The effects of prior warning and lifting-induced fatigue on trunk muscle and postural responses to sudden loading during manual handling.

This study investigated the effects of warning and lifting-induced fatigue on trunk muscle activity and postural responses to sudden loading. Thirty-one male subjects were subjected to sudden loading of a hand-held box with and without prior warning, before and after either lifting-induced fatigue or light callisthenic exercises. Results showed that warning did not alter the level of trunk muscle activity prior to sudden loading. Following warning, there was a reduction in all muscle and joint onset latencies and the magnitude of hip and knee flexion. Although fatigue did not influence muscle and joint initiation, it did negate the effects that warning had on reducing joint displacement. These findings indicate that warning prior to sudden loading may enhance postural responses, reduce ranges of joint motion and increase stability. However, the benefits of prior warning for reducing ranges of joint motion may not be present when a person is fatigued. Sudden unexpected loading and fatigue arising from manual handling practices in the workplace have been identified as contributing factors to the risk of low back injury. Findings from this study provide information that is important for the design of interventions intended to reduce the incidence of manual handling-related back injuries.

Interventions for the prevention and management of neck/upper extremity musculoskeletal conditions: a systematic review.

Considered from medical, social or economic perspectives, the cost of musculoskeletal injuries experienced in the workplace is substantial, and there is a need to identify the most efficacious interventions for their effective prevention, management and rehabilitation. Previous reviews have highlighted the limited number of studies that focus on upper extremity intervention programmes. The aim of this study was to evaluate the findings of primary, secondary and/or tertiary intervention studies for neck/upper extremity conditions undertaken between 1999 and 2004 and to compare these results with those of previous reviews. Relevant studies were retrieved through the use of a systematic approach to literature searching and evaluated using a standardised tool. Evidence was then classified according to a "pattern of evidence" approach. Studies were categorised into subgroups depending on the type of intervention: mechanical exposure interventions; production systems/organisational culture interventions and modifier interventions. 31 intervention studies met the inclusion criteria. The findings provided evidence to support the use of some mechanical and modifier interventions as approaches for preventing and managing neck/upper extremity musculoskeletal conditions and fibromyalgia. Evidence to support the benefits of production systems/organisational culture interventions was found to be lacking. This review identified no single-dimensional or multi-dimensional strategy for intervention that was considered effective across occupational settings. There is limited information to support the establishment of evidence-based guidelines applicable to a number of industrial sectors.

Initial force and postural adaptations when pushing and pulling on floor surfaces with good and reduced resistance to slipping.

The objective of the present study was to determine whether differences in the frictional properties of a floor surface may affect the kinematics and kinetics of pushing and pulling. Eight male participants were required to push and pull a four-wheeled trolley over two level surfaces, on which were mounted floor coverings with good (safety floor) and reduced (standard floor) frictional properties. A psychophysical approach was used to determine the initial maximum acceptable horizontal force required to move the trolley over a short distance (3 m). Three-dimensional (3D) hand and ground reaction forces and 3D postures were measured during initial force exertions. The results showed that psychophysically derived measures of initial horizontal force and horizontal components of hand forces did not differ significantly between floor surfaces. Despite the ability to exert similar forces, the measured maximum coefficient of friction varied according to floor surface. These changes reflected significant alterations in vertical and horizontal components of ground reaction and vertical hand forces, suggesting that participants had maximized the frictional properties available to them. Postures also changed as a consequence of floor surface, with significant changes occurring in knee flexion and trunk extension. This study has shown that handlers involved in the pushing and pulling of trolleys are capable of adjusting posture and the direction of hand and foot forces in order to compensate for reduced levels of floor friction. This has particular relevance when assessing the musculoskeletal loads imposed on the handler and the likely mechanisms of injury resulting from variations in floor conditions when workers undertake pushing and pulling tasks in the workplace.

Bedside safety rails: assessment of strength requirements and the appropriateness of current designs.

Bedside safety rails are used extensively throughout hospitals and residential care environments as a safety device to protect people against the risk of falling out of bed. However, several adverse incidents involving body entrapment have been linked to their use, which have resulted in serious injury to the bed occupants and, in more extreme cases, fatalities. Internationally agreed standards (i.e. European Committee for Standardisation (CEN) standards) for the design and testing of bed rails have recently been developed and are targeted at improved safety requirements (European Committee for Standardisation 19972000). The purpose of the present study was to: 1) determine whether the CEN test procedure for assessing bed rail strength and rigidity requirements is consistent with human force exertions to which bed rails may be exposed; 2) carry out loading tests on bed rails currently in use throughout the UK to determine whether they comply with the current safety recommendations proposed by the CEN standards.A laboratory study was conducted to determine the force exertions of 20 participants performing seven tasks (including activities of both bed occupants and care providers), which were considered representative of the forces to which bed rails could be exposed during normal use. Forces exerted by participants were measured using a force platform and distortions of the bed rails leading to potential entrapment zones were measured using linear displacement transducers. Static load tests were then conducted, in which incremental point loading was applied at the most adverse points on each of nine different bed rails (commonly used in UK nursing and residential care homes) in accordance with the test procedure detailed in the current CEN standards. Maximum static forces exerted by participants were found to range between 250 N and 350 N, which were within the 500 N force tolerance requirements set by the standards. Dynamic tasks involving 'rolling aggressively' against the bed rail produced the highest peak force of 722 N. None of the bed rails included in this study met the requirements of the CEN test procedures, principally due to horizontal lateral displacements being in excess of 50 mm for a 500 N applied force and/or the bed rails' inability to withstand inward horizontal forces of 500 N. Bed rails used with divan beds were often unable to withstand forces greater than 300 N due to turning moments exceeding the bed rail's restraining mechanism. Current CEN standards for assessing the strength and rigidity of bedside safety rails appear to be consistent with the human forces that might arise as a consequence of the normal movement and activities of a bed occupant or care provider. Although compliance with existing standards is not compulsory, findings from the tests carried out on the selection of bed rails in current use throughout the UK highlight the need for improvements in the design and manufacture of bed rails.

Estimation of spinal loads in overhead work.

To explore the spinal loads occurring in overhead working postures and to assess the value of ergonomic reduction of lumbar extension, spinal strain was measured by stature change in simulated motor vehicle maintenance tasks. A field study identified the typical extent of lumbar extension incurred in this type of work. In the laboratory eight male volunteers tightened and loosened bolts both overhead and at chest-height for 30 min periods; records were made of lumbar posture, ground reaction force, and perceived exertion. Stature change was measured using a refined technique which permitted estimation of net effect of the work loads. The field study revealed that motor mechanics typically spent 8% of their time working overhead with up to 10 degrees of lumbar extension. In the laboratory study, the overhead task entailed more lumbar extension and perceived exertion than did the chest-height task; ground reaction forces did not differ substantially between tasks. Only small changes in stature were observed at the end of the work period, and there was no significant difference between the tasks (means: overhead, +0.61 mm; chest-height, -0.23 mm: p = 0.31). Stature change was significantly correlated with lordosis for overhead work such that increased lordosis (compared with chest-height work) was associated with relative stature gain. No evidence was found to indicate a need for ergonomic intervention in overhead work tasks so far as spinal loading is concerned. The lack of substantial change in stature from tasks perceived to involve moderately high levels of exertion was unexpected; it would appear that some elements of dynamic work tasks may have a relative unloading effect, and that lordotic postures reduce load on the spinal discs.

Physiological and spinal responses to circuit weight-training.

Physiological, perceptual and physical responses to a typical circuit weight-training (CWT) regimen were recorded in two studies. The aims were to assess the intensity of exercise during CWT; and to determine whether physical responses as evaluated by spinal shrinkage were related to physiological and perceptual responses to CWT. In the first study (n = 10) heart rate (HR), oxygen consumption (VO2), ventilation (VE), blood lactate (La) and perceived exertion (RPE) were measured in response to CWT. Mean (+/- SD) time to complete three circuits of CWT was 17.8 (+/- 1.4) min. The HR max, VO2 max and peak La, measured first during an incremental treadmill test, were 195 (+/- 13) beats.min-1, 59.7 (+/- 4.8) ml.kg-1.min-1 and 14.3 (+/- 3.5) mM respectively. Mean HR and VO2 during CWT were 69% and 50% of the respective maximal values. The HR-VO2 ratio observed on the treadmill was elevated during CWT, with VO2 being lowered relative to HR. Mean VE and La values were 52.7 (+/- 14.5) l.min-1 and 6.9 (+/- 3.6) mM. The effect of the same CWT regimen on spinal loading as indicated by change in stature (shrinkage) was investigated in a second study (n = 8). The mean (+/- SD) time taken to complete the circuit was 17.4 (+/- 1.3) min. Mean shrinkage due to CWT (2.5 +/- 1.5 mm) was unrelated to the time taken to complete the circuits, to HR, RPE or to low back pain ratings (p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous measurement of lumbar posture using flexible electrogoniometers.

Continuous measurement of changing limb segment angle is possible using a recently introduced flexible electrogoniometer but, unfortunately, the magnitude of linear displacements occurring during flexion and extension of the trunk has prevented its use as a measure of spinal mobility and posture. To overcome this limitation, a specially constructed, lightweight, aluminium carriage has been developed to allow free linear travel of the electrogoniometer, while maintaining the angle recorded between the thoracolumbar junction and the sacrum. The reliability and practicability of this new approach for recording changes in lumbar posture have been investigated. Following bench tests and operator training, measurements of maximal flexion and extension of the lumbar spine were repeated on 12 subjects. The extent of sagittal mobility was compared with measures from a fluid-filled inclinometer and a flexicurve. Analysis of the data showed that the use of the aluminium carriage did not markedly influence the accuracy of the electrogoniometer, and the technique as modified was found to be comparable with standard techniques for estimating the extent of lumbar sagittal flexibility. A field based study, involving four garage mechanics, was undertaken to examine the usability and acceptability of the electrogoniometer technique for continuous measurements. Lumbar curvature was monitored continuously for a two hour period during the course of the mechanics' working day. Dedicated software provided angle-time plots from which it was established that extreme flexed or extended postures were maintained only for relatively short periods; projection to an eight hour shift would indicate that a total of approximately 40 min is spent in extension beyond 10 degrees and flexion beyond 50 degrees. The technique has the potential to provide quantitative information on lumbar posture necessary for non-invasive, biomechanical investigations of spinal loading. It will be particularly useful for both sporting and occupational ergonomics field-studies.

Changes in stature during exercise and sports training.

Shrinkage in stature is used in ergonomics and sports contexts as an index of load on the spine. Measurement is now computer-aided to facilitate data collection. Applications of the technique to sport and exercise have included evaluations of weight-training, running and jumping drills. The technique has also been employed in assessing procedures for spinal unloading such as gravity inversion. Future applications include investigations of procedures used to prevent back injury as well as studies of sports that impose high transient loads on the spine.

Running speed and spinal shrinkage in runners with and without low back pain.

Decreases in stature (shrinkage) are used to indicate exercise induced spinal loading. This study examined the effect of three running speeds on two groups of runners, one with chronic low back pain. The two groups of seven male marathon runners ran at 70%, 85%, and 100% of their marathon race pace for 30 min on separate occasions. Before and after exercise the subjects were seated for 20 min with the lumbar spine supported. Stature was measured before pre-exercise sitting, before running, after 15 min of running, after 30 min of running, and after post-exercise sitting. A stadiometer accurate to within 0.5 mm was used to record changes in stature. Results showed no differences in response to the three running regimens between the groups (P greater than 0.05). Shrinkage was greater during the first 15 min, being 3.26 (+/- 2.78) mm compared with 2.12 (+/- 1.61) mm for the second 15 min of the run (P less than 0.05). The faster the running speed the greater the resultant shrinkage. The 70%, 85%, and 100% conditions caused 3.37 (+/- 2.38), 5.10 (+/- 1.90), and 7.69 (+/- 3.69) mm of shrinkage, respectively (P less than 0.005). These results suggest that low back pain is independent of the shrinkage induced by running. Further research is required to determine the effect of longer duration runs on spinal shrinkage.

Changes in stature following drop jumping and post-exercise gravity inversion.

Spinal shrinkage, measured by changes in stature, is used as an index of spinal loading as alterations reflect changes in intervertebral disc height. Shrinkage induced by various physical activities may be reversed using gravity inversion. The present purpose was to examine the shrinkage induced by a drop jumping regimen and evaluate gravity inversion post-exercise. Eight males, aged 20-31, performed two separate experimental protocols, each on different dates at 1400 h. Subjects stood for 30 min before undertaking an exercise regimen, consisting of five sets of five drop jumps from a height of 1 m, rebounding over a hurdle 0.5 m high. For 20 min, directly following the exercise regimen, subjects on one occasion stood and on a second occasion undertook gravity inversion. Shrinkage was monitored for 40 min after this post-exercise treatment. The stadiometer used to measure shrinkage was accurate to 0.05 mm. The exercise regimen caused a mean shrinkage of 1.68 and 1.81 mm for the two testing sessions. Post-exercise inversion and standing for 20 min increased stature by 5.18 and 0.76 mm, respectively (P less than 0.01). The 40-min standing period following inversion caused a rapid loss in stature (4.07 mm). At 30 min into this recovery period, there was no significant difference in shrinkage for either of the regimens. Results suggest that effects of an inversion treatment are short-lasting.