Analysis of upper-limb muscle fatigue in the process of rotary handling

Workers engaged in repetitive manual material handling (MMH) generally suffer from work-related musculoskeletal disorders (WMSDs), particularly in the arms, shoulders, neck, and waist; this significantly limits the individual's strength and ability to work. Currently, research on upper-limb injuries affecting manufacturing workers focusses on the effect of different working conditions on specific muscle fatigue. However, research on the fatigue transformation relationship among various muscles in the process of working is lacking. Therefore, the purpose of this study was to investigate the fatigue changes between the upper-limb muscles during rotary handing. In this study, 13 male subjects were studied to simulate rotating handling during the manual handling process using surface electromyography (sEMG). Handling angles of 90°, 45°, and 0° were arranged as single variables to conduct the single-factor experiment. The sEMG of the brachioradialis, biceps brachii, trapezius, and multifidus muscle was measured during the operation. The results of this study indicate that the characteristics of muscle fatigue are different at different rotation angles: the multifidus muscle and trapezius were fatigued when the rotation was 90°. Under the condition of a 45° rotation, the activities of the four muscles fluctuated significantly. The slope of the median frequency of the muscles was positive, the load of the four muscles was evenly distributed, and no local fatigue was observed. Under the condition of a 0° rotation, the sEMG indicated that the brachioradialis muscle was fatigued, while the other three muscles had lower loads.     

Relationship between leg and back strength with inter-joint coordination of females during lifting

The role of strength and fatigue in the lifting technique is not very clear, especially with regards to inter-joint coordination. We examined the relationships between muscle strength and endurance with inter-joint coordination of the knee-hip (KH) and hip-back (HB) during a lifting task performed until exhaustion. Thirteen healthy females were recruited to participate in the study. Significant negative correlations were found between HB maximum relative phase angle and leg lifting strength (r = −0.805), knee extensor strength (r = −0.705), knee flexor strength (r = −0.633), back extensor strength (r = −0.593) and back flexor strength (r = −0.596). The greater the strength of these muscles, the more synchronized the hip-back inter-joint coordination. However, no significant relationships were found with endurance test performance. Moreover, although the lifting task induced muscle fatigue, there were no significant fatigue-induced changes in lifting coordination.     

Strength,endurance and fatigue response of rotator cuff muscles during isometric exertions

Among the shoulder musculoskeletal disorders (MSDs), rotator cuff disorders are prevalent and known to substantially limit an individual's strength and ability to work. Despite the frequency and cost of rotator cuff injuries, very little research has been done on understanding the load response relationship of rotator cuff muscles. Therefore, this study was aimed at evaluating the strength, endurance and fatigue response of rotator cuff muscles. As a first step, strengths of Supraspinatus, Infraspinatus, and Teres Minor were measured for ten healthy male participants using muscle specific Maximum Voluntary Contractions (MVC). Then, endurance time and surface Electromyography (EMG) data were recorded during 15%, 30%, 45%, and 60% MVC exertions. Infraspinatus exhibited the highest strength followed by Teres Minor and Supraspinatus. Despite the strength differences, small variations were observed in the endurance time between the muscles. The effect of %MVC exertions on endurance time, average muscle activity and muscle fatigue were statistically significant. Median frequency decreased and muscle activation increased with an increase in force exertion levels; however, the changes observed for an increase in the exertion level from 15% to 30% MVC were much higher than the changes observed for an increase in the exertion level from 45% to 60% MVC.Relevance to industryResults of this study indicate that the rotator cuff muscles have different strengths but exhibit very similar endurance and fatigue behavior. These findings can assist ergonomic practitioners with the design and/or evaluation of workplace upper extremity exertions to reduce/manage stress on the rotator cuff muscles and shoulder.     

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

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

A randomized and controlled trial of a participative ergonomics intervention to reduce injuries associated with manual tasks: physical risk and legislative compliance

A participative ergonomics approach to reducing injuries associated with manual tasks is widely promoted; however only limited evidence from uncontrolled trials has been available to support the efficacy of such an approach. This paper reports on a randomized and controlled trial of PErforM, a participative ergonomics intervention designed to reduce the risks of injury associated with manual tasks. One hundred and seventeen small to medium sized food, construction, and health workplaces were audited by government inspectors using a manual tasks risk assessment tool (ManTRA). Forty-eight volunteer workplaces were then randomly assigned to Experimental and Control groups with the Experimental group receiving the PErforM program. Inspectors audited the workplaces again, 9 months following the intervention. The results showed a significant decrease in estimates of manual task risk and suggested better legal compliance in the Experimental group.     

Cart pushing: The effects of magnitude and direction of the exerted push force, and of trunk inclination on low back loading

The primary objective of the present study was to quantify the relative effect of the magnitude and direction of the exerted push force and of trunk inclination on the mechanical load at the low back using a regression analysis for correlated data. In addition, we explored the effects of handle height and type of pushing activity (standing or walking) on the magnitude and direction of exerted forces, trunk inclination, and low back loading when pushing a four-wheeled cart on a treadmill. An experimental setup was designed in which nine participants pushed a four-wheeled cart on a treadmill. Kinematics and reaction forces on the hand were measured to calculate the net moment at the L5–S1 intervertebral disc. Results show that the magnitude and direction of the exerted push force and the trunk inclination significantly and independently affect low back load. It is concluded that for the ergonomic evaluation of pushing tasks, the inclination of the trunk should be considered, in addition to the magnitude and direction of exerted forces.

Relevance to industry

Pushing carts is a common activity for a considerable part of the workforce and has been associated with musculoskeletal complaints. This paper shows that not only the magnitude of exerted forces determines the low back load but also the direction of the exerted forces and the inclination of the trunk should be considered for ergonomic evaluation.     

Muscle fatigue modelling: Solving for fatigue and recovery parameter values using fewer maximum effort assessments

A three-compartment controller model (3CC) predicts muscle fatigue development. Determination of fatigue (F) and recovery (R) model parameters is critical for model accuracy. Numerical methods can be used to determine parameter values using maximum voluntary contractions (MVCs) as input. We tested the effects of using reduced MVC data on parameter solutions using twenty published datasets of intermittent, isometric contractions. The work here examines three sampling variations using approximately half of the MVCs: MVC measurements distributed equally (dMVC), split between the initial and final times (sMVC), and only during the first half (fMVC). Furthermore, solved F and R parameters were used to model fatigue development for three hypothetical task scenarios. Both model parameters and predictions were statistically insensitive to measured data reduction using dMVC, followed closely by sMVC. However, using the fMVC reduction frequently resulted in overestimated parameter values and produced significantly larger prediction errors. We conclude that parameter solutions are robust when using fewer MVCs as long as they are sampled in a manner that captures later fatigue behavior.     

Psychophysically determined forces of dynamic pushing for female industrial workers: Comparison of two apparatuses

Using psychophysics, the maximum acceptable forces for pushing have been previously developed using a magnetic particle brake (MPB) treadmill at the Liberty Mutual Research Institute for Safety. The objective of this study was to investigate the reproducibility of maximum acceptable initial and sustained forces while performing a pushing task at a frequency of 1 min⁻¹ both on a MPB treadmill and on a high-inertia pushcart. This is important because our pushing guidelines are used extensively as a ergonomic redesign strategy and we would like the information to be as applicable as possible to cart pushing. On two separate days, nineteen female industrial workers performed a 40-min MPB treadmill pushing task and a 2-hr pushcart task, in the context of a larger experiment. During pushing, the subjects were asked to select a workload they could sustain for 8 h without “straining themselves or without becoming unusually tired, weakened, overheated or out of breath.” The results demonstrated that maximum acceptable initial and sustained forces of pushing determined on the high inertia pushcart were 0.8% and 2.5% lower than the MPB treadmill. The results also show that the maximum acceptable sustained force of the MPB treadmill task was 0.5% higher than the maximum acceptable sustained force of Snook and Ciriello (1991). Overall, the findings confirm that the existing pushing data developed by the Liberty Mutual Research Institute for Safety still provides an accurate estimate of maximal acceptable forces for the selected combination of distance and frequency of push for female industrial workers.     

A novel approach for determining fatigue resistances of different muscle groups in static cases

In ergonomics and biomechanics, muscle fatigue models based on maximum endurance time (MET) models are often used to integrate fatigue effect into ergonomic and biomechanical application. However, due to the empirical principle of those MET models, the disadvantages of this method are: 1) the MET models cannot reveal the muscle physiology background very well; 2) there is no general formation for those MET models to predict MET. In this paper, a theoretical MET model is extended from a simple muscle fatigue model with consideration of the external load and maximum voluntary contraction in passive static exertion cases. The universal availability of the extended MET model is analyzed in comparison to 24 existing empirical MET models. Using mathematical regression method, 21 of the 24 MET models have intraclass correlations over 0.9, which means the extended MET model could replace the existing MET models in a general and computationally efficient way. In addition, an important parameter, fatigability (or fatigue resistance) of different muscle groups, could be calculated via the mathematical regression approach. Its mean value and its standard deviation are useful for predicting MET values of a given population during static operations. The possible reasons influencing the fatigue resistance were classified and discussed, and it is still a very challenging work to find out the quantitative relationship between the fatigue resistance and the influencing factors.

Relevance to industry

MSD risks can be reduced by correct evaluation of static muscular work. Different muscle groups have different properties, and a generalized MET model is useful to simplify the fatigue analysis and fatigue modeling, especially for digital human techniques and virtual human simulation tools.     

The effect of a resistance-training program on muscle strength, physical workload, muscle fatigue and musculoskeletal discomfort: An experiment

The aim of the study was to investigate the effectiveness of a resistance-training program on muscle strength of the back and neck/shoulder muscles, relative physical workload, muscle fatigue and musculoskeletal discomfort during a simulated assembly and lifting task. Twenty-two workers were randomized over an 8-week resistance-training group, and a control group. Isokinetic muscle strength was assessed using the Cybex dynamometer, muscle fatigue was measured using EMG, and perceived discomfort was measured using a 10-point scale. At the follow-up, we found no effect of the resistance-training program on isokinetic muscle strength of the back and shoulder muscles. Furthermore, we did not find any effect on EMG data, nor on musculoskeletal discomfort during the simulated work tasks. However, trained workers performed the lifting tasks for a longer time before reporting considerable discomfort than those in the control group.     

Detecting within- and between-day manifestations of neuromuscular fatigue at work: an exploratory study

Cumulative neuromuscular fatigue may result from exposure to physically demanding work, such as repetitive and/or sustained work with insufficient recovery. The aims of this exploratory study were to develop a battery of field usable fatigue measures and to document hand/arm fatigue in physically demanding work over multiple workdays and after a weekend break. Sixteen plumbers were observed for five days and measures of handgrip force, variability, tremor and discomfort were obtained pre-, mid- and post-shift. This exploratory study demonstrated increasing fatigue of the hand/arm over the day and persistent fatigue from Tuesday to Friday, and that a number of the measures did not return to baseline values following a weekend break. The findings provide preliminary evidence of cumulative fatigue in residential plumbing and insight into neuromuscular fatigue measurement. However, further work is needed to develop and refine a set of fatigue measures to detect neuromuscular fatigue at the workplace.     

The influence of age on isometric endurance and fatigue is muscle dependent: a study of shoulder abduction and torso extension

The present study examined differences in isometric muscle capacity between older (55–65 years) and younger (18 – 25 years) individuals. A total of 24 younger and 24 older participants (gender balanced within each group) performed sustained shoulder abductions and torso extensions to exhaustion at 30%, 50% and 70% of individual maximal voluntary contraction (MVC). Along with endurance time, manifestations of localized fatigue were determined based on changes in surface electromyographic signals obtained from the shoulder (middle deltoid) and the torso (multifidus and longissimus thoracis) muscles. Strength recovery was monitored using post-fatigue MVCs over a 15-min period. Compared to the younger group, older individuals exhibited lower muscular strength, longer endurance time and slower development of local fatigue. Age effects on fatigue were typically moderated by effort level, while effects of gender appeared to be marginal. Non-linear relationships between target joint torque and endurance time were observed, with effects of age differing between shoulder abduction and torso extension. Overall, the effects of age on endurance and fatigue were more substantial and more consistent for the shoulder muscle than for the torso muscles and were likely related to differences in muscle fibre type composition. For strength recovery rates, no significant age or gender effects were found in either experiment. In summary, this study suggests that differences in isometric work capacity do exist between older and younger individuals, but that this effect is influenced by effort level and the muscle tested.     

Revisited: Comparison of two techniques to establish maximum acceptable forces of dynamic pushing for male industrial workers

The purpose of this experiment was to replicate a previous psychophysical experiment [Ciriello, V.M., McGorry, R.W., Martin, S.E., Bezverkny, I.B., 1999b. Maximum acceptable forces of dynamic pushing: comparison of two techniques. Ergonomics 42, 32–39] which investigated maximum acceptable initial and sustained forces while performing a 7.6 m pushing task at a frequency of 1 min⁻¹ on a magnetic particle brake treadmill versus pushing on a high-inertia pushcart. Fourteen male industrial workers performed both a 40-min treadmill pushing task and a 2-h pushcart task, with a unique water loading system, in the context of a larger experiment. During pushing, the subjects were asked to select a workload they could sustain for 8 h without “straining themselves or without becoming unusually tired, weakened, overheated or out of breath.” The results revealed that similar to the previous study maximum acceptable sustained forces of pushing determined on the high inertia cart were significantly higher (21%) than the forces determined from the magnetic particle brake treadmill. These results were countered by an 18% decrease in maximum acceptable forces for the criterion magnetic particle brake treadmill task, perhaps due to secular changes in the industrial population. Based on the present findings, it is concluded that the existing pushing data [Snook, S.H., Ciriello, V.M., 1991. The design of manual tasks: revised tables of maximum acceptable weights and forces. Ergonomics 34, 1197–1213] still provides an accurate estimate of maximal acceptable forces for this pushing distance and frequency.

Relevance to industry

Jobs are often redesigned to eliminate lifting and to include carts for transporting loads. Our database on maximum acceptable forces of pushing on a magnetic particle braked treadmill has been used as a tool to design manual handling tasks. This article links the existing database with actual cart pushing.     

A target-based population approach for determining the risk of injury associated with manual pushing and pulling

A new procedure for determining the risk of injury associated with manual pushing and pulling was developed based upon characteristics of the user population (i.e. age, gender and stature) and task requirements (i.e. working height, task frequency and travel distance). The procedure has been integrated into international (ISO, 2004) and European (CEN, 2004) standards for determining recommended force limits for pushing and pulling that can be adapted to suit the user population. These limits consider the muscular strength of the intended target population, as well as the compressive loads on the lumbar spine. Examples are provided to demonstrate variability of the proposed ‘safety’ limits for different task scenarios.

Relevance to industry

The manual handling of physical loads are known risk factors associated with work-related musculoskeletal disorders (WMSD). These disorders are common throughout the industry and may incur considerable costs to both the employer and the employee. The new risk rating procedure enables pushing and pulling tasks to be more closely aligned to the capabilities of the user population and, therefore, has an important role to play in helping to reduce the suffering and costs associated with these disorders.     

Muscle fatigue during intermittent isokinetic shoulder abduction: Age effects and utility of electromyographic measures

Most existing evidence regarding the effects of age on muscular fatigue has focused on prolonged isometric contractions, repeated maximum dynamic contractions and individuals beyond traditional retirement age (>65 years). In the present study, age-related differences in muscle fatigue during submaximal dynamic efforts were examined. There were 24 younger (18–25 years) and 24 older (55–65 years) participants, all of whom were healthy and active, with equal numbers of each gender within each age group. Participants performed repetitive, intermittent shoulder abductions until exhaustion, at peak moments of 30% and 40% of individual maximum voluntary isokinetic contraction (MVIC) and with cycle durations of 20 and 40 s. Fatigue development was determined based on changes in MVIC, electromyographic (EMG) signals and ratings of perceived discomfort (RPD). Following the exhaustive exercises, strength recovery was monitored using a series of MVICs over a 15-min period. Results indicated the existence of an age-related fatigue resistance, with the older group demonstrating significantly slower rates of MVIC decline and RPD increase and smaller modifications in EMG-based fatigue measures. These age effects were generally more pronounced at the higher effort level. Main effects of effort level and cycle duration were also significant, while gender effects appeared to be marginal. Rates of strength recovery were not significantly influenced by age. In addition, the utility of standard EMG-based fatigue measures was assessed. Findings indicated that time-dependent changes in static and dynamic EMG-based measures were roughly comparable in terms of sensitivity and variability, supporting the use of standard EMG analyses for fatigue monitoring during intermittent dynamic contractions.     

Analysis of lumbar spine injury with different back inclinations under whole-body vibration: A finite element study based on whole human body models

Whole-body vibration was found to be a cause of low back pain. Different back inclinations might change the forces on the lumbar spine, resulting in different responses to the vibration. The aim of this study was to investigate the effects of back inclinations on the lumbar spine from the perspective of analysing the internal loads and deformations on the intervertebral discs. Whole human body finite element models at 90°, 95°, 100°, 105°, 110° and 115° inclinations were used to provide a whole-body condition when predicting the behaviour of the lumbar spine. Von Mises stress on the annulus fibrosus, intradiscal pressure, and intervertebral disc height were extracted. The Risk Factors were calculated to evaluate the spinal injury risk under long-term vibration conditions. The results showed that the internal loads and deformations on the intervertebral disc decreased and then increased with the increase of the inclination, and the responses were lower at the 95° and 100° inclinations. The Risk Factors at different inclinations at the 3 Hz load were 0.61, 0.49, 0.53, 0.58, 0.58, and 0.69, respectively, at the 7 Hz load were 0.97, 0.66, 0.71, 0.86, 0.87, and 0.97, respectively, which also showed that injury risk was at a lower level at 95° and 100° inclinations. This study found a relationship between injury risk and back inclination. Occupational drivers are advised to choose a back inclination between 95° and 100° to reduce the possible adverse effects of whole-body vibration during the working condition.     

The implications of probability matching for clinician response to vital sign alarms: a theoretical study of alarm fatigue

Alarm fatigue has been recognised as a significant health technology safety risk. ‘Probability matching’, in which clinicians respond to the alarm at a rate identical to the perceived reliability of the alarm, has been postulated as a model to explain alarm fatigue. In this article, we quantitatively explore the implications of probability matching for systolic blood pressure alarms. We find that probability matching could have a profound effect on clinician response to the alarm, with a response rate of only 8.6% when the alarm threshold is 90 mm Hg and the optimal threshold for a systolic blood pressure alarm would only be 77 mm Hg. We use the mathematical framework to assess a mitigation strategy when clinicians have a limit to the capacity to respond. We find that a tiered alarm in which clinicians receive information on the severity of vital sign perturbation significantly improves the opportunity to rescue patients.

Practitioner Summary: Using a theoretical model, we predict that probability matching, a postulated model of clinician behaviour, can result in a profound decrease in clinician response to alarms for decreased blood pressure. A mitigating strategy is to create alarms that convey information on the degree of vital sign perturbation.     

Research to reality: a critical review of the validity of various criteria for the prevention of occupationally induced low back pain disability

Criteria have been suggested to reduce the incidence, or severity of low back pain disability. Five underlying theories for such criteria have been identified in the literature, and a critical review of the validity of these criteria has been carried out. Despite attributions elsewhere, peer-reviewed validation of the various criteria range from modest to nil. The need for a validation criterion for use in workplace design in order to reduce low back pain disability, or severity, is identified and the need for an international protocol to allow cross-study validation of present and future criteria is suggested.