The effect of fatigue on multijoint kinematics and load sharing during a repetitive lifting test

Effect of muscular fatigue on the cumulative lumbar damage during repetitive lifting task: a comparative study of damage calculation methods

Several methods have been put forward to quantify cumulative loads; however, limited evidence exists as to the subsequent damages and the role of muscular fatigue. The present study assessed whether muscular fatigue could affect cumulative damage imposed on the L5-S1 joint. Trunk muscle electromyographic (EMG) activities and kinematics/kinetics of 18 healthy male individuals were evaluated during a simulated repetitive lifting task. A traditional EMG-assisted model of the lumbar spine was modified to account for the effect of erector spinae fatigue. L5-S1 compressive loads for each lifting cycle were estimated based on varying (i.e. actual), fatigue-modified, and constant Gain factors. The corresponding damages were integrated to calculate the cumulative damage. Moreover, the damage calculated for one lifting cycle was multiplied by the lifting frequency, as the traditional approach. Compressive loads and the damages obtained through the fatigue-modified model were predicted in close agreement with the actual values. Similarly, the difference between actual damages and those driven by the traditional approach was not statistically significant (p = 0.219). However, damages based on a constant Gain factor were significantly greater than those based on the actual (p = 0.012), fatigue-modified (p = 0.017), and traditional (p = 0.007) approaches.Practitioner summary: In this study, we managed to include the effect of muscular fatigue on cumulative lumbar damage calculations. Including the effect of muscular fatigue leads to an accurate estimation of cumulative damages while eliminating computational complexity. However, using the traditional approach also appears to provide acceptable estimates for ergonomic assessments.

Exploring Optimal Objective Function Weightings to Predict Lifting Postures Under Unfatigued and Fatigued States

OBJECTIVE

To explore whether the optimal objective function weightings change when using a digital human model (DHM) to predict origin and destination lifting postures under unfatigued and fatigued states.

BACKGROUND

The ability to predict human postures can depend on state-based influences (e.g., fatigue). Altering objective function weightings within a predictive DHM could improve the ability to predict tasks specific lifting postures under unique fatigue states.

METHOD

A multi-objective optimization-based DHM was used to predict origin and destination lifting postures for ten anthropometrically scaled avatars by using different objective functions weighting combinations. Predicted and measured postures were compared to determine the root mean squared error. A response surface methodology was used to identify the optimal objective function weightings, which was found by generating the posture that minimized error between measured and predicted lifting postures. The resultant weightings were compared to determine if the optimal objective function weightings changed for different lifting postures or fatigue states.

RESULTS

Discomfort and total joint torque weightings were affected by posture (origin/destination) and fatigue state (unfatigued/fatigued); however, post-hoc differences between fatigue states and lifting postures were not sufficiently large to be detected. Weighting the discomfort objective function alone tended to predict postures that generalized well to both postures and fatigue states.

CONCLUSION

Lift postures were optimal predicted using the minimization of discomfort objective function regardless of fatigue state.

APPLICATION

Weighting the discomfort objective can predict unfatigued postures, but more research is needed to understand the optimal objective function weightings to predict postures during a fatigued state.

The effect of back muscle fatigue on EMG and kinematics based estimation of low-back loads and active moments during manual lifting tasks

This study investigated the effects of back muscle fatigue on the estimation of low-back loads and active low-back moments during lifting, using an EMG and kinematics based model calibrated with data from an unfatigued state. Fourteen participants performed lifting tasks in unfatigued and fatigued states. Fatigue was induced through semi-static forward bending. EMG, kinematics, and ground reaction forces were measured, and low-back loads were estimated using inverse dynamics and EMG-driven muscle model. A regression model was developed using data from a set of calibration lifts, and its accuracy was evaluated for unfatigued and fatigued lifts. During the fatigue-inducing task, the EMG amplitude increased by 2.8 %MVC, representing a 38% increase relative to the initial value. However, during the fatigued lifts, the peak EMG amplitude was found to be 1.6 %MVC higher than that observed during the unfatigued lifts, representing a mere 4% increase relative to the baseline unfatigued peak EMG amplitude. Kinematics and low-back load estimates remained unaffected. Regression model estimation errors remained unaffected for 5 kg lifts, but increased by no more than 5% of the peak active low-back moment for 15 kg lifts. We conclude that the regression-based estimation quality of active low-back moments can be maintained during periods of muscle fatigue, although errors may slightly increase for heavier loads.

Tampa Scale of Kinesiophobia may underestimate task-specific fear of movement in people with and without low back pain

Introduction

The Tampa Scale of Kinesiophobia (TSK) is commonly used to assess fear of movement (FoM) in people with low back pain (LBP). However, the TSK does not provide a task-specific measure of FoM, whereas image-based or video-based methods may do so.

Objectives

To compare the magnitude of FoM when assessed using 3 methods (TSK-11, image of lifting, video of lifting) in 3 groups of people: current LBP (LBP), recovered LBP (rLBP), and asymptomatic controls (control).

Methods

Fifty-one participants completed the TSK-11 and rated their FoM when viewing images and videos depicting people lifting objects. Low back pain and rLBP participants also completed the Oswestry Disability Index (ODI). Linear mixed models were used to estimate the effects of methods (TSK-11, image, video) and group (control, LBP, rLBP). Linear regression models were used to assess associations between the methods on ODI after adjusting for group. Finally, a linear mixed model was used to understand the effects of method (image, video) and load (light, heavy) on fear.

Results

In all groups, viewing images (P = 0.009) and videos (P = 0.038) elicited greater FoM than that captured by the TSK-11. Only the TSK-11 was significantly associated with the ODI (P < 0.001). Finally, there was a significant main effect of load on fear (P < 0.001).

Conclusion

Fear of specific movements (eg, lifting) may be better measured using task-specific measures, such as images and videos, than by task-generic questionnaires, such as the TSK-11. Being more strongly associated with the ODI, the TSK-11 still plays an important role in understanding the impact of FoM on disability.

Does intra-lumbar flexion during lifting differ in manual workers with and without a history of low back pain? A cross-sectional laboratory study

Advice to limit or avoid a flexed lumbar curvature during lifting is widely promoted to reduce the risk of low back pain (LBP), yet there is very limited evidence to support this relationship. To provide higher quality evidence this study compared intra-lumbar flexion in manual workers with (n = 21) and without a history of LBP (n = 21) during a repeated lifting task. In contrast to common expectations, the LBP group demonstrated less peak absolute intra-lumbar flexion during lifting than the noLBP group [adjusted difference -3.7° (95%CI -6.9 to -0.6)]. The LBP group was also further from the end of range intra-lumbar flexion and did not use more intra-lumbar range of motion during any lift condition (both symmetrical and asymmetrical lifts and different box loads). Peak absolute intra-lumbar flexion was more variable in the LBP group during lifting and both groups increased their peak absolute intra-lumbar flexion over the lift repetitions. This high-quality capture of intra-lumbar spine flexion during repeated lifting in a clinically relevant cohort questions dominant safe lifting advice.Practitioner summary: Lifting remains a common trigger for low back pain (LBP). This study demonstrated that people with LBP, lift with less intra-lumbar flexion than those without LBP. Providing the best quality in-vivo laboratory evidence, that greater intra-lumbar flexion is not associated with LBP in manual workers, raising questions about lifting advice.

A Comprehensive Evaluation of Spine Kinematics, Kinetics, and Trunk Muscle Activities During Fatigue-Induced Repetitive Lifting

OBJECTIVE

Spine kinematics, kinetics, and trunk muscle activities were evaluated during different stages of a fatigue-induced symmetric lifting task over time.

BACKGROUND

Due to neuromuscular adaptations, postural behaviors of workers during lifting tasks are affected by fatigue. Comprehensive aspects of these adaptations remain to be investigated.

METHOD

Eighteen volunteers repeatedly lifted a box until perceived exhaustion. Body center of mass (CoM), trunk and box kinematics, and feet center of pressure (CoP) were estimated by a motion capture system and force-plate. Electromyographic (EMG) signals of trunk/abdominal muscles were assessed using linear and nonlinear approaches. The L5-S1 compressive force (Fc) was predicted via a biomechanical model. A two-way multivariate analysis of variance (MANOVA) was performed to examine the effects of five blocks of lifting cycle (C1 to C5) and lifting trial (T1 to T5), as independent variables, on kinematic, kinetic, and EMG-related measures.

RESULTS

Significant effects of lifting trial blocks were found for CoM and CoP shift in the anterior-posterior direction (respectively p < .001 and p = .014), trunk angle (p = .004), vertical box displacement (p < .001), and Fc (p = .005). EMG parameters indicated muscular fatigue with the extent of changes being muscle-specific.

CONCLUSION

Results emphasized variations in most kinematics/kinetics, and EMG-based indices, which further provided insight into the lifting behavior adaptations under dynamic fatiguing conditions.

APPLICATION

Movement and muscle-related variables, to a large extent, determine the magnitude of spinal loading, which is associated with low back pain.

Low Back Biomechanics during Repetitive Deadlifts: A Narrative Review

OCCUPATIONAL APPLICATIONSHeavy deadlifting is used as a screening tool or training protocol for recruitment and retention in physically-demanding occupations, especially in the military. Spinal loads experienced during heavy deadlifts, particularly shearing forces, are well above recommended thresholds for lumbar spine injury in occupational settings. Although members of the noted occupation likely have stronger musculoskeletal systems compared to the general population, experiencing shearing forces that are 2 to 4 times larger than the threshold of injury, particularly under repetitive deadlift, may transform a screening tool or training protocol to an occupationally-harmful physical activity.

The Influence of Fatigue on Throwing and YBT-UQ Performance in Male Adolescent Handball Players

Purpose: The goal of the present study was to assess the effects of fatigue on throwing and Upper Quarter Y Balance Test (YBT-UQ) performance in male adolescent handball players. We hypothesized that throwing and YBT-UQ performance will be decreased in response to an upper-body fatigue-protocol.

Method: All male participants (N = 24, age: 14.8 ± 0.7 yrs) were handball players of a regional youth selection team. A radar gun was used for the assessment of throwing velocity. The YBT-UQ was executed assessing medial, inferolateral and superolateral reach directions normalized to the upper limb length together with a composite score. Immediately following a fatigue protocol of different sets of push-ups until failure (i.e., not being able to perform 60% of the initial maximal amount of push-ups), throwing and YBT-UQ performance were assessed again.

Results: Fatigue resulted in a significant decrease in throwing velocity (−3%, p = 0.022, d = 0.32). Concerning YBT-UQ, the fatigue protocol produced significant decreases for the superolateral reach direction (throwing arm reach: −5%, p = 0.017, d = 0.39; non-throwing arm reach: −10%, p < 0.001, d = 0.87) and the composite score (throwing arm reach: −2%, p = 0.026, d = 0.31; non-throwing arm reach: −4%, p = 0.001, d = 0.52) but not for the medial and the inferolateral reach directions.

Conclusions: Fatigue was found to be an impairing factor for throwing performance and shoulder mobility and stability. Therefore, a lower level of fatigue and/or a higher tolerance of fatigue is desirable. Strength-endurance and mobility exercises especially for the shoulder girdle may be a valuable addition for the training routine of youth handball players.

The immediate and prolonged effects of military body armor on the relative timing of thorax and pelvis rotations during toe-touch and two-legged squat tasks

Although military body armor is an effective life saver, it considerably loads more weight on the warfighters, increasing the risk of musculoskeletal injury. This study investigated the immediate and prolonged effects of wearing body armor on timing aspect of lumbo-pelvic coordination during the toe-touch (TT) and two-legged-squat (TLS) tests. A cross-over study design was used wherein twelve asymptomatic and gender-balanced individuals completed two experimental sessions with and without body armor. A session included two similar sets of tests, before and after exposure to a treadmill walk, containing a TT and a TLS test with ten cycles of fast bending and return. Reflective markers were attached on the participants to capture the kinematics of body segments in conjunction with a motion capture system. The mean absolute relative phase (MARP) and deviation phase (DP) between the thorax and pelvis were calculated for each test. The pre-walk MARP in the return was significantly larger with versus without body armor (p = 0.022), while there were no significant effects of body armor on the other outcome measures. In addition, the pre-walk MARP and DP in the bending and return, as well as the walk-induced changes in the MARP in the bending phase were significantly larger in TLS versus TT (p < 0.026). Therefore, using a body armor immediately made the lumbo-pelvic coordination less in-phase during return, but no prolonged effects were found. Further investigation is necessary to specify chances wearing a body armor increases the risk of musculoskeletal injuries in the lower back and lower extremities joints.

Joint moment trade-offs across the upper extremity and trunk during repetitive work

Individuals can coordinate small kinematic changes at several degrees of freedom simultaneously in the presence of fatigue, leaving it unclear how overall biomechanical demands at each joint are altered. The purpose of this study was to evaluate trade-offs in joint moments between the trunk, shoulder, and elbow during repetitive upper extremity work. Participants performed four simulated workplace tasks cyclically until meeting fatigue termination criteria. Emergent fatigue-induced adaptations to repetitive work resulted in task-dependent trade-offs in joint moments. In general, reduced shoulder moments were compensated for by increased elbow and trunk joint moment contributions. Although mean joint moment changes were modest (range: 1-3 Nm) across participants, a wide distribution of responses was observed, with standard deviations exceeding 10 Nm. Re-distributing biomechanical demands across joints may alleviate constant tissue loads and facilitate continued task performance with fatigue but may be at the expense of increasing demands at adjacent joints.

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

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

Effects of Shoulder Taping on Discomfort and Electromyographic Responses of the Neck While Texting on a Touchscreen Smartphone

Background

Prolonged neck flexion during smartphone use is known as a factor of neck pain and alteration of neck muscle activity. Studies on the effects of shoulder taping on neck discomfort and neck muscle responses while texting on a smartphone are still lacking. The aim of this study was to examine the effects of shoulder taping on neck discomfort using a numerical rating scale, and neck muscle activity and fatigue using a surface electromyography during a texting task on a touchscreen smartphone.

Methods

Twenty-five healthy adolescents used the dominant hand to perform a 30-minute texting task using a touchscreen smartphone at two separate times under one of the following two conditions: taping across the upper trapezius muscle and no taping. Neck discomfort, normalized root mean square, and normalized median frequency slopes for upper trapezius, cervical erector spinae, and sternocleidomastoid muscles were recorded.

Results

The results revealed that shoulder taping provided significantly lower neck discomfort than no taping (p < 0.001). However, shoulder taping did not significantly alter normalized root mean square and normalized median frequency slope values of all muscles when compared with no taping controls.

Conclusion

Shoulder taping reduces neck discomfort but does not affect neck muscle activity and fatigue while texting on a touchscreen smartphone.

Proximal and distal muscle fatigue differentially affect movement coordination

Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p < 0.005) in trunk lean and velocity, reduced humeral elevation (11°, p < 0.005), and increased elbow flexion (4°, p < 0.01). In contrast, distal fatigue caused small but significant changes in trunk angles (2°, p < 0.05), increased velocity of wrench movement relative to the hand (17°/s, p < 0.001), and earlier wrist extension (4%, p < 0.005). Movement variability increased at proximal joints but not distal joints after both fatigue protocols (p < 0.05). Varying movements at proximal joints may help people adapt to fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks.

Effects of Trunk Muscle Fatigue on Spine Mechanics during Repetitive Asymmetrical Lifting

The purpose of this study was to determine the effects of repetitive lifting on trunk muscle activity and spine kinematics during an intense, forty minute, asymmetrical lifting and lowering task. Contrary to many previous sagittal plane materials handling studies, the asymmetrical task did result in differences in kinematics between lifting and lowering. Further, there were few consistent effects of fatigue on trunk muscle activity and only spine flexion was observed to decrease over the course of the trials. However, some individual subjects did demonstrate fatigue related changes that may have increased their risk of injury if performed over prolonged periods.

Obesity-related changes in prolonged repetitive lifting performance

Despite the rising prevalence of obesity, little is known about its moderating effects on injury risk factors, such as fatigue, in occupational settings. This study investigated the effect of obesity, prolonged repetitive lifting and their interaction on lifting performance of 14 participants, 7 obese (mean body mass index (BMI): 33.2 kg m(-2)) and 7 non-obese (mean BMI: 22.2 kg m(-2)) subjects. To present a physically challenging task, subjects performed repetitive lifting for 1 h at 120% of their maximum acceptable weight of lift. Generalized linear mixed models were fit to posture and acceleration data. The obese group bent to a ∼10° lower peak trunk sagittal flexion angle, had 17% lower root mean square (RMS) jerk and took 0.8 s longer per lift. Over time, the obese group increased their trunk transverse and sagittal posterior accelerations while the non-obese maintained theirs. Although the majority of lifting variables were unaffected by BMI or its interaction with prolonged lifting duration, the observed differences, combined with a greater upper body mass, necessitate a more cautious use of existing psychophysical lifting limits for individuals who are obese, particularly when fatigued.

Exercise-Based Performance Enhancement and Injury Prevention for Firefighters: Contrasting the Fitness- and Movement-Related Adaptations to Two Training Methodologies

Using exercise to enhance physical fitness may have little impact on performers' movement patterns beyond the gym environment. This study examined the fitness and movement adaptations exhibited by firefighters in response to 2 training methodologies. Fifty-two firefighters were assigned to a movement-guided fitness (MOV), conventional fitness (FIT), or control (CON) group. Before and after 12 weeks of training, participants performed a fitness evaluation and laboratory-based test. Three-dimensional lumbar spine and frontal plane knee kinematics were quantified. Five whole-body tasks not included in the interventions were used to evaluate the transfer of training. FIT and MOV groups exhibited significant improvements in all aspects of fitness; however, only MOV exhibited improvements in spine and frontal plane knee motion control when performing each transfer task (effect sizes [ESs] of 0.2-1.5). FIT exhibited less controlled spine and frontal plane knee motions while squatting, lunging, pushing, and pulling (ES: 0.2-0.7). More MOV participants (43%) exhibited only positive posttraining changes (i.e., improved control), in comparison with FIT (30%) and CON (23%). Fewer negative posttraining changes were also noted (19, 25, and 36% for MOV, FIT, and CON). These findings suggest that placing an emphasis on how participants move while exercising may be an effective training strategy to elicit behavioral changes beyond the gym environment. For occupational athletes such as firefighters, soldiers, and police officers, this implies that exercise programs designed with a movement-oriented approach to periodization could have a direct impact on their safety and effectiveness by engraining desirable movement patterns that transfer to occupational tasks.

Effects of task precision demands on behavioral and physiological changes during a repetitive asymmetric lifting activity

OBJECTIVE

This study investigated the effects of task precision demands on behavioral and physiological changes during repetitive asymmetric lifting.

BACKGROUND

Repetitive lifting encountered in manual material handling leads to muscle fatigue and is a documented risk factor for low back disorder.

METHOD

A total of 17 healthy volunteers performed repetitive asymmetric lifting for 60 min (10 lifts/min). Task precision demands were imposed by varying the entry width onto the destination conveyor. Physiological changes were assessed using near-infrared spectroscopy obtained from the erector spinae muscles. Three-dimensional spine kinematics and moment responses were quantified to understand behavioral changes during the lifting activity.

RESULTS

Task precision demands showed no effect on erector spinae muscle oxygenation levels. Behavioral changes associated with repetitive lifting included increases in the overall lift duration, peak forward bending motion, and three-dimensional movement velocities of the spine, along with a decrease in the lateral bending moment. Relative to low precision demands, high precision demands resulted in 20% longer placement periods, which, in turn, resulted in a 12% increase in the time-integrated twisting postures and a 10% increase in the time-integrated lateral bending moments during load placement.

CONCLUSION

The elevated risk of low back injury when lifting under greater precision demands is likely due to the sustained spine twisting and the sustained lateral bending moment on the spine in the final phase of these lifts.

APPLICATION

Understanding behavioral changes to repetitive asymmetric lifting, especially for tasks requiring greater precision can be used to support injury prevention efforts.

Effects of four days hiking on postural control

Hiking is a demanding form of exercise that may cause delayed responses of the postural muscles and a loss of somatosensory information, particularly when repeatedly performed for several days. These effects may negatively influence the postural control of hikers. Therefore, the aim of this study was to investigate the effects of a four-day hike on postural control. Twenty-six adults of both sexes travelled 262 kilometers, stopping for lunch and resting in the early evening each day. Force platforms were used to collect center of pressure (COP) data at 100 Hz for 70 seconds before hiking started and immediately after arriving at the rest station each day. The COP time course data were analyzed according to global stabilometric descriptors, spectral analysis and structural descriptors using sway density curve (SDC) and stabilometric diffusion analysis (SDA). Significant increases were found for global variables in both the anterior-posterior and medial-lateral directions (COP sway area, COP total sway path, COP mean velocity, COP root mean square value and COP range). In the spectral analysis, only the 80% power frequency (F80) in the anterior-posterior direction showed a significant increase, reflecting the increase of the sway frequencies. The SDC revealed a significant increase in the mean distance between peaks (MD) and a significant decrease in the mean peak amplitudes (MP), suggesting that a larger torque amplitude is required for stabilization and that the postural stability is reduced. The SDA revealed a decrease in the long-term slope (Hl) and increases in the short-term (Ks) and the long-term (Kl) intercepts. We considered the likelihood that the presence of local and general fatigue, pain and related neuromuscular adaptations and somatosensory deficits may have contributed to these postural responses. Together, these results demonstrated that four days of hiking increased sway frequencies and deteriorated postural control in the standing position.

Age-related differences do affect postural kinematics and joint kinetics during repetitive lifting

BACKGROUND

Age is considered a risk factor for manual handling-related injuries and older workers incur higher injury-related costs than younger co-workers. This study investigated the differences between the kinematics and kinetics of repetitive lifting in two groups of handlers of different ages.

METHODS

Fourteen younger (mean 24.4 yr) and 14 older (mean 47.2 yr) males participated in the study. Participants repetitively lifted a box weighing 13 kg at a frequency of 10 lifts/min for a maximum of 20 min. Postural kinematics (joint and lumbosacral angles and angular velocities) and kinetics (joint moments) were measured throughout the lifting task using motion analysis and ground reaction forces. Muscle fatigue of the erector spinae was assessed using electromyography.

FINDINGS

Peak lumbosacral, trunk, hip and knee flexion angles differed significantly between age groups over the duration of the task, as did lumbosacral and trunk angular velocities. The younger group increased peak lumbar flexion by approximately 18% and approached 99% of maximum lumbosacral flexion after 20 min, whereas the older group increased lumbar flexion by 4% and approached 82% maximum flexion. The younger group had a larger increase in peak lumbosacral and trunk angular velocities during extension, which may be related to the increased back muscle fatigue observed among the younger group.

INTERPRETATION

Older participants appeared to control the detrimental effects of fatigue associated with repetitive lifting and limit lumbar spine range of motion. The higher rates of musculoskeletal injury among older workers may stem from a complex interaction of manual handling risk factors.

Precision markedly attenuates repetitive lift capacity

This study investigated the effect of precision on time to task failure in a repetitive whole-body manual handling task. Twelve participants were required to repetitively lift a box weighing 65% of their single repetition maximum to shoulder height using either precise or unconstrained box placement. Muscle activity, forces exerted at the ground, 2D body kinematics, box acceleration and psychophysical measures of performance were recorded until task failure was reached. With precision, time to task failure for repetitive lifting was reduced by 72%, whereas the duration taken to complete a single lift and anterior deltoid muscle activation increased by 39% and 25%, respectively. Yet, no significant difference was observed in ratings of perceived exertion or heart rate at task failure. In conclusion, our results suggest that when accuracy is a characteristic of a repetitive manual handling task, physical work capacity will decline markedly.

PRACTITIONER SUMMARY

The capacity to lift repetitively to shoulder height was reduced by 72% when increased accuracy was required to place a box upon a shelf. Lifting strategy and muscle activity were also modified, confirming practitioners should take into consideration movement precision when evaluating the demands of repetitive manual handling tasks.

Physiological and biomechanical responses to a prolonged repetitive asymmetric lifting activity

This study investigated the effects of a prolonged repetitive asymmetric lifting task on behavioural adaptations during repetitive lifting activity, measures of tissue oxygenation and spine kinematics. Seventeen volunteers repeatedly lifted a box, normalised to 15% of the participant's maximum lifting strength, at the rate of 10 lifts/min for a period of 60 min. The lifts originated in front of the participants at ankle level and terminated on their left side at waist level. Overall, perceived workload increased during the repetitive lifting task. Erector spinae oxygenation levels, assessed using near-infrared spectroscopy, decreased significantly over time. Behavioural changes observed during the repetitive lifting task included increases in the amount of forward bending, the extension velocity and the lateral bending velocity, and a reduced lateral bending moment on the spine. These changes, with the exception of the reduced lateral bending moment, are associated with increased risk of low back disorder.

A randomized controlled trial of limited range of motion lumbar extension exercise in chronic low back pain

STUDY DESIGN

Randomized controlled trial.

OBJECTIVE

To compare the effects of full range of motion (ROM) and limited ROM isolated lumbar extension exercise upon full ROM lumbar extension strength, ROM, perceived pain, and disability.

SUMMARY OF BACKGROUND DATA

Limited ROM is common in chronic low back pain as is lumbar extensor deconditioning. Limited ROM exercise is a common prescription but is yet to be empirically tested.

METHODS

Males (n = 21) and females (n = 17) with nonspecific chronic low back pain were initially recruited. Participants were randomized to either a full ROM (FullROM) or limited ROM (LimROM) training group or a control group. A total of 24 participants (males: n = 14, females: n = 10) completed the study and were included in analysis. The intervention lasted 12 weeks. FullROM and LimROM groups completed isolated lumbar extension resistance training once per week, performing one set of exercise at 80% of their maximal tested functional torque to failure. FullROM group trained through a full ROM. LimROM group trained through the mid 50% of their full ROM.Full ROM isolated lumbar extension strength, lumbar and standing ROM (Schobers test), perceived pain (visual analogue scale), and disability (Revised Oswestry Disability Index) were measured pre- and postintervention.

RESULTS

FullROM and LimROM significantly improved in full ROM lumbar extension strength, perceived pain, and disability compared with the control group. No changes occurred in lumbar or standing ROM. No significant differences were found between either FullROM or LimROM for any outcome measure. Changes in perceived pain and disability met minimal clinically important change values for FullROM (visual analogue scale, -30.3 + 25.76 mm and Oswestry Disability Index, -18.2 + 6.63 patients) and LimROM (visual analogue scale, -16.29 + 10.97 mm and Oswestry Disability Index, -12 + 5.16 patients).

CONCLUSION

The results suggest that both FullROM and LimROM are equally effective in increasing full ROM lumbar extension strength and producing clinically meaningful improvement in perceived pain and disability.

Gender Differences in Trunk and Pelvic Kinematics During Prolonged Ergometer Rowing in Adolescents

The trunk and pelvis kinematics of 20 healthy male and female adolescent rowers were recorded during an ergometer trial using an electromagnetic tracking system (Fastrak). The kinematics of each drive phase were collected during the 1st and 20th minute, respectively. The mean and range of the kinematics, stroke rate and stroke length were compared between genders and over time. Male rowers postured their pelvis with more posterior tilt and their thoracic spine in more flexion than female rowers (P< .05). Both genders postured their pelvis in more posterior pelvic rotation and upper trunk in more flexion over time. Male rowers were found to have a significantly shorter drive phase than female rowers (P= .001). Differences in trunk and pelvic kinematics between adolescent male and female rowers suggest potentially various mechanisms for biomechanical stress. Assessment and training of rowers should take gender differences into consideration.

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.

Differences in posture-movement changes induced by repetitive arm motion in healthy and shoulder-injured individuals

BACKGROUND

Neck/Shoulder pain is linked to movement repetition, awkward postures, prolonged maintenance of static postures, and muscular fatigue. Studies have examined the influence of pain and fatigue on movement characteristics, but few reported multi-dimensional adaptations to movement repetition. We compared the adaptations measured in three-dimensions during a repetitive reaching task in persons with chronic neck/shoulder pain and healthy subjects.

METHODS

A shoulder-injured group (intensity >3/10, duration >3 consecutive months) and an age-sex-matched control group (n=16 in each) performed a repetitive reaching task to voluntary termination. Kinematics, kinetics, heart rate and muscle activity were recorded throughout. Power output on a 10-s pushing/pulling task was assessed pre- and post-reaching. Group comparisons were made in absolute time and at task end.

FINDINGS

Control subjects performed the task 55% longer than the pain group; yet, both groups demonstrated task-related increased heart rate (6 beats per minute) and decreased power output (6 W). Throughout the task, the pain group demonstrated: higher supraspinatus activity, and less elbow flexion and endpoint movement. The control group increased movement amplitude of the endpoint, elbow, and shoulder, while the pain group moved the shoulder less and increased center of mass excursion to maintain the task.

INTERPRETATION

Both groups adapted to the task in unique ways. The control group continually increased elbow and endpoint range of motion, bringing the arm closer to the targets, possibly to prolong task performance. The pain group used a fixed, en block arm strategy, likely to reduce the load on the injured structures; however, this may place other structures at risk for pain and injury.

Is activation of the back muscles impaired by creep or muscle fatigue?

STUDY DESIGN

Intervention study on healthy human subjects.

OBJECTIVE

To determine whether reflex activation of the back muscles is influenced by muscle fatigue or soft tissue creep in the spine.

SUMMARY OF BACKGROUND DATA

Reflex contraction of the back muscles normally acts to limit spinal flexion, and hence protect the underlying spine from injury. However, repeated flexion allows bending moments on the spine to increase. Impaired reflexes as a result of fatigue or soft tissue creep may be contributing factors.

METHODS

A total of 15 healthy volunteers (8 females/7 males aged 23-55 years) underwent 2 interventions, on separate days: (a) sitting flexed for 1 hour to induce creep and (b) performing the Biering-Sorensen test to induce back muscle fatigue. Before and after each intervention, reflex activation of the erector spinae in response to sudden trunk flexion (initiated by a Kin-Com dynamometer) was monitored bilaterally at T10 and L3 using surface electromyography (EMG) electrodes. These recordings indicated the onset latency of reflex activation, the peak EMG, and time to peak, at each site. Measurements before and after each intervention and between muscle sites were compared using a 2-way repeated measures Analysis of Variance.

RESULTS

Spinal creep was confirmed by an increase in maximum flexion of 2.3 degrees +/- 2.5 degrees (P = 0.003), and fatigue by a significant fall in median frequency at one or more sites. Following creep, onset latency increased from 60 +/- 12 milliseconds to 96 +/- 26 milliseconds (P < 0.001) but there was no change in peak EMG or time to peak EMG. Differences between sites (P = 0.004) indicated greater latencies in lumbar compared to thoracic regions, especially after creep. Muscle fatigue had no significant effects on any of the measured parameters.

CONCLUSION

Prolonged spinal flexion can impair sensorimotor control mechanisms and reduce back muscle protection of the underlying spine. The effect is due to time-dependent "creep" in soft tissues rather than muscle fatigue.

Can relative strength between the back and knees differentiate lifting strategy?

OBJECTIVE

This study investigated whether relative strength between the back and knees can differentiate and predict lifting strategy and the effects of gender, load magnitude, and knowledge of strength on the strategy.

BACKGROUND

Although muscular strength is thought to play a vital role in the mechanics of lifting, how localized joint strengths and their relations influence lifting strategy remains unclear.

METHOD

Thirty-two participants (16 men and 16 women) underwent isokinetic strength tests and were then divided into two groups: one provided with the knowledge of their strength test results and the other not. They subsequently performed the same set of simulated lifting tasks while their lifting kinematics were being recorded. Postural indices to quantify the lifting strategies were derived from the kinematic data.

RESULTS

The ratio of back strength versus total knee strength and gender had significant effects on measures quantifying the lifting strategy. A statistical model incorporating gender, strength, and anthropometry achieved an R2 value of .64 and predicted correctly 76% of lifting strategies used by individual participants.

CONCLUSION

Individuals with back strength greater than their total knee strength tended to use a back-preferred lift strategy, and vice versa, suggesting that muscular strength is a determining factor of lifting strategy.

APPLICATION

An emphasis on additional knee strengthening in a training program may change the tendency of using and overstressing the back. APPLICATION of modeling and simulation technology for ergonomics design can be enhanced by more individually and accurately specified lifting strategies based on anthropometry and strength profiles.

Trunk muscle activation during sub-maximal extension efforts

Neuromuscular fatigue of the trunk musculature, particularly lumbar paraspinal and abdominal muscles, is important in when evaluating motor control of the trunk. Activation of agonists and antagonists trunk muscles was hypothesized to change during sub-maximal isometric trunk extension efforts. Thirteen women were positioned in 30 degrees of trunk flexion and performed maximal voluntary isometric contraction in trunk extension against an isokinetic dynamometer. One of two sub-maximal efforts (50% and 70%) was performed to induce neuromuscular fatigue on two different days. Surface electromyography of the lumbar paraspinal (LP), rectus abdominis, and external oblique muscles was recorded during each session. Torque output, median frequency of the power density spectrum, and normalized integrated electromyography were analyzed using repeated measures analysis of variance to evaluate trends in the data over time. Paraspinal muscles showed signs of fatigue in both conditions (p<0.05) Abdominal activity did not increase during the 70% condition, but showed a non-significant trend (p=0.07), coinciding with the reduced median frequency of LP muscles. The neuromuscular system modulates its motor control strategy to identify the muscle activation levels necessary to maintain force output. This information is necessary in the evaluation of contributing mechanisms to trunk stability in furthering preventative and rehabilitative treatments.

Changes in muscle activity and kinematics of highly trained cyclists during fatigue

Muscle fatigue may alter kinematics and contribute to repetitive strain injuries. This study quantified how both localized muscle fatigue and movement kinematics change over time during exhaustive cycling. Seven highly trained cyclists rode a stationary bicycle ergometer at 100% of their maximum oxygen consumption (VO(2) max) until voluntary exhaustion. Cycling kinematics and electromyography (EMG) activity from select lower extremity muscles were recorded. Cross-correlations were computed to quantify how EMG median frequencies (MDFs) changed with changes in movement kinematics. All athletes maintained both cadence and power output for approximately 90% of the trial duration. Significant sustained muscle fatigue occurred in 18 of 28 muscles tested, most prominently in the biceps femoris (p = 0.020) and gastrocnemius (p = 0.018). Kinematics and MDF both fluctuated nonmonotonically as subjects fatigued. Changes in MDF significantly preceded changes in mean trunk lean (p = 0.009) and hip angles (p = 0.025), and trunk lean range of motion ( p = 0.029). Fluctuations in MDF were positively correlated with fluctuations in mean trunk lean (p = 0.009) and knee splay angles (p = 0.011), and with trunk lean (p = 0.002) and ankle (p = 0.001) range of motion. These results therefore establish a direct link between changes in muscle fatigue state and subsequent changes in movement kinematics during cycling.

Slow-time changes in human EMG muscle fatigue states are fully represented in movement kinematics

The ability to identify physiologic fatigue and related changes in kinematics can provide an important tool for diagnosing fatigue-related injuries. This study examined an exhaustive cycling task to demonstrate how changes in movement kinematics and variability reflect underlying changes in local muscle states. Motion kinematics data were used to construct fatigue features. Their multivariate analysis, based on smooth orthogonal decomposition, was used to reconstruct physiological fatigue. Two different features composed of (1) standard statistical metrics (SSM), which were a collection of standard long-time measures, and (2) phase space warping (PSW)-based metrics, which characterized short-time variations in the phase space trajectories, were considered. Movement kinematics and surface electromyography (EMG) signals were measured from the lower extremities of seven highly trained cyclists as they cycled to voluntary exhaustion on a stationary bicycle. Mean and median frequencies from the EMG time series were computed to measure the local fatigue dynamics of individual muscles independent of the SSM- and PSW-based features, which were extracted solely from the kinematics data. A nonlinear analysis of kinematic features was shown to be essential for capturing full multidimensional fatigue dynamics. A four-dimensional fatigue manifold identified using a nonlinear PSW-based analysis of kinematics data was shown to adequately predict all EMG-based individual muscle fatigue trends. While SSM-based analyses showed similar dominant global fatigue trends, they failed to capture individual muscle activities in a low-dimensional manifold. Therefore, the nonlinear PSW-based analysis of strictly kinematic time series data directly predicted all of the local muscle fatigue trends in a low-dimensional systemic fatigue trajectory. These results provide the first direct quantitative link between changes in muscle fatigue dynamics and resulting changes in movement kinematics.

Measurement of spinal range of motion in healthy individuals using an electromagnetic tracking device

Object

The authors measured the range of motion (ROM) of the spine in healthy individuals by using an electromagnetic tracking device to evaluate the functional performance of the spine.

Methods

The authors used the Flock of Birds electromagnetic tracking device with 4 receiver units attached to C-7, T-12, S-1, and the midthigh region. Forward/backward bending, bilateral side bending, and axial rotation of the trunk were performed in 18 healthy individuals.

Results

The average ROM was calculated after 3 consecutive measurements. The thoracic spine generated the greatest angle in axial rotation and smallest angle in backward bending. The lumbar spine generated the greatest angle in forward bending and smallest angle in axial rotation. The hip joints generated the greatest angle in forward bending and smallest angle in backward bending. Additionally, 40% of forward-bending motion occurred in the lumbar spine and 40% occurred in the hip joints. Approximately 60% of backward bending occurred in the lumbar spine; 60% of axial rotation occurred in the thoracic spine; and 45% of side bending occurred in the thoracic spine.

Conclusions

The Flock of Birds electromagnetic tracking device cannot only measure the ROM of spine but also easily differentiate the 6-degree contributions by different segments.

Shifting of activation center in the brain during muscle fatigue: an explanation of minimal central fatigue?

Accumulating evidence suggests that the overall level of cortical activation controlling a voluntary motor task that leads to significant muscle fatigue does not decrease as much as the activation level of the motoneuron pool projecting to the muscle. One possible explanation for this "muscle fatigue>cortical fatigue" phenomenon is that the brain is an organ with built-in redundancies: it has multiple motor centers and parallel pathways, and the center of activation may shift from one location to another when neurons in the previous location become fatigued. This hypothesis was tested by estimating the changes of source locations of high-density (64 channels) scalp electroencephalographic (EEG) signals collected during both fatigue and non-fatigue motor tasks. A current dipole model was used to estimate the EEG sources. The fatigue motor task induced significant muscle fatigue, and the non-fatigue task did not. The EEG signal source that indicated the center of brain activation showed substantial location shifts during the fatigue motor task. The shifts could not be explained by variations of source locations caused by error estimated from the non-fatigue task EEG and simulated data. Compared to the non-fatigue condition, the weighted-center of the source locations for all the participants shifted toward the right hemisphere (ipsilateral to the muscle activation), anterior, and inferior cortical regions under the fatigue condition. Fatigue did not alter dipole (source-signal) strength or the overall level of brain activation. The brain may avoid fatigue by shifting neuron populations that participate in a fatiguing motor task.

Head movement control in visually guided tasks: postural goal and optimality

This work investigates the control of horizontal head movements in the context of unconstrained visually guided head and arm/finger aiming tasks. In a first experiment, the head was free to move while gaze was directed at randomly presented eccentric targets distributed horizontally (0 degrees-120 degrees) at eye level. In a second experiment, the horizontal head orientation was constrained to predetermined positions (0 degrees, 15 degrees, 30 degrees, 45 degrees or 60 degrees rightward) while the right index finger aimed at targets with the arm fully extended. Kinematics of head movements in gaze displacements exhibits an initial component weakly correlated with target position, followed by multiple corrections. Since the eyes are assumed to already be aimed at the target when the corrections occur, it is suggested that one goal of head movement control is to achieve a desired final orientation (posture). This hypothesis is supported by results from the second experiment that reveal an association between eye/head orientation angles and errors exhibited in the visuo-spatial representation of the environment. The minimization of error then underlies the control of head movement as a postural response optimized for a given target and task condition.

Spine loading as a function of lift frequency, exposure duration, and work experience

BACKGROUND

Physiological and psychophysical studies of the effects of lifting frequency have focused on whole-body measurements of fatigue or subjective acceptance of the task and have not considered how spine loads may change as a function of lift frequency or lift time exposure. Our understanding of biomechanical spine loading has been extrapolated from short lifting bouts to the entire work day and may have led us to incorrect assumptions. The objective of this project was to document how spine loading changes as a function of experience, lift frequency, and lift duration while repetitively lifting over the course of an 8-h workday.

METHODS

Twelve novice and twelve experienced manual materials handlers performed repetitive, asymmetric lifts at different load and lift frequency levels throughout an 8-h exposure period. Compression, anterior-posterior shear, and lateral shear were evaluated over the lifting period using an EMG-assisted biomechanical model.

RESULTS

Spinal loads increased after the first 2 h of lifting exposure regardless of the lift frequency. Loading was also greater for the inexperienced subjects compared to experienced lifters. The greatest spine loads occurred at those lift frequencies and weights to which the workers were unaccustomed.

INTERPRETATION

Increases in spine loading were tracked back to the changes in muscle recruitment patterns that typically involved increased muscle coactivation. The results emphasize the importance of previous motor programming in defining spine loads during repetitive lifting. These results indicate a very different influence of frequency and lift time exposure compared to physiologic and psychophysical assessments. This study has shown that it is not sufficient to extrapolate from short lift periods to extended exposure periods if the biomechanical loading implications of the task are of interest.

Effect of fatigue on the precision of a whole-body pointing task

We addressed the issue of the possible degradation of the aiming precision of a whole-body pointing task, when movement coordination is deranged by selective fatigue of the postural task component. The protocol involved continuous repetition (0.1 Hz frequency) of rapid whole-body pointing trials toward a target located beyond arm length, starting from stance and requiring knee flexion. Six healthy human subjects repeated the trials until exhaustion. Such repetition led to electromyography signs of fatigue in rectus femoris (active in body lowering and raising), but not in deltoid (prime mover for arm reaching component). Rectus femoris fatigue affected the equilibrium control strategy, since the anteroposterior displacement of the center of foot pressure was reduced during the fatigued compared with the initial trials. Conversely, the precision of the aiming movement was unaffected by the rectus femoris fatigue in spite of changes in finger trajectory. Trunk inclination at the end of whole-body pointing task and hip and shoulder marker trajectories were unaffected by rectus femoris fatigue. Control experiments were made, whereby fatiguing repetitions of the postural component of the task were performed without finger pointing, except in the first and last five complete whole-body pointing trials. The results were not different from those of the main protocol, except for a transient change in finger trajectory in the very first trial after fatigue. The CNS takes into account the state of postural muscles' fatigue and the concurrently ensuing equilibrium constraints in order to appropriately modify whole-body pointing strategy and keep pointing precision at the target.

Sex differences in the rate of fatigue development and recovery

Background

Many musculoskeltal injuries in the workplace have been attributed to the repetitive loading of muscle and soft tissues. It is not disputed that muscular fatigue is a risk factor for musculoskeltal injury, however the disparity between gender with respect to muscular fatigability and rate of recovery is not well understood. Current health and safety guidelines do not account for sex differences in fatiguability and may be predisposing one gender to greater risk. The purpose of this study was to quantify the sex differences in fatigue development and recovery rate of lower and upper body musculature after repeated bouts of sustained isometric contractions.

Methods

Twenty-seven healthy males (n = 12) and females (n = 15) underwent bilateral localized fatigue of either the knee extensors (male: n = 8; female: n = 8), elbow flexors (male: n = 8; female: n = 10), or both muscle groups. The fatigue protocol consisted of ten 30-second sub-maximal isometric contractions. The changes in maximum voluntary contraction (MVC), electrically evoked twitches, and motor unit activation (MUA) were assessed along with the ability to control the sustained contractions (SLP) during the fatigue protocol using a mixed four-factor repeated measures ANOVA (gender × side × muscle × time) design with significance set at p < 0.05.

Results

There was a significant loss of MVC, MUA, and evoked twitch amplitude from pre- to post-fatigue in both the arms and legs. Males had greater relative loss of isometric force, a higher rate of fatigue development, and were less capable of maintaining the fatiguing contractions in the legs when compared to the females.

Conclusion

The nature of the induced fatigue was a combination of central and peripheral fatigue that did not fully recover over a 45-minute period. The results appear to reflect sex differences that are peripheral, and partially support the muscle mass hypothesis for explaining differences in muscular fatigue.