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Lumbar loading during lifting: a comparative study of three measurement techniques.

Low back loading during occupational lifting is thought to be an important causative factor in the development of low back pain. In order to regulate spinal loading in the workplace, it is necessary to measure it accurately. Various methods have been developed to do this, but each has its own limitations, and none can be considered a "gold standard". The purpose of the current study was to compare the results of three contrasting techniques in order to gain insight into possible sources of error to which each is susceptible. The three techniques were a linked segment model (LSM), an electromyographic (EMG)-based model, and a neural network (NN) that used both EMG and inertial sensing techniques. All three techniques were applied simultaneously to calculate spinal loading when eight volunteers performed a total of eight lifts in a laboratory setting. Averaged results showed that, in comparison with the LSM, the EMG technique calculated a 25.5+/-33.4% higher peak torque and the NN technique a 17.3+/-10.5% lower peak torque. Differences between the techniques varied with lifting speed and method of lifting, and could be attributed to differences in anthropometric assumptions, antagonistic muscle activity, damping of transient force peaks by body tissues, and, specific to the NN, underestimation of trunk flexion. The results of the current study urge to reconsider the validity of other models by independent comparisons.

Adult↗

EMG assessment of back muscle function during cyclical lifting.

A new approach to estimating the frequency compression of the surface EMG signal during cyclical dynamic exercise is described. The basic properties of the method are first developed using simulated EMG signals. Spectral compression is measured by defining the instantaneous median frequency from time-frequency representations of the signal derived from a transformation of the Cohen class. The technique is then used to process real EMG signals from paraspinal muscles during repetitive lifting. Our purpose was to use this new procedure to identify (a) whether changes in the instantaneous median frequency among concurrently active paraspinal muscles during repetitive trunk extension produces a 'fatigue pattern' that is indicative of normal functioning, and (b) whether this pattern is different when the subject produces a sustained isometric trunk extension. Four healthy subjects (26 +/- 4 years; 3 males, 1 female) were tested in both a Back Analysis System, for the production of a sustained static isometric contraction, and a LIDO-Lift Controller (Loredan), for repetitive lifting and lowering of a weighted box. EMG signals were recorded concurrently from six bilateral lumbar paraspinal regions during these tasks. The results demonstrate that static and dynamic tasks result in very different patterns of EMG spectral changes, suggestive of differences in load-sharing and underlying metabolic fatigue processes. Unlike the linear decrease in median frequency observed for static contractions, during dynamic contractions instantaneous median frequency behavior is non-linear and more complex. Examples are provided in which distinct periods of instantaneous median frequency decay are followed by periods of recovery during a single trial of repetitive lifting. It is hypothesized that this difference reflects a complex strategy of utilizing muscle load-sharing during strenuous dynamic exercise to provide periods of metabolic recovery that limit localized fatigue. New analysis procedures to characterize this complex behavior are needed to enhance the technique for assessment of impairment in patients with lower back pain.

Adult↗

Upper lifting performance of healthy young adults in functional capacity evaluations: a comparison of two protocols.

The objectives of this study were to explore the concurrent validity of test results of upper lifting tasks of the Ergo-Kit FCE and the Isernhagen Work Systems (IWS) FCE. Seventy-one healthy young adults performed 5 upper lifting tests with at least 5 min of rest in between. The lifting tests included 3 standard protocols and 2 modified protocols. Three criteria for concurrent validity were established: 1) Pearson correlation higher than .75, 2) nonsignificant two-tailed t test, and 3) mean difference smaller than 5 kg. The results showed that none of the criteria were met for the standard protocols. For the modified protocols criteria 2 and 3 were not met. Individual differences larger than 10 kg were found for both standard and modified protocols. It was concluded that the standard protocols for upper lifting tasks of the Ergo-Kit FCE and the IWS FCE do not meet the criteria for concurrent validity and can, therefore, not be used interchangeably.

Adult↗

Visual perception of lifted weight from kinematic and static (photographic) displays.

Observers of patch-light videotape displays can reliably discriminate levels of lifted weight; accuracy of judgments sometimes approximates that achieved when the observers themselves lift weighted boxes. Results of 6 studies reveal impressive levels of visual weight discrimination based on static displays (photographs) of certain action phases sampled from videos of entire lifting-carrying events. Slow and controlled actions (e.g., walking, placing box on table) supported optimum weight discrimination for both photographic and video displays, whereas the action of lifting a box yielded high levels of discrimination only for video displays. Static and kinematic specification of dynamics, as well as the work by painters and photographers to depict humans and other animals in action, is discussed.

Adolescent↗

Performance of a weight-lifting task by normal and deafferented monkeys.

The role of topographic information from a moving limb in controlling the trajectory of the limb was explored by comparing the ability of 3 normal and 2 unilaterally deafferented monkeys to generate criterion elbow flexions when opposed by different weights. When lifting initially unknown weights, both groups of monkeys reached maximum positions that were inversely related to load. The performance of the deafferented monkeys approached that of the normal monkeys on these first lifts of initially unknown weights. The preceding load had a greater effect on the initial lifts of the deafferented monkeys than on those of the normal monkeys. When allowed to repeatedly lift the same weight, both groups obtained a high density of reinforcement, but the responses of the deafferented monkeys were more dependent on the weight. The results are consistent with the hypothesis that the mechanical properties of muscle make an important contribution to compensation.

Afferent Pathways↗

Heart rate response to two lifting techniques.

OBJECTIVE: To determine the heart rate response to repetitive lifting of light weights employing two techniques, stoop and squat. DESIGN: Randomized cross-over trial. PARTICIPANTS: Twenty healthy volunteers (11 women, 9 men), mean age of 25 years, recruited from the staff of a physical medicine and rehabilitation department. METHODS: Subjects lifted and lowered a box weighing 0, 1, or 3 kg, using the stoop (bent at waist with knees straight) and squat (knees bent) techniques, 20 times in 1 minute. MAIN OUTCOME MEASURES: The heart rate was recorded every 5 seconds during the effort aid 30 seconds and 1 minute after the test. RESULTS: Significantly higher heart rates were found during both the test and recuperation phases of the squat technique with each of the three loads (p < .05). The heart rate increase was also higher with the 3 kg load than with the 1 kg or 0 kg load (p = .0001). CONCLUSION: The heart rate is lower using the stoop technique for lifting. This may explain why individuals choose the more ergonomically risky stoop technique in everyday lifting tasks.

Biomechanical Phenomena↗

Joint coordination during whole-body lifting in women with low back pain after pregnancy.

OBJECTIVE: To quantify differences in the kinematics of lifting between women with low back and/or pelvic pain after pregnancy and women without. DESIGN: Comparison study. SETTING: Research laboratory. PARTICIPANTS: Volunteer sample of 7 women with pain (positive pain drawing, no physical examination) and 9 female controls (not matched). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Duration of downward and upward phases, relative instant of box lift-off, joint angles, spatial angles of trunk and pelvis, pelvic angle relative to trunk, and phase angle relationships between joints. RESULTS: The duration of the upward phase +/- standard deviation was longer in the pain group (1731+/-290 ms vs 1489+/-187 ms, P=.031). At box lift-off, this group had less hip joint flexion (101.9 degrees +/-20.8 degrees vs 78.7 degrees +/-12.4 degrees, P=.015) but more backward pelvis tilt relative to the trunk, that is, more lumbar spine flexion (126.3 degrees +/-16.8 degrees vs 109.0 degrees +/-12.3 degrees, P=.031). The pain group showed an immediate transition from lumbar spine flexion to extension, whereas the controls maintained peak flexion for about 600 ms. The peak phase lag between knee and hip joint extension in the upward phase was larger for the pain group (-29.7 degrees +/-8.3 degrees vs -17.2 degrees +/-5.5 degrees, P=.003). CONCLUSION: Women with low back and/or pelvic pain after pregnancy showed different kinematics of lifting. Further research is needed to determine the exact relationship between the altered kinematics and the underlying disorder.

Adult↗

A cross-validation of the NIOSH limits for manual lifting.

The psychophysical, biomechanical, and physiological criteria used in establishing the NIOSH limits for manual lifting were cross-validated against the data published by different researchers in the subject literature. Assessment of the 1991 NIOSH lifting equation indicated that: (1) NIOSH-based limits are significantly different from the psychophysical limits in the (i) low and high frequencies of lift, and (ii) small and large horizontal distances; (2) NIOSH limits are highly correlated with the data of Snook and Ciriello (1991) in the low frequency range, with the Recommended Weight Limit (RWL) protecting about 85% of the female population and 95% of the male population; (3) the 3.4kN limit for compression on the lumbosacral joint cannot protect the majority of the worker population on the basis of damage load concept; and (4) energy expenditure limits used in development of the RWL index can be sustained by 57 to 99% of worker population when compared to the physiological limits based on previous fatigue studies. Results of the cross-validation for psychophysical criterion confirmed the validity of assumptions made in the 1991 NIOSH revised lifting equation. However, the results of cross-validation for the biomechanical and physiological criteria were not in total agreement with the 1991 NIOSH model.

Adult↗

When is a lifting movement too asymmetric to identify low-back loading by 2-D analysis?

In ergonomics research, two-dimensional (2-D) biomechanical models are often used to study the mechanical loading of the low back in lifting movements. When lifting movements are asymmetric, errors of unknown size may be introduced in a 2-D analysis. In the current study, an estimation of these errors was made by comparing the outcome of a 2-D analysis to the results of a recently developed and validated 3-D model. Four subjects made two repetitions of five lifting movements, differing in the amount of asymmetry. The results showed a significant underestimation of the peak torque by 20, 36 and 61% when the initial position of a box was rotated 30, 60 and 90 degrees with respect to the sagittal plane of the subject. The main cause of this underestimation was a pelvic twist, resulting in an erroneous projection of a pelvic marker on to the sagittal plane due to pelvic twist. It is suggested that from 30 degrees box rotation a 2-D analysis may easily lead to wrong conclusions when it is used to study asymmetric lifting.

Adult↗

Test-retest reliability of isometric and isoinertial testing in symmetric and asymmetric lifting.

The aim of this study was to evaluate test-retest reliability of a dynamometer in measuring lifting strength or force parameters under several combinations of ergonomic factors. Thirteen healthy participants were tested on peak force (PF), related variables and isometric strength (IS) twice, at intervals of 3 months. Correlation coefficients for all parameters in the sagittal plane were 0.60-0.85. Coefficients of variations (CVs) of methodology error for PF in the sagittal plane were 6.2-6.9%. Correlation coefficients and CVs for IS at 90 degrees to the lateral plane were 0.51-0.54 and 16.6-17.9%, respectively. In paired t-tests of the parameters under all conditions, there was a significant difference between test and retest. In the test and retest, ratings of perceived exertions for the low back and the right arm in isometric lifting were significantly higher than those in dynamic lifting. It was concluded that the test-retest reliability of dynamic forces in the dynamometer was high. The peak force in the sagittal plane was considered reliable. In isometric lifting, isometric strength in the sagittal plane seemed reliable, while that at right angles to the lateral plane was considered to be less reliable.

Adult↗

The effects of standing, lifting and noise exposure on preterm birth, growth restriction, and perinatal death in healthy low-risk working military women.

OBJECTIVE: The effects of standing, lifting and noise in low-risk, healthy pregnant women are uncertain. In the past, the heterogeneity of the populations studied, the limitations of the designs of the retrospective and case control studies, and a failure of some of the larger investigations to evaluate all the potential confounding variables has hampered many studies. The purpose of this investigation was to evaluate, throughout pregnancy, the effects of standing, repetitive lifting, and noise in the workplace compared with no standing, lifting or noise exposure, on maternal and perinatal outcomes in a large prospective study of a low-risk healthy population of working women cared for by a single group of health providers. METHODS: This prospective observational study used an extensive questionnaire to collect antepartum, intrapartum, and postpartum information. Information was collected on the initial visit, each subsequent visit, and immediately after delivery. The participating women were divided into groups based on the amount of time spent standing, the amount and extent of repetitive lifting, and noise exposure in the workplace. RESULTS: Eight hundred and fourteen low-risk active duty women participated in this investigation over a 4-year period. Multivariate analysis with non-exposure compared with exposure reinforced the effect of standing on preterm labor (OR 1.80, 95% CI 1.05, 3.16) and preterm birth (OR 1.69, 95% CI 1.03, 2.80) and showed a trend toward an effect of noise exposure on preterm labor (OR 1.76, 95% CI 0.78, 3.39) after controlling for other exposures. CONCLUSIONS: This investigation suggests an association of occupational standing with preterm labor and preterm birth.

Adult↗

Anticipatory postural adjustments before load pickup in a bi-manual whole body lifting task.

Balance regulation and movement control were examined in the context of bi-manual lifting. Subjects picked up a load (20% body mass) after several unloaded cycles using the leg-lift technique. The addition of the load to the body caused the system center of mass to shift forward and thus presented the subject with an expected perturbation of balance. To examine whether the disturbances to balance were counteracted by anticipatory postural adjustments, the last cycle, in which the barbell was grasped and lifted, was compared with the preceding unloaded cycle. Using a global mechanical analysis of the movement, we found that anticipatory postural adjustments were present before load pickup in bi-manual lifting. These anticipatory postural adjustments were characterized by a backward directed horizontal momentum, a backward directed horizontal component of the ground reaction force accompanied with a forward shift of the center of pressure, and a backward shift of the center of mass (CoM). These characteristics could all be understood from the mechanical consideration that adding a load in front of the body induces a forward shift of the CoM. However, major compensations of the position of the CoM were also observed after bar grasp. It is therefore proposed that commands giving rise to postural adjustments are closely tied to commands controlling the ongoing movement. On the basis of this insight the strict dichotomy in the control of posture and movement is being questioned.

Adult↗

Cardiovascular tolerance of healthy elderly subjects to weight-lifting exercises.

OBJECTIVE: To evaluate the hemodynamic strain and the myocardial tolerance of weight-lifting exercises in healthy elderly subjects. METHODS: Sixty-five healthy elderly subjects (32 men/33 women) aged 65-80, were studied. Weight-lifting exercises consisted of two sets of 12 repetitions at 12-repetition maximum (RM) and four sets of five repetitions at 5-RM for, horizontal leg press, seated chest press, and bilateral leg extension movements. Cardiovascular tolerance to weight-lifting exercises was evaluated both physiologically and biologically by measuring heart rate (HR) and blood pressures continuously during exercise, and cardiac troponin I (cTnI) blood concentration before and 6 h postexercise. Comparisons between resting and exercise or postexercise values were performed by a bilateral-paired t-test. A value of P < 0.05 was considered statistically significant. RESULTS: No significant increase in cTnI circulating concentration was observed secondary to exercise (16.56+/-2.23 vs 14.40+/-1.96 ng x L(-1); mean +/- SEM). This was observed despite a significant (P < 0.001) exercise-induced increase in systolic (SAP) and diastolic arterial pressures (DAP) and HR. Highest values of SAP, DAP, and HR (223.6+/-3.1 mm Hg, 139.6+/-1.9 mm Hg, and 108+/-2 min(-1), respectively) were measured during the horizontal leg press exercise. CONCLUSION: These data suggest that weight-lifting exercises can be conducted in healthy elderly subjects without clinical, electrical, and biological sign of myocardial ischemia, if appropriate selection criteria, and proper respiratory techniques during exercise are applied.

Aged↗

Lifting capacity. Indices of subject effort.

The association between manual materials handling and occupational low back injuries has generated a wide variety of devices and protocols for testing lifting capacity. The validity of these tests depends critically on the subject's effort during the evaluation. This study compares the accuracy of several physiologic effort indices in identifying maximal and submaximal lifting efforts. Twenty-one men and twenty-three women free from back pain underwent isometric, isokinetic, and isoinertial tests of lifting capacity applying 50 and 100% efforts in random order. Effort indices included isokinetic force/distance curve variation, isoinertial peak force: weight ratios and peak force--weight differences, and heart rates and peak force variances for all three modes. Differences between 50 and 100% effort means were significant at P less than 0.01 for isokinetic force/distance curve variation, isoinertial peak force: weight ratios, and peak force--weight differences, and for heart rates in all three modes using analysis of variance. Differences were not significant (P greater than 0.05) for peak force variances in any mode using Wilcoxon Signed Rank Tests. According to a discriminant analysis model with optimal cutoff values, the only effort indices with better than 60% accuracy in identifying maximal and submaximal efforts were isokinetic force/distance curve variation (74%) and isoinertial peak force: weight ratios (69%), peak force--weight differences (62%) and heart rates (65%). For each index, subjects were divided into three groups according to whether their lifting outputs during 50% effort bouts were greater than, equal to, or less than one half their outputs in the 100% effort bouts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Lumbar-pelvic coordination is influenced by lifting task parameters.

STUDY DESIGN: Low back kinematics, including relative lumbar and pelvic motions, were quantified during controlled lifting tasks. OBJECTIVES: To evaluate the influence of load and lifting velocity on lumbar-pelvic (LP) coordination. SUMMARY OF BACKGROUND DATA: Sagittal trunk extension is achieved through the coordinated motion of the pelvis and lumbar spine. There are no data to indicate whether lifting task design influences lumbar-pelvic coordination. METHODS: Lumbar and pelvic motions were recorded from 18 healthy subjects while performing isokinetic lifting tasks of 0.1 kg and 10 kg. Coordinated motions of the pelvis (sacral spine) and low-thoracic spine were evaluated using eigenvector analyses and a ratio of lumbar and pelvic angles (L/P). RESULTS: Eigenvector models of the lumbar-pelvic coordination accurately represented empirical coordination profiles. Weight significantly influenced lumbar-pelvic coordination. Trunk extension velocity demonstrated a small but statistically significant influence on lumbar-pelvic coordination. Weight and trunk flexion angle significantly influenced lumbar/pelvic angle ratios. CONCLUSIONS: Trunk extension was achieved through simultaneous but nonlinear contributions from both the pelvis and lumbar spine throughout the range of motion. The lumbar spine accounted for 70% of the total, with increased pelvic contributions in flexed postures. Task weight increased the lumbar contribution to total trunk motion. When performing clinical evaluations of spinal kinematics, it is necessary to recognize that unloaded motions may not fully represent loaded behavior of spinal coordination.

Adult↗

A functional subdivision of hip, abdominal, and back muscles during asymmetric lifting.

STUDY DESIGN: An experimental study of muscle recruitment patterns during asymmetric lifting in healthy individuals. OBJECTIVE: To investigate muscle recruitment patterns during asymmetric lifting, representing a common daily living activity, to determine whether systematic differences exist between functioning of the local and global muscle systems. SUMMARY OF BACKGROUND DATA: The normal function of the local muscle system is to provide sufficient segmental stability to the spine. The global muscle system provides general trunk stabilization and enables the static and dynamic work necessary for daily living and sports activities. Current knowledge about these two muscle groups appears to be specifically derived from anatomic findings and experiments conducted under artificial circumstances. To the authors' knowledge, the recruitment patterns of both muscle groups have not been investigated in daily living activities. METHODS: Twenty-nine healthy individuals performed different variants of asymmetric lifting activities. Electromyographic data were collected from seven hip, abdominal, and back muscle pairs. In addition, trunk kinematics were measured by means of an ultrasonic movement analysis system. RESULTS: The left and right obliquus internus, rectus femoris, and multifidus showed symmetric co-contraction in all variants of activities. In contrast, significant left/right differences were observed in the external oblique, gluteus maximus, iliocostalis lumborum pars thoracis, and latissimus dorsi. CONCLUSIONS: The results of this study show a symmetric activation of the local muscles during the performance of low-load, asymmetric lifting tasks, which suggests that these muscles play a stabilizing role during these manoeuvres. The global muscles, however, hand show asymmetric patterns of activation during the same tasks, supporting their role as global stabilizers and prime movers.

Abdominal Muscles↗

Within-subject variability in low back load in a repetitively performed, mildly constrained lifting task.

STUDY DESIGN: A repeated-measures in vivo experiment. OBJECTIVE: To describe within-subject variability of spinal compression in repetitive lifting. SUMMARY OF BACKGROUND DATA: Epidemiology and failure mechanics suggest that peak loads may be more predictive of injury than average loads. Nevertheless, biomechanical studies usually focus on the latter. METHODS: Ten healthy males performed 360 lifts in 1 hour of a 45-L crate, weighted with a stable 10-kg mass on 1 day and with an unstable mass (10 kg of water) on another day. The maximum compression force in each lift was estimated, using a simple inverse dynamics model and a single equivalent muscle model. RESULTS: The individual distributions of maximum compression force were slightly skewed to the right (average skewness 0.67). Median and 95th percentile values were used to characterize the distribution. The median (50th percentile) compression ranged from 3375 to 6125 N, and from 3632 to 6298 N in the stable and unstable load conditions, respectively. The within-subjects peak (95th percentile) compression forces were from 405 to 1767 N and from 526 to 2216 N, respectively, higher than the median values. The peak values differed significantly between conditions, whereas the difference in medians did not reach significance. Only a limited trendwise (fatigue-related) variance could be demonstrated. CONCLUSION: Peak spinal compression by far exceeds median compression in repetitive lifting and can be affected by task conditions independently from the median. Therefore, the variability of spinal loads needs to be taken into consideration when analyzing and redesigning tasks that can cause spinal injuries.

Adult↗

Testing lifting capacity: validity of determining effort level by means of observation.

STUDY DESIGN: Video observation study. OBJECTIVES: To establish the validity of determining effort level by visual observation of a lifting test. SUMMARY OF BACKGROUND DATA: Determining effort level during a lifting test is critical for interpretation of test performance, yet the validity of these determinations has not been established in patients with chronic nonspecific low back pain. METHODS: Fifteen healthy subjects and 16 patients with chronic nonspecific low back pain performed a standardized lifting test as outlined in the Isernhagen Work System Functional Capacity Evaluation. The lifts were videotaped and independently observed by 9 trained observers, who rated effort levels using an Isernhagen Work System categorical scale and a Borg Category Ratio scale. External effort indexes were established to control for effort at group level. Validity of the observer ratings was analyzed by means of a sensitivity and specificity analysis and correlations between performances and observer ratings. Interrater reliability was analyzed by means of intraclass correlation coefficients and Cohen kappa. RESULTS: External indexes differ significantly between patients with chronic low back pain and healthy subjects, indicating that at group level, patients did not perform maximally. Submaximal performances were correctly rated in 85% to 90% (healthy subjects) and in 100% (patients with chronic nonspecific low back pain) of the cases. "Maximal" performances were correctly rated in 46% to 53% (healthy subjects) and in 5% to 7% (patients with chronic nonspecific low back pain) of the cases. Correlations between performances and observer ratings were r = 0.90 to r = 0.92 (healthy subjects) and r = 0.82 (patients with chronic nonspecific low back pain). Reliability: intraclass correlation coefficient, r = 0.76 (patients with chronic nonspecific low back pain) to r = 0.87 (healthy), Kappa K = 0.50 (patients with chronic nonspecific low back pain) to r = 0.58 (healthy subjects). CONCLUSIONS: Effort level can be determined validly by means of visual observation.

Adolescent↗