG-driven muscle model was used to calculate compression and shear forces at all lumbar intervertebral joints. Larger externally applied forward forces resulted in a flattening of the lumbar lordosis and a slightly more backward directed muscle force. Furthermore, the overall muscle activation increased. At the T12L1 to L3L4 joint, resulting joint shear forces remained small (less than 200N) because the average muscle force pulled backward relative to those joints. However, at the L5S1 joint the average muscle force pulled the trunk forward so that the increase in muscle force with increasing externally applied forward force caused a further rise in shear force (by 102.1N, SD=104.0N), resulting in a joint shear force of 1080.1N (SD=150.4N) at 50Nm moment loading. It is concluded that the response of the neuromuscular system to shear force challenges tends to increase rather than reduce the shear loading at the lumbar joint that is subjected to the highest shear forces.

Spinal loading during manual materials handling in a kneeling posture

Stooped, restricted, kneeling, and other awkward postures adopted during manual materials handling have frequently been associated with LBP onset. However, lift assessment tools have focused on materials handling performed in an upright, or nearly upright standing posture. Unfortunately, many of the tools designed to analyze standing postures are not easily adapted to jobs requiring restricted postures. Therefore, the objective of this study was to evaluate spinal loading during manual materials handing in kneeling postures and determine if those loads can be predicted using simple regression. An EMG-driven biomechanical model, previously validated for upright lifting, was adapted for use in kneeling tasks. Subjects knelt under a 1.07m ceiling and lifted luggage of six weights (6.8, 10.9, 15.0, 19.1, 23.1 and, 27.2kgf) to one of four destination heights (0, 25.4, 53.3, 78.7cm). Spine loading was significantly affected by both destination height and load weight. Destination height increased compression, AP shear and lateral shear by an average of 14.5, 3.7 and 6.6N respectively per cm height increase. Load weight increased compression, AP shear and lateral shear by an average of 83.8, 27.0 and 13.1N respectively per kgf lifted. Regression equations were developed to predict peak spine loading using subject height, load weight and destination height with R(2) values of 0.62, 0.51 and 0.57 for compression, AP and lateral shear respectively.

Active trunk stiffness during voluntary isometric flexion and extension exertions

OBJECTIVE

Compare muscle activity and trunk stiffness during isometric trunk flexion and extension exertions.

BACKGROUND

Elastic stiffness of the torso musculature is considered the primary stabilizing mechanism of the spine. Therefore, stiffness of the trunk during voluntary exertions provides insight into the stabilizing control of pushing and pulling tasks.

METHODS

Twelve participants maintained an upright posture against external flexion and extension loads applied to the trunk. Trunk stiffness, damping, and mass were determined from the dynamic relation between pseudorandom force disturbances and subsequent small-amplitude trunk movements recorded during the voluntary exertions. Muscle activity was recorded from rectus abdominus, external oblique, lumbar paraspinal, and internal oblique muscle groups.

RESULTS

Normalized electromyographic activity indicated greater antagonistic muscle recruitment during flexion exertions than during extension. Trunk stiffness was significantly greater during flexion exertions than during extension exertions despite similar levels of applied force. Trunk stiffness increased with exertion effort.

CONCLUSION

Theoretical and empirical analyses reveal that greater antagonistic cocontraction is required to maintain spinal stability during trunk flexion exertions than during extension exertions. Measured differences in active trunk stiffness were attributed to antagonistic activity during flexion exertions with possible contributions from spinal kinematics and muscle lines of action.

APPLICATION

When compared with trunk extension exertions, trunk flexion exertions such as pushing tasks require unique neuromuscular control that is not simply explained by differences in exertion direction. Biomechanical analyses of flexion tasks must consider the stabilizing muscle recruitment patterns when evaluating spinal compression and shear loads.

Direct measurement of intervertebral disc maximum shear strain in six degrees of freedom: motions that place disc tissue at risk of injury

Human intervertebral disc specimens were tested to determine the regions of largest maximum shear strain (MSS) experienced by disc tissues in each of three principal displacements and three rotations, and to identify the physiological rotations and displacements that may place the disc at greatest risk for large tissue strains and injury. Tearing of disc annulus may be initiated by large interlamellar shear strains. Nine human lumbar discs were tagged with radiographic markers on the endplates, disc periphery and with a grid of wires in the mid-transverse plane and subjected to each of the six principal displacements and rotations. Stereo-radiographs were taken in each position and digitized for reconstruction of the three-dimensional position of each marker. Maximum tissue shear strains were calculated from relative marker displacements and normalized by the input displacement or rotation. Lateral shear, compression, and lateral bending were the motions that produced the mean (95% confidence interval) largest mean MSS of 9.6 (0.7)%/mm, 9.0 (0.5)%/mm, and 5.8 (1.6)%/ degrees , respectively, and which occurred in the posterior, posterolateral and lateral peripheral regions of the disc. After taking into account the reported maximum physiological range of motion for each degree of freedom, motions producing the highest physiological MSS were lateral bending (57.8 (16.2)%) and flexion (38.3 (3.3)%), followed by lateral shear (14.4 (1.1)%) and compression (12.6 (0.7)%).

Can periods of static loading be used to enhance the resistance of the spine to cumulative compression?

Results of in vitro studies conducted on isolated bone specimens have indicated a higher tolerance to static load than exists when exposed to cyclic loading, when controlled for creep rate. If this difference in load tolerance exists, it may be exploited to extend the life of vertebral bone exposed to repetitive compression, and potentially alter the development of spinal injury. However, little work has been conducted on functional spinal units to determine if bone displays this characteristic within an intact joint. Additionally, static loading may result in load redistribution within the intervertebral disc forcing more of the compressive load towards the periphery of the endplate away from the nucleus. In order to examine these potential mechanisms, 218 osteoligamentous porcine functional spinal units were assigned to one of 15 loading scenarios. This involved one of three normalized peak load magnitudes (50%, 70% and 90% of estimated compressive tolerance) and one of five normalized static load applications (0%, 50%, 100%, 200% and 1000% of the total dynamic work duration). Load magnitude significantly altered the resistance to cumulative compression with decreased peak magnitudes corresponding to both increased cumulative load tolerance and increased height loss. Static load periods did not alter the resistance of the spinal unit to cumulative compression or impact the number of cycles tolerated to failure. The insertion of static load periods impacted the total survival time to failure, but only for the 1000% static load group, an exposure unlikely to occur for most in vivo exposures. The insertion of static load periods decreased the amount of height loss during testing which may play a protective role by allowing load redistribution within the vertebral bone and intervertebral disc.

Movement-based feedback may reduce spinal moments in male workers during lift and lowering tasks

BACKGROUND AND PURPOSE

To assess if lifting performance can be modified and spine stresses reduced in workers who perform repetitive material-handling jobs in a warehouse environment via a novel real-time, movement-based feedback training protocol.

METHOD

A pre-test/post-test group study design was used with a control group. Data were collected in a warehouse setting and analysed in a university setting. A convenience sample of 22 male warehouse employees was divided equally, based on height and weight, and assigned to either an experimental group or a control group. The experimental group received real-time, performance-based auditory feedback from their calculated moments during lifting or lowering using an electromagnetic tracking system. The electromagnetic tracking system was used to measure the side-bending, flexion and rotation moments during six lifts under four different conditions. A series of repeated-measures analyses of variance (ANOVA) (one between (Group); one within (Time)) was performed on the average maximum moments from six lifting or lowering cycles for all three directions: side-bending, flexion and rotation.

RESULTS

There were significant group x time interactions for the side-bending moment (p < 0.05) and the flexion moment (p < 0.05) but not the rotation moment (p > 0.05). Lower moments were found in the experimental group, which received the training and feedback, compared to the control group.

CONCLUSIONS

Real-time, auditory feedback combined with coaching during lifting or lowering tasks may be effective in the short term (six weeks) in reducing the average maximum side-bending and flexion moments in warehouse workers. Further research is needed to determine the long-term effects of this training protocol on low back injury rates.

A field study investigating the effects of a rebar-tying machine on trunk flexion, tool usability and productivity

A field study with a before-and-after experimental design was conducted to evaluate the potential reduction in the risk of musculoskeletal injuries to rodworkers when using an automatic rebar-tying machine. Eleven rodworkers participated in this experiment. All dependent variables (trunk posture, rebar-tying time and responses to a usability questionnaire) were first measured before introducing the rebar-tying machine and then after 3 months of usage all dependent variables were measured again. The results of the study indicated that working with a rebar-tying machine significantly reduced the magnitude, frequency and duration of exposure to awkward trunk posture. Tying time was reduced when participants used the machine. The usability questionnaire indicated that most participants preferred to use the rebar-tying machine for ground-level rebar construction. The field study also revealed that the rebar-tying machine is not limited to the reinforcing trade. The machine can be used for other purposes, such as tying electrical conduit and attaching radiant heat tube to steel mesh. Based on trunk posture exposure, rebar-tying time, usability and transferability, it is concluded that the rebar-tying machine can be an effective tool to reduce the frequency and duration of severe trunk flexion, improve usability and increase productivity among concrete reinforcement workers.

Effect of a stiff lifting belt on spine compression during lifting

STUDY DESIGN

An in vivo study on weightlifters.

OBJECTIVES

To determine if and how a stiff back belt affects spinal compression forces in weightlifting.

SUMMARY OF BACKGROUND DATA

In weightlifting, a back belt has been reported to enhance intraabdominal pressure (IAP) and to reduce back muscle EMG and spinal compression forces.

METHODS

Nine experienced weightlifters lifted barbells up to 75% body weight while inhaling and wearing a belt, inhaling and not wearing a belt, and exhaling and wearing a belt. IAP, trunk muscle EMG, ground reaction forces, and kinematics were measured. An EMG-assisted trunk model, including IAP effects, was used to calculate spinal compression and shear forces and to reveal the contribution of back muscles, abdominal muscles, and IAP to moment generation.

RESULTS

The belt reduced compression forces by about 10%, but only when inhaling before lifting. The moment generated by IAP increased when wearing a belt and inhaling, but this moment was small and the increase was largely negated by the flexing moment generated by abdominal muscles.

CONCLUSIONS

Wearing a tight and stiff back belt while inhaling before lifting reduces spine loading. This is caused by a moment generated by the belt rather than by the IAP.

Measuring the physical demands of work in hospital settings: design and implementation of an ergonomics assessment

BACKGROUND

Assessing the physical demands of the heterogeneous jobs in hospitals requires appropriate and validated assessment methodologies.

METHODS

As part of an integrated assessment, we adapted Rapid Entire Body Assessment (REBA), using it in a work sampling mode facilitated by a hand-held personal digital assistant, expanding it with selected items from the UC Computer Use Checklist, and developed a scoring algorithm for ergonomics risk factors for the upper (UB) and lower body (LB).

RESULTS

The inter-rater reliability kappa was 0.54 for UB and 0.66 for LB. The scoring algorithm demonstrated significant variation (ANOVA p<0.05) by occupation in anticipated directions (administrators ranked lowest; support staff ranked highest on both scores). A supplemental self-assessment measure of spinal loading correlated with high strain LB scores (r=0.30; p<0.001).

CONCLUSION

We developed and validated a scoring algorithm incorporating a revised REBA schema adding computer use items, appropriate for ergonomics assessment across a range of hospital jobs.

Quantifying low back peak and cumulative loads in open and senior sheep shearers in New Zealand: examining the effects of a trunk harness

Sheep shearing requires shearers to adopt sustained flexed postures for prolonged periods of time and has been associated with an increased risk of developing low back pain (LBP). However, these postures do not generally result in acute compressive values at L4/L5 exceeding the action limit proposed by the National Institute for Occupational Safety and Health, despite the high prevalence of LBP in this occupation. Therefore, it may not be peak loading that is responsible for LBP in this occupation but instead it may be the effect of cumulative loading over the course of a workday. The primary purpose of this research was to quantify the low back cumulative load exposure in 12 sheep shearers with and without the aid of a commercial trunk harness. Results revealed a significant reduction in the magnitude of cumulative compression with the use of the trunk harness and therefore its use may potentially reduce the risk of injury. The use of the trunk harness also reduced the time spent in axially twisted postures, which have been associated with LBP. However, using the trunk harness also resulted in increased time spent in laterally bent postures, which has been associated with increased risk for pain and injury.

Fatigue failure in shear loading of porcine lumbar spine segments

STUDY DESIGN

An in vitro study on porcine spinal segments.

OBJECTIVES

To determine the differences in mechanical behavior and fatigue strength in shear loading between intact spinal segments and segments without posterior elements, and between segments in neutral and flexed positions.

SUMMARY OF BACKGROUND DATA

Limited data are available on shear strength of spinal segments. Literature suggests that shear loading can lead to failure of the posterior elements and failure of the disc, when the posterior elements cannot provide adequate protection.

METHODS

In 2 experiments, 18 and 20 spines of pigs (80 kg) were used, respectively. Shear strength of the T13-L1 segment was tested, while loaded with 1600-N compression. L2-L3 and L4-L5 segments were loaded with a sinusoidal shear between 20% and 80% of the strength of the corresponding T13-L1 segment and 1600-N compression. In experiment No. 1, the posterior elements were removed in half the segments. In experiment No. 2, half the segments were tested in the neutral position, and half were tested in 10 degrees flexion.

RESULTS

The group without posterior elements had failure earlier than the intact group. In the group without posterior element, stiffness increased on failure; in the intact group, it decreased. In experiment No. 2, no differences between groups were found.

CONCLUSIONS

Repetitive shear loading can induce failure of porcine spinal segments, likely caused by fracture of the posterior elements, and, although repetitive anterior shear forces can also induce disc damage, this appears not to occur in intact segments, not even when flexed close to maximal.

Effects of abdominal muscle coactivation on the externally preloaded trunk: variations in motor control and its effect on spine stability

STUDY DESIGN

A repeated measures biomechanical analysis of the effects of abdominal bracing in preparation for a quick release of the loaded trunk.

OBJECTIVES

To quantify the ability of individuals to abdominally brace the externally loaded trunk, and assess their success in achieving and enhancing appropriate spine stability.

SUMMARY OF BACKGROUND DATA

Spine stability requires trunk muscle coactivation, which demands motor control skill that differs across people and situations. The quick release protocol may offer insight into the motor control scheme and subsequent effect on spine stability.

METHODS

There were 10 individuals who sat, torso upright, in an apparatus designed to foster a neutral spine position. They were instructed to support a posteriorly directed load to the trunk in either their naturally chosen manner, or by activating the abdominal muscles to 10%, 20%, or 30% of maximum ability. The externally applied load was then quickly released, thereby unloading the participant. Muscle pre-activation patterns, spine stability, and kinematic measures of trunk stiffness were quantified.

RESULTS

Participants were able to stabilize their spine effectively by supporting the load in a naturally selected manner. Conscious, voluntary overdriving of this natural pattern often resulted in unbalanced muscular activation schemes and corresponding decreases in stability levels.

CONCLUSIONS

Individuals in an externally loaded state appear to select a natural muscular activation pattern appropriate to maintain spine stability sufficiently. Conscious adjustments in individual muscles around this natural level may actually decrease the stability margin of safety.

Factors associated with the subject's ability to quantify their lumbar flexion demands at work

Continuous measurements of lumbar posture provide the basis for determining the factors influencing the difference between subjective and objective assessments of lumbar posture. The lumbar flexion posture during an entire work day was registered in a group of 13 sewage workers and 14 physical therapists. Subjective lumbar posture data, perceived occupational stress, job satisfaction and 12 month prevalence of low back pain were obtained using standardized questionnaires. For the entire sample, a significant positive correlation was found between the degree of overestimation of the lumbar bending demands at work and the level of occupational stress (p > 0.01) as well as the low back pain prevalence in the past 12 months. Continuous measurement of spinal posture is an important tool not only for comparisons of posture demands during various activities but also for investigations into the complex interactions between the biomechanical and psychosocial determinants of low back pain.