Effects of age and obesity on trunk kinetics and kinematics during dominant side one-handed carrying

The proportions of older and obese people are increasing in both the general and working populations worldwide. Older and obese individuals are more susceptible to work-related musculoskeletal disorders (MSDs) in comparison with healthy, younger individuals. Manual material handling (MMH) is associated with the development of work-related MSDs. Although previous research has suggested that one-handed carrying is a particularly undesirable method of MMH, the effects of one-handed carrying on trunk kinetics and kinematics among older and/or obese people have not been adequately studied. The objective of this study was to examine the effects of age and obesity on trunk angles and moments during dominant side one-handed carrying of various load magnitudes. Twenty (20) participants divided into four groups with respect to age (young and older) and obesity (obese and non-obese) carried different loads (No-load [0 kg], Light [5.67 kg], and Heavy [10.21 kg]) in their dominant hand for approximately 6 m. Three-dimensional (3D) trunk angles and moments approximately about the L4/L5 vertebral segment were calculated using Visual3D. The findings indicated that while carrying a load in the dominant hand plays an important role in changing trunk kinematics and kinetics, the results were not dependent on age and/or obesity category. Absolute moments were greatest among participants in the obese groups; however, these moments were mitigated when normalized to body weight and height (%BW * Ht). Age did not exacerbate the effects of load magnitude on trunk kinetics and kinematics.     

The effect of control strategies for an active back-support exoskeleton on spine loading and kinematics during lifting

With mechanical loading as the main risk factor for LBP, exoskeletons (EXO) are designed to reduce the load on the back by taking over part of the moment normally generated by back muscles. The present study investigated the effect of an active exoskeleton, controlled using three different control modes (INCLINATION, EMG & HYBRID), on spinal compression forces during lifting with various techniques.Ten healthy male subjects lifted a 15 kg box, with three lifting techniques (free, squat & stoop), each of which was performed four times, once without EXO and once each with the three different control modes. Using inverse dynamics, we calculated L5/S1 joint moments. Subsequently, we estimated spine forces using an EMG-assisted trunk model.Peak compression forces substantially decreased by 17.8% when wearing the EXO compared to NO EXO. However, this reduction was partly, by about one third, attributable to a reduction of 25% in peak lifting speed when wearing the EXO. While subtle differences in back load patterns were seen between the three control modes, no differences in peak compression forces were found. In part, this may be related to limitations in the torque generating capacity of the EXO. Therefore, with the current limitations of the motors it was impossible to determine which of the control modes was best. Despite these limitations, the EXO still reduced both peak and cumulative compression forces by about 18%.     

Effects of trunk muscle fatigue and load timing on spinal responses during sudden hand loading

The purpose of this study was to investigate the responses of the spine during sudden loading in the presence of back and abdominal muscle fatigue, with a primary focus on the implications for spinal stability. Fifteen females were studied and each received sudden loads to the hands, at both known and unknown times. Participants received these loading trials (a) while rested, (b) with back muscle fatigue, and (c) with a combination of back and abdominal muscle fatigue. Measures were taken on the EMG activity of two trunk extensor and two abdominal muscles, and on the trunk angle and centre of pressure. A 3 × 2 Repeated Measures ANOVA was also performed. There were no preparations made prior to the perturbation even when it could be anticipated. However, the peak responses that followed were greater in the unexpected versus the expected condition. In addition, trunk muscle fatigue led to an increase in the baseline activity of the trunk muscles but no additional increase in activity just prior to loading. There was increased activation of both (opposing) muscle groups when only one muscle group was fatigued. Because the peak responses following the perturbation were enhanced in the unknown timing condition, preparations must have taken place prior to the anticipated perturbations, perhaps in other segments of the body that were not measured. Also, the load impact may not have been great enough to elicit large preparations. The heightened baseline activity with fatigue suggests that there may have been increased spinal stiffness whenever the spine was fatigued, and not just immediately prior to an impending perturbation. The increased activation of opposing muscle groups is evidence of increased cocontraction in response to fatigue, possibly to maintain stability with decreasing coordination.     

Effect of experimental low back pain on neuromuscular control of the trunk in healthy volunteers and patients with chronic low back pain

Studies of electromyographic (EMG) activity and lumbopelvic rhythm have led to a better understanding of neuromuscular alterations in chronic low back pain (cLBP) patients. Whether these changes reflect adaptations to chronic pain or are induced by acute pain is still unclear. This work aimed to assess the effects of experimental LBP on lumbar erector spinae (LES) EMG activity and lumbopelvic kinematics during a trunk flexion–extension task in healthy volunteers and LBP patients. The contribution of disability to these effects was also examined. Twelve healthy participants and 14 cLBP patients performed flexion–extension tasks in three conditions; control, innocuous heat and noxious heat, applied on the skin over L5 or T7. The results indicated that noxious heat at L5 evoked specific increases in LES activity during static full trunk flexion and extension, irrespective of participants’ group. Kinematic data suggested that LBP patients adopted a different movement strategy than controls when noxious heat was applied at the L5 level. Besides, high disability was associated with less kinematic changes when approaching and leaving full flexion. These results indicate that experimental pain can induce neuromechanical alterations in cLBP patients and healthy volunteers, and that higher disability in patients is associated with decreased movement pattern changes.     

Immediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain

Although deficits in the activation of abdominal muscles are present in people with low back pain (LBP), this can be modified with motor training. Training of deep abdominal muscles in isolation from the other trunk muscles, as an initial phase of training, has been shown to improve the timing of activation of the trained muscles, and reduce symptoms and recurrence of LBP. The aim of this study was to determine if training of the trunk muscles in a non-isolated manner can restore motor control of these muscles in people with LBP. Ten subjects with non-specific LBP performed a single session of training that involved three tasks: “abdominal curl up”, “side bridge” and “birdog”. Electromyographic activity (EMG) of trunk and deltoid muscles was recorded with fine-wire and surface electrodes during rapid arm movements and walking, before and immediately following the intervention. Onset of trunk muscle EMG relative to that of the prime mover (deltoid) during arm movements and the mean, standard deviation (SD) and coefficient of variation of abdominal muscle EMG during walking were calculated. There was no significant change in the times of onset of trunk muscle EMG during arm movements nor was there any change in the variability of EMG of the abdominal muscles during walking. However, the mean amplitude and SD of abdominal EMG was reduced during walking after training. The results of this study suggest that unlike isolated voluntary training, co-contraction training of the trunk muscles does not restore the motor control of the deep abdominal muscles in people with LBP after a single session of training.     

Mechanical demands on the lower back in patients with non-chronic low back pain during a symmetric lowering and lifting task

There is limited information in the literature related to the lower back loading in patients with LBP, particularly those with non-chronic LBP. Toward addressing such a research gap, a case-control study was conducted to explore the differences in lower back mechanical loads between a group of females (n = 19) with non-chronic, non-specific LBP and a group of asymptomatic females (n = 19). The differences in lower back mechanical loads were determined when participants completed one symmetric lowering and lifting of a 4.5 kg load at their preferred cadence. The axial, shearing, and moment components of task demand at the time of peak moment component as well as measures of peak trunk kinematics were analyzed. Patient vs. asymptomatic group performed the task with smaller peak thoracic rotation and peak lumbar flexion. While no differences in the moment component of task demand on the lower back between the patients and controls were found, the shearing (40–50 age group) and axial components of task demand were, respectively, larger and smaller in patients vs. controls. Whether alterations in lower back loads in patients with non-chronic LBP are in response to pain or preceded the pain, the long-term exposure to abnormal lower back mechanics may adversely affect spinal structure and increase the likelihood of further injury or pain. Therefore, the underlying reason(s) as well as the potential consequence(s) of such altered lower back mechanics in patients with non-chronic LBP should to be further investigated.     

Kinematic chain reactions on trunk and dynamic postural steadiness in subjects with recurrent low back pain

Although subjects with recurrent low back pain (LBP) demonstrate altered trunk control, the kinematic and kinetic responses of the trunk have not been carefully investigated. This study was conducted to compare the standing time, spine range of motion (ROM), and dynamic postural steadiness index (DPSI) based on visual condition between subjects with and without recurrent LBP during upright one leg standing. Sixty-three individuals participated in the study, including 34 control subjects and 29 subjects with recurrent LBP. The DPSI was a composite of the medio-lateral (MLSI), anterior-posterior (APSI), and vertical steadiness indices (VSI) on a force platform. The control group demonstrated longer standing time (s) during the eyes-open condition than the LBP group (26.82 ± 6.03 vs. 19.87 ± 9.36; t = 2.96, p = 0.01). Regarding spine ROM, visual condition was significantly different between groups (F = 7.09, p = 0.01) and demonstrated interactions with spine region and group (F = 5.53, p = 0.02). For the kinetic measures, there was a significant interaction between visual conditions and indices (F = 25.30, p = 0.001). In the LBP group, the DPSI was significantly correlated with the MLSI (r = 0.59, p = 0.002), APSI (r = 0.44, p = 0.03), and VSI (r = 0.98, p = 0.01) in the eyes-closed condition. Overall, the results of this study indicated that the LBP group decreased thorax and lumbar spine rotations during the eyes-closed condition. The LBP group also demonstrated positive correlations with the kinetic indices, enhancing dynamic postural steadiness in the eyes-closed condition in order to possibly avoid pain or further injury. This dynamic postural steadiness strategy is necessary to improve kinetic and kinematic chain reactions in the LBP group. This compensatory pattern supports the development of optimal postural correction strategies to prevent LBP recurrence and might represent a chain reaction to protect trunk control without visual input.     

Underestimation of object mass in lifting does not increase the load on the low back.

Sudden, unexpected loading on the low back is associated with a high incidence of low back pain. Experiments in which sudden loading was applied during standing revealed increased compression forces on the spine and increased trunk angle, which may cause injury to the spine and hence explain this association. During a more dynamic daily activity, i.e. lifting, this could not be demonstrated, which may be due to experimental constraints. We therefore reinvestigated the loading of the low back when subjects were lifting an unexpectedly heavy object. Ten males lifted boxes, weighing 1.6 or 6.6 kg, at a self-selected lifting velocity. In some trials the mass of these boxes was unexpectedly increased by 10 kg. The ground reaction forces, body movements and trunk muscle activity were measured and from these, the L5/S1 torques and compression forces were estimated. Underestimation of the mass did not lead to an increase in low back loading. This finding was independent of the mass the subjects were expecting to lift. In conclusion, no evidence was found to support inference regarding causality of the association between sudden loading and low back pain during whole body lifting movements.     

The effects of moving environments on thoracolumbar kinematics and foot center of pressure when performing lifting and lowering tasks

The purpose of this study was to examine how wave-induced platform motion effects postural stability when handling loads. Twelve participants (9 male, 3 female) performed a sagittal lifting/lowering task with a 10 kg load in different sea conditions off the coast of Halifax, Nova Scotia, Canada. Trunk kinematics and foot center of force were measured using the Lumbar Motion Monitor and F-Scan foot pressure system respectively. During motion conditions, significant decreases in trunk velocities were accompanied by significant increases in individual foot center of pressure velocities. These results suggest that during lifting and lowering loads in moving environments, the reaction to the wave-induced postural disturbance is accompanied by a decrease in performance speed so that the task can be performed more cautiously to optimize stability.     

Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review

Objectives To determine whether advice and training on working techniques and lifting equipment prevent back pain in jobs that involve heavy lifting.Data sources Medline, Embase, CENTRAL, Cochrane Back Group’s specialised register, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT were searched up to September-November 2005.Review methods The primary search focused on randomised controlled trials and the secondary search on cohort studies with a concurrent control group. Interventions aimed to modify techniques for lifting and handling heavy objects or patients and including measurements for back pain, consequent disability, or sick leave as the main outcome were considered for the review. Two authors independently assessed eligibility of the studies and methodological quality of those included. For data synthesis, we summarised the results of studies comparing similar interventions. We used odds ratios and effect sizes to combine the results in a meta-analysis. Finally, we compared the conclusions of the primary and secondary analyses.Results Six randomised trials and five cohort studies met the inclusion criteria. Two randomised trials and all cohort studies were labelled as high quality. Eight studies looked at lifting and moving patients, and three studies were conducted among baggage handlers or postal workers. Those in control groups received no intervention or minimal training, physical exercise, or use of back belts. None of the comparisons in randomised trials (17 720 participants) yielded significant differences. In the secondary analysis, none of the cohort studies (772 participants) had significant results, which supports the results of the randomised trials.Conclusions There is no evidence to support use of advice or training in working techniques with or without lifting equipment for preventing back pain or consequent disability. The findings challenge current widespread practice of advising workers on correct lifting technique.     

The effect of unstable loading versus unstable support conditions on spine rotational stiffness and spine stability during repetitive lifting

Lumbar spine stability has been extensively researched due to its necessity to facilitate load-bearing human movements and prevent structural injury. The nature of certain human movement tasks are such that they are not equivalent in levels of task-stability (i.e. the stability of the external environment). The goal of the current study was to compare the effects of dynamic lift instability, administered through both the load and base of support, on the dynamic stability (maximal Lyapunov exponents) and stiffness (EMG-driven model) of the lumbar spine during repeated sagittal lifts. Fifteen healthy males performed 23 repetitive lifts with varying conditions of instability at the loading and support interfaces. An increase in spine rotational stiffness occurred during unstable support scenarios resulting in an observed increase in mean and maximum Euclidean norm spine rotational stiffness (p=0.0011). Significant stiffening effects were observed in unstable support conditions about all lumbar spine axes with the exception of lateral bend. Relative to a stable control lifting trial, the addition of both an unstable load as well as an unstable support did not result in a significant change in the local dynamic stability of the lumbar spine (p=0.5592). The results suggest that local dynamic stability of the lumbar spine represents a conserved measure actively controlled, at least in part, by trunk muscle stiffening effects. It is evident therefore that local dynamic stability of the lumbar spine can be modulated effectively within a young-healthy population; however this may not be the case in a patient population.     

Investigation of trunk muscle co-contraction and its association with low back pain development during prolonged sitting

Previous work has shown muscle activation differences between chronic low back pain patients and healthy controls in sitting postures, and between asymptomatic individuals who do (PDs: pain developers) and do not (NPDs: non-pain developers) develop transient back pain during prolonged standing (as determined using a visual analog scale). The current study aimed to investigate differences in trunk muscle co-contraction between PD and NPD individuals over 2 h of prolonged sitting. Ten healthy males sat continuously for 2 h while performing tasks that simulated computer-aided-drafting; four were classified as PDs, and six as NPDs. Co-contraction indices were calculated from EMG data collected from eight trunk muscles bilaterally, and compared between pain groups and over time. PDs exhibited higher levels of co-contraction than NPDs. Additionally, co-contraction tended to increase over time, and was significantly correlated to pain development. The relationship between co-contraction and back pain development may actually be circular, in that it is both causal and adaptive: high co-contraction initially predisposes to pain development, following which co-contraction further increases in an attempt to alleviate the pain, and the cycle perpetuates. Further work will be required to elucidate the exact nature of this relationship, and to confirm the generalizability to other populations.     

The effect of a knee support on the biomechanical response of the low back

Stooping and squatting postures are seen in a number of industries (e.g., agriculture, construction) where workers must work near ground level for extended periods of time. The focus of the current research was to evaluate a knee support device designed to reduce the biomechanical loading of these postures. Ten participants performed a series of sudden loading tasks while in a semisquat posture under two conditions of knee support (no support and fully supported) and two conditions of torso flexion (45 and 60 degrees ). A weight was released into the hands of the participants who then came to steady state while maintaining the designated posture. As they performed this task, the EMG responses of the trunk extensors (multifidus and erector spinae) were collected, both during the "sudden loading" phase of the trial as well as the steady weight-holding phase of the trial. As expected, the effects of torso flexion angle showed significant decreases in the activation of the multifidus muscles with greater torso angle (indicating the initiation of the flexion-relaxation response). Interestingly, the results showed that the knee support device had no effect on the activation levels of the sampled muscles, indicating that the loss of the degree of freedom from the ankle joint during the knee support condition had no impact on trunk extensor muscle response. The a priori concern with regard to these supports was that they would tend to focus loading on the low back and therefore would not serve as a potential ergonomic solution for these stooping/semisquatting tasks. Because the results of this study did not support this concern, further development of such an intervention is underway.     

The effects of knee support on the sagittal lower-body joint kinematics and kinetics of deep squats

Little work has been done to examine the deep squat position (>130° sagittal knee flexion). In baseball and softball, catchers perform this squat an average of 146 times per nine-inning game. To alleviate some of the stress on their knees caused by this repetitive loading, some catchers wear foam knee supports.ObjectivesThis work quantifies the effects of knee support on lower-body joint kinematics and kinetics in the deep squat position.MethodsSubjects in this study performed the deep squat with no support, foam support, and instrumented support. In order to measure the force through the knee support, instrumented knee supports were designed and fabricated. We then developed an inverse dynamic model to incorporate the support loads. From the model, joint angles and moments were calculated for the three conditions.ResultsWith support there is a significant reduction in the sagittal moment at the knee of 43% on the dominant side and 63% on the non-dominant side compared to without support. These reductions are a result of the foam supports carrying approximately 20% of body weight on each side.ConclusionKnee support reduces the moment necessary to generate the deep squat position common to baseball catchers. Given the short moment arm of the patella femoral tendon, even small changes in moment can have a large effect in the tibial-femoral contact forces, particularly at deep squat angles. Reducing knee forces may be effective in decreasing incidence of osteochondritis dissecans.     

Effects of trunk rotation on scapular kinematics and muscle activity during humeral elevation

Trunk rotation often accompanies humeral elevation, during daily activities as well as sports activities. Earlier studies have demonstrated that changes in spinal posture contribute to scapular motion during humeral elevation. However, the effect of trunk rotation on scapular kinematics during humeral elevation has received scant attention. This study aimed to clarify how trunk rotation affects scapular kinematics and muscle activities during humeral elevation. Electromagnetic motion capture and electromyography were used to assess scapular and clavicular motion and muscle activity in the right and left sides of 12 healthy young men. The subjects were seated and instructed to elevate both arms with the trunk in neutral, ipsilaterally rotated, or contralaterally rotated position. Ipsilaterally rotated trunk position decreased the internal rotation (by 5°, relative to neutral trunk position) and increased the upward rotation (by 4°, relative to neutral trunk position) of the scapula. Trunk position did not affect clavicular motion during humeral movement. Electromyography showed that contralaterally rotated trunk position increased the activity of the upper trapezius and serratus anterior muscles and decreased the activity of the lower trapezius. Therapists should consider the importance of trunk rotation, which may be the key to developing more efficient rehabilitation programs.     

Estimation of low back loading on nurses during patient handling tasks: the importance of bedside reaction force measurement

By means of video recording, measurement of ground reaction forces, and biomechanical modeling of the lower part of the body, the low back loading of nurses during patient handling can be estimated. In this study the force exerted on the bedside by a nurse during different patient handling tasks was measured, and the contribution to the moment at the L4/L5 joint was investigated. It is shown that the bedside reaction moment contributes significantly to the total moment, and could lead to substantial over-estimation if not appropriately included in the calculations, when using an upward biomechanical model for estimating the spinal load of nurses during patient handling tasks.     

Effect of additional loading on kinematics and hydrodynamics of dolphins]

The results of comparative measurements of hydrodynamic resistance of a solid model of dolphin and of additional load imitating an autonomous apparatus placed on the dolphin body are presented. The loading included cylinders (with rounded anterior and posterior ends) and spheres. They were fixed on the dorsal fin of the dolphin model in such a way that the interrelationship between the load and the model by a water stream minimal. In several experiments, a thick ring (dr = 10 mm) was fixed in the region of the dolphin respiratory opening to reach the turbulence of the boundary layer. The dolphin model with loads was towed in a speed range between 1.0 and 4.5 m/s. It was shown that the hydrodynamic resistance of additional loads is comparable with the resistance of the solid dolphin model. For the entire spectrum of loading in the preset range of towing speeds, the coefficient of hydrodynamic resistance of loading (according to the area of the wet body surface) was from 10 to 145% of the coefficient of the dolphin model resistance. It was assumed that the results of the measurements of kinematics and hydrodynamic characteristics of a freely-swimming dolphin can substantially differ from the results obtained on a dolphin carrying devices (at restricted power of the animal). Similar problems can also arise if the animals will carry devices with a higher hydrodynamic resistance.     

Effects of fatigue on lower limb,pelvis and trunk kinematics and muscle activation: Gender differences

Background: Muscle fatigue is associated with biomechanical changes that may lead to anterior cruciate ligament (ACL) injuries. Alterations in trunk and pelvis kinematics may also be involved in ACL injury. Although some studies have compared the effects of muscle fatigue on lower limb kinematics between men and women, little is known about its effects on pelvis and trunk kinematics. The aim of the study was to compare the effects of fatigue on lower limb, pelvis and trunk kinematics and muscle activation between men and women during landing. Methods: The participants included forty healthy subjects. We performed kinematic analysis of the trunk, pelvis, hip and knee and muscle activation analysis of the gluteal muscles, vastus lateralis and biceps femoris, during a single-leg landing before and after fatigue. Results: Men had greater trunk flexion than women after fatigue. After fatigue, a decrease in peak knee flexion and an increase in Gmax and BF activation were observed. Conclusion: The increase in the trunk flexion can decrease the anterior tibiofemoral shear force resulted from the lower knee flexion angle, thereby decreasing the stress on the ACL.