Exploring the link between occupationally relevant whole body vibration and headache and neck pain: is elevated muscle tension an intermediary factor?

Whole body vibration (WBV) is linked to short- and longer-term adverse health outcomes, including cognitive impairment, stress and memory loss, loss of balance, reduced proprioception, visual and vestibular disturbances, gastrointestinal problems, and musculoskeletal disorders. Epidemiological evidence supports the link between WBV and headache and head discomfort, but few experimental studies have examined this relationship, particularly with increased muscle tension, as an intermediary. This study aimed to investigate the relationship between muscle tension and vibration intensity, between perceived neck pain and headache/head discomfort and vibration intensity, and between muscle tension and reported neck pain and headache symptoms from simulated WBV based on field measurements of all-terrain vehicle operation on farm terrain. We observed significantly higher electromyography amplitude in the High condition (equivalent to EU Directive's Exposure Limit Value) compared to both Low (equivalent to EU Directive's Exposure Action Value) and Control (quiet sitting) conditions at the left upper trapezius muscle but there were no significant time effects. Neck pain and headache/head discomfort significantly increased after both Low (91% increase from baseline) and High (154% increase from baseline) vibration conditions but there were no significant differences between conditions. Based on simple regression modeling, the relationship between muscle activity and neck pain or headache was very weak (R2 = 0-0.093). Given the possibility of multiple factors contributing to headache symptoms, future research should not only consider the role of muscle tension but also sensory conflict, excessive noise, biodynamic responses, and a combination of these factors.

Lateral Pelvis and Lumbar Motion in Seated and Standing Office Work and Their Association With Transient Low Back Pain.

OBJECTIVE: To assess frontal plane motion of the pelvis and lumbar spine during 2 h of seated and standing office work and evaluate associations with transient low back pain. BACKGROUND: Although bending and twisting motions are cited as risk factors for low back injuries in occupational tasks, few studies have assessed frontal plane motion during sedentary exposures. METHODS: Twenty-one participants completed 2 h of seated and standing office work while pelvic obliquity, lumbar lateral bending angles, and ratings of perceived low back pain were recorded. Mean absolute angles were compared across 15-min blocks, amplitude probability distribution functions were calculated, and associations between lateral postures and low back pain were evaluated. RESULTS: Mean pelvic obliquity (sit = 4.0 ± 2.8°, stand = 3.5 ± 1.7°) and lumbar lateral bending (sit = 4.5 ± 2.5°, stand = 4.1 ± 1.6°) were consistently asymmetrical. Pelvic obliquity range of motion was 4.7° larger in standing (13.6 ± 7.5°) than sitting (8.9 ± 8.7°). In sitting, 52% (pelvis) and 71% (lumbar) of participants, and in standing, 71% (pelvis and lumbar) of participants, were considered asymmetric for >90% of the protocol. Lateral postures displayed weak to low correlations with peak low back pain (R ≤ 0.388). CONCLUSION: The majority of participants displayed lateral asymmetries for the pelvis and lumbar spine within 5° of their upright standing posture. APPLICATION: In short-term sedentary exposures, associations between lateral postures and pain indicated that as the range in lateral postures increases there may be an increased possibility of pain.

Increasing movement during office work at sit-stand workstations: A novel seating device to facilitate transitions.

A novel active office chair (Movably Pro) was designed to facilitate frequent sit-stand movement 1) through auditory and tactile prompts and 2) with minimal-to-no work surface adjustment when transitioning. The purpose of this study was to compare lumbopelvic kinematics, discomfort, and task performance between the novel chair and traditional sitting/standing. Sixteen participants completed three separate 2-h sedentary exposures. Although participants transitioned every 3 min between sitting and standing with the novel chair, productivity was not affected. When standing in the novel chair, the lumbopelvic angles fell in between traditional sitting and standing (p < 0.01). Movement and/or postural changes that occurred with the novel chair reduced low back and leg discomfort for pain developers (PDs) (p < 0.01). All participants classified as PDs in traditional standing were non-PDs with the novel chair. This intervention was effective in reducing sedentary time without the time loss associated with desk movement.

Reconstructing an accelerometer-based pelvis segment for three-dimensional kinematic analyses during laboratory simulated tasks with obstructed line-of-sight.

Close interface between humans and inanimate objects (furniture, assistive devices, and external loads) can obstruct line-of-sight in biomechanics studies that utilize optoelectronic motion capture systems. This specific problem is frequently encountered with the pelvis segment. This study sought to compare joint and pelvis angles computed from a pelvis-fixed local coordinate system (LCS) that was constructed from optically tracked pelvis landmarks (gold standard) and landmarks derived from angular deviations calculated from triaxial accelerometer data. One participant performed seven tasks: sitting, forward bend, sit-to-stand-to-sit, forward lunge, symmetrical squat, asymmetrical squat, and gait. The root mean square error (RMSE) and coefficient of determination (R2) were examined for the pelvis, lumbar spine, and hip joint angles calculated using the standard and accelerometer-based methods for creating a LCS. The RMSE values for global pelvis angles ranged from 2.2° (gait; R2 = 0.47) to 4.9° (sit-to-stand-to-sit; R2 = 0.98), 0.6° (sitting; R2 = 0.88) to 7.4° (gait; R2 = 0.39), and 1.5° (forward bend; R2 = 0.99) to 2.9° (sit-to-stand-to-sit; R2 = 0.99) for motion about the X, Y, and Z axes, respectively. The magnitude of error observed for adjacent joint motion was lowest about the Z axis for all tasks. In conclusion, the accelerometer-based LCS offers an alternative method for computing pelvis and adjacent joint angles without the reliance on a visual line-of-sight. For motion about the X and Y axes, time-series data derived with the accelerometer-based method may be less representative of discrete events, particularly for gait and lunging tasks.

Analysis of invoked slips while wearing flip-flops in wet and dry conditions: Does alternative footwear alter slip kinematics?

Minimal footwear has become more ubiquitous; however, it may increase slip severity. This study specifically examined the slipping kinematics of flip-flop sandals. Invoked slips from standing were evaluated in dry and wet tile, and a unique wet footbed + wet tile condition, with 40, 50, and 60% bodyweight (BW) committed to the slipping foot. Water did not alter peak slip velocity (PV) at 40% BW, but PV increased with greater slip-foot force on wet tile by ~1 m/s. Interestingly, when floor-contact was lost during the slip, the flip-flops could come off the heel. This decoupling occurred most often when both the tile and footbed were either dry or wet. Given that both decoupling and greater PV were observed on wet tile, slipping in flip-flops under wet conditions may have more serious consequences. The results highlight that slips may occur at both the foot-flip-flop, and flip-flop-tile interfaces.

A Comparison of Clinical Spinal Mobility Measures to Experimentally Derived Lumbar Spine Passive Stiffness.

Spinal stiffness and mobility assessments vary between clinical and research settings, potentially hindering the understanding and treatment of low back pain. A total of 71 healthy participants were evaluated using 2 clinical assessments (posteroanterior spring and passive intervertebral motion) and 2 quantitative measures: lumped mechanical stiffness of the lumbar spine and local tissue stiffness (lumbar erector spinae and supraspinous ligament) measured via myotonometry. The authors hypothesized that clinical, mechanical, and local tissue measures would be correlated, that clinical tests would not alter mechanical stiffness, and that males would demonstrate greater lumbar stiffness than females. Clinical, lumped mechanical, and tissue stiffness were not correlated; however, gradings from the posteroanterior spring and passive intervertebral motion tests were positively correlated with each other. Clinical assessments had no effect on lumped mechanical stiffness. The males had greater lumped mechanical and lumbar erector spinae stiffness compared with the females. The lack of correlation between clinical, tissue, and lumped mechanical measures of spinal stiffness indicates that the use of the term "stiffness" by clinicians may require reevaluation; clinicians should be confident that they are not altering mechanical stiffness of the spine through segmental mobility assessments; and greater resting lumbar erector stiffness in males suggests that sex should be considered in the assessment and treatment of the low back.

A comparison of knee joint moments during high flexion squatting and kneeling postures in healthy individuals.

BACKGROUND: Deep knee bending has been reported as an occupational hazard to workers who have to adopt such postures. High knee joint moments have been associated with knee osteoarthritis initiation and progression. OBJECTIVE: This study aimed to compare four high knee flexion postures (dorsiflexed and plantarflexed kneeling, and flat-foot and heels-up squatting) to determine which one results in lower knee joint flexion and ab/adduction moments. METHODS: Forty-three participants performed five trials of each posture. Peak (for descent/ascent) and mean (for the static hold) external knee flexion and ab/adduction moments were analyzed for each posture using 2-way ANOVAs and post-hoc pairwise comparisons. RESULTS: It was observed that the flat-foot squat resulted in significantly lower knee flexion moment compared to the other three postures (4.63±0.99 % BW·H during the static phase, and 5.83±1.24 % BW·H and 5.94±1.24 % BW·H during descent and ascent phases, respectively). During ascent phase, significant differences was indicated in peak adduction moments for the flat-foot squat in comparison to both styles of kneeling. CONCLUSIONS: When high knee flexion is required but posture is not dictated, flat-foot squat will reduce exposures to high knee moments.

Examining endplate fatigue failure during cyclic compression loading with variable and consistent peak magnitudes using a force weighting adjustment approach: an in vitro study.

Repetitive movement is common in many occupational contexts. Therefore, cumulative load is a widely recognised risk factor for lowback injury. This study quantified the effect of force weighting factors on cumulative load estimates and injury prediction during cyclic loading. Forty-eight porcine cervical spine motion segments were assigned to experimental groups that differed by average peak compression magnitude (30%, 50% and 70% of predicted tolerance) and amplitude variation (consistent, variable). Cyclic loading was performed at a frequency of 0.5 Hz until fatigue failure occurred. Weighting factors were determined and applied instantaneously. Inclusion of weighting factors resulted in statistically similar cumulative load estimates at injury between variable and consistent loading (p > .071). Further, survivorship was generally greater when the peak compression magnitude was consistent compared to variable. These results emphasise the importance of weighting factors as an equalisation tool for the evaluation of cumulative low back loading exposures in occupational contexts. Practitioner summary: Weighting factors can equalise the risk of injury based on compression magnitude. When weighted, the cumulative compression was similar between consistent and variable cyclic loading protocols, despite being significantly different when unweighted and having similar injury rates. Therefore, assessing representative occupational exposures without evaluating task performance variability may underestimate injury risk. Abbreviations: FSU: functional spinal unit; UCT: ultimate compression tolerance.

Incorporating loading variability into in vitro injury analyses and its effect on cumulative compression tolerance in porcine cervical spine units.

During repetitive movement, low-back loading exposures are inherently variable in magnitude. The current study aimed to investigate how variation in successive compression exposures influences cumulative load tolerance in the spine. Forty-eight porcine cervical spine units were randomly assigned to one of six combinations of mean peak compression force (30%, 50%, 70% of the predicted tolerance) and loading variation (consistent peak amplitude, variable peak amplitude). Following preload and passive range-of-motion tests, specimens were positioned in a neutral posture and then cyclically loaded in compression until failure occurred or the maximum 12 h duration was reached. Specimens were dissected to classify macroscopic injury and measurements of cumulative load, cycles, and height loss sustained at failure were calculated. Statistical comparisons were made between loading protocols within each normalized compression group. A significant loading variation × compression interaction was demonstrated for cumulative load (p = 0.026) and cycles to failure (p = 0.021). Cumulative compression was reduced under all normalized compression loads (30% p = 0.016; 50% p = 0.030; 70% p = 0.020) when variable loading was incorporated. The largest reduction was by 33% and occurred in the 30% compression group. The number of sustained cycles was reduced by 31% (p = 0.017), 72% (p = 0.030), and 76% (p = 0.009) under normalized compression loads of 30%, 50%, and 70%, respectively. These findings suggest that variation in compression exposures interact to reduce cumulative compression tolerance of the spine and could elevate low-back injury risk during time-varying repetitive tasks.

The Multisystem Effects of Simulated Agricultural Whole Body Vibration on Acute Sensorimotor, Physical, and Cognitive Performance.

Background: Exposure to whole body vibration (WBV) is common in construction, agriculture, mining, and transportation. There is strong epidemiological evidence linking WBV with adverse health outcomes in the long-term, including low back pain. Fortunately, WBV exposure guidelines to prevent long-term musculoskeletal disorders and discomfort exist. In the shorter-term, it has been speculated that occupational levels of WBV may lead to increased risk of vehicle accidents and falls during egress; however, the acute effects of different vibration intensities remain poorly understood and it is uncertain whether established standards protect the worker from injurious short-term effects. Objective: The aim of this study was to investigate the acute sensorimotor, physical, and cognitive effects of occupationally-relevant, simulated whole body vibration (WBV) at levels equivalent to international standard guideline thresholds for long-term discomfort and musculoskeletal disorder risk. Method: Eighteen participants were recruited to perform four, 60-min conditions: (i) Control-no vibration, (ii) Low vibration-equivalent to the exposure action value, (iii) Shock-transient impacts at 1-min intervals superimposed on the Low condition, and (iv) High vibration-equivalent to the exposure limit value. Whole body vibration was simulated using data based on field-collected accelerations experienced by rural workers while operating an all-terrain vehicle. This vibration signal was manipulated to achieve required intensities for each condition and simulated with a 6 degree-of-freedom hexapod platform. Before and after each condition, we collected: rating of perceived body discomfort, rating of perceived headache, postural sway, blink frequency, King-Devick test, and psychomotor vigilance task. Pre- and post-condition data in each condition were submitted to either a paired t-test (parametric) or Wilcoxon signed-rank test (non-parametric). To determine differences between conditions, each condition's post-condition data was normalized to its pre-condition value and entered as the dependent variable in a repeated measures analysis of variance. Results: All conditions, including Control, led to increased upper body discomfort when compared to pre-exposure baseline. The Low condition led to increased discomfort in seven body locations, headache (91% increase from baseline; t = -2.44, P = 0.03), and postural imbalance (53% increase from baseline; t = -2.88, P = 0.01), but the effect on cognitive functioning was less clear. Shock condition led to whole body discomfort, specifically at nine upper body and lower body locations. The High condition led to increased whole body discomfort at all 10 body locations, headache (154% increase from baseline; t = -2.91, P = 0.01), postural imbalance (61% increase from baseline; t = -2.57, P = 0.02), and decrements in vigilance (mean reaction time: 6% increase from baseline, t = -3.27, P = 0.005; Number of lapses: 100% increase from baseline, S = -42.5, P = 0.002). Conclusion: Although the number of pre-post condition effects increased with higher vibration intensity, these effects were not significantly different from sitting without vibration. Therefore, current guideline thresholds might not protect the worker from acute WBV effects. However, further research is needed to discern these effects from other sources of WBV. Based on this study, future WBV interventions and action controls should not only address vibration reduction, but also consider potential effects from prolonged sitting.

Knee joint moments during high flexion movements: Timing of peak moments and the effect of safety footwear.

AIM: (1) Characterize knee joint moments and peak knee flexion moment timing during kneeling transitions, with the intent of identifying high-risk postures. (2) Determine whether safety footwear worn by kneeling workers (construction workers, tile setters, masons, roofers) alters high flexion kneeling mechanics. METHODS: Fifteen males performed high flexion kneeling transitions. Kinetics and kinematics were analyzed for differences in ascent and descent in the lead and trail legs. RESULTS: Mean±standard deviation peak external knee adduction and flexion moments during transitions ranged from 1.01±0.31 to 2.04±0.66% body weight times height (BW∗Ht) and from 3.33 to 12.6% BW∗Ht respectively. The lead leg experienced significantly higher adduction moments compared to the trail leg during descent, when work boots were worn (interaction, p=0.005). There was a main effect of leg (higher lead vs. trail) on the internal rotation moment in both descent (p=0.0119) and ascent (p=0.0129) phases. CONCLUSION: Peak external knee adduction moments during transitions did not exceed those exhibited during level walking, thus increased knee adduction moment magnitude is likely not a main factor in the development of knee OA in occupational kneelers. Additionally, work boots only significantly increased the adduction moment in the lead leg during descent. In cases where one knee is painful, diseased, or injured, the unaffected knee should be used as the lead leg during asymmetric bilateral kneeling. Peak flexion moments occurred at flexion angles above the maximum flexion angle exhibited during walking (approximately 60°), supporting the theory that the loading of atypical surfaces may aid disease development or progression.

Peak activation of lower limb musculature during high flexion kneeling and transitional movements.

Few studies have measured lower limb muscle activation during high knee flexion or investigated the effects of occupational safety footwear. Therefore, our understanding of injury and disease mechanisms, such as knee osteoarthritis, is limited for these high-risk postures. Peak activation was assessed in eight bilateral lower limb muscles for twelve male participants, while shod or barefoot. Transitions between standing and kneeling had peak quadriceps and tibialis anterior (TA) activations above 50% MVC. Static kneeling and simulated tasks performed when kneeling had peak TA activity above 15% MVC but below 10% MVC for remaining muscles. In three cases, peak muscle activity was significantly higher (mean 8.9% MVC) when shod. However, net compressive knee joint forces may not be significantly increased when shod. EMG should be used as a modelling input when estimating joint contact forces for these postures, considering the activation levels in the hamstrings and quadriceps muscles during transitions. Practitioner Summary: Kneeling transitional movements are used in activities of daily living and work but are linked to increased knee osteoarthritis risk. We found peak EMG activity of some lower limb muscles to be over 70% MVC during transitions and minimal influence of wearing safety footwear.

Analysis of muscle activation patterns during transitions into and out of high knee flexion postures.

Increased risk of medial tibiofemoral osteoarthritis (OA) is linked to occupations that require frequent transitions into and out of postures which require high knee flexion (>90°). Muscle forces are major contributors to joint loading, and an association between compressive forces due to muscle activations and the degeneration of joint cartilage has been suggested. The purpose of this study was to evaluate muscle activation patterns of muscles crossing the knee during transitions into and out of full-flexion kneeling and squatting, sitting in a low chair, and gait. Both net and co-activation were greater when transitioning out of high flexion postures, with maximum activation occurring at knee angles greater than 100°. Compared to gait, co-activation levels during high flexion transitions were up to approximately 3 times greater. Co-activation was significantly greater in the lateral muscle group compared to the medial group during transitions into and out of high flexion postures. These results suggest that compression due to activation of the medial musculature of the knee may not be the link between high knee flexion postures and increased medial knee OA observed in occupational settings. Further research on a larger subject group and workers with varying degrees of knee OA is necessary.