Does ergonomic mismatch at school impact pain in school children?

Musculoskeletal pain in school-aged children is highly prevalent. While there are many potential factors relating to this discomfort, one unexplored factor is the ergonomic mismatch. The objective of this study was to determine whether the degree of mismatch between the body dimensions and the classroom furniture was associated with body discomfort. One hundred and thirty-nine children in a Midwestern U.S. school district participated in the study where demographic information, anthropometric measurements, self-reported regional body discomfort, and furniture measurements were collected. The results indicate an extremely high prevalence of ergonomic mismatch. Contrary to what was hypothesized, the ergonomic mismatch was not associated with body discomfort. The lack of association may have been a result of the extremely high prevalence of ergonomic mismatch as well as potential adaptations by the students. Although almost every student was found to not fit their desk and chairs, ergonomic mismatch had limited impact on the body discomfort. It appears that other factors such as backpack weight and time carrying may contribute more to the discomfort of students. However, caution is stress with regard to dismissing ergonomic mismatch factor as a potential risk factor since the extremely high prevalence may have washed out any effect.

Can a transitional work grant program in a workers' compensation system reduce cost and facilitate return to work?

Although previous research has shown returning the injured worker to work as soon as possible is important to the long-term prospects of the worker remaining in the work force, there is limited economic support for implementing such programs. Thus, the purpose of this case control study was to determine the cost savings of the implementation of a Transitional Work Grant (TWG) program, which consisted of several components including job analyses, education, communication and transitional work (TW). Companies that enrolled in the TWG program were matched to nonparticipating companies (NTW) based on employer size, type of industry, number of overall claims, and number of claims with > 7 days lost time (LT claims) submitted the year prior to enrollment. The study analyzed economic data: number of claims, number of LT claims, indemnity costs, medical costs, and days lost (days away from the workplace). An additional outcome was the ratio of LT claims (> 7 days lost work) to medical only (MO) claims (LT/MO ratio). Overall, participation in the TWG program was associated with decreased indemnity cost and decreased LT/MO ratio. However, effectiveness of the program varied by employer size and industry. In terms of the state of Ohio, these costs translate into substantial savings: more than $2.3 million per year. Although the cost savings and reduction in lost time claims is encouraging, the true benefit of TW has yet to be completely quantified. Future work must account for other potential co-factors and programs that could also contribute to the savings as well as document further the indirect benefits associated with a TWG program, such as improved employee morale and increased productivity and product quality that could be four times greater than the direct savings. In summary, programs such as this one adopted by several companies in Ohio can reduce the cost burden of injuries.

Subject-specific compressive tolerance estimates.

Spinal load models have become an increasingly valuable tool for the evaluation of the stress placed on the spine. In order to get an accurate representation of these spinal loads, they must be compared to known tolerance values. Bone mineral content and density of the lumbar spine of 23 males and 21 females was measured using a dual energy x-ray absorptiometry. Compression tolerance values were predicted by previously published studies based upon bone mineral levels. Anthropometric measurements were recorded and related to the compression tolerance values through the use of multivariate linear regression techniques. Compression tolerance values based on the bone mineral content or density explains more of the individual variability than solely age-based estimates. Several anthropometric variable regression models were developed that resulted in moderate to good predictive power (R(2) = 0.62 to 0.81). The current study describes a useful alternative to traditional tolerance estimates that accounts for individual differences requiring non-invasive and time-efficient procedures.

Spinal loading when lifting from industrial storage bins.

The study documented three-dimensional spinal loading during lifting from an industrial bin. Two lifting styles and two bin design factors were examined in Phase I. The lifting style measures in Phase I were one hand versus two hand and standing on one foot versus two feet. The bin design variables were region of load in the bin and bin height. The Phase II study examined one-handed lifting styles with and without supporting body weight with the free hand on the bin as well as region and the number of feet. Twelve male and 12 female subjects lifted an 11.3 kg box from the bin. Spinal compression, lateral shear and anterior - posterior shear forces were estimated using a validated EMG-assisted biomechanical model. Phase I results indicated that the bin design factor of region had the greatest impact on spinal loading. The upper front region minimized spinal loading for all lifting styles. Furthermore, the lifting style of two hands and two feet minimized spinal loading. However, comparing Phase I two-handed lifting with Phase II one-handed supported lifting, the one-handed supported lifting techniques had lower compressive and anterior - posterior shear loads in the lower regions as well as the upper back region of the bin. A bin design that facilitates lifting from the upper front region of the bin reduces spinal loading more effectively than specific lifting styles. Furthermore, a bin design with a hand hold may facilitate workers using a supported lifting style that reduces spinal loading.

Spine loading characteristics of patients with low back pain compared with asymptomatic individuals.

STUDY DESIGN: Patients with low back pain and asymptomatic individuals were evaluated while performing controlled and free-dynamic lifting tasks in a laboratory setting. OBJECTIVE: To evaluate how low back pain influences spine loading during lifting tasks. SUMMARY OF BACKGROUND DATA: An important, yet unresolved, issue associated with low back pain is whether patients with low back pain experience spine loading that differs from that of individuals who are asymptomatic for low back pain. This is important to understand because excessive spine loading is suspected of accelerating disc degeneration in those whose spines are damaged already. METHODS: In this study, 22 patients with low back pain and 22 asymptomatic individuals performed controlled and free-dynamic exertions. Trunk muscle activity, trunk kinematics, and trunk kinetics were used to evaluate three- dimensional spine loading using an electromyography- assisted model in conjunction with a new electromyographic calibration procedure. RESULTS: Patients with low back pain experienced 26% greater spine compression and 75% greater lateral shear (normalized to moment) than the asymptomatic group during the controlled exertions. The increased spine loading resulted from muscle coactivation. When permitted to move freely, the patients with low back pain compensated kinematically in an attempt to minimize external moment exposure. Increased muscle coactivation and greater body mass resulted in significantly increased absolute spine loading for the patients with low back pain, especially when lifting from low vertical heights. CONCLUSIONS: The findings suggest a significant mechanical spine loading cost is associated with low back pain resulting from trunk muscle coactivation. This loading is further exacerbated by the increases in body weight that often accompany low back pain. Patient weight control and proper workplace design can minimize the additional spine loading associated with low back pain.

Exposure to liquid sulfur mustard.

Chemical weapons continue to pose a serious threat to humanity. With the use of chemical weapons by terrorists in Tokyo, and the projected disarming of the chemical weapon stockpile in this country, the possibility that emergency physicians will encounter patients contaminated by chemical munitions, such as sulfur mustard, exists. Mustard is a vesicating agent with a long latency between exposure and symptoms. Exposure can cause burns, conjunctivitis, pneumonia, and death. We describe 3 workers exposed to mustard at a chemical weapon storage facility. This article reports the first case of an exposure to mustard at a storage facility, as well as the first documented incident occurring in the United States. All physicians who manage patients in an acute care setting should be aware of the presentation and emergency treatments involving patients contaminated with mustard.

A non-MVC EMG normalization technique for the trunk musculature: Part 1. Method development.

Normalization of muscle activity has been commonly used to determine the amount of force exerted by a muscle. The most widely used reference point for normalization is the maximum voluntary contraction (MVC). However, MVCs are often subjective, and potentially limited by sensation of pain in injured individuals. The objective of the current study was to develop a normalization technique that predicts an electromyographic (EMG) reference point from sub-maximal exertions. Regression equations predicting maximum exerted trunk moments were developed from anthropometric measurements of 120 subjects. In addition, 20 subjects performed sub-maximal and maximal exertions to determine the necessary characteristic exertions needed for normalization purposes. For most of the trunk muscles, a highly linear relationship was found between EMG muscle activity and trunk moment exerted. This analysis determined that an EMG-moment reference point can be obtained via a set of sub-maximal exertions in combination with a predicted maximal exertion (expected maximum contraction or EMC) based upon anthropometric measurements. This normalization technique overcomes the limitations of the subjective nature for the MVC method providing a viable assessment method of individuals with a low back injury or those unwilling to exert an MVC as well as could be extended to other joints/muscles.

A non-MVC EMG normalization technique for the trunk musculature: Part 2. Validation and use to predict spinal loads.

Estimates of the amount of force exerted by a muscle using electromyography (EMG) rely partially upon the accuracy of the reference point used in the normalization technique. Accurate representations of muscle activities are essential for use in EMG-driven spinal loading models. The expected maximum contraction (EMC) normalization method was evaluated to explore whether it could be used to assess individuals who are not capable of performing a maximum exertion such as a person with a low back injury. Hence, this study evaluated the utility of an EMG normalization method (Marras and Davis, A non-MVC EMG normalization technique, Part 1, method development. Journal of Electromyography and Kinesiology 2000) that draws upon sub-maximal exertions to determine the reference points needed for normalization of the muscle activities. The EMC normalization technique was compared to traditional MVC-based EMG normalization by evaluating the spinal loads for 20 subjects (10 males and 10 females) performing dynamic lifts. The spinal loads (estimated via an EMG-assisted model) for the two normalization techniques were very similar with differences being <8%. The model performance variables indicated that both normalization techniques performed well (r(2)>0.9 and average error below 6%) with only the muscle gain being affected by normalization method as a result in different reference points. Based on these results, the proposed normalization technique was considered to be a viable method for EMG normalization and for use in EMG-assisted models. This technique should permit the quantitative evaluation of muscle activity for subjects unable to produce maximum exertions.

Crystallohydrodynamics for solving the hydration problem for multi-domain proteins: open physiological conformations for human IgG.

Hydrodynamic methods provide a route for studying the low-resolution conformation--in terms of time-averaged spatial orientation of the Fab' and Fc domains relative to each other--of the human IgG subclasses, IgG1, IgG2, IgG3 and IgG4 in the environment in which many exist naturally---a solution. Representative modelling strategies are now available using 'shell-bead' or 'shell' modelling of the surface of the molecules with the size-independent programme SOLPRO [J. Garcia de la Torre, S.E. Harding, B. Carrasco, Eur. Biophys. J. 28 (1999) 119-132]. The shell model fits to the equivalent inertial surface ellipsoids of the published crystal structures for the Fab' and Fc domains of IgG are made and an apparent hydration delta(app) of 0.51g/g for Fab' and 0.70 g/g for the glycoprotein Fc are obtained, which yield an average value of (0.59+/-0.07) g/g for the intact antibody (2 Fab'+1 Fc). The relative orientations of these domains for each of the IgG subclasses is then found (using where appropriate a cylindrical hinge) from SOLPRO by modelling the Perrin function, P (i.e. 'frictional ratio due to shape') using this delta(app) and experimentally measured sedimentation coefficients. All the IgG subclasses appear as open, rather than compact structures with the degree of openness IgG3>IgG1>(IgG2, IgG4), with IgG3 and IgG1 non-coplanar. The hingeless mutant IgGMcg, with s degrees (20,w) approximately 6.8 S yields a coplanar structure rather similar to IgG2 and IgG4 and consistent with its crystallographic structure. The extension of this procedure for representing solution conformations of other antibody classes and other multi-domain proteins is indicated.

The effects of motion on trunk biomechanics.

OBJECTIVE: To review the literature that evaluates the influence of trunk motion on trunk strength and structural loading. BACKGROUND: In recent years, trunk dynamics have been identified as potential risk factors for developing low-back disorders. Consequently, a better understanding of the underlying mechanisms involved in trunk motion is needed. METHODS: This review summarizes the results of 53 studies that have evaluated trunk motion and its impact on several biomechanical outcome measures. The biomechanical measures consisted of trunk strength, intra-abdominal pressure, muscle activity, imposed trunk moments, and spinal loads. Each of these biomechanical measures was discussed in relation to the existing knowledge within each plane of motion (extension, flexion, lateral flexion, twisting, and asymmetric extension). RESULTS: Trunk strength was drastically reduced as dynamic motion increased, and males were impacted more than females. Intra-abdominal pressure seemed to only be affected by trunk dynamics at high levels of force. Trunk moments were found to increase monotonically with increased trunk motion. Both agonistic and antagonistic muscle activities were greater as dynamic characteristics increased. As a result, the three-dimensional spinal loads increase significantly for dynamic exertions as compared to isometric conditions. CONCLUSIONS: Trunk motion has a dramatic affect on the muscle coactivity, which seems to be the underlying source for the decrease strength capability as well as the increased muscle force, IAP, and spinal loads. This review suggests that the ability of the individual to perform a task "safely" might be significantly compromised by the muscle coactivity that accompanies dynamic exertions. It is also important to consider various workplace and individual factors when attempting to reduce the impact of trunk motions during dynamic exertions. Relevance This review provides insight as to why trunk motions are important risk factors to consider when attempting to control low-back disorders in the workplace. It is apparent that trunk motion increases the risk of low-back disorders. To better control low-back disorders in industry, more comprehensive knowledge about the impact of trunk motion is needed. A better understanding of muscle coactivity may ultimately lead to reducing the risk associated with dynamic exertions.

Assessment of the relationship between box weight and trunk kinematics: does a reduction in box weight necessarily correspond to a decrease in spinal loading?

Typically, the simplest and most cost-efficient ergonomic solution to offset the rising costs of low back injuries is to reduce the box weight that is lifted. However, there is limited research on how a worker interacts with the box. In the present study, we quantify the utility of reducing the weight that is lifted - specifically, how changes in the box weight affect trunk kinematics, trunk moments, and ultimately, spinal loads. In the experiment, 15 participants lifted a variety of box weights (from 9.1 to 41.7 kg) from knee height, carried it a distance of 5 feet (1.5 m), and placed it on a shelf at elbow height. For the lower weights, small increases in box weight (3-9 kg) were offset by the trunk dynamics (sagittal velocity), resulting in no difference in spinal loads. At the same time, spinal loads were found to be significantly higher for weights above 25 kg. Thus, when making ergonomic changes (reduction of box weight), it is important to consider how workers will interact with the box. These results indicate that purely weight-based ergonomic controls might not sufficiently reduce the risk of low back disorders. Furthermore, this study provides additional evidence of the utility of using more complex spinal load models (dynamic, multiple muscle models) when evaluating highly dynamic and complex tasks.

Effect of foot movement and an elastic lumbar back support on spinal loading during free-dynamic symmetric and asymmetric lifting exertions.

The aim of this study was to assess the effect of an elastic lumbar back support on spinal loading and trunk, hip and knee kinematics while allowing subjects to move their feet during lifting exertions. Predicted spinal forces and moments about the L5/S1 intervertebral disc from a three-dimensional EMG-assisted biomechanical model, trunk position, velocities and accelerations, and hip and knee angles were evaluated as a function of wearing an elastic lumbar back support, while lifting two different box weights (13.6 and 22.7 kg) from two different heights (knee and 10 cm above knee height), and from two different asymmetries at the start of the lift (sagittally symmetric and 60 degrees asymmetry). Subjects were allowed to lift using any lifting style they preferred, and were allowed to move their feet during the lifting exertion. Wearing a lumbar back support resulted in no significant differences for any measure of spinal loading as compared with the no-back support condition. However, wearing a lumbar back support resulted in a modest but significant decrease in the maximum sagittal flexion angle (36.5 to 32.7 degrees), as well as reduction in the sagittal trunk extension velocity (47.2 to 40.2 degrees s(-1)). Thus, the use of the elastic lumbar back support provided no protective effect regarding spinal loading when individuals were allowed to move their feet during a lifting exertion.

The relationship between psychosocial work characteristics and low back pain: underlying methodological issues.

OBJECTIVE: To evaluate the current epidemiological evidence linking psychosocial work characteristics with low back pain. BACKGROUND: Psychosocial work characteristics have been widely evaluated as potential risk factors for low back injury. However, studies with different study populations and using various types of measures have had conflicting results. METHODS: This review is the most extensive to date, reviewing 66 articles that have provided empirical evidence about the relationship between psychosocial work characteristics and initial reporting of lower back pain. The studies are reviewed with an emphasis on certain methodological issues: controlling for potential confounding; timing of the data collection; and measurement of the exposures and outcomes. RESULTS: The results of this review suggest that controlling for potential confounding from occupational biomechanical demands had a large influence on the associations found between psychosocial work characteristics and lower back pain. In addition, the use of accurate and reliable measures for the occupational exposures (biomechanical and psychosocial) and the lower back pain outcomes appears to influence the strength of the associations found between psychosocial work characteristics and lower back pain. CONCLUSION: Given the methodological concerns discussed in this review, it is difficult to draw strong causal inferences from this literature. However, it does appear that psychosocial characteristics are related to some lower back pain outcomes, and that employees' reactions to psychosocial work characteristics (e.g., job dissatisfaction and job stress) are more consistently related to lower back pain than are the psychosocial work characteristics themselves (e.g., work overload, lack of influence over work, quality of relationships with coworkers). RELEVANCE: This review attempts to identify and address methodological issues in the literature evaluating the relationship between psychosocial work characteristics and lower back pain. Implications for future research are presented.

An investigation of perceived exertion via whole body exertion and direct muscle force indicators during the determination of the maximum acceptable weight of lift.

The objective of this study was to identify the perceived exertion mechanisms (direct muscle force and whole body exertion) associated with the decision to change the weight of lift during the determination of the maximum acceptable weight of lift (MAWL). Fifteen males lifted a box of unknown weight at a rate of 4.3 lifts/min, and adjusted the weight until their MAWL was reached. Variables such as the predicted muscle forces and heart rate were measured during the lifting exertion, as well as the predicted spinal loading in three dimensions using an EMG-assisted biomechanical model. Multiple logistic regression techniques were used to identify variables that were associated with the decision to change the weights up and down prior to a subsequent lift. Results indicated that the force in the left erector spinae, right internal oblique, and left latissimus dorsi muscles as well as heart rate were associated with decreases in the weight prior to the next lift. It appears that a combination of local factors (muscle force) and whole body exertion factors (heart rate) provide the feedback for the perceived exertion when decreasing the weight. The up-change model indicated that the forces of the right erector spinae, left internal oblique, and the right latissimus dorsi muscles were associated with the decision to increase the weight prior to the next lift. Thus, local factors provide feedback during the decision to increase the weight when starting from light weights. Collectively, these findings indicate that psychophysically determined weight limits may be more sensitive to muscular strain rather than spinal loading.

The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine.

STUDY DESIGN: The effects of psychosocial stress on muscle activity and spinal loading were evaluated in a laboratory setting. OBJECTIVE: To evaluate the influence of psychosocial stress, gender, and personality traits on the functioning of the biomechanical system and subsequent spine loading. SUMMARY OF BACKGROUND DATA: Physical, psychosocial, and individual factors all have been identified as potential causal factors of low back disorders. How these factors interact to alter the loading of the spine has not been investigated. METHODS: Twenty-five subjects performed sagittally symmetric lifts under stressful and nonstressful conditions. Trunk muscle activity, kinematics, and kinetics were used to evaluate three-dimensional spine loading using an electromyographic-assisted biomechanical model. A personality inventory characterized the subject's personality traits. Anxiety inventories and blood pressure confirmed reactions to stress. RESULTS: Psychosocial stress increased spine compression and lateral shear, but not in all subjects. Differences in muscle coactivation accounted for these stress reactions. Gender also influenced spine loading; Women's anterior-posterior shear forces increased in response to stress, whereas men's decreased. Certain personality traits were associated with increased spine loading compared with those with an opposing personality trait and explained loading differences between subjects. CONCLUSIONS: A potential pathway between psychosocial stress and spine loading has been identified that may explain how psychosocial stress increases risk of low back disorders. Psychosocially stressful environments solicited more of a coactivity response in people with certain personality traits, making them more susceptible to spine loading increases and suspected low back disorder risk.

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.

Variation in spinal load and trunk dynamics during repeated lifting exertions.

OBJECTIVES: To quantify the variability in lifting motions, trunk moments, and spinal loads associated with repeated lifting exertions and to identify workplace factors that influence the biomechanical variability. DESIGN: Measurement of trunk dynamics, moments and muscle activities were used as inputs into EMG assisted model of spinal loading. BACKGROUND: Traditional biomechanical models assume repeated performance of a lifting task produces little variability in spinal load because the assessments overlook variability in lifting dynamics and muscle coactivity. METHODS: Five experienced and seven inexperienced manual materials handlers performed 10 repeated lifts at each combination of load weight, task asymmetry and lifting velocity. RESULTS: Box weight, task asymmetry and job experience influenced the magnitude and variability of spinal load during repeated lifting exertions. Surprisingly, experienced subjects demonstrated significantly greater spinal loads and within-subject variability in spinal load than inexperienced subjects. Trial-to-trial variability accounted for 14% of the total variation in compression overall and 32% in lateral shear load. Although the mean spinal load was safely below the NIOSH recommended limit; due to variability about the mean, more than 20% of the lifts exceeded the recommended limit. CONCLUSION: Spinal load changed markedly from one exertion to the next despite identical task requirements. Trial-to-trial variability in kinematics, kinetics, and spinal load were influenced by workplace factors, and may play a role in the risk of low-back pain. RELEVANCE: Ergonomic assessments considering only the mean value of spinal load overlook the fact that a large fraction of the lifts may exceed recommended levels.

Variability in spine loading model performance.

OBJECTIVE: To assess the sources of variability associated with an EMG-assisted model of spine loading. DESIGN: In vivo measurements of trunk dynamics, lifting moments and muscle activities were used as inputs into an EMG-assisted spine loading model. BACKGROUND: Several types of variability are inherent in biomechanical assessments of risk associated with trunk bending motions during lifting. Variability may occur as a function of variations in spine loading due to either subject variations in motion profiles (kinematics) or biomechanical model performance. METHODS: Twelve experienced and inexperienced materials handlers performed 10 repeated lifts where load weight, asymmetry, and velocity were varied. The experiment was replicated on a second day to assess day to day variability. RESULTS: These model performance variables indicated that variability was mainly a function of subject characteristics and experience. Minor variations in variability were associated with the task asymmetry and weight lifted. Advanced analyses suggested that experienced workers had a greater range of back motion compared to inexperienced workers which would affect the length-strength component of the model calibration. CONCLUSIONS: This study indicates that for the results of an EMG-assisted model to be accurate, it is important to ensure that the model reflects a realistic relationship between the trunk muscle length and the muscle force production capacity. Underestimation if this relationship can degrade model fidelity and robustness. RELEVANCE: These results imply that by properly calibrating the model it is then reasonable to assume that the vast majority of variations observed in repeated exertions of a particular trial are due to kinematic and kinetic differences inherent in the muscle control system and not a function of model randomness.

Otologic injuries caused by airbag deployment.

Airbags are clearly successful at mitigating injury severity during motor vehicle accidents. Deployment unfortunately has introduced new injury-causing mechanisms. A retrospective review of 20 patients who sustained otologic injuries resulting from airbag inflation was conducted. The most common symptoms were hearing loss in 17 (85%) and tinnitus in 17 (85%). Objective hearing loss was documented in 21 of 24 (88%) subjectively affected ears; this included unilateral and bilateral sensorineural, unilateral conductive, and mixed hearing losses. Ten patients (50%) had dysequilibrium. Four subjects (20%) had a tympanic membrane perforation; each required surgical closure. Ear orientation toward the airbag was found to be associated with hearing loss (P = 0.027), aural fullness (P = 0.039), and tympanic membrane perforation (P = 0.0004). A wide variety of airbag-induced otologic injuries occur and may have long-term sequelae. It is important for health care personnel to be aware of these potential problems.

Significance of biomechanical and physiological variables during the determination of maximum acceptable weight of lift.

The aim was to identify which biomechanical and physiological variables were associated with the decision to change the weight of lift during the determination of the maximum acceptable weight of lift (MAWL) in a psychophysical study. Fifteen male college students lifted a box of unknown weight at 4.3 lifts/min, and adjusted the weight until their MAWL was reached. Variables such as heart rate, trunk positions, velocities and accelerations were measured during the lifting, as well as estimated spinal loading in terms of moments and spinal forces in three dimensions using an EMG-assisted biomechanical model. Multiple logistic regression techniques identified variables associated with the decision to change the weights up and down prior to a subsequent lift. Results indicated that heart rate, predicted sagittal lift moment and low back disorder (LBD) risk index were associated with decreases in the weight prior to the next lift. Thus, historical measures of LBD risk (e.g. compression, shear force) were not associated with decreases in weight prior to the next lift. Additionally, the magnitudes of the predicted spinal forces and LBD risk were all very high at the MAWL when compared with literature sources of tolerance as well as observational studies on LBD risk. Our findings indicate that the psychophysical methodology may be useful for the decision to lower the weight of loads that may present extreme levels of risk of LBD; however, the psychophysical methodology does not seem to help in the decision to stop changing the weight at a safe load weight.