The influence of occupation on lumbar sagittal motion and posture

The aim of this study was to determine whether sheep shearers have clinically hypothesized adaptive postural and sagittal mobility parameters of the lumbar spine and pelvis. Sixty-four shearers and 64 non-shearers, matched by age and anthropometry and surveyed for present and previous low back pain, participated in a study to determine the effects of occupation on sagittal spinal motion and posture. Lumbar and hip mobility measurements were made with a geometric CAD analysis of lateral photographs using surface reflective markers. Sagittal range of motion demonstrated similar ranges of lumbar flexion between the two groups; however, there was a marked gain in hip flexion in the shearers as well as a marked loss of lumbar extension. The shearers also demonstrated a more lordotic lower lumbar curvature compensated by a flatter (less kyphotic) mid to lower thoracic region. Shearers appear to lose lumbar extension, gain hip flexion and develop an adaptive normal stance. This adaptation appears to be independent of previous or current back pain. Conversely, lumbar extension loss in non-shearers correlates with previous back injury. A stepwise linear regression of all participants indicated that the occupation is the predominant influence on motion and posture followed by age. The implications are one of structural adaptation in this occupational group that does not appear to be correlated with back pain.     

Three-dimensional spinal motion and risk of low back injury during sheep shearing

Sheep shearers are known to work in sustained flexed postures and have a high prevalence of low back pain (LBP). As sustained posture and spinal movement asymmetry under substantial loads are known risk factors for back injury our aim was to describe the 3D spinal movement of shearers while working. We hypothesised that thoraco-lumbar and lumbo-sacral movement would be tri-axial, asymmetric, and task specific. Sufficient retro-reflective markers were placed on the trunk of 12 shearers to define thoraco-lumbar and lumbo-sacral 3D motion during three tasks. Thoraco-lumbar movement consistently involved flexion, left lateral flexion, and right rotation. Lumbo-sacral movement consistently involved right lateral flexion in flexion with minimal rotation. Shearers therefore work in sustained spinal flexion where concurrent, asymmetric spinal movements into both lateral flexion and rotation occur. These asymmetric movements combined with repetitive loading may be risk factors leading to the high incidence of LBP in this occupational group.     

Preparation of dynamic posture and occurrence of low back pain

Abstract

Improper posture is considered as one of the causes for low back pain. This study focused attention on low back pain that occurs when people adopt a dynamic posture. Low back pain in attendants was investigated as a typical example of low back pain in a dynamic posture. When multi-dimensional quantification III was applied to the results of the investigation, low back pain was found to occur in six postural patterns: bending knee posture, the posture of lifting and holding a light object, the posture of tilting the trunk, working posture to push a cart, the posture of turning or lifting a cart, and the posture of stretching. This survey found that low back pain frequently occurred when an unexpected load was imposed on the lumbar region and experiments were conducted to simulate the unexpected loading of this region. The experimental results showed that lumbar muscular activity was not fast enough to cope with the load and resulted in an increased swaying of the trunk. This swaying was considered to induce a load on the lumbar region. It is concluded that low back pain can be prevented if an appropriate preparatory set is taken.     

The influence of a back support harness on spinal forces during sheep shearing

Previous research has classified the occupation of sheep shearing as heavy work where shearers flex their spine and hips for long periods of time, handle awkward loads and expend high amounts of energy. The aim of this research was to investigate the magnitude of spinal forces produced during the shearing phase of the work and to determine whether the use of a commercially available back support harness would reduce these forces. Following discussion on task complexity and risk of back injury with senior shearing instructors, three component tasks of the shearing phase were identified as posing high risk of injury and were prioritized for primary analysis. Although the dragging out of a sheep in preparation for shearing and an unexpected loss of animal control were also identified as being of high risk, technological and instrumentation difficulties precluded their analysis. Twelve experienced shearers were videotaped while shearing with and without the use of a back harness. Surface mounted retro-reflective markers placed on the trunk defined three linked segments: Pelvis, Lumbar and Head, Arms, and Upper Trunk (HAUT). A 3D, link segment, top down, inverse dynamics approach was used to describe the motion and to estimate forces involved during the identified tasks of shearing. The spinal force/time profiles of this sample of shearers demonstrated large compressive and shear forces for all three tasks that are close to the NIOSH and University of Waterloo action limits for compressive and shear forces respectively (McGill , Yingling and McGill , Marras ). The use of the back support harness reduced these forces by substantial and statistically significant amounts. This effect was consistent across all three tasks. The results of this study demonstrate the production of high levels of compressive and shear forces within the spine of shearers during the three shearing tasks studied and that the use of a back support harness can substantially reduce these forces. Therefore the use of a back harness may reduce the cumulative load on the spine during shearing thereby moderating damage to the articular structures. However it is not known whether the harness would protect the spine from a sudden or unexpected force.     

Effectiveness of an ergonomic intervention on work-related posture and low back pain in video display terminal operators: A 3 year cross-over trial

This study investigated the effectiveness of a workstation ergonomic intervention for work-related posture and low back pain (LBP) in Video Display Terminal (VDT) workers. 100 VDT workers were selected to receive the ergonomic intervention, whereas 100 were assigned to a control group. The two groups were then crossed-over after 30 months from baseline. Follow-ups were repeated at 5, 12, and 30 months from baseline and then at 6 months following crossover. Outcomes: Work-related posture and LBP point-prevalence using the Rapid Entire Body Assessment method and a Pain Drawing, respectively. The ergonomic intervention at the workstation improved work-related posture and was effective in reducing LBP point-prevalence both in the first study period and after crossover, and these effects persisted for at least 30 months. In conclusion, our findings contribute to the evidence that individualized ergonomic interventions may be able to improve work-related posture and reduce LBP for VDT workers.     

Quantifying low back peak and cumulative loads in open and senior sheep shearers in New Zealand: Examining the effects of a trunk harness

Sheep shearing requires shearers to adopt sustained flexed postures for prolonged periods of time and has been associated with an increased risk of developing low back pain (LBP). However, these postures do not generally result in acute compressive values at L4/L5 exceeding the action limit proposed by the National Institute for Occupational Safety and Health, despite the high prevalence of LBP in this occupation. Therefore, it may not be peak loading that is responsible for LBP in this occupation but instead it may be the effect of cumulative loading over the course of a workday. The primary purpose of this research was to quantify the low back cumulative load exposure in 12 sheep shearers with and without the aid of a commercial trunk harness. Results revealed a significant reduction in the magnitude of cumulative compression with the use of the trunk harness and therefore its use may potentially reduce the risk of injury. The use of the trunk harness also reduced the time spent in axially twisted postures, which have been associated with LBP. However, using the trunk harness also resulted in increased time spent in laterally bent postures, which has been associated with increased risk for pain and injury.     

Influence of automobile seat lumbar support prominence on spine and pelvic postures: a radiological investigation

Background

The use of lumbar supports has been associated with decreased reports of low back pain during driving exposures. However, there has been limited work investigating whether lumbar supports actually change spine and pelvic postures at the level of the vertebrae.

Purpose

To investigate the effectiveness of a lumbar support in changing radiological measures of lumbar spine and pelvic postures and to examine the impact of support excursion magnitudes on these postures.

Methods

Eight male subjects were recruited with no history of back injury, pathologies or low back pain within the past 6 months. Radiographs were taken in four postures: standing, and sitting with 0 cm, 2 cm and 4 cm lumbar support prominence (LSP).

Results

Lumbar lordosis angle increased from 20° with no support to 25° with 2 cm support and 30° with 4 cm support. Lumbar lordosis angles were significantly different between 0 cm support and 4 cm support (p < 0.0001) and between 2 cm support and 4 cm support (p = 0.0256). Increasing lumbar support reduced the flexion at intervertebral disc joints throughout the lumbar spine, however, these remained significantly different from upright standing (p > 0.001) with the exception of L1/L2 in 4 cm support (p = 0.1381) and L5/S1 for all seated postures (p = 0.0687). All measures of pelvic posture were significantly different in sitting compared to standing (p < 0.0001), however, the lumbar support had no significant impact on seated pelvic posture.

Conclusions

Lumbar supports were shown to impact the vertebral rotations of the lumbar spine yet had no effect on pelvis postures. Increasing support from the current maximum of 2 cm–4 cm resulted in increased lumbar lordosis. The changes were mostly imparted at the upper lumbar spine joints with the most marked change being exhibited at the approximate level of the lumbar support apex: in the L2/L3 joint.     

Effects of restrictive clothing on lumbar range of motion and trunk muscle activity in young adult worker manual material handling

The objective of this study was to examine the effect of wearing restrictive trousers on lumbar spine movement, trunk muscle activity and low back discomfort (LBD) in simulations of manual material handling (MMH) tasks. Twenty-eight young adults participated in the study performing box lifting, liquid container handling while squatting, and forward reaching while sitting on a task chair when wearing tight pants (sizes too small for the wearer) vs. fit pants (correct size according to anthropometry). Each task was repeated three times and video recordings were used as a basis for measuring lumbar range of motion (LRoM). The response was normalized in terms on baseline hip mobility. Trunk muscle activity of rectus abdominis (RA) and erector spinae (ES) muscles were also measured in each trial and normalized. At the close of each trial, participants rated LBD using a visual analog scale. Results revealed significant effects of both pants and task types on the normalized LRoM, trunk muscle activity and subjective ratings of LBD. The LRoM was higher and trunk muscle (ES) activity was lower for participants when wearing tight pants, as compared to fit pants. Discomfort ratings were significantly higher for tight pants than fit. These results provide guidance for recommendations on work clothing fit in specific types of MMH activities in order to reduce the potential of low-back pain among younger workers in industrial companies.     

Trunk posture: reliability, accuracy, and risk estimates for low back pain from a video based assessment method

It has been recently reported that both dynamic movement characteristics, as well as the duration of postures adopted during work, are important in the development of low back pain (LBP). This paper presents a video-based posture assessment method capable of measuring trunk angles and angular velocities in industrial workplaces. The inter-observer reliability, system accuracy, and the relationship of the measured exposures to the reporting of low back pain are reported. The video analysis workstation consisted of a desktop computer equipped with digital video capture and playback technology, a VCR, and a computer game type joystick. The operator could then use a joystick to track trunk flexion and lateral bending during computer-controlled video playback. The joystick buttons were used for binary input of twisting. The inter-observer reliability for peak flexion and percentage of time spent in posture category variables were excellent (ICC>0.8). Lower reliability levels were observed for peak and average velocity and movement related variables. The video analysis system time series data showed very high correlation to the criterion optoelectronic imaging system (r=0.92). Root mean square errors averaged 5.8° for the amplitude probability distribution function data. Trunk flexion variables including peak level, peak velocity, average velocity indicators, and percent time in flexion category indicators all showed significant differences between cases and controls in the epidemiological study. A model consisting of the measures peak trunk flexion, percent time in lateral bend and average lateral bending velocity emerged after multivariable analysis for relationship to low back pain.

Relevance to industry

Risk of injury for the low back is multifactorial. The trunk position and movement velocity are emerging as important parameters. This analysis confirms the importance of these factors and demonstrates the utility of a video-based method to measure them in industrial settings.     

City bus driving and low back pain: a study of the exposures to posture demands, manual materials handling and whole-body vibration

A cross-sectional study was conducted to investigate worker exposure to posture demands, manual materials handling (MMH) and whole body vibration as risks for low back pain (LBP). Using validated questionnaire, information about driving experience, driving (sitting) posture MMH, and health history was obtained from 80 city bus drivers. Twelve drivers were observed during their service route driving (at least one complete round trip) and vibration measurements were obtained at the seat and according to the recommendations of ISO 2631 (1997), for three models of bus (a mini-bus, a single-decker bus, a double-decker bus). The results showed that city bus drivers spend about 60% of the daily work time actually driving, often with the torso straight or unsupported, perform occasional and light MMH, and experience discomforting shock/jerking vibration events. Transient and mild LBP (not likely to interfere with work or customary levels of activity) was found to be prevalent among the drivers and a need for ergonomic evaluation of the drivers' seat was suggested.     

About the impact of repetitive spine flexions due to labour on passive mechanics of the lumbar spine

Repetitive flexion of the lumbar spine during labour may have an impact on the development of low back pain, but current evidence is sparse. This study focuses on the effect of palletising on the lumbar spine's passive mechanics (flexion characteristics). As other passive structures begin to creep from long-term loading, changes in lumbar passive flexion characteristics have been hypothesised. The lumbar spine's passive flexion characteristics were investigated in 22 volunteers before and after palletising. For comparison, measurements were performed also during relaxed upright standing and while palletising with breaks for exercise. Measurement of passive flexion characteristics was done by a custom-made machine, and posture of the lumbar spine was captured by a kinematographic device. The torque acting within the body on lumbar level L4/5 was analysed. To exclude active forces by lumbar muscles during measurements, lumbar muscle activation was monitored by surface electromyography. Lumbar spine passive stiffness increased significantly (almost 50%) due to palletising. After relaxed standing and palletising with exercise breaks, this change could not be generally verified. The increased stiffness of passive structures of the lumbar spine provoked by palletising over half an hour suggests a degree of tissue fatigue. Even though it is unclear which passive structures change their passive mechanics and how this happens, this highlights the importance of break management during repetitive flexion of the lumbar spine.     

The influence of lift frequency,lift duration and work experience on discomfort reporting

Discomfort surveys are commonly used to assess risk in the workplace and prioritize jobs for interventions before an injury or illness occurs. However, discomfort is a subjective measure and the relationship of discomfort to work-related factors is poorly understood. The objective of this study was to understand how reports of discomfort relate to work-related risk factors for the low back. A total of 12 novice and 12 experienced manual materials handlers performed repetitive, asymmetric lifts at different load levels and at six different lift frequencies throughout an 8-h exposure period. Discomfort was recorded hourly throughout the day. Analyses were performed to determine which experimental factors influenced reporting of discomfort and if discomfort trends matched spine loading trends. Novice lifters reported significantly higher discomfort levels than experienced subjects. They also reported increases in discomfort as moment exposure increased and as the exposure time increased. Novices lifting at 8 Nm load moment level reported increased discomfort from 0.07 to 0.63 by the end of the day, at 36 Nm they reported an increase from 0.04 to 0.40 and at 85 Nm they reported an increase from 0.37 to 3.06. Experienced subjects, on the other hand, reported low levels of discomfort regardless of moment exposure, lift frequency or exposure duration. The reported discomforts were generally unrelated to the biomechanical loading on the spine. Discomfort reporting appears to be more a reflection of experience than of work risk factor exposure. Experienced subjects may have more efficient motor patterns, which reduce spinal load and thus discomfort. Novice subjects seemed to have a lower threshold of discomfort. Caution is needed when using discomfort reporting as a means to identify jobs in need of interventions, in that biomechanical loading may not be accurately represented. Discomfort should only be used as a supplement to objective measures, such as spinal loading, to assess the risk of low back disorders.     

The influence of skill and low back pain on trunk postures and low back loads of shearers

Shearing is a rural occupation developing considerable spinal loads and carrying a high risk of low back pain (LBP). Although the workforce has a skill structure, interaction between skill, spinal loads and LBP is unknown. We examined whether skill and LBP influenced trunk postures and loads within a sample of 80 shearers representing shear skill levels. A progression from junior to open class demonstrated a 100% increase in productivity, less time in severe flexion, more time in neutral lateral bend, and more time in axially twisted postures, with no increase in cumulative compressive and anterior shear forces. LBP prevalence increased linearly from 10% for junior through to 76% for open class shearers. Shearers with a history of LBP generated greater cumulative right medio-lateral shear forces, greater left lateral bend and left axial twist moments. Skill-based training that reduces asymmetric forces may help reduce such high prevalence levels of LBP.

Statement of Relevance: Shearing is an important and physically demanding rural occupation. It requires sustained flexed postures that generate considerable spinal loads and a high risk of LBP. This research examines how skill and a history of LBP it carries interact to influence trunk postures and spinal loads within a sample of shearers.     

Effects of seated lumbar extension postures on spinal height and lumbar range of motion during prolonged sitting

Prolonged sitting during sedentary work has been reported as a potential risk factor for low back pain. Furthermore, prolonged sitting can result in both reduced spinal height (SH) and lumbar range of motion (LROM). This study compared the effects of no intervention (control) with two recovery postures on SH and LROM (flexion and extension) during prolonged sitting. Twenty-four participants were randomly assigned to three interventions for three consecutive days. The interventions comprised two seated lumbar extension recovery postures (unsupported sustained and supported dynamic lumbar extension postures) and a control. Both interventions facilitated a relatively short recovery period for both SH and LROM. Supported dynamic lumbar extension conditions significantly helped SH recovery, as compared with control condition, after the first recovery posture intervention, and both postures have potential to maintain LROM. However, both postures failed to induce SH recovery over an extended time.     

The influence of external load configuration on trunk biomechanics and spinal loading during sudden loading

Abstract

Sudden loading is a major risk factor for work-related lower back injuries among occupations involving manual material handling (MMH). The current study explored the effects of external weight configuration on trunk biomechanics and trunk rotational stiffness in the sagittal plane during sudden loading. Fifteen asymptomatic volunteers experienced sudden loadings using the same magnitude of weight (9?kg) with two different configurations (medially- or laterally-distributed) at three levels of height (low, middle and high). Results of this study showed that the medially distributed weight resulted in a significantly higher peak L5/S1 joint compression force (2861 N vs. 2694 N) and trunk rotational stiffness (2413?Nm/rad vs. 1785?Nm/rad) compared to the laterally distributed weight. It was concluded that when experiencing sudden loading, a more laterally distributed weight could increase the load’s resistance to physical perturbations and alleviate spinal loading during sudden loading events.

Practitioner summary: Increased trunk rotational stiffness and peak L5/S1 joint compression force were observed when undergoing a sudden load release of a medially distributed load compared to a laterally distributed load revealing a less stable hand load condition due to the reduced moment of inertia. The laterally distributed load could increase the load’s resistance to physical perturbations and mitigate spinal loading during sudden loading events.     

The effects of obesity on lifting performance

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

The effect of camera viewing angle on posture assessment repeatability and cumulative spinal loading

Video-based task analysis in the workplace is often limited by equipment location and production line arrangement, therefore making it difficult to capture the motion in a single plane. The purpose of this study was to investigate the effects of camera placement on an observer's ability to accurately assess working postures in three dimensions and the resultant influence on the reliability and repeatability of calculated cumulative loading variables. Four video cameras were placed at viewing angles of 0°, 45°, 60° and 90° to the frontal plane, enabling the simultaneous collection of views of four lifting tasks (two symmetric and two asymmetric). A total of 11 participants were trained in the use of the 3DMatch 3-D posture matching software package (developed at the University of Waterloo) and were required to analyse 16 lifting trials. Four of the participants were randomly selected to return within 72 h and repeat the analysis protocol to test intra-observer repeatability. Posture matching agreement between camera views was higher when the body segments had a minimal range of motion during the task. There was no significant participant main effect; however, there was a significant (p < 0.05) task main effect. Intraclass correlation coefficients (ICC) were calculated to assess the between day reliability. Compression, reaction anterior shear and extension moment were all found to have excellent reliability (ICC > 0.75). Joint anterior shear and joint posterior shear both provided fair to good reliability (0.4 > ICC < 0.75). Overall, the impact of the camera viewing angle on an observer's ability to match working postural exposure was found to be small.     

The effect of different surfaces on biomechanical loading of shoulder and lumbar spine during pushing and pulling of two-wheeled containers

Seven waste collectors pushed and pulled a two-wheeled container on three different surfaces: flagstones, paving stones, grass. Net torques at the shoulder joint and the lumbar spine as well as the compression and shear forces in the lumbar spine at the L4/L5 level were calculated for the tilting, initial and sustained phases. The lumbar spine compression force was below 1800N and the shear force was below 200 N in all situations. The shoulder torque when pulling with one hand was up to 80 N m. The container weight affected the magnitude of the push/pull forces and the load on the shoulders but not the load on the lumbar spine. The type of surface affected the magnitude of the push/pull forces during initial and sustained phases, and affected the load on the shoulder in the sustained phase. However, it did not affect the compression in the lumbar spine.     

Methodological considerations for the calculation of cumulative compression exposure of the lumbar spine: A sensitivity analysis on joint model and time standardization approaches

Cumulative lumbar spine loading has attracted much attention as a factor associated with the development of low back pain. While evidence supports cumulative loading to be a plausible mechanism in explaining several workplace injuries, research establishing a threshold limit value (TLV) for cumulative spine loading has been challenging. The lack of a TLV or even a trend towards harmful cumulative load values may suggest that methodological considerations are greatly influencing the results. This paper examines the impact of different joint models (single muscle equivalent, an electromyography-based third order polynomial, a modified version of the polynomial and a hybrid approach) to determine cumulative spine compression, as well as the importance of time standardization in the calculation of a daily cumulative loading dose. Findings demonstrated that the polynomial predicted cumulative compression values were 43–53% higher than those with all other models tested and the single muscle equivalent predicted loads 18% higher than loads predicted using a modified polynomial. Profound differences between modelling approaches suggest that caution should be taken when selecting a muscle model to determine cumulative spine compressive loading. Time standardized cumulative compression values were found to be 28.3% greater than non-standardized estimates, illustrating the importance of selecting a standard time frame in the calculation of cumulative spine compression.     

The influence of desk and display design on posture and muscle activity variability whilst performing information technology tasks

Desk design and computer display height can affect posture and muscle activation during computer use. Amplitudes of postural variables and muscle activity during computer use do not explain the results from epidemiological studies of musculoskeletal discomfort and disorders related to computer use. The purpose of this study was to assess variability of posture and muscle activity during work with two computer display heights and book/paper, in conjunction with a curved desk designed to provide forearm support and a traditional, straight desk.18 male and 18 female participants performed 10-min tasks involving keying, mousing, reading and writing in six desk/display conditions. 3D posture and surface emg were assessed for the final 2 min of each task.The curved desk resulted in greater postural and muscle activity variation, suggesting an advantage of this supportive surface over the straight desk. There was little difference in variability associated with the two display heights. However, greater variability of posture and muscle activity was evident with the book/paper condition. Non-touch typists had greater neck flexion variation.The design of information technology tasks and workstations can influence the short term variation in posture and muscle activity. Variation is influenced independently of mean postures and muscle amplitudes and therefore needs to be considered to adequately assess the risk of musculoskeletal disorders.