Association between spinal loads and the psychophysical determination of maximum acceptable force during pushing tasks

The objective of this study was to investigate potential associations between an individual's psychophysical maximum acceptable force (MAF) during pushing tasks and biomechanical tissue loads within the lumbar spine. Ten subjects (eight males, two females) pushed a cart with an unknown weight at one push every two minute for a distance of 3.9 m. Two independent variables were investigated, cart control and handle orientation while evaluating their association with the MAF. Dependent variables of hand force and tissue loads for each MAF determination and preceding push trial were assessed using a validated, electromyography-assisted biomechanical model that calculated spinal load distribution throughout the lumbar spine. Results showed no association between spinal loads and the MAF. Only hand forces were associated with the MAF. Therefore, MAFs may be dependent upon tactile sensations from the hands, not the loads on the spine and thus may be unrelated to risk of low back injury.

Practitioner Summary: Pushing tasks have become common in manual materials handling (MMH) and these tasks impose different tissue loads compared to lifting tasks. Industry has commonly used the psychophysical tables for job assent and decision of MMH tasks. However, due to the biomechanical complexity of pushing tasks, psychophysics may be misinterpreting risk.     

Assessment of engineering controls designed for handling unstable loads: An electromyography assessment

Low back injury due to manual lifting is historically prevalent in labor intensive industries. Improving risk management options is necessary to reduce the risk of low back injury. Workers lifting unstable loads are at greater risk of back injury compared to workers lifting stable loads. This study focused on the effect of engineering controls on trunk muscle activity. Engineering controls were designed to control the instability of a liquid load. Thirty-nine healthy subjects manually lifted asymmetrically in the transverse direction stable loads, unstable loads, and unstable loads with engineering controls. Trunk and load kinematic and trunk muscle electromyography data were collected during lifting. Unstable loads with engineering controls significantly (p < 0.001) reduced trunk muscle activity compared to unstable loads. Engineering controls should be implemented to reduce the risk of injury to workers handling unstable liquid loads.Relevance to industryManually handling containers filled with liquids is necessary in many industrial workplaces. Risk management solutions for low back injury due to manual lifting of such loads should focus on reducing muscular demand. This study demonstrates that engineering controls designed to increase the stability of a liquid load reduced muscular demand.     

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

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

Dynamic biomechanical modelling of symmetric and asymmetric lifting tasks in restricted postures

This article describes investigations of dynamic biomechanical stresses associated with lifting in stooping and kneeling postures. Twelve subjects volunteered to participate in two lifting experiments each having two levels of posture (stooped or kneeling), two levels of lifting height (350 or 700 mm), and three levels of weight (15,20, or 25 kg). One study examined sagitally symmetric lifting, the other examined an asymmetric task. In each study, subjects lifted and lowered a box every 10 s for a period of 2 min in each treatment combination. Electromyography (EMG) of eight trunk muscles was collected during a specified lift. The EMG data, normalized to maximum extension and flexion exertions in each posture, was used to predict compression and shear forces at the L3 level of the lumbar spine. A comparison of symmetric and asymmetric lifting indicated that the average lumbar compression was greater in sagittal plane tasks; however, both anterior-posterior and lateral shear forces acting on the lumbar spine were increased with asymmetric lifts. Analysis of muscle recruitment indicated that the demands of lifting asymmetrically are shifted to ancillary muscles possessing smaller cross-sectional areas, which may be at greater risk of injury during manual materials handling (MMH) tasks. Model estimates indicated increased compression when kneeling, but increased shear forces when stooping. Increasing box weight and lifting height both significantly increased compressive and shear loading on the lumbar spine. A multivariate analysis of variance (MANOVA) indicated complex muscle recruitment schemes—each treatment combination elicited a unique pattern of muscle recruitment. The results of this investigation will help to evaluate safe loads for lifting in these restricted postures.     

Fatigue influences the dynamic stability of the torso

Fatigue in the extensor muscles of the torso affects neuromuscular recruitment and control of the spine. The goal of this study was to test whether fatigue influences stability of dynamic torso movements. A controlled laboratory experiment measured the change in the maximum finite-time Lyapunov exponent, lambda(max), before and after fatigue of the extensor muscles. Non-linear analyses were used to compute stability from the embedding dimension and Lyapunov exponent recorded during repetitive dynamic trunk flexion tasks. Torso extensor muscles were fatigued to 60% of their unfatigued isometric maximum voluntary exertion force then stability was re-measured. Independent variables included fatigue, task asymmetry and lower-limb constraint. lambda(max) values increased with fatigue suggesting poorer dynamic stability when fatigued. Embedding dimension declined with fatigue indicating reduced dynamic complexity when fatigued. Fatigue-related changes in spinal stability may contribute to the risk of low-back injury during fatiguing occupational lifting tasks. The findings reported here indicate that one mechanism by which fatigue contributes to low back disorders may be spinal instability. This information may contribute to the development of ergonomic countermeasures to help prevent low back disorders.     

Load spatial pathway and spine loading: how does lift origin and destination influence low back response?

While heavy lifting has been identified as an important risk factor for low back disorders, little is known about workplace spatial layout – the relative positions of shelves and the impact of this on spine loads. The objective of the current study was to investigate how the relative positions of the load origin and destination impact three-dimensional spine loads. Seven females and seven males lifted an 11.4?kg box from an origin shelf to a destination shelf, each defined by height (elbow, knee and shoulder level) and asymmetry (60° clockwise, sagittally symmetric, 60° counter-clockwise) while their spine loading was assessed by an electromyographic-assisted model. The results indicated that the starting and destination heights and starting task asymmetry all had significant impact on spine compression (with an increase of between 400 and 1900?N when compared to the most neutral position) and lateral shear (with a 100 to 150?N increase) while the destination height impacted the anterior?–?posterior shear forces (with up to 400?N increase). The results of the current study emphasize the importance of proper workplace spatial layout, specifically the importance of specifying starting position of the load relative to the destination. Adjustment of the starting position will impact the three-dimensional spine loads while the destination height and asymmetry influence the shear forces. Furthermore, the influence of the specific pathway (origin relative to destination) indicates there may be a potential preparatory muscle response leading to the loads on the spine. Thus, the pathway of the box plays an important role in the spine responses during lifting, in that longer and non-neutral pathways increase spine loads – indicating the importance of the relative position of the origin and destination shelf.     

Using sitting as a component of job rotation strategies: Are lifting/lowering kinetics and kinematics altered following prolonged sitting

Workers are often required to perform manual materials handling tasks immediately following periods of prolonged sitting either as a secondary job component of as different tasks in a job rotation strategy. The goal of this investigation was to determine if changes to low-back kinetics and/or kinematics occurred during repetitive lifting/lowering exertions following extended seated exposures. Upper body kinematics, lumbar spine flexion angle, pelvic orientation and bilateral muscle activity from the external abdominal obliques and lumbar erector spinae were recorded for 8 males and 8 females while they alternated between sessions of repetitive lifting/lowering and prolonged sitting. Upper body kinematics were used as inputs to a linked segment model to compute low-back flexion/extension moments, compression, and shear. Peak lumbar flexion was reduced by 1.8° during the lifting/lowering exertions following the first hour of sitting which consequently led to a reduction of approximately 50 N in the reaction anteroposterior shear forces. Sitting postures were consistent with previously reported data. The reduced shear loads during repetitive lift/lower exertions following prolonged sitting may be a consequence of alterations in passive tissue properties which could alter the risk of low-back injury, although future research is required to examine the biomechanical significance of this finding. Changes to both kinematics and kinetics were minimal suggesting that using prolonged sitting as a component of a task series in job rotation does not alter the risk present when combined with repetitive lifting tasks.     

Load spatial pathway and spine loading: how does lift origin and destination influence low back response?

While heavy lifting has been identified as an important risk factor for low back disorders, little is known about workplace spatial layout - the relative positions of shelves and the impact of this on spine loads. The objective of the current study was to investigate how the relative positions of the load origin and destination impact three-dimensional spine loads. Seven females and seven males lifted an 11.4 kg box from an origin shelf to a destination shelf, each defined by height (elbow, knee and shoulder level) and asymmetry (60 degrees clockwise, sagittally symmetric, 60 degrees counter-clockwise) while their spine loading was assessed by an electromyographic-assisted model. The results indicated that the starting and destination heights and starting task asymmetry all had significant impact on spine compression (with an increase of between 400 and 1900 N when compared to the most neutral position) and lateral shear (with a 100 to 150 N increase) while the destination height impacted the anterior - posterior shear forces (with up to 400 N increase). The results of the current study emphasize the importance of proper workplace spatial layout, specifically the importance of specifying starting position of the load relative to the destination. Adjustment of the starting position will impact the three-dimensional spine loads while the destination height and asymmetry influence the shear forces. Furthermore, the influence of the specific pathway (origin relative to destination) indicates there may be a potential preparatory muscle response leading to the loads on the spine. Thus, the pathway of the box plays an important role in the spine responses during lifting, in that longer and non-neutral pathways increase spine loads - indicating the importance of the relative position of the origin and destination shelf.     

Impact of order and load knowledge on trunk kinematics during repeated lifting tasks

OBJECTIVE: To determine if lifting random unknown weights is more detrimental than lifting sequences of unknown weights and to investigate whether load knowledge impacts the effect of lifting random box weights. BACKGROUND: Much research has investigated lifting under known load conditions, but few studies have investigated unknown loads, especially when presented in random order. There has been some documentation of alteration in trunk mechanics when there is an overestimation of the unknown load. METHOD: Ten men and 10 women performed three lifting tasks: random unknown, random known, and same weight. A lumbar motion monitor was used to collect kinematic data, and Borg's Rating of Perceived Exertion (RPE) and a task risk rating were also assessed. RESULTS: Both presentation order and load knowledge impacted trunk kinematics during repeated lifting tasks. However, these differences were relatively low in magnitude. Furthermore, kinematic response and perceived risk and exertion for these conditions varied between genders. CONCLUSION: Lifting random unknown loads appears to alter kinematic responses, particularly for men. Women attempt to modify the effect of random unknown loads by changing the lifting style through alterations in upper limb motions (e.g., drag box toward them prior to lifting). However, a need remains for a more comprehensive biomechanical investigation (e.g., spine loading) into the effects of random unknown loads because many of the effect sizes were small. APPLICATION: Small kinematic adaptations resulting from tasks involving unknown and random loads may be mediated by the use of visual cues, order of presentation, or a change in lifting style.     

Fatigue influences the dynamic stability of the torso

Fatigue in the extensor muscles of the torso affects neuromuscular recruitment and control of the spine. The goal of this study was to test whether fatigue influences stability of dynamic torso movements. A controlled laboratory experiment measured the change in the maximum finite-time Lyapunov exponent, λ_max, before and after fatigue of the extensor muscles. Non-linear analyses were used to compute stability from the embedding dimension and Lyapunov exponent recorded during repetitive dynamic trunk flexion tasks. Torso extensor muscles were fatigued to 60% of their unfatigued isometric maximum voluntary exertion force then stability was re-measured. Independent variables included fatigue, task asymmetry and lower-limb constraint. λ_max values increased with fatigue suggesting poorer dynamic stability when fatigued. Embedding dimension declined with fatigue indicating reduced dynamic complexity when fatigued. Fatigue-related changes in spinal stability may contribute to the risk of low-back injury during fatiguing occupational lifting tasks. The findings reported here indicate that one mechanism by which fatigue contributes to low back disorders may be spinal instability. This information may contribute to the development of ergonomic countermeasures to help prevent low back disorders.     

Accuracy of identification of low or high risk lifting during standardised lifting situations

The aim was to classify lifting activities into low and high risk categories (according to The Danish Working Environment Authority guidelines) based on surface electromyography (sEMG) and trunk inclination (tri-axial accelerometer) measurements. Lifting tasks with different weights, horizontal distance and technique were performed. The lifting tasks were characterised by a feature vector composed of either the 90th, 95th or 99th percentile of sEMG activity level and trunk inclinations during the task. Linear Discriminant Analysis and a subject-specific threshold scheme were applied and lifting tasks were classified with an accuracy of 65.1–65.5%. When lifts were classified based on the subject-specific threshold scheme from low and upper back accelerometers, the accuracy reached 52.1–58.1% and 72.7–78.1%, respectively. In conclusion, the use of subject-specific thresholds from sEMG from upper trapezius and erector spinae as well as inclination of the upper trunk enabled us to identify low and high risk lifts with an acceptable accuracy.

Practitioner Summary: This study contributes to the development of a method enabling the automatic detection of high risk lifting tasks, i.e. exposure to high biomechanical loads, based on individual sEMG and kinematics from an entire working day. These methods may be more cost-effective and may complement observations commonly used by practitioners.     

Musculoskeletal disorder risk during automotive assembly: current vs. seated

Musculoskeletal disorder risk was assessed during automotive assembly processes. The risk associated with current assembly processes was compared to using a cantilever chair intervention. Spine loads and normalized shoulder muscle activity were evaluated during assembly in eight regions of the vehicle. Eight interior cabin regions of the vehicle were classified by reach distance, height from vehicle floor and front to back. The cantilever chair intervention tool was most effective in the far reach regions regardless of the height. In the front far reach regions both spine loads and normalized shoulder muscle activity levels were reduced. In the middle and close reach regions spine loads were reduced, however, shoulder muscle activity was not, thus an additional intervention would be necessary to reduce shoulder risk. In the back far reach region, spine loads were not significantly different between the current and cantilever chair conditions. Thus, the effectiveness of the cantilever chair was dependent on the region of the vehicle.     

Lumbosacral loads in bedmaking.

The purpose of this study was to determine whether the introduction of larger and heavier beds which were lower to the floor increased the physical stress on employees responsible for room cleaning and bedmaking in the hospitality industry. More specifically, this study assessed the effect of bed size (single, double and king) and bed height (460 and 560 mm) on dynamic and static estimates of L5/S1 compression force and static L5/S1 shear force for six simulated components of the overall bedmaking task. Results confirmed the view that static models severely underestimate the loads on the lumbar spine under inertial lifting conditions, and also indicated that: (i) tasks with the greatest hand loads were not necessarily associated with the greatest spinal loads due to differences in the way each task was performed; (ii) L5/S1 loads produced during bedmaking may exceed recommended safe lifting limits for certain task-size height combinations; and (iii) the use of larger and heavier beds in the hospitality industry imposes increased loads on the lumbar spine. The investigation of alternative work practices designed to minimise loads on the lumbar spine is recommended.     

The load on the lumbar spine during asymmetrical bi-manual materials handling

Previous biomechanical analyses of typical load manipulation tasks were mainly limited to sagittal-plane activities or to static cases. This paper includes the biomechanical determination and assessment of lumbar load during asymmetrical bi-manual materials handling tasks which involve lateral turning of the body, trunk inclination, and sagittal flexion and lateral bending of the spine. Diagonal lifting tasks were analysed for different values for load weight (0-40 kg) and task duration (0·75-1·5 s). Whereas a constant grasp height of 15 cm was assumed, the height for releasing the load differed (50, 100, 150 cm). A dynamic spatial human model (‘The Dortmunder’) was used for calculating the torque in the sagittal, frontal, and transversal planes through the lumbosacral joint and for determining the compressive and the sagittal and lateral shear force at the L5-S1 disc. The trajectories of body segments and load are computer-simulated on the basis of postures adopted during the movement. During diagonal lifting of loads, lumbosacral torque in the sagittal plane is considerably larger than the lateral bending and torsional torque components. Dynamic analyses result in higher maximum values in the lumbar-load time curves than static analyses. The shorter the time for task execution, the higher the resultant dynamic effects and, in consequence, the higher the lumbar load. Lumbosacral compression and shear increase with increasing load-release heights due to higher acceleration and retardation of body and load when the same grasp position and task duration are assumed. The maximum load-bearing capacity of the lumbar spine was determined on the basis of strength data for isolated lumbar segments provided in the literature. The compressive strength falls within the same range as the compressive forces calculated for asymmetrical lifting of loads up to 40 kg. On account of the wide scattering of the compressive strength values, the main influences were determined (age and gender). At an age of 40 years, strength is approx. 6·7 kN for males and 4·7 kN for females (decrease with age per decade: 1·0 kN males, 0·6 kN females). In order to avoid overestimating an individual's lumbar compressive strength, predicted values should be reduced, e.g., by the standard deviation in the male or female samples (2·6 kN or 1·5 kN). Although only a few maximum shear force values are available in the literature, comparison with the calculated values for diagonal lifting leads to the conclusion that sagittal and lateral shear should not be ignored in the assessment of lumbar load during asymmetrical handling tasks.     

The load on the lumbar spine during asymmetrical bi-manual materials handling.

Previous biomechanical analyses of typical load manipulation tasks were mainly limited to sagittal-plane activities or to static cases. This paper includes the biomechanical determination and assessment of lumbar load during asymmetrical bi-manual materials handling tasks which involve lateral turning of the body, trunk inclination, and sagittal flexion and lateral bending of the spine. Diagonal lifting tasks were analysed for different values for load weight (0-40 kg) and task duration (0.75-1.5 s). Whereas a constant grasp height of 15 cm was assumed, the height for releasing the load differed (50, 100, 150 cm). A dynamic spatial human model ('The Dortmunder') was used for calculating the torque in the sagittal, frontal, and transversal planes through the lumbosacral joint and for determining the compressive and the sagittal and lateral shear force at the L5-S1 disc. The trajectories of body segments and load are computer-simulated on the basis of postures adopted during the movement. During diagonal lifting of loads, lumbosacral torque in the sagittal plane is considerably larger than the lateral bending and torsional torque components. Dynamic analyses result in higher maximum values in the lumbar-load time curves than static analyses. The shorter the time for task execution, the higher the resultant dynamic effects and, in consequence, the higher the lumbar load. Lumbosacral compression and shear increase with increasing load-release heights due to higher acceleration and retardation of body and load when the same grasp position and task duration are assumed. The maximum load-bearing capacity of the lumbar spine was determined on the basis of strength data for isolated lumbar segments provided in the literature. The compressive strength falls within the same range as the compressive forces calculated for asymmetrical lifting of loads up to 40 kg. On account of the wide scattering of the compressive strength values, the main influences were determined (age and gender). At an age of 40 years, strength is approx. 6.7 kN for males and 4.7 kN for females (decrease with age per decade: 1.0 kN males, 0.6 kN females). In order to avoid overestimating an individual's lumbar compressive strength, predicted values should be reduced, e.g., by the standard deviation in the male or female samples (2.6 kN or 1.5 kN). Although only a few maximum shear force values are available in the literature, comparison with the calculated values for diagonal lifting leads to the conclusion that sagittal and lateral shear should not be ignored in the assessment of lumbar load during asymmetrical handling tasks.     

How to lift a box that is too large to fit between the knees

Many studies compared lifting techniques such as stoop and squat lifting. Results thus far show that when lifting a wide load, high back loads result, irrespective of the lifting technique applied. This study compared four lifting techniques in 11 male subjects lifting wide loads. One of these techniques, denoted as the weight lifters' technique (WLT), is characterised by a wide foot placement, moderate knee flexion and a straight but not upright trunk. Net moments were calculated with a 3-D linked segment model and spinal forces with an electromyographic-driven trunk model. When lifting the wide box at handles that allow a high grip position, the WLT resulted in over 20% lower compression forces than the free, squat and stoop lifting technique, mainly due to a smaller horizontal distance between the l5S1 joint and the load. When lifting the wide box at the bottom, none of the lifting techniques was clearly superior to the others.

Statement of Relevance: Lifting low-lying and large objects results in high back loads and may therefore result in a high risk of developing low back pain. This study compares the utility of a WLT, in terms of back load and lumbar flexion, to more familiar techniques in these high-risk lifting tasks.     

Spine loading and trunk kinematics during team lifting

Two-person or team lifting is a popular method for handling materials under awkward or heavy lifting conditions. While many guidelines and standards address safe lifting limits for individual lifting, there are no such limits for team lifting, and these lifts are poorly understood. The literature associated with team lifting offers some interesting paradoxes. Many studies have indicated that people lift less per individual under team conditions compared with one-person lifting. Yet, at least one study has reported an increase in team-lifting capacity when subjects were height-matched. The current study explored the spine loading characteristics of one- and two-person lifting teams when subjects lifted under several sagittally symmetric and asymmetric conditions. Spine compression was lower for two person lifts for a given weight, while lifting in sagittally symmetric conditions whereas lateral shear became much greater for two-person lifts under asymmetric lifting conditions. This study has linked these changes to differences in trunk kinematic patterns adopted during one- versus two-person lifting.     

Spine loading and trunk kinematics during team lifting

Two-person or team lifting is a popular method for handling materials under awkward or heavy lifting conditions. While many guidelines and standards address safe lifting limits for individual lifting, there are no such limits for team lifting, and these lifts are poorly understood. The literature associated with team lifting offers some interesting paradoxes. Many studies have indicated that people lift less per individual under team conditions compared with one-person lifting. Yet, at least one study has reported an increase in team-lifting capacity when subjects were height-matched. The current study explored the spine loading characteristics of one- and two-person lifting teams when subjects lifted under several sagittally symmetric and asymmetric conditions. Spine compression was lower for two person lifts for a given weight, while lifting in sagittally symmetric conditions whereas lateral shear became much greater for two-person lifts under asymmetric lifting conditions. This study has linked these changes to differences in trunk kinematic patterns adopted during one- versus two-person lifting.     

Trunk kinematics of one-handed lifting,and the effects of asymmetry and load weight

Abstract

This study investigated trunk kinematic differences between lifts performed using either one hand (unsupported) or two hands. These effects were studied while beginning the lifts from different asymmetric starting positions and while lifting different load weights. Each subject lifted a box from a lower to an upper platform under one- and two-handed lifting conditions. Subjects wore a lumbar spine electrogoniometer, from which relative motion components were calculated in the trunk's three cardinal planes. Results of this study showed that one-handed lifting resulted in significantly higher ranges of motion in the lateral and transverse planes and greater flexion in the sagittal plane. Back motion characteristics previously found to be associated with low back disorders were all significantly higher for one-handed lifts. The two-handed lift technique, on the other hand, produced overall faster trunk motions in the sagittal plane and equal or larger acceleration and deceleration magnitudes in all planes of motion. Increases in load asymmetry affected trunk kinematics, in that magnitude values for range of motion, velocity and acceleration became much greater with increasingly asymmetric load positions. Increasing the load weight appeared to have less of an effect on trunk kinematics, with increases in position mostly occurring during sagittal and lateral bending. These results suggest that unsupported one-handed lifting loads the spine more than two-handed lifts, due to the added coupling. Applying these results to a previously developed model, one-handed lifting was also found to increase one's risk of suffering a low back disorder.     

Spine loading and probability of low back disorder risk as a function of box location on a pallet

It is widely believed that depalletizing operations in manufacturing and service environments substantially increase the risk of occupationally related low back disorders (LBDs). It has been established that the weight of the box lifted off a pallet can affect the risk of occupationally related LBD but few have considered the influence of the location of the box on the pallet (region) when assessing risk. Thus, the objective of this study was to assess spinal loading characteristics and the probability of high LBD risk as a function of box weight and its location on the pallet. Ten experienced order selectors were recruited from a local distribution center and were evaluated as they transferred boxes of different weights (40, 50, and 60 lb) from six different locations (regions) of a pallet to a pallet jack. Workers were monitored for their trunk motion characteristics as well as the electromyographic (EMG) activity of ten trunk muscles as they performed the task. Workplace factors as well as trunk kinematic and EMG information were used as inputs to: (1) a risk assessment model, and (2) an EMG-assisted model that was used to predict the three-dimensional spine loadings that occurred during the task. The results indicated that conditions where a worker must reach to a low level of the pallet increased spinal load and risk probability far more than changes in the weight of the box. Thus, spinal loads were significantly large in magnitude and would be expected to lead to an increase in low back disorders when workers lifted form the lowest layer of the pallet. The load moment was found to be strongly influenced by pallet region, which resulted in increased spinal loading and risk probability as the moment increased. This effort has also facilitated our understanding as to why spine loading increases under the various conditions studied in this experiment. Nearly all differences in spinal loading can be explained by a corresponding difference in coactivation of the trunk musculature. This in turn significantly increases the synergistic forces supplied by each muscle to the spine and results in an increase in spinal loading. © 1997 John Wiley & Sons, Inc.