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Armstrong DP, Beach TAC, Fischer SL. Quantifying how functional and structural personal factors influence biomechanical exposures in paramedic lifting tasks. ERGONOMICS 2024; 67:925-940. [PMID: 37830870 DOI: 10.1080/00140139.2023.2270728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
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.
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Affiliation(s)
- Daniel P Armstrong
- Department of Kinesiology, Faculty of Health Sciences, University of Waterloo, Waterloo, Canada
| | - Tyson A C Beach
- Department of Kinesiology, Faculty of Health Sciences, University of Waterloo, Waterloo, Canada
| | - Steven L Fischer
- Department of Kinesiology, Faculty of Health Sciences, University of Waterloo, Waterloo, Canada
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2
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Schrøder Jakobsen L, Samani A, Desbrosses K, de Zee M, Madeleine P. In-Field Training of a Passive Back Exoskeleton Changes the Biomechanics of Logistic Workers. IISE Trans Occup Ergon Hum Factors 2024:1-13. [PMID: 38869954 DOI: 10.1080/24725838.2024.2359371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/21/2024] [Indexed: 06/15/2024]
Abstract
OCCUPATIONAL APPLICATIONSOccupational exoskeletons receive rising interest in industry as these devices diminish the biomechanical load during manual materials handling. Still, we have limited knowledge when it comes to in-field use. This gap often contributes to failure in the implementation of exoskeleton in industry. In this study, we investigated how a training protocol consisting of in-field use of a passive back exoskeleton affected the biomechanics of logistic workers. More specifically, we focused on how the variation of the muscular and kinematic patterns of the user was altered after exoskeleton training. We found that training had a positive effect on exoskeleton use, as a relative decrease of 6-9% in peak back muscle activity was observed post-training. Additionally, training decreased knee flexion by 6°-16°, indicating a more stoop lifting technique. The findings point at the potential benefits of applying a training approach when implementing a back-supporting exoskeleton in logistics.
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Affiliation(s)
- Lasse Schrøder Jakobsen
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Afshin Samani
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Kevin Desbrosses
- INRS, French National Research and Safety Institute for the Prevention of Occupational Accidents and Diseases, Nancy, France
| | - Mark de Zee
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Pascal Madeleine
- ExerciseTech, Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
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Reneman MF, Coenen P, Kuijer PPFM, van Dieën JH, Holtemann A, Igwesi-Chidobe CN, Parker R, Reezigt R, Stochkendahl MJ, Hoegh M. Tensions of Low-Back Pain and Lifting; Bridging Clinical Low-Back Pain and Occupational Lifting Guidelines. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10210-1. [PMID: 38842652 DOI: 10.1007/s10926-024-10210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Michiel F Reneman
- Department of Rehabilitation / Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Societal Participation and Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Musculoskeletal Health, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Netherlands Center for Occupational Diseases, People and Work Outpatient Clinic, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andreas Holtemann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Chinonso Nwamaka Igwesi-Chidobe
- School of Allied Health Professions and Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Romy Parker
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Roland Reezigt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences-Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physiotherapy, Academy of Health, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Mette J Stochkendahl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Morten Hoegh
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Quirk DA, Chung J, Applegate M, Cherin JM, Dalton DM, Awad LN, Walsh CJ. Evaluating adaptiveness of an active back exosuit for dynamic lifting and maximum range of motion. ERGONOMICS 2024; 67:660-673. [PMID: 37482538 PMCID: PMC10803634 DOI: 10.1080/00140139.2023.2240044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
Back exosuits deliver mechanical assistance to reduce the risk of back injury, however, minimising restriction is critical for adoption. We developed the adaptive impedance controller to minimise restriction while maintaining assistance by modulating impedance based on the user's movement direction and nonlinear sine curves. The objective of this study was to compare active assistance, delivered by a back exosuit via our adaptive impedance controller, to three levels of assistance from passive elastics. Fifteen participants completed five experimental blocks (4 exosuits and 1 no-suit) consisting of a maximum flexion and a constrained lifting task. While a higher stiffness elastic reduced back extensor muscle activity by 13%, it restricted maximum range of motion (RoM) by 13°. The adaptive impedance approach did not restrict RoM while reducing back extensor muscle activity by 15%, when lifting. This study highlights an adaptive impedance approach might improve usability by circumventing the assistance-restriction trade-off inherent to passive approaches.Practitioner summary: This study demonstrates a soft active exosuit that delivers assistance with an adaptive impedance approach can provide reductions in overall back muscle activity without the impacts of restricted range of motion or perception of restriction and discomfort.
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Affiliation(s)
- D. Adam Quirk
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Jinwon Chung
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Megan Applegate
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Jason M Cherin
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
| | - Diane M. Dalton
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA
| | - Lou N. Awad
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA
| | - Conor J. Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
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Dehghan P, Arjmand N. The National Institute for Occupational Safety and Health (NIOSH) Recommended Weight Generates Different Spine Loads in Load-Handling Activity Performed Using Stoop, Semi-squat and Full-Squat Techniques; a Full-Body Musculoskeletal Model Study. HUMAN FACTORS 2024; 66:1387-1398. [PMID: 36433743 DOI: 10.1177/00187208221141652] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Adequacy of the Revised NIOSH Lifting Equation (RNLE) in maintaining lumbosacral (L5-S1) loads below their recommended action limits in stoop, full-squat, and semi-squat load-handling activities was investigated using a full-body musculoskeletal model. BACKGROUND The NIOSH committee did not consider the lifting technique adapted by workers when estimating the recommended weight limit (RWL). It is currently unknown whether the lifting technique adapted by workers would affect the competence of the RNLE in keeping spine loads below their recommended limits. METHOD A full-body subject-specific musculoskeletal model (Anybody Modeling System, AMS) driven by a 10-camera Vicon motion capture system (Vicon Motion Systems Inc., Oxford, UK) was used to simulate different static stoop, semi-squat, and full-squat load-handling activities of ten normal-weight volunteers (mean of ∼70 kg corresponding to the 15th percentile of adult American males) with the task-specific NIOSH RWL held in hands. RESULTS Two-way repeated measures ANOVA revealed a significant effect of lifting technique on both the L5-S1 compression (p = 0.003) and shear (p = 0.004) loads with semi-squat technique resulting in significantly larger loads than both stoop and full-squat techniques (p < 0.05). While mean of L5-S1 loads remained smaller than their recommended limits, it is much expected that they pass these limits for heavier individuals, that is, for the 50th percentile of adult American males. CONCLUSION Spinal loads are expected to pass their recommended limits for heavier individuals especially during semi-squat lifting as the most frequently adapted technique by workers. APPLICATION Caution is required for the assessment of semi-squat lifting activities by the RNLE.
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Affiliation(s)
- Parisa Dehghan
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Navid Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Armstrong DP, Davidson JB, Fischer SL. Determining whether biomechanical variables that describe common 'safe lifting' cues are associated with low back loads. J Electromyogr Kinesiol 2024; 75:102867. [PMID: 38325138 DOI: 10.1016/j.jelekin.2024.102867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Lift technique training programs have been implemented to help reduce injury risk, but the underlying content validity of cues used within these programs is not clear. The objective of this study was to determine whether biomechanical variables, that commonly used lifting cues aim to elicit, are associated with resultant low back extensor moment exposures. A sample of 72 participants were recruited to perform 10 repetitions of a floor-to-waist height barbell lift while whole-body kinematics and ground reaction forces were collected. Kinematic, kinetic, and energetic variables representative of characteristics commonly targeted by lifting cues were calculated as predictor variables, while peak and cumulative low back moments were calculated as dependent measures. Multiple regression revealed that 56.6-59.2% of variance in low back moments was explained by predictor variables. From these regression models, generating motion with the legs (both greater hip and knee work), minimizing the horizontal distance of the body to the load, maintaining a stable body position, and minimizing lift time were associated with lower magnitudes of low back moments. These data support that using cues targeting these identified variables may be more effective at reducing peak low back moment exposures via lift training.
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Affiliation(s)
- Daniel P Armstrong
- Department of Kinesiology, Faculty of Health Sciences, University of Waterloo, Waterloo, Canada
| | - Justin B Davidson
- Department of Kinesiology, Faculty of Health Sciences, University of Waterloo, Waterloo, Canada
| | - Steven L Fischer
- Department of Kinesiology, Faculty of Health Sciences, University of Waterloo, Waterloo, Canada.
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Brandl C, Bender A, Schmachtenberg T, Dymke J, Damm P. Comparing risk assessment methods for work-related musculoskeletal disorders with in vivo joint loads during manual materials handling. Sci Rep 2024; 14:6041. [PMID: 38472286 PMCID: PMC10933320 DOI: 10.1038/s41598-024-56580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
The validity of observational methods in ergonomics is still challenging research. Criterion validity in terms of concurrent validity is the most commonly studied. However, studies comparing observational methods with biomechanical values are rare. Thus, the aim of this study is to compare the Ovako Working Posture Analysing System (OWAS) and the Rapid Entire Body Assessment (REBA) with in vivo load measurements at hip, spine, and knee during stoop and squat lifting of 14 participants. The results reveal that OWAS and REBA action levels (AL) can distinguish between different in vivo load measurements during manual lifting. However, the results also reveal that the same OWAS- and REBA-AL do not necessarily provide equal mean values of in vivo load measurements. For example, resultant contact force in the vertebral body replacement for squat lifting ranged from 57% body weight (%BW) in OWAS-AL1 to 138%BW in OWAS-AL3 compared to 46%BW in REBA-AL0 and 173%BW in REBA-AL3. Furthermore, the results suggest that the performed squat lifting techniques had a higher risk for work-related musculoskeletal disorders than the performed stoop lifting techniques.
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Affiliation(s)
- Christopher Brandl
- Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Eilfschornsteinstr. 27, 52062, Aachen, Germany.
- Fraunhofer Institute for Communication, Information Processing and Ergonomics FKIE, Aachen, Germany.
| | - Alwina Bender
- Julius Wolff Institute of Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tim Schmachtenberg
- Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Eilfschornsteinstr. 27, 52062, Aachen, Germany
| | - Jörn Dymke
- Julius Wolff Institute of Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute of Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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Kendell M, Smith A, O'Sullivan P, Beales D, Chan J, Li KM, McMullan M, Smith K, Rabey M. How do people with chronic low back pain pick a pencil off the floor? Physiother Theory Pract 2024; 40:576-593. [PMID: 36066194 DOI: 10.1080/09593985.2022.2120374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Picking objects off the floor is provocative for people with chronic low back pain (CLBP). There are no clinically applicable methods evaluating movement strategies for this task. The relationship between strategy and multidimensional profiles is unknown. OBJECTIVE Develop a movement evaluation tool (MET) to examine movement strategies in people with CLBP (n = 289) picking a pencil off the floor. Describe those movement strategies, and determine reliability of the MET. Explore differences across multidimensional profiles and movement strategies. METHODS An MET was developed using literature and iterative processes, and its inter-rater agreement determined. Latent class analysis (LCA) derived classes demonstrating different strategies using six movement parameters as indicator variables. Differences between classes across multidimensional profiles were investigated using analysis of variance, Kruskal-Wallis, or chi-squared tests. RESULTS Six movement parameters were evaluated. There was substantial inter-rater agreement (Cohen's Kappa = 0.39-0.79) across parameters. LCA derived three classes with different strategies: Class 1 (71.8%) intermediate trunk inclination/knee flexion; Class 2 (24.5%) greater forward trunk inclination, lower knee flexion; Class 3 (3.7%) lower forward trunk inclination, greater knee flexion. Pain duration differed across all classes (p ≤ .001). Time taken to complete forward bends differed between Class 3 and other classes (p = .024). CONCLUSIONS Movement strategies can be reliably assessed using the MET. Three strategies for picking lightweight objects off the floor were derived, which differed across pain duration and speed of movement.
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Affiliation(s)
- Michelle Kendell
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Anne Smith
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Peter O'Sullivan
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Darren Beales
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Jonathan Chan
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Kun Man Li
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Matthew McMullan
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Kelby Smith
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Martin Rabey
- Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Gaffney BMM, Thomsen PB, Leijendekkers RA, Christiansen CL, Stoneback JW. Lumbopelvic movement coordination during walking improves with transfemoral bone anchored limbs: Implications for low back pain. Gait Posture 2024; 109:318-326. [PMID: 38432038 PMCID: PMC11015906 DOI: 10.1016/j.gaitpost.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/03/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Low back pain (LBP) is more prevalent in patients with transfemoral amputation using socket prostheses than able-bodied individuals, in part due to altered spinal loading caused by aberrant lumbopelvic movement patterns. Early evidence surrounding bone-anchored limb functional outcomes is promising, yet it remains unknown if this novel prosthesis influences LBP or movement patterns known to increase its risk. RESEARCH QUESTION How are self-reported measures of LBP and lumbopelvic movement coordination patterns altered when using a unilateral transfemoral bone-anchored limb compared to a socket prosthesis? METHODS Fourteen patients with unilateral transfemoral amputation scheduled to undergo intramedullary hardware implantation for bone-anchored limbs due to failed socket use were enrolled in this longitudinal observational cohort study (7 F/7 M, Age: 50.2±12.0 years). The modified Oswestry Disability Index (mODI) (self-reported questionnaire) and whole-body motion capture during overground walking were collected before (with socket prosthesis) and 12-months following bone-anchored limb implantation. Lumbopelvic total range of motion (ROM) and continuous relative phase (CRP) segment angles were calculated during 10 bilateral gait cycles. mODI, total ROM, CRP and CRP variabilities were compared between time points. RESULTS mODI scores were significantly reduced 12-months after intramedullary hardware implantation for the bone-anchored limb (P = 0.013). Sagittal plane trunk and pelvis total ROM during gait were reduced after implantation (P = 0.001 and P < 0.001, respectively). CRP values were increased (more anti-phase) in the sagittal plane during single limb stance and reduced (more in-phase) in the transverse plane during pre-swing of the amputated limb gait cycle (P << 0.001 and P = 0.029, respectively). No differences in CRP values were found in the frontal plane. SIGNIFICANCE Decreases in mODI scores and lumbopelvic ROM, paired with the changes in lumbopelvic coordination, indicate that bone-anchored limbs may reduce LBP symptoms and reduce compensatory movement patterns for people with unilateral transfemoral amputation.
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Affiliation(s)
- Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States; Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; University of Colorado Bone-Anchored Limb Research Group, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; VA Eastern Colorado Healthcare System, Aurora, CO, United States.
| | - Peter B Thomsen
- University of Colorado Bone-Anchored Limb Research Group, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; VA Eastern Colorado Healthcare System, Aurora, CO, United States; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ruud A Leijendekkers
- Orthopedic research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cory L Christiansen
- University of Colorado Bone-Anchored Limb Research Group, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; VA Eastern Colorado Healthcare System, Aurora, CO, United States; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jason W Stoneback
- University of Colorado Bone-Anchored Limb Research Group, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Banks JJ, Quirk DA, Chung J, Cherin JM, Walsh CJ, Anderson DE. The effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading during squat and stoop lifts. ERGONOMICS 2024:1-14. [PMID: 38389220 DOI: 10.1080/00140139.2024.2320355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
Back support exosuits aim to reduce tissue demands and thereby risk of injury and pain. However, biomechanical analyses of soft active exosuit designs have been limited. The objective of this study was to evaluate the effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading in participants performing stoop and squat lifts of 6 and 10 kg crates, using participant-specific musculoskeletal models. The exosuit did not change overall trunk motion but affected lumbo-pelvic motion slightly, and reduced peak compressive and shear vertebral loads at some levels, although shear increased slightly at others. This study indicates that soft active exosuits have limited kinematic effects during lifting, and can reduce spinal loading depending on the vertebral level. These results support the hypothesis that a soft exosuit can assist without limiting trunk movement or negatively impacting skeletal loading and have implications for future design and ergonomic intervention efforts.
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Affiliation(s)
- Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - David A Quirk
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Jinwon Chung
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Jason M Cherin
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Conor J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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Phan TC, Pranata A, Farragher J, Bryant A, Nguyen HT, Chai R. Regression-Based Machine Learning for Predicting Lifting Movement Pattern Change in People with Low Back Pain. SENSORS (BASEL, SWITZERLAND) 2024; 24:1337. [PMID: 38400495 PMCID: PMC10891548 DOI: 10.3390/s24041337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
Machine learning (ML) algorithms are crucial within the realm of healthcare applications. However, a comprehensive assessment of the effectiveness of regression algorithms in predicting alterations in lifting movement patterns has not been conducted. This research represents a pilot investigation using regression-based machine learning techniques to forecast alterations in trunk, hip, and knee movements subsequent to a 12-week strength training for people who have low back pain (LBP). The system uses a feature extraction algorithm to calculate the range of motion in the sagittal plane for the knee, trunk, and hip and 12 different regression machine learning algorithms. The results show that Ensemble Tree with LSBoost demonstrated the utmost accuracy in prognosticating trunk movement. Meanwhile, the Ensemble Tree approach, specifically LSBoost, exhibited the highest predictive precision for hip movement. The Gaussian regression with the kernel chosen as exponential returned the highest prediction accuracy for knee movement. These regression models hold the potential to significantly enhance the precision of visualisation of the treatment output for individuals afflicted with LBP.
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Affiliation(s)
- Trung C. Phan
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (T.C.P.); (A.P.); (H.T.N.)
| | - Adrian Pranata
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (T.C.P.); (A.P.); (H.T.N.)
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China;
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3000, Australia
| | - Joshua Farragher
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China;
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3000, Australia
| | - Adam Bryant
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Hung T. Nguyen
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (T.C.P.); (A.P.); (H.T.N.)
| | - Rifai Chai
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (T.C.P.); (A.P.); (H.T.N.)
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Bangerter C, Faude O, Eichelberger P, Schwarzentrub A, Girardin M, Busch A, Hasler CC, Schmid S. Conventional video recordings dependably quantify whole-body lifting strategy using the Stoop-Squat-Index: A methods comparison against motion capture and a reliability study. J Biomech 2024; 164:111975. [PMID: 38320342 DOI: 10.1016/j.jbiomech.2024.111975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
Whole-body lifting strategies could be derived from conventional video recordings using the Stoop-Squat-Index, which quantifies the ratio between trunk forward lean and lower extremity joint flexion from 0 (full squat) to 100 (full stoop). The purpose of this study was to compare Stoop-Squat-Indices derived from conventional video recordings to those from a three-dimensional marker-based motion capture system and to evaluate interrater and intrarater reliability of the video-based approach. Thirty healthy participants lifted a 5-kg box under different conditions (freestyle, squat, stoop). Kinematic data were recorded using a Vicon motion capture system (serving as reference standard) and an iPad camera. Stoop-Squat-Indices over the entire lifting cycle were derived separately from both approaches. Agreement was assessed using mean differences (video minus motion capture) and limits of agreement. Reliability was investigated by calculating intraclass correlation coefficients (ICC) and minimal detectable changes (MDC) over the course of the lifting cycle. Systematic errors were identified with Statistical Parametric Mapping-based T-tests. Systematic errors between the video-based and the motion capture-based approach were observed among all conditions. Mean differences in Stoop-Squat-Indices over the lifting cycle ranged from -6.9 to 3.2 (freestyle), from -1.8 to 5.3 (squat) and from -2.8 to -1.1 (stoop). Limits of agreement were lower when the box was close to the floor, and higher towards upright standing. Reliability of the video-based approach was excellent for most of the lifting cycle, with ICC above 0.995 and MDC below 3.5. These findings support using a video-based assessment of Stoop-Squat-Indices to quantify whole-body lifting strategy in field.
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Affiliation(s)
- Christian Bangerter
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Patric Eichelberger
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Annina Schwarzentrub
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Milène Girardin
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Aglaja Busch
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Carol-Claudius Hasler
- Orthopaedic Department, University Children's Hospital of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Stefan Schmid
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
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Bender A, Schmidt H, Wellner DL, Duda GN, Brandl C, Damm P. In vivo load on knee, hip and spine during manual materials handling with two lifting techniques. J Biomech 2024; 163:111963. [PMID: 38286711 DOI: 10.1016/j.jbiomech.2024.111963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
It is generally accepted that the lifting technique strongly influences physical loads within the human body and, thus, the risk of musculoskeletal disorders. However, there is a lack of knowledge regarding whether particular lifting techniques are effective in reducing loads. Hence, this retrospective study quantified (partly published) in vivo loads at joints within the human body during two typical lifting techniques, stoop lifting and squat lifting. Patients who had received instrumented implants underwent in vivo load measurements at either the knee (two patients), the hip (eight patients), or the upper lumbar spine (four patients) while lifting a 10 kg weight frontally with either straight (stoop) or bent (squat) knees. Contact forces and moments and the orientation of the contact force vector were determined and examined using the paired t test of Statistical Parametric Mapping. The two lifting techniques did not differ in terms of load magnitudes but did differ in terms of directions: (i) at the hip joint, the load vector varied significantly (p < 0.05) in the frontal and sagittal planes, (ii) at the knee joint, the load vector differed significantly (p < 0.05) in the sagittal plane (iii) while the load vector and magnitude did not differ at the upper lumbar spine (p > 0.05). Our findings indicate that the lifting technique causes changes in the orientation rather than the magnitude of lower extremity joint contact loads. Even though this quantification could only be performed in a small group of patients, the quantification of the relevance of such lifting technique recommendations will hopefully guide future recommendations towards a more scientific interpretation.
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Affiliation(s)
- Alwina Bender
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany
| | - Hendrik Schmidt
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany
| | - Daniela L Wellner
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany
| | - Christopher Brandl
- Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Aachen, Germany; Fraunhofer Institute for Communication, Information Processing and Ergonomics FKIE, Aachen, Germany
| | - Philipp Damm
- Julius Wolff Institute, Berlin Institute of Health at Charité, Charité - Universitätsmedizin Berlin, Germany.
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Larson DJ, Brown SHM. Effects of trunk extensor muscle fatigue on repetitive lift (re)training using an augmented tactile feedback approach. ERGONOMICS 2023; 66:1919-1934. [PMID: 36636970 DOI: 10.1080/00140139.2023.2168769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
Augmented tactile and performance feedback has been used to (re)train a modified lifting technique to reduce lumbar spine flexion, which has been associated with low back disorder development during occupational repetitive lifting tasks. However, it remains unknown if the presence of trunk extensor neuromuscular fatigue influences learning of this modified lifting technique. Therefore, we compared the effectiveness of using augmented tactile and performance feedback to reduce lumbar spine flexion during a repetitive lifting task, in both unfatigued and fatigued states. Participants completed repetitive lifting tests immediately before and after training, and 1-week later, with half of the participants completing training after fatiguing their trunk extensor muscles. Both groups demonstrated learning of the modified lifting technique as demonstrated by increased thorax-pelvis coordination variability and reduced lumbar range of motion variability; however, experiencing trunk extensor neuromuscular fatigue during lift (re)training may have slight negative influences on learning the modified lifting technique. Practitioner summary: An augmented lift (re)training paradigm using tactile cueing and performance feedback regarding key movement features (i.e. lumbar spine flexion) can effectively (re)train a modified lifting technique to reduce lumbar flexion and redistribute motion to the hips and knees. However, performing (re)training while fatigued could slightly hinder learning this lifting technique.
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Affiliation(s)
- Dennis J Larson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
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Mihcin S, Sahin AM, Yilmaz M, Alpkaya AT, Tuna M, Akdeniz S, Korkmaz NC, Tosun A, Sahin S. Database covering the prayer movements which were not available previously. Sci Data 2023; 10:276. [PMID: 37173298 PMCID: PMC10182010 DOI: 10.1038/s41597-023-02196-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Lower body implants are designed according to the boundary conditions of gait data and tested against. However, due to diversity in cultural backgrounds, religious rituals might cause different ranges of motion and different loading patterns. Especially in the Eastern part of the world, diverse Activities of Daily Living (ADL) consist of salat, yoga rituals, and different style sitting postures. A database covering these diverse activities of the Eastern world is non-existent. This study focuses on data collection protocol and the creation of an online database of previously excluded ADL activities, targeting 200 healthy subjects via Qualisys and IMU motion capture systems, and force plates, from West and Middle East Asian populations with a special focus on the lower body joints. The current version of the database covers 50 volunteers for 13 different activities. The tasks are defined and listed in a table to create a database to search based on age, gender, BMI, type of activity, and motion capture system. The collected data is to be used for designing implants to allow these sorts of activities to be performed.
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Affiliation(s)
- Senay Mihcin
- Department of Mechanical Engineering, Izmir Institute of Technology, Izmir, Turkey.
| | - Ahmet Mert Sahin
- Department of Mechanical Engineering, Izmir Institute of Technology, Izmir, Turkey
| | - Mehmet Yilmaz
- Department of Mechanical Engineering, Izmir Institute of Technology, Izmir, Turkey
| | | | - Merve Tuna
- Department of Mechanical Engineering, Izmir Institute of Technology, Izmir, Turkey
| | - Sevinc Akdeniz
- Department of Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey
| | - Nuray Can Korkmaz
- Department of Mechanical Engineering, Istanbul- Cerrahpasa University, Istanbul, Turkey
| | - Aliye Tosun
- Department of Physiotherapy and Rehabilitation, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
| | - Serap Sahin
- Department of Computer Engineering, Izmir Institute of Technology, Izmir, Turkey
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Motor variability during a repetitive lifting task is impaired by wearing a passive back-support exoskeleton. J Electromyogr Kinesiol 2023; 68:102739. [PMID: 36566692 DOI: 10.1016/j.jelekin.2022.102739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Evaluate whether wearing a passive back-support exoskeleton during repetitive lifting impairs motor variability of erector spinae muscle and spine movement and whether this association is influenced by lifting style. SCOPE Thirty-six healthy males performed ten lifts in four randomized conditions with exoskeleton (without, with) and lifting style (squat, stoop) as dependent variables. One lifting cycle contained four phases: bending/straighten without/with load. Erector spinae muscular activity, thoracic kyphosis and lumbar lordosis were measured with surface electromyography and gravimetric position sensors, respectively. Absolute and relative cycle-to-cycle variability were calculated. The effects of exoskeleton and exoskeleton × lifting style were assessed on outcomes during the complete lifting cycle and its four phases. RESULTS For the complete lifting cycle, muscular variability and thoracic kyphosis variability decreased whereas lumbar lordosis variability increased with exoskeleton. For lifting phases, effects of exoskeleton were mixed. Absolute and relative muscular variability showed a significant interaction effect for the phase straighten with load; variability decreased with exoskeleton during squat lifting. CONCLUSION Using the exoskeleton impaired several motor variability parameters during lifting, supporting previous findings that exoskeletons may limit freedom of movement. The impact of this result on longer-term development of muscular fatigue or musculoskeletal disorders cannot yet be estimated.
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Lind CM, De Clercq B, Forsman M, Grootaers A, Verbrugghe M, Van Dyck L, Yang L. Effectiveness and usability of real-time vibrotactile feedback training to reduce postural exposure in real manual sorting work. ERGONOMICS 2023; 66:198-216. [PMID: 35466852 DOI: 10.1080/00140139.2022.2069869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Vibrotactile feedback training may be used as a complementary strategy to reduce time in demanding postures in manual handling. This study evaluated the short- and medium-term effects of concurrent posture-correction vibrotactile feedback training on trunk inclination exposure in real manual sorting work. Fifteen warehouse workers completed the training and the follow-up sessions. Trunk inclination angles were recorded using the ambulatory Smart Workwear System. Questionnaires were used for assessing system usability, perceived physical exertion, and work ability. The results showed reduced time in trunk inclination >30°, >45°, and >60°, and reductions in the 90th, 95th, and 99th percentile trunk inclination angles, when receiving feedback and immediately after feedback withdrawal. No significant reduction was retained after one and three weeks. The wearer's comfort was scored high, and the feedback did not increase the perceived cognitive demands. No significant effects attributed to changed trunk inclination exposure were observed for perceived physical exertion or work ability. The training program has the potential of contributing to reduced trunk inclination exposure in the short term. Future studies are needed to evaluate if improvements in the feedback training can transfer the short-term results to retained median- and long-term effects.Practitioner summary: A two-day training program with concurrent posture-correction vibrotactile feedback can contribute to reduced exposure of trunk inclination in real manual sorting work in the short term. More research is needed on how to design the feedback training programs in order to be effective in the long term.
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Affiliation(s)
- Carl Mikael Lind
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Mikael Forsman
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Huddinge, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | | | | | | | - Liyun Yang
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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18
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So BCL, Hua C, Chen T, Gao Q, Man SS. Biomechanical assessment of a passive back-support exoskeleton during repetitive lifting and carrying: Muscle activity, kinematics, and physical capacity. JOURNAL OF SAFETY RESEARCH 2022; 83:210-222. [PMID: 36481011 DOI: 10.1016/j.jsr.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 04/24/2022] [Accepted: 08/25/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Most people have experienced low back pain (LBP) more or less in their lifetime. Heavier load weight could increase the risk of LBP, especially in repetitive lifting and carrying tasks. The risk could also increase with the frequency of lifting. This study aims to investigate the effects of a passive back-support exoskeleton (PBSE) on trunk muscle activation, kinematics, and physical capacity in a repetitive lifting task and a carrying task in consideration of load weights in a laboratory setting. RESULTS Results showed that using the PBSE, the activities of the thoracic erector spinae and lumbar erector spinae muscles were reduced significantly by nearly 7% MVC and 3% MVC in the repetitive lifting task and the carrying task, respectively. There was no significant effect of the PBSE on the spine kinematics and physical capacity. PRACTICAL APPLICATIONS This study supports the use of the PBSE to reduce trunk muscle activity in repetitive lifting and carrying tasks.
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Affiliation(s)
- Billy Chun Lung So
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chunzhuo Hua
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tingting Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qingwen Gao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Siu Shing Man
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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19
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Influence of Spine-Focused Verbal Instruction on Spine Flexion During Lifting. J Hum Kinet 2022; 84:12-20. [DOI: 10.2478/hukin-2022-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Lifting with a flexed spine, especially near the end range of motion, has been identified as a potential risk factor for low back injury/pain. Therefore, individuals who develop discomfort from repetitive, prolonged and/or loaded flexed or slouched postures may benefit from a greater awareness of how to control and/or modify their spinal posture to avoid irritating their backs in these situations. This study was therefore designed to test the ability of spine-oriented verbal instructions to reduce intersegmental spine flexion during three lifting tasks. The lifts were first performed without any instructions on lifting technique. An audio recording was then played with instructions to limit bending in the lower back before repeating the lifts. Following the verbal instructions, maximum spine flexion angles significantly (p < 0.05) decreased at intersegmental levels in the lower thoracic and upper lumbar (T8/T9 to L2/L3) regions, but no significant changes were observed at the lower lumbar levels (L3/L4 to L5/S1). Thus, it is concluded that spine-oriented verbal instructions can decrease spine flexion during lifting; however, other cues/instructions may be required to target lower lumbar levels which have been identified as the most prone to injury/pain.
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Phan TC, Pranata A, Farragher J, Bryant A, Nguyen HT, Chai R. Machine Learning Derived Lifting Techniques and Pain Self-Efficacy in People with Chronic Low Back Pain. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176694. [PMID: 36081153 PMCID: PMC9460822 DOI: 10.3390/s22176694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 05/14/2023]
Abstract
This paper proposes an innovative methodology for finding how many lifting techniques people with chronic low back pain (CLBP) can demonstrate with camera data collected from 115 participants. The system employs a feature extraction algorithm to calculate the knee, trunk and hip range of motion in the sagittal plane, Ward’s method, a combination of K-means and Ensemble clustering method for classification algorithm, and Bayesian neural network to validate the result of Ward’s method and the combination of K-means and Ensemble clustering method. The classification results and effect size show that Ward clustering is the optimal method where precision and recall percentages of all clusters are above 90, and the overall accuracy of the Bayesian Neural Network is 97.9%. The statistical analysis reported a significant difference in the range of motion of the knee, hip and trunk between each cluster, F (9, 1136) = 195.67, p < 0.0001. The results of this study suggest that there are four different lifting techniques in people with CLBP. Additionally, the results show that even though the clusters demonstrated similar pain levels, one of the clusters, which uses the least amount of trunk and the most knee movement, demonstrates the lowest pain self-efficacy.
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Affiliation(s)
- Trung C. Phan
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Adrian Pranata
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
- School of Kinesiology, Shanghai University of Sports, Shanghai 200438, China
| | - Joshua Farragher
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Adam Bryant
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Hung T. Nguyen
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Rifai Chai
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
- Correspondence:
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21
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Liechti M, von Arx M, Eichelberger P, Bangerter C, Meier ML, Schmid S. Spatial distribution of erector spinae activity is related to task-specific pain-related fear during a repetitive object lifting task. J Electromyogr Kinesiol 2022; 65:102678. [DOI: 10.1016/j.jelekin.2022.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 05/13/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022] Open
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Patterson CS, Lohman E, Asavasopon S, Dudley R, Gharibvand L, Powers CM. The influence of hip flexion mobility and lumbar spine extensor strength on lumbar spine flexion during a squat lift. Musculoskelet Sci Pract 2022; 58:102501. [PMID: 35026497 DOI: 10.1016/j.msksp.2021.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/02/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Christopher S Patterson
- Loma Linda University Department of Physical Therapy, 24951, N. Circle Dr., A-620, Loma Linda, CA, 92350, USA; Azusa Pacific University, 901 E Alosta Ave. Azusa, CA, 91702, USA.
| | - Everett Lohman
- Loma Linda University Department of Physical Therapy, 24951, N. Circle Dr., A-620, Loma Linda, CA, 92350, USA.
| | - Skulpan Asavasopon
- University of Southern California Division of Biokinesiology and Physical Therapy, 1540 E. Alcazar St. CHP - 155, Los Angeles, CA, 90089, USA
| | - Robert Dudley
- Loma Linda University Department of Physical Therapy, 24951, N. Circle Dr., A-620, Loma Linda, CA, 92350, USA; Azusa Pacific University, 901 E Alosta Ave. Azusa, CA, 91702, USA.
| | - Lida Gharibvand
- Loma Linda University School of Allied Health Professions, 24951 N. Circle Dr., A-620, Loma Linda, CA, 92350, USA.
| | - Christopher M Powers
- University of Southern California Division of Biokinesiology and Physical Therapy, 1540 E. Alcazar St. CHP - 155, Los Angeles, CA, 90089, USA.
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Fujii R, Imai R, Shigetoh H, Tanaka S, Morioka S. Task-specific fear influences abnormal trunk motor coordination in workers with chronic low back pain: a relative phase angle analysis of object-lifting. BMC Musculoskelet Disord 2022; 23:161. [PMID: 35180874 PMCID: PMC8857807 DOI: 10.1186/s12891-022-05118-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pain-related fear influences impaired trunk movement (e.g., limited movement of range and velocity), but it is unclear how fear relates to trunk motor coordination (e.g., a more “in-phase” upper-lower trunk motion pattern). We conducted the present study to: (1) identify the motor coordination pattern of the in-phase upper-lower lumbar movements during the lifting, and (2) determine how pain-related fear is related to the trunk coordination pattern in workers with chronic low back pain (CLBP). Methods We examined 31 male workers with CLBP (CLBP group) and 20 healthy controls with no history of CLBP (HC group). The movement task was lifting a box, the weight of which was 10, 30%, or 50% of the subject’s body weight. We used a 3D motion capture system to calculate the mean absolute relative phase angle (MARP) angle as an index of coordination and the mean deviation phase (DP) as an index of variability. We used a numerical rating scale to assess the subjects’ task-specific fear. Results The MARP angle during trunk extension movement in the 50% condition was significantly decreased in the CLBP group compared to the HCs; i.e., the upper lumbar movement was more in-phase with the lower lumbar movement. The hierarchical multiple regression analysis results demonstrated that a decreased MARP angle was associated with high task-specific fear. Conclusions A more ‘in-phase’ upper-lower lumbar movement pattern was predicted by task-specific fear evoked when performing a work-related activity. Our findings suggest that an intervention for task-specific fear may be necessary to improve an individual’s impaired trunk motor coordination.
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Affiliation(s)
- Ren Fujii
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan. .,Department of Rehabilitation, Medical Corporation Tanakakai, Musashigaoka Hospital, 7-15-1 Kusunoki, Kita-ku, Kumamoto-shi, Kumamoto, 861-8003, Japan.
| | - Ryota Imai
- School of Rehabilitation Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka-shi, Osaka, 597-0104, Japan
| | - Hayato Shigetoh
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, 34 Ooyakeyamada, Yamashina-ku, Kyoto-shi, Kyoto, 607-8175, Japan.,Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Shinichiro Tanaka
- Department of Rehabilitation Medicine, Medical Corporation Tanakakai, Musashigaoka Hospital, 7-15-1 Kusunoki, Kita-ku, Kumamoto-shi, Kumamoto, 861-8003, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan.,Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan
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24
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Ma KY, Nadon AL, McDonald AC, Dickerson CR. Assessing potential trade-offs between the lower back and shoulders: influence of lift training intervention on joint demands. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2022; 28:68-75. [DOI: 10.1080/10803548.2020.1733343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karen Y. Ma
- Department of Kinesiology, University of Waterloo, Canada
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Zenmyou Y, Kawakami K, Goto M, Watanabe K, Okamoto N, Yoshida M, Yamamoto H, Wada C. A survey of physical and occupational therapists’ views on lumbar loading movements. J Phys Ther Sci 2022; 34:683-688. [PMID: 36213190 PMCID: PMC9535249 DOI: 10.1589/jpts.34.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To identify the lumbar loading movements necessary in clinical practice.
[Participants and Methods] A questionnaire survey was conducted among physical and
occupational therapists in Japan. There were no exclusion criteria regarding the number of
years of experience, age, or field of employment. The participants were randomly selected
and administered the questionnaire. They were asked to list and rank the lumbar loadings
they considered necessary. [Results] A total of 739 respondents participated in the
survey. The results of this nationwide survey indicated that the lifting movement of heavy
objects in the trunk flexion position was the most common movement (for 354 participants).
[Conclusion] The main loading movements of the lumbar spine were reported to be heavy
lifting movements (in the trunk flexion position) and trunk rotation movements. As
perspectives, we aim to conduct an analytical study of some of lumbar spine loading
movements outlined in this study, using a musculoskeletal simulator and
electromyography.
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Affiliation(s)
- Yuta Zenmyou
- Department of Physical Therapy, Kokura Rehabilitation Academy: 2-2-10 Kuzuharahigashi, Kokuraminami-ku, Kitakyusyu-shi, Fukuoka 800-0206, Japan
| | - Kei Kawakami
- Department of Rehabilitation, Shinkomonji Hospital, Japan
| | - Masaki Goto
- Department of Rehabilitation, Shinkomonji Hospital, Japan
| | - Kazuya Watanabe
- Department of Physical Therapy, Shimonoseki Nursing & Rehabilitation School, Japan
| | - Nobuhiro Okamoto
- Department of Physical Therapy, Fukuoka Wajiro Rehabilitation Academy, Japan
| | - Mariko Yoshida
- A Nursing Home for the Elderly, Maruyama Choujuen, Japan
| | - Hiroaki Yamamoto
- Department of Physical Therapy, Fukuoka Tenjin Medical Rehabilitation School, Japan
| | - Chikamune Wada
- Department of Life Science and System Engineering, Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Japan
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Oppici L, Grütters K, Garofolini A, Rosenkranz R, Narciss S. Deliberate Practice and Motor Learning Principles to Underpin the Design of Training Interventions for Improving Lifting Movement in the Occupational Sector: A Perspective and a Pilot Study on the Role of Augmented Feedback. Front Sports Act Living 2021; 3:746142. [PMID: 34796319 PMCID: PMC8593185 DOI: 10.3389/fspor.2021.746142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Spine posture during repetitive lifting is one of the main risk factors for low-back injuries in the occupational sector. It is thus critical to design appropriate intervention strategies for training workers to improve their posture, reducing load on the spine during lifting. The main approach to train safe lifting to workers has been educational; however, systematic reviews and meta-analyses have shown that this approach does not improve lifting movement nor reduces the risk of low back injury. One of the main limitations of this approach lies in the amount, quality and context of practice of the lifting movement. In this article, first we argue for integrating psychologically-grounded perspectives of practice design in the development of training interventions for safe lifting. Principles from deliberate practice and motor learning are combined and integrated. Given the complexity of lifting, a training intervention should occur in the workplace and invite workers to repeatedly practice/perform the lifting movement with the clear goal of improving their lifting-related body posture. Augmented feedback has a central role in creating the suitable condition for achieving such intervention. Second, we focus on spine bending as risk factor and present a pilot study examining the benefits and boundary conditions of different feedback modalities for reducing bending during lifting. The results showed how feedback modalities meet differently key requirements of deliberate practice conditions, i.e., feedback has to be informative, individualized and actionable. Following the proposed approach, psychology will gain an active role in the development of training interventions, contributing to finding solutions for a reduction of risk factors for workers.
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Affiliation(s)
- Luca Oppici
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany.,Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Kim Grütters
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| | - Alessandro Garofolini
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Robert Rosenkranz
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.,Acoustic and Haptic Engineering, Faculty of Electrical and Computer Engineering, Technische Universität Dresden, Dresden, Germany
| | - Susanne Narciss
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany.,Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
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27
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The influence of hip extensor and lumbar spine extensor strength on lumbar spine loading during a squat lift. J Electromyogr Kinesiol 2021; 62:102620. [PMID: 34844059 DOI: 10.1016/j.jelekin.2021.102620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/26/2021] [Accepted: 11/13/2021] [Indexed: 11/20/2022] Open
Abstract
Weakness of the hip extensors and lumbar spine extensors has been proposed to contribute to greater demands on the lumbar spine during lifting. The purpose of the current study was to examine the associations among strength of the hip and lumbar spine extensors, lumbar spine extensor moments and lumbar paraspinal muscle activation during a squat lift task. Twenty-seven healthy females participated. Strength of the hip and lumbar spine extensors was measured using a dynamometer. Lumbar spine moments and lumbar paraspinal muscle activity were quantified during the concentric phase of the squat lifting task. There was a significant positive association between lumbar extensor strength and average lumbar extensor moment during lifting (r = 0.498, p = 0.008). Similarly, hip extensor strength was positively associated with the average lumbar extension moment (r = 0.382, p = 0.049). Hip extensor strength was negatively associated with activation of the lumbar paraspinal muscles during lifting (ρ = -0.382, p = 0.049). Stronger individuals are more likely to use their hip extensors and lumbar spine extensors to perform a squat lift task. In contrast, those with lower strength employ subtle biomechanical changes to reduce lumbar spine demand.
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von Arx M, Liechti M, Connolly L, Bangerter C, Meier ML, Schmid S. From Stoop to Squat: A Comprehensive Analysis of Lumbar Loading Among Different Lifting Styles. Front Bioeng Biotechnol 2021; 9:769117. [PMID: 34805121 PMCID: PMC8599159 DOI: 10.3389/fbioe.2021.769117] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022] Open
Abstract
Lifting up objects from the floor has been identified as a risk factor for low back pain, whereby a flexed spine during lifting is often associated with producing higher loads in the lumbar spine. Even though recent biomechanical studies challenge these assumptions, conclusive evidence is still lacking. This study therefore aimed at comparing lumbar loads among different lifting styles using a comprehensive state-of-the-art motion capture-driven musculoskeletal modeling approach. Thirty healthy pain-free individuals were enrolled in this study and asked to repetitively lift a 15 kg-box by applying 1) a freestyle, 2) a squat and 3) a stoop lifting technique. Whole-body kinematics were recorded using a 16-camera optical motion capture system and used to drive a full-body musculoskeletal model including a detailed thoracolumbar spine. Continuous as well as peak compressive, anterior-posterior shear and total loads (resultant load vector of the compressive and shear load vectors) were calculated based on a static optimization approach and expressed as factor body weight (BW). In addition, lumbar lordosis angles and total lifting time were calculated. All parameters were compared among the lifting styles using a repeated measures design. For each lifting style, loads increased towards the caudal end of the lumbar spine. For all lumbar segments, stoop lifting showed significantly lower compressive and total loads (-0.3 to -1.0BW) when compared to freestyle and squat lifting. Stoop lifting produced higher shear loads (+0.1 to +0.8BW) in the segments T12/L1 to L4/L5, but lower loads in L5/S1 (-0.2 to -0.4BW). Peak compressive and total loads during squat lifting occurred approximately 30% earlier in the lifting cycle compared to stoop lifting. Stoop lifting showed larger lumbar lordosis range of motion (35.9 ± 10.1°) than freestyle (24.2 ± 7.3°) and squat (25.1 ± 8.2°) lifting. Lifting time differed significantly with freestyle being executed the fastest (4.6 ± 0.7 s), followed by squat (4.9 ± 0.7 s) and stoop (5.9 ± 1.1 s). Stoop lifting produced lower total and compressive lumbar loads than squat lifting. Shear loads were generally higher during stoop lifting, except for the L5/S1 segment, where anterior shear loads were higher during squat lifting. Lifting time was identified as another important factor, considering that slower speeds seem to result in lower loads.
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Affiliation(s)
- Michael von Arx
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Melanie Liechti
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Lukas Connolly
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
| | - Christian Bangerter
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Michael L. Meier
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Stefan Schmid
- Spinal Movement Biomechanics Group, Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Fujii R, Imai R, Tanaka S, Morioka S. Kinematic analysis of movement impaired by generalization of fear of movement-related pain in workers with low back pain. PLoS One 2021; 16:e0257231. [PMID: 34534260 PMCID: PMC8448367 DOI: 10.1371/journal.pone.0257231] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To identify impaired trunk movement during work-related activity in individuals with low back pain (LBP) and investigate whether abnormalities were caused by generalized fear of movement-related pain. Methods This cross-sectional study was conducted at a hospital in Japan. We recruited 35 participants with LBP (LBP group; 26 males, 9 females) and 20 healthy controls (HC group) via posters at our hospital. The task required lifting an object. We used a 3D motion capture system to calculate the peak angular velocity of trunk flexion and extension during a lifting task. Pain-related factors for the LBP group were assessed using the visual analogue scale (VAS) for pain intensity over the past 4 weeks and during the task, the Tampa Scale for Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), and the Pain Anxiety Symptoms Scale-20 (PASS-20). We compared kinematic variables between groups with a generalized linear mixed model and investigated the relationship between kinematic variables, VAS scores, and psychological factors by performing a mediation analysis. Results The peak angular velocity of trunk extension showed significant main effects on the group factors (LBP group vs. HC group) and their interactions; the value of the kinematic variable was lower at Trial 1 in the LBP group. No LBP participant reported pain during the experiment. The mediation analysis revealed that the relationship between the VAS score for pain intensity over the past 4 weeks and the peak angular velocity of trunk extension in the first trial was completely mediated by the TSK (complete mediation model, 95% bootstrapped CI: 0.07–0.56). Conclusion Individuals with LBP had reduced trunk extension during a lifting task. Generalized fear of movement-related pain may contribute to such impaired trunk movement. Our findings suggest that intervention to ameliorate fear of movement may be needed to improve LBP-associated disability.
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Affiliation(s)
- Ren Fujii
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Kitakatsuragi-gun, Japan
- Department of Rehabilitation, Medical Corporation Tanakakai, Musashigaoka Hospital, Kumamoto-shi, Japan
- * E-mail:
| | - Ryota Imai
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka-shi, Japan
| | - Shinichiro Tanaka
- Department of Rehabilitation Medicine, Medical Corporation Tanakakai, Musashigaoka Hospital, Kumamoto-shi, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Kitakatsuragi-gun, Japan
- Neurorehabilitation Research Center, Kio University, Kitakatsuragi-gun, Japan
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30
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Yun SS, Kim K, Ahn J, Cho KJ. Body-powered variable impedance: An approach to augmenting humans with a passive device by reshaping lifting posture. Sci Robot 2021; 6:6/57/eabe1243. [PMID: 34433655 DOI: 10.1126/scirobotics.abe1243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 07/22/2021] [Indexed: 11/02/2022]
Abstract
The movement patterns appropriate for exercise and manual labor do not always correspond to what people instinctively choose for better comfort. Without expert guidance, people can even increase the risk of injury by choosing a comfortable posture rather than the appropriate one, notably when lifting objects. Even in situations where squatting is accepted as a desirable lifting strategy, people tend to choose the more comfortable strategy of stooping or semisquatting. The common approach to correcting lifting posture, immobilizing vulnerable joints via fixation, is insufficient for preventing back injuries sustained from repetitive lifting. Instead, when lifting small but heavy objects, the entire kinetic chain should cooperate to achieve a series of squat-lifting patterns. Inspired by the observation that force fields affect the coordination of voluntary human motion, we devised a passive exosuit embedded with a body-powered variable-impedance mechanism. The exosuit adds impedance to the human joints according to how far the wearer's movement is from the squat-lifting trajectories so that it hinders stooping but facilitates squatting. In an experiment that entailed lifting a small 10-kg box, 10 first-time users changed their voluntary lifting motion closer to squatting on average. Simulation results based on recorded kinematic and kinetic data showed that this postural change reduced the compression force, shear force, and moment on the lumbosacral joint. Our work demonstrates the potential of using an exosuit to help people move in a desirable manner without requiring a complicated, bulky mechanical system.
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Affiliation(s)
- Sung-Sik Yun
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea.,Department of Mechanical Engineering, Institute of Advanced Machines and Design, Institute of Engineering, Seoul National University, Seoul, Republic of Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jooeun Ahn
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea. .,Department of Physical Education, Seoul National University, Seoul, Republic of Korea.,Institute of Sport Science, Seoul National University, Seoul, Republic of Korea
| | - Kyu-Jin Cho
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea. .,Department of Mechanical Engineering, Institute of Advanced Machines and Design, Institute of Engineering, Seoul National University, Seoul, Republic of Korea
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31
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Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP. PLoS One 2021; 16:e0254241. [PMID: 34288926 PMCID: PMC8294511 DOI: 10.1371/journal.pone.0254241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose To investigate if lumbar and lower limb kinematics or kinetics are different between groups with and without a history of LBP during lifting. Secondly, to investigate relationships between biomechanical variables and pain ramp during repeated lifting. Methods 21 LBP and 20 noLBP participants completed a 100-lift task, where lumbar and lower limb kinematics and kinetics were measured during lifting, with a simultaneous report of LBP intensity every 10 lifts. Lifts were performed in a laboratory setting, limiting ecological validity. Results The LBP group used a different lifting technique to the noLBP group at the beginning of the task (slower and more squat-like). Kinetic differences at the beginning included less peak lumbar external anterior shear force and greater peak knee power demonstrated by the LBP group. However, at the end of the task, both groups lifted with a much more similar technique that could be classified as more stoop-like and faster. Peak knee power remained greater in the LBP group throughout and was the only kinetic difference between groups at the end of the lifting task. While both groups lifted using a more comparable technique at the end, the LBP group still demonstrated a tendency to perform a slower and more squat-like lift throughout the task. Only one of 21 variables (pelvic tilt at box lift-off), was associated with pain ramp in the LBP group. Conclusions: Workers with a history of LBP, lift with a style that is slower and more squat-like than workers without any history of LBP. Common assumptions that LBP is associated with lumbar kinematics or kinetics such as greater lumbar flexion or greater forces were not observed in this study, raising questions about the current paradigm around ‘safe lifting’.
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Knechtle D, Schmid S, Suter M, Riner F, Moschini G, Senteler M, Schweinhardt P, Meier ML. Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults. Pain 2021; 162:1621-1631. [PMID: 33323888 PMCID: PMC8120682 DOI: 10.1097/j.pain.0000000000002170] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/24/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
ABSTRACT There is a long-held belief that physical activities such as lifting with a flexed spine is generally harmful for the back and can cause low back pain (LBP), potentially reinforcing fear-avoidance beliefs underlying pain-related fear. In patients with chronic LBP, pain-related fear has been shown to be associated with reduced lumbar range of motion during lifting, suggesting a protective response to pain. However, despite short-term beneficial effects for tissue health, recent evidence suggests that maintaining a protective trunk movement strategy may also pose a risk for (persistent) LBP due to possible pronociceptive consequences of altered spinal motion, potentially leading to increased loading on lumbar tissues. Yet, it is unknown if similar protective movement strategies already exist in pain-free individuals, which would yield potential insights into the role of fear-avoidance beliefs in motor behavior in the absence of pain. Therefore, the aim of this study is to test whether fear-avoidance beliefs influence spinal motion during lifting in a healthy cohort of pain-free adults without a history of chronic pain. The study subjects (N = 57) filled out several pain-related fear questionnaires and were asked to perform a lifting task (5kg-box). High-resolution spinal kinematics were assessed using an optical motion capturing system. Time-sensitive analyses were performed based on statistical parametric mapping. The results demonstrated time-specific and negative relationships between self-report measures of pain-related fear and lumbar spine flexion angles during lifting, indicating potential unfavorable interactions between psychological factors and spinal motion during lifting in pain-free subjects.
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Affiliation(s)
- Deborah Knechtle
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
| | - Stefan Schmid
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Magdalena Suter
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
| | - Fabienne Riner
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
| | - Greta Moschini
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Marco Senteler
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
- Alan Edwards Center for Research on Pain, McGill University, Montreal, QC, Canada
| | - Michael L. Meier
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital Zurich, University of Zurich, Switzerland
- Department of Chiropractic Medicine, University of Zurich, Switzerland
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Skals S, Bláfoss R, Andersen MS, de Zee M, Andersen LL. Manual material handling in the supermarket sector. Part 1: Joint angles and muscle activity of trapezius descendens and erector spinae longissimus. APPLIED ERGONOMICS 2021; 92:103340. [PMID: 33340719 DOI: 10.1016/j.apergo.2020.103340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/27/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Work-related musculoskeletal disorders are highly prevalent in the supermarket sector with manual material handling being one of the most commonly identified occupational risk factors. This cross-sectional study applied inertial motion capture and electromyography (EMG) to measure full-body kinematics and muscle activity of trapezius descendens and erector spinae longissimus during 50 manual material handling tasks performed by 17 workers in two supermarkets. The handling of bread and cucumbers to high shelf heights showed the highest trapezius muscle activity (from 47% to 59% peak normalized EMG), while the handling of bananas as well as lifting milk, bread and cucumbers from low to high positions showed the highest erector spinae activity (from 59% to 71%). Twenty-two tasks involved flexing the shoulders and trunk more than 90° and 50°, respectively. Based on these results, several manual handling practices in supermarkets should be reconsidered to reduce the physical work demands.
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Affiliation(s)
- Sebastian Skals
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark; Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark.
| | - Rúni Bláfoss
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark; Research Unit for Muscle Physiology and Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Michael Skipper Andersen
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, 9220, Aalborg, Denmark.
| | - Mark de Zee
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark.
| | - Lars Louis Andersen
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark; Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark.
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34
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Kinematic effects of a passive lift assistive exoskeleton. J Biomech 2021; 120:110317. [PMID: 33773297 DOI: 10.1016/j.jbiomech.2021.110317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
The VT-Lowe's exoskeleton was designed to help support the back during repetitive lifting tasks. This study focused on the kinematic differences between lifting with and without the exoskeleton (With-Exo and Without-Exo) over three different lifting styles (Freestyle, Squat, and Stoop) and two different box weights (0% and 20% of bodyweight). Twelve young and healthy males (Age 23.5 +/- 4.42 years; Height 179.33 +/- 6.37 cm; Weight 80.4 +/- 5.59 kg) participated in this study. Variables analyzed include the ankle and knee angles and angle between the Shoulder-Hip-Knee (SHK); the shoulder, elbow, and wrist heights; and the lifting speed and acceleration. The relationships between the torso angle, SHK angle, center of mass of the torso, torso torque, box height, as well as electromyography (EMG) data from a related study were also analyzed. On average, wearing the exoskeleton resulted in a 1.5 degree increase in ankle dorsiflexion, a 2.6 degree decrease in knee flexion, and a decrease of 2.3 degrees in SHK angle. Subjects' shoulder, elbow, and wrist heights were slightly higher while wearing the exoskeleton, and they lifted slightly more slowly while wearing the exoskeleton. Subjects moved more quickly while bending down as compared to standing up, and with the 0% bodyweight box as compared to the 20% bodyweight box. The values for Freestyle lifts generally fell in between Squat and Stoop lift styles or were not significantly different from Squat. EMG data from the leg muscles had relationships with torso torque while the back and stomach muscles showed no significant relationships.
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35
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Armstrong DP, Budarick AR, Pegg CEE, Graham RB, Fischer SL. Feature Detection and Biomechanical Analysis to Objectively Identify High Exposure Movement Strategies When Performing the EPIC Lift Capacity test. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:50-62. [PMID: 32248432 DOI: 10.1007/s10926-020-09890-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The Epic Lift Capacity (ELC) test is used to determine a worker's maximum lifting capacity. In the ELC test, maximum lifting capacity is often determined as the maximum weight lifted without exhibiting a visually appraised "high-risk workstyle." However, the criteria for evaluating lifting mechanics have limited justification. This study applies feature detection and biomechanical analysis to motion capture data obtained while participants performed the ELC test to objectively identify aspects of movement that may help define "high-risk workstyle". Method In this cross-sectional study, 24 participants completed the ELC test. We applied Principal Component Analysis, as a feature detection approach, and biomechanical analysis to motion capture data to objectively identify movement features related to biomechanical exposure on the low back and shoulders. Principal component scores were compared between high and low exposure trials (relative to median exposure) to determine if features of movement differed. Features were interpreted using single component reconstructions of principal components. Results Statistical testing showed that low exposure lifts and lowers maintained the body closer to the load, exhibited squat-like movement (greater knee flexion, wider base of support), and remained closer to neutral posture at the low back (less forward flexion and axial twist) and shoulder (less flexion and abduction). Conclusions Use of feature detection and biomechanical analyses revealed movement features related to biomechanical exposure at the low back and shoulders. The objectively identified criteria could augment the existing scoring criteria for ELC test technique assessment. In the future, such features can inform the design of classifiers to objectively identify "high-risk workstyle" in real-time.
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Affiliation(s)
- Daniel P Armstrong
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Aleksandra R Budarick
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Claragh E E Pegg
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Ryan B Graham
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Steven L Fischer
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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Weiske F, Böhme M, Jäkel J, Zentner J, Witt M. Stair ascent comparison of lower limb kinematics with differing time normalization techniques. J Biomech 2021; 119:110316. [PMID: 33631663 DOI: 10.1016/j.jbiomech.2021.110316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
Understanding gait differences in context of group differences is dependent on statistical testing methods and time normalization techniques (TN). The method induces a relationship of both with one another. As to our knowledge, there has been no investigation into their relation so far. To show empirically what effects may be of importance, we use SPM with linear time interpolation (LI) and Dynamic Time Warping (DTW) separately for data of a study on stair ascent kinematics between two groups. There is a slight difference in statistical significance for the comparison of LI and DTW. LI-uniquely significant time highlight differences due to in-group time-variations, whereas DTW-uniqueness is tied to qualitative differences of homogeneous events. The comparison of stair ascent kinematics with DTW shows more pronounced evidence for backlift-like strategies for the older group, although trunk angles are kept more extended as to ensure stabilty. Thus, the difference in SPM from TN is slight but important, if there is need to mirror said effects methodically.
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Affiliation(s)
- Felix Weiske
- University of Applied Sciences, Leipzig, Germany.
| | - Max Böhme
- University of Applied Sciences, Leipzig, Germany
| | - Jens Jäkel
- University of Applied Sciences, Leipzig, Germany
| | | | - Maren Witt
- Department of Biomechanics, University of Leipzig, Leipzig, Germany
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What do UK osteopaths view as the safest lifting posture, and how are these views influenced by their back pain beliefs? INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Damm P, Reitmaier S, Hahn S, Waldheim V, Firouzabadi A, Schmidt H. In vivo hip and lumbar spine implant loads during activities in forward bent postures. J Biomech 2020; 102:109517. [PMID: 31767284 DOI: 10.1016/j.jbiomech.2019.109517] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/22/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022]
Abstract
Long-term measurements on the lumbar spinal alignment during daily life revealed that humans spent 90% of the day in a forward bent posture. Compared to standing, this posture leads to a substantial increase in spinal loading. The lumbar spine and pelvis, however, contribute differently to the total amount of flexion, which could possibly indicate a different timing of maximum loads in both structures during flexion. This study aimed to evaluate the in vivo implant forces in the hip and lumbar spine during activities in forward bent postures. This work utilized data collected in earlier in vivo measurements on patients either with telemeterized hip endoprostheses (HE) or vertebral body replacements (VBR). The following activities were investigated: standing, upper body flexion with and without weights in the hands using different lifting techniques (straight and bent knees). The maximum resultant forces in VBR were considerably lower than in HE. Increases in flexion inclinations caused direct increases of the resultant forces within VBR, followed by a plateau or even a decrease of the force until maximum inclination. The resultant force in HE displayed an almost continuous increase until the maximum inclination. This general curve behavior resulted in different HE-VBR load ratios, which were affected by lifting additional weights or different lifting techniques. The results emphasize that maximum loads in the spine, in contrast to the hip, do not necessarily occur at maximum upper body flexion as normally expected, rather already at intermediate flexion angles in VBR patients. The results form the basis for more detailed insilico analyzes.
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Affiliation(s)
- Philipp Damm
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Germany
| | - Sandra Reitmaier
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Germany
| | - Sabine Hahn
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Germany
| | - Vivian Waldheim
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Germany
| | - Ali Firouzabadi
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Germany
| | - Hendrik Schmidt
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Germany.
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Kang MH, Lee DK, Kim JS, Oh JS. Effects of the abdominal draw-in maneuver on transversus abdominis thickness, electromyography activity of the trunk muscles, and kinematics of the lumbo-pelvic-hip complex during L & L tasks. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-192134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Min-Hyeok Kang
- Department of Physical Therapy, International University of Korea, Jinju, Korea
| | - Dong-Kyu Lee
- Department of Physical Therapy, Graduate School, Inje University, Gimhae, Korea
| | - Jun-Seok Kim
- Department of Physical Therapy, Gimhae College, Gimhae, Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, Inje University, Gimhae, Korea
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To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2020; 50:121-130. [PMID: 31775556 DOI: 10.2519/jospt.2020.9218] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate whether lumbar spine flexion during lifting is a risk factor for low back pain (LBP) onset/persistence or a differentiator of people with and without LBP. DESIGN Etiology systematic review with meta-analysis. LITERATURE SEARCH Database search of ProQuest, CINAHL, MEDLINE, and Embase up to August 21, 2018. STUDY SELECTION CRITERIA We included peer-reviewed articles that investigated whether lumbar spine position during lifting was a risk factor for LBP onset or persistence or a differentiator of people with and without LBP. DATA SYNTHESIS Lifting-task comparison data were tabulated and summarized. The meta-analysis calculated an n-weighted pooled mean ± SD of the results in the LBP and no-LBP groups. If a study contained multiple comparisons (ie, different lifting tasks that used various weights or directions), then only 1 result from that study was included in the meta-analysis. RESULTS Four studies (1 longitudinal study and 3 cross-sectional studies across 5 articles) included in meta-analysis measured lumbar flexion with intralumbar angles and found no difference in peak lumbar spine flexion when lifting (1.5°; 95% confidence interval [CI]: -0.7°, 3.7°; P = .19 for the longitudinal study and -0.9°; 95% CI: -2.5°, 0.7°; P = .29 for the cross-sectional studies). Seven cross-sectional studies measured lumbar flexion with thoracopelvic angles and found that people with LBP lifted with 6.0° less lumbar flexion than people without LBP (95% CI: -11.2°, -0.9°; P = .02). Most (9/11) studies reported no significant between-group differences in lumbar flexion during lifting. The included studies were of low quality. CONCLUSION There was low-quality evidence that greater lumbar spine flexion during lifting was not a risk factor for LBP onset/persistence or a differentiator of people with and without LBP. J Orthop Sports Phys Ther 2020;50(3):121-130. Epub 28 Nov 2019. doi:10.2519/jospt.2020.9218.
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41
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Molinaro DD, King AS, Young AJ. Biomechanical analysis of common solid waste collection throwing techniques using OpenSim and an EMG-assisted solver. J Biomech 2020; 104:109704. [PMID: 32248942 DOI: 10.1016/j.jbiomech.2020.109704] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/21/2020] [Accepted: 02/18/2020] [Indexed: 11/20/2022]
Abstract
The solid waste collection industry is one of the most common occupations resulting in low back pain (LBP). Lumbar peak joint reaction forces and peak and integrated moments are strong correlates of LBP. To investigate these risks, this study compared three common waste collection throwing techniques of varying lumbar symmetry: the symmetric (SYM) technique, the asymmetric fixed stance (AFS) technique, and the asymmetric with pivot (AWP) technique. Lumbar moments and joint reaction loads were computed for throwing garbage bags of 3, 7, and 11 kg to quantify the effects that technique and object weight have on LBP risk. LBP risk factors were computed using a full-body musculoskeletal model in OpenSim. Muscle activations were estimated using two methods: the EMG-assisted method, which included electromyography data in the solution, and the conventional static optimization method, which did not. The EMG-assisted method more accurately reproduced measured muscle activation, resulting in significantly larger peak compressive and shear forces (p < 0.05) of magnitudes indicative of LBP risk. Risk factors associated with the SYM technique were either larger or not statistically different compared to the asymmetric techniques for the 3 kg condition; however, the opposite result occurred for the 7 and 11 kg conditions (p < 0.05). These results suggest using rapid, asymmetric techniques when handling lightweight objects and slower, symmetric techniques for heavier objects to reduce LBP risk during waste collection throwing techniques. Results indicating increased risk between asymmetric techniques were mostly inconclusive. As expected, increasing bag mass generally increased LBP risk factors, regardless of technique (p < 0.05).
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Affiliation(s)
- Dean D Molinaro
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Andrew S King
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Aaron J Young
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA, USA
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42
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A braced arm-to-thigh (BATT) lifting technique reduces lumbar spine loads in healthy and low back pain participants. J Biomech 2020; 100:109584. [DOI: 10.1016/j.jbiomech.2019.109584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 11/12/2019] [Accepted: 12/10/2019] [Indexed: 11/23/2022]
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Hindle BR, Lorimer A, Winwood P, Keogh JWL. The Biomechanics and Applications of Strongman Exercises: a Systematic Review. SPORTS MEDICINE-OPEN 2019; 5:49. [PMID: 31820223 PMCID: PMC6901656 DOI: 10.1186/s40798-019-0222-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/28/2019] [Indexed: 01/16/2023]
Abstract
Background The sport of strongman is becoming increasingly popular, catering for females, lightweight, and Masters competitors, with strongman exercises also being used by strength and conditioning coaches for a range of athletic groups. Thus, a systematic review was conducted to examine researchers’ current understanding of the biomechanics of strongman exercises, with a view to improve strongman athlete performance, provide biomechanical evidence supporting the transferability of strongman exercises to strength and conditioning/rehabilitation programs, and identify gaps in the current knowledge of the biomechanics of strongman exercises. Methods A two-level search term strategy was used to search five databases for studies relevant to strongman exercises and biomechanics. Results Eleven articles adherent to the inclusion criteria were returned from the search. The studies provided preliminary biomechanical analysis of various strongman exercises including the key biomechanical performance determinants of the farmer’s walk, heavy sled pull, and tire flip. Higher performing athletes in the farmer’s walk and heavy sled pull were characterized by a greater stride length and stride rate and reduced ground contact time, while higher performing athletes in the tire flip were characterized by a reduced second pull phase time when compared with lower performing athletes. Qualitative comparison of carrying/walking, pulling and static lifting strongman, traditional weight training exercises (TWTE), and common everyday activities (CEA), like loaded carriage and resisted sprinting, were discussed to further researchers’ understanding of the determinants of various strongman exercises and their applications to strength and conditioning practice. A lack of basic quantitative biomechanical data of the yoke walk, unilateral load carriage, vehicle pull, atlas stone lift and tire flip, and biomechanical performance determinants of the log lift were identified. Conclusions This review has demonstrated the likely applicability and benefit of current and future strongman exercise biomechanics research to strongman athletes and coaches, strength and conditioning coaches considering using strongman exercises in a training program, and tactical operators (e.g., military, army) and other manual labor occupations. Future research may provide a greater understanding of the biomechanical determinants of performance, potential training adaptations, and risks expected when performing and/or incorporating strongman exercises into strength and conditioning or injury rehabilitation programs.
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Affiliation(s)
- Benjamin R Hindle
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Anna Lorimer
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,Sports Performance Research Institute New Zealand (SPRINZ), AUT Millennium Institute, AUT University, Auckland, New Zealand
| | - Paul Winwood
- Department of Sport and Fitness, Faculty of Community Wellbeing and Development, Toi Ohomai Institute of Technology, Tauranga, New Zealand.,Sports Performance Research Institute New Zealand (SPRINZ), AUT Millennium Institute, AUT University, Auckland, New Zealand
| | - Justin W L Keogh
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,Sports Performance Research Institute New Zealand (SPRINZ), AUT Millennium Institute, AUT University, Auckland, New Zealand.,Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Australia
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44
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Harari Y, Riemer R, Bechar A. Differences in spinal moments, kinematics and pace during single-task and combined manual material handling jobs. APPLIED ERGONOMICS 2019; 81:102871. [PMID: 31422248 DOI: 10.1016/j.apergo.2019.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Yaar Harari
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel; Institute of Agricultural Engineering, Agricultural Research Organization, Bet Dagan, Israel
| | - Raziel Riemer
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Avital Bechar
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel; Institute of Agricultural Engineering, Agricultural Research Organization, Bet Dagan, Israel
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45
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Caneiro JP, O'Sullivan P, Lipp OV, Mitchinson L, Oeveraas N, Bhalvani P, Abrugiato R, Thorkildsen S, Smith A. Evaluation of implicit associations between back posture and safety of bending and lifting in people without pain. Scand J Pain 2019; 18:719-728. [PMID: 29982241 DOI: 10.1515/sjpain-2018-0056] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022]
Abstract
Background and aims Despite lack of support from recent in vivo studies, bending and lifting (especially with a round-back posture) are perceived as dangerous to the back. In light of this view, it has been proposed that pain-free people may hold a common implicit belief that is congruent with the idea that bending and lifting with a round-back represents danger to a person's back, however this has not been evaluated. The aims of this study were: (1) to evaluate implicit associations between back posture and safety related to bending and lifting in pain-free people; (2) to explore correlations between the implicit measure and explicit measures of back beliefs, fear of movement and safety of bending; (3) to investigate self-reported qualitative appraisal of safe lifting. Methods Exploratory cross-sectional study including 67 pain-free participants (no pain, or average pain ≤3/10 for less than one week over the previous 12 months) (52% male), who completed an online survey containing demographic data and self-reported measures of: fear of movement (Tampa Scale for Kinesiophobia for General population - TSK-G), back beliefs (Back Pain Attitudes Questionnaire BackPAQ), and bending beliefs (Bending Safety Belief - BSB - a pictorial scale with images of a person bending/lifting with round and straight back postures). Implicit associations between back posture and safety related to bending and lifting were evaluated with the Implicit Association Test (IAT). A qualitative assessment of descriptions of safe lifting was performed. Results An implicit association between "danger" and "round-back" bending/lifting was evident in all participants (IATD-score=0.65 (SD=0.45; 95% CI [0.54, 0.76]). Participants' profile indicated high fear of movement, unhelpful back beliefs, and perceived danger to round-back bending and lifting (BSBThermometer: 5.2 (SD=3.8; 95% CI [4.26, 6.13] range -10 to 10; t(67)=11.09, p<0.001). There was a moderate correlation between IAT and BSBThermometer (r=0.38, 95% CI [0.16, 0.62]). There were weaker and non-statistically significant correlations between IAT and TSK-G (r=0.28, 95% CI [-0.02, 0.47]), and between IAT and BackPAQDanger (r=0.21, 95% CI [-0.03, 0.45]). Qualitative assessment of safe lifting descriptions indicated that keeping a "straight back" and "squatting" when lifting were the most common themes. Conclusions Pain-free people displayed an implicit bias towards bending and lifting with a "round-back" as dangerous. Our findings support the idea that pain-free people may have a pre-existing belief about lifting, that the back is in danger when rounded. Research to evaluate the relationship between this implicit bias and lifting behaviour is indicated. Implications The findings of this study may have implications for ergonomic guidelines and public health information related to bending and lifting back postures. Additionally, clinicians may need to be aware of this common belief, as this may be reflected in how a person responds when they experience pain.
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Affiliation(s)
- J P Caneiro
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,Body Logic Physiotherapy Clinic, 215 Nicholson Road, Shenton Park, WA 6008, Australia, Phone: +61(08)9381 7940, +61(08)433 803 683, Fax: +61(08)9381 7941, E-mail:
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,Body Logic Physiotherapy Clinic, Shenton Park, Australia
| | - Ottmar V Lipp
- School of Psychology and Speech Pathology, Curtin University, Bentley, Australia
| | - Lara Mitchinson
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,Body Logic Physiotherapy Clinic, Shenton Park, Australia
| | - Nicolai Oeveraas
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Priyanka Bhalvani
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Richard Abrugiato
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Sean Thorkildsen
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
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46
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Squat Lifting Imposes Higher Peak Joint and Muscle Loading Compared to Stoop Lifting. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9183794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
(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.
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Abdoli-Eramaki M, Agababova M, Janabi J, Pasko E, Damecour C. Evaluation and comparison of lift styles for an ideal lift among individuals with different levels of training. APPLIED ERGONOMICS 2019; 78:120-126. [PMID: 31046942 DOI: 10.1016/j.apergo.2019.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 01/29/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
Training for safe lifting techniques is used by employers to lower their workers' exposure to risk of workplace injuries. To determine effectiveness of training, 266 attendees at two professional conferences were asked to identify and demonstrate their preferred lift technique with the demonstration being an ideal floor-to-waist height lift of a10-kg weighted crate. 'Bend your knees' was the most frequent preferred cue for each of the self-reported participant groups: untrained (n = 65), trained (n = 86), and trainers (n = 115) according to safe lifting techniques. The demonstrations showed that this cue was incorporated into the skill of lifting by all groups. Trained participants showed a stronger conformity for depth of squat; but, the overall variability suggested a lack of consensus on the ideal depth of squat. The trained group experienced less loading at L5/S1 (p = .021) compared to untrained that was countered by higher loading of the knee (p = .046). Trainers showed lower knee (p = .006) and shoulder (p = .03) loading with similar L5/S1 loading as the trained participants suggesting a broader set of criteria for safe lifting. While the study population was likely biased towards a common understanding of safe lifting techniques given the conferences were for ergonomists and safety professionals, the results provided valuable insight into potential knowledge gaps, and key messaging that is being delivered and integrated into one's knowledge; a program review of lift training is recommended.
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Affiliation(s)
- Mohammad Abdoli-Eramaki
- School of Occupational and Public Health, Faculty of Community Services, Ryerson University, Toronto, ON, Canada.
| | - Milena Agababova
- School of Occupational and Public Health, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - Joseph Janabi
- School of Occupational and Public Health, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - Elena Pasko
- School of Occupational and Public Health, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - Caroline Damecour
- School of Occupational and Public Health, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
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48
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Chan VCH, Welsh TN, Frost DM, Beach TAC. Using visual aids to influence manual lifting techniques: acute effects of viewing static images on spine motion. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2019; 27:605-612. [PMID: 31112070 DOI: 10.1080/10803548.2019.1620489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose. This study aimed to determine whether untrained observers alter their spine as directed via static images of different lifting techniques. Methods. Ten men and eight women, who had no lifting or visual observation training, performed box lifts. Following a self-selected lifting technique trial, participants performed four experimental lifting trials (in randomized order) wherein they were instructed to execute lifts in accordance with the techniques pictured. These techniques differed by the amount of knee, trunk and spine flexion modeled. Peak lumbar flexion angles and flexion/extension velocities were quantified, and then statistically analyzed via general linear models with two within-participant factors (condition = technique; phase = lift/lower). Results. Lumbar flexion angles and flexion/extension velocities differed between conditions (p < 0.001), although the effects depended on the combination of postural characteristics pictured. A main effect of phase was observed for peak lumbar flexion velocity only (p = 0.001). No condition × phase interaction effects were detected for any dependent variables (p > 0.050). Conclusions. Acute changes in lifting mechanics can be elicited via visual observation of pictured techniques. However, if using pictures to attenuate peak lumbar flexion displacements and velocities when lifting, auxiliary instruction may be needed to direct observers' attention to the spine curvature displayed.
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Affiliation(s)
- Victor C H Chan
- Faculty of Kinesiology and Physical Education, University of Toronto, Canada
| | - Timothy N Welsh
- Faculty of Kinesiology and Physical Education, University of Toronto, Canada.,Centre for Motor Control, University of Toronto, Canada
| | - David M Frost
- Faculty of Kinesiology and Physical Education, University of Toronto, Canada
| | - Tyson A C Beach
- Faculty of Kinesiology and Physical Education, University of Toronto, Canada.,Centre for Motor Control, University of Toronto, Canada
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49
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Chen B, Lanotte F, Grazi L, Vitiello N, Crea S. Classification of Lifting Techniques for Application of A Robotic Hip Exoskeleton. SENSORS (BASEL, SWITZERLAND) 2019; 19:E963. [PMID: 30823508 PMCID: PMC6412280 DOI: 10.3390/s19040963] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Abstract
The number of exoskeletons providing load-lifting assistance has significantly increased over the last decade. In this field, to take full advantage of active exoskeletons and provide appropriate assistance to users, it is essential to develop control systems that are able to reliably recognize and classify the users' movement when performing various lifting tasks. To this end, the movement-decoding algorithm should work robustly with different users and recognize different lifting techniques. Currently, there are no studies presenting methods to classify different lifting techniques in real time for applications with lumbar exoskeletons. We designed a real-time two-step algorithm for a portable hip exoskeleton that can detect the onset of the lifting movement and classify the technique used to accomplish the lift, using only the exoskeleton-embedded sensors. To evaluate the performance of the proposed algorithm, 15 healthy male subjects participated in two experimental sessions in which they were asked to perform lifting tasks using four different techniques (namely, squat lifting, stoop lifting, left-asymmetric lifting, and right-asymmetric lifting) while wearing an active hip exoskeleton. Five classes (the four lifting techniques plus the class "no lift") were defined for the classification model, which is based on a set of rules (first step) and a pattern recognition algorithm (second step). Leave-one-subject-out cross-validation showed a recognition accuracy of 99.34 ± 0.85%, and the onset of the lift movement was detected within the first 121 to 166 ms of movement.
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Affiliation(s)
- Baojun Chen
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| | - Francesco Lanotte
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| | - Lorenzo Grazi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Fondazione Don Carlo Gnocchi, 20148 Milan, Italy.
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Fondazione Don Carlo Gnocchi, 20148 Milan, Italy.
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Picchiotti MT, Weston EB, Knapik GG, Dufour JS, Marras WS. Impact of two postural assist exoskeletons on biomechanical loading of the lumbar spine. APPLIED ERGONOMICS 2019; 75:1-7. [PMID: 30509514 DOI: 10.1016/j.apergo.2018.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 06/09/2023]
Abstract
This study evaluated loading on the low back while wearing two commercially available postural assist exoskeletons. Ten male subjects lifted a box from multiple lift origins (combinations of vertical height and asymmetry) to a common destination using a squatting lifting technique with and without the use of either exoskeleton. Dependent measures included subject kinematics, moment arms between the torso or weight being lifted and the lumbar spine, and spinal loads as predicted by an electromyography-driven spine model. One of the exoskeletons tested (StrongArm Technologies™ FLx) reduced peak torso flexion at the shin lift origin, but differences in moment arms or spinal loads attributable to either of the interventions were not observed. Thus, industrial exoskeletons designed to control posture may not be beneficial in reducing biomechanical loads on the lumbar spine. Interventions altering the external manual materials handling environment (lift origin, load weight) may be more appropriate when implementation is fesible.
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Affiliation(s)
- Michael T Picchiotti
- Spine Research Institute, The Ohio State University, Columbus, OH, USA; Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
| | - Eric B Weston
- Spine Research Institute, The Ohio State University, Columbus, OH, USA; Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA.
| | - Gregory G Knapik
- Spine Research Institute, The Ohio State University, Columbus, OH, USA; Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
| | - Jonathan S Dufour
- Spine Research Institute, The Ohio State University, Columbus, OH, USA; Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, Columbus, OH, USA; Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
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