Difference between male and female workers lifting the same relative load when palletizing boxes

Quantifying how functional and structural personal factors influence biomechanical exposures in paramedic lifting tasks

It is unknown how structural (sex, stature, body mass) and functional (strength, flexibility) personal factors influence lifting strategy in paramedic work. We explored whether variance in peak low back forces and kinematic coordination patterns could be explained by structural and functional personal factors in paramedic lifting tasks. Seventy-two participants performed backboard and stretcher lifts. Peak low back forces normalised to body mass, as well as kinematic coordination patterns, were calculated as dependent variables. Being female, stronger, shorter, having higher body mass, and/or having greater lower body range of motion (ROM) were all independently associated with lower normalised low back forces across backboard and stretcher lifting. Females and stronger individuals seemed to define a movement objective to consistently minimise compressive forces, while individuals with greater hip ROM consistently minimised anteroposterior shear forces. The efficacy of improving strength and hip ROM to reduce low back forces in paramedic lifting should be investigated.Practitioner summary: Females, stronger individuals, and individuals with greater hip range of motion consistently exhibited lower normalised low back forces in paramedic lifting. Improving strength and hip range of motion via training is a potential proactive ergonomics approach to reduce peak low back forces in paramedic lifting tasks.

Differential effects of sex on upper body kinematics and kinetics during fatiguing, Asymmetric lifting

This study quantified sex-specific biomechanical adaptations to fatigue in asymmetric lifting. Twenty-one females and fifteen males performed a prolonged asymmetric lifting protocol while upper body, trunk and pelvis kinematics were collected. Features of movement identified with principal component analysis, and peak joint angular velocities and moments were calculated. Sex-specific kinematic adaptations to fatigue included females adopting a 'stoop-like' lifting strategy to a greater extent than males. Additionally, females exhibited higher vertical elbow positions during load rotation, moved their body toward the destination for load deposit, and did not reduce peak right shoulder flexion velocities, in contrast to male participants. Females also had greater low back and shoulder peak normalized joint moments. When fatigued, females adopted an asymmetric lifting strategy that minimized metabolic demand as supported by smaller decreases in maximum voluntary contractions. However, females' fatigue-related adaptations increased biomechanical exposures associated with injury risk.

Biomechanical Consequences of Using Passive and Active Back-Support Exoskeletons during Different Manual Handling Tasks

The aim of this study was to assess, for both men and women, the consequences of using different back-support exoskeletons during various manual material tasks (MMH) on the activity of back muscles and trunk kinematics. Fifteen men and fourteen women performed MMH involving a 15 kg load (a static task, a symmetric lifting task, and an asymmetric lifting task). Four exoskeleton conditions were tested: without equipment (CON) and with three exoskeletons passive (P-EXO), and active (A-EXO1 and A-EXO2)). The electromyographic activity of the lower trapezius (TZ), latissimus dorsi (LD), erector spinae (ES), gluteus maximus (GM), and biceps femoris (BF) muscles was recorded. Trunk kinematics were evaluated to provide average thoracic, lumbar, and hip angles. The use of the P-EXO decreased the activity of LD, GM, and BF from -12 to -27% (p < 0.01) compared to CON, mostly during the static task. The A-EXO1 and A-EXO2 reduced the muscle activity of all studied muscles from -7 to -62% (p < 0.01) compared to CON and from -10 to -52% (p < 0.005) compared to the P-EXO, independently of the modalities of the experimental tasks. A statistical interaction between the sex and exoskeleton was only observed in a few rare conditions. Occupational back-support exoskeletons can reduce trunk extensor muscle activity compared to no equipment being used. However, these reductions were modulated by the exoskeleton technology (passive vs. active), design (weight and anthropomorphism), and the modalities of the task performed (static vs. dynamic). Our results also showed that the active exoskeletons could modify the trunk kinematics.

Revised NIOSH lifting equation: a critical evaluation

The revised NIOSH lifting equation (RNLE) aims to manage lifting-related lower back pain (LBP), by determining safe load limits. Many researchers have studied the multiplier development criteria, the universal applicability of the equation and its ability to identify an increased risk of LBP in lifting tasks. Although a number of strengths of the equation have been highlighted, many limitations have also been identified. The need for new multipliers, such as worker and environmental characteristics, was highlighted in order to make the equation more adaptable. The RNLE was designed to protect 75% of female workers and is therefore inherently conservative. Additionally, as all multipliers have values less than or equal to 1, the recommended weight limits (RWLs) can be further reduced. Thus, new multipliers may be defined, by combining two or more existing multipliers, to make the RWLs more realistic.

Kinematic adaptations to restricting spine motion during symmetrical lifting

When lifting an object from the ground a person has many possible whole-body movement solutions to accomplish the task. It is unclear why lifters use most of their available lumbar spine flexion range-of-motion despite many ergonomic guidelines advising against doing so. Experimentally restricting spine motion and observing compensatory movement strategies is one approach to address this knowledge gap. A kinematic analysis was performed on 16 participants who completed symmetrical lifting tasks with and without wearing a spine motion-restricting device. Sagittal trunk, lumbar spine, and lower extremity kinematics, along with stance width and foot orientation in the transverse plane were evaluated between restricted and unrestricted lifting conditions. Restricting spine motion required greater ankle dorsiflexion (p < 0.001), knee flexion (p < 0.001), and hip flexion (p < 0.001) motion in comparison to unrestricted lifting. Motion was reallocated such that hip flexion showed the largest increase in restricted lifting, followed by ankle dorsiflexion, then knee flexion compared to unrestricted lifting. Trunk inclination decreased (i.e., more upright) in restricted compared to unrestricted lifting (p < 0.001). Neither stance width (p = 0.163) nor foot orientation (p = 0.228) were affected by restricting spine motion. These adaptive movements observed indicate lower extremity joint motion must be available and controlled to minimize lumbar spine flexion during lifting.

Computational lumbar spine models: A literature review

BACKGROUND

Computational spine models of various types have been employed to understand spine function, assess the risk that different activities pose to the spine, and evaluate techniques to prevent injury. The areas in which these models are applied has expanded greatly, potentially beyond the appropriate scope of each, given their capabilities. A comprehensive understanding of the components of these models provides insight into their current capabilities and limitations.

METHODS

The objective of this review was to provide a critical assessment of the different characteristics of model elements employed across the spectrum of lumbar spine modeling and in newer combined methodologies to help better evaluate existing studies and delineate areas for future research and refinement.

FINDINGS

A total of 155 studies met selection criteria and were included in this review. Most current studies use either highly detailed Finite Element models or simpler Musculoskeletal models driven with in vivo data. Many models feature significant geometric or loading simplifications that limit their realism and validity. Frequently, studies only create a single model and thus can't account for the impact of subject variability. The lack of model representation for certain subject cohorts leaves significant gaps in spine knowledge. Combining features from both types of modeling could result in more accurate and predictive models.

INTERPRETATION

Development of integrated models combining elements from different model types in a framework that enables the evaluation of larger populations of subjects could address existing voids and enable more realistic representation of the biomechanics of the lumbar spine.

Using passive or active back-support exoskeletons during a repetitive lifting task: influence on cardiorespiratory parameters

The objective of this laboratory study was to assess the cardiorespiratory consequences related to the use of different back-support exoskeletons during a repetitive lifting task. Fourteen women and thirteen men performed a dynamic stoop lifting task involving full flexion/extension of the trunk in the sagittal plane. This task was repeated for 5 min with a 10 kg load to handle. Four conditions were tested: with a passive exoskeleton (P-EXO), with two active exoskeletons (A-EXO1 and A-EXO2), as well as without exoskeleton (FREE). The oxygen consumption rate and cardiac costs were measured continuously. Results showed a significantly lower (p < 0.05) oxygen consumption rate for all exoskeletons as compared to FREE (12.6 ± 2.2 ml/kg/min). The values were also significantly lower (p < 0.001) for A-EXO1 (9.1 ± 1.8 ml/kg/min) compared to A-EXO2 (11.0 ± 1.8 ml/kg/min) and P-EXO (11.8 ± 2.4 ml/kg/min). Compared to FREE (59.7 ± 12.9 bpm), the cardiac cost was significantly reduced (p < 0.001) only for A-EXO1 (45.1 ± 11.5 bpm). Several factors can explain these differences on the cardiorespiratory parameters observed between exoskeletons: the technology used (passive vs active), the torque provided by the assistive device, the weight of the system, but also the level of anthropomorphism (related to the number of joints used by the exoskeleton). Our results also highlighted the lack of interaction between the exoskeleton and sex. Thereby, the three back-support exoskeletons tested appeared to reduce the overall physical workload associated with a repetitive lifting task both for men and women.

Workers’ subjective discomfort, muscle fatigue, and kinematics during a manual packaging task

BACKGROUND: Due to the prevalence and increased demand for manual packaging tasks, the concern for worker health and safety has grown. OBJECTIVE: This study aims to assess the effects of gender and work postures on subjective discomfort, muscle fatigue, and kinematics during a manual packaging task. METHODS: Twenty participants, including 10 males and 10 females, were recruited to perform a 60-minute manual packaging task in sitting and standing postures. RESULTS: Discomfort was evidenced by increased the rating of perceived exertion (RPE) values (sit: from 6 to 14.55; stand: from 6 to 17.15) and muscle fatigue was supported by decreased median power frequency (MPF) values for right brachioradialis (RB) (sit: –23.68% ; stand: –16.20%), right upper trapezius (RUT) (sit: –20.14% ; stand: 11.79%), and right erector spinae (RES) (sit: 8.64% ; stand: 11.21%) muscles. Women were more likely to bend forward in a relaxed upper body position, especially while sitting, which may increase the risk of low back pain and women also reported greater discomfort than men, but not in the hands and back. Compared with sitting, the back showed greater muscle fatigue in standing, while muscle fatigue for the shoulders and hands was the opposite. CONCLUSION: These findings suggest that work posture should be considered to prevent fatigue in manual packaging tasks. Given the impact of gender on muscle fatigue, work performed by women and men should both be considered. The results can help to develop action strategies and work posture design to prevent musculoskeletal disorders in the manual packaging industry.

The influence of sex and strength capacity on normalized low-back exposure during lifting: Insights from a joint power analysis

OBJECTIVE

Investigate the influence of sex, strength capacity, and relative load mass on low-back exposure and lower extremity joint power generation in backboard lifting.

BACKGROUND

Sex and strength have been shown to influence lifting strategy, but without load mass being scaled to strength it is unknown which factor influences low-back exposures, and whether there are interactions with load mass.

METHODS

Motion capture and force plate data from 28 participants were collected during backboard lifting at load masses scaled to strength capacity. Differences in normalized peak low-back moment, peak knee-to-hip power magnitude ratio and timing were tested as a function of sex, strength, and load mass.

RESULTS

Stronger participants had lower normalized peak low-back moments (average 32% change from low-capacity across all load masses), with no significant sex effect (p = 0.582). As load mass increased, normalized peak low-back moment, peak knee-to-hip power magnitude and synchronicity decreased.

CONCLUSION

Training to both increase strength capacity and hip-joint power generation may be a strategy to reduce low-back exposure in backboard lifting.

Sex-specific effects of localized muscle fatigue on upper body kinematics during a repetitive pointing task

Background

Females are reported to have a higher risk of musculoskeletal disorders than males. Repetitive motions can lead to muscle fatigue, which may play a mediator role in the development of musculoskeletal disorders. However, sex differences in adaptations to localized fatigue at different joints are poorly understood. We examined the sex-specific effects of fatigue location on shoulder, elbow and spinal joint angles, and angular variabilities during a repetitive pointing task.

Methods

Seven males and ten females performed a 30-s standing repetitive pointing task with their right upper limb when they were non-fatigued (NF), elbow-fatigued (EF), shoulder-fatigued (SF) and trunk-fatigued (TF), while trunk and upper body tridimensional kinematic data was recorded. Joint angles and angular variabilities of shoulder, elbow, upper thoracic spine, lower thoracic spine, and lumbar spine were calculated.

Results

Results showed that shoulder angles changed the most after EF in males, but after SF in females. The similarities between sexes were that SF increased the variabilities at upper (lateral flexion: 0.15° greater than NF, rotation: 0.26° greater than all other conditions) and lower thoracic spine (lateral flexion: 0.13° greater than NF, rotation: averagely 0.1° greater than all other condition) in both sexes. TF altered upper thoracic spine variability (0.36° smaller than SF), lower thoracic spine angle (lateral flexion: 3.00° greater than NF, rotation: 1.68° greater than SF), and lumbar angle (averagely 1.8° smaller than all other conditions) in both sexes. However, females had greater lower thoracic spine angle (lateral flexion: 8.3° greater, p = 0.005) as well as greater upper (rotation: 0.53° greater, p = 0.006) and lower thoracic spine (rotation: 0.5° greater, p = 0.007; flexion: 0.6° greater, p = 0.014) angular variabilities than males.

Conclusions

Results suggest that females’ fatigue responses focused on the trunk and spine. Results highlight a few sex differences in adapting to localized muscle fatigue, which may help explain how sex differences in repetitive motion-related injuries differ between joints.

Predicting load constant of RNLE based on demographics

Manual material handling (MMH) and lifting activities have been identified as risk factors for low back pain (LBP). Of the many tools available to analyse and design lifting tasks, the Revised NIOSH Lifting Equation (RNLE) is perhaps the most widely used. However, the equation is based on data primarily from the west. To make it universally applicable, the effect of worker characteristics like age, gender, weight, and anthropometry on MAWL was studied. A psychophysical methodology was adopted to arrive at the maximum acceptable weight limits (MAWLs). 58 industrial workers (30 men and 28 women) participated in the study. Based on the observations of the study, an equation was developed that would allow the RNLE load constant to be modified for different populations based on simple anthropometric data. The load constant for the Indian population was found to be comparable to the RNLE recommendations.

The influence of hip flexion mobility and lumbar spine extensor strength on lumbar spine flexion during a squat lift

STUDY DESIGN

Cross-sectional; Controlled laboratory study.

OBJECTIVE

To examine the associations among available hip flexion motion, lumbar extensor strength and peak lumbar flexion during a squat lift task.

SUMMARY OF BACKGROUND DATA

Lumbar spine flexion during lifting can result in increased strain on spinal structures. Although decreased available hip flexion motion and reduced strength of the lumbar extensor muscles has been proposed to contribute to greater lumbar flexion during lifting, direct relationships have not been explored.

METHODS

Fifty healthy young adults participated (23 males and 27 females). Strength of the lumbar extensors was measured using a motor-driven dynamometer. Available hip flexion was assessed using 3D motion capture. Peak lumbar spine flexion and hip flexion were quantified during the descent phase of the squat lifting task.

RESULTS

There was a significant negative association between available hip flexion and peak lumbar spine flexion during squat lifting in females (r = -0.407, p = 0.035) but not males (r = -0.341, p = 0.120). Similarly, peak lumbar spine flexion was negatively associated with lumbar extensor strength in females (r = -0.398, p = 0.040) but not males (r = -0.310, p = 0.161). During the squat lift, peak hip motion was positively associated with available hip flexion for both males and females combined (r = 0.774, p < 0.001).

CONCLUSION

Females with less available hip flexion and lower lumbar extensor strength exhibit greater lumbar flexion when performing a lifting task. Clinicians should be aware of the potential contributions of such impairments when instructing patients into various lifting strategies.

Influence of gender and age on musculoskeletal symptoms in white and blue-collar workers - cross-sectional study

OBJECTIVE

Identify the prevalence of musculoskeletal symptoms among blue- and white-collar workers stratified by gender and age.

METHODS

The sample was composed of 390 blue-collar and 510 white-collar workers. Musculoskeletal symptoms were evaluated using the Nordic Musculoskeletal Questionnaire. Independent t-test or Mann-Whitney test were used for the inter-group comparisons. The Chi-square (χ²) association test was applied for categorical variables. Logistic regression analysis was used to determine the influence of gender and age on musculoskeletal symptoms.

RESULTS

The prevalence of shoulder, lower back, and ankle/foot symptoms was higher among blue-collar workers compared to white-collar workers. In the analysis stratified by gender, female blue-collar workers had a higher frequency of shoulder symptoms and male blue-collar workers had a higher frequency of lower back symptoms. In the analysis stratified by age, younger blue collar-workers had a higher frequency of shoulder, lower back, and ankle/foot symptoms compared to young white-collar workers and older white-collar workers had a higher frequency of neck symptoms compared to older blue-collar workers.

CONCLUSIONS

Gender and age exerted an influence on self-reported symptoms in blue- and white-collar workers.

Sex-Dependent Estimation of Spinal Loads During Static Manual Material Handling Activities-Combined in vivo and in silico Analyses

Manual material handling (MMH) is considered as one of the main contributors to low back pain. While males traditionally perform MMH tasks, recently the number of females who undertake these physically-demanding activities is also increasing. To evaluate the risk of mechanical injuries, the majority of previous studies have estimated spinal forces using different modeling approaches that mostly focus on male individuals. Notable sex-dependent differences have, however, been reported in torso muscle strength and anatomy, segmental mass distribution, as well as lifting strategy during MMH. Therefore, this study aimed to use sex-specific models to estimate lumbar spinal and muscle forces during static MHH tasks in 10 healthy males and 10 females. Motion-capture, surface electromyographic from select trunk muscles, and ground reaction force data were simultaneously collected while subjects performed twelve symmetric and asymmetric static lifting (10 kg) tasks. AnyBody Modeling System was used to develop base-models (subject-specific segmental length, muscle architecture, and kinematics data) for both sexes. For females, female-specific models were also developed by taking into account for the female’s muscle physiological cross-sectional areas, segmental mass distributions, and body fat percentage. Males showed higher absolute L5-S1 compressive and shear loads as compared to both female base-models (25.3% compressive and 14% shear) and female-specific models (41% compressive and 23.6% shear). When the predicted spine loads were normalized to subjects’ body weight, however, female base-models showed larger loads (9% compressive and 16.2% shear on average), and female-specific models showed 2.4% smaller and 9.4% larger loads than males. Females showed larger forces in oblique abdominal muscles during both symmetric and asymmetric lifting tasks, while males had larger back extensor muscle forces during symmetric lifting tasks. A stronger correlation between measured and predicted muscle activities was found in females than males. Results indicate that female-specific characteristics affect the predicted spinal loads and must be considered in musculoskeletal models. Neglecting sex-specific parameters in these models could lead to the overestimation of spinal loads in females.

Sex Differences in Rotator Cuff Muscles' Response to Various Work-Related Factors

Occupational ApplicationsDespite the frequency and cost of rotator cuff injuries among male and female workers, very little is known about the strength, endurance, and perceived exertion and electromyographic response of rotator cuff muscles to different exertion levels. In this study, sex differences were studied using muscle-specific maximal and submaximal exertions of the supraspinatus, infraspinatus, and teres minor muscles. Females showed lower strength and endurance, but higher muscle activity and perceived exertion compared to males. The baseline data presented in this paper can assist ergonomic practitioners in determining the worker capacity to ensure that physically-demanding shoulder exertions can be performed without incurring injurious stress. Such data is also essential to establish population norms for the better design of workplace tasks.

Combined influence of transfer distance, pace, handled mass and box height on spine loading and posture

Work-related low back disorders are commonly associated with handling tasks. The objective of this study was to determine the combined influence of distance, pace, handled mass and height, on back loading and posture during free box transfer. Kinematics and kinetics of 17 handlers were recorded during a box transfer task between two pallets. Four-way repeated measures ANOVA were conducted on four lift-deposit height conditions (from lift and deposit of 0.16 or 1.16 m), three distances between pallets (1.5, 1.0 and 0.5 m), two handled masses (10 and 20 kg) and two paces (free and faster). The interaction between distance and height on back loading and posture (P < 0.001) showed that increasing distance to more than 1 m is not recommended to avoid unnecessary cumulative loading. The shorter distance of 0.5 m, which generally reduced the most spine loading, may increase it for transfers varying in height. The effect of pace to reduce spine cumulative loading and increase the peak asymmetric loading (P < 0.05) was accentuated by mass, height and distance. The combined factors revealed the importance of tradeoff between peak, cumulative and asymmetric loading.

Physical Ergonomic Improvement and Safe Design of an Assembly Workstation through Collaborative Robotics

One of the key interesting features of collaborative robotic applications is the potential to lighten the worker workload and potentiate better working conditions. Moreover, developing robotics applications that meets ergonomic criteria is not always a straightforward endeavor. We propose a framework to guide the safe design and conceptualization of ergonomic-driven collaborative robotics workstations. A multi-disciplinary approach involving robotics and ergonomics and human factors shaped this methodology that leads future engineers through the digital transformation of a manual assembly (with repetitive and hazardous operations) to a hybrid workstation, focusing on the physical ergonomic improvement. The framework follows four main steps, (i) the characterization of the initial condition, (ii) the risk assessment, (iii) the definition of requirements for a safe design, and (iv) the conceptualization of the hybrid workstation with all the normative implications it entails. We applied this methodology to a case study in an assembly workstation of a furniture manufacturing company. Results show that the methodology adopted sets an adequate foundation to accelerate the design and development of new human-centered collaborative robotic workstations.

Kinematic and perceptual responses in heavy lifting and pulling: Are there differences between males and females?

This study investigated kinematic and perceptual differences between the sexes in a heavy lifting and pulling task. A 20 kg box was lifted from floor to chest height, and a 70 kg mannequin pulled across 20m. The effect of height, mass and average grip strength on kinematics and perceived workload was examined in 42 (19 females, 23 males) healthy individuals. A univariate linear regression analysis found females lifted with greater lumbar extension compared to males (p < 0.001), and adopted more hip (p = 0.006) and knee flexion (p = 0.036) in the pulling task. Females reported a greater perceived workload in both tasks (p < 0.001). After the multivariable analysis, only grip strength remained significant for perceived workload in the lift (p = 0.04), and height for knee flexion in the pull (p = 0.009). This highlights that height and strength are important factors driving kinematics and perceived workload. Clinicians may consider these factors in heavy manual tasks, more so than sex.

Understanding individual differences in lifting mechanics: Do some people adopt motor control strategies that minimize biomechanical exposure

The movement strategy an individual uses to complete a lift can influence the resultant biomechanical exposure on their low back. We hypothesize that some lifters may choose a motor control strategy to minimize exposure to the low back, where others may not. Lower magnitudes of exposure to the low back coupled with less variability in lift-to-lift exposure and in features of movement strategy related to biomechanical exposure would support that such lifters consider minimizing exposure in their motor control strategy. We tested this hypothesis by investigating if differences in variability of low back exposure measures, as well as features of movement strategy related to resultant low back exposures differed across lifters. Twenty-eight healthy adults participated in the study where ten repetitions of a lifting task with the load scaled to 75% of participant's one-repetition maximum were completed. In all trials, whole-body kinematics and ground reaction forces were collected. Lifters were grouped as low, moderate or high relative exposure based on low back flexion angles and normalized L4/L5 extensor moments when lifting. Principal component analysis was used to identify independent movement strategy features, and statistical testing determined which features differed between high and low exposure lifts. Variability in low back exposures and movement features associated with relative biomechanical exposure were compared across lifter classifications. Significantly less variability was observed in low back exposures among the low exposure lifter group. Additionally, a trend towards lower variability in movement features associated with relative biomechanical exposure was also observed in low exposure lifters. These findings provide initial support for the hypothesis that some lifters likely define a motor control strategy that considers minimizing biomechanical exposure in addition to completing the lift demands. Future work should explore how state and trait-based factors influence an individual to consider biomechanical exposure within their motor control strategy in lifting.

An ergonomic assessment of using laterally-tilting operating room tables and friction reducing devices for patient lateral transfers

Patient lateral transfers between two adjacent surfaces pose high musculoskeletal disorder risks for nurses and patient handlers. The purpose of this research was to examine the ergonomic benefits of utilizing the laterally-tilting function of operating room (OR) tables during such transfers - along with different friction-reducing devices (FRD). This method allows the patient to slide down to the adjacent surface as one nurse guides the transfer and another controls the OR table angle with a remote control. Sixteen nursing students and sixteen college students were recruited to act as nurses and patients, respectively. Two OR table angles were examined: flat and tilted. Three FRD conditions were considered: a standard blanket sheet, a plastic bag, and a slide board. Electromyography (EMG) activities were measured bilaterally from the posterior deltoids, upper trapezii, latissimus dorsi, and lumbar erector spinae muscles. The Borg-CR10 scale was used for participants to rate their perceived physical exertions. The efficiency of each method was measured using a stopwatch. Results showed that the tilted table technique completely replaced the physical efforts that would have been exerted by the pushing-nurse, in that muscle activation did not increase in the pulling-nurse. On the contrary, EMG activities of the pulling-nurse for most of the muscles significantly decreased (p < 0.05). The subjective Borg-ratings also favored the tilted table with significantly lower ratings. However, the tilted table required on average 7.22 s more than the flat table to complete the transfer (p < 0.05). The slide board and plastic bag were associated with significantly lower Borg-ratings and EMG activities for most muscles than blanket sheet, but they both were not significantly different from each other. However, they each required approximately 5 s more than the blanket sheet method to complete the patient transfer (p < 0.05). By switching from flat + blanket sheet to tilted + slide board, EMG activities in all muscles decreased in the range of 18.4-72.3%, and Borg-ratings decreased from about 4 (somewhat difficult) to 1 (very light). The findings of this study propose simple, readily available ergonomic interventions for performing patient lateral transfers that can have significant implications for nurses' wellbeing and efficiency.

A Biomechanical Waist Comfort Model for Manual Material Lifting

Low back pain (LBP) is a common disorder that affects the working population worldwide. LBP causes more disability than any other conditions all around the world. Most existing studies focus on the occupational physical factors in association with LBP, while few focus on individual factors, especially the lack of quantitative calculation of waist comfort in biomechanics. Based on the physical statistics of Chinese men, this research used human posture analysis (HPA) to establish the waist strength formula and analyzed the waist strength during a manual material handling. It also explored the influence of weight and height of lifting objects on the L5-S1 spinal load. On this basis, a waist comfort model was proposed in combination with the recommended weight limit (RWL) recommended by NIOSH, and the parameter selection and waist comfort value were verified by Jack simulation software. The results show that pulling force of the Erector Spinae of the waist is closely related to the weight and lifting height of the object. Parameter verification and Jack software simulation results show that the force of L5-S1 is less than 3400 N, which proves that the waist force under this posture is acceptable. The developed waist comfort model can be applied to evaluate work risk, to adjust working intensity and powered exoskeleton design, aiming to decrease the prevalence of LBP.

Sex differences in upper limb musculoskeletal biomechanics during a lifting task

Women experience higher prevalence of work-related upper limb musculoskeletal disorders compared to men. Previous studies have investigated the biological, kinematic and electromyographic sex-related differences during a lifting task but the actual differences in musculoskeletal loads remain unknown. We investigated the sex differences in three musculoskeletal indicators: the sum of muscle activations, the sum of muscle forces and the relative time spent beyond a shear-compression dislocation ratio. A musculoskeletal model was scaled on 20 women and 20 men lifting a 6 or 12kg box from hip to eye level. Women generated more muscle forces and activations than men, regardless of the lifted mass. Those differences occurred when the box was above shoulder level. In addition, women might spend more time beyond a shear-compression dislocation ratio. Our work suggests higher musculoskeletal loads among women compared to men during a lifting task, which could be the result of poor technique and strength difference.

Analysing the effect of wearable lift-assist vest in squat lifting task using back muscle EMG data and musculoskeletal model

The most common disorders of the musculoskeletal system are low back disorders. They cause significant direct and indirect costs to different societies especially in lifting occupations. To reduce the risk of low back disorders, mechanical lifting aids have been used to decrease low back muscle forces. But there are very few direct ways to calculate muscle forces and examine the effect of personal lift-assist devices, so biomechanical models ought to be used to examine the quality of these devices for assisting back muscles in lifting tasks. The purpose of this study is to examine the effect of a designed wearable lift-assist vest (WLAV) in the reduction of erector spinae muscle forces during symmetric squat lifting tasks. Two techniques of muscle calculation were used, the electromyography-based method and the optimization-based model. The first uses electromyography data of erector spinae muscles and its linear relationship with muscle force to estimate their forces, and the second uses a developed musculoskeletal model to calculate back muscle forces using an optimization-based method. The results show that these techniques reduce the average value of erector spinae muscle forces by 45.38 (± 4.80) % and 42.03 (± 8.24) % respectively. Also, both methods indicated approximately the same behaviour in changing muscle forces during 10 to 60 degrees of trunk flexion using WLAV. The use of WLAV can help to reduce the activity of low back muscles in lifting tasks by transferring the external load effect to the assistive spring system utilized in it, so this device may help people lift for longer.

Workers' biomechanical loads and kinematics during multiple-task manual material handling

This study investigated the biomechanical loads and kinematics of workers during multiple-task manual material handling (MMH) jobs, and developed prediction models for the moments acting on a worker's body and their peak joint angles. An experiment was conducted in which 20 subjects performed a total of 3780 repetitions of a box-conveying task. This task included continuous sequential removing, carrying and depositing of boxes weighing 2-12 kg. The subjects' motion was captured using motion-capture technology. The origin/destination height was the most influencing predictor of the spinal and shoulder moments and the peak trunk, shoulder and knee angles. The relationship between the origin/destination heights and the above parameters was nonlinear. The mass of the box, and the subject's height and mass, also influenced the spinal and shoulder moments. A tradeoff between the moments acting on the L5/S1 vertebrae and on the shoulder joint was found. Compared to the models developed in similar studies that focused on manual material handling (albeit under different conditions), the high-order prediction equation for peak spinal moment formulated in the present study was found to explain between 10% and 48% more variability in the moments. This suggests that using a high-order equation in future studies might improve the prediction.

Is deep squat movement strategy related to floor-to-waist height lifting strategy: implications for physical employment testing

Generalised predictive tests may be viable screening tools to evaluate job candidate workability if movement strategy used in assessment is consistent with movement strategy used in work. This study investigated if deep squat (DS) kinematics could predict floor-to-waist height lifting kinematics. Participants performed three DS repetitions, and 10 lifts of both a 10 kg and 20 kg box. Whole body kinematics were collected to calculate knee, hip and low back angles, and coordination as measured by relative phase angles. Movement features of lower extremity control, including knee and hip angles and coordination, were significantly correlated (r = 0.43-0.85) between the DS and lifting. However, low back movement features, measures linked to injury risk, were not significantly correlated between the DS and lifting. These findings do not support the DS as a suitable movement screen to predict lifting strategy, specifically when considering low back control. Practitioner summary: This study investigated whether lifting strategy could be inferred from deep squat performance. Knee and hip movement strategies were associated between the deep squat and lifting. However, inconsistencies in low back control between the deep squat and lifting limit the deep squat's injury risk assessment potential.

Sex-dependent differences in lumbo-pelvic coordination for different lifting tasks: A study on asymptomatic adults

During manual material lifting, the sagittal motion is mainly characterized through the lumbo-pelvic coordination, which is quantified by the ratio between the lumbar and hip rotations (L/P ratio). Alteration in the L/P ratio is an important indicator for low back pain (LBP). Previous studies demonstrated sex-dependent differences in LBP prevalence during lifting activities. However, the sex-dependent differences in the L/P ratio during different lifting tasks has to data not been investigated. An optoelectronic system was used to measure the sagittal lumbo-pelvic motion in 10 males and 10 females. Task A was lifting one weight from the ground in front of the body to three target heights with straight knees (A1-3: abdomen, chest and head levels, respectively). Task B was lifting two identical weights from the ground at the sides of the body to three target angles with bended knees (B1-3: arms close and 45° and 90° abducted to the trunk, respectively). Lifts of 10 kg (males and females) and 20 kg (males only) were performed and three phases were investigated: Phase 1 - pure flexion without load, Phase 2 - lifting up weights, Phase 3 - lowering down weights. Females generally displayed a smaller L/P ratio than males. In Phases 2 and 3, the L/P ratio was greater than in Phase 1 for Tasks A and B. The L/P ratio increased with a greater lifting height for Task B, but displayed no difference neither between lifting 10 kg and 20 kg, nor between weight lifting and lowering for both tasks. These results can provide indications for sex-specific recommendations for safer lifting activities.

Differences in spinal moments, kinematics and pace during single-task and combined manual material handling jobs

This study compared the spinal moments (i.e., peak and cumulative moments acting on the L5/S1 joint), kinematics (i.e., peak trunk and knee angles) and work pace of workers, when either removing a box from a shelf or depositing a box on a shelf, under two conditions: as a single task or as part of a combined task. An experiment was conducted, in which the subjects performed the tasks and were recorded using a motion capture system. An automated program was developed to process the motion capture data. The results showed that, when the removing and depositing tasks were performed as part of a combined task (rather than as single tasks), subjects experienced smaller peak and cumulative spinal moments and they performed the tasks faster. The results suggest that investigations into the separate tasks that comprise a combination have a limited ability to predict kinematics and kinetics during the combined job.

Effect of Ambient Oxygen Content, Safety Shoe Type, and Lifting Frequency on Subject's MAWL and Physiological Responses

OBJECTIVE

The purpose of this study was to evaluate the lifting capabilities of individuals in hypoxia when they wear different types of safety shoes and to investigate the behavior of the physiological responses induced by the lifting process associated with those variables.

METHODS

An experimental design was used, based on two sessions. The first was training and acclimatization session, then an experimental lifting phase. A total of ten male students of King Saud University were recruited in the study. A four-way repeated measures design, with four independent variables and six dependent variables, was used in this research. The independent variables that were studied in the experimental lifting phase were: ambient oxygen content (15%, 18%, and 21%), safety shoes type (light-duty, medium-duty, and heavy-duty), lifting frequency (1 and 4 lifts/min), and replication (first and second trials). The dependent variables were also: maximum acceptable weights lifting using the psychophysical technique, heart rate (HR), electromyography (EMG) of (biceps brachii, trapezius, anterior deltoid, and erector spinae), safety shoes discomfort rating, rating of perceived exertion, and ambient oxygen discomfort rating.

RESULTS

The maximum acceptable weights lifting that were selected by participants at lower levels of the independent variables (ambient oxygen content 21%, lifting frequency 1 lift/min, and first replication) were significantly higher than at high levels of the independent variables (ambient oxygen content 15%, lifting frequency 4 lift/min, and second replication). Several interaction effects were also significant.

CONCLUSIONS

It provides evidence that the ambient oxygen content increases the intensity of workload in lifting tasks. It showed that oxygen content affects the psychophysical selection of maximum acceptable weights lifting and the physiological responses represented in muscular activities and heart rate. It suggests that ambient oxygen content must be considered along with the type of safety shoes worn when the lifting task at altitudes occurs.

Sex differences in glenohumeral muscle activation and coactivation during a box lifting task

Manual material handling is associated with shoulder musculoskeletal disorders, especially for women. Sex differences in glenohumeral muscle activity may contribute to women's higher injury risk by affecting shoulder load and stability. We assessed the effects of sex (25 women vs 26 men) and lifting load (6 kg vs 12 kg) on muscle activation during box lifting from hip to eye level. Surface and intramuscular electromyography were recorded from 10 glenohumeral muscles. Most muscles were more activated for the heavier box and for women. These effects were larger for 'prime movers' than for stabilisers and antagonists. Despite their apparently heterogeneous effects on muscle activity, sex and mass did not affect Muscle Focus, a metric of coactivation. This may be partly related to the limited sensitivity of the Muscle Focus. Nevertheless, sex differences in strength, more than in coactivation patterns, may contribute to the sex imbalance in the prevalence of musculoskeletal disorders. Practitioner summary: We studied sex differences in glenohumeral muscle activity in a lifting task to eye level. Women lifting a 6-kg box activated their muscles similarly to men lifting a 12-kg box, i.e. up to 48% of their maximum capacity. Interventions minimising shoulder load should be implemented, especially for women. Abbreviations: BB: biceps brachii; DeltA: anterior deltoid; DeltL: lateral deltoid; DeltP: posterior deltoid; DoF: degrees of freedom; ED: effect duration; EMG: electromyography; ES: effect size; Infra: infraspinatus; Lat: latissimus dorsi; MF: muscle focus; MMH: manual material handling; MVA: maximal voluntary activation; Pect: pectoralis major; Subscap: subscapularis; Supra: supraspinatus; TB: triceps brachii.

Squat Lifting Imposes Higher Peak Joint and Muscle Loading Compared to Stoop Lifting

(1) Background: Yearly, more than 40% of the European employees suffer from work-related musculoskeletal disorders. Still, ergonomic guidelines defining optimal lifting techniques to decrease work-related musculoskeletal disorders (WMSDs) has not been unambiguously defined. Therefore, this study investigates if recommended squat lifting imposes lower musculoskeletal loading than stoop lifting while using a complex full body musculoskeletal OpenSim model. (2) Methods: Ten healthy participants lifted two different weights using both lifting techniques. 3D marker trajectories and ground reaction forces were used as input to calculate joint angles, moments and power using a full body musculoskeletal model with articulated lumbar spine. In addition, the muscle activity of nine different muscles was measured to investigate muscle effort when lifting. (3) Results: Peak moments and peak joint power in L5S1 were not different between the squat and the stoop, but higher peak moments and peak power in the hip, knee, elbow and shoulder were found during squat lifting. Moment impulses in L5S1 were higher during stoop lifting. This is reflected in higher peak electromyography (EMG) but lower muscle effort in prior described muscles during the squat. (4) Conclusions: Squat lifting imposes higher peak full body musculoskeletal loading but similar low back loading compared to stoop lifting, as reflected in peak moments, peak power, and peak EMG.

Effects of workers' Body Mass Index and task conditions on exertion psychophysics during Vertical Handling Tasks

BACKGROUND

Obesity prevalence in the workforce is clearly increasing. Simultaneously, manual lifting/lowering loads, referred to as Vertical Handling Tasks (VHT) in this paper, are common in industries and services. Performing VHT exposes workers to physical overload, which can be measured using a psychophysical approach. Various risk factors can increase this overload, including individual factors such as workers' Body Mass Index (BMI).

OBJECTIVE

To study the possible effects of workers' BMI and some task conditions on physical overload during VHT.

METHODS

Psychophysical data were collected from 51 participants having different body constitutions (including non-obese, overweight and obese). The participants performed 6 VHT (3 different loads ×2 workstation configurations), during which they lifted and lowered a test-box between their knees and shoulders. For each task, they reported their perceived exertion using the Borg Category Ratio-10 (CR-10) scale.

RESULTS

The results showed that the CR-10 scale is sensitive to the variation of the task conditions tested. However, the psychophysical data pointed to a tendency to decrease the perception of physical overload as workers' BMI increases.

CONCLUSIONS

This may compromise the validity of the application of psychophysical data as an ergonomic approach for Work-Related Musculoskeletal Disorders (WRMSD) prevention in obese workers.

Sex differences in upper limb 3D joint contributions during a lifting task

Sex-related differences in work technique may contribute to increasing the risk of musculoskeletal joint disorders among women. In lifting tasks, sex differences have been reported for the trunk and lower limb, although women present a higher prevalence of shoulder disorders. We investigated sex differences in the upper limb technique during a lifting task. Trunk and upper limb kinematics were recorded in 27 women and 27 men lifting a box (6 or 12 kg) from hip to eye level. Work technique was quantified through the three-dimensional contribution of each joint to overall box height. The glenohumeral joint showed a higher contribution in women with a 6 kg box and wrist and elbow joints did with a 12 kg box, compared to men at either 6 or 12 kg. Sex differences occurred systematically above shoulder level. Our results argue for careful consideration of sex during ergonomic intervention, particularly during the overhead task. Practitioner Summary: We investigated the sex-related differences in upper limb technique during lifting tasks. Results highlight a sex-specific kinematic strategy above the shoulder level on the glenohumeral joint and on the wrist and elbow joints. To help reduce women's shoulder disorders in overhead task, ergonomic interventions should account for those differences. Abbreviations: DoF: degree-of-freedom; WR/EL: wrist and elbow; GH: glenohumeral; SC/AC: sternoclavicular and acromioclavicular; TR/PE: pelvo-thoracic.

A comparison of lumbar spine and muscle loading between male and female workers during box transfers

There is a clear relationship between lumbar spine loading and back musculoskeletal disorders in manual materials handling. The incidence of back disorders is greater in women than men, and for similar work demands females are functioning closer to their physiological limit. It is crucial to study loading on the spine musculoskeletal system with actual handlers, including females, to better understand the risk of back disorders. Extrapolation from biomechanical studies conducted on unexperienced subjects (mainly males) might not be applicable to actual female workers. For male workers, expertise changes the lumbar spine flexion, passive spine resistance, and active/passive muscle forces. However, experienced females select similar postures to those of novices when spine loading is critical. This study proposes that the techniques adopted by male experts, male novices, and females (with considerable experience but not categorized as experts) impact their lumbar spine musculoskeletal systems differently. Spinal loads, muscle forces, and passive resistance (muscle and ligamentous spine) were predicted by a multi-joint EMG-assisted optimization musculoskeletal model of the lumbar spine. Expert males flexed their lumbar spine less (avg. 21.9° vs 30.3-31.7°) and showed decreased passive internal moments (muscle avg. 8.9% vs 15.9-16.0%; spine avg. 4.7% vs 7.1-7.8%) and increased active internal moments (avg. 72.9% vs 62.0-63.9%), thus producing a different impact on their lumbar spine musculoskeletal systems. Experienced females sustained the highest relative spine loads (compression avg. 7.3 N/BW vs 6.2-6.4 N/BW; shear avg. 2.3 N/BW vs 1.7-1.8 N/BW) in addition to passive muscle and ligamentous spine resistance similar to novices. Combined with smaller body size, less strength, and the sequential lifting technique used by females, this could potentially mean greater risk of back injury. Workers should be trained early to limit excessive and repetitive stretching of their lumbar spine passive tissues.

Spasm and flexion-relaxation phenomenon response to large lifting load during the performance of a trunk flexion-extension exercise

BACKGROUND

The flexion relaxation phenomenon (FRP) has been widely investigated. Nevertheless, no study has been reported on the FRP as well as spasm response to large lifting load. The aim of this study was to evaluate the effect of large lifting load on the FRP response and spasm during execution of a flexion-extension exercise.

METHODS

Twenty-two healthy male university students without low back pain history participated this study. Subjects randomly performed three trials of trunk flexion-extension cycles of 5 s flexion and 5 s extension in each of 4 conditions (three large lifting loads of 15, 20 and 25 kg and one lifting load of 0 kg for comparison). Surface EMG from bilateral erector spinae was recorded during the performance of a trunk anterior flexion-extension exercise. The relaxation phase was determined through the onset of electromyography (EMG) signals. Spasm was evaluated in the relaxation period. The mean normalized electromyography (NEMG) was derived from the raw EMG.

RESULTS

Spasm was observed in more than 45% of the individuals and the intensity of muscle activation was increased by more than 78% in the relaxation phase.

CONCLUSIONS

A large lifting load could lead to a high prevalence of spasms as well as a high intensity of muscle activations on erector spinae muscle in the relaxation period, which may be associated with the development of low back disorder during the performance of a flexion-extension exercise.

Continuous ambulatory hand force monitoring during manual materials handling using instrumented force shoes and an inertial motion capture suit

Hand forces (HFs) are commonly measured during biomechanical assessment of manual materials handling; however, it is often a challenge to directly measure HFs in field studies. Therefore, in a previous study we proposed a HF estimation method based on ground reaction forces (GRFs) and body segment accelerations and tested it with laboratory equipment: GFRs were measured with force plates (FPs) and segment accelerations were measured using optical motion capture (OMC). In the current study, we evaluated the HF estimation method based on an ambulatory measurement system, consisting of inertial motion capture (IMC) and instrumented force shoes (FSs). Sixteen participants lifted and carried a 10-kg crate from ground level while 3D full-body kinematics were measured using OMC and IMC, and 3D GRFs were measured using FPs and FSs. We estimated 3D hand force vectors based on: (1) FP+OMC, (2) FP+IMC and (3) FS+IMC. We calculated the root-mean-square differences (RMSDs) between the estimated HFs to reference HFs calculated based on crate kinematics and the GRFs of a FP that the crate was lifted from. Averaged over subjects and across 3D force directions, the HF RMSD ranged between 10-15N when using the laboratory equipment (FP + OMC), 11-18N when using the IMC instead of OMC data (FP+IMC), and 17-21N when using the FSs in combination with IMC (FS + IMC). This error is regarded acceptable for the assessment of spinal loading during manual lifting, as it would results in less than 5% error in peak moment estimates.