The influence of skill and low back pain on trunk postures and low back loads of shearers

Shearing is a rural occupation developing considerable spinal loads and carrying a high risk of low back pain (LBP). Although the workforce has a skill structure, interaction between skill, spinal loads and LBP is unknown. We examined whether skill and LBP influenced trunk postures and loads within a sample of 80 shearers representing shear skill levels. A progression from junior to open class demonstrated a 100% increase in productivity, less time in severe flexion, more time in neutral lateral bend, and more time in axially twisted postures, with no increase in cumulative compressive and anterior shear forces. LBP prevalence increased linearly from 10% for junior through to 76% for open class shearers. Shearers with a history of LBP generated greater cumulative right medio-lateral shear forces, greater left lateral bend and left axial twist moments. Skill-based training that reduces asymmetric forces may help reduce such high prevalence levels of LBP.

Statement of Relevance: Shearing is an important and physically demanding rural occupation. It requires sustained flexed postures that generate considerable spinal loads and a high risk of LBP. This research examines how skill and a history of LBP it carries interact to influence trunk postures and spinal loads within a sample of shearers.     

The 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.     

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

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

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

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.     

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

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

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

Low back pain in farmers: The association with agricultural work management,disability, and quality of life in Korean farmers

This study aimed to identify the associations among low back pain (LBP), LBP‐related disability, agricultural working condition management, and quality of life (QOL) in Korean farmers. Demographic information, agricultural work management, and outcomes of LBP were obtained by standardized questionnaires (Oswestry Disability Index [ODI] for disability and European Quality of Life‐5 Dimensions‐3‐Level version [EQ‐5D‐3L] for QOL). Presence of LBP was determined if the LBP had lasted longer than 1 week or had been more frequent than once a month, and presence of LBP‐related disability was determined if the ODI score was more than 12. Poor health checkups (OR [odds ratio] = 1.70–86, p < .05), were positively associated with LBP, and working at dawn (OR = 1.85–1.96, p < .05), was positively associated with LBP‐related disability after adjusting related demographic factors. EQ‐5D‐3L indexes were significantly lower in participants with LBP (0.83 ± 0.17 vs. 0.92 ± 0.06, p < .001) and disability (0.81 ± 0.18 vs. 0.93 ± 0.05, p < .001). This study showed that the presence of LBP was related to poor health checkups and that LBP‐related disability was related to a poor working time schedule. These results indicate poor QOL and suggest the need for coping strategies such as regular health checkups and a proper working time schedule.     

Stand up: comparison of two electrical screed levelling machines to reduce the work demands for the knees and low back among floor layers

Electrical screed levelling machines are developed to reduce kneeling and trunk flexion of sand–cement-bound screed floor layers. An observational intervention study among 10 floor layers was performed to assess the differences between a self-propelled and a manually moved machine. The outcome measures were work demands, production time, perceived load, discomfort and applicability. Compared to the self-propelled machine, the duration of kneeling (?13 min; p = 0.003) and trunk flexion (?12 min; p < 0.001) was shorter using the manually moved machine, and the duration of pushing and pulling increased (?39 min; p < 0.001). No significant or relevant differences were found for production time, perceived load and discomfort. Nine out of ten floor layers found the manually moved machine applicable and three out of ten found the self-propelled machine applicable. When compared with the traditional manner of floor laying, both electrical machines reduced the exposure towards kneeling and trunk flexion.

Practitioner Summary: Electrical machines may help to reduce high physical work demands on floor layers. A manually moved machine is better applicable for the installation of screed floors in residences with smaller floor areas. A self-propelled machine is better applicable on large floor areas with a minimum width of 4 m.     

Effect of a desk attachment board on posture and muscle activity in women during computer work

Working at a computer is part of a large number of jobs and has been associated with upper extremity musculoskeletal disorders and back pain. The study evaluated the effects of a board attachment on upper extremity and back. The findings are mixed in that the board may have a positive effect in preventing back pain, but may be detrimental to upper extremities. Effect of a desk attachment board on upper extremity and trunk posture, and muscle activity was assessed in women video display terminal users. Participants completed a standard 20-min computer task under two conditions: 1) using a standard desk; 2) using a desk attachment board designed to support the forearms. Bilateral electromyography of the trapezius, multifidus and longissimus muscles and the right anterior deltoid and forearm extensor muscles was recorded. 3-D trunk and upper extremity posture was monitored. Participants were tested before and after 2 weeks of familiarisation with the board in their workplace. Perceived tension and discomfort were recorded before and after use of the board. Use of the board tended to increase muscle activity in the right trapezius and forearm extensor and to decrease muscle activity in the back. Perceived tension in the low back decreased slightly with the board. The board may be useful in reducing tension in the low back during computer work, but may adversely affect the upper extremities.     

Effects of chronic low back pain,age and gender on vertical spinal creep

This study investigated the effect of chronic low back pain, age, gender, and time of measurement on the magnitude of vertical spinal creep (VSC) and its recovery. A mixed design, involving three independent variables (chronic low back pain, age, and gender) and one repeated variable (time), was used. One hundred and six subjects of both genders, with and without chronic low back pain, aged between 20 and 60 years, participated in the study. The measurement of VSC and its recovery was performed using a seated stadiometer that allowed continuous measurement of VSC without changing the subject's posture over 25 min. Unloaded VSC was measured during the initial 5 min, followed by 10 min with an additional load of 15% of the subject's body weight and then for a further 10 min after the removal of the load. Subjects were grouped into one of eight categories according to the presence of chronic low back pain, age (20–39 years or 40–60 years) and gender. Repeated measures analysis of variance was computed. A significant increase in VSC with time of measurement was observed (p<0.001). No significant main effects for chronic low back pain, age, or gender were found at any time during the 25-min VSC testing protocol. Significant interactions were found between age and gender during the loaded (p = 0.02) and unloaded (p = 0.02) phases. A significant interaction was found between chronic low back pain and gender at the end of the unloaded phase (p = 0.04). These findings suggest a combined influence of chronic low back pain, age, and gender on VSC and its recovery and that the dominance of each variable changed with the time of the measurement. Thus, subjects who differ in the presence of chronic low back pain, age, and gender should not be combined for statistical analysis of VSC and its recovery.     

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.     

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

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

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.     

The impact of office chair features on lumbar lordosis,intervertebral joint and sacral tilt angles: a radiographic assessment

Abstract

Background: The purpose of this study was to determine which office chair feature is better at improving spine posture in sitting. Method: Participants (n = 28) were radiographed in standing, maximum flexion and seated in four chair conditions: control, lumbar support, seat pan tilt and backrest with scapular relief. Measures of lumbar lordosis, intervertebral joint angles and sacral tilt were compared between conditions and sex. Results: Sitting consisted of approximately 70% of maximum range of spine flexion. No differences in lumbar flexion were found between the chair features or control. Significantly more anterior pelvic rotation was found with the lumbar support (p = 0.0028) and seat pan tilt (p < 0.0001). Males had significantly more anterior pelvic rotation and extended intervertebral joint angles through L1–L3 in all conditions (p < 0.0001). Conclusion: No one feature was statistically superior with respect to minimising spine flexion, however, seat pan tilt resulted in significantly improved pelvic posture.

Practitioner Summary: Seat pan tilt, and to some extent lumbar supports, appear to improve seated postures. However, sitting, regardless of chair features used, still involves near end range flexion of the spine. This will increase stresses to the spine and could be a potential injury generator during prolonged seated exposures.     

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.     

Little effect of transfer technique instruction and physical fitness training in reducing low back pain among nurses: a cluster randomised intervention study

The aim of this study was to evaluate the effect of a transfer technique education programme (TT) alone or in combination with physical fitness training (TTPT) compared with a control group, who followed their usual routine. Eleven clinical hospital wards were cluster randomised to either intervention (six wards) or to control (five wards). The intervention cluster was individually randomised to TT (55 nurses) and TTPT (50 nurses), control (76 nurses). The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues. The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks. Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not, when compared to a control group, show any statistical differences according to self-reported low back pain (LBP), pain level, disability and sick leave at a 12-month follow-up. However, the individual randomised intervention subgroup (transfer technique/physical training) significantly improved the LBP-disability (p = 0.001). Although weakened by a high withdrawal rate, teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered. Other priorities such as physical training may be taken into consideration. The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP. However, physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel.     

Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day

A relationship between low back pain (LBP) and prolonged standing or prolonged sitting at work has not been clearly shown, despite its biological plausibility. Because sitting and standing postures vary as to duration and freedom to alternate postures, and standing postures vary as to mobility, associations between specific working postures and LBP were explored using multiple logistic regression. Associations between work factors and self-reported LBP during the previous 12 months that interfered with usual activities were examined among 4493 standing workers and 3237 sitting workers interviewed in the 1998 Quebec Health and Social Survey; 24.5% reported significant LBP. Since the same conditions can correspond to different physiological demands for sitting compared with standing workers, analyses were performed separately for the two groups. Standing without freedom to sit was associated with LBP. Different occupational physical and psychosocial factors were associated with LBP in sitting compared with standing populations.     

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.     

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

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

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

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

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

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

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

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