Evaluation of knee joint forces during kneeling work with different kneepads

Analysis of musculoskeletal pains and productivity impacts among hispanic construction workers

This study investigated the top three musculoskeletal pains (MSP) among Hispanic construction workers in Texas and the relationship between sleep hours, age, and MSPs on worker productivity. The study recruited 228 participants from 28 small construction companies and surveyed them on their occupation, age, sleep hours, MSP, and the impact of pain on productivity. The results indicated that Foot pain was the most common among these workers, followed by Back pain and others. Additionally, the study found that the Foot was the most common body part reported with MSP among roofers, drywall installers, laborers, and helpers. The study conducted a three-factor ANOVA test to analyze if there were any significant differences in productivity based on age, number of MSPs, and sleep hours. The study found that MSPs and sleep hours significantly impacted productivity. However, there was no significant effect of age. The results also showed that the number of MSPs significantly impacted productivity, with an increase in MSPs leading to a more severe impact on productivity. Additionally, those who slept less than 6 h per day had a more severe impact on productivity than those who slept more. The study suggests that targeted interventions to improve musculoskeletal health and productivity in this population are needed and highlights the importance of considering Hispanic construction workers' specific needs when implementing safety measures and addressing pain management in the workplace.

Environmental Risk Factors for Osteoarthritis: The Impact on Individuals with Knee Joint Injury

Osteoarthritis is a debilitating chronic condition involving joint degeneration, impacting over 300 million people worldwide. This places a high social and economic burden on society. The knee is the most common joint impacted by osteoarthritis. A common cause of osteoarthritis is traumatic joint injury, specifically injury to the anterior cruciate ligament. The purpose of this review is to detail the non-modifiable and modifiable risk factors for osteoarthritis with particular focus on individuals after anterior cruciate ligament injury. After reading this, health care providers will better comprehend the wide variety of factors linked to osteoarthritis.

Visualising knee loading patterns during kneeling and the development of a laboratory-based adaptation of the Aberdeen Weight-Bearing Test (Knee)

BACKGROUND

Information regarding the loading of key anatomical structures of the knee during kneeling would enhance existing functional tests, yet current visualisation methods are limited and require further development.

AIMS

(1) Develop a knee loading visualisation technique to investigate loading patterns of the knee during kneeling; and (2) determine the utility of the technique in combination with vertical ground reaction forces and centre of pressure data in the lab-based Aberdeen Weight-Bearing Test (Knee) by assessing their reliability.

METHODS

Fourteen healthy participants conducted kneeling tasks with and without knee pads across two testing sessions. Eight force-sensitive resistors were affixed to the right knee throughout different kneeling tasks: upright kneeling, and reaching forward, back, left, and right. A photo of the force-sensitive resistor configuration was used to generate participant-specific heat maps of knee loading. Two in-ground force platforms were used to measure vertical ground reaction forces and centre of pressure.

RESULTS

The inferior patella tendon showed the highest proportion of activation during both bare and knee pad kneeling for all kneeling tasks. Knee pads reduced the repeatability of knee loading patterns. Force-sensitive resistor activation and vertical ground reaction force components of the lab-based Aberdeen Weight-Bearing Test (Knee) were shown to be reliable, whereas the centre of pressure data was unreliable.

CONCLUSION

We have developed a lab-based technique for visualising knee loading using force-sensitive resistors. The combination of force-sensitive resistor activation and vertical ground reaction force data provides valuable insights into both the magnitude and locations of applied loads throughout kneeling.

Investigating and defining outcomes of suprapatellar versus infrapatellar intramedullary nailing of tibial shaft fractures: a protocol for a pilot randomised controlled trial

Background

Anterior knee pain is often reported following intramedullary nailing of tibial shaft fractures. The aetiology remains unclear, but the surgical approach may play an important role. To date, no biomechanically validated method exists to assess patient outcomes specific to anterior knee pain in this cohort. The central aims of this study are to (1) evaluate the feasibility of a full-scale randomised controlled trial (RCT) investigating the influence of surgical approach on intramedullary nailing of tibial shaft fractures (suprapatellar versus infrapatellar nailing), (2) explore differences in clinical outcomes between the approaches, and (3) explore the development of a biomechanically validated methodology for assessing post-operative anterior knee pain and knee function specific to intramedullary nailing of tibial shaft fractures.

Methods

This pilot study will follow a prospective randomised controlled design at the Royal Adelaide Hospital and The Queen Elizabeth Hospital (South Australia). This study aims to recruit 60 patients between 18 and 60 years old who will be randomly assigned to either the suprapatellar or infrapatellar approach following a decision for intramedullary surgical fixation by the treating surgeon. All nails in this study will be Stryker T2 Alpha nails. Patients will undergo standard radiograph, magnetic resonance imaging, and clinical assessments in-line with their standard operative care, and complete a number of patient-reported and performance-based outcome measures. Performance-based outcome measures will be assessed utilising three-dimensional motion capture techniques. Follow-up time points are 3, 6, 12, and 18 months. Feasibility outcomes include ability to meet enrolment and retention metrics, compliance with all questionnaires and assessment procedures, and the occurrence of any adverse events. The primary clinical outcome is the incidence of anterior knee pain at 12 months after surgery.

Discussion

This study will establish the feasibility and inform the design of a large-scale RCT. Evaluation of all clinical data and patient outcomes will lead to the development of a new tool for assessing patient outcomes in this cohort. Limitations of the study include an unpredictable enrolment rate and loss to follow-up, small sample size, and the unknown ability of three-dimensional motion analysis to pick up the effects of anterior knee pain after tibial nailing.

Trial registration

This trial was prospectively registered on the 7 February 2020 on ANZCTR, ACTRN12620000109909.

Musculoskeletal discomfort in veterinary healthcare professions

BACKGROUND

Veterinarians appear to be at risk for work-related musculoskeletal discomfort (MSD), based on surveys conducted outside the US.

OBJECTIVE

This study provides new information about MSD prevalence in veterinarians and veterinary technicians in the US.

METHODS

Cross-sectional survey and observation.

RESULTS

A survey of 56 veterinarians and 38 veterinary technicians in Ohio found 12-month prevalence of MSD exceeded 60% in the neck, low back, and legs/feet. More than 85% of participants reported that work activities exacerbated discomfort in at least one region. Less than one-third of participants reported symptom-related lost work time. Personal and work-related burnout scores were higher for veterinary technicians, compared with veterinarians. Nine percent of observed work activities performed by veterinarians and 43% performed by veterinary technicians were rated high or very high risk.

CONCLUSIONS

High prevalence of MSD and low lost work time suggest many individuals are working in pain. Increased adoption of existing ergonomics solutions (equipment and process changes), in addition to further investigation of unmet needs, could improve working conditions and reduce musculoskeletal stress in veterinary health professions.

Occupational Risk in Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Observational Studies

OBJECTIVE

To assess the association between occupational exposures and knee osteoarthritis (OA).

METHODS

We systematically searched for observational studies that examined the relationship between occupational exposures and knee OA and total knee replacement. Four databases were searched up to October 1, 2019. Two reviewers independently assessed study quality using the Newcastle-Ottawa Scale and evidence quality using the Grading of Recommendations Assessment, Development and Evaluation approach. Subgroup meta-analyses were conducted for important study characteristics and each type of occupational exposure. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated for the meta-analysis using random-effects models.

RESULTS

Eighty eligible studies were identified including 25 case-control (n = 20,505 total participants), 36 cross-sectional (n = 139,463 total participants), and 19 cohort studies (n = 16,824,492 total participants). A synthesis of 71 studies suggested increased odds of knee OA (OR 1.52 [95% CI 1.37-1.69]) by combining different physically demanding jobs and occupational activities as compared to sedentary occupations and/or low-exposure groups. Odds of knee OA were greater in males and in industry-based studies and studies assessing lifetime occupational exposures. There were 9 specific job titles that were associated with knee OA, including farmer, builder, metal worker, and floor layer. Occupational lifting, kneeling, climbing, squatting, and standing were all associated with higher odds of knee OA as compared to the odds of knee OA in sedentary workers.

CONCLUSION

Strenuous, physically demanding occupations and occupational activities were associated with increased odds of knee OA as supported by moderate-quality evidence. Specifically, agricultural and construction sectors, which typically involve heavy lifting, frequent climbing, prolonged kneeling, squatting, and standing, carried increased odds of knee OA.

Effects of working posture and roof slope on activation of lower limb muscles during shingle installation

Awkward and extreme kneeling during roofing generates high muscular tension which can lead to knee musculoskeletal disorders (MSDs) among roofers. However, the combined impact of roof slope and kneeling posture on the activation of the knee postural muscles and their association to potential knee MSD risks among roofers have not been studied. The current study evaluated the effects of kneeling posture and roof slope on the activation of major knee postural muscles during shingle installation via a laboratory assessment. Maximum normalized electromyography (EMG) data were collected from knee flexor and extensor muscles of seven subjects, who mimicked the shingle installation process on a slope-configurable wooden platform. The results revealed a significant increase in knee muscle activation during simulated shingle installation on sloped rooftops. Given the fact that increased muscle activation of knee postural muscles has been associated with knee MSDs, roof slope and awkward kneeling posture can be considered as potential knee MSD risk factors. Practitioner Summary: This study demonstrated significant effects of roof slope and kneeling posture on the peak activation of knee postural muscles. The findings of this study suggested that residential roofers could be exposed to a greater risk of developing knee MSDs with the increase of roof slope during shingle installation due to increased muscle loading. Abbreviations: MSDs: musculoskeletal disorders; EMG: electromyography; ANOVA: analysis of variance; MNMA: maximum normalized muscle activation; RF: rectus femoris; VL: vastus lateralis; VM: vastus medialis; BF: biceps femoris; S: semitendinosus.

Assessing work-related risk factors for musculoskeletal knee disorders in construction roofing tasks

Roofers often suffer from musculoskeletal disorders (MSDs) to their knees due to spending a large amount of time kneeling while performing work-related roofing activities on sloped rooftops. Several ergonomic studies have identified kneeling as a potential risk factor for knee injuries and disorders. Existing biomechanical models and sensor technologies used to assess work-related risk factors for different construction trades are not applicable in roof work settings especially on slanted rooftop surfaces. This work assesses the impacts of work-related factors, namely working posture and roof slope, on the potential risk of developing knee MSDs due to residential roofing tasks in a laboratory setting. Nine human subjects participated in the experiment and mimicked shingle installation on a slope-configurable wooden platform. Maximum angles of right and left knee flexion, abduction, adduction, and axial rotation (internal and external) were measured as risk indicators using a motion capture system under different roof slope settings. The results demonstrated that roof slope, working posture and their interaction may have significant impacts on developing knee MSDs during roofing activities. Knees are likely to be exposed to increased risk of MSDs due to working in a dynamic kneeling posture during shingle installation. In our study, flexion in both knees and adduction in the right knee were found lower in high-pitched rooftops; however, abduction in the left knee and internal rotation in the right knee were found higher during shingle installation. Hence proper attention is needed for these situations. This study provides useful information about the impact of roof work settings on knee MSDs development, which may facilitate effective interventions such as education, training, and tools to prevent knee injuries in construction roofing tasks.

Are knee savers and knee pads a viable intervention to reduce lower extremity musculoskeletal disorder risk in residential roofers?

One factor commonly associated with musculoskeletal disorder risk is extreme postures. To lessen this risk, individuals must be in an as neutral posture as possible while working. We analyzed how the inclusion of different combinations of two interventions-knee pads and knee savers-can alter lower extremity kinematics during deep or near full flexion kneeling occurs while on different sloped surfaces. Nine male subjects were requested to keep a typical resting posture while kneeling on sloped roofing simulator. We observed that the introduction of a wearable third party device considerably altered lower extremity full flexion kneeling kinematics compared to level deep kneeling. This study provided a sound base for the use of third party devices to reduce musculoskeletal disorder risk on a sloped surface, however further testing with other musculoskeletal disorder risk factors is needed prior to conclusive recommendation.