The impact of a sloped surface on low back pain during prolonged standing work: A biomechanical analysis

Background

Occupations that require prolonged periods of standing have been associated with increased reports of musculoskeletal disorders including low back pain. Previous work has utilized a prospective design of functionally inducing low back pain in previously asymptomatic individuals during a prolonged standing task. Increased trunk and gluteus medius muscle co-activation has been found in previously asymptomatic individuals who developed pain during standing compared with individuals who did not develop pain.

Purpose

The purpose of this study was to investigate the subjective and biomechanical responses of known pain developers and non-pain developers (previously determined during level standing) when exposed to the same prolonged standing task protocol completed while standing on a ±16° sloped surface.

Results

Overall low back pain scores were reduced by 59.4% for the pain development group, identified in level standing, when using the sloped surface. There was a marked decrease in the co-activation of the bilateral gluteus medius muscles in the known pain developers when standing on the sloped surface compared with level standing. However the non-pain developer group responded in the opposite direction by having an increase in the co-activation of these muscles, although they did not have a commensurate increase in low back pain. There were changes in both the postural and joint-loading variables examined. These changes were minimal and in most cases the sloped surface produced responses that bracketed the postures and loading magnitudes found in level standing depending on whether the participant was standing on the +16° or −16° surface.

Conclusions

The sloped surface resulted in decreased subjective low back pain during prolonged standing. There were also associated biomechanical changes resulting from using a sloped surface during prolonged standing. These positive findings were supported in an exit survey satisfaction rating with 87.5% indicating that they would use the sloped surface if they were in an occupational setting that required prolonged standing work.     

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.     

Development and evaluation of an EMG-based model to estimate lumbosacral loads during seated work

Low back pain (LBP) is a common occupational problem and continues to be the leading cause of occupational disability. Among diverse known risk factors, sitting is commonly considered as an important exposure related to LBP risk, and modern living and contemporary work both involve increasing sedentary behaviors including more frequent and prolonged sitting. Specifically, a few studies have assessed lumbosacral loads in seated postures, but no sitting-specific model has been developed to investigate the effects of seated tasks and time-dependent variations in lumbosacral loading during sitting. Here, a three-dimensional, electromyography-based biomechanical model of the trunk was developed to predict lumbosacral loads during a range of seated tasks. This model was a modification of an earlier approach, and specific modifications included a revised representation of lumbar muscle anatomy and viscoelastic soft-tissue properties, and a method to account for muscular fatigue during prolonged sitting. With these enhancements, the predictive ability of the model was assessed over a range of seated tasks that differed in terms of lumbar posture, time pressure, and mental workload. Predicted model parameters corresponded well with values reported earlier. Reasonable levels of correspondence were found between external and predicted lumbosacral moments across all tested tasks. Physical exposures and injury risks related to seated work can potentially be estimated using this modeling approach, which may facilitate future injury prevention strategies.     

An air-spring standing platform does not increase overall movement or metabolic cost during simulated work tasks

Due to the increased popularity of standing-based occupational work stations there is a growing need to understand the impact of ergonomic aids such as standing mats. In particular, while standing mats have been studied in relation to musculoskeletal discomfort and pain, there have been no studies exploring the effects of their use on metabolism and caloric expenditure. The purpose of this study was to examine the metabolic, biomechanical, and pain/discomfort responses to the use of an air-spring standing mat over a 2-h work-simulated standing period. Sixteen participants visited the lab on two separate occasions, each to perform a 2-h standing simulated-work session, once with and once without a standing mat. Metabolic data were recorded at the start, midpoint, and end of the standing sessions. Force plate centre of pressure (COP) and visual analog discomfort score (VAS) measurements were taken every 15 min. Results demonstrated that there was no difference in caloric expenditure between the two sessions. COP variables demonstrated less movement on the standing mat compared to the control day; however, only one of the eight variables (root-mean-square velocity in the medial-lateral direction) was statistically significant (p = 0.02). VAS scores showed no clear benefit of the standing mat on low back or lower limb discomfort. The short-term introduction of an air-spring standing mat during simulated work tasks appears to have no clear benefits on energy expenditure, biomechanical centre of pressure variables, or for alleviating musculoskeletal discomfort. Whether longer term exposure to this type of mat has differential effects remains to be addressed.     

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.     

Ergonomie guidelines for the prevention of low back pain at the workplace

The aim of this paper is to discuss the usefulness of common ergonomie guidelines for preventing low back pain at the workplace. Sixteen recent ergonomie, biomechanical and epidemiological books were reviewed to obtain common ergonomie guidelines for both static and dynamic work (e.g., sitting, lifting), and to obtain an overview of commonly-observed individual and work-related risk factors of low back pain. The results show that the aspects of work for which ergonomie guidelines are presented generally correspond to work-related risk factors as shown by epidemiological studies. However, in quantitative terms the guidelines show a great variety, possibly due to differences in criteria. In certain cases, it is not clear whether or not the guidelines are based on back load or back pain data, due to lack of references. It appears that many guidelines are based upon a combination of back load criteria and other criteria, although it is unknown how these criteria are combined. Hence, many guidelines do not apply specifically to low back pain.

With certain exceptions, most guidelines do not take into account individual factors, although epidemiological studies indicate that several factors such as age, strength, fitness, psychosocial factors, and history of back pain should be considered. However, because of the qualitative character of most current epidemiological studies, results cannot be readily implemented into quantitative ergonomie guidelines.

The above general results are discussed with examples. It is concluded that there is a great need for ergonomie guidelines that apply specifically to low back pain, and for quantitative epidemiological data on which these guidelines may be based.     

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

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

The influence of 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.     

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.     

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

Background

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

Purpose

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

Methods

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

Results

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

Conclusions

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

Effect of participant physiques on increases in shank circumference for the two prolonged standing conditions

This study examined the effect of participant physique on the increase in shank circumference (ISC) for the 2‐hr standing. We recruited 20 healthy male participants (10 with normal body mass index (BMI) and 10 who were overweight) and examined their ISC every 20 min under two prolonged standing conditions (static and intermittent standing). Results showed that prolonged standing types, physiques, and sustained time significantly influence the ISC. The ISC during intermittent standing (mean = 0.38 cm) was significantly lower than that observed during static standing (mean = 0.52cm). That is, 1 min of relaxation after every 20 min of standing can effectively relieve the load on the participants’ shank during standing. The normal (BMI = 21.9) group exhibited a significantly higher ISC than the overweight group (BMI = 26.5) did. This increase was also reflected in the subjective discomfort rating results. The standing type may be more dominant than the worker's physique on the lower‐limb loading when performing prolonged standing tasks.     

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.     

The Influence of Various Seat Design Parameters: A Computational Analysis

Nowadays, low back pain becomes a common healthcare problem. Poor or unsuitable seat design is related to the discomfort and other healthcare problems of users. The aim of this study is to investigate the influence of seat design variables on the compressive loadings of lumbar joints. A basis that includes a musculoskeletal human body model and a chair model has been developed using LifeMOD Biomechanics Modeller. Inverse and forward dynamic simulations have been performed for various seat design parameters. The results show that the inclination of backrest and seat pan may or may not decrease the compressive spinal joint forces, depending on other conditions. The medium‐level height and depth of seat pan and the medium‐level and high‐level height of backrest are found to cause the minimum compressive loads on lumbar joints. This work contributes to a better understanding of sitting biomechanics and provides some useful guidelines for seat design.     

Margin of safety for the human back: a probable consensus based on published studies

Despite numerous efforts to control occurrences of work-related low back pain, it continues to be a significant problem. Since the causation of low back pain is under multifactorial control, it is suggested that the factor most vulnerable at any given time will determine the safety. Epidemiological, biomechanical, physiological, and psychophysical information presented in published literature has been analysed. The data available are related to injuries and the projected margin of safety. This paper therefore, is an integrative, inferential synthesis of the published work to discern the margin of safety. An attempt has been made to conclude, on the basis of objective evidence, an all encompassing criterion to ensure the safety of the back. The psychophysical approach appears to integrate biomechanical and physiological variables on a short term basis in the studies surveyed. However, it remains to be proven that the sensory conditioning due to prolonged and repetitive occupational tasks will remain responsive to cumulative load and fatigue failures.     

Participation in workplace design with reference to low back pain: a case for the improvement of the police patrol car

Thirty Canadian police officers, divided into six groups, participated in the redesign of the interior of the patrol car. Three of the groups consisted of individuals having a history of low back disease. The effect of participating in a design process on the characteristics of the final design and on the perception of the low back pain was studied in a semi-experimental setting. The participants developed a strong commitment to the participatory design process, which was reflected in their productions. The differences between participants with and without a history of a low back disease was not marked. The former tended to stress posture-related elements in their analysis and design.     

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.     

Evaluation of a dynamic arm support for seated and standing tasks: a laboratory study of electromyography and subjective feedback

The goal of this study was to determine whether a new dynamic arm support system reduced shoulder and arm muscle load for seated and standing hand/arm tasks. The new system provides support for both horizontal and vertical arm motion. A total of 11 participants performed ten tasks (five seated and five standing) both with and without the arm support. Outcomes were assessed with electromyography and subjective feedback. Muscle activity was measured over the dominant side supraspinatus, triceps and forearm extensor muscles. Significant (p < 0.01) reductions in static muscle activity were observed in one of ten tasks performed with the support device for the supraspinatus muscle, in five tasks for the triceps and in one task for forearm extensor muscles. Likewise, a significant improvement in subjective measures was reported with the support device for ‘ease of task’ for two of ten tasks, for ‘forearm comfort’ for three of ten tasks and for ‘shoulder effort’ for six of ten tasks. The results suggest that a dynamic forearm support may improve subjective comfort and reduce static muscle loads in the upper extremity for tasks that involve horizontal movement of the arms. For rapid motions, the value of the support is limited due to internal inertia and friction.     

Effects of positioning optimization in an alternative computer workstation for people with and without low back pain

The aim of this study was to measure the impact of positioning optimization on typing performance and user comfort for people with and without low back pain (LBP) in alternative working postures. Participants completed a series of typing tests in each of five randomly ordered alternative working postures ranging from upright to fully supine. Typing accuracy and typing speed were recorded as were subjective measures of overall comfort and body part discomfort. The impact of positioning optimization of the monitor, keyboard, and arm supports was determined by comparing results from an “Optimized” test study protocol (n = 27) with those from a “Non-Optimized” test study protocol (n = 26). The results indicate a significant improvement in user comfort with the optimized positioning, but no significant differences in typing performance between the two test protocols. However, in both tests the slowest typing speeds occurred in the fully reclined and zero gravity working postures. Results of the user comfort scores indicated that for the Non-Optimized test, all alternative working postures were less comfortable than the upright posture. Whereas, in the Optimized test the tilted and reclined postures were comparable to the upright working posture and only the zero gravity posture was viewed as less comfortable.

Relevance to industry

Understanding the importance of position optimization for VDT operators in alternative working postures will provide valuable information toward the development of more comfortable and more accommodating computer workstations.     

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.