Low Back Injury Research Articles

Manual Handling as Contributor of Low Back Pain for Workers: A Case Study at PT Sumber Mandiri Jaya, Kabupaten Merauke

Introduction: Manual handling activities are a main causative factor of low back pain injuries. Around 1.71 billion people worldwide live with musculoskeletal conditions, including low back pain. In the Southeast Asia region, it is estimated that around 369 million people experience low back pain. In Indonesia more than 11.9% of health workers are diagnosed with musculoskeletal disease and diagnostic specific for worker obtained 24.7%. The purpose of this study was to determine the dominant indicators of manual handling for low back pain. Method: Study design used is cross-sectional study. Sample was 62 subjects. The variables of low back pain were collected using a modified questionnaire adopted from the Oswestry Low Back Pain Disability Questionnaire. Data were analyzed with linear regression test for the main indicators contributing to low back pain. Result: Average age of workers is 26.06±7.28, education level senior high school 45%, under 4 years length of work 83.9%. Average manual handling variable is 613.45 ± 383.39, low back pain 6.48 ± 3.607. Manual handling is not significantly related to low back pain r = -0.182. Duration, frequency and load are significant in predicting low back pain. The factors of duration, frequency and lift were estimated to contribute 5.4% for low back pain. Conclusion: The main factors related to low back pain are lifting load for workers, while the factors of lifting duration and frequency are not significantly related to low back pain. The lifting load is the main factor contributing to low back pain.

Using Digital Human Modelling to Evaluate the Risk of Musculoskeletal Injury for Workers in the Healthcare Industry.

Hospital nurses and caregivers are reported to have the highest number of workplace injuries every year, which directly leads to missed days of work, a large amount of compensation costs, and staff shortage issues in the healthcare industry. Hence, this research study provides a new technique to evaluate the risk of injuries for healthcare workers using a combination of unobtrusive wearable devices and digital human technology. The seamless integration of JACK Siemens software and the Xsens motion tracking system was used to determine awkward postures adopted for patient transfer tasks. This technique allows for continuous monitoring of the healthcare worker's movement which can be obtained in the field. Thirty-three participants underwent two common tasks: moving a patient manikin from a lying position to a sitting position in bed and transferring the manikin from a bed to a wheelchair. By identifying, in these daily repetitive patient-transfer tasks, potential inappropriate postures that can be conducive to excessive load on the lumbar spine, a real-time monitoring process can be devised to adjust them, accounting for the effect of fatigue. Experimental Result: From the results, we identified a significant difference in spinal forces exerted on the lower back between genders at different operational heights. Additionally, we revealed the main anthropometric variables (e.g., trunk and hip motions) that are having a large impact on potential lower back injury. These results will lead to implementation of training techniques and improvements in working environment design to effectively reduce the number of healthcare workers experiencing lower back pain, which can be conducive to fewer workers leaving the healthcare industry, better patient satisfaction and reduction of healthcare costs.

The efficacy of injury screening for lower back pain in elite golfers.

Injury prevention is a growing focus for golfers in general and for elite golfers in particular. Movement screening has been proposed as a possible cost-effective means of identifying underlying risk factors and is widely utilised by therapists, trainers and coaches. Our study aimed to establish whether results from movement screening were associated with subsequent lower back injury in elite golfers. Our prospective longitudinal cohort study with one baseline time point included 41 injury-free young elite male golfers who underwent movement screening. After this, the golfers were monitored for 6 months for lower back pain. Seventeen golfers developed lower back pain (41%). Screening tests that were able to differentiate golfers who developed and those who did not develop lower back pain, included: rotational stability test on the non-dominant side (p = 0.01, effect size = 0.27), rotational stability test on the dominant side (p = 0.03; effect size = 0.29) and plank score (p = 0.03; effect size = 0.24). There were no differences observed in any other screening tests. Out of 30 screening tests, only three tests were able to identify golfers not at risk of developing lower back pain. All three of these tests had weak effect sizes. Movement screening was not effective in identifying elite golfers at risk of lower back pain in our study.

Feature Identification Framework for Back Injury Risk in Repetitive Work With Application in Sheep Shearing.

Lower back injuries are a serious global problem. Most of these injuries occur over time with repeated sub-acute stresses. Neuromuscular control dysfunction could predict injury, however injuries are almost never observed alongside this data. No labels are available to identify important features that may be predictive of injury. While there are many individual differences in injury development, the population trend is that each individual's injury tolerance decreases over time with exposure, indicating a monotonic process. This paper proposes a framework for identifying key features of injury using an unsupervised technique that exploits knowledge of injury aetiology by analysing which features contribute to the popular trend using weak monotonicity from data segmented by task repetitions. The feature selection also evaluates feature redundancy. The efficacy of the framework is demonstrated through data from on-site sheep shearers over one day using 17 wearable inertial measurement units and 16 surface electromyography (sEMG) sensors. Consistent with literature, the results demonstrate sEMG features derived from the erector spinae and multifidus muscles are the most important indicators for lower back injury. To evaluate the performance of the proposed population-trend based unsupervised feature selection technique, the self-reported fatigue information is treated as some 'ground truth' information so that this proposed technique can compare with 5 existing unsupervised feature selection techniques. The proposed technique is shown to be the most consistent with the self-reported fatigue information, demonstrating the effectiveness of the proposed method.

Recovering from Laboratory-Induced slips and trips causes high levels of lumbar muscle activity and spine loading.

Slips, trips, and falls are some of the most substantial and prevalent causes of occupational injuries and fatalities, and these events may contribute to low-back problems. We quantified lumbar kinematics (i.e., lumbar angles relative to pelvis) and kinetics during unexpected slip and trip perturbations, and during normal walking, among 12 participants (6F, 6M). Individual anthropometry, lumbar muscle geometry, and lumbar angles, along with electromyography from 14 lumbar muscles were used as input to a 3D, dynamic, EMG-based model of the lumbar spine. Results indicated that, in comparison with values during normal walking, lumbar range of motion, lumbosacral (L5/S1) loads, and lumbar muscle activations were all significantly higher during the slip and trip events. Maximum L5/S1 compression forces exceeded 2700N during slip and trip events, compared with∼1100N during normal walking. Mean values of L5/S1 anteroposterior (930N), and lateral (800N) shear forces were also substantially larger than the shear force during the normal walking (230N). These observed levels of L5/S1 reaction forces, along with high levels of bilateral lumbar muscle activities, suggest the potential for overexertion injuries and tissue damage during unexpected slip and trip events, which could contribute to low back injuries. Outcomes of this study may facilitate the identification and control of specific mechanisms involved with low back disorders consequent to slips or trips.

Staff Low Back Injury Risk During Assisted Falls Virtual Reality Simulations.

Assisted falls occur when staff try to minimize the impact of falls by slowing a patient's descent. Assisting a patient fall may decrease patient injury risk, but biomechanical risk of injury to staff has not been evaluated. Assisted falls virtual reality (VR) simulations were conducted to examine staff low back injury risk during common assisted falls scenarios. VR simulations of a toilet to wheelchair transfer were developed with a male patient avatar for three assisted falls scenarios: standing up from toilet, sitting down on wheelchair, and ambulation. Patient avatar weight was modified to reflect normal, underweight, and overweight adult patients. The average spinal compression force at L5/S1 was calculated for each participant with five trials per three scenarios while utilizing physical ergonomic techniques and compared to the safe spinal compression limit of 3,400 Newtons (N). Six staff participants completed 90 VR simulations in total. The average calculated spinal compression force ranged from 7,132 N to 27,901 N. All participant trials exceeded the safe spinal compression limit of 3,400 N for every assisted falls scenario and avatar weight despite application of ergonomic techniques including wide stance, knees bent, and backs straight. Staff are at risk for low back injury if they assist falls regardless of the adult patient weight and application of ergonomic techniques. Safer alternatives like the implementation of mobility screening tools and safe patient handling and mobility technology are needed to help prevent assisted falls to decrease injury risk to both patients and staff.

Trunk muscle forces and spinal loads during heavy deadlift: Effects of personalization, muscle wrapping, muscle lever arm, and lumbopelvic rhythm.

Heavy deadlift is used as a physical fitness screening tool in the U.S. Army. Despite the relevance of such a screening tool to military tasks performed by Service Members, the biomechanical impact of heavy deadlift and its risk of low-back injury remain unknown. A kinematics-driven musculoskeletal model of spine was implemented to investigate biomechanics of the lower back in a volunteer (23 years old, height of 1.82 m, and body mass of 98.8kg) during a 68 kg deadlift. In search of protective mechanisms, effects of model personalization and variations in trunk musculature and lumbopelvic rhythm were also investigated. The net moment, compression and shear forces at the L5-S1 reached peaks of 684 Nm, 17.2 and 4.2kN, respectively. Geometrical personalization and changes in lumbopelvic rhythm had the least effects on predictions while increases in muscle moment arms (40%) had the largest effects that caused, respectively, 32% and 36% decrease in the maximum compressive and shearing forces. Initiating wrapping of back muscles at farther distances from the spine had opposing effects on spinal loads; peak compression at the L5-S1 decreased by 12% whereas shear increased by 19%. Despite mechanisms considered, spinal loads during heavy deadlift exceed the existing evidence concerning the threshold of injury for spinal segments, suggesting the vulnerability to injury. Chronic exposure to such high-spinal loads may lead to (micro) fractures, degeneration, pathoanatomical changes and finally low-back pain.

Effects of Load Carriage on Postural Control and Spatiotemporal Gait Parameters during Level and Uphill Walking.

Load carriage and uphill walking are conditions that either individually or in combination can compromise postural control and gait eliciting several musculoskeletal low back and lower limb injuries. The objectives of this study were to investigate postural control responses and spatiotemporal parameters of gait during level and uphill unloaded (UL), back-loaded (BL), and front-loaded (FL) walking. Postural control was assessed in 30 asymptomatic individuals by simultaneously recording (i) EMG activity of neck, thoracic and lumbar erector spinae, and rectus abdominis, (ii) projected 95% ellipse area as well as the anteroposterior and mediolateral trunk displacement, and (iii) spatiotemporal gait parameters (stride/step length and cadence). Measurements were performed during level (0%) and uphill (5, 10, and 15%) walking at a speed of 5 km h-1 without and with a suspended front pack or a backpack weighing 15% of each participant's body weight. The results of our study showed that postural control, as indicated by increased erector spinae EMG activity and changes in spatiotemporal parameters of gait that manifested with decreased stride/step length and increased cadence, is compromised particularly during level and uphill FL walking as opposed to BL or UL walking, potentially increasing the risk of musculoskeletal and fall-related injuries.

A Novel Passive Back-support Exoskeleton with a Spring-cable-differential for Lifting Assistance.

Lower back injuries are the most common work-related musculoskeletal disorders. As a wearable device, a back-support exoskeleton (BSE) can reduce the risk of lower back injuries and passive BSEs can achieve a low device weight. However, with current passive BSEs, there is a problem that the user must push against the device when lifting the leg to walk, which is perceived as particularly uncomfortable due to the resistance. To solve this problem, we propose a novel passive BSE that can automatically distinguish between lifting and walking. A unique spring-cable-differential acts as a torque generator to drive both hip joints, providing adequate assistive torque during lifting and low resistance during walking. The optimization of parameters can accommodate the asymmetry of human gait. In addition, the assistive torque on both sides of the user is always the same to ensure the balance of forces. By using a cable to transmit the spring force, we placed the torque generator on the person's back to reduce the weight on the legs. To test the effectiveness of the device, we performed a series of simulated lifting tasks and walking trials. When lifting a load of 10 kg in a squatting and stooping position, the device was able to reduce the activation of the erector spinae muscles by up to 41%. No significant change in the activation of the leg and back muscles was detected during walking.

Mental workload, musculoskeletal disorders, and associated factors among international transport truck drivers.

Many health changes are related to how individuals respond to work events that are influenced by organizational, physical, and human factors. We aim to evaluate the mental workload, the manifestation of musculoskeletal disorders, the associated factors, and their relationships among international transport truck drivers. This is a descriptive, cross-sectional diagnostic study of 70 truck drivers who entered the intermodal terminal of the city of Uruguaiana, state of Rio Grande do Sul, Brazil, in January 2021. Participants completed the NASA Task Load Index questionnaire and the Nordic Musculoskeletal Symptom Questionnaire, along with questions about work characteristics and health care. The results showed that most truck drivers have a high mental workload (90.0%) and have experienced musculoskeletal symptoms in the past 12 months (72.9%). In addition, this occupational group has characteristics that are predictive of health problems, as most work over 10 hours a day (61.5%). The results also show a correlation between mental workload, hours worked, and lower back injuries (p < 0.05). There is also an association between hours worked and the occurrence of musculoskeletal disorders in the neck, shoulders, and lower back in the past 12 months and in the shoulders and lower back in the past 7 days, especially for those who work over 12 hours a day. The population studied had a high mental workload and a high prevalence of musculoskeletal disorders as well as occupational characteristics predictive of harm to both physical and mental health.

ESTUDO SOBRE LESÕES ESPORTIVAS E REABILITAÇÃO EM JOGADORES DE BADMINTON

ABSTRACT Introduction Badminton has a wide audience and a large development market in China. Although it benefits the flexibility of sedentary workers by recruiting the whole body’s musculature, it can also cause a harmful effect due to lack of preparation or intensity during matches. Objective Study the methods of sports injury and rehabilitation of badminton players. Methods 60 badminton players with low back injuries were randomly divided into experimental and control groups. The control group used the traditional method of recovery by manual techniques. An intervention with core stability training lasting 40 minutes three times a week for six weeks was added to the experimental group. Results The degree of injury of badminton players is mostly mild, with some cases of moderate and severe injury. The combination of core strengthening associated with manual therapy rehabilitation and stretching can accelerate the muscular rehabilitation of the lumbar spine. Conclusion In the rehabilitation process of badminton injuries, we should combine physical training with traditional rehabilitation techniques, increasing the effectiveness of sports rehabilitation. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Risk factors and strategies for recovery quality, postoperative pain, and recurrent fractures between percutaneous kyphoplasty and percutaneous vertebroplasty in elderly patients with thoracolumbar compression fractures: a retrospective comparative cohort study.

With the increase of clinical cases and the improvement of operation, we found that recurrent fracture of the adjacent vertebral body is a common long-term complication of percutaneous kyphoplasty (PKP). However, the mechanism of re-fracture of adjacent vertebrae after PKP has not been unified. Therefore, through retrospective study, this paper discussed the risk factors and countermeasures affecting the quality of rehabilitation, postoperative pain and recurrent fracture in elderly PKP patients. From December 2019 to May 2021, 313 patients with osteoporotic spinal fractures were analyzed retrospectively. Cases were allocated to percutaneous vertebroplasty (PVP; n=130) and PKP (n=183) groups according to the modes of operation. Visual analogue scale (VAS), Cobb angle, and Oswestry disability index (ODI) were evaluated. Based on the occurrence of new fractures, the PKP cohort (n=15) and control cohort (n=32) were classified. Questionnaires analyzed the postoperative re-fractures of people with different characteristics, and the influencing factors of postoperative re-fracture were measured by multivariate logistic regression analysis. The postoperative VAS scores were significantly lower in the PKP group. The ODI scores in the PKP group were considerably lower than those in the PVP group after surgery. Univariate analysis indicated that age, number of injured vertebrae, history of complicated fracture, number of operative vertebrae, and bone mineral density (BMD) were remarkably correlated with recurrent fracture after PKP. Logistic regression analysis indicated that age, operative vertebral body, BMD, and the number of injured vertebrae were independent risk factors for recurrent fracture after PKP. BMI, BMD, low back soft tissue injury, postoperative vertebral height recovery rate, sagittal Cobb angle improvement rate, total diffusion coefficient of bone cement, short-term complications, non-union, and recurrent fracture were the main risk factors of residual low back pain after PKP. The clinical efficacy of PKP in elderly patients with thoracolumbar vertebral compression fracture is superior to that of PVP. Clinical attention should be paid to identifying high-risk factors for complications after PKP, and preventive measures should be implemented to help reduce the occurrence of recurrent fractures and postoperative residual pain.

A method to quantify the reduction of back and hip muscle fatigue of lift-support exoskeletons.

Cumulative back muscle fatigue plays a role in the occurrence of low-back injuries in occupations that require repetitive lifting of heavy loads and working in forward leaning postures. Lift-support exoskeletons have the potential to reduce back and hip muscle activity, thereby delaying the onset of fatigue in these muscles. Therefore, exoskeletons are being considered a potentially important tool to further reduce workload-related injuries. However, today no standards have been established on how to benchmark the support level of lift-support exoskeletons. This work proposes an experimental protocol to quantify the support level of a lift-support exoskeletons on instant changes in muscle activity and fatigue development while maintaining a static forward leaning posture. It then applies the protocol to experimentally assess the effect of the support provided by a commercially available lift-support exoskeleton, the LiftSuit 2.0 (Auxivo AG, Schwerzenbach, Switzerland), on the user. In a sample of 14 participants, the amplitude of the muscle activity of the back muscles and hip muscles () was significantly reduced. Wearing the exoskeleton significantly reduced the amount of fatigue developed during the task (). Changes in muscle fatigue can be objectively recorded and correlated with relevant changes for exoskeleton users: the time a task can be performed and perceived low-back fatigue. Thus, including such measures of fatigue in standardized benchmarking procedures will help quantify the benefits of exoskeletons for occupational use.

Analysis of Front Leg Kinematics of Cricket Bowler Using Wearable Sensors and Machine Learning

A fast bowler in the game of cricket is exposed to high-intensity actions and is more prone to lumbar stress fractures, ankle sprains, and knee, shoulder, and lower back injuries. There are different phases of bowling, from running to ball release, viz., run-up, predelivery stride (PDS), mid-bound (MB), front foot contact (FFC), ball release, and follow through. The front leg motion of the bowler plays a crucial role in delivering the ball efficiently. An improper landing after the jump causes most of the injuries as more strain is induced on the knee, ankle, and groin region. Loss of balance during the follow-through is the other most common reason for injury. A braced front leg at FFC helps the bowler transfer the momentum gained during the run-up into a fast-bowling action. For a refined understanding of the motion of the bowler and the causes of injuries, the identification of bowling phases is crucial. This article proposes the design of a miniature and economical wearable sensor unit using a Bosch BNO055 inertial measurement unit (IMU) sensor that the players can comfortably wear during the game. A novel method for calculating knee flexion of bowlers at FFC using quaternion data gathered from sensors is presented. Two wearable units were placed on the bowler’s front leg to collect motion data. Supervised machine-learning algorithms have been evaluated for classifying bowling phases using statistical features extracted from the sensor data to assist coaches and players with data-driven and evidence-based bowlers’ training.

Comparisons of Trunk Motions and Low Back Injury Risk between Alternative Hotel Room Cleaning Methods.

Hotel room cleaners frequently report job-related pain, with high rates of work-related musculoskeletal disorder injuries established for this group of workers. Surprisingly, there is limited published research documenting the impact of interventions to reduce ergonomic-related injury risks specific to hotel room cleaners' job tasks. In this study focused on hotel bathroom-cleaning and furniture-dusting tasks, twelve experienced hotel room cleaners used their standard method and a risk-reduction method-a tool with a handle that could extend, to perform these tasks. The female study participants' average age was 45.3 (SD 8.7) years with an average of 10 years of work experience as cleaners (range: 0.8-26.0 years). Trunk kinematics and a low back injury risk assessment were measured using the Lumbar Motion Monitor. All study metrics were significantly reduced when cleaning tasks involved use of adjustable, long-handled tools (p < 0.05). This study demonstrated that commonly available cleaning and dusting tools with extendable handles can significantly reduce low back injury risk among hotel room cleaners and potentially reduce injury risk to other body parts known to be the site of musculoskeletal disorders in this workforce. The study findings suggest that cleaning or housekeeping jobs in other industries where these same tasks are performed could benefit from use of extended-handle tools like those investigated here.

The Lost Art of Spinal Physical Examination

Abstract Spinal examination findings of “spasm” and “facet pain” are unreliable. A thorough neurological examination can help differentiate true symptomatic radiculopathy from nonverifiable radicular complaints. Manual muscle testing may miss subtle findings. The correct diagnosis for most low-back injuries in the worker's compensation setting is “nonspecific spinal pain.”

Winter breaks: How do they affect injuries in field hockey?

The Irish Hockey League (IHL) introduced an eight-week winter break for the first time in the 2018/2019 season. We evaluated the effects of this eight-week break by comparing injury outcome metrics in the 2018/2019 (winter break) season and the 2017/2018 (no winter break) season. Prospective cohort study. Each season was split into three distinct periods: period one consisted of the first nine weeks of each season; period two, weeks ten to 18; and period three, the final weeks. For the 2018/2019 season, the winter break was implemented in period two (weeks 10 to18). Relative risk with 95 % CI and injury incidence (1000h) were compared across the two seasons. Overall, 173 and 150 injuries we incurred during the 2017/2018 (no winter break) and 2018/2019 (winter break season) seasons respectively. Compared to 2017/2018 season, total injury incidence rate, injury severity, and injury burden were all significantly higher in period three during the 2018/2019 season (i.e., following the winter break). Furthermore, injured athletes had a 2.5-times higher relative risk of sustaining an injury after the winter break. Relative risks of 15.3 and 21.4 were observed for lower back injuries and fractures after the winter break, when compared with no break. Although fewer injuries were incurred during the 2018/2019 season, significantly more injuries were sustained in the period after the implementation of the winter break when compared to the corresponding period during the 2017/2018 season.

Biomechanical effects of a mechanical lift on the risk of low back injury during transfers from bed to wheelchair

Biomechanical effects of a mechanical lift on the risk of low back injury during transfers from bed to wheelchair

Factorial and Construct Validity of Sit-Up Test of Different Durations to Assess Muscular Endurance of Police Students

Background: The number of completed sit-ups in a given period of time is a commonly used assessment to measure trunk endurance in tactical populations. This study investigated factorial and construct validity of three different durations of a sit-up test—30 s, 60 s, and 120 s; Methods: Anthropometric characteristics and sit-ups performed for 30, 60, and 120 s by101 (♂: n = 62 and ♀: n = 39) police students were assessed. A factorial analysis was used to determine if three test durations group together in one factor, correlation analysis determined whether the sit-up tests were associated with anthropometric measures and whether the three variations in the test duration correlated between each other, and the Fisher’s transformation determined whether these correlations differed significantly; Results: All three sit-up variations loaded together into one factor in both sexes, providing factorial validity for all three test durations. Anthropometrics were associated with sit-up tests lasting 30 s in males and 120 s in females. A sit-up test lasting 60 s correlated significantly stronger to 120 s than to the 30 s sit-up test; Conclusions: The 60 s sit-up test seems to have the highest construct validity, as it was not affected by anthropometrics, and it may be an optimal choice for its lower risk of lower back injuries. By applying the results of this study, agencies could reduce the bias that may occur during the sit-up test and reduce the risk of injury during physical fitness assessment.

In vivo intervertebral disc mechanical deformation following a treadmill walking “stress test” is inversely related to T1rho relaxation time

To assess the in vivo relationship between the mechanical response of intervertebral discs (IVDs) to dynamic activity and IVD biochemical composition assessed via T1rho relaxation imaging. Eighteen asymptomatic participants with no history of low back pain (LBP), injury, or surgery underwent magnetic resonance (MR) imaging of their lumbar spine prior to and immediately following a treadmill walking "stress test." Anatomic (SPACE, FLASH) MR images were obtained pre- and post-exercise and utilized to measure IVD mechanical deformation. Quantitative (T1rho) imaging was performed pre-exercise to reflect IVD composition. Pre-exercise anatomic images were also utilized to assess IVD degenerative status based on the modified Pfirrmann scale. To quantify mechanical response, 3D surface models of the L1-L2-L5-S1 IVDs were created from manual segmentations of pre- and post-exercise anatomic images and utilized to assess changes in IVD height. IVD strain (%) was defined as change in IVD height normalized to pre-activity height. Linear mixed models were used to assess the relationships between IVD mechanical deformation (strain), composition (T1rho relaxation time), and degenerative status (Pfirrmann grade). Increased compressive IVD strain was associated with lower T1rho relaxation times in the nucleus pulposus (NP) of the disc (βT1rho=5.07,CI:[1.52,7.77],Rmarg2=0.52,p=0.005). Thus, an inverse relationship between IVD strain and NP T1rho relaxation time was observed. The in vivo mechanical response of the IVD to the "stress test" was sensitive to differences in NP composition. The results of this study suggest that quantification of in vivo IVD mechanical function and composition may provide insight into IVD health.