Effects of shoulder rotation combined with elbow flexion on discomfort and EMG activity of ECRB muscle

Work related MusculoSkeletal Disorders (WMSDs) are injuries or dysfunctions caused by occupational or non occupational tasks involving bad postures, high frequency of exertions or high force levels. In the present study, the effects of shoulder flexion/extension combined with elbow flexion angle on discomfort score were investigated for repetitive gripping task. A laboratory experimental simulation was conducted. Ten male participants volunteered in this study. Four levels of shoulder flexion/extension (−45° extension, 0° neutral, 45° & 90° flexion) with three levels of elbow flexion angle (45°, 90° & 135°) were taken as levels of independent variables. There were 12 combinations available for each participant and the experiment was conducted on the basis of random order of experimental combinations for each participant. Discomfort score on 100 mm visual analogue scale (VAS) and Electromyography (EMG) activity of Extensor Carpi Radialis Brevis (ECRB) muscle were dependent variables for the analyses. The task for the experiment was of 150N ± 5N grip force at a frequency of 15 exertions/minute for five minutes duration. After performing the MANOVA on the recorded data, the results showed that the shoulder flexion/extension and elbow flexion both were highly significant (p < 0.001). Also it was found that −45° shoulder extension combined with 45° elbow flexion angle was the most discomfort posture. The practical relevance of the study is that, in industrial tasks such posture should be avoided to minimize risk of WMSDs.Relevance to industryThe findings in terms of relationship between discomfort/EMG vs. shoulder rotation combined with elbowflexion are important to design Industrial tasks with the reduced risk of WMSDs. Such as, sheet metal cutting, fabrication of sheet metal work, die casting, and drilling operations may require the shoulder movements in extenion/flexion combined with elbowflexion.     

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.     

Disturbance and recovery of trunk mechanical and neuromuscular behaviours following prolonged trunk flexion: influences of duration and external load on creep-induced effects

Trunk flexion results in adverse mechanical effects on the spine and is associated with a higher incidence of low back pain. To examine the effects of creep deformation on trunk behaviours, participants were exposed to full trunk flexion in several combinations of exposure duration and external load. Trunk mechanical and neuromuscular behaviours were obtained pre- and post-exposure and during recovery using sudden perturbations. Intrinsic trunk stiffness decreased with increasing flexion duration and in the presence of the external load. Recovery of intrinsic stiffness required more time than the exposure duration and was influenced by exposure duration. Reflexive trunk responses increased immediately following exposure but recovered quickly (～2.5 min). Alterations in reflexive trunk behaviour following creep deformation exposures may not provide adequate compensation to allow for complete recovery of concurrent reductions in intrinsic stiffness, which may increase the risk of injury due to spinal instability.

Statement of relevance: An increased risk of low back injury may result from flexion-induced disturbances to trunk behaviours. Such effects, however, appear to depend on the type of flexion exposure, and have implications for the design of work involving trunk flexion.     

Effects of combined wrist flexion/extension and forearm rotation and two levels of relative force on discomfort

This study investigated perceived discomfort in an isometric wrist flexion task. Independent variables were wrist flexion/extension (55%, 35% flexion, neutral, 35% and 55% extension ranges of motion (ROM)), forearm rotation (60%, 30% prone, neutral, 30% and 60% supine ROM) and two levels of flexion force (10% and 20% maximum voluntary contraction (MVC)). Discomfort was significantly affected by flexion force, forearm rotation and a two-way interaction of force with forearm rotation (each p < 0.05). High force for 60%ROM forearm pronation and supination resulted in increasingly higher discomfort for these combinations. Flexion forces were set relative to the MVC in each wrist posture and this appears to be important in explaining a lack of significant effect (p = 0.34) for flexion/extension on discomfort. Regression equations predicting discomfort were developed and used to generate iso-discomfort contours, which indicate regions where the risk of injury should be low and others where it is likely to be high. Regression equations predicting discomfort and iso-discomfort contours are presented, which indicate combinations of upper limb postures for which discomfort is predicted to be low, and others where it is likely to be high. These are helpful in the study of limits for risk factors associated with upper limb musculoskeletal injury in industry.     

Disturbance and recovery of trunk mechanical and neuromuscular behaviours following prolonged trunk flexion: influences of duration and external load on creep-induced effects

Trunk flexion results in adverse mechanical effects on the spine and is associated with a higher incidence of low back pain. To examine the effects of creep deformation on trunk behaviours, participants were exposed to full trunk flexion in several combinations of exposure duration and external load. Trunk mechanical and neuromuscular behaviours were obtained pre- and post-exposure and during recovery using sudden perturbations. Intrinsic trunk stiffness decreased with increasing flexion duration and in the presence of the external load. Recovery of intrinsic stiffness required more time than the exposure duration and was influenced by exposure duration. Reflexive trunk responses increased immediately following exposure but recovered quickly (～2.5 min). Alterations in reflexive trunk behaviour following creep deformation exposures may not provide adequate compensation to allow for complete recovery of concurrent reductions in intrinsic stiffness, which may increase the risk of injury due to spinal instability. STATEMENT OF RELEVANCE: An increased risk of low back injury may result from flexion-induced disturbances to trunk behaviours. Such effects, however, appear to depend on the type of flexion exposure, and have implications for the design of work involving trunk flexion.     

Change in spine height measurements following sustained mid-range and end-range flexion of the lumbar spine

Workers lose height during the day. Flexion-based exercises and body positions are commonly prescribed to unload the spine and prevent back pain. Lumbar extension positions have been researched and result in an increase in spine height. End-range lumbar extension postures increase spine height to a greater extent than mid-range lumbar extension postures, but these positions are not always tolerated by patients with lumbar conditions. No study to date has investigated the effect of end-range versus mid-range lumbar flexion postures on spine height changes. The purpose of this study was to investigate the effects of two techniques commonly used in clinical settings to unload the lumbar intervertebral disc (IVD) segments through increasing spine height in: (1) a sidelying mid-range lumbar flexion position; and (2) a sidelying end-range lumbar flexion position. A total of 20 asymptomatic women and 21 asymptomatic men with a mean age of 23.8 years (±2.5) participated in the study. Subjects were randomized systematically into 2 groups to determine the order of testing position. Measurements were taken with a stadiometer in the sitting position to detect change in spine height after each position. Results of the paired t-tests indicated that compared to the spine height in sitting, the sidelying end-range lumbar flexion position resulted in a statistically significant (p < .001) mean spine height gain of 4.78 mm (±4.01) while the sidelying mid-range lumbar flexion position resulted in a statistically significant (p < .001) mean spine height gain of 5.84 mm (±4.4). No significant difference between the height changes observed following the two sidelying positions was found (p = .22). Sidelying lumbar flexion positions offer valuable alternatives to lumbar extension positions to increase spine height, possibly through increasing hydration levels of the lumbar IVD and could be proposed as techniques to offset spinal shrinkage and the biomechanical consequences of sustained loads.     

The influence of occupation on lumbar sagittal motion and posture

The aim of this study was to determine whether sheep shearers have clinically hypothesized adaptive postural and sagittal mobility parameters of the lumbar spine and pelvis. Sixty-four shearers and 64 non-shearers, matched by age and anthropometry and surveyed for present and previous low back pain, participated in a study to determine the effects of occupation on sagittal spinal motion and posture. Lumbar and hip mobility measurements were made with a geometric CAD analysis of lateral photographs using surface reflective markers. Sagittal range of motion demonstrated similar ranges of lumbar flexion between the two groups; however, there was a marked gain in hip flexion in the shearers as well as a marked loss of lumbar extension. The shearers also demonstrated a more lordotic lower lumbar curvature compensated by a flatter (less kyphotic) mid to lower thoracic region. Shearers appear to lose lumbar extension, gain hip flexion and develop an adaptive normal stance. This adaptation appears to be independent of previous or current back pain. Conversely, lumbar extension loss in non-shearers correlates with previous back injury. A stepwise linear regression of all participants indicated that the occupation is the predominant influence on motion and posture followed by age. The implications are one of structural adaptation in this occupational group that does not appear to be correlated with back pain.     

The influence of occupation on lumbar sagittal motion and posture

The aim of this study was to determine whether sheep shearers have clinically hypothesized adaptive postural and sagittal mobility parameters of the lumbar spine and pelvis. Sixty-four shearers and 64 non-shearers, matched by age and anthropometry and surveyed for present and previous low back pain, participated in a study to determine the effects of occupation on sagittal spinal motion and posture. Lumbar and hip mobility measurements were made with a geometric CAD analysis of lateral photographs using surface reflective markers. Sagittal range of motion demonstrated similar ranges of lumbar flexion between the two groups; however, there was a marked gain in hip flexion in the shearers as well as a marked loss of lumbar extension. The shearers also demonstrated a more lordotic lower lumbar curvature compensated by a flatter (less kyphotic) mid to lower thoracic region. Shearers appear to lose lumbar extension, gain hip flexion and develop an adaptive normal stance. This adaptation appears to be independent of previous or current back pain. Conversely, lumbar extension loss in non-shearers correlates with previous back injury. A stepwise linear regression of all participants indicated that the occupation is the predominant influence on motion and posture followed by age. The implications are one of structural adaptation in this occupational group that does not appear to be correlated with back pain.     

Three-dimensional spinal motion and risk of low back injury during sheep shearing

Sheep shearers are known to work in sustained flexed postures and have a high prevalence of low back pain (LBP). As sustained posture and spinal movement asymmetry under substantial loads are known risk factors for back injury our aim was to describe the 3D spinal movement of shearers while working. We hypothesised that thoraco-lumbar and lumbo-sacral movement would be tri-axial, asymmetric, and task specific. Sufficient retro-reflective markers were placed on the trunk of 12 shearers to define thoraco-lumbar and lumbo-sacral 3D motion during three tasks. Thoraco-lumbar movement consistently involved flexion, left lateral flexion, and right rotation. Lumbo-sacral movement consistently involved right lateral flexion in flexion with minimal rotation. Shearers therefore work in sustained spinal flexion where concurrent, asymmetric spinal movements into both lateral flexion and rotation occur. These asymmetric movements combined with repetitive loading may be risk factors leading to the high incidence of LBP in this occupational group.     

Psychophysical studies of repetitive wrist flexion and extension

Abstract

The purpose of this experiment was to investigate the feasibility of using psychophysical methods to determine maximum acceptable forces for various types and frequencies of repetitive wrist motion. Four adjustable work stations were built to simulate repetitive wrist flexion with a power grip, wrist flexion with a pinch grip, and wrist extension with a power grip. The study consisted of two separate experiments. Subjects worked for two days per week during the first experiment, and five days per week during the second experiment. Fifteen women completed the first experiment, working seven hours each day, two days per week, for 20 days. Repetition rates of 2, 5, 10, 15 and 20 motions per minute were used with each flexion and extension task. Maximum acceptable torques were determined for the various motions, grips, and repetition rates without dramatic changes in wrist strength, tactile sensitivity, or number of symptoms. Fourteen different women completed the second experiment, performing a wrist flexion motion (power grip) fifteen times per minute, seven hours per day, five days per week, for 23 days. There were no significant differences in maximum acceptable torque from day to day. However, the average maximum acceptable torque for a five days per week exposure was 36-3% lower than for the same task performed two days per week. Assuming that maximum acceptable torques decrease 36-3% for other repetition rates and motions, tables of maximum acceptable force were developed for female wrist flexion (power grip), female wrist flexion (pinch grip), and female wrist extension (power grip).     

Influence of snow shovel shaft configuration on lumbosacral biomechanics during a load-lifting task

Lower-back injury from snow shovelling may be related to excessive joint loading. Bent-shaft snow shovels are commonly available for purchase; however, their influence on lower back-joint loading is currently not known. Therefore, the purpose of this study was to compare L5/S1 extension angular impulses between a bent-shaft and a standard straight-shaft snow shovel. Eight healthy subjects participated in this study. Each completed a simulated snow-lifting task in a biomechanics laboratory with each shovel design. A standard motion analysis procedure was used to determine L5/S1 angular impulses during each trial, as well as peak L5/S1 extension moments and peak upper body flexion angle. Paired-samples t-tests (α = 0.05) were used to compare variables between shovel designs. Correlation was used to determine the relationship between peak flexion and peak moments. Results of this study show that the bent-shaft snow shovel reduced L5/S1 extension angular impulses by 16.5% (p = 0.022), decreased peak moments by 11.8% (p = 0.044), and peak flexion by 13.0% (p = 0.002) compared to the straight-shaft shovel. Peak L5/S1 extension moment magnitude was correlated with peak upper body flexion angle (r = 0.70). Based on these results, it is concluded that the bent-shaft snow shovel can likely reduce lower-back joint loading during snow shovelling, and thus may have a role in snow shovelling injury prevention.     

Disturbance and recovery of trunk mechanical and neuromuscular behaviours following repetitive lifting: influences of flexion angle and lift rate on creep-induced effects

Repetitive lifting is associated with an increased risk of occupational low back disorders, yet potential adverse effects of such exposure on trunk mechanical and neuromuscular behaviours were not well described. Here, 12 participants, gender balanced, completed 40 min of repetitive lifting in all combinations of three flexion angles (33, 66, and 100% of each participant's full flexion angle) and two lift rates (2 and 4 lifts/min). Trunk behaviours were obtained pre- and post-exposure and during recovery using sudden perturbations. Intrinsic trunk stiffness and reflexive responses were compromised after lifting exposures, with larger decreases in stiffness and reflexive force caused by larger flexion angles, which also delayed reflexive responses.Consistent effects of lift rate were not found. Except for reflex delay no measures returned to pre-exposure values after 20 min of recovery. Simultaneous changes in both trunk stiffness and neuromuscular behaviours may impose an increased risk of trunk instability and low back injury.

Practitioner summary An elevated risk of low back disorders is attributed to repetitive lifting. Here, the effects of flexion angle and lift rate on trunk mechanical and neuromuscular behaviours were investigated. Increasing flexion angle had adverse effects on these outcomes, although lift rate had inconsistent effects and recovery time was more than 20 min.     

Biomechanical analysis of upper trapezius,erector spinae and brachioradialis fatigue in repetitive manual packaging tasks: Evidence from Chinese express industry workers

This study aims to assess the effects of repetitive motion-induced fatigue during manual packaging on kinematics and muscle activity of the arm, back and shoulder. Eighteen participants performed a 60-min manual packaging task. Electromyography median frequency of RUT, RES, LES and RB decreased by 13.2% (p < 0.05), 12.8% (p < 0.05), 11.3% (p < 0.05) and 21% (p < 0.001), respectively over time. The head flexion and the right upper arm flexion angles significantly (p < 0.001) differed among different packaging sizes, and similar results were observed for left upper arm flexion and rotation. The trunk and pelvis angles significantly (p < 0.05) differed over time under three kinds of packaging. The results showed there was an increase in the rating of perceived exertion from 8.56 to 16.94 (p<0.01) during the task. The outcomes of this study indicate repetitive movements in the manual packaging task resulted in elevated prevalence of muscle discomfort in packaging workers, especially the right brachioradialis. Interventions such as specific work: rest ratios, workplace redesign should be explored to relieve muscle fatigue and discomfort.Relevance to industryFor workers performing repetitive manual packaging tasks, biomechanical analysis of different muscles groups can help in developing appropriate ergonomic interventions.     

Passive stiffness changes in the lumbar spine and effect of gender during prolonged simulated driving

Gender differences in lumbar and pelvic posture have been reported previously in prolonged sitting, both in an office chair and automobile seat. To date, it is not known whether these postural exposures during prolonged driving affect the passive lumbar spine flexion stiffness. The purpose of this study was to examine time-varying responses of passive lumbar spine stiffness, lumbar spine and pelvic postures during a 2 h simulated driving trial. Secondary goals investigated the influence of gender on lumbar spine stiffness, discomfort scores and seat pressure profiles. Twenty (10 males, 10 females) subjects were recruited to complete a 2 h simulated driving task. Passive lumbar range of motion was measured on a customized frictionless jig before, halfway through and at the end of 2 h. During driving there was a time-varying difference in the lumbar flexion angles adopted by the gender groups. A significant interaction (p = 0.0458) was found for gender and time with women being found to sit significantly different than males in the second hour of driving exhibiting greater maximum lumbar flexion (60.0% ROM (±1.27) than men 50.0% ROM (±1.5). Both men and women demonstrated similar passive stiffness changes characterized by an initial increase in transitional zone stiffness after 1 h (+0.1 Nm/degree for males and +0.3 Nm/degree for females, p = 0.2372). Over 2 h of driving there was a non-significant trend of genders to respond differently to the seated exposure. Specifically transitional zone stiffness was found to increase in males (0.86 (SD 0.31) to 0.92 (SD 0.31) Nm/degree) and decrease in females (0.81 (SD0.88) to 0.73 (SD 0.52) Nm/degree) (p = 0.1178). Differences in lumbar posture and passive stiffness over 2 h of simulated driving were demonstrated between genders in this study.Relevance to industryGender specific ergonomic interventions should be investigated for the automobile seat. Additionally, the changes in passive stiffness induced by prolonged seated exposures could introduce altered low back kinematics in activities performed after a long car ride. Lifting scenarios such as luggage unloading or parcel delivery are common activities immediately after driving. The altered stiffness of the lumbar spine in these activities could have potential ergonomics and injury related implications for both the general population and professional drivers.     

Comparison of risk assessment procedures used in OCRA and ULRA methods

The aim of this study was to analyse the convergence of two methods by comparing exposure and the assessed risk of developing musculoskeletal disorders at 18 repetitive task workstations. The already established occupational repetitive actions (OCRA) and the recently developed upper limb risk assessment (ULRA) produce correlated results (R = 0.84, p = 0.0001). A discussion of the factors that influence the values of the OCRA index and ULRA's repetitive task indicator shows that both similarities and differences in the results produced by the two methods can arise from the concepts that underlie them. The assessment procedure and mathematical calculations that the basic parameters are subjected to are crucial to the results of risk assessment. The way the basic parameters are defined influences the assessment of exposure and risk assessment to a lesser degree. The analysis also proved that not always do great differences in load indicator values result in differences in risk zones.     

Repetitive task indicator as a tool for assessment of upper limb musculoskeletal load induced by repetitive task

A unified repetitive task indicator (RTI) has been proposed, characterizing the upper limb load resulting from repetitive work. Within RTI, the work task is described using parameters which refer to the duration of particular sequences of the work cycle and force exerted, taking into account the posture of the upper limb. On the basis of theoretical and experimental studies, undertaken by the author and on the basis of results of experimental studies conducted in other international research laboratories, available in the literature, an analysis was conducted with the aim of developing and verifying the RTI. A comparison of the RTI with indicators of internal load was performed for eight published study cases. The experimental study cases used for verification purposes were conducted for various variants of load (various types and levels of the external force and duration of cycle periods) and for various physiological indicators of internal load. Strong correlations between RTI and indicators of internal load expressed by the unified indicator (IL), showed considerable credibility of the RTI. Results of the verification are noteworthy, given the wide range of cases examined, differing in terms of the conditions under which they were done, the population examined and internal load indicators used. Thus, this analysis indicates that the proposed RTI reflects well the upper limb load occurring as a result of performing repetitive work.     

The ratio of thoracic to lumbar compression force is posture dependent

Despite the evidence suggesting that between 8% and 55% of manual labourers experience thoracic pain, research on spinal loading during occupational tasks has been almost invariably limited to the lumbar spine. In this study, we determined the ratio of thoracic to lumbar compression force and the relative risk of injury to each region in various postures. Compressive forces on the spine were calculated based on previously reported thoracic and lumbar intradiscal pressures and disc cross-sectional areas. Flexion postures were associated with an approximate doubling in lumbar compression force but only small increases (or even decreases) in thoracic compression. The ratio of thoracic to lumbar compression was above the tolerance ratio (i.e. the ratio of thoracic to lumbar compressive strength) during upright postures and below the tolerance ratio during flexion postures, indicating that upright postures may pose a greater relative risk of injury to the thoracic spine than to the lumbar spine.

Practitioner summary: Previously reported thoracic and lumbar in vivo disc pressures during various postures were compared. The ratio of thoracic and lumbar compression increased during upright postures and decreased in flexed postures, indicating that upright postures may pose a greater risk of injury to the thoracic spine than to the lumbar spine.     

Biomechanical aspects of occupational neck postures during dental work

A typical occupational risk factor for developing neck symptoms is prolonged flexion of the cervical spine. The present aim was to determine joint moments and muscle activity of the neck during forward flexion of the cervical spine to evaluate the load in the neck region. Three dimensional video (3-D) and surface electromyography (EMG) from the splenius muscles were recorded in two common work postures. Using a 3-D static link segment model, moments at the atlanto-occipital (A-O) joint and the seventh cervical-first thoracal (C7-T1) joint were estimated. Maximal extension moments were estimated from maximal neck extension strength. Extension moments at the C7-T1 joint were significantly higher for a highly flexed position (45% of max) compared to a moderately flexed position (32% of max), but remained unchanged at the A-O joint (40% of max). The mean RMS amplitude was 9% of maximal EMG in both positions (no bilateral differences). This difference between mechanical load and muscle load indicates that EMG may seriously underestimate the total loads of the tissue. Lateral flexion influenced the lateral flexion moment while rotation did not influence the rotation moment. The study demonstrates the importance of quantification of joint loads in occupational risk assessment of the neck.

Relevance to industry

3-D biomechanical calculations provide information on the mechanical load during work. Because EMG may underestimate total tissue load, calculations of joint moments in combination with information on muscle activity and strength are necessary to estimate different tissue loading of significance for overall risk identification.     

Characterisation of trunk muscle activation amplitude patterns during a simulated checkstand operation with continuously changing flexor and lateral moment demands

While the typical physical exposure to modern-day workers has changed from heavy to low level repetitive demands, there is limited research that examines light occupations. This study examined trunk muscle recruitment strategies in response to a simulated checkout operation. Surface electromyography and kinematic variables were recorded from 29 healthy subjects. Four principal patterns accounted for 95.3% of the variation. Significant differences in scores captured different strategies in response to reach conditions and external moment directions. Synergistic co-activation of ipsilateral back sites and differential activation among external oblique and erector spinae sites suggests that the central nervous system may control different regions of the trunk musculature to optimally account for asymmetrical demands. The strategy between the internal oblique and back extensor sites suggests that a specific co-activation strategy may be needed during lighter work. During low-load occupational tasks, several recruitment strategies were required to maintain spinal stability and account for changing external moments.

Statement of Relevance: Different recruitment strategies found in response to changing external moments offer new insights into neuromuscular control for lighter work. Specifically, multiple trunk muscle sites interact in a complex manner, taking into account task specificity and individual variation that are valuable in workstation design, evaluating injury risk and estimating spinal loads.     

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.