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International Journal of Industrial Ergonomics 29 (2002) 161169

Are back and leg muscle strengths determinants of lifting


motion strategy? Insight from studying the effects of
simulated leg muscle weakness
Xudong Zhanga,*, Trina Buhrb
a

Department of Mechanical and Industrial Engineering, University of Illinois at Urbana-Champaign, 1206 West Green Street, Urbana,
IL 61801, USA
b
Medtronic Inc., Minneapolis, MN 55432, USA
Received 14 January 2001; accepted 18 September 2001

Abstract
This paper describes the rst of a series of studies aimed at elucidating whether back and leg muscle strengths are the
intrinsic determinants of lifting motion strategy. The study started with an experiment in which six female subjects
performed lifting tasks under three conditions: one unconstrained condition in which subjects used a self-selected lifting
strategy and two simulated muscle weakness conditions in which they used a real-time EMG-based biofeedback
technique to control either gastrocnemius or rectus femoris contraction level at 45% of the pre-calibrated maximum
strength. The lifting trials were measured and then kinematically modeled to derive index values that quantied the
motion strategies. The effects on initial posture and peak joint angular velocity were also examined. Results showed
that both simulated muscle weakness conditions had a marked effect on the lifting strategy. While subjects preferred a
strategy that predominantly or signicantly relied on the legs under unconstrained condition, a general trend of
alteration towards a back-lift strategy was observed when simulated leg muscle weakness was administered.
Implications of a suggested causal relationship between muscular strength and lifting motion strategy are discussed.
Relevance to industry
This work seeks to identify and quantify a causal relationship between degraded back or leg muscular strength and
lifting motion alteration. Such a relationship can contribute towards the development of a motion-based strength
evaluation system for applications including return-to-work assessment and rehabilitation progress monitoring. It can also
lead to practical guidelines and computer simulation models for designing consumer products or workplaces that better
accommodate special populations with degraded strength capabilities. r 2002 Elsevier Science B.V. All rights reserved.
Keywords: Muscle strength; Lifting motion strategy; Biofeedback

1. Introduction
*Corresponding author. Department of Mechanical and
Industrial Engineering, University of Illinois at UrbanaChampaign, 1206 West Green Street, Urbana, IL 61801,
USA. Tel.: +1-217-265-8031; fax: +1-217-244-6534.
E-mail address: xudong@uiuc.edu (X. Zhang).

Muscle strength degeneration, either age-related


or injury-induced, can signicantly impact the
lives for a large yet increasing portion of our

0169-8141/02/$ - see front matter r 2002 Elsevier Science B.V. All rights reserved.
PII: S 0 1 6 9 - 8 1 4 1 ( 0 1 ) 0 0 0 6 2 - 2

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X. Zhang, T. Buhr / International Journal of Industrial Ergonomics 29 (2002) 161169

population. For instance, low-back pain, as one of


the most prevalent and costly musculoskeletal
disorders among industrial workers is usually
accompanied with back strength degradation
(Chafn, 1974; Langrana et al., 1984; Kishino
et al., 1985). Leg muscle strength for the steadily
expanding elderly population could, on average,
decline by 20% to 50% or more with reference to
healthy young adults (Murray et al., 1980, 1985;
Young et al., 1984, 1985; Vandervoort et al., 1986,
1990). Comparable age-related decrement in back
strength has also been documented (Balogun et al.,
1991). Naturally, degradation of muscular
strength leads to reduced functional capabilities
and possibly elevated risk of injury or re-injury in
performing physical activities.
Lifting is a common volitional daily task
required in numerous occupational as well as
leisure settings. In fact, according to a survey by
the National Longitudinal Surveys of Labor
Market Experience, the inability to lift or carry
weights was singled out as the factor most
signicantly related to limitations in the kind or
amount of work performed by the elderly (Chirikos and Nestel, 1985). Another survey of 5100
men and 4705 women aged 5574 years by Kovar
and LaCroix (1987) indicated that up to 17%
reported the inability and another 41% reported
difculty when tasks including stooping, crouching, lifting and carrying a 25-lbs weight were being
performed. It is for these reasons that considerable
investigative efforts have been dedicated to quantifying the relationship between strengths, specically of back and/or leg muscles, and lifting
capacity (Chafn et al., 1978; Garg et al., 1980;
Paulson, 1981; Pytel and Kamon, 1981; Wilmarth
and Herekar, 1991). A general conclusion from
these investigations is that back and leg muscle
strengths are indeed the two primary limiting
factors of an individuals lifting capacity.
Muscle forces produce bodily movements. Thus,
one possible manifestation of strength degeneration, particularly when it is localized (i.e., specic
to one or a few muscle groups), may be aberration
of the movements that rely on the specic muscles.
There, however, appears to be a dilemma that
hinders systematic investigation of how muscle
degradation. On one hand, since most volitional

motions often do not require maximum muscle


action, a causal relationship between strength
degradation and motion aberration is not readily
identiable. On the other hand, it is inadvisable to
have human subjects with compromised strength
engage in physical tasks at a level near or
exceeding the maximum capacity. Thus, direct
evidence from studies employing subjects with
degraded strength is sparse. In the context of
manual lifting research, some indirect evidence has
accumulated, suggesting that a causal relationship
between strength degradation and motion aberration might be plausible.
Lifting movements without substantial arm
assistance require signicant involvement of back
and/or leg muscles. Two typical motion strategies
for dynamic lifting are referred to as back-lift and
leg-lift strategies which utilize primarily the back
and leg muscle groups, respectively (Garg and
Herrin, 1979; Kumar, 1984; Toussaint et al., 1992;
Burgess-Limerick and Abernethy, 1997). These
two strategies have rather different biomechanical
consequences in terms of the physical stress posed
to the involved body joints: a back lift, as
compared to a leg lift, usually begins with a
stooping posture, and generally results in higher
back muscle stress and disc compression force at
the lower spine region; a leg lift, with a more
upright torso and squatting initial posture, places
greater physical demand on the leg muscles and
knee joint while relieving the low back (Garg and
Herrin, 1979; Beijani et al., 1984). Results from
several lifting studies have suggested that people
alter their lifting kinematics as the external load
changes. As reported by Garg and Herrin (1979), a
back-lift technique facilitates greater mechanical
work and allows a heavier load to be lifted.
Schipplein et al. (1990) conrmed the tendency to
lift more with the back and less with the legs as the
load being lifted increases. Their ndings also
suggested that lifting strategy is dependent upon
the external weight being lifted as well as an
individuals lifting ability, and that the quadriceps
muscle strength limits the ability to lift with exed
knees. A further investigation conducted by the
same research group (Tramow et al., 1993)
revealed that when quadriceps muscles became
fatigued, subjects adapted a change from more of a

X. Zhang, T. Buhr / International Journal of Industrial Ergonomics 29 (2002) 161169

squat towards a stoop lift. Although all these prior


studies employed normal healthy subjects, they
appear to logically lead to the hypothesis that
people with reduced back or leg strength may, as a
protective mechanism, adopt a lifting motion
strategy that tends to relieve the weakened or
weaker muscles.
The long-term objective of our series of studies
is to seek a better understanding of what
inherently dictates the general movement strategy
during lifting activities, by testing the above
hypothesis in a systematic fashion. In this particular study, we explored an original use of
EMG-based biofeedback to simulate leg muscle
weakness, as a solution to the dilemma stated
earlier. The specic aim of this study, therefore,
was to investigate the effects of simulated leg
muscle weakness on lifting motion strategy. This
was accomplished through measuring, modeling,
and visualizing the strategies of lifting motions
performed by healthy female subjects with leg
muscles selectively inhibited using real-time EMGbased biofeedback control.

2. Methods
2.1. Subjects
Six females aged 2128 years volunteered to
serve as subjects of this study. Subjects were
selected within a relatively narrow height and
weight range (stature: 156170 cm; weight: 51
65 kg) to minimize the anthropometric effect. All
subjects reported above average physical activity
level and good to excellent health, with no prior
history of low-back pain, dizziness, recent surgery,
leg pain, or abnormal motion pattern. Subjects
read and signed a consent form which was
approved by the institutional human subject
review committee.
2.2. Experimental protocol
The subjects performed lifting tasks in which
they moved a 15 kg box vertically from the ground
to their waist level in a sagittally symmetric
manner (Fig. 1a). The task was performed under

163

Fig. 1. The lifting task performed during the study (a) and a
three-segment linkage representation for kinematic modeling of
the lifting motions (b). Spherical reective markers were placed
unilaterally on subjects bony landmarks including the lateral
malleolus, the lateral femoral condyle, and the greater
trochanter, which correspond to the ankle, the knee, the hip,
and shoulder joints, respectively. The linkage representation
incorporates three degrees of freedom (y1 ; y2 ; and y3 ).

three different conditions: (1) unconstrained condition in which subjects performed the lifting task
using a self-selected strategy; (2) simulated weak
gastrocnemius condition in which subjects performed the lifting task while keeping the gastrocnemius contraction level at 45% of the maximum;
(3) simulated weak rectus femoris condition in
which subjects performed the same lifting task
while keeping their rectus femoris contraction level
at 45% of the maximum. The latter two conditions
were achieved using a real-time EMG-based
biofeedback control technique. This technique
required bipolar electrodes to be placed on the
belly of the medial gastrocnemii and the rectus
femorii such that the subjects were able to monitor
the EMG amplitude of a particular muscle group
while performing the lifting tasks, and keep it at a
pre-set level of 45% of the maximum. The
maximum EMG level was pre-determined during
a calibration procedure in which the subjects
isokinetic strengths (knee extension and ankle
plantar exion) and the corresponding peak
EMG values were recorded. Selection of the 45%

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X. Zhang, T. Buhr / International Journal of Industrial Ergonomics 29 (2002) 161169

weakness level was based on the following


information. In a preliminary study that required
pilot subjects to perform unconstrained free-style
lifting, it was found that the EMG levels of rectus
femorii and gastrocnemii varied between 5060%
of the maximum. Thus, a 45% EMG biofeedback
level would be the uniform level to pose a
challenge but not to an excessive extent (e.g.,
exertion not enough to lift a specied load). In
addition, a computer-simulated sensitivity analysis
was conducted in which the knee extension torque
was systematically varied as percentages of measured knee extension strength, and fed into a
forward dynamics simulation model. The analysis
showed that 45% of the maximum (strength) was
about the level at which the initial static posture
started to show some effect (Buhr, 1998). Note,
however, the initial static posture does not
necessarily indicate whether overall a back-lift or
a leg-lift strategy is utilized (Zhang et al., 2000).
More elaborate descriptions of the real-time
EMG-based biofeedback control technique and
the forward dynamics sensitivity analysis are
presented in Buhr (1998).
Subjects were instructed to maintain a consistent and comfortable lifting speed throughout all
the trials. At no time was a particular lifting
strategy prescribed to the subjects. Practice trials
were allowed until the subjects gained complete
familiarity with the tasks and indicated they felt
ready to proceed. This was particularly important
for the simulated muscle weakness conditions in
which the subjects needed substantial training to
be able to properly track the EMG signals and
inhibit the muscle contraction at the specied level.
When a generally specied lifting task was
completed successfully, the subject was asked to
repeat the task under the same condition. Sufcient inter-trial rests were provided to the subjects
to minimize the effect of muscle fatigue.
2.3. Lifting movement measurement
Lifting movements were recorded by capturing
reective surface markers placed on the right side
of the subjects at the lateral malleolus, the lateral
femoral condyle, and the greater trochanter, and
the acromion process (Fig. 1a). A single camera

motion capture system (Motion Analysist) embedded with the LiftTrakt processing software
was used. The sampling frequency was 60 Hz. The
measured 2D coordinates of markers allowed
construction of a planar linkage representation
consisting of three segmentsFthe torso, the upper
leg, and lower leg, as illustrated in Fig. 1b. This
linkage representation served as the basis for
kinematic modeling as described in the following.

2.4. Kinematic modeling and lifting motion strategy


visualization
Eighteen measured lifting movements (as the
rst of two replicates obtained under the same
condition) were modeled, using an approach
proposed by Zhang et al. (2000), to derive lifting
strategy index values. This approach models
dynamic lifting strategies in the velocity domain
as different ways of partitioning postural changes
between the torso and leg segments. The index is
composed of two parameters assigned to the two
leg segments, quantifying their motion contributions relative to the torso. Given a measured lifting
movement, its index parameter values, ranging
from 0.1 to 10, are estimated through an enumeration search process with the objective of minimizing the tting error. The index affords a lifting
strategy classication that captures the entire
movement yet in a compact binary form: at
least one of the index values is no less than 1 for a
typical leg lift; none exceeds 1 for a typical back
lift. Indistinct or intermediate strategies (e.g., a leg
segment is signicantly involved during a lift that
predominantly relies on the torso, or vice versa)
may also be discerned, as the involvement of each
segment in a lifting movement is quantied. In
addition, the response surfaces, which depict the
tting error as a function of the two index
parameters, would show distinctive characteristics
for different lifting strategies. These response
surfaces, along with the index values, facilitate a
visualization of the lifting strategies and possible
effect of simulated leg muscle weakness. Examples
of response surfaces for a typical back-lift strategy
and a typical leg-lift strategy are illustrated in
Fig. 2a and b, respectively (Zhang et al., 2000).

X. Zhang, T. Buhr / International Journal of Industrial Ergonomics 29 (2002) 161169

165

by a moving Hanning-weighted window averaging


method (note prole smoothing was not necessary
for the above kinematic modeling, as the index
derivation was effectively a curve-tting process).
The angular velocities were calculated through
numeric differentiation of the smoothed angular
proles using a three-point central difference
technique (Winter, 1990, p. 47). The peak velocity
was then determined as the maximum absolute
value. The initial postural angles and the peak
joint angular velocity values were compared
statistically between task conditions (unconstrained, simulated weak gastrocnemius, and
simulated weak rectus femoris) using two-sided
paired t-tests. These analyses of initial postural
angle and peak joint angular velocity included
both replicates (i.e., a total of 36 trials).

3. Results

Fig. 2. Response surfaces for a typical back lift (a) and a


typical leg lift (b). Note that the index parameters r1 and r2 are
designated to the lower leg (y1 ) and upper leg (y2 ), respectively
(Adapted from Zhang et al., 2000, Journal of Biomechanics).

2.5. Analyses of initial posture and peak joint


angular velocity
Since the initial strategy of positioning the body
may not always be indicative of the motion
strategy used in a dynamic lifting process (Zhang
et al., 2000), complementary analyses were performed to examine the effects of simulated muscle
weakness on initial static posture and peak joint
angular velocity. The initial static posture was
quantied by the three joint angles y1 2y3 (see
Fig. 1b). The derivation of joint angular velocity
consisted of several steps. The joint angular
proles were rst smoothed via a low-pass lter

The enumeration search processes yielded 18


pairs of index values and corresponding response
surfaces for the 18 lifting trials performed by 6
subjects under three different conditions (Fig. 3).
Note that an index, with its two parameters r1 and
r2 designated to the lower and upper leg,
respectively, is in fact the minimum on the
response surface. For unconstrained free-style,
there was less consistency in the lifting strategy
but subjects seemed to prefer a strategy that
predominantly or signicantly relied on the legs,
as suggested by that at least one of the two index
parameters is much greater than 1. The response
surfaces for these free-style lifts also largely
resemble that of a typical leg lift (Fig. 2b) except
the one for subject 6 (for which the index
parameter values strongly indicate a leg-lift
strategy). With the exception of subject 1, both
simulated muscle weakness conditions had a
marked effect on the index value as well as the
shape of the response surfacesFa change towards
a back-lift strategy was evident. However, neither
the index values nor the response surfaces appear
to exhibit patterns that would show a difference
between the two conditions of simulated muscle
weakness. In other words, there was no evidence to
suggest that simulated weak gastrocnemius or

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X. Zhang, T. Buhr / International Journal of Industrial Ergonomics 29 (2002) 161169

Fig. 3. Lifting motion strategy index values and response surfaces for 18 trials performed by six subjects under three different
conditions.

rectus femoris would incur a back-lift strategy but


with relatively more lower or upper leg involvement.
Table 1 summarizes the effects of simulated leg
muscle weakness on the initial posture and the
peak joint angular velocity. Both simulated weakness conditions caused signicantly more extended
knees at the beginning of lifts: the average
decreases in y2 or increases in the knee extension
induced by the simulated weak gastrocnemius and
rectus femoris were, respectively, 611 and 571. This
effect implies that the subsequent lifting motion
would use the back as the primary mover, which is
consistent in general with what was revealed by the
above indexes. No signicant change however

could be identied in the initial hip joint angle or


the ankle joint angle. A reduced leg motion
contribution under simulated muscle weakness
condition was also evidenced in the peak joint
angular velocityFit decreased signicantly for the
knee joints. Again, the peak joint angular velocity
values for the hip and ankle do not seem to
provide any indication of change.

4. Discussions
Currently, a clear understanding of why people
elect one motion strategy over another in a lifting
task is lacking. A variety of task variables, such as

X. Zhang, T. Buhr / International Journal of Industrial Ergonomics 29 (2002) 161169


Table 1
Mean (7 Standard Deviation) values of initial postural angles
and peak joint angular velocities under three task conditions
Unconstrained
free style
Initial
postural
angle (1)
Ankle
873
Knee
124710
Hip
14477
Peak
angular
velocity
(1/s)
Ankle
Knee
Hip

45716
145729
185735

Simulated weak
gastrocnemius

Simulated weak
rectus femoris

973
**63733
14077

1175
**67716
14076

60719
**65729
**145723

60721
**96725
180737

** Signicant at a po0:01 level; * Signicant at a po0:05 level.

the size and weight of the object being handled,


and the origin or destination locations of the
object, may inuence or even enforce a particular
lift style. However, when people are allowed to use
self-preferred free styles for the same lifting
tasks, there is not much consistency in the postures
and movements adopted by different individualsFthis is also somewhat evidenced in the
results from this study. Whether it is due to
entrenched habit or determined by some intrinsic
mechanism remains a mystery. This in fact has
been used as an argument against prescription or
instruction of proper lifting techniques. One of the
reasons that previous investigations along this line
were not discerning or sometimes even resulted in
contradictory ndings may be that normal subjects
(in terms of muscle strength) were being studied.
Use of biofeedback technique to simulate muscle
weakness or subjects with degraded strength
enables us to examine whether such perturbations cause alterations in lifting motion, and
eventually elucidate whether back and knee
strengths are the intrinsic determinants of lifting
motion strategy. Results from this initial study
encourage subsequent investigations employing
subjects with degraded back or leg muscle
strength. Most importantly, it appears that in-

167

dividuals with some degree of strength degradation (e.g., 2040% of the norms) but still able to
safely perform moderate level load-lifting tasks
may exhibit identiable motion aberrations.
In addition to advanced basic understanding of
the role of muscle strength in determining lifting
motion strategies or motor strategies in general,
the current and subsequent studies may lead to a
quantitative description of the relationship between muscle strength degradation and motion
aberration. Two implications are foreseeable.
First, such a quantied relationship can be used
conversely for diagnosing muscle strength changes
in applications such as return-to-work assessment
or rehabilitation progressing monitoring. A motion-based means may offer a potentially more
exible, practical, and reliable alternative than
conventional strength testing for mechanical capacity evaluation. Rigorous strength testing is and
will continue to be cumbersome in both protocol
and equipment. In contrast, technological advancement has allowed human motions to be
captured and analyzed in a non-intrusive, relatively time-efcient, and cost-effective manner.
There are also circumstances under which true
strength measures are difcult to obtain. For
instance, individuals with musculoskeletal condition claims may not be willing to perform
maximum voluntary exertions in a strength test.
This latter concern might partly contribute to the
ineffectiveness of pre-employment strength testing
in reducing work-related musculoskeletal disorder
claims (Chafn et al., 1999, pp. 507510). Second,
a possible cause-effect relationship between
strength degradation and motion aberration can
be used to guide the design of consumer products
and workplaces that better accommodate special
populations, especially those with comprised
strength capabilities. A quantitative relationship
may also lead to a predictive model for computer
simulation of motions performed by people with
weakened muscle strength. Such a model would be
a valuable addition to the existing biomechanical
analysis and ergonomic assessment models that
are largely based on natural normative movements.
The lifting strategy indexes, complemented by
the initial postural angles and peak joint angular

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X. Zhang, T. Buhr / International Journal of Industrial Ergonomics 29 (2002) 161169

velocity values, appear to be effective in quantitatively characterizing the lifting kinematics. Nevertheless, use of initial postural angles alone, or even
along with the peak joint angular velocity analysis,
cannot provide a complete characterization. As
shown in this study, these latter measures were
conrmative but not very informative by themselves.
Two limitations of the present study are
recognized. First, there was only one level (45%)
of simulated muscle weakness. Although this was
not arbitrary but determined by methodical
analyses, a multi-level simulation would offer
much richer insight into issues such as what
strength degradation level would be just enough
to cause signicant motion aberration or to
prevent an individual from successfully performing
a particular lifting task. These issues have very
meaningful implications on ergonomic job design
and injury prevention. Second, the sample size of
our experiment was limited and not sufcient for
deriving a mathematical model that maps the
various strength degradation levels to different sets
of index parameters. A large-scale empirical effort,
using subjects with moderate level of muscle
strength deciency, is underway and will facilitate
the development of a robust model.

Acknowledgements
This work was supported in part by a grant
from the University of Illinois at Urbana-Champaign Campus Research Board.

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