Continuous assessment of low back loads in long-term care nurses

Considerable effort has been spent evaluating aspects of low back injury risk in nursing yet comprehensive evaluation of all work tasks has been limited. The purpose of this study was to evaluate peak and cumulative lumbar spine loads experienced by personal support workers. A total of 20 female long-term care workers were observed and had trunk posture monitored via an inclinometer throughout their shift. When adjusted for an 8-h workday, workers experienced cumulative loads of 21.3 ± 4.6 MNs, 1.8 ± 0.6 MNs and 2.9 ± 1.4 MNs for compression, lateral and anterior shear, respectively. Patient care, unloaded standing, walking and miscellaneous tasks accounted for almost 80% of cumulative compression, while lifts and transfers accounted for less than 10%. Mechanical lift assists reduced peak loads and contributed minimally to cumulative loading. These findings suggest that both peak and cumulative spine loads should be considered when evaluating injury risk in the nursing profession.

Statement of Relevance: This study has shown that tasks other than patient transfers and lifts are important in the assessment of low back injury risk in nurses. The method developed is a relatively straightforward approach that can be used to estimate peak and cumulative spine load to provide insight to risk of injury in many occupational settings.     

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 ratio of thoracic to lumbar compression force is posture dependent

Despite the evidence suggesting that between 8% and 55% of manual labourers experience thoracic pain, research on spinal loading during occupational tasks has been almost invariably limited to the lumbar spine. In this study, we determined the ratio of thoracic to lumbar compression force and the relative risk of injury to each region in various postures. Compressive forces on the spine were calculated based on previously reported thoracic and lumbar intradiscal pressures and disc cross-sectional areas. Flexion postures were associated with an approximate doubling in lumbar compression force but only small increases (or even decreases) in thoracic compression. The ratio of thoracic to lumbar compression was above the tolerance ratio (i.e. the ratio of thoracic to lumbar compressive strength) during upright postures and below the tolerance ratio during flexion postures, indicating that upright postures may pose a greater relative risk of injury to the thoracic spine than to the lumbar spine.

Practitioner summary: Previously reported thoracic and lumbar in vivo disc pressures during various postures were compared. The ratio of thoracic and lumbar compression increased during upright postures and decreased in flexed postures, indicating that upright postures may pose a greater risk of injury to the thoracic spine than to the lumbar spine.     

An optimal sampling approach to modelling whole-body vibration exposure in all-terrain vehicle driving

Abstract

Exposure to whole-body vibration (WBV) presents an occupational health risk and several safety standards obligate to measure WBV. The high cost of direct measurements in large epidemiological studies raises the question of the optimal sampling for estimating WBV exposures given by a large variation in exposure levels in real worksites. This paper presents a new approach to addressing this problem. A daily exposure to WBV was recorded for 9–24 days among 48 all-terrain vehicle drivers. Four data-sets based on root mean squared recordings were obtained from the measurement. The data were modelled using semi-variogram with spectrum analysis and the optimal sampling scheme was derived. The optimum sampling period was 140 min apart. The result was verified and validated in terms of its accuracy and statistical power. Recordings of two to three hours are probably needed to get a sufficiently unbiased daily WBV exposure estimate in real worksites. The developed model is general enough that is applicable to other cumulative exposures or biosignals.

Practitioner Summary: Exposure to whole-body vibration (WBV) presents an occupational health risk and safety standards obligate to measure WBV. However, direct measurements can be expensive. This paper presents a new approach to addressing this problem. The developed model is general enough that is applicable to other cumulative exposures or biosignals.     

Sagittal plane lumbar loading when navigating an obstacle and carrying a load

The current study quantified lumbar loading while carrying an anterior load mass and navigating an obstacle. Eight healthy male participants walked down a walkway and crossed an obstacle under three randomised LOAD conditions; empty-box (2 KG), five kilogram (5 KG) and ten kilogram (10 KG). Each walk was assessed at two events: left foot mid-stance (LMS) and right toe-crossing (TC) to characterise any changes from approach to crossing. Measures of interest included: trunk pitch, L4/L5 joint moment, compression, joint anterior–posterior shear and erector spinae activation. Findings demonstrate that obstacle crossing extended posture by 50, 41, 44%, respectively for each carried load magnitude. Further, these results indicate that shear rather than compressive loading may be an important consideration during crossing due to increase by 8, 9, 22% from LMS to TC for each load magnitude tested. These results provide insight into sagittal lumbar loading when navigating an obstacle while carrying a load.

Practitioner Summary: The risk of carrying while navigating obstacles on the lumbar spine is not completely understood. The forces at the lumbar spine while simultaneously carrying and obstacle crossing were analysed. Data indicate that carrying and obstacle crossing influence lumbar shear loads, thereby moderately increasing the relative risk at lumbar spine.     

(Abstracts)Changing Industrial Demands

Abstract

The frequency dependence of discomfort caused by vertical mechanical shocks has been investigated with 20 seated males exposed to upward and downward shocks at 13 fundamental frequencies (1–16 Hz) and 18 magnitudes (±0.12 to ±8.3 ms^?2). The rate of growth of discomfort with increasing shock magnitude depended on the fundamental frequency of the shocks, so the frequency dependence of equivalent comfort contours (for both vertical acceleration and vertical force measured at the seat) varied with shock magnitude. The rate of growth of discomfort was similar for acceleration and force, upward and downward shocks, and lower and higher magnitude shocks. The frequency dependence of discomfort from shocks differs from that of sinusoidal vibrations having the same fundamental frequencies. This arises in part from the frequency content of the shock. Frequency weighting W_b in BS 6841:1987 and ISO 2631-1:1997 provided reasonable estimates of the discomfort caused by the shocks investigated in this study.

Practitioner Summary: No single frequency weighting can accurately predict the discomfort caused by mechanical shocks over wide ranges of shock magnitude, but vibration dose values with frequency weighting W_b provide reasonable estimates of discomfort caused by shocks similar to those investigated in this study with peak accelerations well below 1 g.     

Spine loading during laboratory-simulated fireground operations — inter-individual variation and method of load quantification

Abstract

Spine loading data are needed to design low-back health-preserving ergonomic interventions for firefighters. Study objectives were to quantify spine loads during simulated fireground operations using simple (polynomial) and advanced (EMG-assisted musculoskeletal model) methods and to describe the variation in spine loads between performers (N?=?20). Spine compression forces differed by as much as 5.5 times bodyweight between individuals performing identical tasks. Anteroposterior and mediolateral shear forces varied by as much 3.2 and 2.1 times bodyweight between individuals performing the same tasks, respectively. Large variations in spine load magnitudes were documented regardless of whether simple or advanced quantification methods were used. Results suggest that low-back loading demands on the fireground would vary widely depending on the physical characteristics of individual firefighters, movement strategies employed, and tasks performed. Thus, personalised ergonomic interventions are warranted to regulate spine loading and load tolerance in firefighters.

Practitioner summary: Even when performing the same work, the associated spine loading demands will vary widely across people due to differences in their body sizes, shapes, and movement strategies. Therefore, personalised interventions are needed to regulate spine loading and load tolerance in workers (e.g. obesity prevention, physical capacity-building exercise, and movement [re]training).     

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.     

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.     

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.     

Wheelchair pushing and turning: lumbar spine and shoulder loads and recommended limits

Abstract

The objective of this study was to determine how simulated manual wheelchair pushing influences biomechanical loading to the lumbar spine and shoulders. Sixty-two subjects performed simulated wheelchair pushing and turning in a laboratory. An electromyography-assisted biomechanical model was used to estimate spinal loads. Moments at the shoulder joint, external hand forces and net turning torque were also assessed. Multiple linear regression techniques were employed to develop biomechanically based wheelchair pushing guidelines relating resultant hand force or net torque to spinal load. Male subjects experienced significantly greater spinal loading (p < 0.01), and spine loads were also increased for wheelchair turning compared to straight wheelchair pushing (p < 0.001). Biomechanically determined maximum acceptable resultant hand forces were 17–18% lower than psychophysically determined limits. We conclude that manual wheelchair pushing and turning can pose biomechanical risk to the lumbar spine and shoulders. Psychophysically determined maximum acceptable push forces do not appear to be protective enough of this biomechanical risk.

Practitioner Summary: This laboratory study investigated biomechanical risk to the low back and shoulders during simulated wheelchair pushing. Manual wheelchair pushing posed biomechanical risk to the lumbar spine (in compression and A/P shear) and to the shoulders. Biomechanically determined wheelchair pushing thresholds are presented and are more protective than the closest psychophysically determined equivalents.     

Two linear regression models predicting cumulative dynamic L5/S1 joint moment during a range of lifting tasks based on static postures

Previous studies have indicated that cumulative L5/S1 joint load is a potential risk factor for low back pain. The assessment of cumulative L5/S1 joint load during a field study is challenging due to the difficulty of continuously monitoring the dynamic joint load. This study proposes two regression models predicting cumulative dynamic L5/S1 joint moment based on the static L5/S1 joint moment of a lifting task at lift-off and set-down and the lift duration. Twelve men performed lifting tasks at varying lifting ranges and asymmetric angles in a laboratory environment. The cumulative L5/S1 joint moment was calculated from continuous dynamic L5/S1 moments as the reference for comparison. The static L5/S1 joint moments at lift-off and set-down were measured for the two regression models. The prediction error of the cumulative L5/S1 joint moment was 21±14 Nm × s (12% of the measured cumulative L5/S1 joint moment) and 14±9 Nm × s (8%) for the first and the second models, respectively.

Practitioner Summary: The proposed regression models may provide a practical approach for predicting the cumulative dynamic L5/S1 joint loading of a lifting task for field studies since it requires only the lifting duration and the static moments at the lift-off and/or set-down instants of the lift.     

Additional helmet and pack loading reduce situational awareness during the establishment of marksmanship posture

Abstract

The pickup of visual information is critical for controlling movement and maintaining situational awareness in dangerous situations. Altered coordination while wearing protective equipment may impact the likelihood of injury or death. This investigation examined the consequences of load magnitude and distribution on situational awareness, segmental coordination and head gaze in several protective equipment ensembles. Twelve soldiers stepped down onto force plates and were instructed to quickly and accurately identify visual information while establishing marksmanship posture in protective equipment. Time to discriminate visual information was extended when additional pack and helmet loads were added, with the small increase in helmet load having the largest effect. Greater head-leading and in-phase trunk–head coordination were found with lighter pack loads, while trunk-leading coordination increased and head gaze dynamics were more disrupted in heavier pack loads. Additional armour load in the vest had no consequences for Time to discriminate, coordination or head dynamics. This suggests that the addition of head borne load be carefully considered when integrating new technology and that up-armouring does not necessarily have negative consequences for marksmanship performance.

Practitioner Summary: Understanding the trade-space between protection and reductions in task performance continue to challenge those developing personal protective equipment. These methods provide an approach that can help optimise equipment design and loading techniques by quantifying changes in task performance and the emergent coordination dynamics that underlie that performance.     

The influence of lumbar extensor muscle fatigue on lumbar–pelvic coordination during weightlifting

Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar–pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar–pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar–pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment.

Practitioner Summary: Lumbar extensor muscle fatigue generates more in-phase lumbar–pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.     

The assessment of material handling strategies in dealing with sudden loading: The effects of load handling position on trunk biomechanics

Back injury caused by sudden loading is a significant risk among workers that perform manual handling tasks. The present study investigated the effects of load handling position on trunk biomechanics (flexion angle, L5/S1 joint moment and compression force) during sudden loading. Eleven subjects were exposed to a 6.8 kg sudden loading while standing upright, facing forward and holding load at three different vertical heights in the sagittal plane or 45° left to the sagittal plane (created by arm rotation). Results showed that the increase of load holding height significantly elevated the peak L5/S1 joint compression force and reduced the magnitude of trunk flexion. Further, experiencing sudden loading from an asymmetric direction resulted in significantly smaller peak L5/S1 joint compression force, trunk flexion angle and L5/S1 joint moment than a symmetric posture. These findings suggest that handling loads in a lower position could work as a protective strategy during sudden loading.     

Occupational and environmental risk factors for falls among workers in the healthcare sector

Falls are a leading cause of occupational injury for workers in healthcare, yet the risk factors of falls in this sector are understudied. Falls resulting in workers' compensation for time-loss from work from 2004–2007 for healthcare workers in British Columbia (BC) were extracted from a standardised incident-reporting database. Productive hours were derived from payroll data for the denominator to produce injury rates; relative risks were derived through Poisson regression modelling. A total of 411 falls were accepted for time-loss compensation. Compared to registered nurses, facility support workers (risk ratio (95% CI) = 6.29 (4.56–8.69)) and community health workers (6.58 (3.76–11.50)) were at high risk for falls. Falls predominantly occurred outdoors, in patients' rooms and kitchens depending on occupation and sub-sector. Slippery surfaces due to icy conditions or liquid contaminants were a leading contributing factor. Falls were more frequent in the colder months (January–March). The risk of falls varies by nature of work, location and worker demographics. The findings of this research will be useful for developing evidence-based interventions.

Statement of Relevance: Falls are a major cause of occupational injury for healthcare workers. This study examined risk factors including occupation type, workplace design, work setting, work organisation and environmental conditions in a large healthcare worker population in BC, Canada. The findings of this research should contribute towards developing evidence-based interventions.     

Effects of backpack load on critical changes of trunk muscle activation and lumbar spine loading during walking

This study investigated the effects of carrying a backpack while walking. Critical changes featuring the disproportionality of increases in trunk muscle activation and lumbar joint loading between light and heavy backpack carriage weight may reveal the load-bearing strategy (LBS) of the lumbar spine. This was investigated using an integrated system equipped with a motion analysis, a force platform and a wireless surface electromyography (EMG) system to measure the trunk muscle EMG amplitudes and lumbar joint component forces. A predictive goal programming model was developed to determine the most critical changes in trunk muscle activation and lumbar joint loading. Results suggested that lightweight backpack carriage at approximately 3% of body weight (BW) might reduce the peak lumbosacral compression force by 3% during walking compared with no load condition. The most critical changes in both trunk muscle activation and lumbosacral joint loading were found at a backpack load of 10% of BW.

Practitioner Summary: This study investigated the effects of backpack load on the LBS of lumbar spine while walking. A backpack load of 3% of BW might reduce the peak lumbosacral compression force by 3 and 10% of BW induced the most critical changes in LBS of lumbar spine.     

Analysis method for revealing human and organisational factors of occupational accidents with movement disturbance (OAMDs)

Abstract

Slips, trips and other movement disturbances account for 20 to 30% of recorded occupational accidents (OAs). The causal representations of these accidents hamper their prevention. An analysis method dedicated to occupational accidents with movement disturbance (OAMDs) has been developed to change these representations. In France, the causal tree method (CTM) is very commonly used for analysing OAs. An initial version of an OAMD analysis method, which overcomes the problems encountered when analysing these accidents using the CTM, has been developed. This OAMD analysis method was reviewed by six targeted prevention officers and as a result some proposals have been discarded and this initial version has been transformed into three additional CTM modules. The purpose of these modules is to identify human and organisational factors and provide a formal representation of damage caused, beyond bodily injuries.

Practitioner summary: A method for analysing occupational accidents triggered by a slip, a trip or any other movement disturbance has been developed in consideration of the practices and constraints in companies. In particular, this method allows us to highlight the human and organisational factors involved in the accident situation.

Abbreviations: OA: occupational accident; OAMD: occupational accident with movement disturbance; CTM: causal tree method     

Whole body vibration exposure patterns in Canadian prairie farmers

Abstract

Whole body vibration is a significant physical risk factor associated with low back pain. This study assessed farmers’ exposure to whole body vibration on the Canadian prairies according to ISO 2631-1. Eighty-seven vibration measurements were collected with a triaxial accelerometer embedded in a rubber seat pad at the operator-seat interface of agricultural machinery, including tractors, combines, pickup trucks, grain trucks, sprayers, swathers, all-terrain vehicles, and skid steers. Whole body vibration was highest in the vertical axis, with a mean (range) frequency-weighted root mean squared acceleration of 0.43 m/s² (0.19?1.06 m/s²). Mean crest factors exceeded 9 in all 3 axes, indicating high mechanical shock content. The vertical axis vibration dose value was 7.55 m/s^1.75 (2.18?37.59 m/s^1.75), with 41.4% of measurements within or above the health guidance caution zone. These high exposures in addition to an ageing agricultural workforce may increase health risks even further, particularly for the low back.

Practitioner Summary: Agricultural workers are frequently exposed to whole body vibration while operating farm equipment, presenting a substantial risk to musculoskeletal health including the low back. Assessing vibration exposure is critical in promoting a safe occupational environment, and may inform interventions to reduce farmer’s exposure to vibration.     

Biomechanically determined hand force limits protecting the low back during occupational pushing and pulling tasks

Though biomechanically determined guidelines exist for lifting, existing recommendations for pushing and pulling were developed using a psychophysical approach. The current study aimed to establish objective hand force limits based on the results of a biomechanical assessment of the forces on the lumbar spine during occupational pushing and pulling activities. Sixty-two subjects performed pushing and pulling tasks in a laboratory setting. An electromyography-assisted biomechanical model estimated spinal loads, while hand force and turning torque were measured via hand transducers. Mixed modelling techniques correlated spinal load with hand force or torque throughout a wide range of exposures in order to develop biomechanically determined hand force and torque limits. Exertion type, exertion direction, handle height and their interactions significantly influenced dependent measures of spinal load, hand force and turning torque. The biomechanically determined guidelines presented herein are up to 30% lower than comparable psychophysically derived limits and particularly more protective for straight pushing.

Practitioner Summary: This study utilises a biomechanical model to develop objective biomechanically determined push/pull risk limits assessed via hand forces and turning torque. These limits can be up to 30% lower than existing psychophysically determined pushing and pulling recommendations. Practitioners should consider implementing these guidelines in both risk assessment and workplace design moving forward.