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PubMed2000

Flexion and rotation of the trunk and lifting at work are risk factors for low back pain: results of a prospective cohort study.

STUDY DESIGN: A 3-year prospective cohort study among workers of 34 companies in the Netherlands. OBJECTIVES: To investigate the relation between flexion and rotation of the trunk and lifting at work and the occurrence of low back pain. SUMMARY OF BACKGROUND DATA: Previous studies on work-related physical risk factors for low back pain either lacked quantification of the physical load or did not take confounding by individual and psychosocial factors into account. METHODS: The study population consisted of 861 workers with no low back pain at baseline and complete data on the occurrence of low back pain during the 3-year follow-up period. Physical load at work was assessed by means of analyses of video-recordings. Information on other risk factors and the occurrence of low back pain was obtained by means of self-administered questionnaires. RESULTS: An increased risk of low back pain was observed for workers who worked with the trunk in a minimum of 60 degrees of flexion for more than 5% of the working time (RR 1.5, 95% CI 1.0-2.1), for workers who worked with the trunk in a minimum of 30 degrees of rotation for more than 10% of the working time (RR 1.3, 95% CI 0.9-1. 9), and for workers who lifted a load of at least 25 kg more than 15 times per working day (RR 1.6, 95% CI 1.1-2.3). CONCLUSIONS: Flexion and rotation of the trunk and lifting at work are moderate risk factors for low back pain, especially at greater levels of exposure.

Adult↗
PubMed1994

Knowledge and use of lifting techniques among a group of undergraduate student nurses.

As part of a nursing degree course, one of the authors (M.K.) gathered data on the knowledge and use of lifting techniques among a group of undergraduate student nurses. A 17-item questionnaire was administered to one cohort of 19 third-year students. The results show that while they were aware of lifts recommended by the RCN and by other researchers, they reported that they frequently used lifts not recommended by the above sources during their medical placement. This behaviour seemed to mirror the practices of ward staff. Possible explanations for the knowledge-practice gap are offered.

Cohort Studies↗
PubMed2003

A participatory approach to the study of lifting demands and musculoskeletal symptoms among Hong Kong workers.

AIMS: To investigate the use of a worker based methodology to assess the physical stresses of lifting tasks on effort expended, and to associate this loading with musculoskeletal outcomes (MO). METHODS: A cross sectional study was conducted on 217 male manual handling workers from the Hong Kong area. The effects of four lifting variables (weight of load, horizontal distance, twisting angle, and vertical travel distance) on effort were examined using a linguistic approach (that is, characterising variables in descriptors such as "heavy" for weight of load). The numerical interpretations of linguistic descriptors were established. In addition, the associations between on the job effort and MO were investigated for 10 body regions including the spine, and both upper and lower extremities. RESULTS: MO were prevalent in multiple body regions (range 12-58%); effort was significantly associated with MO in 8 of 10 body regions (odds ratios with age adjusted ranged from 1.31 for low back to 1.71 for elbows and forearm). The lifting task variables had significant effects on effort, with the weight of load having twice the effect of other variables; each linguistic descriptor was better described by a range of numerical values rather than a single numerical value. CONCLUSIONS: The participatory worker based approach on musculoskeletal outcomes is a promising methodology. Further testing of this approach is recommended.

Adult↗
PubMed1993

Left ventricular response in healthy young men during heavy-intensity weight-lifting exercise.

We examined cardiac volumes (using echocardiography), intra-arterial blood pressure (BP), and intrathoracic pressure (ITP) in healthy males performing leg press exercise to failure at 95% of their maximum dynamic strength. Compared with preexercise, during the lifting phase of exercise, end-diastolic volume (EDV; 147 +/- 8 to 103 +/- 7 ml) and end-systolic volume (ESV; 54 +/- 5 to 27 +/- 4 ml) decreased (P < 0.05); heart rate (82 +/- 6 to 143 +/- 5 beats/min), systolic BP (160 +/- 6 to 270 +/- 21 Torr), diastolic BP (91 +/- 2 to 183 +/- 18 Torr), ITP (0.8 +/- 0.8 to 57.8 +/- 24 Torr), and peak systolic BP/ESV (SBP/ESV; 3.0 +/- 0.3 to 11.0 +/- 1.5 Torr/ml) increased (P < 0.05); and stroke volume decreased (94 +/- 3 to 77 +/- 4 ml; P > 0.05). Full knee extension was associated with most values returning to preexercise levels except for ESV (38 +/- 7 ml), heart rate (130 +/- 9 beats/min), and ITP (-12.5 +/- 2.1 Torr). During the lowering phase, significant decreases in EDV to 105 +/- 14 ml and ESV to 27 +/- 7 ml were observed with increases in systolic BP to 207 +/- 23 Torr, diastolic BP to 116 +/- 8 Torr, and SBP/ESV to 10.0 +/- 2.5 Torr/ml. Stroke volume decreased to 78 +/- 9 ml (P > 0.05). Thus rapid changes in cardiac volumes, contractility, and pressure occur during weight lifting that are related to different phases of the lift.

Adult↗
PubMed2004

Brain activity during predictable and unpredictable weight changes when lifting objects.

When humans repetitively lift the same object, the fingertip forces are targeted to the weight of the object. The anticipatory programming of the forces depends on sensorimotor memory representations that provide information on the object weight. In the present study, we investigate the neural substrates of these sensorimotor memory systems by recording the neural activity during predictable or unpredictable changes in the weight of an object in a lifting task. An unpredictable change in weight leads to erroneous programming of the fingertip forces. This triggers corrective mechanisms and an update of the sensorimotor memories. In the present fMRI study, healthy right-handed subjects repetitively lifted an object between right index finger and thumb. In the constant condition, which served as a control, the weight of the object remained constant (either 230 or 830 g). The weight alternated between 230 and 830 g during the regular condition and was irregularly changed between the two weights during the irregular condition. When we contrasted regular minus constant and irregular minus constant, we found activations in the right inferior frontal gyrus pars opercularis (area 44), the left parietal operculum and the right supramarginal gyrus. Furthermore, irregular was associated with stronger activation in the right inferior frontal cortex as compared with regular. Taken together, these results suggest that the updating of sensorimotor memory representations and the corrective reactions that occur when we manipulate different objects correspond to changes in synaptic activity in these fronto-parietal circuits.

Adult↗
PubMedDate not supplied

Ankle joint load and leg muscle activity during lifting.

The load on the talocrural joint during three different ways of lifting was compared and discussed with biomechanical and ergonomical aspects. Healthy subjects lifted a 12.8-kg box from floor to table-level with bent and straight knees. The loading moment of force about the bilateral ankle axis was calculated by means of a computerized static sagittal plane model. Electromyography was recorded from the tibial anterior, gastrocnemius, and soleus muscles. The mean maximum loading moment was found to be 68 newton-meters with an estimated joint compressive force of 2.9 times body weight. The lowest loading moments obtained were associated with lifting the burden between bent knees and close to the pelvis.

Adult↗
PubMed2003

Effects of load and speed on lumbar vertebral kinematics during lifting motions.

This experimental study investigated the effects of load magnitude and movement speed on lumbar vertebral kinematics during lifting task performance. Ten participants performed sagittally symmetric lifting movements with systematically varied load using either a normal or a faster-than-normal speed. Skin-surface markers were strategically placed over the participants' spinous processes and other landmarks representing major body joints and were recorded during the movements by a motion capture system. The center of rotation (COR) locations and segmental movement profiles for lumbar vertebrae L2 to L5 were derived and analyzed. Results suggested that (a) the COR locations and vertebral angular displacement were not significantly affected by the speed or load variation; (b) a faster speed tended to shorten the time to complete the acceleration for all the lumbar vertebrae considered; and (c) the load increase incurred a tendency for the L5 to complete the primary displacement in a briefer time while enduring greater peak acceleration and velocity. The findings lead to a better understanding of the relation between lifting dynamics and spinal motion. Potential applications of this research include the development of more accurate biomechanical models and software tools for depicting spinal motions and quantifying low-back stress.

Adult↗
PubMed2003

The effects of competition and the presence of an audience on weight lifting performance.

The purpose of this investigation was to examine the effects of the presence of an audience and competition on maximal weight lifting performance. Thirty-two recreationally trained participants (15 men, 17 women; 21 +/- 2.5 years) performed a 1 repetition maximum (1 RM) bench press during 3 different situations (coaction, competitive coaction, and audience condition). Subjects also completed the Activation-Deactivation Adjective Checklist Short Form following the 3 trials to measure arousal state during each of the 3 trials. Significant differences (p < 0.05) were found between competitive coaction and coaction trials as well as between audience and coaction trials. Both men and women demonstrated the highest performance in front of an audience (105 +/- 48 kg) followed by competition (103 +/- 46 kg) and then the coaction trial (93 +/- 43 kg). No significant difference in arousal was measured between trials. The data suggest that performing a maximal lift in the presence of an audience or in competition facilitates performance and support the self-presentation and self-awareness theories. Social facilitation effects should be controlled in research settings and may aid the performance of weight lifting activities during events or competition.

Adult↗
PubMed2006

The influence of size perception and internal modeling on the control process while lifting.

The present study sought to verify object size perception through internal modeling while lifting an object. Electromyography (EMG) activity of the upper limb muscles was recorded while 20 healthy females alternately lifted two containers of the same weight, but were unequal in size. When subjects lifted the small container, a significant increase was observed in the EMG activity. Most subjects determined that the small container was heavier than the large container, and predicted that the large container would be heavier than the small container due to size difference. The results may be explained by supporting that subjects predict object weight based on perception of size through internal modeling; however, predictions are cross-checked and modified through sensory feedback based on subjective weight.

Adult↗
PubMed2004

Lifting strengths in different exertion heights conditioned on extended legs.

This study recruited seven height-matched healthy males to examine their maximum isometric lifting strengths across 13 exertion heights, ranging from 25 cm to 133 cm in increment of 9 cm. The results showed a nonlinear (increasing-decreasing-increasing) strength-height relationship for all subjects. The subjects' lifting strength was strongest (mean 1253.2 N) at the exertion height of 61 cm and weakest (mean 454.1 N) at the exertion height of 115 cm. Due to a large variability of strength ratio for the weakest individual strength to the strongest individual strength across the 13 exertion heights, ranging from 59.6% to 83.7%, practitioners should be cautious when assessing workers' lifting capacity based on strength testing.

Body Height↗
PubMed1995

Health care concerns related to lifting: an inside look at intervention strategies.

As members of injury prevention and injury management teams, physical therapists and occupational therapists have the opportunity to evaluate back stress associated with patient-lifting activities. In this study, three mathematical formulas are presented that can be used to objectively assess health care workers' maximum safe lifting capacity for moving patients. Recommendations to reduce the rate of back injury in health care workers include the use of lifting machines for moving patients, mandatory in-service education on body mechanics, and employee assistance programs that improve job satisfaction and worker morale.

Accidents, Occupational↗
PubMed1996

Defining and implementing a 'no lifting' standard.

Following the launch this spring of the RCN's campaign to reduce injuries from manual lifting of patients, this article describes the main policies and guidelines relating to lifting and handling, and tells how these were used to develop and implement a 'no lifting' standard on an elderly care ward.

Back Pain↗
PubMedDate not supplied

[The epidemiology of musculoskeletal changes due to biomechanical overload of the spine in the manual lifting of patients].

The painful lumbosacral symptoms associated with manual lifting by nursing staff constitutes an increasingly important problem in Occupational Health. This category of workers is in fact particularly exposed to risk situations involving the lumbar region of the spine, due especially to the extreme variability of work on the shift, the nature of what is lifted and not always sufficient knowledge and proper performance of the movements. On the basis of a review of a series of studies made on this topic, it was possible to assess the incidence and prevalence of low back pain in selected populations and identify the postural risk to which nursing staff are exposed at work, stressing also the importance of a correct knowledge of manual lifting techniques, frequency and mode of performing them, and the psychological aspects (perception of the intensity of tasks and osteoarticular strain). It was also observed that the data on painful lumbosacral symptoms were underestimated due to the type of epidemiological investigations carried out (mostly cross-sectional) and that comparison of the data proposed was often difficult due to the different criteria of evaluation used to classify the painful symptoms and also to the various epidemiological parameters used (incidence, cumulative incidence, prevalence).

Adult↗
PubMedDate not supplied

[The assessment of the risk due to the manual lifting of patients: the initial descriptive and analytical results on exposure levels].

The paper reports the results of risk evaluation of patient lifting or moving obtained from a multicentre study on 216 wards, for both acute hospital patients and in geriatric residences. In all situations the exposure to patient lifting was assessed using a concise index (MAPO). Analysis of the results showed that only 9% of the workers could be considered as exposed to negligible risk (MAPO Index = 0-1.5); of these 95.7% worked in hospital wards and only 4.3% in geriatric wards. A further confirmation of the higher level of exposure of workers in long-term hospitalization was that 42.3% were exposed to elevated levels (MAPO Index > 5) compared with 27.7% observed in hospital ward workers. The mean values of the exposure index were 6.8 for hospital wards and 9.64 for geriatric residences and, although much higher in the latter, both categories showed high exposure. In the orthopaedic departments of the hospitals the values were higher than in the geriatric wards (MAPO Index = 10.1); medical and surgical departments showed values similar to the mean values observed in the geriatric wards. These high values were due to: severe shortage of equipment life lifting devices (95.5%) and minor aids (99.5%), partial inadequacy of the working environment (69.2%), poor training and information (96.1% lacking); only the supply of wheelchairs was adequate (65.8%). All of which points to an almost generalized non-observance of the regulations listed under Chapter V of Law No. 626/94. However, the proposed method of evaluation allows anyone who has to carry out prevention and improvement measures to identify priority criteria specifically aimed at the individual factors taken into consideration. By simulating an intervention for improvement aimed at equipment and training, 96% of the wards would be included in the negligible exposure class (MAPO Index 0-1.5).

Humans↗
PubMedDate not supplied

[The assessment of exposure to the risk of the manual lifting of patients and the results of clinical studies in the hospitals of Bolzano and Bressanone].

A study was made in two hospitals in the province of Bolzano in order to ascertain the possible relationship between risk due to manual lifting of patients and occurrence of back disorders in healthcare workers. Risk analysis was carried out in 16 wards, with 207 workers assessed by means of clinical/anamnestic check-up of the spine. In the majority of the wards analysed the index of exposure to patient lifting was average or high due mainly to the lack of equipment, unsatisfactory structures and furnishings, and organizational factors. This was particularly evident in the Bressanone hospital where there were fewer workers to each department. As regards the clinical assessment of the spine, from the overall analysis of the results it was seen that in the hospital in Bressanone the prevalence of degenerative disorders of the lumbosacral region of the spine was 3.9% and in the Bolzano hospital it was 5.7%. Similar differences were observed in the prevalences of episodes of acute low back pain reported in the previous 12 months: Bressanone 7.7%, Bolzano 3.8%. In both hospitals 3rd grade SAP was diagnosed in about 5% of the subjects examined and globally clinical/functional alterations of the lumbar spine were observed in 20% of the Bressanone workers and in 27.2% of the Bolzano workers. Management of the cases judged unfit for manual lifting of patients was particularly difficult because of the high percentage of such cases (8-9%). On the basis of these results, the administrations of both hospitals undertook a series of short-, medium- and long-term interventions in order to reduce the risk for the spine.

Adolescent↗
PubMed2002

Rectus sheath hooking: alternative method of abdominal wall lifting and fixing for laparoscopy: a pilot cadaver bio-mechanical study.

Four bio-mechanical tests were used to study properties of the rectus sheath for laparoscopic abdominal access procedure and to provide surgical exposure by the ChulaLift gasless retractor. The profile of forces and displacement showed how some patients were good candidates for the gasless operation. The lifting weight should not excess 10 kg for minimal harm and optimal exposure. The rectus hooking could be an alternative choice for abdominal wall fixing during the first trocar entry. One-cm width hooking, the rectus sheath could withstand 18-20 kg lifting force. The exposure provided by the gasless technique was narrow between the lateral ports compared to the conventional technique. The rectus sheath could be hooked to provide effective fixing of the area to be penetrated by the first trocar, and this fascial layer could be lifted to produce exposure in the gasless technique.

Abdominal Muscles↗
PubMed2002

The reliability of determining effort level of lifting and carrying in a functional capacity evaluation.

OBJECTIVES: To establish inter- and intra-rater reliability of observations in a functional capacity evaluation. BACKGROUND: Functional capacity evaluations are used to assess a person's functional capacity as it relates to work. Lifting and carrying are important aspects of a functional capacity evaluation. An evaluator determines the patient's levels of effort through standardized observations. Questions remain with regards to the reliability of these observations. METHODS: Four healthy subjects were videotaped while performing two lifts and four carries with progressive loads. The videotape was scrambled randomly and viewed twice by 3 physical therapists and 2 occupational therapists. The evaluators determined the amount of effort it required (light, medium, heavy, and maximum). The inter- and intra-rater reliability of the observations was expressed by means of percentage agreement. RESULTS: Inter-rater reliability ranged 87-96%, intra-rater reliability ranged 93-97%. CONCLUSION: The results indicate that by means of standardized observations, therapists can reliably determine effort level during lifting and carrying in healthy subjects, and thus affirm the findings of other studies of similar design.

Adult↗
PubMed2005

Dynamic versus static analyses of lifting a box from the floor.

Lifting objects from below knee height has been implicated as a source of low back pain and injury. Static models have often been used to assess forces produced in the lumbar region by lifting; however, inertial forces generated by acceleration may be significant. Therefore, the goal of this investigation was to assess differences between static and dynamic analysis methods. Sagittal plane kinematics were collected on 21 men and 22 women of college age while lifting a milk crate (men = 25 kg, women = 15 kg) from the floor to standing knuckle height on level as well as sloped (facing uphill and downhill at 10 degrees and 20 degrees) ground conditions. Both static and dynamic top-down inverse models were utilized to assess net muscular moments at L5/S1 as well as the posture of the person at the time of static max (TSM) and dynamic max (TDM) moments. The TDM moment was significantly later than the TSM in the level through uphill conditions (p < 0.001). The dynamic max moment was significantly greater than the static max moment in all conditions (p < 0.001). Torso angles at TSM exhibited a significantly greater forward lean (by < 2 degrees) in the level through uphill conditions (p < 0.001). Overall low-back curvature, hip angles, knee angles, and ankle angles were not affected by the type of model (p > 0.05), though several minor differences occurred at conditions other than the level (most dramatic in the downhill 20 degrees condition). Therefore, if moments are of interest, a dynamic model should be utilized. However, body position is very similar at TSM and TDM.

Adaptation, Physiological↗