Physical workload,trapezius muscle activity,and neck pain in nurses' night and day shifts: A physiological evaluation

The purpose of this study was to compare physical workload, electromyography (EMG) of the trapezius muscle, neck pain and mental well-being at work between night and day shifts in twenty Swiss nurses. Work pulse (average increase of heart rate over resting heart rate) was lower during night (27 bpm) compared to day shifts (34 bpm; p < 0.01). Relative arm acceleration also indicated less physical activity during night (82% of average) compared to day shifts (110%; p < 0.01). Rest periods were significantly longer during night shifts. Trapezius muscle rest time was longer during night (13% of shift duration) than day shifts (7%; p < 0.01) and the 50th percentile of EMG activity was smaller (p = 0.02), indicating more opportunities for muscle relaxation during night shifts. Neck pain and mental well-being at work were similar between shifts. Subjective perception of burden was similar between shifts despite less physical burden at night, suggesting there are other contributing factors.     

The biomechanical demands of manual scaling on the shoulders & neck of dental hygienists

Abstract

The purpose of this study was to evaluate the postural and muscular demands placed on the shoulders and neck of dental hygienists when performing a simulated manual scaling task. Nineteen healthy female dental hygienists performed 30-min of simulated manual scaling on a manikin head in a laboratory setting. Surface electromyography was used to monitor muscle activity from several neck and shoulder muscles, and neck and arm elevation kinematics were evaluated using motion capture. The simulated scaling task resulted in a large range of neck and arm elevation angles and excessive low-level muscular demands in the neck extensor and scapular stabilising muscles. The physical demands varied depending on the working position of the hygienists relative to the manikin head. These findings are valuable in guiding future ergonomics interventions aimed at reducing the physical exposures of dental hygiene work.

Practitioner Summary: Given that this study evaluates the physical demands of manual scaling, a procedure that is fundamental to dental hygiene work, the findings are valuable to identify ergonomics interventions to reduce the prevalence of work-related injuries, disability and the potential for early retirement among this occupational group.     

Neck postures in air traffic controllers with and without neck/shoulder disorders

Prolonged computer work with an extended neck is commonly believed to be associated with an increased risk of neck-shoulder disorders. The aim of this study was to compare neck postures during computer work between female cases with neck-shoulder disorders, and healthy referents. Based on physical examinations, 13 cases and 11 referents were selected among 70 female air traffic controllers with the same computer-based work tasks and identical workstations. Postures and movements were measured by inclinometers, placed on the forehead and upper back (C7/Th1) during authentic air traffic control. A recently developed method was applied to assess flexion/extension in the neck, calculated as the difference between head and upper back flexion/extension. Results: cases and referents did not differ significantly in neck posture (median neck flexion/extension: -10 degrees vs. -9 degrees ; p=0.9). Hence, the belief that neck extension posture is associated with neck-shoulder disorders in computer work is not supported by the present data.     

Modulation of mechanical and muscular load by footwear during catering

The BGN (Berufsgenossenschaft Nahrungsmithl und Gaststätten) reports 70% of job induced days off work to be connected with traumas of the ankle joint or overloading of the leg, knee and lower back, with an increased incidence in service areas outdoors (R. Grieshaber, personal communication). Workspace environments usually contain narrow passages, slopes or stairs and sudden changes between different surfaces. The aim of this study was to investigate the biomechanical load on the lower extremity and the low back during catering service when wearing different types of footwear. Thus, the potential for altering mechanical stress experienced during catering by variations in footwear was explored. Sixteen experienced waiters followed a course typical for a combined indoor?–?outdoor service area. Three different types of footwear were investigated using pressure distribution measurements, rearfoot goniometry and electromyography. A discriminant analysis revealed that the factors subject, shoe and surface affect rear foot movement or pressure distribution in different ways. A MANOVA demonstrated significant differences in loading parameters between footwear types. In general, these differences increased in magnitude in critical situations, such as climbing stairs or crossing slippery surfaces. The results of this study demonstrate that manipulations to footwear offer a great potential for modulating loads experienced during catering. Based on the results, the effects of constructional features are discussed. The method proposed can be applied to evaluate shoe modifications under realistic workplace conditions.     

Physical workload on neck and upper limb using two CAD applications

The aim was to evaluate (1) the physical workload on neck and upper limb in computer-aided design (CAD) work; (2) the impact of two applications (PROFESSIONAL-CADAM and PRO/Engineering) and (3) two input devices (computer mouse and keyboard), as well as (4) sitting and standing work positions. Fifteen CAD operators were interviewed and examined physically. For nine subjects, the physical workload was measured: electromyography (EMG) of trapezius and forearm extensor muscles, inclinometry of the head, the upper back and upper arms, as well as wrist goniometry. The muscular load was low in CAD work, but the inter-individual variation was considerable. Neither the positions were extreme, nor the movements. The applications, per se, did not have a large impact on the workload, but because of the need for different input devices the effect was strong. Using a keyboard meant higher angular velocities than using a mouse. Hence, when choosing a new software, which requires mainly a mouse as input device, this has to be balanced against the risk of disorders.     

Analysis of applied forces and electromyography of back and shoulders muscles when performing a simulated hand scaling task

Hand scaling is a physically demanding task responsible for numerous overexertion injuries in underground mining. Scaling requires the miner to use a long pry bar to remove loose rock, reducing the likelihood of rock fall injuries. The experiments described in this article simulated “rib” scaling (scaling a mine wall) from an elevated bucket to examine force generation and electromyographic responses using two types of scaling bars (steel and fiberglass-reinforced aluminum) at five target heights ranging from floor level to 176 cm. Ten male and six female subjects were tested in separate experiments. Peak and average force applied at the scaling bar tip and normalized electromyography (EMG) of the left and right pairs of the deltoid and erectores spinae muscles were obtained. Work height significantly affected peak prying force during scaling activities with highest force capacity at the lower levels. Bar type did not affect force generation. However, use of the lighter fiberglass bar required significantly more muscle activity to achieve the same force. Results of these studies suggest that miners scale points on the rock face that are below their knees, and reposition the bucket as often as necessary to do so.     

Assessment of workload and arm position during different work sequences: a study with portable devices on construction workers

It is recognised that work related shoulder pain is overrepresented among construction workers compared to other occupations. Studies have shown that working with hands above shoulder level increases the shoulder load. Most studies have been confined to the laboratory. The present project was carried out to map the muscular engagement and postures of construction workers undertaking ceiling fitting, and to compare the results to those of the laboratory studies. Two ambulatory devices were used, one allowing recording of electromyographic (EMG) signals bilaterally from the trapezius muscle, and the other to record the position of both arms and back by means of measuring the angles between the vertical line and the back and both upper arms. These recordings were performed during 1.5–2 h work sequences. The results show that the work was mostly performed in an upright position, that both arms were used to a similar amount and that the workers for a large proportion of their working time had their upper arms at levels that are considered harmful in view of shoulder load. The EMG data showed that nearly 50% of the work was spent with trapezius activity that exceeded that of the reference contraction used (about 15% of maximal voluntary contraction) and that the time spent in muscular relaxation was 10%. It was concluded that the exposure of construction workers undertaking ceiling fitting meets the criteria formulated on the basis of laboratory experiments with respect to a high risk of acquiring chronic shoulder pain, due to rotator cuff tendinitis.     

Physical and mental workload interactions in a sterile processing department

Work in healthcare facilities has been categorized as a high-risk job for developing Work-Related Musculoskeletal Disorders (WMSDs). Little attention has been given to the Sterile Processing Department (SPD) employees who are exposed to both mentally and physically demanding conditions, factors that may impose an elevated risk in the development of WMSDs. Previous studies have shown that WMSDs can be a result of complex interactions between physical, psychosocial, biological, and individual characteristics. However, the evidence of specific associations is still inconclusive. The objective of this study was to determine if the perception of mental workload causes workers to adopt more risky body postures. The study was carried out in four phases: 1) identification of musculoskeletal disorders using customized Nordic questionnaires, 2) ergonomic assessment of SPD using REBA method, 3) mental workload assessment of SPD using NASA-TLX, and 4) interaction between physical (postural risk) and mental workload through the performance of a task at two different levels of workload conducted through a controlled experiment. The findings indicate that increases in REBA scores and NASA-TLX indices were associated with days and conditions with higher workloads. Results showed evidence that increments on mental workload are related to worsening postures, increasing the risk of developing musculoskeletal disorders. These results serve to raise awareness and warn employees about the need to pause and analyze the way they perform their duties under high levels of workload in an attempt to reduce WMSDs risk in healthcare sector employees.     

Job enlargement and mechanical exposure variability in cyclic assembly work

Cyclic assembly work is known to imply a high risk for musculoskeletal disorders. To have operators rotate between work tasks is believed to be one way of decreasing this risk, since it is expected to increase variation in mechanical and psychological exposures (physical and mental loads). This assumption was investigated by assessing mechanical exposure variability in three assembly tasks in an electronics assembly plant, each on a separate workstation, as well as in a ‘job enlargement’ scenario combining all three stations. Five experienced operators worked for 1?h on each station. Data on upper trapezius and forearm extensor muscle activity were obtained by means of electromyography (EMG), and working postures of the head and upper arms were assessed by inclinometry. The cycle-to-cycle variance of parameters representing the three exposure dimensions: level, frequency and duration was estimated using ANOVA algorithms for each workstation separately as well as for a balanced combination of all three. For a particular station, the variability of trapezius EMG activity levels relative to the mean was higher than for extensor EMG: between-cycles coefficients of variation (CV) about 0.15 and 0.10, respectively. A similar relationship between CV applied to the parameter describing frequency of EMG activity. Except for head inclination levels, the between-cycles CV was larger for posture parameters than for EMG. The between-cycles variance increased up to six fold in the job enlargement scenario, as compared to working at only one station. The difference in mean exposure between workstations was larger for trapezius EMG parameters than for forearm extensor EMG and postures, and hence the effect of job enlargement on exposure variability was more pronounced for the trapezius. For some stations, job enlargement even implied less cycle-to-cycle variability in forearm extensor EMG parameters than working at that station only. Whether the changes in exposure variability associated with job enlargement were sufficient to imply a decreased risk for musculoskeletal disorders is not known.     

Physical,mental, emotional,and subjective workload components in train drivers

This study, using 12 train drivers on a high speed track and 11 drivers on a mountain track, tried to differentiate between the physical, emotional, mental, and subjective workload components imposed on the drivers during work. With the simultaneous recording and on-line analysis of heart rate and physical activity, the emotional component in terms of the so-called additional heart rate was separated from the physical component. Mental workload was calculated by the heart rate variability and by shifts in the T-wave amplitude of the ECG. Speed of the train, mode of driving, and stress of the situation were rated by two observers who accompanied the drivers in the cabin. During speeds up to l00km/h as compared to standstills no heart rate changes occurred, but with speeds from l00km/h up to 200 km/h heart rate decreased indicating a monotony effect. However, heart rate variability, and T-wave amplitude indicated higher mental load during driving in most speed categories. Starting the train and coming to a halt showed greater emotional workload as compared to moving. Observer ratings of stress and subjective ratings of stress by the drivers revealed several discrepancies. Discrepancies were also seen between workload as indicated by the physiological parameters, and corresponding stress ratings by the observers or by the drivers.     

Variability in mechanical exposure within and between individuals performing a highly constrained industrial work task

Data on exposure variability is an important remedy for designing and interpreting studies of occupational ergonomics. The present study aimed at retrieving the within- and between-subjects variance of several mechanical exposure parameters in a repeated, short-cycle task. Seven experienced operators repeatedly secured joints using two types of hand-held nutrunners. The joints were placed in three different locations on a rack, simulating automotive assembly. Bilateral muscle activity from the upper trapezius and the lower arm extensors, as well as head and upper arm inclination was continuously monitored. Exposure levels and their variance components were assessed in several data subsets using ANOVA. The results were interpreted in terms of statistical precision and power, and discussed as markers of important ergonomic qualities. A substantial exposure variability was found within and between subjects in all joint locations and for both tools. For mixed work across tools and locations, the necessary number of subjects to arrive at a group mean exposure with 95% confidence limits corresponding to ± 10% of the mean ranged between 8 and 158, with posture recordings tending to require smaller populations than muscle activity recordings. Within-subject variance increased 2- to 37-fold, depending on exposure parameter, when work was ‘enlarged’ from securings with a specified location and tool to a mix of all locations and tools. Systematic differences between subjects in variability and responsiveness to ‘work enlargement’ indicated individualized motor control strategies. The results illustrate the importance of exposure variability data to the design of proper measurement strategies. They also suggest that the sizes of exposure variability per se can be interpreted as operational indices of what is thought to be important ergonomic risk indicators, such as the ‘sameness’ of repeated operations and the allowance for flexible working techniques.     

Electromyography as a measure of peak and cumulative workload in intermediate care and its relationship to musculoskeletal injury: an exploratory ergonomic study

Injury rates in Intermediate Care (IC) facilities are high and the factors related to these injuries are unclear. The objectives of this exploratory sub-study, which is part of a large multi-faceted study in 8 IC facilities are to: (1) evaluate EMG measured over a full-shift in the back and shoulders of 32 care aides (CAs) as an indicator of peak and cumulative workload (n = 4 x 8 facilities); investigate the relationship between EMG measures and injury indicators; and explore the relationship between EMG measures and other workload measurements. Lumbar EMG was converted to predicted cumulative spinal compression and ranged in CAs from 11.7 to 22.8 MNs with a mean of 16.4 MNs. Average compression was significantly different during different periods of the day (p < 0.001) with highest compression during pre-breakfast when CAs assist most with activities of daily living. Significant differences were found in average compression between low and high injury facilities for 3 of 5 periods of the day (p < 0.010). Peak compressions exceeding 3400 N occurred for very little of the workday (e.g. 11.25s during the 75 min period pre-breakfast). Peak neck/shoulder muscle activity is low (99% APDF ranged from 8.33% to 28% MVC). Peak and cumulative spinal compression were significantly correlated with lost-time and musculoskeletal injury rates as well as with total tasks observed in the CAs (p < 0.01). Perceived exertion was only correlated with peak compressions (p < 0.01). Facilities with low injury rates provided significantly more CAs (p < 0.01) to meet resident needs, and subsequently CAs performed fewer tasks, resulting in less peak and cumulative spinal loading over the day.     

Electromyographic fatigue in neck/shoulder muscles and endurance in women with repetitive work

EMG was recorded with surface electrodes from the trapezius and deltoid muscles during a static endurance test at approximately 20% of maximal voluntary contraction. Objective parameters for localized muscular fatigue were derived from the time course of the root mean square (RMS) and mean power frequency (MPF) of the EMG recordings. Isotonic regression is introduced as a tool for assessment of such parameters. The most pronounced sign of fatigue for trapezius was an increase in the RMS values, while for deltoid it was a decrease in the MPF values. This could be explained by the different functions of the two muscles. The endurance time for a group of 11 women in industrial work with repetitive short-cycled work tasks who were diagnosed with neck/shoulder disorders (tension neck) was significantly shorter (p<0·05) than for a group with the same work, but without neck/shoulder disorders (n=ll), and shorter than for a control group (n=ll). Regarding the EMG fatigue measures, there were no significant differences between the three groups. We did not find any relationships between endurance time and the EMG parameters. The results indicate that neck/shoulder disorders were not associated with divergent mechanisms for developing fatigue in the muscles, as recorded with surface EMG.     

The effect of tool handle shape on hand muscle load and pinch force in a simulated dental scaling task

Work-related upper extremity musculoskeletal disorders, including carpal tunnel syndrome, are prevalent among dentists and dental hygienists. An important risk factor for developing these disorders is forceful pinching which occurs during periodontal work such as dental scaling. Ergonomically designed dental scaling instruments may help reduce the prevalence of carpal tunnel syndrome among dental practitioners. In this study, eight custom-designed dental scaling instruments with different handle shapes were used by 24 dentists and dental hygienists to perform a simulated tooth scaling task. The muscle activity of two extensors and two flexors in the forearm was recorded with electromyography while thumb pinch force was measured by pressure sensors. The results demonstrated that the instrument handle with a tapered, round shape and a 10 mm diameter required the least muscle load and pinch force when performing simulated periodontal work. The results from this study can guide dentists and dental hygienists in selection of dental scaling instruments.     

Relationship between trapezius load and the incidence of musculoskeletal illness in the neck and shoulder

A relationship between m. trapezius load measured by electromyography (EMG) and the incidence of musculoskeletal illness in the neck and shoulder regions, was investigated both for assembly workers and VDT operators. For assembly workers, the static trapezius load (probability 0.1 of the amplitude probability distribution function, APDF) was significantly reduced from 4.3% MVC (Maximum Voluntary Contraction) to 1.4% MVC as a group median value after an ergonomic adaptation of their work places. Musculoskeletal sickleave was significantly reduced from 22.9 days to 1.8 days as a medium duration per-man-labour year for the same group.

Three groups of VDT operators were examined in terms of trapezius load and pain intensity and duration before and after an ergonomic intervention. All groups reported significant less intensity or duration of pain either in the neck or in the shoulder regions after the intervention. The trapezius load was reduced for all groups post vs. prior intervention. This reduction was measured in terms of a decrease in the static level of APDF and an increase in the number of periods per minute and total duration of muscle activity below 1% MVC. The results from this study indicate that the trapezius load may be a predictor for development of musculoskeletal illness in the neck and shoulder regions.     

Vibrations transmitted from human hands to upper arm,shoulder, back,neck, and head

Some powered hand tools can generate significant vibration at frequencies below 25 Hz. It is not clear whether such vibration can be effectively transmitted to the upper arm, shoulder, neck, and head and cause adverse effects in these substructures. The objective of this study is to investigate the vibration transmission from the human hands to these substructures. Eight human subjects participated in the experiment, which was conducted on a 1-D vibration test system. Unlike many vibration transmission studies, both the right and left hand-arm systems were simultaneously exposed to the vibration to simulate a working posture in the experiment. A laser vibrometer and three accelerometers were used to measure the vibration transmitted to the substructures. The apparent mass at the palm of each hand was also measured to help in understanding the transmitted vibration and biodynamic response. This study found that the upper arm resonance frequency was 7–12 Hz, the shoulder resonance was 7–9 Hz, and the back and neck resonances were 6–7 Hz. The responses were affected by the hand-arm posture, applied hand force, and vibration magnitude. The transmissibility measured on the upper arm had a trend similar to that of the apparent mass measured at the palm in their major resonant frequency ranges. The implications of the results are discussed.Relevance to industryMusculoskeletal disorders (MSDs) of the shoulder and neck are important issues among many workers. Many of these workers use heavy-duty powered hand tools. The combined mechanical loads and vibration exposures are among the major factors contributing to the development of MSDs. The vibration characteristics of the body segments examined in this study can be used to help understand MSDs and to help develop more effective intervention methods.     

Risk of neck musculoskeletal disorders among males and females in lifting exertions

Work-related neck disorders are common among various occupational groups. Despite clear epidemiological evidence for the association of these disorders with forceful arm exertions, the effect of such exertions on the biomechanical behavior of the neck muscles is currently not well understood. In this study, the effect of lifting tasks on the biomechanical loading of neck muscles was investigated for males and females. Twenty-six participants (13 males and 13 females) performed bi-manual isometric lifting tasks at knuckle, elbow, shoulder, and overhead heights by exerting 25%, 50%, and 75% of their maximum strength. The activity of the cervical trapezius and sternocleidomastoid muscles was recorded bilaterally using surface electromyography. Higher activity of the cervical trapezius muscle (10% MVC–43% MVC) compared to the sternocleidomastoid muscle (4% MVC–18% MVC) was observed. Females tend to use the sternocleidomastoid muscle to a greater extent than males, whereas, higher cervical trapezius muscle activation was observed for males than females. The main effect of weight and height, and weight by height interaction on the activity of neck muscles was statistically significant (all p < 0.001). The results of this study demonstrate that the neck muscles play an active role during lifting activities and may influence development of musculoskeletal disorders due to resulting physiological changes.     

Physical workload and psychosocial working conditions in Swedish pig transport drivers

Working conditions of 20 Swedish pig transport drivers (PTD) were assessed by a questionnaire, a workshop, and recorded postures and movements during on-farm loading, driving, unloading at abattoir and vehicle cleaning. High arm positions and high frequencies of shoulder problems indicated an excessive physical load on shoulders. Extreme crouching postures inside vehicles and high frequencies of lower back problems indicated high load on the back of PTDs. Inadequate design of on-farm loading areas was associated with knee discomfort. Observed variation in workload between PTDs could be explained by differences in physical working environment and pig handling practices. PTDs reported high job satisfaction and commitment although conflicts with farmers and official veterinarians, as well as regulatory conflicts were emphasized. We conclude that issues of inadequate farm and abattoir facilities, stakeholder conflicts and insufficient training in animal handling need to be addressed to ensure sustainable PTD working conditions.     

An evaluation of a lane support system for bus rapid transit on narrow shoulders and the relation to bus driver mental workload

The use of dedicated bus shoulders is a key method for implementing bus rapid transit (BRT) in areas that do not have the space for additional infrastructure. However, the narrow width of the bus shoulder and the need to anticipate traffic hazards in the adjacent lane can both be significant stressors for bus drivers. Bus driver mental workload and stress in response to these conditions should be a significant concern both for operational safety and driver health.

This pilot study evaluated the potential stressors of traffic density and shoulder width in the context of an express BRT service in a large US metropolitan area. In addition, the study considered the potential role of a prototype lane support system (LSS) to support vehicle control within the narrow shoulder boundaries. Ten experienced bus drivers drove an actual route with an instrumented bus equipped with and without LSS. Self-reported effort was recorded along with performance measures of speed and position control relevant to mobility and safety objectives.

Bus drivers did note stressors in the BRT environment and the prototype LSS. However, the use of the shoulder during high-density traffic conditions did improve mobility. Moreover, the LSS did enhance safety on the shoulder when there was high-density traffic in the adjacent lane. However, there was no evidence that the LSS reduced bus driver workload while operating in the narrow shoulder. Future research should consider the impact of BRT operations and support systems on bus driver mental workload and stress, and support the deployment of such devices for bus operations on shoulders during high traffic volumes.