Kermit G. Davis

The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine.

Study Design. The effects of psychosocial stress on muscle activity and spinal loading were evaluated in a laboratory setting. Objective. To evaluate the influence of psychosocial stress, gender, and personality traits on the functioning of the biomechanical system and subsequent spine loading. Summary of Background Data. Physical, psychosocial, and individual factors all have been identified as potential causal factors of low back disorders. How these factors interact to alter the loading of the spine has not been investigated. Methods. Twenty-five subjects performed sagittally symmetric lifts under stressful and nonstressful conditions. Trunk muscle activity, kinematics, and kinetics were used to evaluate three-dimensional spine loading using an electromyographic-assisted biomechanical model. A personality inventory characterized the subject’s personality traits. Anxiety inventories and blood pressure confirmed reactions to stress. Results. Psychosocial stress increased spine compression and lateral shear, but not in all subjects. Differences in muscle coactivation accounted for these stress reactions. Gender also influenced spine loading; Women’s anterior–posterior shear forces increased in response to stress, whereas men’s decreased. Certain personality traits were associated with increased spine loading compared with those with an opposing personality trait and explained loading differences between subjects. Conclusions. A potential pathway between psychosocial stress and spine loading has been identified that may explain how psychosocial stress increases risk of low back disorders. Psychosocially stressful environments solicited more of a coactivity response in people with certain personality traits, making them more susceptible to spine loading increases and suspected low back disorder risk.

Spine loading characteristics of patients with low back pain compared with asymptomatic individuals.

Study Design. Patients with low back pain and asymptomatic individuals were evaluated while performing controlled and free-dynamic lifting tasks in a laboratory setting. Objective. To evaluate how low back pain influences spine loading during lifting tasks. Summary of Background Data. An important, yet unresolved, issue associated with low back pain is whether patients with low back pain experience spine loading that differs from that of individuals who are asymptomatic for low back pain. This is important to understand because excessive spine loading is suspected of accelerating disc degeneration in those whose spines are damaged already. Methods. In this study, 22 patients with low back pain and 22 asymptomatic individuals performed controlled and free-dynamic exertions. Trunk muscle activity, trunk kinematics, and trunk kinetics were used to evaluate three- dimensional spine loading using an electromyography- assisted model in conjunction with a new electromyographic calibration procedure. Results. Patients with low back pain experienced 26% greater spine compression and 75% greater lateral shear (normalized to moment) than the asymptomatic group during the controlled exertions. The increased spine loading resulted from muscle coactivation. When permitted to move freely, the patients with low back pain compensated kinematically in an attempt to minimize external moment exposure. Increased muscle coactivation and greater body mass resulted in significantly increased absolute spine loading for the patients with low back pain, especially when lifting from low vertical heights. Conclusions. The findings suggest a significant mechanical spine loading cost is associated with low back pain resulting from trunk muscle coactivation. This loading is further exacerbated by the increases in body weight that often accompany low back pain. Patient weight control and proper workplace design can minimize the additional spine loading associated with low back pain.

Variation in spinal load and trunk dynamics during repeated lifting exertions.

OBJECTIVES To quantify the variability in lifting motions, trunk moments, and spinal loads associated with repeated lifting exertions and to identify workplace factors that influence the biomechanical variability. DESIGN Measurement of trunk dynamics, moments and muscle activities were used as inputs into EMG assisted model of spinal loading. BACKGROUND Traditional biomechanical models assume repeated performance of a lifting task produces little variability in spinal load because the assessments overlook variability in lifting dynamics and muscle coactivity. METHODS Five experienced and seven inexperienced manual materials handlers performed 10 repeated lifts at each combination of load weight, task asymmetry and lifting velocity. RESULTS Box weight, task asymmetry and job experience influenced the magnitude and variability of spinal load during repeated lifting exertions. Surprisingly, experienced subjects demonstrated significantly greater spinal loads and within-subject variability in spinal load than inexperienced subjects. Trial-to-trial variability accounted for 14% of the total variation in compression overall and 32% in lateral shear load. Although the mean spinal load was safely below the NIOSH recommended limit; due to variability about the mean, more than 20% of the lifts exceeded the recommended limit. CONCLUSION Spinal load changed markedly from one exertion to the next despite identical task requirements. Trial-to-trial variability in kinematics, kinetics, and spinal load were influenced by workplace factors, and may play a role in the risk of low-back pain. RELEVANCE Ergonomic assessments considering only the mean value of spinal load overlook the fact that a large fraction of the lifts may exceed recommended levels.

Spine loading during asymmetric lifting using one versus two hands

This study documented three-dimensional spinal loading associated with asymmetric lifting while using either one or two hands to perform the task. Lift asymmetry was defined as a function of the load origin relative to the sagittal plane of the body. Lifts occurred at 0, 30, or 60 degrees off the sagittal plane on both sides of the body (lifting from the right and from the left relative to the sagittal plane). Ten subjects lifted a 13.7 kg box from one of these origins to a sagittally symmetric destination. Spinal loads were estimated through the use of a validated EMG-assisted model. Spine compression and lateral shear forces increased as the lift origin became more asymmetric. However, spinal compression and lateral shear increased by about twice the rate when lifting from origins to the left of the sagittal plane compared to lifting from origins to the right of the sagittal plane. Anterior-posterior spinal shear decreased as asymmetry increased with larger decreases occurring when lift origins occurred to the right of the sagittal plane. One-hand lifting changed the compression and shear profiles significantly. One-hand lifts using the hand on the same side of the body as the load resulted in compression forces that were approximately equal to those observed when lifting with two hands in a sagittally symmetric position. Anterior-posterior shear decreased and lateral shear increased under these conditions. These results reflect the trade-offs that must be considered among spinal forces during asymmetric lifting while using one or two hands. These findings have significant implications for task assessment interpretation and workplace design.

A non-MVC EMG normalization technique for the trunk musculature : Part 1. Method development

Normalization of muscle activity has been commonly used to determine the amount of force exerted by a muscle. The most widely used reference point for normalization is the maximum voluntary contraction (MVC). However, MVCs are often subjective, and potentially limited by sensation of pain in injured individuals. The objective of the current study was to develop a normalization technique that predicts an electromyographic (EMG) reference point from sub-maximal exertions. Regression equations predicting maximum exerted trunk moments were developed from anthropometric measurements of 120 subjects. In addition, 20 subjects performed sub-maximal and maximal exertions to determine the necessary characteristic exertions needed for normalization purposes. For most of the trunk muscles, a highly linear relationship was found between EMG muscle activity and trunk moment exerted. This analysis determined that an EMG-moment reference point can be obtained via a set of sub-maximal exertions in combination with a predicted maximal exertion (expected maximum contraction or EMC) based upon anthropometric measurements. This normalization technique overcomes the limitations of the subjective nature for the MVC method providing a viable assessment method of individuals with a low back injury or those unwilling to exert an MVC as well as could be extended to other joints/muscles.

Spine loading in patients with low back pain during asymmetric lifting exertions

BACKGROUND CONTEXT Recurrent low back pain (LBP) is a common and costly problem that might be related to increased spine loads in those with LBP. However, we know little about how the spine is loaded when those with LBP perform lifting exertions. PURPOSE Document spine loading patterns of patients with LBP performing symmetric and asymmetric lifting exertions compared with asymptomatic individuals performing the same tasks. STUDY DESIGN Spine loadings during lifting exertions that varied in asymmetric origin as well as horizontal and vertical distance from the spine were compared between asymptomatic subjects and patients with LBP. METHODS Sixty-two patients with LBP and 61 asymptomatic individuals performed a variety of lifting exertions that varied in lift origin horizontal and vertical position (region), lift asymmetry position and weight lifted. An electromyography-assisted model was used to evaluate spine loading in each subject during the lifting exertions. Differences in spine loading between the LBP and asymptomatic subjects were noted as a function of the experimental variables. RESULTS Patients with LBP experienced greater spine compression and shear forces when performing lifting tasks compared with asymptomatic individuals. The least taxing conditions resulted in some of the greatest differences between LBP and asymptomatic individuals. CONCLUSIONS Greater levels of antagonistic muscle coactivation resulted in increases in spine loading for patients with LBP. Specific lifting conditions that tend to exacerbate loading can be identified by means of physical workplace requirements. These findings may impact acceptable return-to-work conditions for those with LBP.

Evaluation of spinal loading during lowering and lifting

OBJECTIVE: To estimate the three-dimensional spinal loads during various lifting and lowering tasks. DESIGN: The in vivo measurements of the trunk dynamics, moments, and myoelectric activity were used as inputs into an electromyographic-assisted model used to predict the three-dimensional spinal loads. BACKGROUND: Previous studies of eccentric motions have investigated muscle activity, trunk strength, and trunk moments. A void in the body of knowledge exists in that none of these studies investigated spinal loading. METHODS: Ten subjects lifted (40 degrees of flexion to 0 degrees ) and lowered (0 degrees of flexion to 40 degrees ) boxes while positioned in a structure that restrained the pelvis and hips. The tasks were performed under isokinetic trunk velocities of 5, 10, 20, 40, and 80 deg s(-1) while holding a box with weights of 9.1, 18.2, and 27.3 kg. RESULTS: Lowering strength was found to be 56% greater than lifting strength. The lowering tasks produced significantly higher compression forces but lower anterior-posterior shear forces than the lifting tasks. The differences in the spinal loads produced by the two lifting tasks were attributed to differences in coactivity and unequal lifting moments (i.e. holding the box farther away from the body). CONCLUSIONS: The nature of the spinal loads that occur during lowering and lifting were significantly different. The difference in spinal loads may be explained by different lifting styles.

Effects of box features on spine loading during warehouse order selecting

Low back disorders in distribution centres or warehouses have been identified as an area of elevated risk in many industries. The task of an order selector requires workers manually to lift boxes from storage bins to a mobile pallet. This study explored the effect of box features and box location when lifting from a pallet in a storage bin upon spine loading. Ten experienced warehouse workers were asked to lift boxes from a pallet while the size, weight, handle features and location of the box on a pallet were changed. An EMG-assisted model was employed to assess spine compression, lateral shear and anterior-posterior shear during the lifts. The position from which the worker lifted a box on a pallet had the most profound effect on spine loading while the lower level of the pallet represented the greatest loadings on the spine. Box weight did not appear to be a feasible means of controlling spine loading unless its position on the pallet could also be controlled. The inclusion of handles had an effect similar to reducing the box weight by 4.5 kg, whereas box size did not effectively affect spine loading. The mechanisms by which these factors affect spine loading are discussed.

Biomechanical assessment of lifting dynamics, muscle activity and spinal loads while using three different styles of lifting belt.

OBJECTIVE: To demonstrate the influence of different types of lifting belts on trunk motion, muscle activity and spine loading during symmetric and asymmetric lifting exertions. DESIGN. IN VIVO: measurements were achieved representing lifting dynamics, applied trunk moments and myoelectric activity. Dynamic spinal loads were determined from a validated biomechanical model of lifting. BACKGROUND: There is a great deal of controversy as to whether lifting belts are a benefit or a liability to manual materials-handling activities. A review of the literature demonstrates that there is a large amount of conflicting evidence and few definitive, well-executed studies upon which to base an opinion regarding these devices. METHODS: Fifteen subjects lifted boxes of 14 kg and 23 kg from sagitally symmetric and asymmetric origins to an upright posture. Dynamic trunk motions, lifting moments, myoelectric activity and modelled spinal loads were examined as a function of three belt styles (elastic, leather, and orthotic) and compared with results from a no-belt condition. RESULTS: Lifting belts reduced peak trunk angles, velocities and accelerations in the sagittal, lateral and transverse planes. However, only the elastic belt successfully reduced trunk motions in all three dimensions. The orthotic belt significantly increased the lifting moment associated with a given weight. A minor redistribution in muscle activity was observed when wearing an elastic belt. A statistically significant reduction in spinal load was associated with the elastic belt. However, a great deal of variability between subjects was noted. Some subjects experienced increased spinal load while wearing the elastic lifting belt. CONCLUSIONS: These results demonstrate that the biomechanical operation of lifting can be influenced by the type of lifting belts used.

Characteristics of job rotation in the Midwest US manufacturing sector

Job rotation has been advocated as a suitable intervention to control work-related musculoskeletal disorders. However, little is known regarding the prevalence of job rotation, methods used to identify jobs for rotation or the benefits or limitations of job rotation. A web-based questionnaire was developed to survey job rotation practices from Midwest US manufacturing companies. Results indicated that 42.7% of the companies contacted used job rotation, where the median time for which they had used job rotation was 5 years. Job rotation was used mainly to reduce exposure to risk factors for work-related injuries and to reduce work related injuries, whereas supervisor decisions and ergonomic analyses were used to select jobs for the rotation scheme. Major limitations to successful implementation of job rotation included rotation of individuals with medical restrictions, decreased product quality and lack of jobs to rotate to. These findings suggest that further study is needed to determine if exposure to risk factors is reduced through current efforts.