Causes of Reportable Injuries

Mechanics of the
Human Spine
Lifting and Spinal Compression

Text: Chapter 7
Nordin and Frankel: Ch. 10 by Margareta Lindh
Hall Ch. 9 (more muscle anatomy detail than required)

Types of Handling Accidents

Manual Handling Injuries
¾ Approximate 33% of the U.S. workforce is
presently required to exert significant force
as part of their jobs (NIOSH, 1981).
¾ This can lead to external injuries (cuts,
bruises, crush injuries, lacerations of fingers,
hands, forearms, ankles and feet), internal
injuries (muscle and ligament tears, hernias,
knee ankle and shoulder injuries) and
cumulative back injuries (slipped disc).

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 Most
flexion in
these
regions

Review terms: tension, compression,

shear, bending, torsion. Low Back Pain (LBP)
¾ Lifetime prevalence of LBP is very high (80+%)
¾ MMH is a major cause of work related LBP and
other musculoskeletal injuries.
¾ However, LBP is common in work environments
where no MMH occur, such as seated work.
¾ Work-related psychological stress and lifestyle
factors may also increase LBP risk.
¾ Possibly only 33% of work-related LBP is due to
lifting and bending tasks (Brown, 1973 & Magora, 1974)

Relative loads on the third

lumbar disk for living subjects

Upright standing
depicted as 100%

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 The line of gravity
shifts further ventrally
during relaxed
unsupported sitting (B)
as the pelvis is tilted
backward and the
lumbar lordosis
flattens (this creates a
longer lever arm).
When sitting erect (C)
the pelvic backward tilt
is reduced and the
lever arm shortens
(still longer than when
standing (A).

Decrease is
seen in all
spinal regions

Compressive Disk Force vs.

different backrest inclination
and size of lumbar support

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 Causes of LBP Personal Risk Factors
¾ Physique / anthropometry / strength
LBP is a big industrial
(static / dynamic endurance)
problem (low back
injury claims account ¾ Physical fitness / health history / spinal
for 40-50% of abnormalities / spinal mobility
compensation claims in ¾ Age / gender
some industries) but, ¾ Psychophysical factors / motivation
as stated, it is not only ¾ Training and selection (experience)
caused by lifting.

Workplace Risk Factors Analysing Lifting Tasks

¾ Load characteristics (weight, size, shape,
handles, other couplings)
¾ Posture / handling techniques (stretching,
reaching, twisting)
¾ Confined environments / spatial restraints
¾ Safety aspects / protective equipment
¾ Duration / repetition
¾ Work organization (spacing tasks out) More detail
¾ Environment (heat, humidity, noise, glare, etc.) in Kin 380

Lifting task evaluation criteria

Epidemiological Analysis
¾ Biomechanical
The approach is concerned ¾ maximum disc compressive force
with identifying the
¾ limits lumbosacral stress
incidence, distribution and
¾ NIOSH cut-off value of 3.4 kN (≈350 kg)
type of injury in the
workforce. It is hoped that ¾ most important for infrequent lifting tasks
by studying comparative ¾ Physiological
data, conclusions can be ¾ maximum energy expenditure
drawn about injury type, ¾ limits metabolic stress and fatigue
contributing factors and ¾ NIOSH cut-off value of 2.2-4.7 kcal/min
probability of occurrence. (varies with specific task variables)
¾ most important in repetitive lifting tasks

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 Lifting task evaluation criteria Justification for the Criteria
Psychophysical ¾ Regarding the Biomechanical criteria in
¾ limits loads based on workers perception the revised NIOSH equation (1991):
¾ uses the concept of a maximum acceptable ¾why choose L5/S1?
weight
¾why compressive force [Fcomp]?
¾ applicable to nearly all lifting tasks (except
high-frequency lifting above 6 lifts per min) ¾why 3.4 kN?
¾ NIOSH cut-off acceptable to 75% of
female workers and 99% of male workers.
¾ other researchers (Snook, Mital et.al. provide
different tables for males and females).

L5 / S1 ? Compressive Force Vector?

¾ Studies have confirmed that lifting under certain
conditions is limited more by the stresses on the
lumbar spine than by limitations of strength.
¾ Biomechanical models of lifting show that large
moments are created in the trunk (especially if the
load cannot be held close).
¾ The disk between L5/S1 has the potential to incur
the greatest moment and is one of the most
vulnerable tissues to force-induced injuries.
¾ Between 85-95% of all disk herniations occur
relatively equally at the L4/L5 & L5/S1 levels.
¾ The relative importance of compressive, shear
and torsional forces is not well understood.
¾ Disc compression is thought to be largely
responsible for vertebral end-plate fracture, disc
herniation, and resulting nerve root irritation.
¾ Back compression is a good predictor of low-
back and other overexertion injuries? [Herrin+, 1986]
¾ Due to clinical interest in this area data exists
on the compressive strength of the lumbar
vertebral bodies and intevertebral disks.

Chaffin & Park, 1973

3.4 kN = maximum compression 20

¾ NIOSH reviewed data from cross-sectional LBP

field studies that provided estimates (from incidence 15
biomechanical modeling) of Fcomp generated
by lifting tasks and subsequent injuries. (freq. rates
¾ Herrin et. al. 1986 studied 55 jobs (2934 per 200,000 10
potentially stressful MMH tasks) and traced man-hours
worked)
medical records (6912 workers).
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¾ For jobs with Fcomp between 4.5-6.8 kN the
rate of back problems was 1.5 times greater 0
than for jobs with Fcomp less than 4.5 kN 0-250 250-450 450-650 >650
Predicted compressive forces on L5/S1 disc (kg)

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 ¾ Calculate the forward
Cadaver Data (clockwise) bending
moment about L5/S1
¾ Jager & Luttman (1989) found the mean
(red square)
compressive strength of lumbar segments to
Lw = 0.25 m
be 4.4 kN with a SD of 1.88 kN.
Lp = 0.4 m
¾ If normally distributed, 30% of segments had ¾ Answer = -192.5 Nm
a lumbar strength less than 3.4 kN. ¾ If the erector spinae
¾ Brinckmann et. al. (1988) found compressive moment arm is estimated
strength ranged 2.1 to 9.6 kN. <21% fractured at 0.05 m. What is the
(or suffered end-plate failure) below 3.4 kN magnitude of the muscle
force?
¾ How relevant are cadaver results to LBP?
¾ Answer = 3850 N

Lw = 0.18 m Lw = 0.25 m 1 2
Lp = 0.35 m Lp = 0.5 m Muscle Force
212.5/0.05 =
1 2 4250 N

Muscle Force
151/0.05 =
3020 N
Find the muscle
moment and
muscle force

Lw = 0.18 m Lw = 0.25 m
Compression and Shear
Lp = 0.35 m Lp = 0.5 m 2
¾ Once you have calculated the muscle force
you can calculate the compressive and 1
shear forces across L5/S1. Trunk angle Trunk angle
80o 65o
¾ However, you cannot do this for the
questions just given. Why? Think about
what information you would need and how
you would go about calculating these Find the
values.
compressive
¾ You need to know the alignment of the and shear
segment in question (i.e. trunk).
forces at
L5/S1

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 Compression & Shear Solution Free Body Diagrams
¾ In this simple model, three main forces act 200 N 200 N
on the lumbar spine at the lumbosacral Trunk
(L5/S1) level: Segment
Ignore
¾ The force produced by the weight of the arm weight
upper body (body mass above L5/S1).
Arm
¾ The force produced by the weight of the
object. ΣFy = 0 Segment
Fm
¾ The force produced by the erector spinae
muscles (which acts approximately at right 450 N
angles to the disc inclination).
Shear
200 N Compressive Force

Compression and Shear Compression Calculations

200 N Muscle force = 3020
Trunk 3020 + (450 x sin 80) + (200 x sin 80) - C = 0
1
Segment 3020 + 443.16 + 196.96 - C = 0
C = 3660.12 = 3660 N
Shear force
components in blue
Fm Muscle force = 4250
Compressive force
2 4250 + (450 x sin 65) + (200 x sin 65) - C = 0
450 N
components in pink 4250 + 407.84 + 181.26 - C = 0
C = 4839.10 = 4839 N
θ

The solution to this diagram is in the

Shear Calculations Lw = 0.25 m Nordin and Frankel text
Lp = 0.4 m ¾ Same diagram as used earlier
Muscle force does not act in shear direction
¾ As the other examples
(450 x cos 80) + (200 x cos 80) - S = 0
1 calculate the total forward
78.142 + 34.730 - S = 0 bending moment produced by
S = 112.87 = 113 N these two forces and the
resultant muscle force
required to maintain stable
equilibrium.
(450 x cos 65) + (200 x cos 65) - S = 0 ¾ Assuming the trunk is aligned
2 55o to the horizontal (forward
190.18 + 84.52 - S = 0
bend of 35o) find the
S = 274.70 = 274 N
compressive and shear forces
acting on L5/S1.

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 Problem?
Forces Acting on the Link
¾ How do you actually know where
the centre of gravity of the Segment Model
segments above L5/S1 are
located?
¾ Gravitational forces.
¾ You can calculate it knowing the
segment centre of mass ¾ Ground reaction forces and other
locations…BUT.. external forces.
¾ This is time consuming and you ¾ Muscle forces and joint reaction forces.
will miss additional information
that can be calculated just as
easily

Remember this is really Chaffin’s Model

what it looks like.
Fj Fm3 So if you are
calculating NET joint
Fm2
forces remember that
they are just that
“NET”. They bear no
Fm1 relationship to the true
joint reaction force!
mg

Ry2
Rx2 Action and Reaction Limitations of this Method
between two segments
M2 ¾ Any force which is calculated at a joint will
Newton’s Third Law! be the vector sum of the muscle forces
m2g (note plural, usually there is more than
Ry1 one common tendon for muscles crossing
-M1 that joint) and the true joint reaction force
Rx1
(bone-on-bone force).
-Rx1 M1 ¾ Unfortunately this net joint force cannot be
separated into its muscular and joint
-Ry1 reaction components.
m1g

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 Advantages
L4
¾ The advantage of this method is that net
muscle moments can be calculated for all
the joints (with the models shown in the
lecture on lifting, we are calculating the
moment only about one joint). L5
¾ If you calculate a moment across a joint
system where you can accurately model the
muscle as a single equivalent muscle (e.g.
erector spinae), then you can determine
muscle force and joint reaction force as we S1
have done in many of our problems already.
5-6 cm

Mean Isometric Joint Moments of Force (Nm)

Predicted Strength [strength values] Stobbe’82

¾ There are tables suggesting safe limits for Male %var. Female %var.
muscle moments for various joints. Hip Flexion 232 17 168 38
¾ Other tables provide maximal strength Extension 251 31 128 41
muscle moments. It is for the ergonomist, Knee Flexion 118 4 69 32
designer, etc, to decide if task is suitable.
Extension 267 3 123 33
¾ Still other tables provide equations to
predict strength. These generally factor in Trunk Flexion 301 19 174 24
joint angles. Extension 391 19 244 22
% var. = % variability = (S.D./mean) x 100

Inverted Pendulum
Link Segment Models Assumptions

¾ Each segment has a fixed mass located as

a point mass at its centre of gravity.
¾ The location of the centre of gravity remains
fixed during movement.
¾ The joints are considered to be hinge (pin)
joints (2 dimensional models).
¾ The moment of inertia of each segment
about its mass centre (or distal and proximal
joint centres) is constant during movement.

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 Buckling
¾ If the work done on
the spine (energy
applied) is greater
than the work the
muscles can do to
stiffen the spine,
then the spine will
buckle.

Comp Spinal Exercises / Core Strength

¾ Know the neutral spine position
Rounded Straight
¾ Proper lordosis
¾ Blood pressure cuff tests
Shear
¾ Check posture during lifting / work
¾ Avoid trunk flexion
¾ At full flexion spinal erector muscles are inactive

Ligament Force
Fully flexed spine inactivates back extensors, Muscle Force
loads the posterior passive tissues and results
in high shearing forces. Neutral spine posture
disables interspinous ligaments reducing shear. Joint Shear Joint Shear

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