Disturbance and recovery of trunk mechanical and neuromuscular behaviours following repetitive lifting: influences of flexion angle and lift rate on creep-induced effects

Repetitive lifting is associated with an increased risk of occupational low back disorders, yet potential adverse effects of such exposure on trunk mechanical and neuromuscular behaviours were not well described. Here, 12 participants, gender balanced, completed 40 min of repetitive lifting in all combinations of three flexion angles (33, 66, and 100% of each participant's full flexion angle) and two lift rates (2 and 4 lifts/min). Trunk behaviours were obtained pre- and post-exposure and during recovery using sudden perturbations. Intrinsic trunk stiffness and reflexive responses were compromised after lifting exposures, with larger decreases in stiffness and reflexive force caused by larger flexion angles, which also delayed reflexive responses.Consistent effects of lift rate were not found. Except for reflex delay no measures returned to pre-exposure values after 20 min of recovery. Simultaneous changes in both trunk stiffness and neuromuscular behaviours may impose an increased risk of trunk instability and low back injury.

Practitioner summary An elevated risk of low back disorders is attributed to repetitive lifting. Here, the effects of flexion angle and lift rate on trunk mechanical and neuromuscular behaviours were investigated. Increasing flexion angle had adverse effects on these outcomes, although lift rate had inconsistent effects and recovery time was more than 20 min.     

The effects of a sloped ground surface on trunk kinematics and L5/S1 moment during lifting

There are many work environments that require workers to perform manual materials handling tasks on ground surfaces that are not perfectly flat (e.g. in agriculture, construction, and maritime workplaces). These sloped ground surfaces may have an impact on the lifting strategy/technique employed by the lifter, which may, in turn, alter the biomechanical loading of the spine. Describing the changes in kinematics and kinetics of the torso is the first step in assessing the impact of these changes and is the focus of the current research. Subjects' whole-body motions were recorded as they lifted a 10 kg box while standing on two inclined surfaces (facing an upward slope: 10° and 20°), two declined surfaces (facing a downward slope: ? 10° and ? 20°), and a flat surface (0°) using three lifting techniques (leg lift, back lift and freestyle lift). These data were then used in a two-dimensional, five-segment dynamic biomechanical model (top-down) to evaluate the effect of these slopes on the net moment about the L5/S1 joint. The results of this study showed an interesting interaction effect wherein the net L5/S1 moment was relatively insensitive to changes in slope angle under the back lift condition, but showed a significant effect during the leg lift and freestyle lifting conditions. The results show that under the freestyle lifting condition the peak L5/S1 moment was significantly higher for the inclined surfaces as compared to the flat surfaces (6.8% greater) or declined surfaces (10.0% greater). Subsequent component analysis revealed that both trunk flexion angle and angular trunk acceleration were driving this response. Collectively, the results of this study indicate that ground slope angle does influence the lifting kinematics and kinetics and therefore needs to be considered when evaluating risk of low back injury in these working conditions.     

The effects of a sloped ground surface on trunk kinematics and L5/S1 moment during lifting

There are many work environments that require workers to perform manual materials handling tasks on ground surfaces that are not perfectly flat (e.g. in agriculture, construction, and maritime workplaces). These sloped ground surfaces may have an impact on the lifting strategy/technique employed by the lifter, which may, in turn, alter the biomechanical loading of the spine. Describing the changes in kinematics and kinetics of the torso is the first step in assessing the impact of these changes and is the focus of the current research. Subjects' whole-body motions were recorded as they lifted a 10 kg box while standing on two inclined surfaces (facing an upward slope: 10 degrees and 20 degrees), two declined surfaces (facing a downward slope: -10 degrees and -20 degrees), and a flat surface (0 degrees) using three lifting techniques (leg lift, back lift and freestyle lift). These data were then used in a two-dimensional, five-segment dynamic biomechanical model (top-down) to evaluate the effect of these slopes on the net moment about the L5/S1 joint. The results of this study showed an interesting interaction effect wherein the net L5/S1 moment was relatively insensitive to changes in slope angle under the back lift condition, but showed a significant effect during the leg lift and freestyle lifting conditions. The results show that under the freestyle lifting condition the peak L5/S1 moment was significantly higher for the inclined surfaces as compared to the flat surfaces (6.8% greater) or declined surfaces (10.0% greater). Subsequent component analysis revealed that both trunk flexion angle and angular trunk acceleration were driving this response. Collectively, the results of this study indicate that ground slope angle does influence the lifting kinematics and kinetics and therefore needs to be considered when evaluating risk of low back injury in these working conditions.     

Static and dynamic lifting strength at different reach distances in symmetrical and asymmetrical planes.

Postural and therefore biomechanical standardization in strength testing has not been rigorously and consistently applied. To develop a quantitative relationship between strength and posture (body position, symmetry, and reach) 30 normal subjects (18 male and 12 females) were required to stoop and squat lift or exert in the relevant posture against a standardized instrumented handle. The isometric lifting efforts and isokinetic lifts were studied. The isokinetic lifts were done at a linear velocity of 50cm/s of the hand displacement from the floor to the knuckle heights of the respective subjects in stoop and squat postures. The isometric stoop lifting efforts were exerted in two standardized postures: (a) with 60 degrees hip flexion; and (b) with 90 degrees hip flexion. The isometric squat lifting efforts were also exerted in two standardized postures: (a) with 90 degrees knee flexion; and (b) with 135 degrees knee flexion. All isometric lifting efforts and isokinetic lifts were performed at half, three-quarters, and full horizontal reach in sagitally symmetrical, 30 degrees left lateral, and 60 degrees left lateral planes. Isometric stoop and squat lifting efforts were also measured in self-selected optimal postures. These 56 conditions were tested in random order. The analysis of variance revealed that the gender, the mode of lifting, the postural asymmetry and reach of lifting affected the strength significantly (p less than 0.0001). Most two-way and three-way interactions were significant (p less than 0.01). Of 108 prediction regression equations, 103 were significant with up to 90% of the variation explained by anthropometric variables and sagittal plane strength. The reach affected the strength most profoundly followed by postural asymmetry and the mode of lifting.     

Static and dynamic lifting strength at different reach distances in symmetrica] and asymmetrical planes

Postural and therefore biomechanical standardization in strength testing has not been rigorously and consistently applied. To develop a quantitative relationship between strength and posture (body position, symmetry, and reach) 30 normal subjects (18 male and 12 females) were required to stoop and squat lift or exert in the relevant posture against a standardized instrumented handle. The isometric lifting efforts and isokinetic lifts were studied. The isokinetic lifts were done at a linear velocity of 50cm/s of the hand displacement from the floor to the knuckle heights of the respective subjects in stoop and squat postures. The isometric stoop lifting efforts were exerted in two standardized postures: (a) with 60° hip flexion; and (b) with 90° hip flexion. The isometric squat lifting efforts were also exerted in two standardized postures: (a) with 90° knee flexion; and (b) with 135° knee flexion. All isometric lifting efforts and isokinetic lifts were performed at half, three-quarters, and full horizontal reach in sagitally symmetrical, 30° left lateral, and 60° left lateral planes. Isometric stoop and squat lifting efforts were also measured in self-selected optimal postures. These 56 conditions were tested in random order. The analysis of variance revealed that the gender, the mode of lifting, the postural asymmetry and reach of lifting affected the strength significantly (p<0·0001). Most two-way and three-way interactions were significant (p<0·01). Of 108 prediction regression equations, 103 were significant with up to 90% of the variation explained by anthropometric variables and sagittal plane strength. The reach affected the strength most profoundly followed by postural asymmetry and the mode of lifting.     

Development of predictive equations for lifting strengths

The purpose of the study was to determine relationship between lifting strengths of male and female subjects and body posture, type of lift (stoop or squat) and velocity of lift. Thirty normal young adults (18 males and 12 females) volunteered for the study. All subjects were required to perform a total of 56 tasks. Of these, 28 were stoop lifts and 28 were squat lifts. In each of the categories of stoop and squat lifts, the strengths were tested in standard posture, isokinetic (linear velocity of 500 mm/s), and isometric modes at half, three-quarters and full horizontal individual reach distances in sagittal, 30 degrees lateral and 60 degrees lateral planes. The strengths were measured using a static dynamic strength tester with a load cell and an IBM microcomputer with an A/D card. The peak and average strength values were extracted and statistically compared across conditions and gender (ANOVA). Finally a multiple regression analysis was carried out to predict strength as a function of reach, posture and velocity of lift. The ANOVA revealed a highly significant effect of gender, reach, plane and velocity (p < 0.01). All regression equations (108) were significant (p < 0.01), and more than 70% of variance in lifting strength was accounted for by the anthropometric variables and sagittal plane strength values. Such an established relationship allows one to predict the human lifting strength capabilities for industrial application based on simple anthropometric and strength characteristics.     

Spinal loading in static and dynamic postures: EMG and intra-abdominal pressure study

Abstract

The difference in physiological stress between static posture loading and dynamic lift is poorly understood. Therefore, the quantitative pattern of gradual increase and decrease of stress as measured by EMG of erectores spinae at T₁₂ and L₃ and intraabdominal pressure (IAP) due to steady progressive loading and unloading in static stooping posture was studied and compared with that of stoop lifting of the same weight. For dynamic loading and unloading a steady flow of 25 kg of water into or out of a plastic tub held in the hand while maintaining a stooping posture was used. The subjects also performed stoop lifting weights of 15 and 25 kg. In static posture loading the mean EMG at T₁₂ was approximately 50% of the L₃ level. During unloading in that posture it was reduced to 33%. The level of electromyographic activity at T₁₂ for loading was not significantly different from unloading. At L₃ however, the magnitude increased significantly for unloading. The EMG and intraabdominal pressure responses of static posture were between 33 and 50% of the corresponding phases during stoop lifting of the same weight. An insignificant difference in IAP and heart rate between static posture loading and stoop lifting indicates a less critical role of IAP and no difference in cardiac stress in less stressful tasks.     

Short-duration fatigue alters neuromuscular coordination of trunk musculature: implications for injury

The aim of this investigation was to determine the effect of muscle fatigue, produced by two different fatigue protocols, on the coordination of trunk and thigh muscles during the performance of a manual-handling task (e.g. a weighted stoop lift). The two fatigue protocols were designed to produce either (a) a non-specific widespread fatigue of trunk and limb muscles (e.g. rowing fatigue protocol), or (b) a specific fatigue of the trunk extensor musculature (e.g. back extension fatigue protocol). Specifically, we wished to determine whether the coordination of trunk muscles during a stoop lift was compromised more, or less, by either of these two fatigue protocols. Ten male subjects (20-24 years) were tested utilising an electromyographic technique which collected electromyograms from trunk flexor and extensor muscles, as well as the Hamstring muscle group, during a pre- and a post-fatigue performance of a weighted stoop lift. The results showed that the back extension fatigue protocol, but not the rowing fatigue protocol, produced significant (p<0.05) changes in the timing of trunk muscle activation during a stoop lift. The longer periods of muscle activation seen only after the back extension fatigue protocol, suggested that fatigue of these muscles had required the CNS to alter their periods of activation to a pattern similar to that previously seen in elderly populations. The results also suggested that intense short-duration motor tasks, which may differentially target the back and its musculature, could leave the spine susceptible to increased risk of injury even though worker perceptions of general fatigue are low. Risk assessment guidelines for manual handling should consider not only the weight and frequency of the lift, but lift duration as well to maintain worker safety.     

Development of Human Posture Simulation Method for Assessing Posture Angles and Spinal Loads

Video‐based posture analysis employing a biomechanical model is gaining a growing popularity for ergonomic assessments. A human posture simulation method of estimating multiple body postural angles and spinal loads from a video record was developed to expedite ergonomic assessments. The method was evaluated by a repeated measures study design with three trunk flexion levels, two lift asymmetry levels, three viewing angles, and three trial repetitions as experimental factors. The study comprised two phases evaluating the accuracy of simulating self‐ and other people's lifting posture via a proxy of a computer‐generated humanoid. The mean values of the accuracy of simulating self‐ and humanoid postures were 12° and 15°, respectively. The repeatability of the method for the same lifting condition was excellent (～2°). The least simulation error was associated with side viewing angle. The estimated back compressive force and moment, calculated by a three‐dimensional biomechanical model, exhibited a range of 5% underestimation. The posture simulation method enables researchers to quantify simultaneously body posture angles and spinal loading variables with accuracy and precision comparable to on‐screen posture‐matching methods.     

Lift performance and lumbar loading in standing and seated lifts

This study investigated the effect of posture on lifting performance. Twenty-three male soldiers lifted a loaded box onto a platform in standing and seated postures to determine their maximum lift capacity and maximum acceptable lift. Lift performance, trunk kinematics, lumbar loads, anthropometric and strength data were recorded. There was a significant main effect for lift effort but not for posture or the interaction. Effect sizes showed that lumbar compression forces did not differ between postures at lift initiation (Standing 5566.2?±?627.8 N; Seated 5584.0?±?16.0) but were higher in the standing posture (4045.7?±?408.3 N) when compared with the seated posture (3655.8?±?225.7 N) at lift completion. Anterior shear forces were higher in the standing posture at both lift initiation (Standing 519.4?±?104.4 N; Seated 224.2?±?9.4 N) and completion (Standing 183.3?±?62.5 N; Seated 71.0?±?24.2 N) and may have been a result of increased trunk flexion and a larger horizontal distance of the mass from the L5-S1 joint.

Practitioner Summary: Differences between lift performance and lumbar forces in standing and seated lifts are unclear. Using a with-in subjects repeated measures design, we found no difference in lifted mass or lumbar compression force at lift initiation between standing and seated lifts.     

Muscular and centre of pressure response to sudden release of load in symmetric and asymmetric stoop lifting tasks

Sudden changes in load during asymmetric lifting may be associated with a particularly high risk of loss of balance and spinal injury. Centre of pressure (COP) motions and electromyographic responses of trunk and lower limb muscles were studied in 10 normal male volunteers during sudden release of 20, 40, 60 and 80N stoop lifting loads in symmetric and asymmetric postures. Similar overall COP responses and muscular response strategies to sudden release of load were seen in both postures, although the asymmetric posture showed a larger medio-lateral COP displacements and greater co-contraction asymmetries. While sudden release of load in asymmetric stoop lifting does not seem to involve a greater risk of fall than symmetric lifting, the muscular response results in more complex and asymmetric loading of the trunk, indicating greater localised segmental loading and therefore increased risk of tissue injury.     

Efficiency and effectiveness of stoop and squat lifting at different frequencies

The study investigated the effects of frequency (10 and 20 lifts/min) and technique (squat and stoop) of repetitive lifting of a barbell (19 kg) on the relationship between mean power output (Pm) and energy cost in 9 male power-lifters. Oxygen uptake (VO2) was measured directly and continuously and power output was deduced from film analysis using an inverse dynamic analysis. Power output and VO2 were significantly greater for squat than for stoop lifting at the same frequency. The mechanical efficiency (ME), defined as Pm divided by the energy equivalence of VO2, increased from 12% at rate 10 to 18.5% at rate 20, but there was no significant difference between the two techniques. The effectiveness (EF), defined as the productive external power output (only work done on the barbell) divided by the energy equivalence of VO2, was significantly higher for the stoop lift than for the squat lift. EF is judged as a more useful measure than ME for characterizing the relative energy cost of a lifting task.     

Fatigue influences the dynamic stability of the torso

Fatigue in the extensor muscles of the torso affects neuromuscular recruitment and control of the spine. The goal of this study was to test whether fatigue influences stability of dynamic torso movements. A controlled laboratory experiment measured the change in the maximum finite-time Lyapunov exponent, lambda(max), before and after fatigue of the extensor muscles. Non-linear analyses were used to compute stability from the embedding dimension and Lyapunov exponent recorded during repetitive dynamic trunk flexion tasks. Torso extensor muscles were fatigued to 60% of their unfatigued isometric maximum voluntary exertion force then stability was re-measured. Independent variables included fatigue, task asymmetry and lower-limb constraint. lambda(max) values increased with fatigue suggesting poorer dynamic stability when fatigued. Embedding dimension declined with fatigue indicating reduced dynamic complexity when fatigued. Fatigue-related changes in spinal stability may contribute to the risk of low-back injury during fatiguing occupational lifting tasks. The findings reported here indicate that one mechanism by which fatigue contributes to low back disorders may be spinal instability. This information may contribute to the development of ergonomic countermeasures to help prevent low back disorders.     

Review of: “ Systems Documentation: Techniques of persuasion in large organizations”. By FRANK WHITEHOHSE, ( London: Business Books, 1973.) [Pp. viii + 191.] £450.

The use of back belts in industry has increased despite the lack of scientific evidence supporting their efficacy. The purpose of this study was to investigate the effect of a semi-rigid lumbosacral orthosis (SRLSO) on oxygen consumption during 6-min submaximal repetitive lifting bouts of 10 kg at a lifting frequency of 20 repetitions min^-1. Fifteen healthy subjects (13 men, two women) participated in this study. Each subject performed squat and stoop lifting with and without an SRLSO for a total of four lifting bouts. Lifting bouts were performed in random order. Oxygen consumption during the final minute of each lifting bout was used for analysis. A two-way analysis of variance with repeated measures was used to analyse the effects of lift and belt conditions. The stoop and squat methods were significantly different, with the squat lift requiring 23% more oxygen on average than the stoop lift for equal bouts of work. No significant difference was found between the belt and no belt condition within the same lifting technique and no interaction was present. These data suggest that an SRLSO does not passively assist the paravertebral muscles (PVM) in stabilizing the spine during submaximal lifting bouts.     

Rapid Communication Effects of posture,weight and frequency on trunk muscular activity and fatigue during repetitive lifting tasks

Abstract

We examined the effects of posture, weight and frequency on trunk muscular activity and fatigue during repetitive dynamic lifting. Electromyographic (EMG) signals from eight primary trunk muscles were collected during 120 min for four different task conditions. The patterns of muscle recruitment and the levels of relative activation were analysed using the normalized EMG data. Median power frequency (MPF) shift patterns were analysed to examine muscular fatigue. The muscles in the dorsal part of the trunk were activated at the symmetric posture, while the muscles on the contralateral side to the workload were more strongly activated at the asymmetric posture. Decreasing trends of MPFs were found in some active muscles, and they were more pronounced for the asymmetric posture than for the symmetric posture. It was also seen that the muscles became fatigued faster for the light load-high frequency task than for the heavy load-low frequency task.     

Fatigue influences the dynamic stability of the torso

Fatigue in the extensor muscles of the torso affects neuromuscular recruitment and control of the spine. The goal of this study was to test whether fatigue influences stability of dynamic torso movements. A controlled laboratory experiment measured the change in the maximum finite-time Lyapunov exponent, λ_max, before and after fatigue of the extensor muscles. Non-linear analyses were used to compute stability from the embedding dimension and Lyapunov exponent recorded during repetitive dynamic trunk flexion tasks. Torso extensor muscles were fatigued to 60% of their unfatigued isometric maximum voluntary exertion force then stability was re-measured. Independent variables included fatigue, task asymmetry and lower-limb constraint. λ_max values increased with fatigue suggesting poorer dynamic stability when fatigued. Embedding dimension declined with fatigue indicating reduced dynamic complexity when fatigued. Fatigue-related changes in spinal stability may contribute to the risk of low-back injury during fatiguing occupational lifting tasks. The findings reported here indicate that one mechanism by which fatigue contributes to low back disorders may be spinal instability. This information may contribute to the development of ergonomic countermeasures to help prevent low back disorders.     

Postural and trunk muscle response to sudden release during stoop lifting tasks before and after fatigue of the trunk erector muscles

The effect of fatigue on the muscular and postural response to sudden release of different stoop lifting loads was studied. Ten male volunteers performed a series of stoop lifting trials before and after fatigue of the erector spinae. Trials were performed using loads of 20, 40, 60, and 80 N, and sudden release of load was triggered randomly on one of the repetitions using an electromagnetic release. The onset of release was registered by an accelerometer, centre of pressure (COP) motion was recorded via a forceplate, and EMG activities of the latissimus dorsi (LD), erector spinae (ES), rectus abdominus (RA), external oblique (EO) and internal oblique (IO) muscles were recorded. A slightly reduced lifting speed was seen after fatigue, particularly at the higher loads, but this had little effect on the perturbing force at release, which was dominated by the release load. A significant effect of fatigue was seen on the antero-posterior COP motion, with the postural disturbance being decreased after fatigue. Fatigue resulted in a significant increase in ES (p = 0.029) and LD (p = 0.015) relaxation times and, while the response patterns (relaxation, contraction or no response) of the anterior trunk muscles (RA, EO, IO) were not always consistent, the proportion of response by relaxation was greater after fatigue. This resulted in a lower incidence but longer duration of co-contraction of the ES-RA, ES-EO and ES-EO muscle groups following fatigue, such that the mean co-contraction duration of these groups showed no significant differences before and after fatigue. The response to sudden release is a balance between maintaining postural stability and at the same time preventing the trunk musculature from overloading the spine and risking tissue injury. While fatigue of the trunk extensors does not appear to increase either the risk of fall or stumble or the incidence of co-contraction following sudden release of stoop lifting tasks, the duration of co-contraction appears to increase following fatigue. Further study is required to quantify the loading on the spine during sudden release of different lifting tasks before and after more realistic fatigue conditions.     

Postural perturbation and muscular response following sudden release during symmetric squat and stoop lifting

Squat and stoop lifting have been examined in some detail, but limited data exist regarding the sudden release of load during such lifting. Ten participants performed squat and stoop lifting trials with loads of 20, 40, 60 and 80N, and sudden release was randomly included in one of the lifting cycles. Postural perturbation was recorded via centre of pressure displacement using a force platform and the electromyographic response of trunk and lower limb muscles was recorded.

Results indicated that irrespective of lifting posture, an ‘ankle’ response strategy to sudden release was elicited, where the anterior muscles of the lower limb contracted first, followed by the anterior trunk muscles, relaxation of the posterior trunk muscles and, finally, relaxation of the posterior lower limb muscles. The latency of muscles responding by contraction tended to decrease slightly with increasing load for both postures, while the latency of muscles responding by relaxation increased, resulting in increased trunk muscle co-contraction durations. The postural disturbance appeared to be greater for squat lifting than stoop lifting at the higher loads of 60 and 80N, as the centre of pressure moves significantly closer to the posterior limit of static stability (the line joining the heels).

In terms of stability and muscular response, squat lifting may not be the most appropriate strategy if a sudden release of loads greater than approximately 50N is likely.     

Postural perturbation and muscular response following sudden release during symmetric squat and stoop lifting

Squat and stoop lifting have been examined in some detail, but limited data exist regarding the sudden release of load during such lifting. Ten participants performed squat and stoop lifting trials with loads of 20, 40, 60 and 80N, and sudden release was randomly included in one of the lifting cycles. Postural perturbation was recorded via centre of pressure displacement using a force platform and the electromyographic response of trunk and lower limb muscles was recorded.Results indicated that irrespective of lifting posture, an 'ankle' response strategy to sudden release was elicited, where the anterior muscles of the lower limb contracted first, followed by the anterior trunk muscles, relaxation of the posterior trunk muscles and, finally, relaxation of the posterior lower limb muscles. The latency of muscles responding by contraction tended to decrease slightly with increasing load for both postures, while the latency of muscles responding by relaxation increased, resulting in increased trunk muscle co-contraction durations. The postural disturbance appeared to be greater for squat lifting than stoop lifting at the higher loads of 60 and 80N, as the centre of pressure moves significantly closer to the posterior limit of static stability (the line joining the heels).In terms of stability and muscular response, squat lifting may not be the most appropriate strategy if a sudden release of loads greater than approximately 50N is likely.     

Maximum acceptable repetitive lifting workload by Chinese subjects

This study used psychophysical methods to determine the acceptable mean maximum lifting workload for eight Chinese young male subjects, and examined the effects of lifting technique (including freestyle, stoop and squat), lifting frequency (including 2, 3, 4, 5 and 6 lifts/min) and physical characteristics on the maximum acceptable workload. The results are described as follows: (1) The maximum acceptable weights selected by subjects varied from 11.34 to 18.33 kg with changes in lifting technique and frequency. These data were lower than those previously obtained; (2) The upper limit of physiological tolerance over an 8 h workday was also generally lower than previously suggested. However, this upper limit varied with changes in lifting technique and frequency, and in some circumstances it was the same as or even higher than previous limit; (3) Lifting efficiency was affected significantly by technique and frequency. The rank order of efficiency for three lifting techniques were freestyle, stoop and squat. Efficiency was greatest when lifting frequency was between 5 and 6 lifts/min; and (4) The correlations between the maximum acceptable workloads selected by subjects and anthropometric sizes were significant, but those between maximum acceptable workload and isometric strength were not.