Risk Factor For Low Back Disorders Research Articles

Developing Physical Exposure-Based Back Injury Risk Models Applicable to Manual Handling Jobs in Distribution Centers

Using our ultrasound-based “Moment Monitor,” exposures to biomechanical low back disorder risk factors were quantified in 195 volunteers who worked in 50 different distribution center jobs. Low back injury rates, determined from a retrospective examination of each company's Occupational Safety and Health Administration (OSHA) 300 records over the 3-year period immediately prior to data collection, were used to classify each job's back injury risk level. The analyses focused on the factors differentiating the high-risk jobs (those having had 12 or more back injuries/200,000 hr of exposure) from the low-risk jobs (those defined as having no back injuries in the preceding 3 years). Univariate analyses indicated that measures of load moment exposure and force application could distinguish between high (n = 15) and low (n = 15) back injury risk distribution center jobs. A three-factor multiple logistic regression model capable of predicting high-risk jobs with very good sensitivity (87%) and specificity (73%) indicated that risk could be assessed using the mean across the sampled lifts of the peak forward and or lateral bending dynamic load moments that occurred during each lift, the mean of the peak push/pull forces across the sampled lifts, and the mean duration of the non-load exposure periods. A surrogate model, one that does not require the Moment Monitor equipment to assess a job's back injury risk, was identified although with some compromise in model sensitivity relative to the original model.

Identifying Safe Load Moment Exposures for the Back

Low back disorders continue to be the most common and significant work-related musculoskeletal disorders in the US. Identifying what constitutes a “safe” physical workload has been the biggest challenge facing injury prevention efforts. Prior low back injury risk models have focused on manufacturing activities where there is limited variability in the parameters used to describe the exposures to low back disorder risk factors. Lifting tasks in distribution centers can have considerably more variability in load and physical layout. The goal of this project was to identify and quantify measures that characterize the biomechanical risk factors, including measures of the load moment exposure, and measures that characterize the duty cycle that are predictive of low back disorders in distribution centers. Thus, our hypothesis was that we could define a relationship between moment exposure parameters and the low back disorder incidence rates. A cross-sectional study was designed to examine the mechanical risk factors responsible for reported low back injury in distributions centers. The physical exposure was measured on 195 workers on 50 jobs in 21 distribution centers using a sonic-based Moment Exposure Tracking System (METS). The METS measures load, force, load moment, torso kinematics, and temporal parameters of the job simultaneously. For each job, low back injury rates were collected retrospectively from the company's records over the prior 3-year period. The data were used to develop a risk model designed to predict back injury risk based upon direct measures of load and load moment exposure. The model incorporates biomechanical variables which include the load moment and horizontal sliding forces, as well as a temporal variable indicating the opportunity for micro-breaks during the work process. Overall, the presented model has very good sensitivity (87%) and specificity (73%).

Identifying Safe Load Moment Exposures for the Back

Low back disorders continue to be the most common and significant work-related musculoskeletal disorders in the US. Identifying what constitutes a “safe” physical workload has been the biggest challenge facing injury prevention efforts. Prior low back injury risk models have focused on manufacturing activities where there is limited variability in the parameters used to describe the exposures to low back disorder risk factors. Lifting tasks in distribution centers can have considerably more variability in load and physical layout. The goal of this project was to identify and quantify measures that characterize the biomechanical risk factors, including measures of the load moment exposure, and measures that characterize the duty cycle that are predictive of low back disorders in distribution centers. Thus, our hypothesis was that we could define a relationship between moment exposure parameters and the low back disorder incidence rates. A cross-sectional study was designed to examine the mechanical risk factors responsible for reported low back injury in distributions centers. The physical exposure was measured on 195 workers on 50 jobs in 21 distribution centers using a sonic-based Moment Exposure Tracking System (METS). The METS measures load, force, load moment, torso kinematics, and temporal parameters of the job simultaneously. For each job, low back injury rates were collected retrospectively from the company's records over the prior 3-year period. The data were used to develop a risk model designed to predict back injury risk based upon direct measures of load and load moment exposure. The model incorporates biomechanical variables which include the load moment and horizontal sliding forces, as well as a temporal variable indicating the opportunity for micro-breaks during the work process. Overall, the presented model has very good sensitivity (87%) and specificity (73%).

Computation of trunk equilibrium and stability in free flexion–extension movements at different velocities

Velocity of movement has been suggested as a risk factor for low-back disorders. The effect of changes in velocity during unconstrained flexion–extension movements on muscle activations, spinal loads, base reaction forces and system stability was computed. In vivo measurements of kinematics and ground reaction forces were initially carried out on young asymptomatic subjects. The collected kinematics of three subjects representing maximum, mean and minimum lumbar rotations were subsequently used in the kinematics-driven model to compute results during the entire movements at three different velocities. Estimated spinal loads and muscle forces were significantly larger in fastest pace as compared to slower ones indicating the effect of inertial forces. Spinal stability was improved in larger trunk flexion angles and fastest movement. Partial or full flexion relaxation of global extensor muscles occurred only in slower movements. Some local lumbar muscles, especially in subjects with larger lumbar flexion and at slower paces, also demonstrated flexion relaxation. Results confirmed the crucial role of movement velocity on spinal biomechanics. Predictions also demonstrated the important role on response of the magnitude of peak lumbar rotation and its temporal variation.

A participatory ergonomics intervention to reduce risk factors for low-back disorders in concrete laborers

Construction laborers rank high among occupational groups with work-related musculoskeletal injuries involving time way from work. The goals of this project were to: (1) introduce an ergonomic innovation to decrease the risk of low-back disorder (LBD) group membership, (2) quantitatively assess exposure, and (3) apply a participatory intervention approach in construction. Laborers manually moving a hose delivering concrete to a placement site were evaluated. The hypothesis tested was that skid plates would prevent hose joints from catching on rebar matting, and the hose would slide more easily. This would decrease the need for repetitive bending and use of excessive force. Four laborers were evaluated wearing the Lumbar Motion Monitor (LMM), a tri-axial electrogoniometer that records position, velocity and acceleration. Workers were measured during three comparable concrete pours. Worker perceptions of the innovation utility and exertion were surveyed. During initial use of skid plates, flexion increased significantly ( p<0.001) while velocity, acceleration and moments did not change. After implementing a worker modification, low back velocity, acceleration and moments were significantly reduced ( p<0.05). Reductions in these factors have been associated with decreased risk of belonging to an occupational group with LBDs. Use of secured skid plates during horizontal concrete hose movement may in part decrease the risk of LBD group membership among concrete laborers. Crew participation resulted in skid plates being a more effective intervention. The LMM is a promising tool for quantitative assessment in construction.

Combined Spinal Motion and Loading in Occupational Low Back Disorders

Low back disorders (LBDs) are considered the most prevalent musculoskeletal disorders in occupational settings. There is significant epidemiological and biomechanical evidence that implicates combined motion and loading as important risk factors for LBDs. The purpose of this paper is to demonstrate a potential approach for quantifying 3-D combined motion, loading, and loading rates in ergonomic research. Data from a field study were used to quantify combined; three-dimensional (3-D) trunk velocities of low and high-risk groups, and data from lifting study were used to assess the 3-D combined spinal loading and loading rate. The results showed that evaluating the percent of time the magnitude of 3-D vectors was over defined limits (velocities, loads, or load rates) provides the important temporal aspect of risk factors, which is commonly ignored in LBD risk assessment. The results also showed that loading rate was a sensitive indicator of dynamic loading. In conclusion, the present approach allows the detailed assessment of combined loading and motion, and evaluates the sensitivity of these patterns to various workplace conditions.

Four assessment tools of ergonomics interventions: case study at an electric utility's warehouse system.

An ergonomics program was developed in a Midwestern electric utility warehouse system. Tasks problematic with respect to work-related musculoskeletal disorders (WMSDs) affecting both the back and upper extremities were identified and engineering controls were implemented. Quantitative analysis was performed on each task before and after ergonomics intervention to evaluate exposure to the risk of WMSDs. Four methods were used to evaluate the risk of exposure to injury before and after ergonomics intervention: the 1991 National Institute for Occupational Safety and Health (NIOSH) lifting equation, the Static Strength Prediction Program, the Lumbar Motion Monitor, and the Borg psychophysical assessment of effort. Results from applying these four methods to the reengineered tasks showed that the probability of low-back disorder risk factors was reduced by as much as 29%, the percentage of people capable of performing tasks was increased by as much as 90%, the NIOSH Lifting Index was reduced from above 2.0 to less than 2.0, and the psychophysical assessment of effort was consistently reduced from the "heavy or strong" range to the "light or moderate" range.

LBD Risk Factors and the Structural Stability Tolerance of the Lumbar Spine

A model of low-back injury is presented suggesting structural instability is a risk factor in occupation injury. The purpose of this research was to document the potential for spinal buckling as a function of asymmetric and sagittal trunk angle during lifting. A biomechanical model was developed to compute the Euler stability and determine the structural tolerance of the lumbar spine in work-related postures. When applied load and associated spinal compression exceeds the structural tolerance, i.e. buckling load, the spinal column fails. Analyses demonstrate the structural tolerance is often less than material tolerance estimates, particularly in flexed and asymmetric postures. Furthermore, the structural tolerance is reduced in sagittally flexed and asymmetric lifting postures. Hence, the relation between stability and trunk posture correlated with low-back disorder (LBD) risk factors. Results suggest musculoskeletal instability may help explain the relation between LBD risk and lifting posture.

A Biomechanical Assessment of Axial Twisting Exertions

Axial twisting of the torso has been identified as a significant risk factor for occupationally related low-back disorders. The purpose of this investigation was to examine the influence of dynamic twisting parameters upon spinal load. Measured trunk moments and muscle activities were employed in a biomechanical model to determine loads on the lumbar spine. Spinal loads were examined as a function of dynamic torsional exertions under various conditions of force, velocity, position, and direction. Results demonstrate significant flexion-extension and lateral moments were generated during the twisting exertions. Muscle coactivity was significantly greater than equivalent levels measured during sagittal lifting exertions. Relative spinal compression during dynamic twisting exertions was twice that of static exertions. Spine loading also varied as a function of whether the trunk was twisted to the left or right, and the direction of applied torsion, i.e. clockwise versus counter-clockwise. The results may help explain, biomechanically, why epidemiological findings have repeatedly identified twisting as a risk factor for low-back disorder

Industrial Quantification of Occupationally-Related Low Back Disorder Risk Factors

Few assessment technigues have attempted to define the role of occupational trunk motion in the risk of occupationally-related low back disorder (LBD) even though laboratory studies have indicated that motion significantly Increases spine loading. An in-vivo study was performed to assess the contribution of three- dimensional dynamic trunk motions to the risk of LBD during occupational lifting in industry. Over 400 industrial lifting jobs were studied in 48 industries. Specific manual materials handling jobs historically identify as either high risk or low risk for LBD were identified. A tri-axial electrogoniometer was worn by workers and documented the three-dimensional trunk motion characteristics associated with these high risk or low risk jobs. Workplace characteristics such as load moment arm, load weight, etc. were also documented for each of the repetitive lifting tasks. A multiple logistic regression model indicated that a combination of five trunk motion and workplace factors (lifting frequency, load moment, trunk lateral velocity, trunk twisting velocity, and trunk sagittal angle) predicted occupational-related LBD risk well. The analyses have enabled us to determine the LBD risk associated with combined changes in the magnitudes of the five factors. This model could be used as a quantitative, objective measure to redesign the workplace so that the risk of occupationally-related LBD is minimized.