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.     

External L5–S1 joint moments when lifting wire mesh screen used to prevent rock falls in underground mines

Bolting large sheets of wire mesh screen (WMS) to the roof of underground mines prevents injuries due to rock falls. However, WMS can be heavy and awkward to lift and transport, and may result in significant spinal loading. Accordingly, six male subjects (mean age = 45.8 years + 7.5 SD) were recruited to lift WMS in a laboratory investigation of the biomechanical demands. Biomechanical modeling was used to estimate external moments about L5–S1 for sixteen lifting tasks, using two sizes of WMS. Full-size WMS involved a two-person lift, while half-size WMS involved a one-person lift. Lifts were performed under 168 cm and 213 cm vertical space. Restriction in vertical space increased the maximum L5–S1 extensor moment from 254 to 274 Nm and right lateral bending moment from 195 to 251 Nm. Lifting full sheets of screen (as opposed to half sheets) resulted in an average 33 Nm increase in L5–S1 extensor moment. The L5–S1 extensor moment was increased by an average of 44 Nm (18%) when lifting screens positioned flat on the floor compared to an upright position.

Relevance to industry

Large flexible materials are commonly lifted in industrial work environments, and may involve the efforts of two or more workers. The current study examines the low back loading associated with lifting large flexible screens and presents recommendations to reduce spine loading.     

Assessment of an EMG-based method for continuous estimates of low back compression during asymmetrical occupational tasks.

Variables, such as peak and accumulated moments and spine compression forces, have been shown to be risk factors for occupational low back pain. Estimates of these forces during prolonged, dynamic, asymmetric tasks using biomechanical models is complex and time-consuming. A simple technique for continuous measurement of these variables over a prolonged period is needed to measure the distribution of spinal loading during both sagittal plane lifts and complex asymmetrical jobs. The aim of this study was to determine whether a linear normalization of erector spinae EMG to spine compression force, called compression normalized EMG (CNEMG), could be used to estimate spinal loading for simulations of asymmetrical occupational tasks. The estimates of spine compression force obtained using the normalized EMG are presented in the form of an amplitude probability distribution function and are compared with estimates of a three-dimensional biomechanical model. The per cent time a worker spends above particular levels of spinal loading of interest, such as the NIOSH action limit for compression, are displayed. Five males performed simulated occupational tasks. The exposure time at a specific level of spine compression force for a combination of three tasks, estimated by CNEMG, was, on average, within 6.5% of the time calculated by the biomechanical model. However, if the task combination was dominated by an axial twisting moment, then the difference was, on average, 13.4%. The difference in magnitude of spine compression at a specific probability was, on average, 14.9% and when axial trunk twist dominated, 30.7%. It is concluded that CNEMG can estimate probability at a specific level of spine compression force when the task combination is characterized by a predominant extensor moment in the sagittal plane. Estimates of spine compression at a specific probability, and estimates obtained during task combinations dominated by an axial twisting moment, are poor.     

Assessment of an EMG-based method for continuous estimates of low back compression during asymmetrical occupational tasks

Variables, such as peak and accumulated moments and spine compression forces, have been shown to be risk factors for occupational low back pain. Estimates of these forces during prolonged, dynamic, asymmetric tasks using biomechanical models is complex and time-consuming. A simple technique for continuous measurement of these variables over a prolonged period is needed to measure the distribution of spinal loading during both sagittal plane lifts and complex asymmetrical jobs. The aim of this study was to determine whether a linear normalization of erector spinae EMG to spine compression force, called compression normalized EMG (CNEMG), could be used to estimate spinal loading for simulations of asymmetrical occupational tasks. The estimates of spine compression force obtained using the normalized EMG are presented in the form of an amplitude probability distribution function and are compared with estimates of a three-dimensional biomechanical model. The per cent time a worker spends above particular levels of spinal loading of interest, such as the NIOSH action limit for compression, are displayed. Five males performed simulated occupational tasks. The exposure time at a specific level of spine compression force for a combination of three tasks, estimated by CNEMG, was, on average, within 6.5% of the time calculated by the biomechanical model. However, if the task combination was dominated by an axial twisting moment, then the difference was, on average, 13.4%. The difference in magnitude of spine compression at a specific probability was, on average, 14.9% and when axial trunk twist dominated, 30.7%. It is concluded that CNEMG can estimate probability at a specific level of spine compression force when the task combination is characterized by a predominant extensor moment in the sagittal plane. Estimates of spine compression at a specific probability, and estimates obtained during task combinations dominated by an axial twisting moment, are poor.     

Lumbar motion response to a constant load velocity lift

An experiment was performed to evaluate the motions of the lumbar spine during a constant load velocity lift. For the purposes of this study, a constant load velocity refers to the linear vertical velocity of the load. This vertical load velocity was controlled using a modified angular isokinetic dynamometer, which produced linear isokinetic motion during a lift. A lumbar monitor was used to observe the position, velocity, and acceleration changes that occurred in the lumbar spine during the lifting task. The results indicate that under constant load velocity conditions, significant angular accelerations occur at the lumbar level. The nature of these accelerations was found to depend on several variables associated with a lifting task, such as the load velocity and the asymmetry of the lift. The physical significance of these results would be increased spinal loading above that which would be predicted using a static model.     

The effects of job rotation on the risk of reporting low back pain

Job rotation has been widely recommended as an administrative control to reduce the risk of developing work-related musculoskeletal disorders. However, evidence of its benefits are hard to find in the literature. The effect of job rotation on predictions for the risk of reporting low back pain was estimated using Low Back Pain Reporting (LBPR) and Time Weighted Average (TWA) approaches. Index scores calculated using the peak hand force, the peak L4/L5 shear force and the L4/L5 moment cumulated over the entire shift were used to estimate the effects of job rotation on the probability of reporting low back pain. Simulations of realistic rotations between two jobs showed that workers in low demand jobs who rotate into higher demand jobs experience a linear increase in reporting probability using the TWA approach. With the LBPR approach a step increase in reporting probability occurred because of the immediate exposure to the peak loading parameters associated with the more demanding job. With a 50-50 rotation the TWA and LBPR index scores increased by 39% and 57%, respectively. With the LBPR approach the redistribution of risk was not uniform with job rotation. The increase was greater for those who rotated into the demanding job compared to the reduction experienced by those who rotated out of the demanding job. The effects of job rotation are not easily estimated because of the complex effect that mixing jobs has on peak and cumulative tissue loading.     

The effects of job rotation on the risk of reporting low back pain

Job rotation has been widely recommended as an administrative control to reduce the risk of developing work-related musculoskeletal disorders. However, evidence of its benefits are hard to find in the literature. The effect of job rotation on predictions for the risk of reporting low back pain was estimated using Low Back Pain Reporting (LBPR) and Time Weighted Average (TWA) approaches. Index scores calculated using the peak hand force, the peak L4/L5 shear force and the L4/L5 moment cumulated over the entire shift were used to estimate the effects of job rotation on the probability of reporting low back pain. Simulations of realistic rotations between two jobs showed that workers in low demand jobs who rotate into higher demand jobs experience a linear increase in reporting probability using the TWA approach. With the LBPR approach a step increase in reporting probability occurred because of the immediate exposure to the peak loading parameters associated with the more demanding job. With a 50-50 rotation the TWA and LBPR index scores increased by 39% and 57%, respectively. With the LBPR approach the redistribution of risk was not uniform with job rotation. The increase was greater for those who rotated into the demanding job compared to the reduction experienced by those who rotated out of the demanding job. The effects of job rotation are not easily estimated because of the complex effect that mixing jobs has on peak and cumulative tissue loading.     

The assessment of material handling strategies in dealing with sudden loading: influences of foot placement on trunk biomechanics

Sudden unexpected loading has been identified as a risk factor of work-related low back pain (LBP). This study investigated the effects of different foot placements and load-releasing locations on trunk biomechanics under an unexpected sudden loading event. Fifteen subjects experienced sudden release of a 6.8-kg external load from symmetric or asymmetric directions while maintaining four different foot placements. The results showed that subjects experienced on average 4.1° less trunk flexion, 6.6 Nm less L5/S1 joint moment and 32.0 N less shear force with staggered stance with the right foot forward (the most preferred placement) compared with wide stance (the least preferred placement). Asymmetric load-releasing positions consistently resulted in smaller impacts on trunk biomechanics than symmetric positions. The findings suggest that staggered stance and asymmetric load-holding position can be used as a protective load-handling posture against LBP caused by sudden loading.     

Significance of biomechanical and physiological variables during the determination of maximum acceptable weight of lift

The aim was to identify which biomechanical and physiological variables were associated with the decision to change the weight of lift during the determination of the maximum acceptable weight of lift (MAWL) in a psychophysical study. Fifteen male college students lifted a box of unknown weight at 4.3 lifts/min, and adjusted the weight until their MAWL was reached. Variables such as heart rate, trunk positions, velocities and accelerations were measured during the lifting, as well as estimated spinal loading in terms of moments and spinal forces in three dimensions using an EMG-assisted biomechanical model. Multiple logistic regression techniques identified variables associated with the decision to change the weights up and down prior to a subsequent lift. Results indicated that heart rate, predicted sagittal lift moment and low back disorder (LBD) risk index were associated with decreases in the weight prior to the next lift. Thus, historical measures of LBD risk (e.g. compression, shear force) were not associated with decreases in weight prior to the next lift. Additionally, the magnitudes of the predicted spinal forces and LBD risk were all very high at the MAWL when compared with literature sources of tolerance as well as observational studies on LBD risk. Our findings indicate that the psychophysical methodology may be useful for the decision to lower the weight of loads that may present extreme levels of risk of LBD; however, the psychophysical methodology does not seem to help in the decision to stop changing the weight at a safe load weight.     

Significance of biomechanical and physiological variables during the determination of maximum acceptable weight of lift.

The aim was to identify which biomechanical and physiological variables were associated with the decision to change the weight of lift during the determination of the maximum acceptable weight of lift (MAWL) in a psychophysical study. Fifteen male college students lifted a box of unknown weight at 4.3 lifts/min, and adjusted the weight until their MAWL was reached. Variables such as heart rate, trunk positions, velocities and accelerations were measured during the lifting, as well as estimated spinal loading in terms of moments and spinal forces in three dimensions using an EMG-assisted biomechanical model. Multiple logistic regression techniques identified variables associated with the decision to change the weights up and down prior to a subsequent lift. Results indicated that heart rate, predicted sagittal lift moment and low back disorder (LBD) risk index were associated with decreases in the weight prior to the next lift. Thus, historical measures of LBD risk (e.g. compression, shear force) were not associated with decreases in weight prior to the next lift. Additionally, the magnitudes of the predicted spinal forces and LBD risk were all very high at the MAWL when compared with literature sources of tolerance as well as observational studies on LBD risk. Our findings indicate that the psychophysical methodology may be useful for the decision to lower the weight of loads that may present extreme levels of risk of LBD; however, the psychophysical methodology does not seem to help in the decision to stop changing the weight at a safe load weight.     

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.     

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.     

A biomechanical evaluation of lifting speed using work- and moment-related measures.

A biomechanical evaluation of lifting speed was conducted in the laboratory. The study investigated the effects of lifting speed on several predetermined biomechanical cost functions. The lifting tasks consisted of five lifting speeds labelled as the slowest, slow, normal, fast and fastest, and three weights, 50, 65 and 80% of their maximum acceptable weight of lift. The speed at each level was determined individually by each subject according to their capability. The study found that work-related measures, including the total net muscle work, total absolute net muscle work and work done to the load, decreased significantly as the lifting speed increased (p < 0.05, < 0.001 and < 0.001, respectively). The time integral of sum of squared ratio of joint moment and strength also decreased significantly (p < 0.001). This indicates that lifting at a faster speed tends to reduce the work the body has to do. The peak speed of load occurred at 70% of total lifting time for the slowest lifts, but at 30% of total lifting time for other lifting speeds. Performing lifts at the minimum speeds changed the usual speed coordination technique the subjects used.     

Muscle activity during patient transfers: a preliminary study on the influence of lift assists and experience

The purpose of this study was to examine muscle activity patterns during patient handling during manual transfers, and transfers using floor and ceiling lifts. EMG patterns during transfers from bed to wheelchair and wheelchair to bed as well as patient repositioning in novices and experienced participants were examined. Surface EMG was recorded from the upper and lower erector spinae, latissimus dorsi and trapezius muscles bilaterally. Overall, normalized mean and peak muscle activity were lowest using the ceiling lift, increasing with the floor lift, which were lower than manual transfers (novices: all p < 0.01). Experienced patient handlers demonstrated approximately two times greater trapezius and latissimus dorsi activity than novices, combined with lower mean erector spinae activity (p < 0.05, for most tasks). Integrated EMG for all muscles was directly proportional to the transfer time and was lowest during the manual transfer followed by the ceiling lift, with the floor lift being highest. The difference between the muscle activity patterns between the experienced and novice patient handlers may suggest a learned behaviour to protect the spine by distributing load to the shoulder. Further examination of the muscle activation patterns differences between experience levels could improve training techniques to develop better patient handling strategies.     

The effect of personality type on muscle coactivation during elbow flexion.

A great deal of interest has been generated recently regarding the influence that psychosocial factors may have on the reporting of and disability associated with work-related musculoskeletal disorders. The current study considers the potential influence of one psychosocial factor--personality type--on basic neuromuscular control strategies and biomechanical loading. The study investigated the hypothesis that Type A people exhibit increased muscular antagonism relative to their Type B counterparts. Volunteers participated in an EMG-based biomechanical study to investigate the coactivation patterns of the major muscles that span the elbow joint during elbow flexion exertions. Results showed that, averaging across all conditions, the antagonist muscle activity was significantly higher for Type A individuals than for their Type B counterparts (10% of maximum for Type A, 5.5% of maximum for Type B). Although the study was somewhat limited in its size and scope, the results indicate that certain psychosocial factors may be more than a filter in postinjury response and may directly influence biomechanical loading. A potential application of this research is an increased awareness that certain individuals may be at greater risk of developing work-related musculoskeletal disorders.     

The accuracy of self-report and trained observer methods for obtaining estimates of peak load information during industrial work

The purpose of this study was to determine how well self-report (questionnaire=QR) and trained observer (checklist=OBS) data recording methods compared with more expensive video analysis (VID) for estimating various peak physical loading exposure variables on the low backs of 99 employees during work in an automobile assembly plant. The variables studied were L4/L5 spine compression and shear forces, L4/L5 moment, trunk angle, and hand load. Peak low back loads associated with the working postures of, and the applied loads on, each worker were estimated using a 2D biomechanical model that could accommodate inertial forces acting in various directions on the hands independently. Correlations between the VID and OBS methods were greater for each variable than between VID and QR methods, with ranges in coefficients from 0.6 to 0.8, and 0.1 to 0.4, respectively, giving a discouraging impression of the QR, and the OBS method to a lesser degree, for peak low back exposure assessment. Despite the better performance of OBS method for individuals, it was still only able to account for between 36% and 64% of the variance relative to the VID method. When all workers were considered as a single group, compression and shear forces, moment and hand load estimates were the same regardless of method used to collect the data. Self-reported trunk flexion was significantly greater than that reported by trained observers or on video (p<0.0001).Relevance to industryConsiderable time and expense could be saved in large scale studies if it were possible to rely on worker's reports or observation of the physical demands of their jobs instead of traditional video and biomechanical analyses. Assessments of peak exposure of individuals using the self-report and observation methods were discouraging. Analysis of a single group proved more promising, but other groups need to be studied. Interview assisted self-reports may help to improve assessments of individuals and also need to be investigated in the future.     

A biomechanical evaluation of lifting speed using work- and moment-related measures

A biomechanical evaluation of lifting speed was conducted in the laboratory. The study investigated the effects of lifting speed on several predetermined biomechanical cost functions. The lifting tasks consisted of five lifting speeds labelled as the slowest, slow, normal, fast and fastest, and three weights, 50, 65 and 80% of their maximum acceptable weight of lift. The speed at each level was determined individually by each subject according to their capability. The study found that work-related measures, including the total net muscle work, total absolute net muscle work and work done to the load, decreased significantly as the lifting speed increased (p&lt;0.05, &lt;0.001 and &lt;0.001, respectively). The time integral of sum of squared ratio of joint moment and strength also decreased significantly (p&lt;0.001). This indicates that lifting at a faster speed tends to reduce the work the body has to do. The peak speed of load occurred at 70% of total lifting time for the slowest lifts, but at 30% of total lifting time for other lifting speeds. Performing lifts at the minimum speeds changed the usual speed coordination technique the subjects used.     

Muscle activity during patient transfers: a preliminary study on the influence of lift assists and experience

The purpose of this study was to examine muscle activity patterns during patient handling during manual transfers, and transfers using floor and ceiling lifts. EMG patterns during transfers from bed to wheelchair and wheelchair to bed as well as patient repositioning in novices and experienced participants were examined. Surface EMG was recorded from the upper and lower erector spinae, latissimus dorsi and trapezius muscles bilaterally. Overall, normalized mean and peak muscle activity were lowest using the ceiling lift, increasing with the floor lift, which were lower than manual transfers (novices: all p?<?0.01). Experienced patient handlers demonstrated approximately two times greater trapezius and latissimus dorsi activity than novices, combined with lower mean erector spinae activity (p?<?0.05, for most tasks). Integrated EMG for all muscles was directly proportional to the transfer time and was lowest during the manual transfer followed by the ceiling lift, with the floor lift being highest. The difference between the muscle activity patterns between the experienced and novice patient handlers may suggest a learned behaviour to protect the spine by distributing load to the shoulder. Further examination of the muscle activation patterns differences between experience levels could improve training techniques to develop better patient handling strategies.     

Lumbar spine forces during manoeuvring of ceiling-based and floor-based patient transfer devices

Patient handling continues to represent a high risk task for low back pain (LBP) among health caregivers. Previous studies indicated that manual transfers of patients impose unacceptable loads on the spine even when two caregivers perform the transfer. Patient lift devices are considered a potential intervention; however, few biomechanical analyses have investigated the spine loads and LBP risk associated with these transfer devices. This study analysed the 3-D spine forces imposed upon the lumbar spine when 10 subjects manipulated ceiling-based and floor-based patient lifts through various patient handling conditions and manoeuvres. The results indicated that ceiling-mounted patient lift systems imposed spine forces upon the lumbar spine that would be considered safe, whereas floor-based patient handling systems had the potential to increase anterior/posterior shear forces to unacceptable levels during patient handling manoeuvres. Given these findings, ceiling-based lifts are preferable to floor-based patient transfer systems.     

Biomechanical aspects of occupational neck postures during dental work

A typical occupational risk factor for developing neck symptoms is prolonged flexion of the cervical spine. The present aim was to determine joint moments and muscle activity of the neck during forward flexion of the cervical spine to evaluate the load in the neck region. Three dimensional video (3-D) and surface electromyography (EMG) from the splenius muscles were recorded in two common work postures. Using a 3-D static link segment model, moments at the atlanto-occipital (A-O) joint and the seventh cervical-first thoracal (C7-T1) joint were estimated. Maximal extension moments were estimated from maximal neck extension strength. Extension moments at the C7-T1 joint were significantly higher for a highly flexed position (45% of max) compared to a moderately flexed position (32% of max), but remained unchanged at the A-O joint (40% of max). The mean RMS amplitude was 9% of maximal EMG in both positions (no bilateral differences). This difference between mechanical load and muscle load indicates that EMG may seriously underestimate the total loads of the tissue. Lateral flexion influenced the lateral flexion moment while rotation did not influence the rotation moment. The study demonstrates the importance of quantification of joint loads in occupational risk assessment of the neck.

Relevance to industry

3-D biomechanical calculations provide information on the mechanical load during work. Because EMG may underestimate total tissue load, calculations of joint moments in combination with information on muscle activity and strength are necessary to estimate different tissue loading of significance for overall risk identification.