The association between back pain and trunk posture of workers in a special school for the severe handicaps

Promoting Regeneration in Degenerative Disc Disease

OBJECTIVE

The degenerative disc disease has a multifactorial etiology and mechanical stress is one of the most important etiological factor. The purpose of this study was to evaluate the intervertebral disc (IVD) after axial stress diminution from the point of view of its proteoglycan (PG) content, with preoteoglicans (PGs) being very important in the normal function but also in the degenerative or regenerative processes.

METHODS

This is a single-center, prospective, non-randomized study of 38 degenerated intervertebral discs treated with monosegmental or polisegmental posterior lumbar spinal fixation in 27 patients. During surgery, a posterior intervertebral distraction at operated levels was applied. Patients' mean age was 50.77 years and the mean follow-up 28.74 months. Both clinical (visual analog pain scale, Oswestry disability index) and radiological (lumbar spine lordosis, disc thickness) analyses were made before and after surgery. A new method of cartilage analysis, which was also validated for the IVD, delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) was used to determine the PG content before and after surgery for both the intervertebral degenerative disc and control level L1-L2 disc.

RESULTS

The clinical features improved significantly. The thickness of the operated discs increased by an average of 1.71 mm postoperatively and remained unchanged in the control group. The lumbar lordosis did not change significantly. In dGEMRIC studies, the discs accumulated in average 410.08 units /cm2 of gadolinium before surgery and 272.45 units/cm2 after surgery, without significant changes in the control group.

CONCLUSION

Our study shows an improvement of PG quantity in degenerated IVD due to a decrease in gadolinium binding seen in dGEMRIC study. Thus, we can ameliorate IVD homeostasis by eliminating mechanical stress, which could be a step towards the process of disc regeneration.

Prolonged slumped sitting causes neck pain and increased axioscapular muscle activity during a computer task in healthy participants - A randomized crossover study

INTRODUCTION

Sitting posture may contribute to spinal pain. Effects of postures on pain, sensitivity and muscle activity during computer tasks were investigated.

METHODS

Twenty-five healthy participants, seated at a workstation without backrest, completed four, 15-min typing tasks: A)Upright with forearm-support; B)Upright without forearm-support; C)Slumped with forearm-support; D)Slumped without forearm-support. Participants rated pain every minute on a numerical rating scale (NRS). RMS-EMG was recorded from upper/lower trapezius (UT, LT), serratus anterior and anterior/middle deltoid. At baseline and after tasks, pressure pain thresholds (PPTs) were recorded bilaterally over the head, UT, and leg.

RESULTS

All tasks caused clinically relevant increased NRS (≥2/10) compared to baseline (P < 0.001). NRS was higher in Task-D (P < 0.003) and lower in Task-B (P < 0.005) than others. PPTs did not change from baseline. Task-D caused higher UT and LT RMS-EMG (P < 0.02) than other tasks.

CONCLUSION

A 15-min task caused pain irrespective of posture with some causing larger changes than others.

The two-stage therapeutic effect of posture biofeedback training on back pain and the associated mechanism: A retrospective cohort study

Introduction: Back pain is an extremely common symptom experienced by people of all ages and the number one cause of disability worldwide.² Poor posture has been identified as one of the factors leading to back pain. Digital biofeedback technology demonstrates the promising therapeutic ability in pain management through posture training. One common goal of such an approach is to increase users' posture awareness with associated movement correction. However, we lack a deep understanding of the biofeedback therapeutic mechanisms and the temporal dynamics of efficacy. Objective: This study investigates the temporal dynamics of the biofeedback learning process and associated outcomes in daily life settings, testing the mechanism of the biofeedback-associated pain reduction. Methods: This retrospective real-world evidence study followed 981 users who used the UpRight posture biofeedback platform. Piecewise mixed models were used for modeling the two-stage trajectory of pain levels, perceived posture quality, and weekly training duration following an 8-week biofeedback training. Also, the mediation effect of perceived posture quality on the analgesic effect of training duration was tested using Monte Carlo simulations based on lagged effect mixed models. Results: The analysis revealed significant pain level reduction (p <.0001) and posture quality improvement (p <.0001) during the first 4 weeks of the training, maintaining similar pain levels and perceived posture quality during the next 4 weeks. In addition, weekly training duration demonstrated an increase during the first 3 weeks (p <.001) and decreased during the next 5 weeks (p <.001). Moreover, training duration predicted following-week perceived posture quality (p <.001) and in turn perceived posture quality predicted following-week pain (p <.001) (p = 0.30). Finally, perceived posture quality mediated the effect of weekly training duration on the pain levels in 2 weeks (p <.0001). Conclusion: Our findings provide a better understanding of the therapeutic dynamic during digital biofeedback intervention targeting pain, modeling the associated two-stage process. Moreover, the study sheds light on the biofeedback mechanism and may assist in developing a better therapeutic approach targeting perceived posture quality.

Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial

A randomized controlled study with a six-month follow-up was conducted to investigate the effects of sagittal head posture correction on 3D spinal posture parameters, back and leg pain, disability, and S1 nerve root function in patients with chronic discogenic lumbosacral radiculopathy (CDLR). Participants included 80 (35 female) patients between 40 and 55 years experiencing CDLR with a definite hypolordotic cervical spine and forward head posture (FHP) and were randomly assigned a comparative treatment control group and a study group. Both groups received TENS therapy and hot packs, additionally, the study group received the Denneroll cervical traction orthotic. Interventions were applied at a frequency of 3 x per week for 10 weeks and groups were followed for an additional 6-months. Radiographic measures included cervical lordosis (CL) from C2–C7 and FHP; postural measurements included: lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, and pelvic inclination. Leg and back pain scores, Oswestry Disability Index (ODI), and H-reflex latency and amplitude were measured. Statistically significant differences between the groups at 10 weeks were found: for all postural measures, CL (p = 0.001), AHT (p = 0.002), H-reflex amplitude (p = 0.007) and latency (p = 0.001). No significant difference for back pain (p = 0.2), leg pain (p = 0.1) and ODI (p = 0.6) at 10 weeks were identified. Only the study group’s improvements were maintained at the 6-month follow up while the control groups values regressed back to baseline. At the 6-month follow-up, it was identified in the study group that improved cervical lordosis and reduction of FHP were found to have a positive impact on 3D posture parameters, leg and back pain scores, ODI, and H-reflex latency and amplitude.

Factors Associated with Musculoskeletal Disorders among Regular and Special Education Teachers: A Narrative Review

Musculoskeletal disorder (MSD) is a major health problem, which can lead to an enormous burden to the institution as well as chronic disability to the individual. Teachers are at risk of developing MSD due to the exposure to various ergonomic risk factors. Teachers of special education, for example, are expected to perform extra duty such as lifting and moving students, feeding food, changing diapers, and helping them in ambulation. Although there is an adequate amount of scientific research on MSD's prevalence and its risk factors among regular teachers, only few studies have focused on special education teachers. This review aimed to address these gaps by describing the evidence from various papers on the prevalence of MSD among regular and special education teachers and the related risk factors. The papers have been gathered using electronic databases, including PubMed, Science Direct, Google Scholar, and Springer. The prevalence of MSD among regular teachers ranges from 48.7% to 73.7%, while the prevalence ranges from 38.7% to 94% in special education teachers. Risk factors, such as individual (age, duration of teaching, working hours, and work burden), physical (teaching activities, affected body areas), and psychological factors (stress, anxiety, fear), were identified. From the review, it is recommended to implement ergonomically designed workplaces, comprehensive ergonomic training, psychological approaches, and functional training among teachers at risk.

Quantifying Lumbar Movement Patterns of Allied Health Professionals in an Australian Health Care Facility

Health professionals responsible for return to work plans have little data about allied health movement to guide recommendations following lower back injury. This study aimed to quantify the lumbar movement patterns of allied health professionals within a health care facility throughout a normal workday. An observational case study was undertaken at a public health care facility with 122 allied health professionals. The lumbar movements were recorded with the ViMove together with pain scale measurement. The mean (SD) recording time for allied health was 7.7 (0.7) hours. A mean (SD) 3 (1.4) hours total were spent in standing, 3.8 (1.7) hours in sitting, and 0.8 (0.4) hours in locomotion. Forty-nine flexions were recorded on average per session, most identified as short term (<30 s) within low range (0°-20°). Lumbar movement patterns differed among professions. Thirty-seven (31%) participants reported a history of lower back injury, and 57 (47%) reported low back pain at the end of their workday. This study provides an insight into allied health professionals' back movement in a hospital or community-based health care setting. These data may inform those who make return to work recommendations or provide rehabilitation services for allied health professionals working with a lower back injury.

Exploring Teachers' Back Pain Concerning Their Habits, Rules, Leisure Activities, and Physical Activity Breaks at Work

The role of a teacher in the Faculty of Health Sciences involves teaching students, preparing lessons, and participating in other activities such as research projects and management processes. Professional participation is part of their involvement in daily occupations, which are taking place in teachers' socio-cultural context and are necessary for their well-being. Teachers' work performance can be enabled or constrained by their professional habits, including habits while using computers. We investigated awareness of and adherence to recommendations on ergonomics and preventive measures for back pain among the Faculty of Health Sciences employees. This study was aimed at investigating the relationship between the influence of their habits during computer use and back pain. An online questionnaire was sent to the teaching staff of the Faculty of Health Sciences (n = 115). 73% of the staff opened the online questionnaire, 43% fully completed the questionnaire. Data were processed using SPSS statistical program, version 20.0. Descriptive statistics, Pearson's correlation coefficient, and factor analysis were calculated. Analysis of the results showed a significant statistical association between the professional habits and roles [daily computer use (r = .443, P < .01); position of different body parts during computer use [head (r = .669, P < .001), shoulder (r = .446, P < .01), legs and feet (r = .483, P < .01), screen inclination (r = .577, P < .01), adjusting chair settings (r = .608, P < .01), distance between eyes and screen (r = .766, P < .01)]; physical activities break at work [r = .758, P < .01], and back pain. Considering ergonomic principles when designing the work environment can have a major impact on employees' health and quality of work. As experts in the field of health sciences, faculty members are not sufficiently aware of the impact of an improperly designed work environment on employee health, which affects work habits.

The use of posture-correcting shirts for managing musculoskeletal pain is not supported by current evidence - a scoping review of the literature

BACKGROUND AND AIMS

The concept of bad posture being a dominant driver of pain is commonly held belief in the society. This may explain the significant attention supportive clothing such as posture-correcting shirts has recently gained in Scandinavia and the USA. The aim of this scoping review was to present an overview and synthesis of the available evidence for the use of posture-correcting shirts aimed at reducing pain or postural discomfort and optimising function/posture.

METHODS

A systematic search was conducted for literature investigating the effect of posture-correcting shirts on musculoskeletal pain or function. PubMed, Embase, CINAHL, PEDro and the Cochrane Library were searched for relevant literature. Results of the searches were evaluated by two independent reviewers in three separate steps based on title, abstract and full text. For data synthesis, the population, intervention, comparator and outcome were extracted. The quality of the literature was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the risk of bias was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) assessment tool or the RoB 2.0 tool for individually randomized, parallel group trials. The overall confidence in the literature was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

A total of 136 articles were identified and six of these were included in the review. These studies were heterogeneous with regards to aims, outcomes and methods, presenting contrasting results. The overall findings were that posture-correcting shirts change posture and subjectively have a positive effect on discomfort, energy levels and productivity. The quality of the included literature was poor to fair with only one study being of good quality. The risk of bias was serious or critical for the included studies. Overall, this resulted in very low confidence in available evidence. An important limitation of all studies was that they were conducted in pain-free individuals.

CONCLUSIONS

The contrasting findings and the low quality of current literature, questions the intended effect of posture-correcting shirts and whether the changes it creates are in fact useful for clinical practice. Moreover, the findings are contrasted by the available evidence regarding posture and pain with a particular focus on whether this management strategy may have a detrimental effect on people living with musculoskeletal pain. A major limitation to the existing literature on the effect of posture-correcting shirts is that no studies have investigated their effect in clinical populations.

IMPLICATIONS

Based on the available literature and the major limitation of no studies investigating clinical populations, there is no good quality evidence to support recommendation of posture-correcting shirts as a management strategy for musculoskeletal pain. Promotion of this product may reinforce the inaccurate and unhelpful message that poor posture leads to pain. The efficacy of such garments should be tested in clinical populations and not only in pain-free individuals, to assess whether there is any meaningful benefit of this management approach. Until then, the use of posture-correcting shirts for musculoskeletal pain is not supported by current evidence.

Finite element simulation and clinical follow-up of lumbar spine biomechanics with dynamic fixations

Arthrodesis is a recommended treatment in advanced stages of degenerative disc disease. Despite dynamic fixations were designed to prevent abnormal motions with better physiological load transmission, improving lumbar pain and reducing stress on adjacent segments, contradictory results have been obtained. This study was designed to compare differences in the biomechanical behaviour between the healthy lumbar spine and the spine with DYNESYS and DIAM fixation, respectively, at L4-L5 level. Behaviour under flexion, extension, lateral bending and axial rotation are compared using healthy lumbar spine as reference. Three 3D finite element models of lumbar spine (healthy, DYNESYS and DIAM implemented, respectively) were developed, together a clinical follow-up of 58 patients operated on for degenerative disc disease. DYNESYS produced higher variations of motion with a maximum value for lateral bending, decreasing intradiscal pressure and facet joint forces at instrumented level, whereas screw insertion zones concentrated stress. DIAM increased movement during flexion, decreased it in another three movements, and produced stress concentration at the apophyses at instrumented level. Dynamic systems, used as single systems without vertebral fusion, could be a good alternative to degenerative disc disease for grade II and grade III of Pfirrmann.

Work-related musculoskeletal disorders and ergonomic risk factors in special education teachers and teacher's aides

Background

Work-related musculoskeletal disorders (WMSDs) have become increasingly common among health-related professionals. Special education personnel who serve students with disabilities often experience physical strains; however, WMSDs have been overlooked in this population. The objectives of this study were to investigate the work-related ergonomics-associated factors in this population and to evaluate their correlation with the WMSDs prevalence.

Methods

A questionnaire with three domains, namely demographics, prevalence of work-related musculoskeletal disorders, and ergonomic factors, designed by our research team was delivered to educators who work in special education schools.

Results

Approximately 86 % of the 388 special education school teachers and teacher’s aides in this study experienced musculoskeletal disorders. The lower back, shoulder, and wrist were the three most affected regions. A logistic regression analysis revealed that the participants’ background factors, namely >5.5 years of experience (odds ratio [OR] = 4.090, 95 % CI: 1.350-12.390), students with multiple disorders (OR = 2.412, 95 % CI: 1.100-5.287), and other work-related ergonomic factors (assistance in diaper changing and others duties), were strongly associated with the prevalence of WMSD. Nap habit (OR = 0.442, 95 % CI: 0.230-0.851) and having teaching partners in the same class (OR = 0.486, 95 % CI: 0.250-0.945) resulted in low possibility of acquiring WMSDs. The use of supportive devices was associated with a low WMSD prevalence.

Conclusions

The present study revealed an association between WMSDs and specific job features among teachers and teacher’s aides in special education schools. Future efforts should emphasize examining safe student-handling ergonomics, formulating policies regarding student-teacher ratio, incorporating mandatory break times at the workplaces, and promoting personal health for preventing work-related injuries.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2777-7) contains supplementary material, which is available to authorized users.

Requirements for more effective prevention of work-related musculoskeletal disorders

BACKGROUND

Exposures to occupational hazards substantially increase workers' risk of developing musculoskeletal disorders (MSDs) and can exacerbate pre-existing disorders. The effects on MSD risk of the physical requirements of work performance are well recognised, but there is now ample evidence that work-related psychosocial hazards can also have substantial effects; further, some hazards may be additive or interactive. This evidence is not reflected in current workplace risk management practices.

DISCUSSION

Barriers to more effective workplace management of MSD risk include: the widespread belief that risk arises largely or entirely from physical hazard exposures; regulatory and guidance documents targeting MSDs, most of which reflect this belief; risk assessment tools that focus narrowly on subsets of mainly physical hazards and yet generate outputs in the form of MSD risk indicators; and the conventional occupational health and safety (OHS) risk management paradigm, which is ill-suited to manage MSD risk. It is argued that improved workplace management of MSD risk requires a systems-based management framework and more holistic risk assessment and control procedures that address risk from all types of hazard together rather than in isolation from each other, and that support participation by workers themselves. New MSD risk management tools are needed to meet these requirements. Further, successful implementation of such changes is likely to require some restructuring of workplace responsibilities for MSD risk management. Line managers and supervisors often play key roles in generating hazards, both physical and psychosocial, so there is a need for their more active participation, along with OHS personnel and workers themselves, in routine risk assessment and control procedures. MSDs are one of our largest OHS problems, but workplace risk management procedures do not reflect current evidence concerning their work-related causes. Inadequate attention is given to assessing and controlling risk from psychosocial hazards, and the conventional risk management paradigm focuses too narrowly on risk from individual hazards rather than promoting the more holistic approach needed to manage the combined effects of all relevant hazards. Achievement of such changes requires new MSD risk management tools and better integration of the roles of OHS personnel with those of line managers.

A comparison of instrumentation methods to estimate thoracolumbar motion in field-based occupational studies

The performance of an inertial measurement unit (IMU) system for directly measuring thoracolumbar trunk motion was compared to that of the Lumbar Motion Monitor (LMM). Thirty-six male participants completed a simulated material handling task with both systems deployed simultaneously. Estimates of thoracolumbar trunk motion obtained with the IMU system were processed using five common methods for estimating trunk motion characteristics. Results of measurements obtained from IMUs secured to the sternum and pelvis had smaller root-mean-square differences and mean bias estimates in comparison to results obtained with the LMM than results of measurements obtained solely from a sternum mounted IMU. Fusion of IMU accelerometer measurements with IMU gyroscope and/or magnetometer measurements was observed to increase comparability to the LMM. Results suggest investigators should consider computing thoracolumbar trunk motion as a function of estimates from multiple IMUs using fusion algorithms rather than using a single accelerometer secured to the sternum in field-based studies.

The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study

OBJECTIVE

The purpose of this study was to determine the immediate and long-term effects of a multimodal program, with the addition of forward head posture correction, in patients with chronic discogenic lumbosacral radiculopathy.

METHODS

This randomized clinical study included 154 adult patients (54 females) who experienced chronic discogenic lumbosacral radiculopathy and had forward head posture. One group received a functional restoration program, and the experimental group received forward head posture corrective exercises. Primary outcomes were the Oswestry Disability Index (ODI). Secondary outcomes included the anterior head translation, lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, pelvic inclination, leg and back pain scores, and H-reflex latency and amplitude. Patients were assessed at 3 intervals (pretreatment, 10-week posttreatment, and 2-year follow-up).

RESULTS

A general linear model with repeated measures indicated a significant group × time effect in favor of the experimental group on the measures of ODI (F = 89.7; P < .0005), anterior head translation (F = 23.6; P < .0005), H-reflex amplitude (F = 151.4; P < .0005), H-reflex latency (F = 99.2; P < .0005), back pain (F = 140.8; P < .0005), and leg pain (F = 72; P < .0005). After 10 weeks, the results revealed an insignificant difference between the groups for ODI (P = .08), back pain (P = .29), leg pain (P = .019), H-reflex amplitude (P = .09), and H-reflex latency (P = .098). At the 2-year follow-up, there were significant differences between the groups for all variables adopted for this study (P < .05).

CONCLUSIONS

The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.

Prevalence and influencing factors of chronic back pain among staff at special schools with multiple and severely handicapped children in Germany: results of a cross-sectional study

Background

In Germany, about 70,000 teachers and educational staff were teaching at more than 3,000 special schools during the school year 2010/2011. Nursing services like lifting pupils form a substantial part of the work content of the staff at special schools. Since nursing care often involves carrying and lifting pupils, there is a reason to assume an adverse effect on the musculoskeletal health of teachers and other professionals. With the present study we aimed to describe the prevalence and risk factors of chronic back pain among employees at this type of school.

Methods

The cross-sectional survey was carried out between August 2010 and August 2012 at 13 special schools focusing on motoric and/or holistic development of handicapped children in Rhineland-Palatinate (Germany). Teachers and educational staff were interviewed using a questionnaire. We applied multivariable logistic regression analyses to identify influencing factors of chronic back pain.

Results

Altogether 395 persons (response rate: 59.7%) participated in our study. Respondents were mostly female (86.8%) with a mean age of 45 years. The prevalence of chronic back pain was 38.7%. More than 40% reported frequently carrying and lifting heavy loads (>20 kg). Age [adjusted OR = 1.03 (95%-CI 1.00-1.05) for 1-year increase in age], current smoking [adjusted OR = 2.31 (95%-CI 1.27-4.23)], depression/depressive mood [adjusted OR = 1.85 (95%-CI 1.12-3.06)], frequently carrying and lifting heavy loads [adjusted OR = 2.69 (95%-CI 1.53-4.75)], and frequent exposure to environmental impacts [adjusted OR = 2.18 (95%-CI 1.26-3.76)] were influencing factors of chronic back pain in the final multivariable regression model.

Conclusions

A large proportion of teachers and educational staff suffered from chronic back pain in our study, indicating a high need for treatment in this professional group. Increasing age, current smoking, a diagnosed depression/depressive mood, carrying and lifting heavy loads, and exposure to environmental impacts were associated with chronic back pain. Due to the sparse literature on the topic, further studies using a longitudinal design are necessary for a better understanding of the risk factors of chronic back pain.

Work-related musculoskeletal disorders and ergonomic risk factors in early intervention educators

BACKGROUND

Early intervention educators who serve children with special needs often suffer from physical strains. The objectives of this study were to investigate the prevalence of work-related musculoskeletal disorders in this population, and to evaluate the relationship between work-related musculoskeletal disorders and personal/ergonomic risk factors.

METHODS

A self-designed questionnaire consisting three domains (demographics/prevalence of work-related musculoskeletal disorders/ergonomic risk factors) was delivered to educators who work in early intervention institutions.

RESULTS

Ninety-four percent of early intervention educators suffered from musculoskeletal disorders. Logistic regression revealed that some work-related ergonomic factors were highly associated with symptoms on lower back, shoulder and neck, with odds ratios ranging from 0.321 to 4.256.

CONCLUSION

High prevalence of work-related musculoskeletal disorders impacts this occupation negatively. Further regulations to the institutions regarding workplace health promotion and environment modification, as well as training to the employees for body mechanics, should be implemented to prevent injury occurrence.

Development and kinematic verification of a finite element model for the lumbar spine: application to disc degeneration

The knowledge of the lumbar spine biomechanics is essential for clinical applications. Due to the difficulties to experiment on living people and the irregular results published, simulation based on finite elements (FE) has been developed, making it possible to adequately reproduce the biomechanics of the lumbar spine. A 3D FE model of the complete lumbar spine (vertebrae, discs, and ligaments) has been developed. To verify the model, radiological images (X-rays) were taken over a group of 25 healthy, male individuals with average age of 27.4 and average weight of 78.6 kg with the corresponding informed consent. A maximum angle of 34.40° is achieved in flexion and of 35.58° in extension with a flexion-extension angle of 69.98°. The radiological measurements were 33.94 ± 4.91°, 38.73 ± 4.29°, and 72.67°, respectively. In lateral bending, the maximum angles were 19.33° and 23.40 ± 2.39, respectively. In rotation a maximum angle of 9.96° was obtained. The model incorporates a precise geometrical characterization of several elements (vertebrae, discs, and ligaments), respecting anatomical features and being capable of reproducing a wide range of physiological movements. Application to disc degeneration (L5-S1) allows predicting the affection in the mobility of the different lumbar segments, by means of parametric studies for different ranges of degeneration.

A systematic review of musculoskeletal disorders among school teachers

BACKGROUND

Musculoskeletal disorders (MSD) represent one of the most common and most expensive occupational health problems in both developed and developing countries. School teachers represent an occupational group among which there appears to be a high prevalence of MSD. Given that causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study, the objective of this systematic review was to investigate the prevalence and risk factors for MSD among teaching staff.

METHODS

The study involved an extensive search of MEDLINE and EMBASE databases in 2011. All studies which reported on the prevalence and/or risk factors for MSD in the teaching profession were initially selected for inclusion. Reference lists of articles identified in the original search were then examined for additional publications. Of the 80 articles initially located, a final group of 33 met the inclusion criteria and were examined in detail.

RESULTS

This review suggests that the prevalence of self-reported MSD among school teachers ranges between 39% and 95%. The most prevalent body sites appear to be the back, neck and upper limbs. Nursery school teachers appear to be more likely to report suffering from low back pain. Factors such as gender, age, length of employment and awkward posture have been associated with higher MSD prevalence rates.

CONCLUSION

Overall, this study suggests that school teachers are at a high risk of MSD. Further research, preferably longitudinal, is required to more thoroughly investigate the issue of MSD among teachers, with a greater emphasis on the possible wider use of ergonomic principles. This would represent a major step forward in the prevention of MSD among teachers, especially if easy to implement control measures could be recommended.

Low back pain among personal care workers in an old age home: work-related and individual factors

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35-39.35, p < .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86-22.97, p = .074) and neck (OR = 0.18, CI = 0.04-0.81, p < .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70-3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work.

Low Back Pain among Personal Care Workers in an Old Age Home

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35–39.35, p < .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86–22.97, p = .074) and neck (OR = 0.18, CI = 0.04–0.81, p < .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70–3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work.

Comparison of biomechanical loading during use of conventional stud welding equipment and an alternate system

We investigated the effect of an alternative welding system designed to reduce exposure to extreme trunk flexion on measures of trunk inclination and muscle activity. Among 10 participants, data were collected while using conventional stud welding equipment and while using the alternate system. Paired t-tests were used to compare results between the two welding systems. Mean trunk inclination angle was reduced with the alternate system (34.4° versus 9.7°, p < 0.01). Percent time with trunk inclination angles greater than 60° was also reduced (40.0% versus 4.7%, p < 0.01). In general, the alternate system resulted in less desirable upper trapezius muscle activity levels. The alternate system appears to be effective in reducing exposure to extreme trunk flexion among stud welders. Continued development of the system should explore features designed to reduce shoulder forces and improve productivity.

Effects of the Twin Shoe (Darco) to compensate height differences in normal gait

BACKGROUND

After foot surgery or in diseases such as diabetes, orthopaedic shoes with an elevated sole construction are used to off-load the affected foot. The height difference between the shoes results in a leg length discrepancy and an abnormal gait pattern arises which can cause long-term discomfort in the joints of the lower extremity and the lower back. To compensate for this discrepancy and to ensure a symmetrical gait pattern a Twin Shoe (Darco) has been designed.

AIM

To investigate the effect of wearing orthopaedic shoes in combination with the Twin Shoe on normal gait biomechanics.

STUDY DESIGN

Cross-sectional study in a laboratory setting.

METHODS

Normal gait was recorded in 15 healthy subjects with a gait analysis system. Four different shoe conditions were measured. Selected biomechanical parameters were calculated and compared between the shoe conditions.

RESULTS

Walking in orthopaedic shoes with an elevated sole without compensation on the contralateral side leads to significant asymmetrical joint movements and higher loads in feet, knees, hips and the lower back during gait. By using the Twin Shoe these abnormal patterns were improved but not entirely compensated.

CONCLUSIONS

Using the Twin Shoe as a partner to orthopaedic shoes with an elevated sole construction improves gait asymmetry and increased loading of joints induced by functional leg length discrepancy.