Cause Of Musculoskeletal Injuries Research Articles

The Single-Person Lateral Decubitus Ankle Sling Fracture Reduction Technique

Ankle fractures are common pathologies encountered in the emergency department. Reduction of ankle fractures can be a challenging task to perform alone and can place medical personnel in mechanically disadvantageous positions. In addition, body weight and awkward lifting are leading preventable causes of musculoskeletal injuries among medical staff. The single-person lateral decubitus ankle sling fracture reduction method described is a simple and reproducible technique that utilizes the classic principles described by Dr Quigley in 1959. This technique optimizes patient positioning, utilizes gravity, and incorporates a stable ankle sling. This also incorporates a relaxed patient position to promote a successful ankle fracture reduction. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Low Back Pain Among Nurses in a Tertiary Care Teaching Hospital at Malappuram Kerala.

Background:Numerous nurses suffer from low back pain of various origins, which causes them to lose productivity, obtain unwanted medical reports, and sometimes even retire before their time. Age, heredity, obesity, bad posture, poor body mechanics, pregnancy, tension, personal stress, and traumatic incidents like falls or vehicle accidents are all potential causes of musculoskeletal injuries on the job. Methodology:A descriptive study was done with the help of a semi-structured questionnaire to determine the burden of low back pain among nurses in a tertiary medical college. The data were entered into a Microsoft Excel sheet (Redmond, USA) before being transferred to SPSS. The frequency was expressed in proportion. A Chi-square was done to test the association. Result:Among 220 nurses, 89 (40.4%) complained of mild low back pain, 86 (39.09%) complained of moderate pain, and seven (0.03%) of them had severe low back pain. Due to low back pain, among the 182 (82.7%) nurses who have low back pain, 46 of them had to take one or more days' leave from work. Thirty-six nurses have had low back pain for more than four years. As a mode of treatment, 43 nurses have taken either medicine or injection; 25 of them have taken rest; four are on Ayurvedic treatment, and 110 nurses haven't taken any treatment. Conclusion: The majority of the nurses complained of low back aches. Care must be taken to take adequate rest after prolonged standing and proper treatment. Frequent bending and using an abnormal posture must be avoided. The use of ergonomically designed chairs should be emphasized for the protection of the back.

S644 ColoWrap Real-World Evidence: Colonoscopy Compression Device Mitigates Ergonomic Hazards for Endoscopists and Staff

Introduction: Looping during colonoscopy increases scope forces and torquing which are causes of ergonomic injury among endoscopists. In addition, manual abdominal pressure and patient repositioning, used to address looping in 52% and 34% of colonoscopies, respectively, are known causes of musculoskeletal injuries among endoscopy staff. ColoWrap (ColoWrap, LLC, Durham, NC) is an anti-looping abdominal compression device applied during colonoscopy to decrease looping and limit the need for manual pressure and patient repositioning. We aimed to determine extent to which ColoWrap reduces ergonomic hazards associated with colonoscopy by performing a chart review and obtaining physician and staff feedback following use of the device. Methods: This retrospective, multi-center, observational chart review included patients that underwent colonoscopy with the ColoWrap device between September 25, 2016, and June 15, 2022. Demographics and procedural information were abstracted from patient records. Physician and staff experiences were captured using a survey instrument. Results: 849 procedures were included in the review. The population was majority male (53%), over 60 (mean age: 60.8 ± 11.6), and obese (mean BMI: 33.6 ± 7.2). 49 patients (5.7%) had an abdominal hernia, 139 (16.3%) had at least one prior abdominal surgery, and 52 (6.1%) had a history of difficult or incomplete colonoscopy. Cecal intubation was achieved in 841 cases (99.1%). Mean cecal intubation time was 6.8 ± 6.2 (min). Manual pressure was used in 109 cases (12.8%); significant manual pressure ( > 3 min) was needed in only 21 procedures (2.5%). Patient repositioning was used in 48 cases (5.6%). No significant adverse events were reported. 84% of physicians indicated that ColoWrap use mitigated looping, shortened cecal intubation time, and reduced physical strain associated with advancing the scope. 90% of endoscopy staff reported reduced manual pressure and patient repositioning, and alleviation of musculoskeletal pain (Figure). Conclusion: ColoWrap is safe and significantly reduces manual pressure and patient repositioning during colonoscopy relative to published rates. Physicians using ColoWrap experience less looping and physical strain and endoscopy staff suffer less musculoskeletal pain. The device is a viable tool among solutions to improve the safety and efficiency of colonoscopy. Further studies to identify circumstances in which ColoWrap use offers the greatest benefit to patients, physicians, and staff are warranted.Figure 1.: Endoscopist and Endoscopy Staff Experience with ColoWrap Device

Adjustments in Shoulder and Back Kinematics during Repetitive Palletizing Tasks.

Repetitive task performance is a leading cause of musculoskeletal injuries among order-picking workers in warehouses. The repetition of lifting tasks increases the risk of back and shoulder injuries among these workers. While lifting in this industry is composed of loaded and unloaded picking and placing, the existing literature does not address the separate analysis of the biomechanics of the back and shoulder for these events. To that end, we investigated the kinematics of the back and shoulder movements of nine healthy male participants who performed three sessions of a simulated de/palletization task. Their back and shoulder kinematics were sensed using an optical motion capture system to determine the back inclination and shoulder flexion. Comparison of the kinematics between the first and last sessions indicated statistically significant changes in the timings, angles, coordination between the back and shoulder, and moments around the shoulder (). The majority of the significant changes were observed during the loaded events, which confirms the importance of the separation of these events for biomechanical analysis. This finding suggests that focusing worker evaluation on the loaded periods can provide important information to detect kinematic changes that may affect musculoskeletal injury risk.

WORK-RELATED MUSCULOSKELETAL DISORDERS AMONG HEALTH PROFESSIONALS: REVIEW OF THE PREVALENCE, COMPLICATIONS, PREDISPOSING FACTOR, RELATED OUTPUT PERFORMANCE AND MANAGEMENT

Musculoskeletal disorders are injuries over a period of time due to workers' exposure to some multifactorial work hazards. The major causes of musculoskeletal injuries are long work involving forceful, repeating movements, and maintaining awkward body postures. This paper focuses on the associated prevalence, complications, predisposing factors, related output performance, and management of musculoskeletal disorders among health-related professionals. Work-related musculoskeletal disorders (WMSD) are unhealthy situations that occur in work environments to workers thereby leading to health hazards. Which in most cases leads to high costs to employers, for instance, absenteeism lost productivity and increased health care, disability, worker’s compensation costs, and so on. MSD cases are more severe than the average nonfatal injury or illness. Nurses have the highest incident rate of WMSD but are not fatal and are followed by physicians, pharmacists, laboratory scientists, and physiotherapists in that order. The body parts of these health workers associated with WMSD include both the upper and lower limbs, with the structure of the upper limb being the most affected. Therefore, relevant measures should be taken by policymakers to adjust workplace ergonomics and staff welfare should be paramount to reduce musculoskeletal injuries among professional health workers, and they should be enlightened on proper workplace ergonomics.

Musculoskeletal Injuries Among Females in the Military: A Scoping Review.

Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews-Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.

Real-time indicators and influence factors of muscle fatigue in push-type work

Muscle fatigue is a significant cause of musculoskeletal injury and can easily induce unsafe behaviour. Push-type work is a common type of physical work, and if not designed appropriately, may lead to muscle fatigue. Previous studies on muscle fatigue mainly focus on investigating continuous force exertion, and in most of them, a constant muscle force is assumed, thereby ignoring the fluctuations present in exertion. In this study, bolt hole drilling was chosen to represent typical push-type work, and the muscle fatigue from this work was examined. The experimental system designed in this study monitored the muscle force in real time. In the experiments, different thrust angles (15°, 45°, and 75°), different relative force values (20% MVC, 40% MVC, and 60% MVC; MVC: maximum voluntary contraction) and different working time intervals (0 s, 30 s, 60 s, and 90 s) were considered. The results demonstrate that there is a significant positive correlation between the rating of perceived exertion (RPE) and muscle force attenuation (r = 0.786, p = 0). The cubic regression model (Y = − 0.00071x3 − 0.024x2 − 0.334x + 1.146, R2 = 0.639) fits the data most closely. Therefore, force attenuation can be used as a real-time indicator of muscle fatigue. In addition, the relative force value and thrust angle have a significant impact on the RPE score, whereas the working time interval has no major effect on it. This study provides a new method for evaluating muscle fatigue and a basis for the design of push-type work to reduce fatigue-induced accidents and musculoskeletal injuries.

Functional Performance of Firefighters After Exposure to Environmental Conditions and Exercise.

Slips, trips, and falls are leading causes of musculoskeletal injuries in firefighters. Researchers have hypothesized that heat stress is the major contributing factor to these fireground injuries. To examine the effect of environmental conditions, including hot and ambient temperatures, and exercise on functional and physiological outcome measures, including balance, rectal temperature, and perceived exertion. Randomized controlled clinical trial. Laboratory environmental chamber. A total of 13 healthy, active career firefighters (age = 26 ± 6 years [range = 19-35 years], height = 178.61 ± 4.93 cm, mass = 86.56 ± 16.13 kg). Independent variables consisted of 3 conditions (exercise in heat [37.41°C], standing in heat [37.56°C], and exercise in ambient temperature [14.24°C]) and 3 data-collection times (preintervention, postintervention, and postrecovery). Each condition was separated from the others by at least 1 week and lasted a maximum of 40 minutes or until the participant reached volitional fatigue or a rectal temperature of 40.0°C. Firefighting-specific functional balance performance index, rectal temperature, and rating of perceived exertion. Exercise in the heat decreased functional balance, increased rectal temperature, and altered the perception of exertion compared with the other intervention conditions. A bout of exercise in a hot, humid environment increased rectal temperature in a similar way to that reported in the physically active population and negatively affected measures of functional balance. Rather than independently affecting balance, the factors of exercise and heat stress appeared to combine, leading to an increased likelihood of slips, trips, and falls.

Ankle and knee moment and power adaptations are elicited through load carriage conditioning in males

Soldiers routinely conduct load carriage and physical training to meet occupational requirements. These tasks are physically arduous and are believed to be the primary cause of musculoskeletal injury. Physical training can help mitigate injury risk when specifically designed to address injury mechanisms and meet task demands. This study aimed to assess lower-limb biomechanics and neuromuscular adaptations during load carriage walking in response to a 10-week evidence-based physical training program. Thirteen male civilian participants donned 23 kg and completed 5 km of load carriage treadmill walking, at 5.5 km h−1 before and after a 10-week physical training program. Three-dimensional motion capture and force plate data were acquired in over-ground walking trials before and after treadmill walking. These data were inputs to a musculoskeletal model which estimated lower-limb joint kinematics and kinetics (i.e., moments and powers) using inverse kinematics and dynamics, respectively. A two-way analysis of variance revealed significant main effect of training for kinematic and kinetics parameters at the knee and ankle joints (p < 0.05). Post-Hoc comparisons demonstrated a significant decrease (4.2%) in total negative knee power between pre- and post-March 5 km measures after training (p < 0.05). Positive power contribution shifted distally after training, increasing at the post-march measure from 39.9% to 43.6% at the ankle joint (p < 0.05). These findings demonstrate that a periodised training program may reduce injury risk through favourable ankle and knee joint adaptations.

Victims of Severe Intimate Partner Violence Are Left Without Advocacy Intervention in Primary Care Emergency Rooms: A Prospective Observational Study.

Intimate partner violence (IPV) is a common cause of musculoskeletal injury. Although serious injuries are relatively rare, IPV is one of the leading causes of homicide. IPV victims seeking help in health care are known to be at specific risk of re-abuse. Previous studies of IPV victims in emergency room (ER) settings have focused on injury patterns, but little is known about the violence behind bruises and fractures. The aim of this study was to examine how violence severity and known risk factors for lethal re-abuse in IPV victims attending ERs are associated with injury severity, different patient groups, and referral to advocacy services. This was a prospective, observational, multicenter study of 146 self-reporting IPV victims in two Level IV trauma centers in Helsinki from October 2012 to November 2013. In our sample, serious injuries were rare, but patients had typically suffered severe violence, and half had at least one risk factor for lethal re-abuse. Both sexes and all age groups were represented among the patient profiles, and 88% attended ERs outside common working hours. Only 19% were referred to advocacy, and severe violence or risk factors for lethal re-abuse did not affect prevalence of referrals. Our results show that IPV victims in primary care ERs have typically either experienced severe violence or are at serious risk of re-abuse and even death. The resulting injuries do not usually require medical aftercare, and victims typically present outside common working hours. In the absence of a clear follow-up protocol, most IPV victims are left without any advocacy intervention.

A preliminary case study of the effect of shoe-wearing on the biomechanics of a horse’s foot

Horse racing is a multi-billion-dollar industry that has raised welfare concerns due to injured and euthanized animals. Whilst the cause of musculoskeletal injuries that lead to horse morbidity and mortality is multifactorial, pre-existing pathologies, increased speeds and substrate of the racecourse are likely contributors to foot disease. Horse hooves have the ability to naturally deform during locomotion and dissipate locomotor stresses, yet farriery approaches are utilised to increase performance and protect hooves from wear. Previous studies have assessed the effect of different shoe designs on locomotor performance; however, no biomechanical study has hitherto measured the effect of horseshoes on the stresses of the foot skeleton in vivo. This preliminary study introduces a novel methodology combining three-dimensional data from biplanar radiography with inverse dynamics methods and finite element analysis (FEA) to evaluate the effect of a stainless steel shoe on the function of a Thoroughbred horse’s forefoot during walking. Our preliminary results suggest that the stainless steel shoe shifts craniocaudal, mediolateral and vertical GRFs at mid-stance. We document a similar pattern of flexion-extension in the PIP (pastern) and DIP (coffin) joints between the unshod and shod conditions, with slight variation in rotation angles throughout the stance phase. For both conditions, the PIP and DIP joints begin in a flexed posture and extend over the entire stance phase. At mid-stance, small differences in joint angle are observed in the PIP joint, with the shod condition being more extended than the unshod horse, whereas the DIP joint is extended more in the unshod than the shod condition. We also document that the DIP joint extends more than the PIP after mid-stance and until the end of the stance in both conditions. Our FEA analysis, conducted solely on the bones, shows increased von Mises and Maximum principal stresses on the forefoot phalanges in the shod condition at mid-stance, consistent with the tentative conclusion that a steel shoe might increase mechanical loading. However, because of our limited sample size none of these apparent differences have been tested for statistical significance. Our preliminary study illustrates how the shoe may influence the dynamics and mechanics of a Thoroughbred horse’s forefoot during slow walking, but more research is needed to quantify the effect of the shoe on the equine forefoot during the whole stance phase, at faster speeds/gaits and with more individuals as well as with a similar focus on the hind feet. We anticipate that our preliminary analysis using advanced methodological approaches will pave the way for new directions in research on the form/function relationship of the equine foot, with the ultimate goal to minimise foot injuries and improve animal health and welfare.

A study to evaluate host factors for musculoskeletal injuries secondary to trauma among elderly people of Northwestern India

Introduction: As the population ages, the problems related to falls and fractures are expected to grow. This poses a great challenge to the health-care systems. Meeting these challenges requires a clear understanding of the prevalence and nature of falls. It also means identifying factors responsible for injury causation. The current study was conducted with the aim to evaluate host factors responsible for musculoskeletal injuries (MSIs) in the elderly. Materials and Methods: A hospital-based, questionnaire-based, descriptive study was conducted on all elderly (60 years) patients attending a tertiary care teaching hospital with MSIs secondary to trauma between 2013 and 2014. Results: A total of 200 elderly with MSIs secondary to trauma attending the tertiary care center between 2013 and 2014 were evaluated for the purpose of this study. Exactly half of them (50%) were more than 70 years of age. Intoxication and presence of visual and hearing impairment were observed as significantly associated with occurrence of MSIs. Discussion: Trauma is a common cause of MSI among the elderly. Therefore, identification and evaluation of host factors are important as this can help in planning prevention of injuries in elderly. Conclusion: MSIs due to trauma are a focus of public health practice as they pose a serious health threat, occur frequently, and are in most situations preventable.

드롭랜딩 시 착지형태에 따른 충격흡수구간의 운동역학적 특성

Objective : The purpose of this study was to investigate the biomechanical properties of shock absorption strategy and postural stability during the drop landing for each types. Methods : The motions were captured with Vicon Motion Capture System, with the fourteen infra-red cameras (100Hz) and synchronized with GRF(ground reaction force) data(1000Hz). Ten male soccer players performed a drop landing with single-leg and bi-legs on the 30cm height box. Dependent variables were the CoM trajectory and the Joint Moment. Statistical computations were performed using the paired t-test and ANOVA with Turkey HSD as post-hoc. Results : The dominant leg was confirmed to show a significant difference between the left leg and right leg as the inverted pendulum model during Drop Landing(Phase 1 & Phase 2). One-leg drop landing type had the higher CoM displacement, the peak of joint moment with the shock absorption than Bi-leg landing type. As a lower extremity joint kinetics analysis, the knee joint showed a function of shock absorption in the anterior-posterior, and the hip joint showed a function of the stability and shock absorption in the medial-lateral directions. Conclusion : These findings indicate that the instant equilibrium of posture balance(phase 1) was assessed by the passive phase as Class 1 leverage on the effect of the stability of shock absorption(phase 2) assessed by the active phase on the effect of Class 2 leverage. Application : This study shows that the cause of musculo-skeletal injuries estimated to be focused on the passive phase of landing and this findings could help the prevention of lower damage from loads involving landing related to the game of sports.

Improving transfer task practices used with air travelers with mobility impairments: A systematic literature review

Manual lifting in healthcare and air transportation is a high-risk activity and a primary cause of musculoskeletal injuries for workers who are required to provide transfer assistance to people with mobility impairments. In the healthcare industry, safe patient-handling programs and policies are accepted as effective ways to prevent worker injury and to improve patient safety. We reviewed evidence-based studies and several websites for disability groups and the airline industry. Seven studies found significant improvements in musculoskeletal comfort levels and declines in musculoskeletal injuries. One study found significant improvements in every musculoskeletal group surveyed. Our review of websites revealed that there were no published research studies or policies about safe handling practices for air travelers. It is evident that passengers with mobility impairments have different expectations for assistance, not congruent with existing services offered by the airline industry.

83 International variation in musculoskeletal sickness absence: Findings from the CUPID study

ObjectivesTo quantify the variation in rates of absence for musculoskeletal pain across 47 occupational groups (mostly nurses and office workers) from 18 countries, and to explore personal and group-level risk...

International variation in absence from work attributed to musculoskeletal illness: findings from the CUPID study

ObjectivesTo quantify the variation in rates of absence due to musculoskeletal pain across 47 occupational groups (mostly nurses and office workers) from 18 countries, and to explore personal and group-level...

Risks and causes of musculoskeletal injuries among health care workers

Musculoskeletal injuries (MSIs) persist as the leading category of occupational injury in health care. Limited evidence exists regarding MSIs for occupations other than direct patient care providers. An evaluation of the risks, causes and activities associated with MSIs that includes non-patient care health care occupations is warranted. To examine the risks and causes of time-loss MSIs for all occupations in health care. Workers employed by a health region in British Columbia were followed from April 2007 to March 2008 using payroll data; injuries were followed using an incidence surveillance database. Frequency and rates were calculated for all occupational injuries and MSIs and relative risks (RRs) were computed using Poisson regression. Causes and occupational activities leading to MSIs were tabulated for direct care occupations and non-patient care occupations. A total of 944 injuries resulting in time-loss from work were reported by 23 742 workers. Overall, 83% injuries were musculoskeletal. The two occupations showing highest RR of MSIs relative to registered nurses were facility support service workers [RR = 3.16 (2.38-4.18), respectively] and care aides [RR=3.76 (3.09-4.59)]. For direct patient care occupations, the leading causes of MSIs were awkward posture (25%) and force (23%); for non-patient care occupations were force (25%) and slip/fall (24%). Patient handling activities accounted for 60% of all MSIs for direct care occupations. For non-patient care occupations, 55% of MSIs were due to material/equipment handling activities. Prevention efforts for MSIs should be directed to non-patient care occupations as well and consider their occupation-specific causes and activities.

Musculoskeletal Injuries and Minor Trauma in Space: Incidence and Injury Mechanisms in U.S. Astronauts

Astronauts have sustained musculoskeletal injuries and minor trauma in space, but our knowledge of these injuries is based mainly on anecdotal reports. The purpose of our study was to catalog and analyze all in-flight musculoskeletal injuries occurring throughout the U.S. space program to date. A database on in-flight musculoskeletal injuries among U.S. astronauts was generated from records at the Johnson Space Center. A total of 219 in-flight musculoskeletal injuries were identified, 198 occurring in men and 21 in women. Incidence over the course of the space program was 0.021 per flight day for men and 0.015 for women. Hand injuries represented the most common location of injuries, with abrasions and small lacerations representing common manifestations of these injuries. Crew activity in the spacecraft cabin such as translating between modules, aerobic and resistive exercise, and injuries caused by the extravehicular activity (EVA) suit components were the leading causes of musculoskeletal injuries. Exercise-related injuries accounted for an incidence of 0.003 per day and exercise is the most frequent source of injuries in astronauts living aboard the International Space Station (ISS). Interaction with EVA suit components accounted for an incidence of 0.26 injuries per EVA. Hand injuries were among the most common events occurring in U.S. astronauts during spaceflight. Identifying the incidence and mechanism of in-flight injuries will allow flight surgeons to quantify the amount of medical supplies needed in the design of next-generation spacecraft. Engineers can use in-flight injury data to further refine the EVA suit and vehicle components.

The effect of foot imbalance on point of force application in the horse.

Foot imbalance is believed to be a common cause of musculoskeletal injury in the horse; its biomechanical effects are, however, poorly understood. Wedges (angle 3.7 and 5 degrees) were attached to modified shoes to elevate one aspect of both front feet of Thoroughbred-type horses. The point of force application during weightbearing was determined at trot using a forceplate system. A total of 8 horses were studied with a minimum of 4 providing data for each wedge condition. The results demonstrated that application of a standard steel horse shoe to a balanced foot has minimal effect on the point of force trace through stance. Alteration of mediolateral hoof balance resulted in a displacement of point of force application by about 10 mm in the direction of the wedge throughout stance. Elevation of the heels delayed unloading of the heels and elevation of the toe advanced unloading. Reassessment 24 h after shoeing showed minimal change in the point of force trace. This work demonstrates that a horse is unable to compensate for an acute foot imbalance by redistributing the load under the foot. The higher loads in the elevated region are likely to have a detrimental effect on the hoof structure and horn growth in that part of the hoof.

Management of housekeeping by feedback.

Loss of balance resulting from, for instance, slipping, stumbling and stepping on objects is one cause of musculoskeletal injuries. Good order and tidiness are thus one way of preventing injuries. An experiment on the provision of feedback in regard to performance yielded promising results with respect to the improvement of work practices. The experiment was conducted in a company known for its high standard of cleanliness. The first step was to define the correct work practices (14 behavioural rules). An observation method for measuring the housekeeping standard was then devised on the basis of these rules, and observation tours were conducted in two departments, once or twice a week for 2 months. Each lasted from 2 to 3 hours and covered about 250 items in the larger department and over 150 in the smaller. A training seminar (1 hour) was then held. The 14 work practices were explained and illustrated with slides. A few weeks later the result of each observation lour was drawn on a large graph which had ...