Duration and intensity of occupational lifting and risk of long-term sickness absence: Prospective cohort study with register follow-up among 45 000 workers.

OBJECTIVE: This study aimed to investigate the prospective association of lifting duration and lifting load with the risk of long-term sickness absence (LTSA). METHODS: We followed manual workers with occupational lifting (N=45 346) from the Work Environment and Health in Denmark Study (2012-2018) for two years in a high-quality national register on social transfer payments (DREAM). Cox regressions with model-assisted weights were employed to estimate the risk of LTSA from lifting duration and loads. RESULTS: During follow-up, 9.6% of the workers had an episode of LTSA. Compared to workers with seldom lifting (reference), workers lifting ½ and ¾ of the workday had increased risk of LTSA [hazard ratios (HR) of 1.36 [95% confidence interval (CI) 1.20-1.56] and 1.22 (95% CI 1.07-1.39)], respectively. Lifting load showed a positive exposure-response association with LTSA (trend test, P<0.01), with HR for lifting 5-15, 16-29, and ≥30 kg at 1.11 (95% CI 1.02-1.22), 1.17 (95% CI 1.03-1.34), and 1.29 (95% CI 1.11-1.50), respectively. Age-stratified analyses showed increased risk of LTSA among workers ≥50 years with a high proportion of work-related lifting compared to their younger counterparts. CONCLUSIONS: Occupational lifting for ½ the workday increased the risk of LTSA, while higher occupational lifting load exacerbated this risk in an exposure-response manner. The study underscores the importance of reducing both lifting duration and loads for prevention of LTSA at the workplace, especially among older workers.

The Importance of Lifting Height and Load Mass for Muscular Workload during Supermarket Stocking: Cross-Sectional Field Study.

High physical work demands increase the risk of musculoskeletal disorders and sickness absence. Supermarket work involves a high amount of manual material handling. Identifying specific ergonomic risk factors is an important part of occupational health and safety efforts in the supermarket sector. In this cross-sectional field study among 64 supermarket workers, we used electromyography during the workday to determine the influence of lifting height and load mass on muscular workload of the low-back and neck/shoulder muscles during un-restricted manual material handling (grocery stocking). We found a significant effect of load mass, i.e., higher loads associated with higher muscular workload in the low-back and neck/shoulder muscles. We demonstrated a significant interaction between start and end position, i.e., lifts performed from 'Low' start positions to 'High' end positions demonstrated the highest low-back muscular workload, whereas 'High' positions were associated with increased neck/shoulder workload. In conclusion, lifting higher loads and lifting goods from low to high positions (low-back) and at high positions (neck/shoulder) are associated with higher muscular workload. These results can be used to guide highly warranted preventive initiatives to reduce the physical workload during supermarket work.

Technical field measurements of muscular workload during stocking activities in supermarkets: cross-sectional study.

Multiple studies have reported high prevalence of musculoskeletal disorders among supermarket workers. Technical field measurements can provide important knowledge about ergonomic risk factors for musculoskeletal disorders in the physical working environment, but these measurements are lacking in the supermarket sector. Therefore, using wearable electromyography and synchronous video recording in 75 supermarket workers, this cross-sectional study measured muscular workload during stocking activities in six different types of general store departments and during the thirteen most common work tasks across five different supermarket chains. Our results showed that muscular workload varies, especially for the low-back muscles, across (1) supermarket chains, (2) departments, and (3) specific stocking activities. Highest workloads of the low-back and neck/shoulders were seen in the fruit and vegetables department and during heavy, two-handed lifts of parcels (especially without using technical aids). In conclusion, physical work demands during supermarket stocking activities differ between chains, departments, and work tasks. These results can be used by company representatives and work environment professionals to specifically address and organize the stocking procedures to reduce the muscular workload during supermarket stocking.

Effects of load mass and position on the dynamic loading of the knees, shoulders and lumbar spine during lifting: a musculoskeletal modelling approach.

Musculoskeletal models may enhance our understanding of the dynamic loading of the joints during manual material handling. This study used state-of-the-art musculoskeletal models to determine the effects of load mass, asymmetry angle, horizontal location and deposit height on the dynamic loading of the knees, shoulders and lumbar spine during lifting. Recommended weight limits and lifting indices were also calculated using the NIOSH lifting equation. Based on 1832 lifts from 22 subjects, we found that load mass had the most substantial effect on L5-S1 compression. Increments in asymmetry led to large increases in mediolateral shear, while load mass and asymmetry had significant effects on anteroposterior shear. Increased deposit height led to higher shoulder forces, while the horizontal location mostly affected the forces in the knees and shoulders. These results generally support the findings of previous research, but notable differences in the trends and magnitudes of the estimated forces were observed.

Manual material handling in the supermarket sector. Part 2: Knee, spine and shoulder joint reaction forces.

Manual material handling is common in supermarkets and may be a contributing factor to the high prevalence of work-related musculoskeletal disorders, particularly to the lower back. This cross-sectional study applied state-of-the-art musculoskeletal models driven by kinematic data obtained in two supermarkets to estimate joint reaction forces in the knees, shoulders and lumbar spine under dynamic lifting conditions. Based on 1479 lifts from 15 workers, 8 tasks for which the compression or shear forces in the L5-S1 joint exceeded well-known biomechanical tolerance limits were identified. High shoulder forces were associated with lifting relatively heavy merchandise to high shelves, while the weight of the handled merchandise was the main predictor of high knee forces. The study addressed well-known limitations associated with traditional lifting analysis tools and was the first to present a detailed analysis of the biomechanical loads during manual material handling tasks in the supermarket sector based on field measurements.

Manual material handling in the supermarket sector. Part 1: Joint angles and muscle activity of trapezius descendens and erector spinae longissimus.

Work-related musculoskeletal disorders are highly prevalent in the supermarket sector with manual material handling being one of the most commonly identified occupational risk factors. This cross-sectional study applied inertial motion capture and electromyography (EMG) to measure full-body kinematics and muscle activity of trapezius descendens and erector spinae longissimus during 50 manual material handling tasks performed by 17 workers in two supermarkets. The handling of bread and cucumbers to high shelf heights showed the highest trapezius muscle activity (from 47% to 59% peak normalized EMG), while the handling of bananas as well as lifting milk, bread and cucumbers from low to high positions showed the highest erector spinae activity (from 59% to 71%). Twenty-two tasks involved flexing the shoulders and trunk more than 90° and 50°, respectively. Based on these results, several manual handling practices in supermarkets should be reconsidered to reduce the physical work demands.

Estimation of Spinal Loading During Manual Materials Handling Using Inertial Motion Capture.

Musculoskeletal models have traditionally relied on measurements of segment kinematics and ground reaction forces and moments (GRF&Ms) from marked-based motion capture and floor-mounted force plates, which are typically limited to laboratory settings. Recent advances in inertial motion capture (IMC) as well as methods for predicting GRF&Ms have enabled the acquisition of these input data in the field. Therefore, this study evaluated the concurrent validity of a novel methodology for estimating the dynamic loading of the lumbar spine during manual materials handling based on a musculoskeletal model driven exclusively using IMC data and predicted GRF&Ms. Trunk kinematics, GRF&Ms, L4-L5 joint reaction forces (JRFs) and erector spinae muscle forces from 13 subjects performing various lifting and transferring tasks were compared to a model driven by simultaneously recorded skin-marker trajectories and force plate data. Moderate to excellent correlations and relatively low magnitude differences were found for the L4-L5 axial compression, erector spinae muscle and vertical ground reaction forces during symmetrical and asymmetrical lifting, but discrepancies were also identified between the models, particularly for the trunk kinematics and L4-L5 shear forces. Based on these results, the presented methodology can be applied for estimating the relative L4-L5 axial compression forces under dynamic conditions during manual materials handling in the field.

Shoulder and arm muscle activity during elastic band exercises performed in a hospital bed.

OBJECTIVE: Muscle atrophy is a common side-effect of bed rest during hospitalization. However, resistance training may minimize or even prevent these complications. Therefore, we evaluated the efficiency of four upper-body elastic resistance exercises that could be performed while lying or sitting in a hospital bed. METHODS: Twenty-two healthy subjects performed three repetitions of each exercise in a supine and seated position with a perceived intensity of 3 (low) and 8 (high) on the Borg CR10 Scale. Surface electromyography was collected from 12 shoulder and arm muscles (e.g. trapezius, deltoideus, and biceps brachii), and normalized to a maximal voluntary isometric contraction (nEMG). RESULTS: During all exercises performed at high intensity, moderate (>40%) to high (>60%) levels of nEMG were found for the majority of the analysed muscles, e.g. deltoideus (from 37% to 69%, median 57.5%), trapezius (from 43% to 66%, median 51%), and infraspinatus (from 54% to 66%, median 59%), with the exception of pectoralis major (from 29% to 47%, median 39.5%) and latissimus dorsi (from 15% to 22%, median 18.5%). No significant differences were found between the supine and seated positions for any of the exercises. CONCLUSION: This study showed that high levels of shoulder and arm muscle activity can be achieved while lying or sitting in a hospital bed using appropriate exercises with elastic bands. The data presented here can be used by physiotherapists as a guideline for selecting suitable and effective strengthening exercises during in-hospital rehabilitation to counteract bed-rest related muscle atrophy in the upper body.

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.

Electromyographic evaluation of high-intensity elastic resistance exercises for lower extremity muscles during bed rest.

PURPOSE: Prolonged hospital bed rest after severe injury or disease leads to rapid muscle atrophy and strength loss. Therefore, the main aim of this study was to evaluate the efficacy of lower extremity strengthening exercises using elastic resistance that can be performed while lying in a hospital bed. METHODS: Using a cross-sectional design, 22 healthy individuals performed three consecutive repetitions of 14 different lower extremity exercises using elastic resistance, with a perceived intensity corresponding to 8 on the Borg CR-10 scale. Surface electromyography was measured on 13 lower extremity muscles and normalized to the maximal EMG (nEMG). Likewise, exercise satisfaction was evaluated by a questionnaire. RESULTS: All participants were able to perform all exercises without discomfort and generally rated them satisfactory. High levels of muscle activity were observed for all prime movers. For example, the "femoris muscle setting" exercise showed high levels of muscle activity for rectus femoris, vastus lateralis, and vastus medialis (79, 75, and 79% nEMG, respectively), while biceps femoris and semitendinosus were highly active during the prone knee flexion exercise with (72 and 71% nEMG, respectively) and without Kinesiology Tape (73 and 77% nEMG, respectively). CONCLUSION: High levels of muscle activity in the lower extremities can be achieved using elastic resistance exercises performed when lying in a hospital bed. Even though performed on healthy individuals, the present study has the potential to provide a reference table of exercises to select from when individualizing and progressing strengthening exercises during the early rehabilitation of bedridden individuals.

3D digital headform models of Australian cyclists.

Traditional 1D anthropometric data have been the primary source of information used by ergonomists for the dimensioning of head and facial gear. Although these data are simple to use and understand, they only provide univariate measures of key dimensions. 3D anthropometric data, however, describe the complete shape characteristics of the head surface, but are complicated to interpret due to the abundance of information they contain. Consequently, current headform standards based on 1D measurements may not adequately represent the actual head shape variations of the intended user groups. The purpose of this study was to introduce a set of new digital headform models representative of the adult cyclists' community in Australia. Four models were generated based on an Australian 3D anthropometric database of head shapes and a modified hierarchical clustering algorithm. Considerable shape differences were identified between our models and the current headforms from the Australian standard. We conclude that the design of head and facial gear based on current standards might not be favorable for optimal fitting results.

Reducing Physical Risk Factors in Construction Work Through a Participatory Intervention: Protocol for a Mixed-Methods Process Evaluation.

BACKGROUND: Previous research has shown that reducing physical workload among workers in the construction industry is complicated. In order to address this issue, we developed a process evaluation in a formative mixed-methods design, drawing on existing knowledge of the potential barriers for implementation. OBJECTIVE: We present the design of a mixed-methods process evaluation of the organizational, social, and subjective practices that play roles in the intervention study, integrating technical measurements to detect excessive physical exertion measured with electromyography and accelerometers, video documentation of working tasks, and a 3-phased workshop program. METHODS: The evaluation is designed in an adapted process evaluation framework, addressing recruitment, reach, fidelity, satisfaction, intervention delivery, intervention received, and context of the intervention companies. Observational studies, interviews, and questionnaires among 80 construction workers organized in 20 work gangs, as well as health and safety staff, contribute to the creation of knowledge about these phenomena. RESULTS: At the time of publication, the process of participant recruitment is underway. CONCLUSIONS: Intervention studies are challenging to conduct and evaluate in the construction industry, often because of narrow time frames and ever-changing contexts. The mixed-methods design presents opportunities for obtaining detailed knowledge of the practices intra-acting with the intervention, while offering the opportunity to customize parts of the intervention.