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PubMed2004

Differences in motor recruitment and resulting kinematics between low back pain patients and asymptomatic participants during lifting exertions.

BACKGROUND: Low back disorders are a prevalent problem in society today and may lead to chronic debilitating low back pain. Developing our understanding of temporal muscle and kinematic patterns during manual material handling tasks may provide insight for preventing the cascading series of events leading to chronic low back pain. METHODS: Sixty-two low back pain patients and 61 asymptomatic participants performed a variety of lifting exertions that varied in lift origin horizontal and vertical distance, lift asymmetry, and weight. Electromyographic activity of 10 trunk muscles as well as trunk and pelvic kinematics was recorded during each exertion. Differences in muscle activation and kinematic parameters were compared between low back pain patients and asymptomatic participants as a function of experimental conditions. FINDINGS: Both the left and right erector spinae activated significantly earlier and were on significantly longer in low back pain patients compared to asymptomatic participants. The horizontal and vertical location of the lift influenced the EMG and kinematic differences between the low back pain patients and asymptomatic participants. INTERPRETATION: These finding indicate that low back pain patients would be exposed to increase muscle activity resulting in higher spine loads for a greater length of time compared to asymptomatic participants. The longer exposure time to increased spine load may lead to greater risk of future low back injury and cascading events leading to debilitating low back pain. The longer muscle activation time suggests that low back pain patients have changed their motor program from an open to a closed loop system.

Adult↗
PubMed1999

Biomechanics: an integral part of sport science and sport medicine.

Biomechanics is one of the disciplines in the field of Human Movement and Exercise Science and it can be divided into three broad categories from a research perspective. Clinical biomechanics involves research in the areas of gait, neuromuscular control, tissue mechanics, and movement evaluation during rehabilitation from either injury or disease. Occupational biomechanics typically involves research in the areas of ergonomics and human growth or morphology as they influence movement. While these two categories will briefly be discussed, the primary aim of this paper is to show the role of biomechanics in sports science and sports medicine. Research in sports biomechanics may take the form of describing movement from a performance enhancement (such as matching of impulse curves in rowing) or injury reduction perspective (such as diving in swimming or the assessment of knee joint loading during downhill walking). However, the strength of sports biomechanics research is the ability to establish an understanding of causal mechanisms for selected movements (such as the role of internal rotation of the upper arm in hitting or striking, and the influence of elastic energy and muscle pre-stretch in stretch-shorten-cycle actions). The growth of modelling and computer simulation has further enhanced the potential use of sports biomechanics research (such as quantification of knee joint ligament forces from a dynamic model and optimising gymnastics performance through simulation of in-flight movements). Biomechanics research may also play an integral role in reducing the incidence and severity of sporting injuries (such as identification of the causes of back injuries in cricket, and the causes of knee joint injuries in sport). In the following discussion no attempt will be made to reference all papers published in each of these areas because of the enormity of the task. Published and current work from the biomechanics laboratory at the Department of Human Movement and Exercise Science at The University of Western Australia will generally be used to illustrate the scope of biomechanics research within that institution.

Athletic Injuries↗
PubMed2004

The influence of individual low back health status on workplace trunk kinematics and risk of low back disorder.

A case-control study was conducted to determine whether or not kinematic-based low back disorder risk measurement (Marras et al. 1993) of the job was significantly different for those workers suffering from recent low back injuries compared to asymptomatic controls. Two hundred low back injured workers returning to full duty work and 200 asymptomatic controls were evaluated while performing the same job. There were no statistically significant differences between the two groups on any trunk motion measures or workplace measures. Therefore, job design is dictating the kinematic motions of the torso and not the worker's low back health. In addition, there was not a significant difference in job risk estimates using the lumbar motion monitor risk model. The mean risk (and standard deviation) for the low back injured group and the asymptomatic controls was 0.502 (0.178) and 0.501 (0.193), respectively. This study suggests that trunk kinematics and subsequent risk estimates are dictated primarily by job design and not influenced by the low back health status of the worker.

Adult↗
PubMed2000

Sudden and unexpected loading generates high forces on the lumbar spine.

STUDY DESIGN: A cross-sectional study of spinal loading in healthy volunteers. OBJECTIVES: To measure the bending and compressive forces acting on the lumbar spine, in a range of postures, when unknown loads are delivered unexpectedly to the hands. SUMMARY OF BACKGROUND DATA: Epidemiologic studies suggest that sudden and unexpected loading events often lead to back injuries. Such incidents have been shown to increase back muscle activity, but their effects on the compressive force and bending moment acting on the spine have not been fully quantified. Furthermore, previous investigations have focused on the upright posture only. METHODS: In this study, 12 volunteers each stood on a force plate while weights of 0, 2, 4, and 6 kg (for men, 40% less for women) were delivered into their hands in one of three ways: 1) by the volunteer holding an empty box with handles, into which an unknown weight was dropped; 2) by the same way as in 1, but with volunteer wearing a blindfold and earphones to eliminate sensory cues; or 3) by the volunteer sliding a box of unknown weight off a smooth table. Experiments were carried out with participants standing in upright, partially flexed, and moderately flexed postures. Spinal compression resulting from muscular activity was quantified using electromyographic signals recorded from the back and abdominal muscles. The axial inertial force acting up the long axis of the spine was calculated from the vertical ground reaction force. The bending moment acting on the osteoligamentous spine was quantified by comparing measurements of lumbar curvature with the bending stiffness properties of cadaveric lumbar spines. RESULTS: The contribution from abdominal muscle contraction to overall spinal compression was small (average, 8%), as was the axial inertial force (average, 2.5%), and both were highest in the upright posture. Peak bending moments were higher in flexed postures, but did not increase much at the moment of load delivery in any posture. Peak spinal compressive forces were increased by 30% to 70% when loads were suddenly and unexpectedly dropped into the box, and by 20% to 30% when they were slid off the table, as compared with loads simply held statically in the same posture (P < 0.001). The removal of audiovisual cues had little effect. CONCLUSIONS: Sudden and alarming events associated with manual handling cause a reflex overreaction of the back muscles, which substantially increases spine compressive loading. Manual handling regulations should aim to prevent such events and limit the weight of objects to be lifted.

Abdominal Muscles↗
PubMed1994

Migraine as a sequela to chronic low back pain.

The occurrence of headache as a sequela of low back pain was examined in a sample of chronic pain patients. All patients had low back pain without history of head, neck, or upper back injury or headache onset simultaneous with the low back pain. Consistent with prior research, headache was found to be a common concomitant of back pain. In many patients, headache was found to have begun or exacerbated markedly after onset of low back pain. Prevalence of migraine in female patients was significantly higher than the population prevalence for females in the United States; this was not true for male patients. Potential mechanisms for explaining the high prevalence of migraine following low back pain are discussed, including increased muscle tension, psychosocial factors, and analgesic overuse.

Female↗
PubMed1992

Prevention of low back pain: basic ergonomics in the workplace and the clinic.

Redesigning the job is a strategy for preventing low back injuries at work or for accommodating injured employees who return to work. An evaluation of the physical job demands is necessary in either strategy. Several job demands are associated with low back pain and injury--heavy physical work, static or postural effort, dynamic work-load and exposure to wholebody vibration. Traditional work measurement studies emphasize a rigorous task analysis. By adding biomechanical, physiological and psychophysical measurements, a comprehensive evaluation is possible. There is no standard scheme for a workplace evaluation. The method depends on the end use of the analysis. Job evaluation for workplace design requires an emphasis on equipment and work conditions; evaluation for placement of injured employees should emphasize the operational demands of the tasks. Few studies considered the multifactorial aetiology of low back pain. Most studies that measured the magnitude of biomechanical, physiological and psychophysical stresses attempted to define peak work-loads. The attempt to evaluate the effects of subacute cumulative traumas is only in the beginning. Most ergonomic intervention programmes modify the loads, the design of objects handled, lifting techniques, workplace layout and task design. The effectiveness of these interventions in controlling medical costs or morbidity has not been clearly demonstrated. Consequently, occupational risk factors may be more important for evaluating disability. Job familiarity is the key to effective medical management. Ergonomic analysis procedures may be useful within rehabilitation settings that also provide placement services. The reason is that they facilitate communication between all elements involved in the rehabilitation process. Proper communication procedures are also crucial in implementing ergonomic interventions in the workplace. A health care provider should be part of a task force that oversees these interventions. Future effort should be directed to finding a method that health care practitioners could be competent to carry out effectively in a clinical setting. Expert systems offer promising results in disseminating ergonomic knowledge in primary and secondary health care facilities.

Ambulatory Care Facilities↗
PubMed2001

A randomized controlled trial to prevent patient lift and transfer injuries of health care workers.

STUDY DESIGN: Randomized controlled trial (RCT). OBJECTIVES: To compare the effectiveness of training and equipment to reduce musculoskeletal injuries, increase comfort, and reduce physical demands on staff performing patient lifts and transfers at a large acute care hospital. SUMMARY OF BACKGROUND DATA: Back injury to nursing staff during patient handling tasks is a major issue in health care. The value of mechanical assistive devices in reducing injuries to these workers is unclear. METHODS: This three-armed RCT consisted of a "control arm," a "safe lifting" arm, and a "no strenuous lifting" arm. A medical, surgical, and rehabilitation ward were each randomly assigned to each arm. Both intervention arms received intensive training in back care, patient assessment, and handling techniques. Hence, the "safe lifting" arm used improved patient handling techniques using manual equipment, whereas the "no strenuous lifting" arm aimed to eliminate manual patient handling through use of additional mechanical and other assistive equipment. RESULTS: Frequency of manual patient handling tasks was significantly decreased on the "no strenuous lifting" arm. Self-perceived work fatigue, back and shoulder pain, safety, and frequency and intensity of physical discomfort associated with patient handling tasks were improved on both intervention arms, but staff on the mechanical equipment arm showed greater improvements. Musculoskeletal injury rates were not significantly altered. CONCLUSIONS: The "no strenuous lifting" program, which combined training with assured availability of mechanical and other assistive patient handling equipment, most effectively improved comfort with patient handling, decreased staff fatigue, and decreased physical demands. The fact that injury rates were not statistically significantly reduced may reflect the less sensitive nature of this indicator compared with the subjective indicators.

Back Injuries↗
PubMed2003

Aeroallergens, allergic rhinitis, and sedating antihistamines: risk factors for traumatic occupational injury and economic impact.

BACKGROUND: The U.S. workplace injury burden is significant. Our objective was to assess the particular impact of aeroallergen, allergic rhinitis, and antihistamine exposures and side effects on the risk of traumatic work-related injuries, and the associated economic impact. METHODS: This is an observational case-control study with 1,223 acute traumatic injury cases that are compared to 1,202 chronic back injury controls. Structured telephone interviews were conducted in 1998 and 1999 on Workers' Compensation applicants injured in 1997. Antihistamine use and pollen levels were measured 2 weeks prior to the injury date. RESULTS: Sedating antihistamine exposures elevated acute injury risk (main effect OR: 2.93). A significant increase in traumatic injury risk was observed for combined sedating antihistamine and high pollen exposures among subjects with physician and self-diagnosed allergic rhinitis (OR: 2.41). Direct medical costs associated with this increased risk were estimated at $143 million in 2001. CONCLUSIONS: Workers with physician-diagnosed allergic rhinitis have as high a reliance on sedating antihistamines as do self-diagnosed and self-medicating nasal allergy sufferers. High pollen exposures along with sedating antihistamine use may confer significant additional injury risks among allergic rhinitis sufferers. Medical management "best practices" of diagnosed allergic rhinitis should include avoidance of sedating antihistamines to minimize acute, traumatic injury risks.

Adult↗
PubMed1984

[Extragenital injuries in rape].

The documentation of extragenital injuries to verify violent cohabitation has considerable forensic relevance. 1,875 police files in Hamburg were investigated. Injuries were analysed under the following aspects: kinds, localisations and patterns. According to the most frequent conduct of the doer (manual fixation of the victim and beats in 60% of all cases), consequences of contused violence (i.e. effusions of blood, contusions, dehiscences) were found in 50% of all cases. Injuries due to semi-sharp violence, wounds of genitals or signs of choke were relatively rare (15-3-3%). An isolated state of genital organs is of minor importance. The most frequent localisations of injuries were face and arms, less frequently legs and back. Injuries as result of manual fixation, defence or abutment formed the main patterns. "Banal" hurts were also found. In numerous cases, the outer appearance of the lesions enabled conclusions regarding the instrument used (i.e. double wales after beats with a stick). Self-inflicted injuries can mostly be discerned by their kind and localisation. Rape without any injuries is conceivable as the result of missing defence in the presence of severe threat. Psychic alterations were found in 20% of the cases, half of them continuing for a long time. The medical examination of the suspected man must include the search of signs of a fight (scratch marks, bites), localised at the hands, face and neck (besides ascertainment of traces, for example, smears of semen and smegma, i.e. from the glans penis). Extent and thoroughness of medical examinations as presently practised are discussed critically. The manner in which these examinations are conducted, is considered to be the main cause of a "secondary victimisation" of the raped woman.

Adjustment Disorders↗
PubMed1991

Industrial back pain complaints. A broader perspective.

Industry has looked to medicine for assistance in developing screening and prevention programs to reduce the problem of industrial back injuries. Unfortunately, little is known about the pathology underlying most back symptoms, and few risk factors for industrial back pain complaints have been clearly and consistently identified. These limitations in knowledge have placed obvious constraints on the design of effective intervention programs. Recent information on the importance of perceptions of the nonphysical work environment and other psychosocial factors provide a broader perspective of the industrial back pain problems that may lead to more enlightened and effective approaches.

Back Pain↗
PubMed1991

A prospective, randomized comparison of computed tomography with conventional diagnostic methods in the evaluation of penetrating injuries to the back and flank.

We prospectively compared computed tomography with conventional diagnostic methods in the evaluation of penetrating injuries to the back and flank in 85 patients. Immediate laparotomy was performed in 24 patients because of physical findings, and these patients were not randomized. Nine unnecessary operations were performed in this group, and these nine patients had significantly higher hospital costs than patients in either randomized group. In the randomized patients, there were only three true-positive and three false-positive findings. Both computed tomographic evaluation (31 patients) and conventional evaluation (30 patients) were highly accurate and specific for injuries that required operation. Evaluation with computed tomography required a longer time to make a hospital disposition but required fewer diagnostic tests. Computed tomography can be useful in the assessment of penetrating injuries to the back and flank.

Abdominal Injuries↗
PubMed1992

Industrial rehabilitation medicine. 2. Assessment of the problem, pathology, and risk factors for disability.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on industrial rehabilitation medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article covers ergonomic assessment of upper limb and low back injury, medical diagnostics for upper extremity cumulative trauma disorder (UE-CTD) and low back pain, and an evaluation of delayed recovery following work injury. Advances that are covered in this article involve factors contributing to UE-CTD, lumbar spine-imaging techniques, and the high-risk variables that contribute to prolonged disability.

Back Pain↗
PubMed2006

[Gymnastic school sport injuries--aspects of preventive measures].

INTRODUCTION: Gymnastic school sport injuries account for a significant morbidity and mortality among children and adolescents. Preventive issues may be derived from a thorough in-depth analysis of the pattern and circumstances of gymnastic injuries. METHODS: During a school year among 3993 schools in 43 889 classes with 993 056 pupils 2234 school sport injuries have been reported to the Gemeinde Unfall Versicherung (GUV) Niedersachsen, Germany. RESULTS: Gymnastic sport injuries account for 18 % (403 accidents), which is second after ball sports injuries. Regarding the distribution of the gymnastic disciplines, vault was the major discipline with 34 %, followed by floor exercise (21.3 %), mini- and competition trampoline (16.8 %), and parallel bars (8.2 %). The analysis of the type of injury during vault accidents revealed contusion (31 %) as the predominant injury, followed by sprains (15.4 %), and fractures (15.4 %). Floor exercise injuries distributed among distorsions (26.7 %), contusions (18.6 %), muscle tears (14 %). Back injuries especially of the cervical and thoracic spine, accounted for 40 % of all their injuries. Minor head injuries account for 4.7 % of all floor exercise injuries. Mini-trampoline injuries distribute among contusions (30 %), fractures (22.5 %), distorsions (7.5 %). 21.8 % collisions were noted against a box in comparison to 6.8 % in case of the horse. CONCLUSION: Gymnast injuries account for a significant number of all school sport related injuries. Vault and floor exercise account for the vast majority of all injuries, with alarming high numbers of spine injuries during floor exercise and mini-trampoline. A preservation of a high level of attention during a sport lesson, safety measures including appropriate mats and landing zones are mandatory to reduce injuries. Muscle injuries and ankle sprains can be prevented by a prospective proprioceptive training intervention to be implemented in school sports.

Adolescent↗