output from many muscles to directly assess which muscles are active in response to an external load.Current methods use the real time recording of electromyographic (EMG) activity from trunk muscles and three dimensional geometric model of the trunk to predict the three-dimensionalloading of the spine under dynamic lifting conditions over time (Granata & Marras, 1993, 1995;Marras & Granata, 1995, 1997a, b; Marras & Sommerich, 1991a, b; McGill & Norman, 1985, 1986;van Dieen, Hoozemans, van der Beek & Mullender, 2002; van Dieen, JJ, Groen, Toussaint & Meijer,2001). Applications of these models have demonstrated that spine loading varies as a function of rep-etition (Granata, Marras & Davis, 1999), forward bending (Granata & Marras, 1995; Marras & Sommer-ich, 1991b), and trunk moment (Granata & Marras, 1993, 1995; Marras & Sommerich, 1991b). Loadingcan occur in compression, shear, or torsion. To date, these models are the most accurate models availablefor the assessment of realistic work conditions. When the results of these studies are combined withthe epidemiological studies that lifting below knuckle height, or at a greater horizontal distance fromthe trunk are more hazardous than lifting done between knuckle height and mid-chest height close tothe body, a strong rationale is present for assessing LBD risk as a function of load location during lifting.
50.2.2 Load Tolerance
While the tolerance limits for spine damage is not completely understood, for the vertebral end plate, therange of
in vitro
tolerances is known from laboratory studies of the relationship of compression forces. Alldirect tolerance data has been derived from cadaveric tissue damage to the disc or the vertebral end plates.Severalpossiblemechanismsofinjury arethoughttoexist.One ofthemoreplausiblemechanismsfor LBDsinvolves microfracture of the vertebral end plates. As healing occurs, scar tissue develops at the endplatethat interferes with nutrient delivery to the disc. This loss of nutrient results in atrophy of the discfibers, which may initiate chronic damage to the disc and may result in disc degeneration or herniation.There is some scientific evidence that the
in vivo
and
in vitro
tolerance levels do not differ greatly (Waters, Putz-Anderson, Garg & Fine, 1993; Yoganandan, 1986). Increasing levels of disc compressioninitiate a number of other harmful disc responses at the cellular level, thus, providing further evidenceof a cumulative damage to the spine (Lotz & Chin, 2000; Lotz, Colliou, Chin, Duncan & Liebenberg, 1998).Jager and coworkers (Jager & Luttmann, 1999; Jager, Luttmann & Laurig, 1991) have shown thatlumbar vertebra tolerances vary as a function of gender and age. Their data suggests that approximately 30% of lumbar segments have a tolerance of 3.4 kN or less (Waters et al., 1993). This value of 3.4 kN wasselected as a tolerance criterion in developing the NIOSH lifting equation. While there is uncertainty about whether this is a reliable predictor of risk for low back disorders, there is epidemiological datato suggest that it is a reasonable one (Chaffin & Park, 1973; Herrin, Jaraiedi & Anderson, 1986).Chaffin and Park found that the incidence for jobs with less than 2.5 kN of spine compression wasless than 5%, while jobs with more than 4.5 kN of compression had an incidence of more than 10%.Andersson, Svensson, and Oden (1983) reported that when males performed lifting tasks resulting inspine compression forces greater than 3.4 kN, they had a 40% higher incidence rate of low back painthan did males employed in jobs with lower predicted forces. Herrin et al. (1986) found that jobswith compression forces between 4.5 and 6.8 kN had an incidence rate of 1.5 times greater than jobswith compression forces that were less than 4.5 kN.Tolerance to spine loading is reduced in highly repetitive tasks or when there is substantial flexion of the spine. Vertebral strength is reduced by 30% with 10 loading cycles and by 50% with 5000 loadingcycles (Brinkmann, Biggermann & Hilweg, 1988). Solomonow, Zhou, Baratta, Lu, and Harris (1999)demonstrated that cyclical loading induces creep into the viscoelastic tissues of the spinal tissueswhich desensitizes the mechanoreceptors, possibly increasing exposure of the tissues to instability andrisk of injury even before the muscles fatigue. In addition, the posture of the spine at which point theload is applied appears to be of great significance to the tolerance of the spine as well as to the ability of the spine to receive nutrients. A flexed spine may be as much as 40% weaker than during anupright posture (Gunning, Callaghan & McGill, 2001). Such observations may explain why in some
The ACGIH TLV
w
for Low Back Risk
50
-3
© 2006 by Taylor & Francis Group, LLC
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