Low Back Moments Research Articles

Determining whether biomechanical variables that describe common ‘safe lifting’ cues are associated with low back loads

Lift technique training programs have been implemented to help reduce injury risk, but the underlying content validity of cues used within these programs is not clear. The objective of this study was to determine whether biomechanical variables, that commonly used lifting cues aim to elicit, are associated with resultant low back extensor moment exposures. A sample of 72 participants were recruited to perform 10 repetitions of a floor-to-waist height barbell lift while whole-body kinematics and ground reaction forces were collected. Kinematic, kinetic, and energetic variables representative of characteristics commonly targeted by lifting cues were calculated as predictor variables, while peak and cumulative low back moments were calculated as dependent measures. Multiple regression revealed that 56.6–59.2% of variance in low back moments was explained by predictor variables. From these regression models, generating motion with the legs (both greater hip and knee work), minimizing the horizontal distance of the body to the load, maintaining a stable body position, and minimizing lift time were associated with lower magnitudes of low back moments. These data support that using cues targeting these identified variables may be more effective at reducing peak low back moment exposures via lift training.

The effect of back muscle fatigue on EMG and kinematics based estimation of low-back loads and active moments during manual lifting tasks

This study investigated the effects of back muscle fatigue on the estimation of low-back loads and active low-back moments during lifting, using an EMG and kinematics based model calibrated with data from an unfatigued state. Fourteen participants performed lifting tasks in unfatigued and fatigued states. Fatigue was induced through semi-static forward bending. EMG, kinematics, and ground reaction forces were measured, and low-back loads were estimated using inverse dynamics and EMG-driven muscle model. A regression model was developed using data from a set of calibration lifts, and its accuracy was evaluated for unfatigued and fatigued lifts. During the fatigue-inducing task, the EMG amplitude increased by 2.8 %MVC, representing a 38% increase relative to the initial value. However, during the fatigued lifts, the peak EMG amplitude was found to be 1.6 %MVC higher than that observed during the unfatigued lifts, representing a mere 4% increase relative to the baseline unfatigued peak EMG amplitude. Kinematics and low-back load estimates remained unaffected. Regression model estimation errors remained unaffected for 5 kg lifts, but increased by no more than 5% of the peak active low-back moment for 15 kg lifts. We conclude that the regression-based estimation quality of active low-back moments can be maintained during periods of muscle fatigue, although errors may slightly increase for heavier loads.

The influence of sex and strength capacity on normalized low-back exposure during lifting: Insights from a joint power analysis

ObjectiveInvestigate the influence of sex, strength capacity, and relative load mass on low-back exposure and lower extremity joint power generation in backboard lifting. BackgroundSex and strength have been shown to influence lifting strategy, but without load mass being scaled to strength it is unknown which factor influences low-back exposures, and whether there are interactions with load mass. MethodsMotion capture and force plate data from 28 participants were collected during backboard lifting at load masses scaled to strength capacity. Differences in normalized peak low-back moment, peak knee-to-hip power magnitude ratio and timing were tested as a function of sex, strength, and load mass. ResultsStronger participants had lower normalized peak low-back moments (average 32% change from low-capacity across all load masses), with no significant sex effect (p = 0.582). As load mass increased, normalized peak low-back moment, peak knee-to-hip power magnitude and synchronicity decreased. ConclusionTraining to both increase strength capacity and hip-joint power generation may be a strategy to reduce low-back exposure in backboard lifting.

Influence of Load Knowledge on Biomechanics of Asymmetric Lifting.

Background: Load knowledge has been identified as a factor affecting the risk of low back pain (LBP) during symmetric lifting. However, the effects of load knowledge in asymmetric lifting tasks have not been reported yet. The purpose of this study was to investigate the load knowledge influence on lifting biomechanics in asymmetric lifting tasks; Methods: Twenty-four male adults were recruited to complete a psychophysical lifting capacity test and a simulated asymmetric lifting task. The lifting task was set with load knowledge of ‘no knowledge’ (NK), ‘weight known’ (WK), ‘fragile material known’ (FK), and ‘weight and fragile material known’ (WFK) for different lifting load weights. Trunk kinematics and kinetics were collected and analyzed; Results: When fragility information was presented, trunk sagittal flexion acceleration, lateral flexion velocity and acceleration, and average lateral bending moment were significantly lowered at the deposit phase. Lifting a high load weight was found to significantly increase low back sagittal bending moment at the lifting phase and low back moments of all three dimensions at the deposit phase; Conclusions: The decrease of trunk kinematic load suggests that providing material fragility information to workers in asymmetric lifting tasks would be effective in reducing their risk of LBP.

Biomechanical comparisons of back and front squats with a straight bar and four squats with a transformer bar

ABSTRACT The purpose was to quantify trunk and lower extremity biomechanics among back and front squats with a straight bar and four squats with different anterior-posterior load placements imposed by a transformer bar. Ten males and eight females performed six squat conditions: back and front squats with a straight bar, back and front squats with a transformer bar, and squats with more posteriorly or anteriorly placed loads with a transformer bar. A constant load of 70% of the participant’s one-repetition maximum in the straight-bar front squat was used. Kinematic and kinetic data were collected to quantify joint biomechanics at an estimated parallel squat position in the descending and ascending phases. Squats with more anteriorly placed load significantly decreased trunk flexion and pelvis anterior tilt angles with large effect sizes but increased low-back extension moments with medium to large effect sizes. Hip, knee, and ankle extension moments were generally similar among most conditions. Participants adjusted their trunk and pelvis to mediate the effects of load placements on low-back and lower extremity moments. While lower extremity loading was similar among different squats, the different trunk and pelvis angles and low-back moments should be taken into consideration for people with low-back impairment.

Air-assisted devices reduce biomechanical loading in the low back and upper extremities during patient turning tasks

This laboratory study evaluated different assistive devices for reducing biomechanical loading during patient turning tasks. Twenty caregivers (18 females and 2 males) performed standardized patient turning tasks with two simulated patients (body mass: 74 kg and 102 kg). The turning tasks were performed in two turning directions (toward vs. away relative to caregivers) using five device conditions: draw sheet, friction-reducing turning sheet, air-assisted transfer device, air-assisted turning device, and no assistive device. Low back and upper extremity muscle activity, trunk and shoulder postures, low back moment, and self-reported usability ratings were evaluated. While all assistive devices reduced trunk flexion, both air-assisted transfer and turning devices reduced the trunk flexion (p's < 0.001) and muscle activity (p's < 0.001) in the erector spinae and triceps compared to no assistive device condition. These results suggest that the air-assisted devices have potential as an effective intervention to considerably reduce physical risk factors associated with caregivers' musculoskeletal disorders in low back and upper extremities.

BIOMECHANICAL MATCHING OF LOW BACK EXTERNAL DEMANDS DURING THE OPEN- AND CLOSED-CHAIN SIDE BRIDGE

The side-bridge (SB) is a commonly used closed-chain task to assess trunk muscle endurance and side-to-side endurance asymmetry. An open-chain variation of the SB, that positions the participant in an inclined side-lying posture, may be useful for those who report shoulder pain or fatigue as the reason for terminating the closed-chain SB. Low back loading demands of the open- and closed-chain variations should be matched to facilitate comparison of SB endurance measures. To quantify the low back reaction moments during the open- and closed-chain SB and determine the appropriate open-chain angle of inclination that matches the lateral bend moment magnitude of the closed-chain SB. Observational cohort. Upper body and trunk postural data were obtained during the closed-chain SB and during the open-chain SB at each of four inclination angles from a group of eight healthy male adults. Ground reaction force (GRF) data were also collected during the closed-chain SB. Low back reaction moments were calculated using a static 'top-down' linked segment model in both SB variations. Latent growth modeling was used to determine the angle of inclination in the open-chain SB that produced a low back lateral bend moment that matched the closed-chain SB. Sensitivity of the matching open-chain inclination angle was evaluated by rotating the measured GRF vector from the closed-chain SB by five degrees clockwise and counter-clockwise in the frontal plane. The open-chain inclination angle that best matched the loading demands of the closed-chain SB was 38 ± 12 degrees. Clockwise rotation of the measured GRF in the closed-chain SB increased the matching inclination angle to 56 ± 17 degrees. Counter-clockwise rotation reduced the matching inclination angle to 17 ± 11 degrees. Secondary descriptive analysis of spine posture and off-axis low back moments revealed biomechanically relevant differences between SB positions. The average open-chain SB angle of inclination that matched the closed-chain SB approximated the 45-degree recommendation offered in the literature. Differences in spine posture and off-axis low back reaction moments, and the potential impact on holding times, should be considered if using the open-chain SB. 2b.

Evaluation of Multi-axial Active Suspension to Reduce Whole Body Vibration Exposures and Associated Biomechanical Loading in Mining Heavy Equipment Vehicle Operators

The purpose of this study was to evaluate the efficacy of multi-axial (lateral + vertical) active suspension in reducing multi-axial WBV exposures and related biomechanical loading in the neck and low back as compared to an industry standard single-axial (vertical) passive suspension seat. In a repeated-measures laboratory study with 13 subjects, while recreating field-measure vehicle vibration on a 6-degree-of-freedom motion platform, we measured WBV [weighted average vibration: A(8) and vibration dose values: VDV(8)], net joint torque in the low back (L5/S1) and neck, muscle activity in low back (erector spinae) and neck muscle (splenius capitis). The results showed that the multi-axial active suspension seat was more effective in reducing vertical (Z-axis) WBV [A(8) and VDV(8)] as compared to the single-axial passive suspension seats (p &lt; 0.001), while little difference between two suspension seats were found in lateral (Y) axis. The peak low back moment with respect to the sagittal (Y) axis was significantly lower on the multi-axial active suspension seat compared to the single-axial passive suspension seat (p=0.01). Despite lack of statistical significance, the low back and neck muscle activity tended to be lower on the multi-axial active suspension compared to the single-axial passive suspension. These results indicate that the multi-axial suspension may have potential to reduce biomechanical loading in the low back.

Biomechanical Comparison of the Reverse Hyperextension Machine and the Hyperextension Exercise.

Lawrence, MA, Chin, A, and Swanson, BT. Biomechanical comparison of the reverse hyperextension machine and the hyperextension exercise. J Strength Cond Res 33(8): 2053-2056, 2019-The purpose of this study was to compare activation of the erector spinae, gluteus maximus, and biceps femoris muscles, lower back extension moment, and lower extremity range of motion (ROM) between the reverse hyperextension (RHE) and hyperextension (HE) exercises. Motion and muscle activation of the trunk and lower extremity were measured while 20 recreationally active individuals performed 2 sets of 10 repetitions of each exercise. Equivalent loads were used for each exercise. Peak, average, and integrated muscle activity, low back moment, and ROM between the trunk and pelvis and the thigh and trunk were calculated. A Wilcoxon signed-rank test (p = 0.05) revealed significantly greater integrated activity of the biceps femoris and gluteus maximus during the HE exercise. The RHE exercise generated greater peak (+129%), integrated (+63%), and mean (+78%) low back moment as compared to the HE exercise. The RHE resulted in a significantly greater thigh to trunk ROM, 76.6 compared with 64.7. However, the RHE used less lumbar flexion, 20.4 compared with 31.1 for the HE. The RHE movement profile is preferable because it provides greater hip ROM with less angular stress and equivalent erector spinae activity.

Design and Pilot Evaluation of a Reconfigurable Spinal Exoskeleton.

Low back pain is a leading cause of disability, and there is a tremendous need for nonsurgical, nonpharmaceutical interventions to manage it. Versatile spinal exoskeletons have been proposed as a method of supporting or augmenting the wearer, but experimental data from human subjects are limited, and the effects of such exoskeletons remain poorly understood. We thus present a prototype of a reconfigurable spinal exoskeleton that features easily adjustable resistance and compression at multiple spinal levels, allowing us to study the effect of different exoskeleton configurations on the body. In a pilot evaluation with a single subject, both thoracic and abdominal compression were found to affect trunk angle, low back moment and the electromyogram of the erector spinae, though different exoskeleton configurations had different effects during different tasks. This supports the premise that intelligent mechanical adjustments of a spinal exoskeleton are necessary for optimal support or augmentation of the wearer, though the results need to be examined in a larger, varied sample of subjects.

Biomechanical compensations of the trunk and lower extremities during stepping tasks after unilateral transtibial amputation

BackgroundLower extremity movement compensations following transtibial amputation are well-documented and are likely influenced by trunk posture and movement. However, the biomechanical compensations of the trunk and lower extremities, especially during high-demand tasks such as step ascent and descent, remain unclear. MethodsKinematic and kinetic data were collected during step ascent and descent tasks for three groups of individuals: diabetic/transtibial amputation, diabetic, and healthy. An ANCOVA was used to compare peak trunk, hip and knee joint angles and moments in the sagittal and frontal planes between groups. Paired t-tests were used to compare peak joint angles and moments between amputated and intact limbs of the diabetic/transtibial amputation group. FindingsDuring step ascent and descent, the transtibial amputation group exhibited greater trunk forward flexion and lateral flexion compared to the other two groups (P<0.016), which resulted in greater low back moments and asymmetric loading patterns in the lower extremity joints. The diabetic group exhibited similar knee joint loading patterns compared to the amputation group (P<0.016), during step descent. InterpretationThis study highlights the biomechanical compensations of the trunk and lower extremities in individuals with dysvascular transtibial amputation, by identifying low back, hip, and knee joint moment patterns unique to transtibial amputation during stepping tasks. In addition, the results suggest that some movement compensations may be confounded by the presence of diabetes and precede limb amputation. The increased and asymmetrical loading patterns identified may predispose individuals with transtibial amputation to the development of secondary pain conditions, such as low back pain or osteoarthritis.

Detailed assessment of low-back loads may not be worth the effort: A comparison of two methods for exposure-outcome assessment of low-back pain

The trade-off between feasibility and accuracy of measurements of physical exposure at the workplace has often been discussed, but is unsufficiently understood. We therefore explored the effect of two low-back loading measurement tools with different accuracies on exposure estimates and their associations with low-back pain (LBP).Low-back moments of 93 workers were obtained using two methods: a moderately accurate observation-based method and a relatively more accurate video-analysis method. Group-based exposure metrics were assigned to a total of 1131 workers who reported on their LBP status during three follow-up years. The two methods were compared regarding individual and group-based moments and their predictive value for LBP.Differences between the two methods for peak moments were high at the individual level and remained substantial at group level. For cumulative moments, differences between the two methods were attenuated as random inaccuracies cancelled out. Peak moments were not predictive for LBP in any method while cumulative moments were, suggesting comparable predictive values of the two methods. While assessment of low-back load improves from investing in collecting relatively more accurate individual-based data, this does not necessarily lead to better predictive values on a group level, especially not for cumulative loads.

Age-related biomechanical differences during asymmetric lifting

This study investigated age-related biomechanical differences during asymmetric lifting. Eleven younger and twelve older participants were instructed to lift loads of different weights to an asymmetric destination. The trunk kinematics and low back moments were examined. The results showed that older adults adopted safer lifting strategies compared with younger adults. Specifically, the peak trunk sagittal flexion angle was 32% lower and the peak trunk transverse twisting angle was 22% lower in older adults compared with those in younger adults. It was also found that the average low back moment in the deposit phase was 32% higher in older adults than that in younger adults, most probably due to the age-related increased body weight. Based on these findings and the fact of age-related decreased muscle strengths, physical exercise programs were suggested to be more effective than instructions of safe lifting strategies in LBP risk reduction during asymmetric lifting for older adults. For younger adults, safe lifting strategy instructions might be effective to reduce risks of LBP. Relevance to industryLifting tasks are very common in occupational settings which are often associated with low back pain (LBP). The findings from the present study can aid in better understanding differences in LBP risks of asymmetric lifting between older and younger adults. Implications on ergonomic interventions for reducing LBP risks of asymmetric lifting have been discussed as well based on these findings.

Biomechanical analysis of low back load when sneezing

BackgroundAlthough sneezing is known to induce low back pain, there is no objective data of the load generated when sneezing. Moreover, the approaches often recommended for reducing low back pain, such as leaning with both hands against a wall, are not supported by objective evidence. MethodsParticipants were 12 healthy young men (mean age 23.25±1.54 years) with no history of spinal column pain or low back pain. Measurements were taken using a three-dimensional motion capture system and surface electromyograms in three experimental conditions: normal for sneezing, characterized by forward trunk inclination; stand, in which the body was deliberately maintained in an upright posture when sneezing; and table, in which the participants leaned with both hands on a table when sneezing. We analyzed and compared the intervertebral disk compressive force, low back moment, ground reaction force, trunk inclination angle, and co-contraction of the rectus abdominis and erector spinae muscles in the three conditions. FindingsThe intervertebral disk compressive force and ground reaction force were significantly lower in the stand and table conditions than in the normal condition. The co-contraction index value was significantly higher in the stand condition than in the normal and table conditions. InterpretationWhen sneezing, body posture in the stand or table condition can reduce load on the low back compared with body posture in the normal sneezing condition. Thus, placing both hands on a table or otherwise maintaining an upright body posture appears to be beneficial for reducing low back load when sneezing.

Cumulative mechanical low-back load at work is a determinant of low-back pain

ObjectivesReported associations of physical exposures during work (eg, lifting, trunk flexion or rotation) and low-back pain (LBP) are rather inconsistent. Mechanical back loads (eg, moments on the low back) as...

Cumulative Low Back Load at Work as a Risk Factor of Low Back Pain: A Prospective Cohort Study

Purpose Much research has been performed on physical exposures during work (e.g. lifting, trunk flexion or body vibrations) as risk factors for low back pain (LBP), however results are inconsistent. Information on the effect of doses (e.g. spinal force or low back moments) on LBP may be more reliable but is lacking yet. The aim of the present study was to investigate the prospective relationship of cumulative low back loads (CLBL) with LBP and to compare the association of this mechanical load measure to exposure measures used previously. Methods The current study was part of the Study on Musculoskeletal disorders, Absenteeism and Health (SMASH) study in which 1,745 workers completed questionnaires. Physical load at the workplace was assessed by video-observations and force measurements. These measures were used to calculate CLBL. Furthermore, a 3-year follow-up was conducted to assess the occurrence of LBP. Logistic regressions were performed to assess associations of CLBL and physical risk factors established earlier (i.e. lifting and working in a flexed posture) with LBP. Furthermore, CLBL and the risk factors combined were assessed as predictors in logistic regression analyses to assess the association with LBP. Results Results showed that CLBL is a significant risk factor for LBP (OR: 2.06 (1.32–3.20)). Furthermore, CLBL had a more consistent association with LBP than two of the three risk factors reported earlier. Conclusions From these results it can be concluded that CLBL is a risk factor for the occurrence of LBP, having a more consistent association with LBP compared to most risk factors reported earlier.

Estimation of low back moments from video analysis: A validation study

This study aimed to develop, compare and validate two versions of a video analysis method for assessment of low back moments during occupational lifting tasks since for epidemiological studies and ergonomic practice relatively cheap and easily applicable methods to assess low back loads are needed. Ten healthy subjects participated in a protocol comprising 12 lifting conditions. Low back moments were assessed using two variants of a video analysis method and a lab-based reference method. Repeated measures ANOVAs showed no overall differences in peak moments between the two versions of the video analysis method and the reference method. However, two conditions showed a minor overestimation of one of the video analysis method moments. Standard deviations were considerable suggesting that errors in the video analysis were random. Furthermore, there was a small underestimation of dynamic components and overestimation of the static components of the moments. Intraclass correlations coefficients for peak moments showed high correspondence (>0.85) of the video analyses with the reference method. It is concluded that, when a sufficient number of measurements can be taken, the video analysis method for assessment of low back loads during lifting tasks provides valid estimates of low back moments in ergonomic practice and epidemiological studies for lifts up to a moderate level of asymmetry.

Three-dimensional peak and cumulative L4/L5 spine loads and trunk postures during non-occupational tasks

Cumulative low back loading has been shown to be a risk factor for low back pain reporting in the workplace. Evaluation of tasks outside of work might offer insight into why workers continue to have low back pain and may report pain differentially even when doing the same job. This study utilized a video-based 3D posture sampling approach to document joint postures of 18 people over a 2-hour period while performing non-repetitive tasks in and around their own homes. A 3D rigid link segment model was used to calculate reaction forces and moments at L4/L5 and joint models were used to calculate joint forces. Average peak (4.0 kN) and cumulative (9.9 MN·s) compression force estimates indicate significant loads on the low back occur during non-occupational tasks, despite the fact that participants spent most of their time (86.2%) in neutral trunk postures. Cumulative anterior reaction shear force (440 kN·s) was found to be comparable to those documented for a wide variety of occupational tasks, when extrapolated to an 8-hour shift. To our knowledge, this study is the first to include a full complement of 3D low back forces and moments, in conjunction with an assessment of trunk posture, for non-occupational activities. The evidence suggests that considering 3D peak and cumulative low back loading during non-occupational tasks is warranted and may help to explain some of the variability in the reporting of workplace-related low back disorders despite extensive ergonomic intervention.

Mechanical loading of the low back during cardiopulmonary resuscitation

Aim Back pain is often seen in professional rescuers after carrying out resuscitation. Back loading is known to be affected by the working surface height, but the relationship between the surface height and back loading during cardiopulmonary resuscitation (CPR) is poorly understood. The purpose of this study was to examine how back loading changes in response to CPR posture and surface height. Methods Twenty-two experienced professional rescuers performed CPR using three surface heights; the floor (F), a table at a height of 63 cm (HT) and one at a height of 37 cm (LT). Results The mean and maximal low back moment and compression force at HT were significantly smaller than those at LT and F. Conclusion The results suggest that the HT task of chest compression produces the lowest low back moment and compression force. Thus, HT positioning may decrease the probability of low back pain and is suggested to be optimal height for inexperienced resuscitators, those with back injury, or those requiring a long operating duration.

Links between the Mechanics of Ventilation and Spine Stability

Spine stability is ensured through isometric coactivation of the torso muscles; however, these same muscles are used cyclically to assist ventilation. Our objective was to investigate this apparent paradoxical role (isometric contraction for stability or rhythmic contraction for ventilation) of some selected torso muscles that are involved in both ventilation and support of the spine. Eight, asymptomatic, male subjects provided data on low back moments, motion, muscle activation, and hand force. These data were input to an anatomically detailed, biologically driven model from which spine load and a lumbar spine stability index was obtained. Results revealed that subjects entrained their torso stabilization muscles to breathe during demanding ventilation tasks. Increases in lung volume and back extensor muscle activation coincided with increases in spine stability, whereas declines in spine stability were observed during periods of low lung inflation volume and simultaneously low levels of torso muscle activation. As a case study, aberrant ventilation motor patterns (poor muscle entrainment), seen in one subject, compromised spine stability. Those interested in rehabilitation of patients with lung compromise and concomitant back troubles would be assisted with knowledge of the mechanical links between ventilation during tasks that impose spine loading.