Foot positioning instruction, initial vertical load position and lifting technique: effects on low back loading

This study investigated the effects of initial load height and foot placement instruction in four lifting techniques: free, stoop (bending the back), squat (bending the knees) and a modified squat technique (bending the knees and rotating them outward). A 2D dynamic linked segment model was combined with an EMG assisted trunk muscle model to quantify kinematics and low back loading in 10 subjects performing 19 different lifting movements, using 10.5 kg boxes without handles. When lifting from a 0.05 m height with the feet behind the box, squat lifting resulted in 19.9% (SD 8.7%) higher net moments (p < 0.001) and 17.0% (SD 13.2%) higher compression forces (p < 0.01) than stoop lifting. This effect was reduced to 12.8% (SD 10.7%) for moments and a non-significant 7.4% (SD 16.0%) for compression forces when lifting with the feet beside the box and it disappeared when lifting from 0.5 m height. Differences between squat and stoop lifts, as well as the interaction with lifting height, could to a large extent be explained by changes in the horizontal L5/S1 intervertebral joint position relative to the load, the upper body acceleration, and lumbar flexion. Rotating the knees outward during squat lifts resulted in moments and compression forces that were smaller than in squat lifting but larger than in stoop lifting. Shear forces were small ( < 300 N) at the L4/L5 joint and substantial (1100 - 1400 N) but unaffected by lifting technique at the L5/S1 joint. The present results show that the effects of lifting technique on low back loading depend on the task context.     

Cart pushing: The effects of magnitude and direction of the exerted push force, and of trunk inclination on low back loading

The primary objective of the present study was to quantify the relative effect of the magnitude and direction of the exerted push force and of trunk inclination on the mechanical load at the low back using a regression analysis for correlated data. In addition, we explored the effects of handle height and type of pushing activity (standing or walking) on the magnitude and direction of exerted forces, trunk inclination, and low back loading when pushing a four-wheeled cart on a treadmill. An experimental setup was designed in which nine participants pushed a four-wheeled cart on a treadmill. Kinematics and reaction forces on the hand were measured to calculate the net moment at the L5–S1 intervertebral disc. Results show that the magnitude and direction of the exerted push force and the trunk inclination significantly and independently affect low back load. It is concluded that for the ergonomic evaluation of pushing tasks, the inclination of the trunk should be considered, in addition to the magnitude and direction of exerted forces.

Relevance to industry

Pushing carts is a common activity for a considerable part of the workforce and has been associated with musculoskeletal complaints. This paper shows that not only the magnitude of exerted forces determines the low back load but also the direction of the exerted forces and the inclination of the trunk should be considered for ergonomic evaluation.     

The effects of ergonomic interventions on low back moments are attenuated by changes in lifting behaviour

This study investigated the effects of ergonomic interventions involving a reduction of the mass (from 16 to 11 and 6 kg) and an increase in the initial lifting height (from pallet height to 90 cm above the ground) of building blocks in a mock-up of an industrial depalletizing task, investigating lifting behaviour as well as low back moments (calculated using a 3-D linked segment model). Nine experienced construction workers participated in the experiment, in which they removed building blocks from a pallet in the way they normally did during their work. Most of the changes in lifting behaviour that were found would attenuate the effect of the investigated interventions on low back moments. When block mass was reduced from 16 to 6 kg, subjects chose to lift the building block from a 10 (SD 10) cm greater distance from the front edge of the pallet and with a 100 (SD 66) degrees/s² higher trunk angular acceleration. When initial lifting height was increased, subjects chose to shift the building blocks less before actually lifting them, resulting in a 10.7 (SD 10) cm increase in horizontal distance of the building blocks relative to the body at the instant of peak net total moment. Despite these changes in lifting behaviour, the investigated ergonomic interventions still reduced the net total low back moment (by 4.9 (SD 2.0) Nm/kg when block mass was reduced and 53.6 (SD 41.0) Nm when initial lifting height was increased).     

Effect of lifting height and load mass on low back loading

The objective of this study was to quantify the effect of lifting height and mass lifted on the peak low back load in terms of net moments, compression forces and anterior–posterior shear forces. Ten participants had to lift a box using four handle heights. Low back loading was quantified using a dynamic 3-D linked segment model and a detailed electromyographic driven model of the trunk musculature. The effects of lifting height and lifting mass were quantified using a regression technique (GEE) for correlated data. Results indicate that an increase in lifting height and a decrease in lifting mass were related to a decrease in low back load. It is argued that trunk flexion is a major contributor to low back load. For ergonomic interventions it can be advised to prioritise optimisation of the vertical location of the load to be lifted rather than decreasing the mass of the load for handle heights between 32 cm and 155 cm, and for load masses between 7.5 and 15 kg. Lifting height and load mass are important determinants of low back load during manual materials handling. This paper provides the quantitative effect of lifting height and mass lifted, the results of which can be used by ergonomists at the workplace to evaluate interventions regarding lifting height and load mass.     

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.     

Trunk muscle activation and low back loading in lifting in the absence of load knowledge

People who know the actual mass of an object to be lifted normally prepare themselves before attempting a lift to control the movement and to minimize low back loading. In this study, the trunk muscular reactions and low back torque were investigated in the situation in which the individual did not know the actual mass but only had some idea of the range within which the mass lay. Nine males lifted boxes weighing 6.5 or 16.5 kg under the condition in which they knew the actual mass before attempting a lift (the ‘known’ condition) and the condition in which they only had the information that the mass would be within the range of 6.5–16.5 kg (the ‘unknown’ condition). The ground reaction forces and body movements were measured in the trials and, from these, the L5/S1 torques were calculated. The activation of back and abdominal muscles was also measured. For the 6.5 kg weight, a higher (16%) back muscle activation in grasping the box and a higher (10%) peak L5/S1 torque in actual lifting were observed in the ‘unknown’ compared with the ‘known’ weight condition. For the 16.5 kg weight, the back muscle activation was lower (10%) during grasping, and higher (10%) during lifting in the ‘unknown’ compared with the ‘known’ weight condition. Knowledge of the load had no effect on the activation of the abdominal muscles. It was concluded that in the so-called ‘unknown’ conditions, the risks of low back injury were increased in comparison with the conditions where the actual weight was known in advance.     

Effect of lifting height and load mass on low back loading

The objective of this study was to quantify the effect of lifting height and mass lifted on the peak low back load in terms of net moments, compression forces and anterior-posterior shear forces. Ten participants had to lift a box using four handle heights. Low back loading was quantified using a dynamic 3-D linked segment model and a detailed electromyographic driven model of the trunk musculature. The effects of lifting height and lifting mass were quantified using a regression technique (GEE) for correlated data. Results indicate that an increase in lifting height and a decrease in lifting mass were related to a decrease in low back load. It is argued that trunk flexion is a major contributor to low back load. For ergonomic interventions it can be advised to prioritise optimisation of the vertical location of the load to be lifted rather than decreasing the mass of the load for handle heights between 32 cm and 155 cm, and for load masses between 7.5 and 15 kg. Lifting height and load mass are important determinants of low back load during manual materials handling. This paper provides the quantitative effect of lifting height and mass lifted, the results of which can be used by ergonomists at the workplace to evaluate interventions regarding lifting height and load mass.     

Characterization of cashier shoulder and low back muscle demands

Cashiers commonly report musculoskeletal discomfort in their shoulders, neck, and low back. This may result from excessive loading, awkward postures, insufficient rest, or task repetition. Recently, widespread introduction of reusable, consumer-supplied bags has introduced challenges in assessing exposures in this occupational group. Limited information exists on the physical demands associated with cashier work, particularly in the context of multiple bagging formats; this study was thus designed to generate a novel data set describing standard grocery packaging tasks. Twenty-five experienced cashiers completed 36 grocery packaging tasks consisting of twice performing all combinations of workload intensity (6, 20 items), workstation height (low, medium, high), and packaging type (plastic bags, reusable bags, bins). Surface electromyography (EMG) was measured bilaterally for 5 shoulder and 3 low back muscles and processed to generate integrated muscle demand for each combination evaluated. A mixed effect ANOVA was used to assess the influences of gender, intensity, package type, side, (muscles on the right or left side of the body) and workstation height on individual and total muscular demands. High workload intensity combined with several other factors to increase muscle demands, including using plastic or reusable bags for packaging and increasing workstation height. Gender and side also interacted with workload intensity to influence muscle activity. Encouraging rest breaks, the use of bins for packaging, and decreasing cashier workstation height may help reduce potentially injurious muscular effort for cashiers.     

The impact of drywall handling tools on the low back

Carpenters and other construction workers who install drywall have high rates of strains and sprains to the low back and shoulder. Drywall is heavy and awkward to handle resulting in increased risk of injury. The purpose of this study was to evaluate several low-cost coupling tools that have the potential to reduce awkward postures in drywall installers. Five coupling tools were evaluated using the Lumbar Motion Monitor that measures trunk kinematics and predicts probability of low back disorder group membership risk (LBD risk). Workers answered surveys about their comfort while using each tool. The results indicate that use of the 2-person manual lift and the J-handle provide the best reduction in awkward postures, motions, low back sagittal moment, and LBD risk. The two-person manual lift appears to be the safest method of lifting and moving drywall, though using the two-person J-handle also significantly reduces injury risk. Given that carpenters are skeptical about using equipment that can get in the way or get lost, a practical recommendation is promotion of two-person manual lifting. For single-person lifts, the Old Man tool is a viable option to decrease risk of MSDs.     

The effect of stance width on trunk kinematics and trunk kinetics during sagitally symmetric lifting

Lifting technique can have a significant impact on spine loading during lifting. The sports biomechanics literature has documented changes in trunk and lower extremity kinematics and muscle coactivation patterns as a function of stance width during high force dead lift and squat exercises. The focus of the current study was to explore whether these lifting stance width effects might translate into the occupational setting under more moderate load level conditions. Twelve subjects performed repetitions of a sagittally symmetric lifting and lowering task (10 kg load) under three stance width conditions: narrow (feet together), moderate (feet shoulder width) and wide (feet 150% of shoulder width). As they performed these exertions, trunk kinematics were captured using the lumbar motion monitor while the activity of the trunk muscles (erector spinae, rectus abdominis) and lower extremity muscles (gluteus maximus, vastus lateralis and vastus medialis) were evaluated using normalized electromyography. The results showed that both the range of motion and peak acceleration in the sagittal plane were significantly affected by the stance width. The muscle activation levels, however, were not significantly affected by the stance width. These results collectively would indicate that the stance width effects seen in power lifting activities do not translate well into the occupational environment where more moderate loads are typically lifted.

Relevance to industry

Exploring alternative lifting strategies may provide an opportunity to reduce the incidence of low back disorders. Lifting stance width is one variable that has not been explored in the ergonomics literature.     

The effects of operator position,pallet orientation,and palletizing condition on low back loads in manual bag palletizing operations

Many mining commodities are packaged and shipped using bags. Small bags are typically loaded onto pallets for transport and require a significant amount of manual handling by workers. This specific task of manual bag handling has been associated with the development of musculoskeletal disorders (MSDs), especially low back disorders. This study evaluates the biomechanical demands of different work layouts when performing manual palletizing of small bags, and evaluates the biomechanical stresses associated with different stacking techniques. Results indicate that peak forward bending moments as well as spinal compression and shear forces are higher when the pallet is situated at the side of the conveyor as opposed to the end of the conveyor. At low levels of the pallet, controlled bag placement results in higher peak forward bending moments than stacking at higher levels and when dropping the bag to lower levels. The results of this study will be used to inform the development of an audit tool for bagging operations in the mining industry.Relevance to industryIn many cases for workers loading small bags, compression forces exceed the NIOSH criterion of 3400 N. Orientation of the pallet has a significant impact on spinal compression, and positioning the pallet at the end of the conveyor reduces the estimated compressive loading on the lumbar spine by approximately 800 N.     

Mechanical behaviour and strength of the motion segment under compression: Implications for the evaluation of physical work load

It has been shown that the energy storage in motion segments under compression, which is dependent on the temporal pattern of the force applied, is a good predictor of the occurrence of damage. In the present paper two case-studies are described in which energy storage is calculated to evaluate work load. In the first case-study job-rotation, a change of the temporal characteristics of the work load appears to cause a decrease of the energy stored and hence of the risk of damage. In a case-study on lifting it is shown that the effect of a reduction of the intensity of the work load (i.e. a reduction of the mass lifted), can be offset by changes of the frequency or duration of lifting. These adverse effects of the change in frequency or duration are not adequately reflected in the NIOSH lifting guidelines. It is concluded that temporal characteristics have to be considered when evaluating work load and that the calculation of energy storage in the motion segment can be used to this end.     

The effects of horizontal load speed and lifting frequency on lifting technique and biomechanics

Lifting loads that have a horizontal velocity (e.g. lifting from a conveyor) is often seen in industry and it was hypothesised that the inertial characteristics of these loads may influence lifting technique and low back stress. Seventeen male participants were asked to perform lifting tasks under conditions of four horizontal load speeds (0 m/s, 0.7 m/s, 1.3 m/s and 2.4 m/s) and two lifting frequencies (10 and 20 lifts/min) while trunk motions and trunk muscle activation levels were monitored. Results revealed that increasing horizontal load speed from 0 m/s to 2.4 m/s resulted in an increase in peak sagittal angle (73° vs. 81°) but lower levels of peak sagittal plane angular acceleration (480°/s² vs. 4°/s²) and peak transverse plane angular acceleration (200°/s per s vs. 140°/s per s) and a consistent increase in trunk muscle co-activation. Participants used the inertia of the load to reduce the peak dynamics of the lifting motion at a cost of increased trunk flexion and higher muscle activity.

Statement of Relevance: Conveyors are ubiquitous in industry and understanding the effects of horizontal load speed on the lifting motions performed by workers lifting items from these conveyors may provide some insight into low back injury risk posed by these tasks.     

The effects of load weight and load starting height on variability of lifting kinematics and kinetics

Trunk kinematic variables have been used to understand the risk of low back injuries in the workplace. Variability in the trunk kinematics as an individual performs a repetitive lifting task is an underexplored area of research. In the current study, it was hypothesized that workplace variables (starting height of lift and load weight) would have an impact on the variance in the kinematic and kinetic variables. Twenty participants performed 60 repetitions of an asymmetric lifting task under four different conditions representing two levels of load weight (5% or 10% of the participant's body weight) and two levels of starting height (80% or 120% of the participant's knee height). The Lumbar Motion Monitor was used to capture trunk kinematic variables from the concentric range of lifting motion while ground reaction forces were collected using a force platform. The primary dependent variables were the variance of kinematic and kinetic variables across these 60 repetitions. The results showed a significant effect of starting height on the variance of sagittal plane trunk kinematics with the lower starting height generating an increased variance (sagittal range of motion increased by 55%, average sagittal velocity increased by 95%, peak sagittal velocity increased by 105%, and peak sagittal acceleration increased by 130%). There was no consistent significant main effect of either independent variable on the variance of the transverse plane kinematics. Additionally, there was no significant effect of load weight on the variance of any trunk kinematic variables tested. In terms of ground reaction forces, it was shown that the starting height of the load had a significant effect on the variance of peak vertical ground reaction force, while the weight of the load had a significant effect on the variance of the peak shear force.     

The muscular load on the lower back and shoulders due to lifting at different lifting heights and frequencies

The aim of the study was to investigate the muscular load on the lower back and shoulders and the circulatory load on employees at a post center during repetitive lifting of mail transport boxes. A mock-up was designed in the laboratory, a total of nine combinations of lifting height and frequency were studied. Surface EMG was recorded bisymmetrically from m. erector spinae (L3-level) and m. trapezius. The circulatory load was evaluated by measuring the heart rate. The results show a trade off between the low back and shoulders. The maximum load on the low back occurred at the low lifting height (36.3 and 54.4 cm) whereas the maximum load on the shoulders occurred at the high lifting height (144.9 and 163.0 cm).     

Little effect of transfer technique instruction and physical fitness training in reducing low back pain among nurses: a cluster randomised intervention study

The aim of this study was to evaluate the effect of a transfer technique education programme (TT) alone or in combination with physical fitness training (TTPT) compared with a control group, who followed their usual routine. Eleven clinical hospital wards were cluster randomised to either intervention (six wards) or to control (five wards). The intervention cluster was individually randomised to TT (55 nurses) and TTPT (50 nurses), control (76 nurses). The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues. The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks. Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not, when compared to a control group, show any statistical differences according to self-reported low back pain (LBP), pain level, disability and sick leave at a 12-month follow-up. However, the individual randomised intervention subgroup (transfer technique/physical training) significantly improved the LBP-disability (p = 0.001). Although weakened by a high withdrawal rate, teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered. Other priorities such as physical training may be taken into consideration. The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP. However, physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel.     

Trunk kinematics of one-handed lifting,and the effects of asymmetry and load weight

Abstract

This study investigated trunk kinematic differences between lifts performed using either one hand (unsupported) or two hands. These effects were studied while beginning the lifts from different asymmetric starting positions and while lifting different load weights. Each subject lifted a box from a lower to an upper platform under one- and two-handed lifting conditions. Subjects wore a lumbar spine electrogoniometer, from which relative motion components were calculated in the trunk's three cardinal planes. Results of this study showed that one-handed lifting resulted in significantly higher ranges of motion in the lateral and transverse planes and greater flexion in the sagittal plane. Back motion characteristics previously found to be associated with low back disorders were all significantly higher for one-handed lifts. The two-handed lift technique, on the other hand, produced overall faster trunk motions in the sagittal plane and equal or larger acceleration and deceleration magnitudes in all planes of motion. Increases in load asymmetry affected trunk kinematics, in that magnitude values for range of motion, velocity and acceleration became much greater with increasingly asymmetric load positions. Increasing the load weight appeared to have less of an effect on trunk kinematics, with increases in position mostly occurring during sagittal and lateral bending. These results suggest that unsupported one-handed lifting loads the spine more than two-handed lifts, due to the added coupling. Applying these results to a previously developed model, one-handed lifting was also found to increase one's risk of suffering a low back disorder.     

The effects of speed,frequency, and load on measured hand forces for a floor to knuckle lifting task

The purpose of this study was to describe and quantify measured hand forces during floor to knuckle lifting of various loads. Hand forces of five subjects were measured with a strain gauge apparatus for normal and fast speeds of lifting at 1,4, and 8 l/min. The pattern of hand force over time exhibited peaks in force in the shape of a spike for all fast lifts, indicating that subjects did not lift smoothly. For normal speed of lift, only one of the five subjects executed some lifts smoothly, indicating that it may be possible to lift smoothly, but most lifters probably do not. Peaks of horizontal and vertical components of hand force were tabulated by speed of lift, frequency, and load.     

The effects of a back belt on posture, strength, and spinal compressive force during static lift exertions

The experiment reported in this paper evaluated changes in lifting posture, static lifting strength and the estimated L3/L4 spinal compressive force resulting from the use of an abdominal support or ‘back' belt. Torso posture and maximum static lift strength were measured for eight male and eight female subjects using symmetric and asymmetric hand positions at calf height and elbow height. Body posture, and hand forces were also used as input to a three-dimensional static biomechanical model of the torso used to estimate L3/L4 spinal compressive force. The results showed axial twist of the torso to be significantly lower for calf height asymmetric exertions when the abdominal support belt was worn. The measured reduction in axial twist was approximately four degrees. No other significant effects on posture due to the support belt were found. Static lift strength was not significantly increased or reduced when the support belt was used. Predicted spinal compressive force was significantly lower when a support belt was worn (2840 N compared to 3125 N when the belt was not worn). Overall, the results of the experiment demonstrate a very limited benefit to the user of abdominal support belts, primarily due to reduced or restricted motion during asymmetric and lower-level lifts.Relevance to industryBack belts are commonly used in industry to mitigate manual materials handling hazards. One assumption often made by those recommending the use of back belts is that they substantially reduce the bending and twisting of the torso. The experiment reported in this paper tests this assumption and provides information on the utility of back belts.