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PubMed1993

Ergonomic education for nursing students.

An educational package of common ergonomic training as well as behavioural training was implemented in nursing education. The teaching methods also had the aim of increasing students' awareness of the importance of total work environment for the prevention of back injuries. The experimental group was, on the whole, more pleased with their education than the control group. The experimental group judged their ability to analyse the work environment higher than the control group did. Observations in some practical work-tasks showed that students from the experimental group worked in physically more favourable positions with less strain on the body.

Curriculum↗
PubMed2001

Physical ergonomics in low-back pain prevention.

This paper reviews the current state of knowledge regarding the tools used in evaluating the workplace and worker in hopes of preventing low-back injury. Information regarding the current state of expenditure and trends toward ergonomic intervention are discussed. Acknowledgment is made of the increasing shift of responsibility from Compensation Boards to industry, and a review proactive preventative strategies and medical knowledge is included. Current ergonomic assessment tools are reviewed and the role of the Physical Ergonomist is introduced. Suggestions are made regarding the value of current and future approaches in prevention and direction of research.

Biomechanical Phenomena↗
PubMed2000

Herrmann multiple synostosis syndrome with neurological complications caused by spinal canal stenosis.

A young man was found to have multiple synostosis syndrome type I after presenting with a neck injury causing a cervical spinal cord contusion. Neurological symptoms and signs suggested spinal cord compression. Magnetic resonance (MR) and computerized tomography (CT) imaging of the spine showed spinal canal stenosis with cord compression at C3-C6, a deformed spinal canal flattened in the anteroposterior dimension, vertebral fusions and deformed lateral processes of the vertebrae. He had a long broad nose with hypoplasia of the alae nasi, conductive hearing loss requiring hearing aids, muscular build, stiff spine, prominent acromia, pectus excavatum, ischial prominences, short fifth fingers, fusion at the proximal interphalangeal joints of the fifth fingers with indistinct overlying creases, and toe syndactyly. Spinal cord stenosis is a serious complication of multiple synostosis syndrome, that should be kept in mind in considering the risk of neck or back injury associated with certain sports or other activities. In both the multiple synostosis syndrome and the less severe proximal symphalangism deafness syndrome, mutations have been detected in the human homologue of the noggin gene on chromosome 17q21-q22.

Abnormalities, Multiple↗
PubMedDate not supplied

Low-back pain in nurses and some loading factors of work.

Questionnaires were sent to qualified nurses (QNs) and nursing aides (NAs) to study the prevalence of low-back pain (LBP) and sciatica in relation to age, work-load, free time activities, menstruation, pregnancies and number of children. LBP and sciatica severe enough to make them unfit for daily tasks were significantly more common in NAs. Back injury and disability pension due to sciatic symptoms were also more common in NAs. Occupationally, NAs had twice the amount of lifting, bending, and rotation, while QNs reported more sitting and standing at work. Under the age of 30, the heaviness of the work was related to LBP in both NAs and QNs. It was concluded that prevention should be directed to improvements in the occupational work load, particularly for younger nurses.

Adult↗
PubMed1987

The management of work-related back pain.

This paper describes the Spinal Treatment Program at Columbia Hospital in Milwaukee. The primary goal of the program is to efficiently return the employee with a work-related back injury to the work setting. The two-phase program has been developed to provide treatment of acute injury, patient education, work hardening, and an assessment of the patient's ability to perform job tasks. Preliminary evaluative data are presented for patients treated from 1982 to 1984. The patient's discharge status (returned or did not return to work) was examined as a function of sex, age, educational level, employment category, duration of pain, or worker's compensation status. Results indicated that discharge status was significantly related to sex, employment category, duration of pain, and worker's compensation status.

Adult↗
PubMed2004

Ergonomics and biology of spinal rotation.

Spinal rotation, though being a very common motion of the body, is poorly understood. Furthermore, this motion and the extent of its development is unique to the human. Beyond the extent of its need in common activities, spinal rotation is a destabilizating motion for an inherently unstable structure. Spinal rotation has been argued to be an essential feature for an efficient bipedal gait. Also, it provides leverage to the upper extremities in delivering a forceful impact. An artificial restriction/elimination of spinal rotation resulted in significantly shorter stride length, slower walking velocity, and higher energy consumption in walking (p < 0.05). Spinal rotation also decreases the amount of force the spinal muscles can generate (to 25% of spinal extension). However, its extensive employment in industrial activities has been associated with 60.4% of back injuries. It is further stated that the amount of scientific information currently available is inadequate to biomechanically model the spinal response in a working environment. For example, when the spine is pre-rotated, a further rotation in the direction of pre-rotation decreases the force production significantly (p < 0.01) and increases the EMG activity significantly (p < 0.01) but the pattern changes with effort in the opposite direction. This and other properties (described in the paper) render biomechanical models inadequate. Muscle activation pattern and neuromotor behaviour of spinal muscles in flexion/extension and rotation of the spine are significantly different from each other (p < 0.01). The localized fatigue in different spinal muscles in the same contraction is significantly different and has been called differential fatigue. Finally, the trunk rotation, being pivotal for bipedal locomotion has brought many back problems to the human race.

Abdominal Muscles↗
PubMed1998

The value of lumbar spine magnetic resonance imaging in the demonstration of anular tears.

STUDY DESIGN: Retrospective review of magnetic resonance imaging and discography in patients investigated for low back pain before spinal fusion. OBJECTIVE: To determine the sensitivity of magnetic resonance imaging in the detection of painful anular tears manifested by the high-intensity zone. SUMMARY OF BACKGROUND DATA: Two studies have produced results showing that magnetic resonance imaging has a high specificity for the detection of painful anular tears manifested by a high-intensity zone. However, in a recent study, results showed no significant correlation between the high-intensity zone and pain reproduction. The sensitivity of magnetic resonance imaging in identifying anular tears in a symptomatic population has not been determined. METHODS: Anular tears were identified in magnetic resonance images by the presence of a high-intensity zone in the posterior anulus. The results were compared with the demonstration of painful anular tears on discogram, which has been considered the gold standard. RESULTS: The study group comprised 58 patients (31 men, 27 women; mean age 42, range 21-63 years). One hundred and fifty-two discs were injected and examined by discography, and 108 were considered degenerate. Of these, 86 had anular tears (54 posterior, 6 anterior, 26 both). Seventy anular tears were associated with concordant pain provocation. Twenty-seven high-intensity zones were identified in magnetic resonance imaging, of which 24 were associated with pain reproduction by discography. The sensitivity, specificity, positive predictive value, and negative predictive value of magnetic resonance imaging in the diagnosis of concordantly painful posterior anular tears are therefore 26.7%, 95.2%, 88.9%, and 47%, respectively. CONCLUSION: These results confirm that the high-intensity zone is a marker of a painful posterior anular tear. However, the usefulness of this sign is limited by low sensitivity.

Adult↗
PubMed1992

Myoelectric activity and sequencing of selected trunk muscles during isokinetic lifting.

Trained weight lifters lift heavy loads without a concomitant degree of acute low-back injuries. To study the process by which large loads are lifted with minimal injury, integrated electromyographic signals were recorded from four large muscle groups: gluteus maximus, quadriceps, latissimus dorsi, and erector spinae in 4 weight lifters and 11 asymptomatic control subjects. These signals were recorded during a floor-to-knuckle-height isokinetic lift (dead lift) at 30.5 and 45.7 cm/sec. The signals were normalized for the height of the lift and the maximal isokinetic integrated electromyographic activity. The weight lifters achieved maximal force at 50% of maximal lift height, whereas the control subjects achieved it at 67%. Although not statistically significant, the weight lifters used the gluteus maximus more during the early stages of the lift, perhaps contributing to earlier development of force. This process would stabilize the pelvis and permit the erector spinae to extend the trunk more efficiently. The weight lifter then completed the lift with prolonged and increasing activity in the quadriceps. This technique may minimize the required force in the erector spinae and the forces on the low-back structures. Clinical implications include more effective strength training of lifting muscle groups other than spinal extensors and the teaching of lifting strategies employed by weight lifters in low-back rehabilitation and work-hardening programs.

Back↗
PubMed1984

The load on the lumbar spine during isometric strength testing.

Reports of back discomfort and even back injuries during isometric strength testing in specific lifting positions indicated an analysis of the loads on the lumbar spine during this type of testing. A biomechanical analysis, which has been validated against EMG and intravital disc pressure measurements, was used for the calculations of the loads in four test persons. The calculations indicated compressive loads on L3 ranging from 5000-11,000 N during squat and torso lifting. Such loads in vitro have been found to cause structural failures of the vertebral endplates. Similar loads also may result in damage to the spine in vivo.

Adult↗
PubMed1989

Trunk strength during asymmetric trunk motion.

It is important to understand how trunk strength varies as a function of workplace factors so that the work environment can be designed to minimize the risk of low back injury. In this study maximal trunk torque production around the lumbosacral junction was measured in 44 subjects as trunk concentric and eccentric isokinetic velocity and trunk asymmetric line of action were varied. Trunk torque decreased by approximately 8.5% of maximum for every 15 deg of asymmetric trunk angle. Increases in concentric velocity decreased trunk strength, whereas increases in eccentric trunk velocity increased strength. Significant interactions were also found, and it was determined that the common finding that eccentric strength exceeds concentric strength is true only for forward trunk angles at all asymmetric angles. These results should have significant implications for the design of manual materials handling tasks.

Adolescent↗
PubMed1991

The effects of method of use, tool design, and roof height on trunk muscle activities during underground scaling bar use.

Epidemiologic studies have shown that the scaling bar, a hand tool used in underground mining, is frequently associated with the risk of back injury. An experiment was performed to investigate the effects of method of tool use, mine roof height, and tool design upon the activity of six trunk muscles and the ability to exert force with the bar. Roof height and scaling bar design had the largest effects on levels of muscle activation. Striking force did not differ significantly between tool designs. A biomechanical model was used to evaluate the collective effects of the trunk musculature activities upon spine loading. It was found that a significant reduction in predicted spine compression and shear forces can be achieved through the use of a counterbalanced scaling bar. The implications of these results are discussed.

Back Pain↗
PubMedDate not supplied

An ergonomic evaluation of a patient handling device: the elevate and transfer vehicle.

This study evaluated a Patient Handling Device (PHD) called the Elevate and Transfer Vehicle (ETV). The ETV works on the principle of leverage to transfer a patient from one seated position to another. Three types of product evaluation were used: expert appraisal; user trials; and performance tests. Expert appraisal was conducted by a panel of 11 people including an ergonomist, an industrial designer, two engineers, including one employed as an academic in a School of Mechanical, Manufacturing and Medical Engineering, and seven health professionals. The experts evaluated the ETV using a checklist and group discussions. They generally agreed that the advantages of the ETV tested were it's simplicity, the convenient position to adjust clothing for toileting and the need for only one carer. They noted comfort, security of straps, centre of gravity and manoeuvrability as the main areas for improvement. User trials consisted of nine male and nine female volunteer users assigned to carer/patient pairs. Following a training period, each user subjectively evaluated the ETV by structured interview. User trial results indicated ease of use, prevention of back injuries in carers and minimal body contact were advantages of the ETV. The main problems with using the ETV appeared to be the inadequate 'prop' and straps, the 'jolt' and lack of dignity for the patient. Several critical performance tests were conducted to determine compliance to Australian Standards for design. Areas of non-compliance included strength of frame and static stability. The findings suggest that most of the identified problems of the ETV could be overcome with minor design improvements. The general consensus of participants was to keep the design simple, maintain fast transfers and maintain the position of the patient to enable ease of clothing adjustment for toileting.

Adult↗
PubMed2001

Do electric patient beds reduce the risk of lower back disorders in nurses?

The aim of this study was to compare the probability estimates of lower back disorder (LBD) for a nurse performing a range of simulated patient care activities involving manual and electric patient beds. Studies of simulated patient care involving patient beds were undertaken using electrically powered and manually operated patient beds. The estimated probabilities of back injury, as calculated by the Lumbar Motion Monitor (LMM), between the two beds were compared statistically. A statistically significant reduction in LBD probability was observed in those functions that were completely achieved by the electrical mechanism. No significant difference in risk was observed in the patient care activities involving manipulating the patient in and around the bed that are more typical of 'heavy' orthopaedic nursing care in a busy acute ward environment. A potential for increased patient independence was observed during this trial. The LMM recorded no real risk reduction between situations involving electric or manual patient beds in those actions typically required of nurses in an acute orthopaedic ward caring for a disabled patient.

Beds↗
PubMed1990

Low-back pain. Factors of value in predicting outcome.

Two separate samples of 50 workers' compensation patients were assessed within 3 to 6 months of their first back injury and were reassessed at a mean of 13.7 months postinjury, at which time work status was also determined. A number of predictors on the first assessment then were correlated with return to work. These predictors included orthopaedic evaluations of severity and prognosis, the number of nonorganic physical signs, Minnesota Multiphasic Personality Inventory (MMPI) scales 1 and 3, age, education, proficiency in English, and the accuracy of patients' understanding of the bases for their medical condition as determined by the Schema Assessment Instrument (SAI). The SAI was the only variable to predict return to work significantly in both samples. These data point to the importance of patients' understanding of their medical condition for their prognosis.

Adult↗
PubMed2006

Outcomes of anterior cruciate ligament injuries to running backs and wide receivers in the National Football League.

BACKGROUND: Anterior cruciate ligament injuries are common in professional football players, and their career impact is unclear. PURPOSE: To quantify the affect of anterior cruciate ligament injuries on professional football player performance. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: Anterior cruciate ligament injury data from the National Football League were collected during a 5-year period (1998-2002) for running backs and wide receivers. Recorded variables included player age, experience, position, time to return to competition, and yearly total yards and touchdowns. Power ratings (total yards divided by 10 plus touchdowns multiplied by 6) were calculated for the injury season as well as for the 3 seasons before and after injury. A control group consisted of all running backs and wide receivers without an identified anterior cruciate ligament injury who competed in the 2000 season. RESULTS: Data were analyzed for 31 running backs and wide receivers with 33 anterior cruciate ligament injuries. More than one fifth of players never returned to a National Football League game. Returning players first competed in a game 55.8 +/- 5.4 weeks (mean +/- standard error) after injury. For the 24 anterior cruciate ligament-injured players with a minimum total power rating (sum of all 7 seasons) of 200 points, power rating per game played decreased from 9.9 +/- 1.1 preinjury to 6.5 +/- 0.9 postinjury. This decline in power rating per game played was statistically significant (P = .002) when compared with the change for the 146 control players. CONCLUSION: Nearly four fifths of National Football League running backs and wide receivers who sustain an anterior cruciate ligament injury return to play in a game. On return to competition, player performance of injured players is reduced by one third.

Adult↗
PubMedDate not supplied

Safer handling practice for nurses: a review of the literature.

The lifting and handling of people is an integral part of nursing care and has been blamed for a high incidence of back injuries to nurses. Changes to nursing practice have been dictated by this level of injury following the passing of health and safety legislation in 1992. This review seeks to evaluate the growing body of research from a range of disciplines in order to establish an evidence base for the moving and handling of patients. It identifies that studies considering the impact of changes in practice on patient outcomes are lacking. The term 'safer handling practice' has been used by the author to indicate a new way of thinking in relation to moving and handling people in health and care settings. A definition of safer handling practice has been derived from the literature with concomitant implications for training. Using this body of knowledge alongside studies investigating mobility of older people, the literature was used deductively to ascertain that safer handling practice has the potential to influence positively the mobility of older people. The author suggests further research to be conducted in the field of safer handling practice.

Activities of Daily Living↗
PubMed2002

Estimated moments at L5/S1 level and muscular activation of back extensors for six prone back extension exercises in healthy individuals.

The purpose of this study was to identify the prone back extension (PBE) exercises that offer the most resistance to the back extensor muscles. Twenty males with no previous history of low back injury performed two repetitions of eight exercises. These consisted of two maximal isometric voluntary activations (MVA) and six different PBE exercises. The participants, while lying prone on a bench, were asked to raise either their trunk or legs to the horizontal position and hold for one second (static phase) before returning to the original position. The exercises differed according to the particular segments that were raised into extension. To assess the PBE exercises, a biomechanical model was used to estimate the level of load resistance (%MVA) relative to the maximum voluntary activation strength (MVA). In addition, electromyography (EMG) was included to measure the level of muscle activity (%MVE) relative to the maximum voluntary activation EMG (MVE) value reached during the MVA. A significant relationship of 0.86 was found between the mass of the subject and the peak reaction moment during the MVA. Peak level of load resistance averaged around 50% MVA with the exception of exercise no. 5 where the subject had to raise in extension his trunk, legs and arms (65% MVA). The erector spinae (ES) activity level reached a peak value of 61% MVE for exercise no. 5. In the exercises where only the trunk was lifted, the peak level of ES was below 47% MVE and the average activity during the static phase reached approximately 26% MVE. For healthy individuals PBE exercises can be considered low intensity exercises (< 50% MVA; except exercise no. 5) and can be used to improve the endurance of the back muscles.

Adolescent↗