The efficacy of training for three manual handling strategies based on the observation of expert and novice workers

The influence of transfer distance and pace of work on foot positioning strategies and low back loading in a manual material handling task

Foot positioning strategies are a key parameter in manual materials handling. The objective of this study was to assess the effects of transfer distance, pace and foot positioning on low back loading. Sixteen handlers performed a free handling task with conditions of pace (self-selected and 25% faster), distance (1.5 m, 1.0 m and 0.5 m), height (near-ground and above-waist levels), and mass (10 kg and 20 kg). A linear mixed model was used to evaluate the effects of mass, distance, pace and height on foot positioning occurrences. A non-parametric test (nparLD) was used to evaluate the effects of Pace × Foot positioning and Distance × Foot positioning on L5/S1 sagittal and asymmetrical moments. Positioning the feet aside from the lifting pallet was more prevalent when transferring at shorter transfer distances, high lifting height, and faster pace. When the feet were oriented aside the lifting area, asymmetrical peak moments were slightly higher when transferring at short distance. Facing the lifting pallet may ensure load symmetry, but orienting the feet aside may help to adapt to fast pace or short transfer distance.

Biomechanical Assessments of the Upper Limb for Determining Fatigue, Strain and Effort from the Laboratory to the Industrial Working Place: A Systematic Review

Recent human-centered developments in the industrial field (Industry 5.0) lead companies and stakeholders to ensure the wellbeing of their workers with assessments of upper limb performance in the workplace, with the aim of reducing work-related diseases and improving awareness of the physical status of workers, by assessing motor performance, fatigue, strain and effort. Such approaches are usually developed in laboratories and only at times they are translated to on-field applications; few studies summarized common practices for the assessments. Therefore, our aim is to review the current state-of-the-art approaches used for the assessment of fatigue, strain and effort in working scenarios and to analyze in detail the differences between studies that take place in the laboratory and in the workplace, in order to give insights on future trends and directions. A systematic review of the studies aimed at evaluating the motor performance, fatigue, strain and effort of the upper limb targeting working scenarios is presented. A total of 1375 articles were found in scientific databases and 288 were analyzed. About half of the scientific articles are focused on laboratory pilot studies investigating effort and fatigue in laboratories, while the other half are set in working places. Our results showed that assessing upper limb biomechanics is quite common in the field, but it is mostly performed with instrumental assessments in laboratory studies, while questionnaires and scales are preferred in working places. Future directions may be oriented towards multi-domain approaches able to exploit the potential of combined analyses, exploitation of instrumental approaches in workplace, targeting a wider range of people and implementing more structured trials to translate pilot studies to real practice.

A first step towards a framework for interventions for individual working practice to prevent work-related musculoskeletal disorders: a scoping review

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are a key topic in occupational health. In the primary prevention of these disorders, interventions to minimize exposure to work-related physical risk factors are widely advocated. Besides interventions aimed at the work organisation and the workplace, interventions are also aimed at the behaviour of workers, the so-called individual working practice (IWP). At the moment, no conceptual framework for interventions for IWP exists. This study is a first step towards such a framework.

METHODS

A scoping review was carried out starting with a systematic search in Ovid Medline, Ovid Embase, Ovid APA PsycInfo, and Web of Science. Intervention studies aimed at reducing exposure to physical ergonomic risk factors involving the worker were included. The content of these interventions for IWP was extracted and coded in order to arrive at distinguishing and overarching categories of these interventions for IWP.

RESULTS

More than 12.000 papers were found and 110 intervention studies were included, describing 810 topics for IWP. Eventually eight overarching categories of interventions for IWP were distinguished: (1) Workplace adjustment, (2) Variation, (3) Exercising, (4) Use of aids, (5) Professional skills, (6) Professional manners, (7) Task content & task organisation and (8) Motoric skills.

CONCLUSION

Eight categories of interventions for IWP are described in the literature. These categories are a starting point for developing and evaluating effective interventions performed by workers to prevent WMSDs. In order to reach consensus on these categories, an international expert consultation is a necessary next step.

Biomechanical differences in experts' and novices' footstep patterns during a palletizing task

Very few studies have examined differences between experts' and novices' foot positioning and movements during manual materials handling tasks. The impact of footstep patterns on low back loading needs to be better understood. The goals of this study were to characterize foot placement and movements in novices and experts and to assess their impact on back loading considering the height of grasp. The task consisted in transferring 24 15 kg boxes from a pallet to another. Foot placement and movements were classified with a recently developed taxonomy. Results show that experts' feet remained static more often than novices' feet during the lifting phase. Positioning the feet towards the deposit site during lifting increased asymmetrical moments, especially for novices. Positioning one foot forward increased asymmetrical moments for novices. Overall, footstep strategies are an effective indicator of low back exposure and should be considered in ergonomic studies.

Effect of Expertise on Shoulder and Upper Limb Kinematics, Electromyography, and Estimated Muscle Forces During a Lifting Task

OBJECTIVE

To highlight the working strategies used by expert manual handlers compared with novice manual handlers, based on recordings of shoulder and upper limb kinematics, electromyography (EMG), and estimated muscle forces during a lifting task.

BACKGROUND

Novice workers involved in assembly, manual handling, and personal assistance tasks are at a higher risk of upper limb musculoskeletal disorders (MSDs). However, few studies have investigated the effect of expertise on upper limb exposure during workplace tasks.

METHOD

Sixteen experts in manual handling and sixteen novices were equipped with 10 electromyographic electrodes to record shoulder muscle activity during a manual handling task consisting of lifting a box (8 or 12 kg), instrumented with three six-axis force sensors, from hip to eye level. Three-dimensional trunk and upper limb kinematics, hand-to-box contact forces, and EMG were recorded. Then, joint contributions, activation levels, and muscle forces were calculated and compared between groups.

RESULTS

Sternoclavicular-acromioclavicular joint contributions were higher in experts at the beginning of the movement, and in novices at the end, whereas the opposite was observed for the glenohumeral joint. EMG activation levels were 37% higher for novices but predicted muscle forces were higher in experts.

CONCLUSION

This study highlights significant differences between experts and novices in shoulder kinematics, EMG, and muscle forces; hence, providing effective work guidelines to ensure the development of a safe handling strategy is important.

APPLICATION

Shoulder kinematics, EMG, and muscle forces could be used as ergonomic tools to identify inappropriate techniques that could increase the prevalence of shoulder injuries.

Deliberate Practice and Motor Learning Principles to Underpin the Design of Training Interventions for Improving Lifting Movement in the Occupational Sector: A Perspective and a Pilot Study on the Role of Augmented Feedback

Spine posture during repetitive lifting is one of the main risk factors for low-back injuries in the occupational sector. It is thus critical to design appropriate intervention strategies for training workers to improve their posture, reducing load on the spine during lifting. The main approach to train safe lifting to workers has been educational; however, systematic reviews and meta-analyses have shown that this approach does not improve lifting movement nor reduces the risk of low back injury. One of the main limitations of this approach lies in the amount, quality and context of practice of the lifting movement. In this article, first we argue for integrating psychologically-grounded perspectives of practice design in the development of training interventions for safe lifting. Principles from deliberate practice and motor learning are combined and integrated. Given the complexity of lifting, a training intervention should occur in the workplace and invite workers to repeatedly practice/perform the lifting movement with the clear goal of improving their lifting-related body posture. Augmented feedback has a central role in creating the suitable condition for achieving such intervention. Second, we focus on spine bending as risk factor and present a pilot study examining the benefits and boundary conditions of different feedback modalities for reducing bending during lifting. The results showed how feedback modalities meet differently key requirements of deliberate practice conditions, i.e., feedback has to be informative, individualized and actionable. Following the proposed approach, psychology will gain an active role in the development of training interventions, contributing to finding solutions for a reduction of risk factors for workers.

An ergonomics educational training program to prevent work-related musculoskeletal disorders to novice and experienced workers in the poultry processing industry: A quasi-experimental study

This quasi-experimental study was conducted in a poultry processing industry with the aim of assessing the benefits of ergonomics educational training for novice and experienced workers in preventing work-related musculoskeletal disorders. Sociodemographic and occupational questionnaires were used to evaluate age, marital status, education, time in job, musculoskeletal complaints and pain intensity, perceived effort, biomechanical exposure, and perception of ease or difficulty in adoption of ergonomics educational training. Musculoskeletal complaints in the neck, back, and wrists were reduced with training, but pain intensity was reduced only in the wrist region. A reduction in the occupational biomechanical exposure from the baseline to immediately post-training and 2 months after training both for novice and experienced workers was also observed. The novice workers group differed from the experienced workers by presenting a higher reduction of biomechanical exposure in the cutting room. All workers in this study benefited from the ergonomics educational training in the short and medium term. However, the success of training was highly dependent on the content and approach of the training.

The Impact of Participants' Anthropometry on Muscle Activation Levels While Interacting with the Level of Expertise, Task Type, and Single Muscles

In this research paper, we implemented a mixed factor design in order to investigate the effect of four anthropometries: height, weight, lower-arm dimensions, and upper-arm dimensions on the muscle activation level of participants when interacting with three types of moderators: experiment expertise, task type, and muscle type. The research paper focused on two levels of expertise (novice and expert), two tasks (deck-building and picket installation), and four arm muscles (Brachioradialis (BR), Extensor Carpi Ulnaris (ECU), Flexor Carpi Radialis (FCR), and Flexor Carpi Ulnaris (FCU)), which resulted in 16 (2 × 2 × 4) groups. For each of the 16 groups, the data were analyzed in order to investigate the relationship between the four anthropometries and the four muscle activation levels of the participants. Amos software (IBM, Armonk, NY, USA), along with multiple group structural equation modeling, was used to test a total of 16 direct relationships, as well as the moderation effects in the designed experiment. The results show that the participants' expertise can moderate the relationship between their height and muscle activation levels, the relationship between their weight and muscle activation levels, and the relationship between their lower arm dimensions and muscle activation levels. Moreover, the findings of this research paper demonstrate that the relationship between the lower arm dimensions and muscle activation levels, and the relationship between weight and muscle activation levels are moderated by the type of muscle used by the participants (i.e., BR, ECU, FCR, and FCU).

Optimal foot-position of caregiver based on muscle activity of lower back and lower limb while providing sit-to-stand support

[Purpose] In caregivers, low load posture is necessary to prevent lower back pain during patient handling activities such as sit-to-stand support. This study focused on the foot-position of caregivers as an adjustable and useful parameter. A wide stance decreases the stress on the lumbar vertebra. However, this foot-position increases loading of the spinae erector muscles. The aim of this study was to investigate the relationship of anterior-posterior and lateral-medial distances between feet and activity of the spinae erector muscles to determine the optimal foot-position for reducing stress on the lumbar vertebra without increasing spinae erector muscle load. [Participants and Methods] Five young male participants were asked to provide sit-to-stand support 10 times using nine normalized foot-positions with different anterior-posterior and lateral-medial distances. Surface electromyograms of the erector spinae and lower limb muscles were measured during sit-to-stand support. [Results] The results showed that the optimal foot-position (anterior-posterior 55%, lateral-medial 20% of body height) increased muscle activity within the lower limb muscles compared with the lower back muscles and did not increase loads on the erector spinae muscle. [Conclusion] Optimizing foot-position can reduce stress on the lumbar vertebra without increasing load on the spinae erector muscles.

Motion-Based Prediction of Hands and Feet Contact Efforts During Asymmetric Handling Tasks

This paper proposes a method to predict the external efforts exerted on a subject during handling tasks, only with a measure of his motion. These efforts are the contacts forces and moments on the ground and on the load carried by the subject. The method is based on a contact model initially developed to predict the ground reaction forces and moments. Discrete contact points are defined on the biomechanical model at the feet and the hands. An optimization technique computes the minimal forces at each of these points, satisfying the dynamic equations of the biomechanical model and the load. The method was tested on a set of asymmetric handling tasks performed by 13 subjects and validated using force platforms and an instrumented load. For each task, predictions of the vertical forces obtained an RMSE of about 0.25 N/kg for the feet contacts and below 1 N/kg for the hand contacts. L5/S1 joint moments were then computed using the predicted and the measured data. RMSE of 18 Nm and rRMSE below 10% were obtained for the flexion/extension component. In conclusion, this method enables to quantitatively assess asymmetric handling tasks on the basis of kinetics variables without additional instrumentation, such as force sensors, and thus improve the ecological aspect of the studied tasks. This method has a great potential to be applied in work tasks analyses in ergonomics studies or sports gestures analyses involving hand contacts in exercise science.

Adding Handles to Optimize Manual Box Handling

The risk factors for developing musculoskeletal disorders in material handling tasks are well known. Among strategies for controlling risks, modifying boxes by adding handles is suggested. However, there are no clear recommendations regarding box modification as an approach to improve musculoskeletal health. In this study, we investigated the main literature databases to identify effects of box modification on reducing physical load. Electronic and manual searches were performed to identify studies that evaluated effects of boxes handles on physical exposure during handling tasks. The included studies were very heterogeneous (methods of assessment, types of handles used, and methodological quality), jeopardizing synthesis of evidence. Despite the mentioned limitations, we could suggest some features that could improve manual handling in practical settings, like the use of cylindrical handles forms with intermediate diameters (between 31 and 51 mm) and 30° inclination. Those characteristics demonstrated positive results on physical exposure. Regular cut-outs were indicated as a beneficial approach when boxes are handled in high surfaces. When handling occurs in medium heights or in the floor level, handles positioned on the top of the box might bring better results. Efforts to standardize methods are important to support both objective and subjective assessment of box handle design, as well to improve the internal validity of studies.

Can experience modulate handler responses to boxes designed to decrease musculoskeletal load?

Biomechanical load during the handling of commercial (cardboard box with and without cut out) and non-commercial boxes (cardboard box with a retreat on the bottom edges), on experienced compared to inexperienced subjects was evaluated. Thirty-seven inexperienced and 21 experienced workers handled all boxes at shoulder and ground levels. Biomechanical load on upper limb was investigated through posture and electromyography (EMG) recordings. Comfort and effort were assessed immediately after each handling. In general, experienced workers had low range of motion. On the other hand, EMG was similar between both groups, except when non-commercial boxes were handled in non-favourable heights. Comfort was higher when a non-commercial box was handled versus a commercial one, regardless of the group. Both groups had a lower biomechanical load when handling the non-commercial boxes compared to the commercial ones. However, experienced workers did not have the same advantage as inexperienced subjects when handling those new boxes. Practitioner Summary: Box designs favouring intuitive hand coupling and more efficient postures have potential to reduce the risk of upper-limb musculoskeletal disorders in inexperienced subjects. However, ergonomist has to deal with workers on different levels of experience. Results of this study can support the development of effective recommendations for the working context.

Effects of work experience on fatigue-induced biomechanical changes during repetitive asymmetric lifts/lowers

Repetitive lifting/lowering is associated with an increased risk of work-related low back disorders (WRLBDs), and fatigue may exacerbate such risk. Work methods used by experienced workers are potential models for developing worker training to reduce WRLBDs, though whether experience modifies the effects of fatigue on WRLBD risk is largely unknown. Here, six novices and six experienced workers completed 185 cycles of repetitive, asymmetric lifts/lowers. Physical demands, whole-body balance and torso movement stability were assessed using torso kinematics/kinetics, linear/angular momenta and Lyapunov exponents, respectively. Several fatigue-induced changes in movement strategies were evident. Novices decreased and experienced workers increased peak lumbar moments post-fatigue, suggesting lower WRLBD risks among the former in terms of torso kinetics. Other than lumbar moments, though, fatigue substantially reduced group-level differences in torso twisting velocities and accelerations. Post-fatigue movement strategies of experienced workers thus did not appear to be advantageous in terms of WRLBD risk.

Lifting strategies of expert and novice workers during a repetitive palletizing task

Thirty manual material handlers (15 experts and 15 novices) were invited to perform series of box transfers under conditions similar to those of large distribution centers. The objective of the present study was to verify whether multiple box transfers leading to fatigue would also lead to differences between expert and novice workers in joint motions and in back loading variables (L5/S1 moments). The task consisted in transferring 24 15-kg boxes from one pallet to another (4 layers of boxes; 6 boxes/layer: 3 in the front row, 3 in the back) at a self-determined pace and then at an imposed pace of 9 lifts/min for a total of 240 lifts. The underlying idea was to set a challenging task that would force the experts to use their skills. Full-body 3D kinematic data were collected as well as external foot forces. A dynamic 3D linked segment model was used to estimate the net moments at L5/S1. The results clearly show that the experts bent their lumbar spine less (10° less) and were closer (4 cm) to the box than novice workers. Knee flexions were similar in both groups except when the box was lifted from ground level (expert ≈ 71°, novice ≈ 48°). The peak resultant moment was not statistically different (expert = 168 Nm, novice = 184 Nm) although experts had lower values on average than novices when lifting heights (and deposit heights) of the boxes increased. Therefore, experts differed from novice workers mostly in the posture-related variables. These differences are especially important to consider when the box is located on the ground, as the back posture and back loading are then at their greatest magnitude and could have a major impact on the distribution of internal forces on the spine.

The effect of lift teams on kinematics and muscle activity of the upper extremity and trunk in bricklayers

STUDY DESIGN

Workplace-simulation study using a crossover design.

OBJECTIVES

To evaluate the effect of lift teams on trunk and upper extremity kinematics and muscle activity among bricklayers.

BACKGROUND

Healthcare practitioners often instruct individuals with work-related musculoskeletal disorders in proper lifting techniques. Bricklayers are especially affected by lifting-related musculoskeletal disorders. Lift teams are a possible intervention for reducing exposure to heavy lifting.

METHODS

Eighteen apprentice bricklayers constructed walls with concrete blocks alone (1 person) and in 2-person lift teams. Peak shoulder and trunk kinematics and normalized mean surface electromyography of the upper trapezius, lumbar paraspinals, and flexor forearm muscles were collected bilaterally. Differences between construction methods and rows 1, 3, and 6 of the wall were calculated with repeated-measures analyses of variance.

RESULTS

Working in lift teams required less trunk flexion (P = .008) at row 1 but more sidebending at row 6 (P<.001) than working alone. Dominant-side lumbar paraspinal activity was lower at row 3 (P = .008) among lift-team workers. Lift-team peak shoulder flexion was lower at row 3 (P = .002), whereas abduction was higher at rows 1 (P = .007) and 6 (P<.001). Concomitantly, nondominant upper trapezius activity and flexor forearm activity were significantly higher for lift teams at row 6 (P<.001 and P = .007). Block moment arm was significantly greater for lift teams at all rows (P≤.002).

CONCLUSION

Working in lift teams may be a beneficial intervention for reducing trunk flexion and lumbar paraspinal activity when bricklayers work at heights between the knees and waist, but lift teams are not recommended at higher working heights.

Experienced workers exhibit distinct torso kinematics/kinetics and patterns of task dependency during repetitive lifts and lowers

Individual differences in work methods may be related to the risk of injury during manual material handling tasks, yet existing evidence comparing experienced workers and novices is mixed. This study assessed torso kinematics and kinetics among six experienced workers and six novices during repetitive lifts/lowers under different task configurations (symmetric vs. asymmetric and lift vs. lower). Several important potential confounding effects were controlled. Peak kinematic and kinetic measures were typically higher among experienced workers and suggestive of exposure to higher levels of low back injury risk, though overall exposure levels were moderate. Work methods used by experienced workers were modified between task conditions, whereas novice behaviours were more consistent. Control of torso kinematics/kinetics may thus not be a primary factor in determining experienced worker's work methods, and future investigation is needed to establish if, or under what conditions, these methods are protective and/or should be the basis for interventions including training.

PRACTITIONER SUMMARY

Whether lifting experience reduces low back injury risk is unclear from earlier findings. Results from a controlled experiment suggest that lifting experience may not be associated consistently with reduced physical demands or injury risk. Further investigation is needed to assess the utility of training based on the methods of experienced workers.

Assessment of Upper Extremity Postures in Novice and Expert during Simulated Carpentry Tasks

Research has shown differences in working postures between experts and novices for lifting tasks, though there is limited research on upper extremity postural differences between experts and novices. This study quantified upper extremity postural differences between novices and experts while completing two simulated finished carpentry tasks: deck building and picket installation. A 16 camera, motion capture system was used to track upper extremity posture for 21 expert and 21 novice participants while performing 15 minute laboratory task simulations. A biomechanical model, built in AnyBody Modeling System, was used to extract seven different joint postures for wrist, elbow, and shoulder. In general, experts assumed more neutral postures, thereby reducing injury risk associated with non-neutral postures, though task, as expected, dictated the working posture assumed. The picket installation task imposed higher levels of non-neutral wrist and elbow postures; while the deck building imposed higher levels of non-neutral shoulder postures.

Relative importance of expertise, lifting height and weight lifted on posture and lumbar external loading during a transfer task in manual material handling

The objective of this study was to measure the effect size of three important factors in manual material handling, namely expertise, lifting height and weight lifted. The effect of expertise was evaluated by contrasting 15 expert and 15 novice handlers, the effect of the weight lifted with a 15-kg box and a 23-kg box and the effect of lifting height with two different box heights: ground level and a 32 cm height. The task consisted of transferring a series of boxes from a conveyor to a hand trolley. Lifting height and weight lifted had more effect size than expertise on external back loading variables (moments) while expertise had low impact. On the other hand, expertise showed a significant effect of posture variables on the lumbar spine and knees. All three factors are important, but for a reduction of external back loading, the focus should be on the lifting height and weight lifted.

PRACTITIONER SUMMARY

The objective was to measure the effect size of three important factors in a transfer of boxes from a conveyor to a hand trolley. Lifting height and weight lifted had more effect size than expertise on external back loading variables but expertise was a major determinant in back posture.

Effect of initial horizontal object position on peak L5/S1 moments in manual lifting is dependent on task type and familiarity with alternative lifting strategies

This study investigated whether the effects of initial horizontal object position on peak L5/S1 total moment (PTM) are affected by task type or familiarity with alternative lifting strategies during manual lifting. Nine subjects lifted low-lying boxes from far and close initial horizontal positions in a typical laboratory lifting task (without any transportation of the load) and in a more realistic lifting task in which the box was transported to a location at a few metres distance. Subsequently, subjects were familiarised with alternative lifting strategies (e.g. shifting and tilting) and they then repeated the more realistic lifting task. Compared with the typical laboratory lifting task, the more realistic lifting task resulted in 6% larger PTMs for the close-positioned box. Familiarisation with alternative lifting techniques resulted in a 10% reduction in PTMs for the far-positioned box. As a result, the effect of initial horizontal box position on PTMs was smaller for the more realistic lifting task than for the typical laboratory lifting task and vanished after familiarisation with alternative lifting strategies. STATEMENT OF RELEVANCE: This study showed that the effect of horizontal box position on peak L5/S1 moments is dependent on the type of lifting task (comparing a typical laboratory simulated lifting task with a more realistic task involving carrying the load for a short distance) and familiarity with alternative lifting strategies. Therefore, it is recommended that back loading should be evaluated in a realistic simulation of the work situation or at the workplace itself.

Biomechanical differences between expert and novice workers in a manual material handling task

The objective was to verify whether the methods were safer and more efficient when used by expert handlers than by novice handlers. Altogether, 15 expert and 15 novice handlers were recruited. Their task was to transfer four boxes from a conveyor to a hand trolley. Different characteristics of the load and lifting heights were modified to achieve a larger variety of methods by the participants. The results show that the net moments at the L5/S1 joint were not significantly different (p > 0.05) for the two groups. However, compared with the novices, the experts bent their lumbar region less (experts 54° (SD 11°); novices 66° (SD 15°)) but bent their knees more (experts approx. 72° (SD approx. 30°); novices approx. 53° (SD approx. 33°), which brought them closer to the box. The handler's posture therefore seems to be a major aspect that should be paid specific attention, mainly when there is maximum back loading. STATEMENT OF RELEVANCE: The findings of this research will be useful for improving manual material handling training programmes. Most biomechanical research is based on novice workers and adding information about the approach used by expert handlers in performing their tasks will help provide new avenues for reducing the risk of injury caused by this demanding physical task.

What constitutes effective manual handling training? A systematic review

BACKGROUND

Injuries caused by manual handling are a major burden to society. Manual handling training programmes have been designed to reduce the likelihood of injury among the workforce; however, concerns have been raised over the efficacy of current manual handling training methods.

AIMS

To undertake a systematic review of the literature examining the effectiveness of different approaches to training in manual handling.

METHODS

Peer-reviewed publications along with published conference proceedings published in English, between 1980 and 2009, on the topic of manual handling training comprised the search criteria. A published checklist for reviewing papers was selected, which formed the basis for assessing the quality of the papers reviewed.

RESULTS

A total of 1827 papers were located. Following elimination of duplicates, 221 papers were collected and reviewed. Of these, 53 papers were intervention studies with the primary aim of investigating the effectiveness of manual handling training. The review identified little evidence supporting the effectiveness of both technique- and educational-based manual handling training. In addition, there was considerable evidence supporting the idea that the principles learnt during training are not applied in the working environment. Strength and flexibility training shows promise; however, further research is needed to ascertain whether such an intervention is sustainable over the long term.

CONCLUSIONS

The evidence collected indicates that manual handling training is largely ineffective in reducing back pain and back injury. High priority should be given to developing and evaluating multidimensional interventions, incorporating exercise training to promote strength and flexibility, which are tailored to the industrial sector.

Can a new behaviorally oriented training process to improve lifting technique prevent occupationally related back injuries due to lifting?

STUDY DESIGN

A prospective randomized control trial.

OBJECTIVE

To determine the degree to which a new behavior-based lift training program (LiftTrainer; Ascension Technology, Burlington, VT) could reduce the incidence of low back disorder in distribution center jobs that require repetitive lifting.

SUMMARY OF BACKGROUND DATA

Most studies show programs aimed at training lifting techniques to be ineffective in preventing low back disorders, which may be due to their conceptual rather than behavioral learning approach.

METHODS

A total of 2144 employees in 19 distribution centers were randomized into either the LiftTrainer program or a video control group. In the LiftTrainer program, participants were individually trained in up to 5, 30-minute sessions while instrumented with motion capture sensors to quantify the L5/S1 moments. Twelve months following the initial training, injury data were obtained from company records.

RESULTS

Survival analyses (Kaplan-Meier) indicated that there was no difference in injury rates between the 2 training groups. Likewise, there was no difference in the turnover rates. However, those with a low (<30 Nm) average twisting moment at the end of the first session experienced a significantly (P < 0.005) lower rate of low back disorder than controls.

CONCLUSIONS

While overall the LiftTrainer program was not effective, those with twisting moments below 30 Nm reported fewer injuries, suggesting a shift in focus for "safe" lifting programs.

Manual materials handling in mining: the effect of rod heights and foot positions when lifting "in-the-hole" drill rods

There is a paucity of studies focusing on the lifting of rods or long awkward heavy objects. In-the-hole (ITH) drilling is a heavy repetitive mining task, which has been identified as having a relatively high incidence and severity rate of musculoskeletal injuries. The purpose of this study was to examine how the load experienced by ITH drill operators changed when lifting a vertical drilling rod (1.61m, 35kg) using two rod heights and four different foot positions. In addition, a symmetrical lift with a lifting index (LI) of 1.4 also served as a comparison to determine possible risk of low back injury. Eleven experienced ITH drill operators participated in the study. Each subject was required to lift a vertical drilling rod until the upper body was in an erect posture using four different foot positions (0 degrees =subject facing the rod, 45 degrees =subject oblique to the rod, 90 degrees =subject right side to the rod and freestyle). In addition, two rod height conditions were studied where the base of the vertical rod was supported either (1) at ground level (height of rod CG=0.83m) or (2) on a 20cm rack (height of rod CG=1.03m). Finally, each subject lifted a 21.5kg box in the sagittal plane, which corresponded to an LI of 1.4 in the NIOSH lifting equation. Reflective markers were placed on the subjects, and three video cameras and one force plate were used to record the forces and the motion of the subjects' segments. Two surface electrodes were applied on the right and the left erector spinae (ES) at the level of L3. Back loading was defined by the level of the peak moments, the mechanical work and erector spinae muscle activity (EMG). It was found that the vertical height of the rod had the most significant impact on back loading, while the effect of the initial foot positioning relative to the rod was limited by the technique adopted by the drillers. Moreover, it was found that some of the subjects used techniques less strenuous for the back than others. Finally, the asymmetrical lifting component was found to be the most negative aspect of lifting an ITH drill rod compared to a standard symmetrical lift (NIOSH).

The Effect of a Repetitive, Fatiguing Lifting Task on Horizontal Ground Reaction Forces

There are many outdoor work environments that involve the combination of repetitive, fatiguing lifting tasks and less-than-optimal footing (muddy/slippery ground surfaces). The focus of the current research was to evaluate the effects of lifting-induced fatigue of the low back extensors on lifting kinematics and ground reaction forces. Ten participants performed a repetitive lifting task over a period of 8 minutes. As they performed this task, the ground reaction forces and whole body kinematics were captured using a force platform and magnetic motion tracking system, respectively. Fatigue was verified in this experiment by documenting a decrease in the median frequency of the bilateral erector spinae muscles (pretest-posttest). Results indicate significant (p< 0.05) increases in the magnitude of the peak anterior/posterior (increased by an average of 18.3%) and peak lateral shear forces (increased by an average of 24.3%) with increasing time into the lifting bout. These results have implications for work environments such as agriculture and construction, where poor footing conditions and requirements for considerable manual materials handling may interact to create an occupational scenario with an exceptionally high risk of a slip and fall.

Ergonomic identification and biomechanical evaluation of workers' strategies and their validation in a training situation: summary of research

Our goal was to evidence the role of workers in the search for safer manual handling strategies. Different strategies used by expert and novice workers, such as footwork (positioning/displacement), box manoeuvres (handgrips and load tilting) and posture were ergonomically identified. They were biomechanically evaluated to shed light on their potential for safe handling by reducing back loadings, back asymmetries and mechanical work requirements. The experts' strategies were validated in a training situation and evaluated by two independent studies among novice workers. The first, a control study, showed that free practice did not lead to safer handling practices. The second, a training situation based on observing contrasted performances of experts and novices for footwork, box manoeuvres and back posture, when combined with practice and the search for optimal solutions, prompted the novices to adopt new ways of manoeuvring boxes and positioning themselves that appear safer for back efforts, asymmetries, and mechanical work. These elements should be included in educational programs for safe handling.

RELEVANCE

The observation of contrasted strategies of expert and novice workers using an ergonomic approach, supplemented by biomechanical evaluations of these strategies, is a key factor in designing training programs for safe handling.

Scaling of lifting forces in relation to object size in whole body lifting

Subjects prepare for a whole body lifting movement by adjusting their posture and scaling their lifting forces to the expected object weight. The expectancy is based on visual and haptic size cues. This study aimed to find out whether lifting force overshoots related to object size cues disappear or persist over a number of repeated lifts. In addition, the influence of the degree of alternation between load sizes, and the influence of knowledge of actual object weights prior to the lifts, were investigated with regard to their effect on force overshoots. Four experiments were performed using a large and a small box, each of 8.4 kg weight, and varying degrees of alternation between boxes. In two of the experiments, subjects were informed about the weight of the objects, while in the other two experiments they were not informed about the weight of the objects. When boxes were lifted 15 times before switching to the other box, rapid diminishing of force scaling errors was observed. However, when boxes were alternated each lift or after three lifts, persisting force scaling overshoots were found in lifting the large box compared to the small one. When participants were given information regarding the actual object weight, force overshoots in the first pair of large and small box lifts were not different from overshoots in experiments where subjects were not informed about the weight of the objects. This shows that, for occupational lifting, risks related to force overshoots in lifting large objects can persist despite experience in lifting the objects and despite the use of labels indicating the weight of the objects.