Sean Gallagher

Examining the Interaction of Force and Repetition on Musculoskeletal Disorder Risk: A Systematic Literature Review

Objective: Our aims were (a) to perform a systematic literature review of epidemiological studies that examined the interaction of force and repetition with respect to musculoskeletal disorder (MSD) risk, (b) to assess the relationship of force and repetition in fatigue failure studies of musculoskeletal tissues, and (c) to synthesize these findings. Background: Many epidemiological studies have examined the effects of force and repetition on MSD risk; however, relatively few have examined the interaction between these risk factors. Method: In a literature search, we identified 12 studies that allowed evaluation of a force-repetition interaction with respect to MSD risk. Identified studies were subjected to a methodological quality assessment and critical review. We evaluated laboratory studies of fatigue failure to examine tissue failure responses to force and repetition. Results: Of the 12 epidemiological studies that tested a Force × Repetition interaction, 10 reported evidence of interaction. Based on these results, the suggestion is made that force and repetition may be interdependent in terms of their influence on MSD risk. Fatigue failure studies of musculoskeletal tissues show a pattern of failure that mirrors the MSD risk observed in epidemiological studies. Conclusions: Evidence suggests that there may be interdependence between force and repetition with respect to MSD risk. Repetition seems to result in modest increases in risk for low-force tasks but rapid increases in risk for high-force tasks. This interaction may be representative of a fatigue failure process in affected tissues.

Torso flexion loads and the fatigue failure of human lumbosacral motion segments

Study Design. Spine loads associated with lifting a 9-kg weight were estimated at three torso flexion angles (0°, 22.5°, and 45°), and lumbosacral motion segments were cyclically loaded using these loads until failure or to a maximum of 10,020 cycles. Objectives. To simulate the postures and loads experienced by the lumbar spine during repetitive lifting of moderate weights in different torso flexion postures, and to analyze the fatigue failure response of lumbosacral motion segments. Summary of Background Data. Previous fatigue failure studies of lumbar motion segments have not reproduced the combination of spinal postures, loads, and load rates anticipated in different torso flexion postures during lifting tasks characteristic of those in occupational settings. Methods. Twelve fresh human lumbosacral spines were dissected into three motion segments each (L1–L2, L3–L4, and L5–S1). Motion segments within each spine were randomly assigned to a simulated torso flexion angle (0°, 22.5°, or 45°) using a partially balanced incomplete block experimental design. Spinal load and load rate were determined for each torso flexion angle using previously collected data from an EMG-assisted biomechanical model. Motion segments were creep loaded for 15 minutes, then cyclically loaded at 0.33 Hz. Fatigue life was taken as the number of cycles to failure (10 mm displacement after creep loading). Specimens were inspected to determine failure mechanisms. Results. The degree of torso flexion had a dramatic impact on cycles to failure. Motion segments experiencing the 0° torso flexion condition averaged 8,253 cycles to failure (±2,895), while the 22.5° torso flexion angle averaged 3,257 (±4,443) cycles to failure, and motion segments at the 45° torso flexion angle lasted only 263 cycles(±646), on average. The difference was significant at P < 0.0001, and torso flexion accounted for 50% of the total variance in cycles to failure. Conclusions. Fatigue failure of spinal tissues can occur rapidly when the torso is fully flexed during occupational lifting tasks; however, many thousands of cycles canbe tolerated in a neutral posture. Future lifting recommendations should be sensitive to rapid development of fatigue failure in torso flexion.

Tolerance of the lumbar spine to shear: A review and recommended exposure limits

BACKGROUND The lumbar spine may experience significant shear forces during occupational tasks due to the force of gravity acting on the upper body when bending the trunk forward, or when performing tasks involving pushing or pulling. Shear force limits of 1000 N and 500 N have been recommended by previous authors for maximum permissible limit and action limit, respectively. METHODS The present paper reviews literature in terms of shear tolerance (ultimate shear stress and fatigue life in shear stress) of the lumbar spine and develops recommended limits based on results of studies examining shear loading of human motion segments. Weibull analysis was used to assess fatigue failure data to estimate distributions of failure at different percentages of ultimate shear stress. FINDINGS Based on Weibull analysis of fatigue failure data from the best available data, a 1000 N shear limit would appear acceptable for occasional exposure to shear loading (≤ 100 loadings/day); however, a 700 N limit would appear appropriate for repetitive shear loading (100-1000 loadings/day) for most workers. INTERPRETATION Results of the current analysis support the 1000 N limit for shear stress, but for a rather limited number of cycles (<100 per day). Due to the logarithmic nature of the fatigue failure curve, a 700 N shear limit would appear to be acceptable for frequent shear loadings (100-1000 per day). This value is slightly higher than the action limit of 500 N previously recommended.

Head-and-Face Anthropometric Survey of Chinese Workers

Millions of workers in China rely on respirators and other personal protective equipment to reduce the risk of injury and occupational diseases. However, it has been >25 years since the first survey of facial dimensions for Chinese adults was published, and it has never been completely updated. Thus, an anthropometric survey of Chinese civilian workers was conducted in 2006. A total of 3000 subjects (2026 males and 974 females) between the ages of 18 and 66 years old was measured using traditional techniques. Nineteen facial dimensions, height, weight, neck circumference, waist circumference and hip circumference were measured. A stratified sampling plan of three age strata and two gender strata was implemented. Linear regression analysis was used to evaluate the possible effects of gender, age, occupation and body size on facial dimensions. The regression coefficients for gender indicated that for all anthropometric dimensions, males had significantly larger measurements than females. As body mass index increased, dimensions measured increased significantly. Construction workers and miners had significantly smaller measurements than individuals employed in healthcare or manufacturing for a majority of dimensions. Five representative indexes of facial dimension (face length, face width, nose protrusion, bigonial breadth and nasal root breadth) were selected based on correlation and cluster analysis of all dimensions. Through comparison with the facial dimensions of American subjects, this study indicated that Chinese civilian workers have shorter face length, smaller nose protrusion, larger face width and longer lip length.

Lifting in stooped and kneeling postures: Effects on lifting capacity, metabolic costs, and electromyography of eight trunk muscles

Abstract Twelve healthy, experienced underground coal miners performed lifting capacity tests in stooped and kneeling postures using a modified psychophysical, procedure. Subjects adjusted weight in a lifting box to the maximum they could handle without undue fatigue in an asymmetric lifting task. Lifting periods were 20 min in duration and the frequency was 10 lifts/min. Tests were performed under a 48-in. roof that restricted the subjects posture. Psychophysical, physiological, and biomechanical dependent measures included the maximum acceptable weight of lift (MAWL), heart rate (HR), rate of oxygen consumption (VO 2 ), ventilation volume rate (V E ), respiratory exchange ratio (R), and integrated electromyography (EMG) of eight trunk muscles. Results indicated that the MAWL was significantly lower when kneeling than when stooped (p 2 (p

Effects of posture on dynamic back loading during a cable lifting task

This study evaluated spinal loads associated with lifting and hanging heavy mining cable in a variety of postures. This electrical cable can weigh up to 10 kg per metre and is often lifted in restricted spaces in underground coal mines. Seven male subjects performed eight cable lifting and hanging tasks, while trunk kinematic data and trunk muscle electromyograms (EMGs) were obtained. The eight tasks were combinations of four postures (standing, stooping, kneeling on one knee, or kneeling on both knees) and two levels of cable load (0 N or 100 N load added to the existing cable weight). An EMG-assisted model was used to calculate forces and moments acting on the lumbar spine. A two-way split-plot ANOVA showed that increased load (p<0.05) and changes in lifting posture (p<0.05) independently affected trunk muscle recruitment and spinal loading. The increase in cable load resulted in higher EMG activity of all trunk muscles and increased axial and lateral bending moments on the spine (p<0.05). Changes in posture caused more selective adjustments in muscle recruitment and affected the sagittal plane moment (p<0.05). Despite the more selective nature of trunk EMG changes due to posture, the magnitude of changes in spinal loading was often quite dramatic. However, average compression values exceeded 3400 N for all cable lifting tasks.

A comparison of fatigue failure responses of old versus middle-aged lumbar motion segments in simulated flexed lifting

Study Design. Survival analysis techniques were used to compare the fatigue failure responses of elderly motion segments to a middle-aged sample. Objectives. To compare fatigue life of a middle-aged sample of lumbosacral motion segments to a previously tested elderly cohort. An additional objective was to evaluate the influence of bone mineral content on cycles to failure. Summary of Background Data. A previous investigation evaluated fatigue failure responses of 36 elderly lumbosacral motion segments (average age, 81 ± 8 years) subjected to spinal loads estimated when lifting a 9-kg load in 3 torso flexion angles (0°, 22.5°, and 45°). Results demonstrated rapid fatigue failure with increased torso flexion; however, a key limitation of this study was the old age of the specimens. Methods. Each lumbosacral spine was dissected into 3 motion segments (L1–L2, L3–L4, and L5–S1). Motion segments within each spine were randomly assigned to a spinal loading condition corresponding to lifting 9 kg in 3 torso flexion angles (0°, 22.5°, or 45°). Motion segments were statically loaded and allowed to creep for 15 minutes, then cyclically loaded at 0.33 Hz. Fatigue life was taken as the number of cycles to failure (10 mm displacement after creep loading). Results. Compared with the older sample of spines, the middle-aged sample exhibited increased fatigue life (cycles to failure) in all the torso flexion conditions. Increased fatigue life of the middle-aged specimens was associated with the increased bone mineral content (BMC) in younger motion segments (mean ± SD, 30.7 ± 11.1 g per motion segment vs. 27.8 ± 9.4 g). Increasing bone mineral content had a protective influence with each additional gram increasing survival times by approximately 12%. Conclusion. Younger motion segments survive considerably longer when exposed to similar spine loading conditions that simulate repetitive lifting in neutral and flexed torso postures, primarily associated with the increased bone mineral content possessed by younger motion segments. Cycles to failure of young specimens at 22.5° flexion were similar to that of older specimens at 0° flexion, and survivorship of young specimens at 45° flexion was similar to the older cohort at 22.5°.

Acceptable weights and physiological costs of performing combined manual handling tasks in restricted postures

Eight healthy, male underground coal miners (mean age = 36.9 yrs +/- 4.5 SD) participated in a study examining psychophysically acceptable weights and physiological costs of performing combined lifting and lowering tasks in restricted head-room conditions. Independent variables included posture (stooping or kneeling on two knees), task symmetry (symmetric or asymmetric), and vertical lift distance (35 cm or 60 cm). All tasks were 10 min in duration and were performed under a 1.22 m ceiling to restrict the subjects posture. Subjects were required to raise and lower a lifting box every 10s, and asked to adjust the box weight to the maximum amount they could handle without undue strain or fatigue. During the final 5 min of each test, data were collected to determine the energy expenditure requirements of the task. Results of this study demonstrated that psychophysical lifting capacity averaged 11.3% lower when kneeling as compared to stooping. Subjects selected 3.5% more weight in asymmetric tasks, and lifted 5.0% less weight to the 60 cm shelf compared to the 35 cm shelf. Heart rate was not significantly affected by posture, but was increased an average of 4 beats/min in asymmetric conditions, and by 3.5 beats/min while lifting/lowering to/from the high shelf. Oxygen uptake was increased by 9% when stooped, by 10% when lifting/lowering asymmetrically, and by 8.2% when performing the task to the high shelf. Results of this study indicate that, wherever possible, materials that must be lifted manually in low-seam coal mines be designed in accordance with the decreased lifting capacity exhibited in the kneeling posture.

Trunk Extension Strength and Muscle Activity in Standing and Kneeling Postures

Study Design. A split‐plot experimental design was used to evaluate the influence of posture, trunk angle, and rotational velocity on peak torque output and myoelectric activity during maximal trunk extension maneuvers. Objectives. To determine whether the kneeling posture alters extension torque capabilities in isometric and isokinetic exercises as compared with standing. Also, to ascertain whether recruitment of trunk muscles is modified by such a postural change. Summary of Background Data. Factors such as workplace geometry may force workers to adopt awkward or unusual postures in the performance of manual tasks. An understanding of the limitations placed on strength in unconventional working postures is crucial to the proper design of jobs. Methods. Twenty‐one healthy male subjects (mean age = 36 years ± 7 SD) performed 12 trunk extension exertions in standing and kneeling postures. Isometric tests were performed at 22.5°, 45°, and 67.5° of trunk flexion. Isokinetic tests were done at three velocities: 30°/sec, 60°/sec, and 90°/sec. Electromyographic data were collected from eight trunk muscles to assess muscle recruitment under each condition. A priori orthogonal contrasts were specified for analysis of both torque and electromyographic data. Results. The kneeling posture was associated with a 15% decrease in peak torque output when contrasted with standing; however, no concomitant change in trunk muscle activity was evident. Trunk hyperflexion (isometric tests) and increasing rotational velocity (isokinetic tests) were associated with reduced torque in both postures. Trunk muscle activity was primarily affected by changes in trunk angle and velocity of contraction. Conclusions. A reduced extensor capability exists in the kneeling posture, despite equivalent trunk muscle activity. The similar activation patterns in both postures suggest that the strength deficit does not result from alterations in trunk muscle function. Rather, it may be the consequence of a reduced capability to rotate the pelvis in the kneeling posture, due to a disruption of the biomechanical linkage of the leg structures.

Dynamic biomechanical modelling of symmetric and asymmetric lifting tasks in restricted postures

This article describes investigations of dynamic biomechanical stresses associated with lifting in stooping and kneeling postures. Twelve subjects volunteered to participate in two lifting experiments each having two levels of posture (stooped or kneeling), two levels of lifting height (350 or 700 mm), and three levels of weight (15, 20, or 25 kg). One study examined sagitally symmetric lifting, the other examined an asymmetric task. In each study, subjects lifted and lowered a box every 10 s for a period of 2 min in each treatment combination. Electromyography (EMG) of eight trunk muscles was collected during a specified lift. The EMG data, normalized to maximum extension and flexion exertions in each posture, was used to predict compression and shear forces at the L3 level of the lumbar spine. A comparison of symmetric and asymmetric lifting indicated that the average lumbar compression was greater in sagittal plane tasks; however, both anterior-posterior and lateral shear forces acting on the lumbar spine were increased with asymmetric lifts. Analysis of muscle recruitment indicated that the demands of lifting asymmetrically are shifted to ancillary muscles possessing smaller cross-sectional areas, which may be at greater risk of injury during manual materials handling (MMH) tasks. Model estimates indicated increased compression when kneeling, but increased shear forces when stooping. Increasing box weight and lifting height both significantly increased compressive and shear loading on the lumbar spine. A multivariate analysis of variance (MANOVA) indicated complex muscle recruitment schemes--each treatment combination elicited a unique pattern of muscle recruitment. The results of this investigation will help to evaluate safe loads for lifting in these restricted postures.