Thomas Karakolis

The impact of sit–stand office workstations on worker discomfort and productivity: A review

This review examines the effectiveness of sit-stand workstations at reducing worker discomfort without causing a decrease in productivity. Four databases were searched for studies on sit-stand workstations, and five selection criteria were used to identify appropriate articles. Fourteen articles were identified that met at least three of the five selection criteria. Seven of the identified studies reported either local, whole body or both local and whole body subjective discomfort scores. Six of these studies indicated implementing sit-stand workstations in an office environment led to lower levels of reported subjective discomfort (three of which were statistically significant). Therefore, this review concluded that sit-stand workstations are likely effective in reducing perceived discomfort. Eight of the identified studies reported a productivity outcome. Three of these studies reported an increase in productivity during sit-stand work, four reported no affect on productivity, and one reported mixed productivity results. Therefore, this review concluded that sit-stand workstations do not cause a decrease in productivity.

A comparison of trunk biomechanics, musculoskeletal discomfort and productivity during simulated sit-stand office work

Abstract Sedentary office work has been shown to cause low back discomfort and potentially cause injury. Prolonged standing work has been shown to cause discomfort. The implementation of a sit–stand paradigm is hypothesised to mitigate discomfort and prevent injury induced by prolonged exposure to each posture in isolation. This study explored the potential of sit–stand to reduce discomfort and prevent injury, without adversely affecting productivity. Twenty-four participants performed simulated office work in three different conditions: sitting, standing and sit–stand. Variables measured included: perceived discomfort, L4–L5 joint loading and typing/mousing productivity. Working in a sit–stand paradigm was found to have the potential to reduce discomfort when compared to working in a sitting or standing only configuration. Sit–stand was found to be associated with reduced lumbar flexion during sitting compared to sitting only. Increasing lumbar flexion during prolonged sitting is a known injury mechanism. Therefore, sit–stand exhibited a potentially beneficial response of reduced lumbar flexion that could have the potential to prevent injury. Sit–stand had no significant effect on productivity. Practitioner Summary: This study has contributed foundational elements to guide usage recommendations for sit–stand workstations. The sit–stand paradigm can reduce discomfort; however, working in a sit–stand ratio of 15:5 min may not be the most effective ratio. More frequent posture switches may be necessary to realise the full benefit of sit–stand.

Is Standing the Solution to Sedentary Office Work

There has been a major shift toward office workstations that accommodate standing postures. This shift is attributable to negative health and musculoskeletal issues from sedentary exposures. However, changing exposures from sitting to standing does not eliminate these issues, as evidence indicates prolonged standing also induces problems. Reducing seated exposure and rotating frequently between sitting and standing has been shown to result in positive health outcomes, reduced discomfort, and increased work performance. Implementing sit-stand workstations has promise to mitigate work-related health issues, if the users are provided with training that includes accommodations for individual work patterns and preferences.

Is intervertebral disc pressure linked to herniation?: An in-vitro study using a porcine model

Approximately 40% of low back pain cases have been attributed to internal disc disruption. This disruption mechanism may be linked to intradiscal pressure changes, since mechanical loading directly affects the pressure and the stresses that the inner annulus fibrosus experiences. The objective of this study was to characterize cycle-varying changes in four dependent measures (intradiscal pressure, flexion-extension moments, specimen height loss, and specimen rotation angle) using a cyclic flexion-extension (CFE) loading protocol known to induce internal disc disruption. A novel bore-screw pressure sensor system was used to instrument 14 porcine functional spinal units. The CFE loading protocol consisted of 3600 cycles of flexion-extension range of motion (average 18.30 (SD 3.76) degrees) at 1Hz with 1500N of compressive load. On average, intradiscal pressure and specimen height decreased by 47% and 62%, respectively, and peak moments increased by 102%. From 900 to 2100 cycles, all variables exhibited significant changes between successive time points, except for the specimen posture at maximum pressure, which demonstrated a significant shift towards flexion limit after 2700 cycles. There were no further changes in pressure range after 2100 cycles, whereas peak moments and height loss were significantly different from prior time points throughout the CFE protocol. Twelve of the 14 specimens showed partial herniation; however, injury type was not significantly correlated to any of the dependent measures. Although change in pressure was not predictive of damage type, the increase in pressure range seen during this protocol supports the premise that repetitive combined loading (i.e., radial compression, tension and shear) imposes damage to the inner annulus fibrosus, and its failure mechanism may be linked to fatigue.

Localized strain measurements of the intervertebral disc annulus during biaxial tensile testing

Both inter-lamellar and intra-lamellar failures of the annulus have been described as potential modes of disc herniation. Attempts to characterize initial lamellar failure of the annulus have involved tensile testing of small tissue samples. The purpose of this study was to evaluate a method of measuring local surface strains through image analysis of a tensile test conducted on an isolated sample of annular tissue in order to enhance future studies of intervertebral disc failure. An annulus tissue sample was biaxial strained to 10%. High-resolution images captured the tissue surface throughout testing. Three test conditions were evaluated: submerged, non-submerged and marker. Surface strains were calculated for the two non-marker conditions based on motion of virtual tracking points. Tracking algorithm parameters (grid resolution and template size) were varied to determine the effect on estimated strains. Accuracy of point tracking was assessed through a comparison of the non-marker conditions to a condition involving markers placed on tissue surface. Grid resolution had a larger effect on local strain than template size. Average local strain error ranged from 3% to 9.25% and 0.1% to 2.0%, for the non-submerged and submerged conditions, respectively. Local strain estimation has a relatively high potential for error. Submerging the tissue provided superior strain estimates.

Evaluating Abdominal and Lower-Back Muscle Activity While Performing Core Exercises on a Stability Ball and a Dynamic Office Chair:

Objective: The purpose of this study was to evaluate the ability of a dynamic office chair to activate the core muscles while participants performed exercises sitting on the chair compared to a stability ball. Background: Prolonged sitting has become an accepted part of the modern office. However, epidemiological evidence suggests that sedentary postures are linked to many adverse effects on health. The concept of dynamic or active sitting is intended to promote movement while sitting to reduce the time spent in prolonged, static postures. Methods: Sixteen participants performed four pelvic rotation exercises (front-back, side-side, circular, and leg lift) on both a dynamic office chair and a stability ball. Muscle activity from 12 torso muscles were evaluated with surface electromyography. Results: For all exercises, trunk muscle activity on the chair was comparable to that on a stability ball. The right external oblique was the only muscle to produce greater peak activity (p = .019) when using the ball compared to the chair (21.4 ± 14.0 percent maximal voluntary excitations (%MVE) and 14.7 ± 10.8 %MVE for the ball and chair, respectively). The left thoracic erector spinae produced greater average activity (p = .044) on the chair than on the ball. Conclusion: These findings suggest that this dynamic sitting approach could be an effective tool for core muscle activation while promoting movement and exercise while sitting at work. Application: Muscle activations on the dynamic chair are comparable to those on a stability ball, and dynamic office chairs can promote movement and exercise while sitting at work.

Determination of Orientation and Practice Requirements When Using an Obstacle Course for Mobility Performance Assessment

Objective: Determine effect of orientation (introduction and familiarization) and practice (repeated performance) on human performance under various load conditions as assessed by an obstacle course. Background: Obstacle courses are commonly used as screening tools by military, police, and firefighters or to assess human capabilities and the effect of wearing personal protective equipment (PPE) and other occupationally necessary equipment on mobility task performance. Unfortunately, little is formally documented about the effect of orientation and practice on performance outcomes of obstacle or mobility courses being used. Method: Forty-eight participants were recruited from the Canadian Army Infantry and Combat Engineer population. Participants either received regular or extensive orientation of the course before completing it. Following orientation, participants completed the course five consecutive times while wearing their PPE with full fighting order (FFO) and five consecutive times while wearing no PPE and non-FFO across a five-day period (maximum two runs per day), with ensemble presentation order counterbalanced. Total course completion time and individual obstacle completion times were measured for each run of the course. Results: While wearing FFO, participants continued to decrease the time required for completing the course; however, while wearing non-FFO, time to course completion did not significantly change over the five runs. There were no differences in course completion times for the regular and extensive course orientation groups. Conclusions: Considerations required to mitigate orientation and practicing effects can differ depending on type or complexity of load condition. While wearing FFO, practicing effects can introduce undesired confounding factors into data collection. Application: Any practice runs on an obstacle course prior to its use as an assessment tool should focus on the loaded (e.g., FFO) condition because improvement on loaded runs is likely transferred to unloaded, but this does not apply in the reverse.

The Effect of Local Hydration Environment on the Mechanical Properties and Unloaded Temporal Changes of Isolated Porcine Annular Samples

Preventing dehydration during in vitro testing of isolated layers of annulus fibrosus tissue may require different test conditions than functional spine units. The purpose of the study was twofold: (A) to quantify changes in mass and thickness of multilayer annulus samples in four hydration environments over 120 min; and (B) to quantify cycle-varying biaxial tensile properties of annulus samples in the four environments. The environments included a saline bath, air, relative humidity control, and misting combined with controlled humidity. The loading protocol implemented 24 cycles of biaxial tensile loading to 20% strain at a rate of 2%/s with 3-, 8-, and 13-min of intermittent rest. Specimen mass increased an average (standard deviation) 72% (11) when immersed for 120 min (p < 0.0001). The air condition and the combined mist and relative humidity conditions reduced mass by 45% (15) and 25% (23), respectively, after 120 min (p < 0.0014). Stress at 16% stretch in the air condition was higher at cycle 18 (18 min of exposure) and cycle 24 (33 min of exposure) compared to all other environments in both the axial and circumferential directions (p < 0.0460). There was no significant change in mass or thickness over time in the relative humidity condition and the change in circumferential stress at 16% stretch between cycles 6 and 24 was a maximum of 0.099 MPa and not statistically significant. Implementation of a controlled relative humidity environment is recommended to maintain hydration of isolated annulus layers during cyclic tensile testing.

A finite element evaluation of the moment arm hypothesis for altered vertebral shear failure force

The mechanism of vertebral shear failure is likely a bending moment generated about the pars interarticularis by facet contact, and the moment arm length (MAL) between the centroid of facet contact and the location of pars interarticularis failure has been hypothesised to be an influential modulator of shear failure force. To quantitatively evaluate this hypothesis, anterior shear of C3 over C4 was simulated in a finite element model of the porcine C3–C4 vertebral joint with each combination of five compressive force magnitudes (0–60% of estimated compressive failure force) and three postures (flexed, neutral and extended). Bilateral locations of peak stress within C3s pars interarticularis were identified along with the centroids of contact force on the inferior facets. These measurements were used to calculate the MAL of facet contact force. Changes in MAL were also related to shear failure forces measured from similar in vitro tests. Flexed and extended vertebral postures respectively increased and decreased the MAL by 6.6% and 4.8%. The MAL decreased by only 2.6% from the smallest to the largest compressive force. Furthermore, altered MAL explained 70% of the variance in measured shear failure force from comparable in vitro testing with larger MALs being associated with lower shear failure forces. Our results confirmed that the MAL is indeed a significant modulator of vertebral shear failure force. Considering spine flexion is necessary when assessing low-back shear injury potential because of the association between altered facet articulation and lower vertebral shear failure tolerance.