An Investigation of the Variability in Human Performance during Sagittally Symmetric Lifting Tasks

Can we enable individuals to reach further down without rounding their backs before beginning a lift? Examining the influence of starting foot and trunk position on reach depth

There is disagreement regarding the efficacy of 'safe' lifting recommendations for reducing low back disorder risk. These recommendations commonly focus on minimising lumbar spine flexion, which limits the range of allowable starting lift positions for that person. This study evaluated whether starting postural adaptations could allow a person to reach down further without rounding their lumbar spine before beginning a lift. Reach displacement was measured as participants performed a series of maximal reach tasks under different combinations of stance width, foot orientation and trunk inclination, with their lumbar spine motion restricted. There were no interactions between any of the three postural adaptations or any effect of stance width or trunk inclination. Seventy-nine percent of participants achieved their greatest reach displacement with their feet externally rotated, which contributed to a 4 cm greater reach displacement compared to a neutral foot orientation (p < 0.001).Practitioner summary: This study examined whether aspects of initial posture could influence the ability to adhere to 'safe' lifting recommendations across a range of lift heights. As a component of lifting (re)training interventions, practitioners should consider starting lift posture adaptations (e.g. manipulating foot external rotation) to improve capacity to adhere to recommendations.

The highs and lows of lifting loads: SPM analysis of multi-segmental spine angles in healthy adults during manual handling with increased load

Introduction: Manual handling personnel and those performing manual handling tasks in non-traditional manual handling industries continue to suffer debilitating and costly workplace injuries. Smart assistive devices are one solution to reducing musculoskeletal back injuries. Devices that provide targeted assistance need to be able to predict when and where to provide augmentation via predictive algorithms trained on functional datasets. The aim of this study was to describe how an increase in load impacts spine kinematics during a ground-to-platform manual handling task. Methods: Twenty-nine participants performed ground-to-platform lifts for six standardised loading conditions (50%, 60%, 70%, 80%, 90%, and 100% of maximum lift capacity). Six thoracic and lumbar spine segments were measured using inertial measurement units that were processed using an attitude-heading-reference filter and normalised to the duration of the lift. The lift was divided into four phases weight-acceptance, standing, lift-to-height and place-on-platform. Statistical significance of sagittal angles from the six spine segments were identified through statistical parametric mapping one-way analysis of variance with repeated measures and post hoc paired t-tests. Results: Two regions of interest were identified during a period of peak flexion and a period of peak extension. There was a significant increase in spine range of motion and peak extension angle for all spine segments when the load conditions were increased (p < 0.001). There was a decrease in spine angles (more flexion) during the weight acceptance to standing phase at the upper thoracic to upper lumbar spine segments for some condition comparisons. A significant increase in spine angles (more extension) during the place-on-platform phase was seen in all spine segments when comparing heavy loads (>80% maximum lift capacity, inclusive) to light loads (<80% maximum lift capacity) (p < 0.001). Discussion: The 50%-70% maximum lift capacity conditions being significantly different from heavier load conditions is representative that the kinematics of a lift do change consistently when a participant's load is increased. The understanding of how changes in loading are reflected in spine angles could inform the design of targeted assistance devices that can predict where and when in a task assistance may be needed, possibly reducing instances of back injuries in manual handling personnel.

Comparing upper arm and trunk kinematics between manufacturing workers performing predominantly cyclic and non-cyclic work tasks

Musculoskeletal disorders (MSDs) are common among manufacturing workers. Exposure to non-neutral postures and high movement speeds associated with MSDs among manufacturing workers may depend on the extent of the variability in the work tasks performed (i.e., predominantly "cyclic" versus "non-cyclic" work). The objectives of this study were to (i) compare mean levels of full-shift exposure summary metrics based on both posture and movement speed between manufacturing workers performing predominantly cyclic (n = 18) and non-cyclic (n = 17) tasks, and (ii) explore patterns of between- and within-worker exposure variance and between-minute (within-shift) exposure level and variation within each group. Inertial sensors were used to measure exposures for up to 15 full shifts per participant. Results indicated (i) substantially higher upper arm and trunk movement speeds among workers performing predominantly cyclic tasks relative to workers performing non-cyclic tasks despite similar postures, and (ii) greater exposure variability both between and within workers in the non-cyclic group.

Goal equivalent manifold analysis of task performance in non-specific LBP and healthy subjects during repetitive trunk movement: Effect of load, velocity, symmetry

Motor abundance allows reliability of motor performance despite its variability. The nature of this variability provides important information on the flexibility of control strategies. This feature of control may be affected by low back pain (LPB) and trunk flexion/extension conditions. Goal equivalent manifold (GEM) analysis was used to quantify the ability to exploit motor abundance during repeated trunk flexion/extension in healthy individuals and people with chronic non-specific LBP (CNSLBP). Kinematic data were collected from 22 healthy volunteers and 22 CNSLBP patients during metronomically timed, repeated trunk flexion/extension in three conditions of symmetry, velocity, and loading; each at two levels. A goal function for the task was defined as maintaining a constant movement time at each cycle. Given the GEM, flexibility index and performance index were calculated respectively as amounts of goal-equivalent variability and the ratio of goal-equivalent to non-goal-equivalent variability. CNSLBP group was as similar as healthy individuals in both flexibility index (p=0.41) and performance index (p=0.24). Performance index was higher in asymmetric (p<0.001), high velocity (p<0.001), and loaded (p=0.006) conditions. Performance and flexibility in using motor abundance were influenced by repeated trunk flexion/extension conditions. However, these measures were not significantly affected by CNSLBP.

Motor variability in occupational health and performance

Several recent reviews have reported that 'repetitive movements' constitute a risk factor for occupational musculoskeletal disorders in the neck, shoulder and arm regions. More variation in biomechanical exposure is often suggested as an effective intervention in such settings. Since increasing variation using extrinsic methods like job rotation may not always be possible in an industrial context, the intrinsic variability of the motor system may offer an alternative opportunity to increase variation. Motor variability refers to the natural variation in postures, movements and muscle activity observed to different extents in all tasks. The current review discusses research appearing in motor control, sports sciences and occupational biomechanics literature to answer whether motor variability is important to consider in an occupational context, and if yes, whether it can be manipulated by training the worker or changing the working conditions so as to increase biomechanical variation without jeopardizing production. The review concludes that motor variability is, indeed, a relevant issue in occupational health and performance and suggests a number of key issues for further research.

Two linear regression models predicting cumulative dynamic L5/S1 joint moment during a range of lifting tasks based on static postures

Previous studies have indicated that cumulative L5/S1 joint load is a potential risk factor for low back pain. The assessment of cumulative L5/S1 joint load during a field study is challenging due to the difficulty of continuously monitoring the dynamic joint load. This study proposes two regression models predicting cumulative dynamic L5/S1 joint moment based on the static L5/S1 joint moment of a lifting task at lift-off and set-down and the lift duration. Twelve men performed lifting tasks at varying lifting ranges and asymmetric angles in a laboratory environment. The cumulative L5/S1 joint moment was calculated from continuous dynamic L5/S1 moments as the reference for comparison. The static L5/S1 joint moments at lift-off and set-down were measured for the two regression models. The prediction error of the cumulative L5/S1 joint moment was 21 ± 14 Nm × s (12% of the measured cumulative L5/S1 joint moment) and 14 ± 9 Nm × s (8%) for the first and the second models, respectively. Practitioner Summary: The proposed regression models may provide a practical approach for predicting the cumulative dynamic L5/S1 joint loading of a lifting task for field studies since it requires only the lifting duration and the static moments at the lift-off and/or set-down instants of the lift.

Relative importance of expertise, lifting height and weight lifted on posture and lumbar external loading during a transfer task in manual material handling

The objective of this study was to measure the effect size of three important factors in manual material handling, namely expertise, lifting height and weight lifted. The effect of expertise was evaluated by contrasting 15 expert and 15 novice handlers, the effect of the weight lifted with a 15-kg box and a 23-kg box and the effect of lifting height with two different box heights: ground level and a 32 cm height. The task consisted of transferring a series of boxes from a conveyor to a hand trolley. Lifting height and weight lifted had more effect size than expertise on external back loading variables (moments) while expertise had low impact. On the other hand, expertise showed a significant effect of posture variables on the lumbar spine and knees. All three factors are important, but for a reduction of external back loading, the focus should be on the lifting height and weight lifted.

PRACTITIONER SUMMARY

The objective was to measure the effect size of three important factors in a transfer of boxes from a conveyor to a hand trolley. Lifting height and weight lifted had more effect size than expertise on external back loading variables but expertise was a major determinant in back posture.

Hand-hold location and trunk kinematics during box handling

Trunk kinematics variables have been shown to be related to low back injury risk during lifting tasks and it was hypothesised that changes in hand-hold positions could influence trunk kinematics and thereby risk. Fourteen subjects lifted a 5 or 10 kg box using four different hand placement locations (two symmetric and two asymmetric) while their trunk kinematics (position, velocity and acceleration in the sagittal, coronal and transverse planes) were captured using the lumbar motion monitor (LMM). These kinematics data were then used to calculate the probability of high risk group membership (PHRGM) as defined in the LMM risk assessment model. The results showed significant effects of hand placement on trunk kinematics, resulting in significant changes in the PHRGM variable ranging from a low of 20% in a the symmetric low load condition to a high of 38% under the asymmetric, 10 kg condition. STATEMENT OF RELEVANCE: Manual materials handlers use a variety of hand-hold positions on boxes during lifting. Where a lifter grabs the box can influence the trunk kinematics during the lifting task and these kinematics have been shown to provide some insight into risk of low back injury. This study documents the trunk postures and kinematics as a function of hand-hold position.

The effects of obesity on lifting performance

Obesity in the workforce is a growing problem worldwide. While the implications of this trend for biomechanical loading of the musculoskeletal system seem fairly straightforward, the evidence of a clear link between low back pain (LBP) and body mass index (BMI) (calculated as whole body mass in kilograms divided by the square of stature in meters) has not been shown in the epidemiology literature addressing this topic. The approach pursued in the current study was to evaluate the lifting kinematics and ground reaction forces of a group of 12 subjects -- six with a BMI of less than 25 kg/m(2) (normal weight) and six with a BMI of greater than 30 kg/m(2) (obese). These subjects performed a series of free dynamic lifting tasks with varied levels of load (10% and 25% of capacity) and symmetry (sagittally symmetric and 45 degrees asymmetric). The results showed that BMI had a significant effect (p<0.05) on trunk kinematics with the high BMI group exhibiting higher peak transverse plane (twisting) velocity (59% higher) and acceleration (57% higher), and exhibiting higher peak sagittal plane velocity (30% higher) and acceleration (51% higher). When normalized to body weight, there were no significant differences in the ground reaction forces between the two groups. This study provides quantitative data describing lifting task performance differences between people of differing BMI levels and may help to explain why there is no conclusive epidemiological evidence of a relationship between BMI and LBP.

Within-subject variability in low back load in a repetitively performed, mildly constrained lifting task

STUDY DESIGN

A repeated-measures in vivo experiment.

OBJECTIVE

To describe within-subject variability of spinal compression in repetitive lifting.

SUMMARY OF BACKGROUND DATA

Epidemiology and failure mechanics suggest that peak loads may be more predictive of injury than average loads. Nevertheless, biomechanical studies usually focus on the latter.

METHODS

Ten healthy males performed 360 lifts in 1 hour of a 45-L crate, weighted with a stable 10-kg mass on 1 day and with an unstable mass (10 kg of water) on another day. The maximum compression force in each lift was estimated, using a simple inverse dynamics model and a single equivalent muscle model.

RESULTS

The individual distributions of maximum compression force were slightly skewed to the right (average skewness 0.67). Median and 95th percentile values were used to characterize the distribution. The median (50th percentile) compression ranged from 3375 to 6125 N, and from 3632 to 6298 N in the stable and unstable load conditions, respectively. The within-subjects peak (95th percentile) compression forces were from 405 to 1767 N and from 526 to 2216 N, respectively, higher than the median values. The peak values differed significantly between conditions, whereas the difference in medians did not reach significance. Only a limited trendwise (fatigue-related) variance could be demonstrated.

CONCLUSION

Peak spinal compression by far exceeds median compression in repetitive lifting and can be affected by task conditions independently from the median. Therefore, the variability of spinal loads needs to be taken into consideration when analyzing and redesigning tasks that can cause spinal injuries.

The effects of motion on trunk biomechanics

OBJECTIVE

To review the literature that evaluates the influence of trunk motion on trunk strength and structural loading.

BACKGROUND

In recent years, trunk dynamics have been identified as potential risk factors for developing low-back disorders. Consequently, a better understanding of the underlying mechanisms involved in trunk motion is needed.

METHODS

This review summarizes the results of 53 studies that have evaluated trunk motion and its impact on several biomechanical outcome measures. The biomechanical measures consisted of trunk strength, intra-abdominal pressure, muscle activity, imposed trunk moments, and spinal loads. Each of these biomechanical measures was discussed in relation to the existing knowledge within each plane of motion (extension, flexion, lateral flexion, twisting, and asymmetric extension).

RESULTS

Trunk strength was drastically reduced as dynamic motion increased, and males were impacted more than females. Intra-abdominal pressure seemed to only be affected by trunk dynamics at high levels of force. Trunk moments were found to increase monotonically with increased trunk motion. Both agonistic and antagonistic muscle activities were greater as dynamic characteristics increased. As a result, the three-dimensional spinal loads increase significantly for dynamic exertions as compared to isometric conditions.

CONCLUSIONS

Trunk motion has a dramatic affect on the muscle coactivity, which seems to be the underlying source for the decrease strength capability as well as the increased muscle force, IAP, and spinal loads. This review suggests that the ability of the individual to perform a task "safely" might be significantly compromised by the muscle coactivity that accompanies dynamic exertions. It is also important to consider various workplace and individual factors when attempting to reduce the impact of trunk motions during dynamic exertions. Relevance This review provides insight as to why trunk motions are important risk factors to consider when attempting to control low-back disorders in the workplace. It is apparent that trunk motion increases the risk of low-back disorders. To better control low-back disorders in industry, more comprehensive knowledge about the impact of trunk motion is needed. A better understanding of muscle coactivity may ultimately lead to reducing the risk associated with dynamic exertions.

Low-back stresses when learning to use a materials handling device

This study examines the potential effect of short-term practice on low-back stresses during manual lifting and lowering of a 15 kg load, and while using two different types of materials handling devices (MHDs) to lift and lower a 40 kg load. The two MHDs used were an articulated balance arm and a pneumatic hoist. The expectation was that low-back dynamic moments, EMG measured torso muscle antagonism, and EMG predicted L4/L5 disc compression forces would rapidly decrease with practice, and that the manual lift-lower activities would be learned faster than the MHD-assisted exertions. Four naïve male college age subjects performed 40 lift and lower exertions, both manually and with the two MHDs for a total of 24 experiments. Non-linear regressions of the peak and average low-back moments, EMGs and disc compression values revealed only small decreases in the values (from 2 to 14%) over the 40 trials, and it was only statistically significant for five of the 48 regressions. This would seem to indicate that if learning is present in these tasks it is going to be very slow learning, and thus future studies will need to include a much larger number of trials. The effects of MHDs on the learning rates when compared to manual lifting learning rates was not statistically significant. It was shown, however, that MHDs had a particularly beneficial effect on reducing L4/L5 compression forces during load lowering activities despite the MHD load being much heavier than the manual load. It also was found that the level of torso muscle co-contraction increased significantly (2-4 times) when MHD handling was involved compared to manual lifting and lowering.