Evaluation of upper-limb body postures based on the effects of back and shoulder flexion angles on subjective discomfort ratings,heart rates and muscle activities

A possible limitation of many ergonomics checklists that evaluate postures is an independent evaluation of each body segment without considering the coordination between body segments and resulting in the under-/over-estimation of body postures. A total of 20 men were selected to evaluate the effects of shoulder and back flexion angles on the upper-limb muscle activities, subjective discomforts and heart rates. Interesting findings were obtained from the coordination between back flexion angles and shoulder flexion angles. At a back flexion angle of 45°, the discomfort and heart rates were the least at a shoulder flexion angle of 45°. The %MVC also showed a similar trend. It could be inferred that the 0° shoulder flexion angle would be a natural posture, when the back flexion angle is 0°, whereas 45° shoulder flexion might be a more natural posture when the back flexion angle is 45°.

Statement of Relevance: This study evaluated the effects of back and shoulder flexion angles on subjective as well as objective measures. The findings of this study considered the coordination between two body flexion angles and could be used to improve the accuracy of existing ergonomics evaluation methods for body postures.     

An examination of shoulder kinematics and kinetics when using a commercial trunk harness while sheep shearing

Sheep shearing is a very physically demanding occupation, especially on the low back, such that many commercial harnesses have been developed to help reduce the load on the back. Such harnesses have been shown to significantly reduce peak and cumulative low back loads; however, the effect that these harnesses have on the shoulders, which are also highly involved during sheep shearing, has not been previously examined. The purpose of this study was to examine the shoulder postures and cumulative shoulder moments of 12 New Zealand sheep shearers. The use of the trunk harness reduced the percentage of time spent in shoulder flexion greater than 90 degrees and the time spent in shoulder abduction greater than 45 degrees as well as reduced the cumulative net joint flexor, abductor, and adductor shoulder moments by a minimum of 21%, 14%, and 42%, respectively. Therefore, the use of a commercial trunk harness to reduce low back injury may also help to reduce the risk of shoulder injury while sheep shearing.     

The effects of shoulder posture on neck and shoulder musculoskeletal loading and discomfort during smartphone usage

While using their smartphone, users tend to adopt awkward neck and shoulder postures for an extended duration. Such postures impose the risk of MSDs on those body parts. Numerous studies have been undertaken to examine neck posture; however, few studies have investigated shoulder postures. This study examined various shoulder postures during smartphone use and their effect on neck and shoulder kinematics, muscle loading, and neck/shoulder discomfort. Thirty-two asymptomatic young adult smartphone users randomly performed texting tasks for 3 min at four different shoulder flexion angles (15°, 30°, 45°, and 60°), while maintained a neck posture in the neutral position (0° neck flexion angle). Measures were taken of neck and shoulder muscle activity of the cervical erector spinae (CES), anterior deltoid (AD), upper trapezius (UT) and lower trapezius (LT), and kinematic data (angle, distance and gravitational moment). Results showed AD and LT muscle activity significantly increased when the shoulder flexion angle increased with an opposite effect on CES and UT. A recommended shoulder posture was identified as 30° flexion, as this yielded the best compromise between activation levels of the four muscles studied. This angle also induced the lowest neck/shoulder discomfort score. The findings suggest smartphone users hold their device at approximately 30° shoulder flexion angle with their neck in a neutral posture to reduce the risk of shoulder and neck musculoskeletal disorders when smartphone texting.Relevance to industrySmartphone use in the manufacturing and service industries is an integral part of work and useful means of communication tool. Awkward postures during extensive smartphone use impose an increased risk of both neck and shoulder musculoskeletal disorders. Shoulder flexion angles need consideration when making recommendations about safe work postures during smartphone use.     

Lumbar posture and individual flexibility influence back muscle flexion-relaxation phenomenon while sitting

Although numerous studies have documented back muscle flexion-relaxation phenomenon (FRP) in standing postures, few studies have examined the FRP in various seated lumbar postures and individual flexibilities. This study, therefore, recruited 18 male students and assigned to low- and high-flexibility groups (9 in each). Activation of thoracic and lumbar erector spinae (ES) and lumbosacral angles were examined while participants sat in two postures (lordosis and kyphosis) and flexed their trunks at 15°, 30°, 45°, 60°, and maximum flexion. Results showed that kyphotic lumbar posture caused relatively low and unchangeable thoracic and lumbar ES activations, whereas lordotic lumbar posture engendered more contractive and varying thoracic and lumbar ES activations. Flexible participants exhibited higher thoracic ES activation than less flexible participants during lordotic sitting. Thoracic ES seemed to play a compensative role to stabilize the spine in the lordotic sitting posture, especially when the trunk was flexed over 45°. In lordotic lumbar posture, FRP occurred only in the lumbar ES; however, the activation and lumbosacral angles were still higher than those in kyphotic posture. The increased back muscle activation associated with lumbar lordosis may partially share the load on passive interspinous tissues, which are close to the discs during these flexed trunk positions.Relevance to industryThis study suggests that various lumbar postures and individual flexibilities may cause different FRP patterns when sitting. While performing seated tasks, people should exercise caution about the lumbar posture.     

Measuring posture for epidemiology: Comparing inclinometry,observations and self-reports

The objective of this study was to use and evaluate three postural assessment methods for epidemiological studies of back disorders. The methods were: (1) a data-logging inclinometer; (2) observations by trained observers; (3) self-reports by employees. All methods were feasible in 50 heavy industry worksites. Inclinometry provided quantitative measures of flexion–extension (mean 17°, SD 11.2°), lateral flexion (mean 8.5°, SD 2.6°) and trunk movement speed (mean 14.3° per second, SD 4.9° per second). Observations and self-reports provided estimates of time spent in various trunk angles, general postures, materials handling and vehicles. Compared to observations, self-reports under-reported less common tasks, but over-reported task durations. In statistical modelling to determine if observations or self-reports could be used to estimate measured postures, observations accounted for 30 to 61% of the inclinometer measurement variance and self-reports for 33 to 40%. A combination of inclinometry and observations would be an ideal option to provide both depth and breadth of data on postures and other physical exposures for epidemiological research.     

Simultaneous measurements of posture and movements of head and trunk by continuous three-dimensional registration

The postures of three groups of employees were measured: straddle carrier drivers, crane operators and office employees. This type of sedentary work can be characterized as being highly static. Using a continuous three-dimensional registration device, the postures and movements of head and trunk were recorded simultaneously. The results show that the adopted postures and patterns of movement were predominantly imposed by the workplace. The posture of the crane operators was the most static compared to the other occupations. The most adopted posture in the sagittal plane for crane operators was trunk flexion of 5° and head flexion of 60°. Typically, a straddle carrier driver rotated his head more than 45° to the left or right for 28% of the day, which far exceeded that of the other groups. The measuring device provides accurate and reproducible data that can subsequently be used for calculating the postural load and for ergonomic analysis.     

Reduction of farmers' postural load during occupationally oriented medical rehabilitation

Farmers' back problems may be associated with the amount of back flexion and the handling of heavy loads. The aim of this study was to analyse the effects of occupationally oriented medical rehabilitation courses on female farmers' postural load. Twenty seven female farmers (aged from 32 to 52 years) took part in four rehabilitation courses at one rehabilitation centre in Finland. The subjects suffered from various musculoskeletal symptoms, which decreased their work ability. The rehabilitation courses included two periods: the first lasted for 3 weeks and the latter for 1 week, organized 6 months after the first period. The work postures and their load on the musculoskeletal system were classified by the computerized OWAS method in three daily work phases. During the 3-week periods new work techniques were learned, and simultaneous bent and twisted postures for the back decreased from 34 to 4% of all studied work postures. Similarly, postures with one or both arms above shoulder level were reduced from 44 to 24%. Rechecking after the 6-month period confirmed that the adoption of new work techniques was consistent. The study showed that female farmers could change their work techniques during this kind of intensive rehabilitation period, and the changes were seen 6 months later in the follow-up.     

Effect of wearing jeans on the back muscle flexion-relaxation phenomenon

The flexion–relaxation phenomenon (FRP) in back muscles is related to the lower back load. Although the FRP has been widely discussed, the effect of wearing jeans—a common attire in workplaces—on the FRP is unexplored. This study recruited 20 male participants with high and low flexibilities (10 each) and measured the related muscle activity and lumbopelvic movement at five trunk flexion angles (0°–90°) when wearing two types of bottom wears (swim trunks and fit jeans). Results revealed that the bottom wear type and trunk angle significantly affected all responses, whereas flexibility affected only erector spinae and hamstring activities. Participants with high flexibility and wearing swim trunks exhibited greater erector spinae activity than did those with low flexibility and wearing jeans. Thus, those who have low flexibility or are wearing jeans are likely to experience more activity reductions in erector spinae. However, the result with hamstring activity was the opposite. Wearing jeans limited participants’ pelvic rotation, forcing them to bend their lumbar spine further to complete trunk flexion, thus reducing erector spinae activity. A looser attire should be chosen to avoid constraining the pelvic rotation when work involves a deep trunk flexion.Relevance to industryPeople wearing jeans have limited pelvic movement and decreased erector spinae activity during deep trunk flexion, and this may further strain their interspinous ligaments. Thus, people should not wear fit jeans when in workplaces where their work involves stooping or trunk flexion exceeding 45° to minimize the load on their lower back.     

Trunk postural demands of occupational activities of some merchant pregnant women in Benin,West Africa

Strenuous physical work puts expectant mothers at risk of experiencing back pain during the gestational months. Pregnant women in Benin perform physically demanding occupational tasks that include the lifting and carriage of heavy loads on their heads for commercial activities. A large percentage of pregnant subjects (58%) reported having back pain episodes since the start of their pregnancy. However, the mean Oswestry score of the affected participants was relatively low with a mean score of 0.2 (SD: 0.12), on a scale form 0 to 1. An evaluation of the postural demands of the occupational activities of these women revealed that they performed on average 328 trunk flexions at angles exceeding 60°, with 66 of these flexions sustained for more than 4 s, during the average 7.9 h where trunk postures were recorded. They also spent on average 36% of the recording time at trunk flexion angles larger than 20°. These results show that the merchant pregnant women in the Porto-Novo area in Benin are at great risk for developing back disorders during pregnancy.

Practitioner Summary: Results will make a first contribution to the literature by identifying the stressful postures adopted during a typical day. The findings of this study can help in the development of preventative concepts and postural modification techniques to decrease the occurrence of back pain during pregnancy for women in Benin.     

Evaluation of upper-limb body postures based on the effects of back and shoulder flexion angles on subjective discomfort ratings, heart rates and muscle activities

A possible limitation of many ergonomics checklists that evaluate postures is an independent evaluation of each body segment without considering the coordination between body segments and resulting in the under-/over-estimation of body postures. A total of 20 men were selected to evaluate the effects of shoulder and back flexion angles on the upper-limb muscle activities, subjective discomforts and heart rates. Interesting findings were obtained from the coordination between back flexion angles and shoulder flexion angles. At a back flexion angle of 45°, the discomfort and heart rates were the least at a shoulder flexion angle of 45°. The %MVC also showed a similar trend. It could be inferred that the 0° shoulder flexion angle would be a natural posture, when the back flexion angle is 0°, whereas 45° shoulder flexion might be a more natural posture when the back flexion angle is 45°. STATEMENT OF RELEVANCE: This study evaluated the effects of back and shoulder flexion angles on subjective as well as objective measures. The findings of this study considered the coordination between two body flexion angles and could be used to improve the accuracy of existing ergonomics evaluation methods for body postures.     

Trunk postures and peak and cumulative low back kinetics during upright posture sheep shearing

Sheep shearing is the most demanding occupation in the wool harvesting industry and is known to have a high prevalence of low back pain. While use of a commercially available trunk harness reduces load on the low back, the extreme trunk flexion associated with shearing still remains. A novel, upright posture shearing technique has been designed to allow a more neutral spine posture. This study assessed this upright technique and found significant reductions in both trunk flexion and cumulative low back loading when compared to either the traditional method or the use of the trunk harness. Moments about the shoulder tended to be higher while using the upright shearing technique and further investigation of shoulder kinetics will be required to assess whether this creates injury risk to the upper extremity. Despite increased shoulder moments, the reduction in flexion and cumulative loading with the use of the upright technique has the potential to reduce risk of low back pain among shearers.     

An evaluation of backpack harness systems in non-neutral torso postures

Much of the research on backpack design has been focused on spinal loading/biomechanics while the wearer is in a neutral/upright trunk posture, such as those employed by outdoor enthusiasts and schoolchildren. This research has led to some important harness design improvements that reduce trunk muscle exertions, fatigue and improve overall comfort. There are number of occupations, however, wherein workers wear back-mounted packs/devices (e.g. air tanks) while working in non-neutral trunk postures. The objective of the current study was to evaluate the effects of these non-neutral postures on biomechanical loading and then reconsider the backpack system design recommendations. Fifteen participants were asked to support a 18.2 kg load on their back while assuming static forward flexed postures of the torso (15 degrees , 30 degrees , 45 degrees , and 60 degrees of sagittal bend). The mass on the back was attached to the participant through two different harness mechanisms: a basic harness design (as seen on college student backpacks) and a more advanced design containing lateral stiffness rods and a weight-bearing hip belt (as seen on backpacks for hikers). While performing these static, posture maintenance tasks, the activation levels of the bilateral trapezius, erector spinae, and rectus abdominis were collected. Participants also provided subjective ratings of comfort. The results showed that there was a significant interaction between harness type and forward flexion angle for the trapezius and the erector spinae muscles. The normalized EMG for the trapezius muscles showed a 14% and 11% reduction in muscle activity at 15 degrees and 30 degrees , respectively, with the advanced design but these positive effects of the advanced design were not found at the greater flexion angles. Likewise the erector spinae muscles showed a 24% and 14% reduction in muscle activity at 15 degrees and 30 degrees , respectively, with the advanced design harness but these effects of the advanced design were not found at the greater forward flexion angles. The level of forward flexion angle affected the rectus abdominis muscle activity, but neither the harness type main effect nor the interaction of harness type and forward flexion angle was significant. The subjective survey results agreed with the EMG results and showed the advanced design harness was generally more comfortable with respect to the shoulder and low back areas. Collectively, the subjective and objective results show a significant improvement with the advanced harness system but also note an interesting interaction with degree of sagittal flexion, indicating a diminished effectiveness of the design improvements at forward flexed postures. Design criteria for harness systems in these forward flexed postures are discussed.     

Inter-rater reliability of an inertial measurement unit sensor-based posture-matching method: A pilot study

Posture quantification is important for analyzing trunk and upper extremity loading and estimating the risk of work-related musculoskeletal disorders. This study introduced an inertial measurement unit sensor-based posture-matching (ISPM) method. The ISPM method is the concept that involves observers wearing sensors and simulating postures in photos or videos obtained at job sites to assess the postural risks for the trunk and upper extremity. We tested the inter-rater reliability of the method in 4 novice observers. For the trunk, shoulder/elbow, and wrist joint angle category, weighted kappa scores were 0.89, 0.52, and 0.26, respectively. The results of the ISPM method indicated moderate or high inter-rater reliability for trunk flexion, shoulder flexion/extension, shoulder abduction/adduction, and elbow flexion. The ISPM method was more reliable than conventional observation-based posture assessment tools used for trunk posture analyses. However, the assessment of upper extremity angles indicated that the reliability of ISPM was lower than that of conventional observation-based posture assessment tools. This was a proof-of-concept study conducted using a few samples. Therefore, further testing is necessary to support the findings.Relevance to industryThe ISPM method requires a minimal level of training. It uses conventional video recording and imposes almost no interruptions to the workers’ performance. The ISPM method showed moderate inter-rater reliability for the trunk, shoulder flexion/extension, shoulder abduction/adduction, and elbow flexion during the joint angle analysis.     

The effect of fatigue on trunk muscle activation patterns and spine postures during simulated firefighting tasks

The purpose of this study was to determine the effect of a fatiguing task (3 min intense stair climbing) on the adopted spinal postures and trunk muscular activation patterns during three highly physically demanding simulated firefighting tasks. Following the fatigue protocol, it was observed that individuals adopted significantly greater spinal flexion (16.3° maximum prior to fatigue as compared to 20.1° post fatigue) and displayed reduced abdominal muscle activation as compared to before the fatigue protocol (mean ranging from 16.6% maximum voluntary contraction (MVC) to 30.6% MVC prior to fatigue as compared to ranging from 14.6% MVC to 25.2% MVC post fatigue). The reduced abdominal activation may be due to a reduction in co-contraction during these tasks, which may compromise spinal stability. Reduced co-contraction combined with the increased spinal flexion may increase the risk of sustaining an injury to the low back.     

Bowing with a trunk flexion of 90°: Perspectives on consumers and service personnel

In this study, we analyzed 100 questionnaire responses to determine consumer conceptions of service personnel bowing as a gesture of politeness. In addition, 12 female participants demonstrate five distinct degrees of bowing by bending their trunk 30°, 45°, 60°, and 90° from an upright position; their spinal curvature and trunk muscle activations were measured. The results showed that most respondents believed that bowing at 30° was the most satisfactory angle, followed by 45°. Bowing at 45° or 60° caused the survey respondents to feel honored, whereas bowing at 90° induced feelings of surprise and novelty; however, this angle produced the lowest proportion level of agreements on the items at ease, necessary, and appropriate among the 100 respondents. When the 12 participants bowed at an angle ≤60°, their spinal posture became increasingly kyphotic, and their muscle activations became more pronounced. Myoelectric silencing of the erector spinae was observed when the participants bowed at 90°, which can increase the risk of low back injury. These findings provide service industries with a reference for the design of service encounters.Relevance to industryBowing has traditionally signified politeness and respect in many countries. However, whether bowing at a greater trunk flexion actually satisfies customers remains unclear. Findings from this study clarify the customer perceptions and body loads of service personnel when bowing at various trunk positions. The extreme bowing postures (e.g., 90° trunk flexion) should be avoided.     

Long-duration assessment of upper arm posture and motion and their association with perceived symptoms among bakery workers

Awkward shoulder postures have been suggested to be a cause of shoulder discomfort among bakery workers. This study aimed at long-duration assessment of upper arms posture and motion and their association with perceived symptoms among bakery workers. Among workers in three types of bread systems, fifty-seven bakers were randomly selected. The self-reported rates for the perceived severity and frequency of shoulder discomfort were collected through questionnaires. Working postures and movements of the shoulders during work were continuously recorded with inclinometry measurements for three hours. Percentage of time spent with the upper arm right elevated more than 60° was significantly correlated with the perceived discomfort rate in the right shoulder for all bakery workers (r = 0.48 to 0.63, p ≤ 0.05). A significant correlation was found between angular velocity with the perceived discomfort intensity for right upper arm.(r = 0.60 to 0.87, ≤0.005) of all workers in the three baking systems. Physical exposure in bakers was characterized by significantly more awkward postures and the percentage of time spent with the upper arms elevated more than 60°. The current findings can facilitate more informed decisions with respect to both engineering (e.g.ergonomic workstation and tool design) and administration (e.g. work organization) control strategies.     

Quantitative postural load assessment for whole body manual tasks based on perceived discomfort

Many Korean workers are exposed to repetitive manual tasks or prolonged poor working postures that are closely related to back pain or symptoms of musculoskeletal disorders. Workers engage in tasks that require not only handling of heavy materials, but also assuming prolonged or repetitive non-neutral work postures. Poor work postures that have been frequently observed in the workplaces of shipbuilding shops, manufacturing plants, automobile assembly lines and farms often require prolonged squatting, repetitive arm raising and wrist flexion and simultaneous trunk flexion and lateral bending. In most manufacturing industries, workers have to assume improper work postures repetitively, several hundreds of times per day depending on daily production rate. A series of psychophysical laboratory experiments were conducted to evaluate the postural load at various joints. A postural load assessment system was then developed based on a macro-postural classification scheme. The classification scheme was constructed based on perceived discomfort for various joint motions as well as previous research outcomes. On the basis of the perceived discomfort, postural stress levels for the postures at individual joints were also defined by a ratio scale to the standing neutral posture. Laboratory experiments simulating automobile assembly tasks were carried out to investigate the relationship between body-joint and whole-body discomfort. Results showed a linear relationship between the two types of discomfort, with the shoulder and low back postures being the dominant factor in determining the whole body postural stresses. The proposed method was implemented into a computer software program in order to automate the procedure of analysing postural load and to enhance usability and practical applicability.     

Quantitative postural load assessment for whole body manual tasks based on perceived discomfort

Many Korean workers are exposed to repetitive manual tasks or prolonged poor working postures that are closely related to back pain or symptoms of musculoskeletal disorders. Workers engage in tasks that require not only handling of heavy materials, but also assuming prolonged or repetitive non-neutral work postures. Poor work postures that have been frequently observed in the workplaces of shipbuilding shops, manufacturing plants, automobile assembly lines and farms often require prolonged squatting, repetitive arm raising and wrist flexion and simultaneous trunk flexion and lateral bending. In most manufacturing industries, workers have to assume improper work postures repetitively, several hundreds of times per day depending on daily production rate. A series of psychophysical laboratory experiments were conducted to evaluate the postural load at various joints. A postural load assessment system was then developed based on a macro-postural classification scheme. The classification scheme was constructed based on perceived discomfort for various joint motions as well as previous research outcomes. On the basis of the perceived discomfort, postural stress levels for the postures at individual joints were also defined by a ratio scale to the standing neutral posture. Laboratory experiments simulating automobile assembly tasks were carried out to investigate the relationship between body-joint and whole-body discomfort. Results showed a linear relationship between the two types of discomfort, with the shoulder and low back postures being the dominant factor in determining the whole body postural stresses. The proposed method was implemented into a computer software program in order to automate the procedure of analysing postural load and to enhance usability and practical applicability.     

Efficacy of adjusting working height and mechanizing of transport on physical work demands and local discomfort in construction work

The efficacy of ergonomics measures to reduce physical work demands in a real working situation is often assumed, but seldom studied. In this study, the effect of adjusting working height and mechanization of transport on physical work demands and local discomfort of bricklayers' work was evaluated during a field experiment in the construction industry. In a within-subjects controlled experiment, 10 bricklayers and 10 bricklayers' assistants worked in two different conditions. Working height of bricks and mortar, and transport of materials were manipulated. The physical work demands were assessed through real time observations at the work site. Local discomfort of the lower back and of the shoulder region was measured by means of a visual analogue scale. Working with a scaffolding console to adjust the working height of the storage of materials resulted in a significant reduction of the frequency and duration of trunk flexion (?>?60°) by 79% and 52% respectively, compared with bricks set out on the ground floor. Mechanization of transport of materials resulted in a significant reduction of the frequency and duration of trunk flexion (?>?60°) by 94% and 92% respectively, compared with the condition of manual handling. The frequency of handling objects (?>?4?kg) reduced significantly by 86%. Local discomfort of the lower back was significantly less in the ergonomic conditions, while no significant difference was found for local discomfort of the shoulder between both conditions in bricklayers' assistants.     

Paramedics on the job: Dynamic trunk motion assessment at the workplace

Many paramedics' work accidents are related to physical aspects of the job, and the most affected body part is the low back. This study documents the trunk motion exposure of paramedics on the job. Nine paramedics were observed over 12 shifts (120 h). Trunk postures were recorded with the computer-assisted CUELA measurement system worn on the back like a knapsack. Average duration of an emergency call was 23.5 min. Sagittal trunk flexion of >40° and twisting rotation of >24° were observed in 21% and 17% of time-sampled postures. Medical care on the scene (44% of total time) involved prolonged flexed and twisted postures (∼10 s). The highest extreme sagittal trunk flexion (63°) and twisting rotation (40°) were observed during lifting activities, which lasted 2% of the total time. Paramedics adopted trunk motions that may significantly increase the risk of low back disorders during medical care and patient-handling activities.