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PubMed1997

Lower extremity alignment and risk of overuse injuries in runners.

A group of 304 runners enrolling in a marathon training program had alignment measurements performed and completed a questionnaire on training practices and injuries over the previous 12 months. The alignment measures consisted of arch index (AI), heel valgus (HV), knee tubercle-sulcus angle (TSA), knee varus (KV), and leg-length difference (LLD). Results indicated few consistent statistical associations between these alignment measures and risk of injuries, either bivariately or multivariately: left AI with hamstring injuries; right AI with shin injuries; right HV with back injuries; left TSA with ankle injuries; KV with hip injuries; and LLD with back, ankle, and foot injuries. A few statistically significant relationships were also found between other training and anthropometric factors and injuries: mileage with hamstring injuries; interval training with shin injuries; hard surfaces with back and thigh injuries; shoe use patterns with foot and overall injuries; and body mass index with heel injuries. We conclude that lower-extremity alignment is not a major risk factor for running injuries in our relatively low mileage cohort; however, prospective studies are necessary to confirm or refute these findings.

Adult↗
PubMed2005

The effect of altered pitch length on performance and technique in junior fast bowlers.

The aim of this study was to assess the effect of pitch length (20.12 m [full length], 18 m and 16 m) on the fast bowling performance and technique of junior cricketers. Performance measures included ball release speed and accuracy, while technique variables evaluated were those shown to be related to the aetiology of lower back injury. Thirty-seven fast bowlers from the under-11 (n=14), under-13 (n=11) and under-15 (n=12) age groups were filmed bowling five deliveries at each of the above pitch lengths. Two synchronized NAC video cameras operating at 200 Hz permitted three-dimensional reconstruction of the hip and shoulder alignments, while a standard digital video camera operating at 50 Hz (positioned perpendicular to the bowling action) was used to measure front knee angle and ball release speed. Accuracy scores were taken from a zoned target at the batsman's stumps. A two-way analysis of variance with repeated measures (with age and pitch length as the between- and within-participant variables, respectively) was used to compare each age group at the 0.05 significance level. Results showed that accuracy improved in all age groups at shorter pitch lengths, although ball velocity remained constant throughout all trials. Shoulder counter-rotation increased significantly for the under-13 bowlers when bowling on the full-length pitch in comparison with the two shorter lengths. Counter-rotation also increased on the full-length pitch in the under-11 age group, although this increase was not significant. The under-15 bowlers' techniques did not change as pitch length increased. As under-11 and under-13 bowlers adopted a "safer" bowling action with superior accuracy on the 18?m compared with the full length pitch, it was concluded that these age groups should bowl on an 18?m pitch to reduce the likelihood of lower back injuries and improve accuracy.

Adolescent↗
PubMedDate not supplied

Invasive procedures for treating herniated discs: clinical and cost considerations.

Low back injury is the most frequent cause of occupational time loss and disability. A small percentage of back injuries represent surgical disease, and great care must be taken in applying surgical therapy to this complex problem. Perhaps the most important factor in surgical management of low back injury is accurate clinical and neurodiagnostic assessment. Because of the high cost of poor surgical outcomes, diagnostic tests and surgical procedures should be chosen on the basis of efficacy rather than cost per individual case. This is because the cost of an unsatisfactory result quickly eliminates any savings accumulated by performing a less precise or less effective procedure. The best surgical outcomes appear to result from a process consisting of (1) thorough clinical evaluation, (2) electrophysiological studies in selected cases, (3) CT scanning with multiplanar reformatting and three-dimensional images as needed, and (4) individually designed surgical procedures. When used as described elsewhere, this sequence appears to best define the association between clinical and radiographic abnormalities, provide the best percentage of successful results, and potentially offer the greatest long-term economies.

Back Pain↗
PubMed2000

Misclassification of physical work exposures as a design issue for musculoskeletal intervention studies.

OBJECTIVES: This study determined the impact of misclassification due to using job titles as surrogate variables for physical work exposures to assess confounding in a study of the preventive effect of back belts on back injury. The authors present retail merchandise data that quantify misclassification from residual confounding by physical work exposures on injury rate ratios when available administrative job titles are used. METHODS: Job title and direct observation data on 134 workers were used to calculate the percentage to which the job-title-adjusted rate ratio for back injury accounts for confounding by the true physical work exposures, awkward postures, and heavy weight handling. Workers' compensation data, an estimate of the effect of back belts from the literature, and the percentage of adjustment of the rate ratio due to the job title variable were used to calculate the magnitude of bias from the rate ratio adjusted for job title. RESULTS: The job title variable was found to have sensitivities of 97% and 85% and specificities of 68% and 58% for awkward postures and heavy weight handling, respectively. The magnitude of confounding bias remaining for the back-injury rate ratio when the job title surrogate was used was 24% for postures and 45% for heavy weight handling. CONCLUSIONS: The administrative job title performed poorly in this setting; residual confounding was sufficient to bias the rate ratio from 2.0 to 1.3. The effect of additional sources of misclassification and the need for better exposure measures than job title are discussed.

Back Injuries↗
PubMed2000

The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes.

OBJECTIVE: To determine the relationship of previous lower extremity (LE) injury and/or low back pain (LBP) on hip abduction and extension strength. DESIGN: Cohort study of college athletes at time of preparticipation screening physical. SETTING: An NCAA Division I college. PARTICIPANTS: Two hundred ten college athletes (140 males and 70 females) from an NCAA Division I school. MAIN OUTCOME MEASURES: Mean and maximal hip abduction and extension strengths were recorded using a specially designed dynamometer anchoring station. Previous injury to the LE or LBP in the past year was recorded via personal interview at the time of screening and verified by review of previous injury records. RESULTS: A significant difference in side-to-side symmetry of maximum hip extension strength was observed in female subjects who reported LE injury or LBP as compared to those who did not. Side-to-side difference in hip strength, however, did not differ between male athletes, regardless of reported LE injury or LBP status. CONCLUSION: Female athletes appear to have a differing response of the proximal hip musculature to LE injury or LBP, as compared with their male counterparts. Research is under way to further validate these findings. CLINICAL RELEVANCE: This study provides some reasoning to support the screening of hip strength during the preparticipation physical, as it may be important in the prevention of LE injury and LBP in collegiate athletes.

Adult↗
PubMed2000

Occupational disability related to back pain: application of a theoretical model of work disability using prospective cohorts of manual workers.

BACKGROUND: A new model of work disability was developed based on the assumption that four different groups of workers are present at the beginning of a prospective epidemiologic study: one group of workers without back pain, and three groups of workers with back pain and a gradient of work disability. The goal of this research was to verify if these groups comprise workers at different levels of risk of occurrence of complete work disability related to back injury. METHODS: Prospective cohorts of manual workers (n=578) were followed for 1 year to document the risk of occurrence of complete disability related to back injury. RESULTS: The results showed that the workers who presented with back pain without work disability at the beginning of the study were at less risk compared to all the other workers in the cohort. Moreover, an effect modification was found between the workers who initially presented with back pain without work disability and a past history of compensation for back injury, adding credence to the non-similarity of these workers to the others. CONCLUSIONS: Based on these results, further studies should focus on improving the knowledge of the characteristics of these workers leading to a better understanding of how to prevent occupational low-back pain.

Adult↗
PubMed2000

Manual handling activities and injuries among nurses: an Australian hospital study.

The aims of this study were to identify patterns of manual handling activities and their associated injuries and consequences among nurses working at a large teaching and referral medical centre in Melbourne, Australia. A self-report 140-item questionnaire was distributed to 523 registered nurses working full time at the medical centre. Of the 269 (51.4%) nurses who completed the questionnaire, 108 (40.1%) retrospectively reported an injury associated with manual handling activity, of which 75.9% (82) comprised back injuries. When all full-time nurses working at the medical centre are considered, the prevalence of all manual handling injuries was 20.6% (n=108) and 15.7% (n=87) for back injuries. About two-thirds (67.6%) of all manual handling injuries were associated with direct patient care activities and another third (32.4%) with non-direct patient care activities. Approximately one-third (34.3%) of all injuries were associated with lifting patients and this activity comprised one half of all causes associated with injuries arising from direct patient care activities. The consequences of injuries were significant. Recommendations for reducing manual handling activities and injuries are made and future research directions are discussed.

Adult↗
PubMed2004

Prediction of chronic disability in work-related musculoskeletal disorders: a prospective, population-based study.

BACKGROUND: Disability associated with work-related musculoskeletal disorders is an increasingly serious societal problem. Although most injured workers return quickly to work, a substantial number do not. The costs of chronic disability to the injured worker, his or her family, employers, and society are enormous. A means of accurate early identification of injured workers at risk for chronic disability could enable these individuals to be targeted for early intervention to promote return to work and normal functioning. The purpose of this study is to develop statistical models that accurately predict chronic work disability from data obtained from administrative databases and worker interviews soon after a work injury. Based on these models, we will develop a brief instrument that could be administered in medical or workers' compensation settings to screen injured workers for chronic disability risk. METHODS: This is a population-based, prospective study. The study population consists of workers who file claims for work-related back injuries or carpal tunnel syndrome (CTS) in Washington State. The Washington State Department of Labor and Industries claims database is reviewed weekly to identify workers with new claims for work-related back injuries and CTS, and these workers are telephoned and invited to participate. Workers who enroll complete a computer-assisted telephone interview at baseline and one year later. The baseline interview assesses sociodemographic, employment-related, biomedical/health care, legal, and psychosocial risk factors. The follow-up interview assesses pain, disability, and work status. The primary outcome is duration of work disability over the year after claim submission, as assessed by administrative data. Secondary outcomes include work disability status at one year, as assessed by both self-report and work disability compensation status (administrative records). A sample size of 1,800 workers with back injuries and 1,200 with CTS will provide adequate statistical power (0.96 for low back and 0.85 for CTS) to predict disability with an alpha of.05 (two-sided) and a hazard ratio of 1.2. Proportional hazards regression models will be constructed to determine the best combination of predictors of work disability duration at one year. Regression models will also be developed for the secondary outcomes.

Activities of Daily Living↗
PubMed1997

Watch your back!

In 1994-95 there were over 1,962 major back injuries in the health industry, an increase of 30% over the previous five years. Furthermore, the health industry accounted for 15% of all major back injuries in NSW and 10% of the cost associated with these major back injuries.

Humans↗
PubMed1987

Compensable back pain and migrants.

Ten years of cases of compensable back pain from a rehabilitation centre were reviewed for evidence that is relevant to the strongly negative stereotypes that are held commonly about migrant workers. The prevalence of migrant workers with back injuries was found to be similar to that in the occupations with higher accident liabilities in the surrounding municipalities. The relative proportion of musculoligamentous injuries and the more objectively confirmable back injuries was not related to the country of birth. Better predictors of treatment outcome were: the time that had elapsed between the injury and admission to the Centre; whether the referral was direct or indirect after the previous treatment; and the degree of fluency in English. It is concluded that the stereotypes that describe migrant workers as accident-prone or malingerers cannot be supported and that the vulnerability of migrant workers to the "accident-victim syndrome" can be accounted for without reference to ethnic characteristics.

Accidents, Occupational↗
PubMed1996

Physical activity, trauma, and ALS: a case-control study.

AIMS: The association of trauma and physical activity with ALS is controversial. We explored the relation in a pilot case-control study. MATERIAL AND METHODS: ALS patients were selected from a university muscle disease clinic and paired with two matched controls: one from the clinic, but having different diseases, and one from the community. RESULTS: We found several strong and statistically significant differences between ALS cases and the matched controls. These included severe head, neck and back injury (OR = 5.3), the frequency of sweating in work (OR = 1.6) or leisure activity (also OR = 1.6), and earning a school letter (OR = 3.1). Other measures of trauma and activity, while not achieving statistical significance (p < 0.05), were in accord with these findings. DISCUSSION: Possible explanations include trauma and vigorous exercise precipitating ALS; trauma as an early sign of disease; or a third factor associated with ALS predisposing to injury. CONCLUSIONS: Severe head, neck, and back injury and frequency of sweating both in work and leisure activity showed a strong association with ALS. Further study could test narrower and less common exposures with greater statistical power.

Amyotrophic Lateral Sclerosis↗
PubMedDate not supplied

Prevention strategies and the low back in industry.

Several different approaches have been tried in industry to prevent low-back injuries. The scientific literature shows that only job-specific strength testing and ergonomic job design are partially effective in preventing low-back injuries. Job-specific strength testing is supported as a means of identifying high-risk workers who need to perform manual materials handling. However, this approach should be carefully validated for its effectiveness before it is used as a form of selection procedure. At present, ergonomic job design offers the most potential for preventing disabling low-back injuries and other musculoskeletal injuries. Quantitative and objective methods (such as NIOSH guidelines, biomechanical models, energy expenditure, and strength data) are available to analyze a given job and to determine the relative risk of an injury.

Ergonomics↗
PubMed1991

Determinants of sciatica and low-back pain.

Several factors were studied for their association with the prevalence of chronic low-back syndromes, sciatica, and unspecified low-back pain (LBP) in 2,946 women and 2,727 men (age range, 30-64 years) participating in the Mini-Finland Health Survey, a project aimed at comprehensive evaluation of the population's health. On the basis of a standardized clinical examination, a physician diagnosed sciatica in 5.1% and LBP in 11.6% of the subjects. Those with a previous traumatic back injury had a 2.5-fold risk of having sciatica or LBP. The fractions of sciatica and LBP attributable to such back injuries were estimated to be 16.5% and 13.7%, respectively. Sum indices of both physical and mental stress at work were found to be directly proportional to the prevalence of sciatica and LBP. Smokers had an increased risk of LBP, and body height was related positively to the prevalence of sciatica. These associations, however, were inconsistent between sex and age subgroups. In the presence of osteoarthritis in the knee, hip, or hand, LBP was prevalent (adjusted odds ratio [OR], 5.3; 95% confidence interval [CI], 4.1-6.9), but sciatica was not (OR, 1.1; 95% CI, 0.7-1.7). Diabetics were found to have a significantly decreased prevalence of LBP (OR, 0.4; 95% CI, 0.3-0.8). Many factors, independent of each other, determine the occurrence of chronic low-back syndromes. The determinants of sciatica and LBP are different to some extent.

Adult↗
PubMed2000

Continuous assessment of back stress (CABS): a new method to quantify low-back stress in jobs with variable biomechanical demands.

Jobs with a high degree of variability in manual materials handling requirements expose limitations in current low-back injury risk assessment tools and emphasize the need for a probabilistic representation of the biomechanical stress in order to quantify both acute and cumulative trauma risk. We developed a hybrid assessment methodology that employs established assessment tools and then represents their evaluations in a way that emphasizes the distributions of biomechanical stress. Construction work activities in the home building industry were evaluated because of the high degree of variability in the manual material handling requirements. Each task was evaluated using the Revised NIOSH Lifting Equation, The University of Michigan Three-Dimensional Static Strength Prediction Program, and the Ohio State University Lumbar Motion Monitor Model. The output from each model was presented as time-weighted histograms of low-back stress, and the assessments were compared. The results showed considerable differences in what were considered high-risk activities, indicating that these 3 assessment tools consider the risk of low-back injury from different perspectives. The time-weighted distribution aspect of this methodology also contributed vital information toward the identification of high-risk activities. These results illustrate the necessity for more advanced low-back injury risk assessment techniques for jobs with highly variable manual materials handling requirements.

Back↗
PubMedDate not supplied

[Exertion-induced low back pain: a case-control study of health service workers in a local health unit].

Data concerning all accidents with absence from work exceeding three days were analysed in a cohort of 5000 workers (all employees of a Local Health Unit). A total of 1062 accidents were recorded in the file from 1987 to 1989, 118 coded as "low-back injury". A case-control study design was used to detect the main causes of these accidents, using accidents coded as other than low-back injury as controls. The odds ratios and related confidence limits were calculated in order to assess the degree of association, taking account of potentially confounding factors. A significant relationship was observed between hospital wards and other health service departments rated as "high exposure" and low-back injury (OR high exposure versus low exposure = 2.13; 95% C.L. 1.06-4.29). Selection bias and its influence on the results is also discussed.

Adolescent↗
PubMed1996

Rehabilitation of injuries in competitive swimmers.

Competitive swimmers perform highly repetitive motions, therefore characteristic overuse injuries of the shoulder, back, and knee can occur. A thorough history and examination should be performed by both physician and physical therapist. The combination of hypovascularity, fatigue, poor stroke mechanics, and the progressive instability of a hypermobile joint results in shoulder impingement. Medical evaluation should determine the existence of any glenohumeral joint instability or signs of impingement. Back injuries are most commonly due to disc degeneration, hyperextension, or myofascial involvement. Medial knee pain is most common in breaststroke swimmers and may be due to excessive valgus and rotatory stress. Frequently seen diagnosis includes patellofemoral pain, medial collateral ligament stress syndrome, and medial synovitis. Treatment will focus on elimination of inflammation. Rehabilitation should focus on stabilisation exercises for hypermobile joints, postural correction, strengthening and flexibility.

Athletic Injuries↗
PubMed2005

Ubiquitin immunoreactivity in the midbrain as a marker of stress to motor nervous systems in fatal injury.

Previous studies showed an increase in the ubiquitin (Ub)-immunoreactive structures in the midbrain in acute deaths from asphyxiation and in fires in adult subjects. The present study examined the Ub-immunoreactivity in the midbrain as a marker of stress to motor nervous systems in fatal injury cases (over 35 years of age, n=140: blunt injuries, n=82; sharp injuries, n=58), compared with that in control groups (n=61) including death by strangulation, acute cardiac and cerebrovascular diseases. The intranuclear Ub-immunopositive inclusion of the pigmented dopaminergic neurons of the substantia nigra (inclusion Ub-index) and the granular 'dot-like' Ub-immunoreactivity area ('dot-like' Ub-area) in the crus cerebri were analyzed. In blunt injuries, those markers were high in abdomen and back injuries and low in head and chest injuries. The inclusion Ub-index was higher in the crush/pressure injury group than in those with injuries due to impact traffic accidents and falls. 'Dot-like' Ub-area was also low in falls. In sharp injury cases, cardiac injury with hemopericardium showed a higher inclusion Ub-index. These findings suggested that the stress to the motor nervous system may be very intense in crush/pressure injury and hemopericardium than in impact injury and fatal hemorrhages, respectively, and in abdomen and back injuries than in head and chest injuries.

Adult↗
PubMed1993

Disabling injuries to childcare workers in Minnesota, 1985 to 1990. An analysis of potential risk factors.

Injuries to clients in childcare centers have been studied to some degree, but the problem of worker injuries in childcare centers has remained unexplored. To investigate this problem, data were accessed from two sources for the years 1985 to 1990: 1) Minnesota Department of Jobs and Training for data pertinent to the populations of childcare center workers for each year of the study, and the 2) Minnesota Department of Labor for all case files relevant to reported injuries incurred by childcare center workers for each year of the study. Data analyses were conducted of all injuries as well as a subanalysis of back injuries incurred by female workers. The overall injury rate for the 6-year period was 1.08 per 100 workers. Of the 440 childcare worker injury cases, a mean age of 32 years (range, 17 to 72 years) was identified; 50% of all cases were below the age of 29 years. Analysis by subclassifications of childcare workers indicated that cooks had the highest injury rate (3.61 per 100 workers) and the greatest mean number of weeks of temporary total disability (13.2 weeks). According to anatomic site, injuries involving the back accounted for the greatest proportion of the total injuries (34.1%); 49% involved lifting a child. To protect childcare workers adequately, additional policies and regulations will be required, as well as further study in this area. Emphasis in the area of back injury is clearly needed, including education on proper lifting techniques and relevant application of engineering technology.(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗