Effects of low back disability status on lower back discomfort during sustained and cyclical trunk flexion

A laboratory study was conducted to determine the effects of back disability status on endurance time and perceived discomfort during trunk flexion. Eighty participants (40 with chronic or recurrent low back pain (CRLBP), 40 pain-free) were tested. The trunk was flexed to 15 degrees, 30 degrees, 45 degrees and 60 degrees under three conditions: 1) continuous static flexion; 2) cyclical flexion with 20% rest; and 3) cyclical flexion with 40% rest. Each condition was performed for up to 600 s or until the participant reached his/her pain tolerance limit. Dependent variables included time to distracting discomfort (TDD), total endurance time (TET) and perceived discomfort. For continuous exertions, CRLBP participants had lower TDD (p < 0.001), lower TET (p < 0.001) and greater discomfort (p < 0.001) compared to pain-free controls. In both groups, TDD and TET decreased and perceived discomfort increased as the flexion angle increased. For intermittent exertions, CRLBP participants reported greater discomfort than pain-free participants (p < 0.001). Increasing rest from 20 to 40% reduced discomfort in CRLBP participants, but produced no consistent benefit in pain-free participants. To accommodate persons with CRLBP, consideration should be given to reducing both the magnitude (angle) and duration of trunk flexion required by their jobs.     

A history of low back pain affects pelvis and trunk mechanics during a sustained lift/lower task

This study compared three-dimensional trunk and pelvis range of motion (ROM) during a sustained asymmetric box lift/lower task between a group with a history of low back pain (HBP, n = 9) and a group with no history of low back pain (NBP, n = 9). Participants lifted an 11-kg box for 10 min at 12 cycles/min from ankle height in front to shelves 45 deg off-centre at waist height. Kinematic data were collected at the beginning (min1), middle (min5) and end of the bout (min9). Two-way analyses of variance were performed for all variables. Pelvis and trunk transverse ROM were similar at min1. By min9, HBP group did not change (31.9 ± 9 deg); however, ROM decreased in NBP group (21.6 ± 6 deg, p < 0.05). Therefore, despite no current pain, the HBP group demonstrated protective lifting mechanics compared to controls. Also discussed are implications for studying lifting paradigms at sub-maximal effort over longer periods of time.

Practitioner summary: Differences between groups over time demonstrate residual consequences of low back pain (LBP) in a manual materials handling scenario. Individuals with a history of LBP (pain free for 6 months) demonstrated more conservative lifting mechanics towards the end of the bout compared to controls with no history of LBP.     

Prevalence and work-related risk factors for reduced activities and absenteeism due to low back symptoms

Although quite a lot is known about the risk factors for low back symptoms (LBS), less is known about the risk factors for the consequences of LBS. A sample of 3003 men and women randomly selected from the New Zealand Electoral Roll, were interviewed by telephone about self reported physical, psychosocial, organizational, environmental factors and the consequences of LBS (i.e. self-reported reduced activities and absenteeism). The 12-month period prevalence of reduced activities and absenteeism were 18% and 9%, respectively. Lifting (OR 1.79 95% CI 1.16-2.77) increased the risk of reduced activities. Working in awkward/tiring positions (OR 2.11 95% CI 1.20-3.70) and in a cold/damp environment (OR 2.18 95% CI 1.11-4.28) increased the risk of absenteeism. Among those with LBS, reduced activities increased with working in a hot/warm environment (OR 2.14 95% CI 1.22-3.76) and absenteeism was increased with work in awkward/tiring positions (OR 2.06 95% CI 1.13-3.77), tight deadlines (OR 1.89 95% CI 1.02-3.50), and a hot/warm environment (OR 3.35 95% CI 1.68-6.68). Interventions to reduce the consequences of LBS should aim to reduce awkward/tiring positions, lifting and work in a cold/damp environment. For individuals with LBS, additional focus should be to reduce tight deadlines, and work in hot/warm environments.     

Effects of shoulder rotation combined with elbow flexion on discomfort and EMG activity of ECRB muscle

Work related MusculoSkeletal Disorders (WMSDs) are injuries or dysfunctions caused by occupational or non occupational tasks involving bad postures, high frequency of exertions or high force levels. In the present study, the effects of shoulder flexion/extension combined with elbow flexion angle on discomfort score were investigated for repetitive gripping task. A laboratory experimental simulation was conducted. Ten male participants volunteered in this study. Four levels of shoulder flexion/extension (−45° extension, 0° neutral, 45° & 90° flexion) with three levels of elbow flexion angle (45°, 90° & 135°) were taken as levels of independent variables. There were 12 combinations available for each participant and the experiment was conducted on the basis of random order of experimental combinations for each participant. Discomfort score on 100 mm visual analogue scale (VAS) and Electromyography (EMG) activity of Extensor Carpi Radialis Brevis (ECRB) muscle were dependent variables for the analyses. The task for the experiment was of 150N ± 5N grip force at a frequency of 15 exertions/minute for five minutes duration. After performing the MANOVA on the recorded data, the results showed that the shoulder flexion/extension and elbow flexion both were highly significant (p < 0.001). Also it was found that −45° shoulder extension combined with 45° elbow flexion angle was the most discomfort posture. The practical relevance of the study is that, in industrial tasks such posture should be avoided to minimize risk of WMSDs.Relevance to industryThe findings in terms of relationship between discomfort/EMG vs. shoulder rotation combined with elbowflexion are important to design Industrial tasks with the reduced risk of WMSDs. Such as, sheet metal cutting, fabrication of sheet metal work, die casting, and drilling operations may require the shoulder movements in extenion/flexion combined with elbowflexion.     

Disturbance and recovery of trunk mechanical and neuromuscular behaviours following prolonged trunk flexion: influences of duration and external load on creep-induced effects

Trunk flexion results in adverse mechanical effects on the spine and is associated with a higher incidence of low back pain. To examine the effects of creep deformation on trunk behaviours, participants were exposed to full trunk flexion in several combinations of exposure duration and external load. Trunk mechanical and neuromuscular behaviours were obtained pre- and post-exposure and during recovery using sudden perturbations. Intrinsic trunk stiffness decreased with increasing flexion duration and in the presence of the external load. Recovery of intrinsic stiffness required more time than the exposure duration and was influenced by exposure duration. Reflexive trunk responses increased immediately following exposure but recovered quickly (～2.5 min). Alterations in reflexive trunk behaviour following creep deformation exposures may not provide adequate compensation to allow for complete recovery of concurrent reductions in intrinsic stiffness, which may increase the risk of injury due to spinal instability.

Statement of relevance: An increased risk of low back injury may result from flexion-induced disturbances to trunk behaviours. Such effects, however, appear to depend on the type of flexion exposure, and have implications for the design of work involving trunk flexion.     

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.     

The influence of a preventive educational programme on trunk flexion in janitors

The influence of a preventive educational back care programme on the movement patterns of the spine during work was assessed objectively and subjectively in six janitors. Trunk flexion was measured in the subjects using a flexion analyser before they attended a preventive educational back care programme and twice afterwards. The results show that the subjects increased the amount of time spent in an upright position by about a third after the educational programme and maintained this change two and a half to three months later. They also decreased the time spent in moderate and deep forward flexion (37-72 degrees ) by about half and also maintained this decrease at three months. These changes are consistent with a decrease of the mechanical load on the spine. The study emphasises that it is possible to alter movement patterns of the spine, and thereby decrease the load during janitorial work, by a suitably designed educational programme.     

The effect of dynamic sitting on the prevention and management of low back pain and low back discomfort: a systematic review

Dynamic sitting has been proposed to reduce low back pain (LBP) and/or low back discomfort (LBD) while sitting. This is supported by studies suggesting that subjects with LBP assume more static, sustained postures while sitting. This systematic review investigated the effect of dynamic sitting on LBP among subjects with LBP and the development of LBD among pain-free subjects. Electronic databases were searched by two independent assessors. All prospective studies which compared the effect of a dynamic sitting condition on LBP or LBD to another sitting condition were eligible, with no minimum follow-up period applied. The quality of the included studies was assessed using the PEDro scale. Seven high-quality studies were eligible, including five crossover studies and two randomised controlled trials. The results suggest there is currently no evidence to support the use of dynamic sitting as a stand-alone approach in the management of LBP. PRACTITIONER SUMMARY: This systematic review investigated the effect of dynamic sitting on LBP or LBD. Seven high-quality studies met the inclusion and exclusion criteria. Overall, the evidence suggests that dynamic sitting approaches are not effective as a stand-alone management approach for LBP.     

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 influence of individual low back health status on workplace trunk kinematics and risk of low back disorder

A case-control study was conducted to determine whether or not kinematic-based low back disorder risk measurement (Marras et al. ) of the job was significantly different for those workers suffering from recent low back injuries compared to asymptomatic controls. Two hundred low back injured workers returning to full duty work and 200 asymptomatic controls were evaluated while performing the same job. There were no statistically significant differences between the two groups on any trunk motion measures or workplace measures. Therefore, job design is dictating the kinematic motions of the torso and not the worker's low back health. In addition, there was not a significant difference in job risk estimates using the lumbar motion monitor risk model. The mean risk (and standard deviation) for the low back injured group and the asymptomatic controls was 0.502 (0.178) and 0.501 (0.193), respectively. This study suggests that trunk kinematics and subsequent risk estimates are dictated primarily by job design and not influenced by the low back health status of the worker.     

The influence of individual low back health status on workplace trunk kinematics and risk of low back disorder

A case-control study was conducted to determine whether or not kinematic-based low back disorder risk measurement (Marras et al. 1993) of the job was significantly different for those workers suffering from recent low back injuries compared to asymptomatic controls. Two hundred low back injured workers returning to full duty work and 200 asymptomatic controls were evaluated while performing the same job. There were no statistically significant differences between the two groups on any trunk motion measures or workplace measures. Therefore, job design is dictating the kinematic motions of the torso and not the worker's low back health. In addition, there was not a significant difference in job risk estimates using the lumbar motion monitor risk model. The mean risk (and standard deviation) for the low back injured group and the asymptomatic controls was 0.502 (0.178) and 0.501 (0.193), respectively. This study suggests that trunk kinematics and subsequent risk estimates are dictated primarily by job design and not influenced by the low back health status of the worker.     

Specific flexion-related low back pain and sitting: comparison of seated discomfort on two different chairs

No study has examined the effectiveness of prescribing seating modifications according to the individual clinical presentation of people with low back pain (LBP). A dynamic, forward-inclined chair (‘Back App’) can reduce seated paraspinal muscle activation among pain-free participants. This study examined 21 participants whose LBP was specifically aggravated by prolonged sitting and was eased by standing. Low back discomfort (LBD) and overall body discomfort (OBD) were assessed every 15 min while participants sat for 1 h on both the dynamic, forward-inclined chair and a standard office chair. LBD increased significantly more (p = 0.005) on the standard office chair, with no significant difference (p = 0.178) in OBD between the chairs. The results demonstrate that, in a specific flexion-related subgroup of people with LBP, increased LBD during sitting can be minimised through modifying chair design. Mechanisms that minimise seated discomfort may be of relevance in LBP management, as part of a biopsychosocial management plan.

Practitioner summary: This study examined low back discomfort (LBD) during a typing task among people with low back pain (LBP). Sitting on a dynamic, forward-inclined chair resulted in less seated LBD than sitting on a standard office chair. Further research is required to examine the long-term effectiveness of ergonomics interventions in LBP.     

Sit-stand workstations and impact on low back discomfort: a systematic review and meta-analysis

Background: Sit-stand workstations are proposed solutions to reduce sedentary time at work. Numerous companies are using them to mitigate health concerns such as musculoskeletal discomfort. Objective: To review the literature on sit-stand workstations and low back discomfort. Method: We conducted a meta-analysis on literature published before 17 November 2016 that addressed the relationship between sit-stand workstations and musculoskeletal discomfort, focusing on the low back. Results: Twelve articles were identified and eight that presented results in means (SD) were included. Among a pain-free population, the standardised mean difference was ?0.230 for low back discomfort with use of sit-stand workstations. When applying the SMD to studies using the 10-point pain scale, the effect estimates ranged between ?0.30 and ?0.51. Conclusion: sit-stand workstations may reduce low back pain among workers. Further research is needed to help quantify dosage parameters and other health outcomes.

Practitioner Summary: In a sedentary population, changing posture may reduce the chance of developing low back pain. The literature lacks studies on specific populations such as those who have pre-existing low back pain and also does not adequately address the dosage of sit-stand time required to help reduce pain.     

Static and dynamic characteristics of the trunk and history of low back pain

A pilot research was undertaken to study the relationship between static and dynamic characteristics of the trunk and the existence of low back pain. Isoinertial dynamic tests were performed using an ISOSTATION B200 dynamometer on 33 non LBP workers and 11 LBP workers. Ranges of motion and isometric strengths were not systematically different between LBP and non LBP, while these differences were significant for the average absolute velocities during dynamics tests against 25 or 50% of the isometric torques. For the mean quadratic velocity during tests against 50% of the isometric torques, a value of 75 degrees per second can be proposed as a threshold for discriminating between LBP and non LBP. The sensitivity and specificity of this test increased to 92 and 88% respectively when the past LBP history was also taken into account. This confirms that trunk velocity during isoinertial movements is very sensitive to low back condition and research should be pursued to identify the biomechanical reasons for this and possibly differentiate between the different symptoms of LBP.     

A comparison of trunk biomechanics,musculoskeletal discomfort and productivity during simulated sit-stand office work

Sedentary office work has been shown to cause low back discomfort and potentially cause injury. Prolonged standing work has been shown to cause discomfort. The implementation of a sit–stand paradigm is hypothesised to mitigate discomfort and prevent injury induced by prolonged exposure to each posture in isolation. This study explored the potential of sit–stand to reduce discomfort and prevent injury, without adversely affecting productivity. Twenty-four participants performed simulated office work in three different conditions: sitting, standing and sit–stand. Variables measured included: perceived discomfort, L4–L5 joint loading and typing/mousing productivity. Working in a sit–stand paradigm was found to have the potential to reduce discomfort when compared to working in a sitting or standing only configuration. Sit–stand was found to be associated with reduced lumbar flexion during sitting compared to sitting only. Increasing lumbar flexion during prolonged sitting is a known injury mechanism. Therefore, sit–stand exhibited a potentially beneficial response of reduced lumbar flexion that could have the potential to prevent injury. Sit–stand had no significant effect on productivity.

Practitioner Summary: This study has contributed foundational elements to guide usage recommendations for sit–stand workstations. The sit–stand paradigm can reduce discomfort; however, working in a sit–stand ratio of 15:5 min may not be the most effective ratio. More frequent posture switches may be necessary to realise the full benefit of sit–stand.     

Isodynamic evaluation of trunk muscles and low-back pain among workers in a steel factory

A cross-sectional study was conducted to explore the relationship between dynamic parameters of trunk muscle strength and the occurrence of low-back pain (LBP). Isodynamic strength measurements were performed among 31 male maintenance workers with spells of low-back pain in the past 12 months and 28 maintenance workers without a history of low-back pain. In general, workers with low-back pain showed a lower trunk muscle performance than the workers without low-back pain. Only the measures of torque during lateral movement differed significantly between both groups. Regression analysis revealed the importance of the nature of low-back pain for trunk muscle strength. Most parameters of trunk muscle strength were significantly decreased among workers with chronic low-back pain of a rather severe nature, showing reductions from 18% to 50%. None of the work-related risk factors for low-back pain contributed significantly to the prediction of trunk strength measures. The study suggests that isodynamic evaluation of trunk muscle strength may assist in determining objective measures for the severity of low-back pain rather than in evaluating a subject's capability of successfully coping with a specific work load.     

Effects of the weight configuration of hand load on trunk musculature during static weight holding

The performance of manual material handling tasks is one major cause of lower back injuries. In the current study, we investigated the influence of the weight configuration of hand loads on trunk muscle activities and the associated spinal stability. Thirteen volunteers each performed static weight-holding tasks using two different 9 kg weight bars (with medial and lateral weight configurations) at two levels of height (low and high) and one fixed horizontal distance (which resulted in constant spinal joint moment across conditions). Results of the current study demonstrated that holding the laterally distributed load significantly reduced activation levels of lumbar and abdominal muscles by 9–13% as compared with holding the medially distributed load. We believe such an effect is due to an elevated rotational moment of inertia when the weight of the load is laterally distributed. These findings suggest that during the design and assessment of manual material handling tasks, such as lifting and carrying, the weight configuration of the hand load should be considered.

Practitioner summary: Elevated trunk muscle activities were found when holding a medially distributed load vs. a laterally distributed load (with an equivalent external moment to the spine), indicating a reduced spinal stability due to the reduced rotational moment of inertia. The configuration of the hand load should be considered when evaluating manual material handling tasks.     

Investigating the effect of real-time spinal postural biofeedback on seated discomfort in people with non-specific chronic low back pain

A total of 24 participants with non-specific chronic low back pain (NSCLBP) sat for 2 h while their seated posture and low back discomfort (LBD) were analysed. A total of 16 pain developers (PDs), whose LBD increased by at least two points on the numeric rating scale, repeated the procedure 1 week later, while receiving postural biofeedback. PDs were older (p = 0.018), more disabled (p = 0.021) and demonstrated greater postural variability (p < 0.001). The ramping up of LBD was reduced (p = 0.002) on retesting, when sitting posture was less end-range (p < 0.001), and less variable (p = 0.032). Seated LBD appears to be related with modifiable characteristics such as sitting behaviour. Among people with sitting-related NSCLBP, the ramping up of LBD was reduced by modifying their sitting behaviour according to their individual clinical presentation. The magnitude of change, while statistically significant, was small and no follow-up of participants was completed. Further research should examine integrating biofeedback into comprehensive biopsychosocial management strategies for NSCLBP.

Practitioner Summary: The effect of real-time postural biofeedback on LBD was examined among people with LBP. Postural biofeedback matched to the individual clinical presentation significantly reduced LBD within a single session. Further research should examine the long-term effectiveness of postural biofeedback as an intervention for LBP.     

Effects of posture on dynamic back loading during a cable lifting task

This study evaluated spinal loads associated with lifting and hanging heavy mining cable in a variety of postures. This electrical cable can weigh up to 10 kg per metre and is often lifted in restricted spaces in underground coal mines. Seven male subjects performed eight cable lifting and hanging tasks, while trunk kinematic data and trunk muscle electromyograms (EMGs) were obtained. The eight tasks were combinations of four postures (standing, stooping, kneeling on one knee, or kneeling on both knees) and two levels of cable load (0 N or 100 N load added to the existing cable weight). An EMG-assisted model was used to calculate forces and moments acting on the lumbar spine. A two-way split-plot ANOVA showed that increased load (p<0.05) and changes in lifting posture (p<0.05) independently affected trunk muscle recruitment and spinal loading. The increase in cable load resulted in higher EMG activity of all trunk muscles and increased axial and lateral bending moments on the spine (p<0.05). Changes in posture caused more selective adjustments in muscle recruitment and affected the sagittal plane moment (p<0.05). Despite the more selective nature of trunk EMG changes due to posture, the magnitude of changes in spinal loading was often quite dramatic. However, average compression values exceeded 3400 N for all cable lifting tasks.