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PubMed1995

The perceived relationship between back symptoms and preceding injury.

A questionnaire was used to gather information regarding the prevalence of minor back symptoms related to performing everyday tasks, including sitting, lifting, etc. in a population of hospital employees. We studied 175 subjects, of whom 111 had not suffered a back injury. Of this group, 68 (61.3 per cent) had suffered back discomfort during or after performing everyday tasks. Sixty-four reported a previous injury to their back, and of these 55 (85.9 per cent) described back discomfort during or after performing everyday tasks. Of the symptomatic cases, 46 (83.3 per cent) maintained that they had no back symptoms prior to their injury, and attributed all of their back symptoms to the injury. The chi 2 test was used to test the null hypothesis that the group attributing their symptoms to injury was derived from the same population as the group who had not suffered any definite injury, and yet had back symptoms. This hypothesis was rejected (P < 0.001), indicating that there was a significant difference between these two groups. We conclude that individuals who sustain a back injury sometimes do not recall that they suffered symptoms prior to their injury. This may be of medico-legal importance in cases where compensation is being sought.

Activities of Daily Living↗
PubMed2000

Designing safe job rotation schedules using optimization and heuristic search.

Job rotation is one method that is sometimes used to reduce exposure to strenuous materials handling; however, developing effective rotation schedules can be complex in even moderate sized facilities. The purpose of this research is to develop methods of incorporating safety criteria into scheduling algorithms to produce job rotation schedules that reduce the potential for injury. Integer programming and a genetic algorithm were used to construct job rotation schedules. Schedules were comprised of lifting tasks whose potential for causing injury was assessed with the Job Severity Index. Each method was used to design four job rotation schedules that met specified safety criteria in a working environment where the object weight, horizontal distance and repetition rate varied over time. Each rotation was assigned to a specific gender/lifting capacity group. Five versions of the integer programming search method were applied to this problem. Each version generated one job rotation schedule. The genetic algorithm model was able to create a population of 437 feasible solutions to the rotation problem. Utilizing cluster analysis, a rule set was derived from the genetic algorithm generated solutions. These rules provided guidelines for designing safe job rotation schedules without the use of a computer. The advantages and limitations of these approaches in developing administrative controls for the prevention of back injury are discussed.

Algorithms↗
PubMed1999

Biomechanics of increased exposure to lumbar injury caused by cyclic loading: Part 1. Loss of reflexive muscular stabilization.

STUDY DESIGN: The recording of electromyographic responses from the in vivo lumbar multifidus of the cat, obtained while cyclic loading was applied as in occupational bending/lifting motion over time. OBJECTIVES: To determine whether the effectiveness of stabilizing reflexive muscular activity diminishes during prolonged cyclic activity; the recovery of lost muscle activity by a 10-minute rest; and whether such diminished muscular activity is caused by fatigue, neurologic habituation, or desensitization of mechanoreceptors in spinal viscoelastic tissues resulting from its laxity. SUMMARY OF BACKGROUND DATA: The literature repeatedly confirms observation that cyclic occupational functions expose workers to a 10-fold increase in episodes of low back injury and pain. The biomechanical evidence indicates that creep in the viscoelastic tissues of the spine causes increased laxity in the intervertebral joints. The impact of cyclic activity on the function of the muscles, which are the major stabilizing structures of the spine, is not known. METHODS: Electromyography was performed from the L1 to L7 in vivo multifidus muscles of the cat, while cyclic passive loading of 0.25 Hz was applied to L4-L5. Cyclic loading was applied for 50 minutes, followed by 10 minutes rest and a second 50-minute cyclic loading session. A third 50-minute cyclic loading period also was applied after the preload was reset to 0.5 N to offset the effect of laxity. RESULTS: Reflexive muscular activity was recorded from the multifidus muscles of all lumbar levels at the initiation of the first 50 minutes of cyclic loading. Activity recorded on electromyography quickly diminished with each cycle during the first 8 minutes of loading to 15% of its initial value. A slower decrease in muscular activity was evident throughout the remaining period, settling at 5% to 10% of its initial level by the end of 50 minutes. A 10-minute rest provided a 20% to 25% recovery of the electromyographic activity, but that was lost within the first minute of cycling. Offsetting the laxity in the spine resulted in full restoration of the electromyographic activity at all lumbar levels. CONCLUSIONS: The creep induced in the viscoelastic tissues of the spine as a result of cyclic loading desensitizes the mechanoreceptors within, which is manifest in dramatically diminished muscular activity, allowing full exposure to instability and injury, even before fatigue of the musculature sets in.

Animals↗
PubMedDate not supplied

Reducing the costs of patient transfers.

This study examined the potential cost savings of a new patient transfer device that uses air pressure to assist in the movement of patients. The analysis for a single hospital indicates that this new technology is no less expensive than traditional patient transfer methods if only the direct costs of staff utilization are considered. However, reductions are projected for indirect costs associated with work-related back injuries. A methodology is recommended for conducting similar evaluations at other institutions.

Air Pressure↗
PubMed2006

Manual materials handling in mining: the effect of rod heights and foot positions when lifting "in-the-hole" drill rods.

There is a paucity of studies focusing on the lifting of rods or long awkward heavy objects. In-the-hole (ITH) drilling is a heavy repetitive mining task, which has been identified as having a relatively high incidence and severity rate of musculoskeletal injuries. The purpose of this study was to examine how the load experienced by ITH drill operators changed when lifting a vertical drilling rod (1.61m, 35kg) using two rod heights and four different foot positions. In addition, a symmetrical lift with a lifting index (LI) of 1.4 also served as a comparison to determine possible risk of low back injury. Eleven experienced ITH drill operators participated in the study. Each subject was required to lift a vertical drilling rod until the upper body was in an erect posture using four different foot positions (0 degrees =subject facing the rod, 45 degrees =subject oblique to the rod, 90 degrees =subject right side to the rod and freestyle). In addition, two rod height conditions were studied where the base of the vertical rod was supported either (1) at ground level (height of rod CG=0.83m) or (2) on a 20cm rack (height of rod CG=1.03m). Finally, each subject lifted a 21.5kg box in the sagittal plane, which corresponded to an LI of 1.4 in the NIOSH lifting equation. Reflective markers were placed on the subjects, and three video cameras and one force plate were used to record the forces and the motion of the subjects' segments. Two surface electrodes were applied on the right and the left erector spinae (ES) at the level of L3. Back loading was defined by the level of the peak moments, the mechanical work and erector spinae muscle activity (EMG). It was found that the vertical height of the rod had the most significant impact on back loading, while the effect of the initial foot positioning relative to the rod was limited by the technique adopted by the drillers. Moreover, it was found that some of the subjects used techniques less strenuous for the back than others. Finally, the asymmetrical lifting component was found to be the most negative aspect of lifting an ITH drill rod compared to a standard symmetrical lift (NIOSH).

Accidents, Occupational↗
PubMedDate not supplied

Teaching students safer methods of patient transfer.

Lifting patients is a major contributor to back injuries. The commonly used method for lifting patients, the under-axilla grasp method, exceeds the level of force that can safely be exerted to the lumbar-sacral area of the spine. Using assistive devices decreases the injury rate. The author discusses how student nurses can be taught to use assistive devices and thus avoid the under-axilla grasp method of transfer

Activities of Daily Living↗
PubMed1997

Randomized controlled trials in industrial low back pain. Part 3. Subacute/chronic pain interventions.

The most significant costs attributed to settlement of workplace back injury claims are related to chronic low back pain (LBP). Unfortunately, our knowledge of this fact has not led to a reduction of the considerable costs paid out annually by employers and insurers to deal with the chronic pain syndrome. This article is the third in a series of reviews on randomized controlled trials found in the English language medical literature between 1975 and 1993. Of more than 4,000 LBP citations, 35 studies met-the selection criteria of randomization, reasonable concurrent controls and work return comparisons. This review focuses on the 12 studies utilizing nonsurgical interventions for subacute and chronic LBP, including multidisciplinary pain clinics, exercise, cognitive-behavioral strategies, and others. A 26-point quality system was again used to compare the methodologic rigor of each study. The majority of prospective studies investigating return to work after chronic LBP have methodological limitations; additional research is clearly needed to more confidently answer the question of what interventions improve work capacity in patients with chronic LBP.

Behavior Therapy↗
PubMed2000

Health risks and the health care professional.

Health care professionals are one of a large group of individuals who are exposed to significant risks by virtue of their occupation, such as the police, mountain rescuers, fire-service. The types of risk to which health care professionals are exposed are numerous, many of which remain largely unrecognised by the public and may even be underestimated by the professionals themselves. Examples of these health risks include fatigue, emotional/psychological trauma, physical injury caused by the use of machinery, back injuries, possible even violent physical assault from a patient or hospital visitor. There is also a very significant risk of acquiring an illness in the course of employment, for example, physical damage caused by the prolonged use of toxic substances, and also infectious diseases which are acquired by various routes, such as air-borne infections, needle-stick injuries. Subjective risk evaluation and the notion of risk in health care from the patients' perspective has been widely considered over many years, and in a number of different areas, including medical research, screening procedures, consent to surgery or other medical intervention. In this paper, however, the moral dilemmas which may arise for health care professionals in relation to health risks are highlighted and specific questions are raised.

Choice Behavior↗
PubMed1998

Injuries in professional Rugby Union.

OBJECTIVE: To document injury rates in professional rugby players in the Rugby Super 12 competition and to act as a pilot study for future studies of rugby injuries. DESIGN: Prospective longitudinal study encompassing the 1997 Super 12 rugby season. SETTING: A New Zealand Super 12 rugby squad. PATIENTS AND PARTICIPANTS: 25 professional rugby players (replacement players were used for unavailable players, so although 30 different players were used during the season, there were only 25 in the squad at any one time). OUTCOME MEASURES: An "injury" was defined as something that prevented a player from taking part in two training sessions, from playing the next week, or something requiring special medical treatment (suturing or special investigations). An injury was "significant" if it prevented the player from being able to play one week after sustaining it (that is, if it made the player miss the next match). RESULTS: The overall injury rate was 120/1000 player hours. The rate of significant injuries was 45/1000 player hours. Those playing the position of "forward" had a higher overall injury rate than other players, but there was no difference in significant injury rate between the forwards and the backs. Injuries that caused players to miss game time occurred almost exclusively during the pre-season program or in the final third of the season. The majority of injuries were musculo-tendinous sprains or strains. The phase of play responsible for the majority of injuries was the tackle. The most frequently injured body part was the head and face. No catastrophic injuries occurred during the study period. CONCLUSIONS: Injury rates increase with increasing grade of rugby, injury rates in the Super 12 competition being higher than in first grade rugby. There is very little quality data on rugby injuries, and the few studies available use different methods of data collection and injury definition. There is a pressing need for the collection of accurate ongoing epidemiological data on injuries in rugby.

Athletic Injuries↗
PubMed1984

Hypermobility and injuries in a professional ballet company.

A study was conducted on members of the Cape Performing Arts Board (CAPAB) professional ballet company to determine the prevalence of hypermobility and to document the injuries sustained over a ten year period. If forward flexion, which is acquired through training, is excluded as a parameter the difference in hypermobility between dancers and controls is not statistically significant. Considering the stresses imposed on the musculoskeletal system, the number of injuries was surprisingly low. Ligamentous injuries about the ankle and knee were both common and accounted for the major morbidity. There were minor differences in the nature and severity of injuries in the male and female dancers. Back injuries, fractures and osteoarthrosis were uncommon and shin splints was not recorded in any of the dancers.

Adult↗
PubMed1998

Survey of injuries among West End performers.

OBJECTIVES: To obtain more information about injuries of West End performers. METHODS: A retrospective survey of 269 performers appearing in 20 West End productions (12 dramas and eight musicals). RESULTS: In current productions, 46% of all performers sustained at least one injury for an average of 0.87 injuries per performer. Lower extremity injuries were the most common for dancers (52.2% of injuries) and actors (43.2%) with neck and back injuries the second most common. Sprains and strains were the most common diagnoses. 61% of performers thought that their injuries were preventable. Most performers consulted nonphysician healthcare providers. Factors significantly influencing the risk of injuries for performers include female sex, a history of previous injuries, missed performances due to previous injuries, more physically demanding roles, and performing on raked (angled) stages. CONCLUSION: West End performers commonly sustain injuries. Although primary prevention of most theatrical injuries is not possible, modification of raked stages may reduce the incidence. This study may be helpful to the growing number of healthcare providers who practice performing arts medicine and may stimulate additional concern and research in the medical and theatrical communities about the performance injuries of professionals, amateurs, and theatrical students worldwide.

Accidents, Occupational↗
PubMedDate not supplied

Back school programs. The ballet dancer.

This article discusses factors influencing back injury in ballet dancers and describes a back rehabilitation program. This program, which applies principles of motor skill acquisition in a progressive manner, has been modified for the young ballet dancer to incorporate aspects of dance class.

Adolescent↗
PubMed2003

Competitive figure skating injuries.

The nature, type and frequency of injuries occurring at a national figure skating competition were examined. Data was compiled from the medical history form of all 208 participants and the on-site evaluations of the 55 skaters who presented for treatment. Twenty-six percent of all the skaters were injured during the competition. Senior skaters accounted for more injuries than their junior counterparts. Pairs skaters appeared to be more susceptible to injury, incurring significantly more injuries than singles or dance skaters. As in other reports, injuries to the lower extremities predominated. Low back injury comprised 14.6% of all injuries. Thirty-five (64%) of the 55 injuries were exacerbations of a pre-existing injury and twenty (36%) were new ones. Most competitive figure skating injuries are of the overuse type, suggesting a need to evaluate predisposing factors and methods of rehabilitation.

Journal Article↗
PubMed2001

Osseous stress reaction in a rower diagnosed with positron emission tomography (PET): a case report.

Back injury is one of the most frequently encountered injuries in the collegiate rower. The differential diagnosis of back pain in the competitive rower includes muscle strain, ligament/tendon injury, stress reaction, stress fracture, and a tear in the annulus fibrosis. Endurance sports, such as rowing, have an increased frequency of stress injury The diagnosis of stress reaction cannot be made with plain radiographs. Many studies have firmly established the efficacy of single photon emission computed tomography (SPECT) bone scans and magnetic resonance imaging in establishing the diagnosis of a stress reaction We present a case of a collegiate rower with mid back pain secondary to a stress reaction of the endplates of the costotransverse articulation at the T8 level diagnosed by a positive positron emission tomogram study in the setting of a negative SPECT scan.

Journal Article↗
PubMedDate not supplied

Patient and staff safety: voluntary reporting.

Central to efforts to assure the quality of patient care in hospitals is having accurate data about quality and patient problems. The purpose was to describe the reporting rates of medication administration errors (MAE), patient falls, and occupational injuries. A questionnaire was distributed to staff nurses (N = 1105 respondents) in a national sample of 25 hospitals. This addressed voluntary reporting, work environment factors, and reasons for not reporting occurrences. More than 80% indicated that all MAEs should be reported, but only 36% indicated that near misses should be reported. Perceived levels of actual reporting were: 47% of MAEs, 77% of patient falls, 48% of needlesticks, 22% of other exposures to body fluids, and 17% of back injuries. Administrative response to reports, personal fears, and unit quality management were related to reporting. Patient and staff safety occurrences are underreported. Strong quality management processes and positive responses to reports of occurrences may increase reporting and enhance safety.

Accidental Falls↗
PubMed1997

Injuries sustained by caregivers of disabled elderly people.

OBJECTIVE: to investigate the occurrence of physical injury experienced by informal caregivers whilst moving and lifting their disabled elderly dependents at home. DESIGN: a descriptive study using in-depth interviews. SETTING: departments of elderly medicine at two teaching hospitals and one district general hospital. SUBJECTS: 46 informal caregivers of elderly patients admitted under a regular hospital respite care scheme, 41 of whom were interviewed. RESULTS: most caregivers were elderly (median age 70 years), 21 having a medical condition which restricted their physical activity. Thirty one caregivers had injured themselves whilst lifting and handling their dependents. Most sustained back injuries. Eight caregivers were temporarily unable to continue caring as a result of the injuries they sustained. Sixteen patients had been injured whilst being moved by their caregivers. Only 19 caregivers had received instruction in manual handling. CONCLUSION: informal caregivers are often poorly trained and equipped and at risk of injury. To enable them to continue providing optimal care at home, their physical health should be assessed and they should be trained in safe lifting and handling techniques.

Adult↗
PubMed1998

Lumbar disc degeneration in relation to occupation.

OBJECTIVES: The aim was to study risk factors of lumbar disc degeneration demonstrable with magnetic resonance imaging (MRI) with special emphasis on occupational load and back accidents. METHODS: The subjects in this cross-sectional study were 53 machine drivers, 51 construction carpenters, and 60 municipal office workers aged 40-45 years. Data on possible risk factors were available from current structured questionnaires and for 4 and 7 years in retrospect. The prevalence of lumbar disc degeneration L2/L3-L5/S1 was determined with MRI. RESULTS: An increased risk was found for posterior disc bulges among the carpenters and for anterior disc bulges among the machine drivers, but decreased signal intensity was not related to occupation. Car driving was also associated with anterior disc bulges. All signs of disc degeneration were related to a history of back accidents. Disc degeneration was not related to body height, overweight, smoking, or the frequency of physical exercise. CONCLUSIONS: Occupational load affects the risk of disc degeneration of the lumbar spine. Accidental back injuries and motor vehicle driving are associated with an increased risk of disc degeneration. Anterior and posterior disc bulges seem to be related to different types of physical loads.

Adult↗