Control of trunk motion following sudden stop perturbations during cart pushing

Manual material handling in the Tehran Grand Bazaar, a type of traditional heavy work with musculoskeletal effects

BACKGROUND

Manual Material Handling (MMH) is a type of heavy work that causes a wide variety of musculoskeletal disorders (MSDs). Porters constitute a poor socioeconomic group of workers who are faced with these risk factors. This study focuses on porters who push and pull loads of goods on handcarts inside and outside the Tehran Grand Bazaar.

OBJECTIVES

This study was conducted to investigate the prevalence of MSDs in porters of the Tehran Grand Bazaar.

METHODS

Based on official registries, more than 5000 porters work in the Tehran Grand Bazaar. In total, 398 porters were selected using the simple random sampling method. The prevalence of MSDs was assessed using the Standardized Nordic Questionnaire for the Analysis of Musculoskeletal Symptoms. The tasks of the porters were analyzed during walk-through surveys in the Tehran Grand Bazaar.

RESULTS

The prevalence of MSDs in at least one body part was 53.8% in the last 12 months and 45.2% in the last 7 days. The most prevalent symptoms in the last 12 months were low-back pain (29.6%) and knee pain (19.6%). Symptoms were associated with age, height, weight, waist circumference, work duration, number of children, and manually handling goods heavier than 20 kg.

CONCLUSIONS

The prevalence of MSDs is high in the porters of the Tehran Grand Bazaar, likely due to heavy MMH.

Are pushing and pulling work-related risk factors for upper extremity symptoms? A systematic review of observational studies

Systematically review observational studies concerning the question whether workers that perform pushing/pulling activities have an increased risk for upper extremity symptoms as compared to workers that perform no pushing/pulling activities. A search in MEDLINE via PubMed and EMBASE was performed with work-related search terms combined with push/pushing/pull/pulling. Studies had to examine exposure to pushing/pulling in relation to upper extremity symptoms. Two authors performed the literature selection and assessment of the risk of bias in the studies independently. A best evidence synthesis was used to draw conclusions in terms of strong, moderate or conflicting/insufficient evidence. The search resulted in 4764 studies. Seven studies were included, with three of them of low risk of bias, in total including 8279 participants. A positive significant relationship with upper extremity symptoms was observed in all four prospective cohort studies with effect sizes varying between 1.5 and 4.9. Two out of the three remaining studies also reported a positive association with upper extremity symptoms. In addition, significant positive associations with neck/shoulder symptoms were found in two prospective cohort studies with effect sizes of 1.5 and 1.6, and with shoulder symptoms in one of two cross-sectional studies with an effect size of 2.1. There is strong evidence that pushing/pulling is related to upper extremity symptoms, specifically for shoulder symptoms. There is insufficient or conflicting evidence that pushing/pulling is related to (combinations of) upper arm, elbow, forearm, wrist or hand symptoms.

Effectiveness of powered hospital bed movers for reducing physiological strain and back muscle activation

Battery powered bed movers are becoming increasingly common within the hospital setting. The use of powered bed movers is believed to result in reduced physical efforts required by health care workers, which may be associated with a decreased risk of occupation related injuries. However, little work has been conducted assessing how powered bed movers impact on levels of physiological strain and muscle activation for the user. The muscular efforts associated with moving hospital beds using three different methods; powered StaminaLift Bed Mover (PBM1), powered Gzunda Bed Mover (PBM2) and manual pushing were measured on six male subjects. Fourteen muscles were assessed moving a weighted hospital bed along a standardized route in an Australian hospital environment. Trunk inclination and upper spine acceleration were also quantified. Powered bed movers exhibited significantly lower muscle activation levels than manual pushing for the majority of muscles. When using the PBM1, users adopted a more upright posture which was maintained while performing different tasks (e.g. turning a corner, entering a lift), while trunk inclination varied considerably for manual pushing and the PBM2. The reduction in lower back muscular activation levels may result in lower incidence of lower back injury.

Description and analysis of hand forces in medicine cart pushing tasks

The primary objectives of this study were to describe and analyze the hand force exertion patterns of experienced nursing home nurses and nursing students during dynamic medicine cart pushing tasks in Initial, Sustained, Turning, and Stopping motion phases. A 2 × 2 × 2 factorial experiment was conducted with 22 participants to estimate the effects of lane congestion, precision cart control, and floor surface on horizontal hand forces. Root mean squared (RMS) lane deviation patterns were also described to provide an indicator of cart handling difficulty across the different study conditions. Descriptive statistics revealed that nurses exerted greater mean hand force (10%) and made more (12%) lane deviation than students and that the highest two-hand forces of 147N were measured in the Turning phase on carpet. Strong correlations between work experience group, body mass, and BMI required that force data for nurses and students be collapsed in analytical models where no group differences existed. Predicted pushing forces on carpeted floor surface were significantly greater than on tile in Initial (14N), Sustained (14N) and Turning (18N), except in stopping where pulling forces were 37N lower. High lane congestion predicted significant peak force increases of 4N and 7N in Sustained and Turning, respectively, but decreased by 20N in Initial. High precision control led to significant decreases in two-hand forces that ranged from 4 to 20N across motion phases. Complex interactions among the experimental factors suggest that work environment (lane congestion and floor surface) and work demands (precision control) should be included in the evaluation of pushing tasks and considered prior to making renovations to nursing home environments.

Trunk muscle control in response to (un)expected turns in cart pushing

Before altering the travel direction in normal gait, anticipatory activation in trunk muscles is observed, followed by a top-down sequence of rotation of body segments. Turning while pushing a cart is a more challenging task for the trunk because of its low stiffness in pushing while walking and the interaction with the high inertia of the cart. 12 healthy subjects pushed a 200 kg cart at shoulder and hip height while making turns (gradual, sharp and unexpected sharp). The normalized electromyogram amplitudes of left (right) lateral and anterior external oblique muscle, and right (left) internal oblique muscle were averaged to represent left (right) trunk rotator muscle activity. The baseline values of trunk rotator muscle activity before the turn and the peak values after the turn were determined. Additionally, peak values of hand forces, twisting moments and twisting motions were assessed. Before turning, higher trunk rotator muscle activity than in straight pushing without turning was only observed before making a turn in the gradual or sharp turn conditions. After the turn, clockwise twisting motion was associated with a clockwise twisting moment induced by the reaction forces at the left hand. Anticipatory activation was initially absent in the unexpected sharp turn, while bilateral trunk rotator muscle activity increased after the turn, indicating co-contraction. In the unexpected turn condition the combination of an uncontrolled twisting motion with delayed muscle activation may increase the potential risk of low-back injury.

Handle height and expectation of cart movement affect the control of trunk motion at movement onset in cart pushing

As unexpected sudden unloading of the trunk may cause low-back injury, the objective of the present study was to investigate whether handle height and the expectation of cart movement in pushing affect trunk control at movement onset. Eleven healthy male participants pushed a 200-kg cart with handles at shoulder and hip heights. The cart would suddenly move when externally released (externally triggered condition) or when static friction was overcome (self-initiated condition). Before self-initiated cart movement, trunk stiffness and muscle activity were significantly higher than before an externally triggered onset at comparable pushing force. Lower muscle activity and trunk stiffness at shoulder height compared with the hip height before the onset resulted in higher trunk inclination after the onset. In conclusion, higher preparatory activation of trunk muscles serves to increase trunk stiffness in anticipation of cart movement and may reduce the impact of the perturbation associated with the onset of cart movement. STATEMENT OF RELEVANCE: Sudden cart movement in pushing causes an unexpected unloading perturbation to the trunk. This perturbation was shown to cause uncontrolled trunk movement, which may explain how pushing tasks can be associated with low-back injury. Effects of handle height and awareness of the subjects of the possible cart movement suggest directions for prevention.