Journal of Manipulative and Physiological Therapeutics 37
Volume 23 • Number I • January 2000
REVIEW OF THE LITERATURE
Sitting Biomechanics,Part I1: Optimal Car Driver's Seat and Optimal Driver's Spinal Model
Donald D. HarrLwm, DC, PhD," Sanghak O. Harrison, DC," Arthur C. Croft, DC/' Deed E.
Harrison, DC,' and Stephan J. Troyanovich, DO t
ABSTRACT
Background: Driving has been associated
with signs and symptoms caused by vibrations.
Sitting causes the pelvis to rotate backwards
and the lumbar lordosis to reduce. Lumbar
support and armrests reduce disc pressure and
electromyographically recorded values. How-
ever, the ideal driver's seat and an optimal
seated spinal model have not been described.
Objective: To determine an optimal automol
seat and an ideal spinal model of a driver.
Data Sources: Information was obtained from peer-reviewed
scientific journals and texts, automotive engineering reports.
and the National Library of Medicine.
Conclusion: Driving predisposes vehicle operators to low-back
pain and degeneration. The optimal seat would have an ad-
justable seat back incline of 100° from horizontal, a changeable
INTRODUCTION
Although the ergonomics of sitting in a factory or office
have been studied extensively, the biomechanics of automo-
bile drivers and passengers have received less attention. Re-
cently, because of a complete void in the literature for a
seated driver's spinal position, an automotive engineering
firm requested that the authors determine an optimal driver's
spinal model. Because the design of a driver's seat directly
affects the driver's spinal biomechanics and extremity er-
gonomics, the design of an optimal car seat is also of interest.
To accomplish these 2 goals--optimal driver's seated
spinal model and optimal car seat d e s i g n - - w e searched
automotive engineering American National Standards, auto-
motive engineering reports, Index Medicus at the National
Library of Medicine (1949 to 1998), and relevant texts.
DISCUSSION
Epidemiology
Patients with low-back pain frequently report an intoler-
ance to sitting; their severity of pain is inversely related to
~Chiropractic BioPhysics Nonprofit, Inc, Harvest, Ale.
bSpine Research Institute of San Diego, Calif.
cPrivate practice of chiropractic, Elko, Nev.
dPrivate Practice of chiropractic, Normal, I11.
Submit reprint requests to: Donald D. Harrison, PhD, DC, Chiro-
practic BioPhysics Nonprofit, Inc, 210 Bent Oak Circle, Harvest,
AL 35749.
Paper submitted January 8, 1999; in revised form January 26, 1999.
01t~1-4754120001$12.00 + 0 76/11103476 © 2000 JMPT
.~pth of seat back to front edge of seat bottom.
adjustable height, an adjustable seat bottom in-
cline, firm (dense) foam in the seat bottom
cushion, horizontally and vertically adjustable
lumbar support, adjustable bilateral arm rests,
adjustable head restraint with lordosis pad,
seat shock absorbers to dampen frequencies in
the 1 to 20 Hz range, and linear front-back
:ravel of the seat enabling drivers of all sizes to
ach the pedals. The lumbar support should be
ating in depth to reduce static load. The seat
oacK snould be damped to reduce rebounding of the
torso in rear-end impacts. The optimal driver's spinal model
would be the average Harrison model in a 10° posterior inclining
seat back angle. (J Manipulative Physiol Ther 2000;23:37-47)
Key Indexing Terms: Sitting; Biomechanics; Lordosis; Ergo-
nomics; Spinal Model; Motor Vehicles; Whiplash Injury; Chiro-
practic
the ability to change posture if seated.l'2 People without his-
tory of low-back pain still have neck pain, back pain, and
sciatica after prolonged static sitting. 3 Drivers have little
room to change posture because of being confined to a small
space by the constraints of control positions, pedals, and
vision requirements. Drivers are in a high-risk group for
spinal disorders, including back pain, neck pain, sciatica,
spondyloarthrosis, degeneration, and herniated discs. 412
Kelsey 5 and Kelsey and Hardy 6 found that truck drivers were
4 times more likely to develop a herniated lumbar disc.
Professional driving frequently involves known risk factors
such as prolonged sitting, ergonomic factors, whole-body
vibration, twisting and bending, and heavy lifting. Rosegger
and Rosegger ~ reported that 70% of tractor drivers had pre-
mature degenerative changes in their spines as evidenced by
radiography.
Anderson et al~3 studied muscle activity (electromyogra-
phy [EMG]), intradisc pressure, and optimal positions for
car seats. Although sitting has been indirectly blamed for a
multitude of health problems, vibration of drivers has been
directly linked to pain and degenerative diseases of the
spine. It is thought that dense foam in the seat bottom will
reduce vibration to the occupant from the car.
Recently, Jurgens ~4 presented a review of seat pressure
distribution and seat bottom contour. In 1996, Brienza et air5
presented their seating system structure, which has a support
surface of vertical elements arranged in an 11 x 12 array.
These elements depress linearly by the amount of pressure
applied, thus forming a pressure distribution with measured
38 Journal of Manipulative and Physiological Therapeutics
Volume 23 • Number I • January 2000
Sitting Biomechanics, Part II • Harrison et a/
B Verlical Vibration, Truck, Dirt Road
2 Frequency in Hertz (HZ)
1,8
~ 1,6
~- 1.4
_~1.2
8 In 1980, Pope et a135 reported that many vehicles, includ-
0.8
0.6
O'u 5 1 15
Frequency (HZ)
Fig 2 . Acceleration load transfer versus frequency for vibration of
a typical male subject showing resonate spinal frequencies.
values. Fig 1 illustrates the seat-pressure distribution in a
soft seat without lumbar cushion compared with a firm seat
with lumbar support. However, more must be done than
incorporating denser foam to dampen vibrations.
Vibrational Effects
Many studies z6"29 have shown that low-back pain and
degenerative diseases of the spine occur more frequently in
drivers than in the general population. In 1987, Heliovaara28
discovered that vibration was the greatest occupational risk
factor among many types of workers. Investigators 3°-34 have
pinpointed specific vibrational frequencies and vibrational
magnitudes that cause resonance in the upright spine. At cer-
tain natural frequencies, the spinal system will absorb and
transmit motion in excess of the input. This mechanic
behavior is characteristic of a resonating system. 24 In 1982,
Wilder et a124 identified 3 frequencies that cause the spine to
resonate: 4.75 Hz, 9.5 Hz, and 12.7 Hz. Fig 2 illustrates a
typical subject's response to vibration at frequencies from 0
to 20 Hz. In the Wilder et a124 study, resonance meant that
the spine vibrated vertically more than would be expected
for applied loads,
0.6
0.5
iio.
i
5 10 15 20 25
Fig 3. Spectral cmalysis of vibrations of a Swedish truck on dirt
road. Vibrational fi'equencies of vehicles are commonly in the 0-20
HZ range. Swedish truck seats are damped at 4 to 6 HZ, which is
the largest resonate frequency of the seated human spine.
ing light trucks, jeeps, motorcycles, vans, and buses, vibrate
in the 3.0 to 6.0 Hz range, a range that includes the largest
amplitude found for human spine resonance, approximately
4.75 Hz. In 1986, Panjabi et al 3~ showed that spinal reso-
nance was much more involved than just the vertical reso-
nance previously measured. They measured vertical, hori-
zontal, and rotational vibrational resonance of the spine at
specific frequencies. They determined 4.4 Hz as the largest
amplitude of resonate spinal frequencies and determined
that the resonance of the sacrum and pelvis were significant-
ly higher (9% to 18%) than in the lumbar vertebrae. They
hypothesized that the lumbar lordosis' flexibility caused a
decrease in the resonate frequency of the vertebrae.
Dieckmann 36 in 1957 and Coermann 37 in 1962 compared
the movement of the head with the input at the seat to mea-
sure spinal resonate frequencies in the 4.0 to 8.0 Hz range. In
1966, Christ and Dupuis 38 determined 4.0 Hz as a resonate
spinal frequency in the vertical and horizontal directions.
Bovenzi and Zadini 29 discussed the mechanisms of low-
back injury from vehicle vibrations.and spinal resonance.
They stated that EMG measurements obtained during vibra-
tion (based on Seide139 and Seroussi et al4°) are not protec-
tive. In fact, the enhanced muscle tension increases the load
on the vertebral bodies and discs. This causes fatigue and
pain and results in an increased susceptibility of the spine to
injury. 41 From Brinckmann et a142 and Hansson et al, 43
cyclic compression loading on the spine in vitro caused
degenerative changes, such as end-plate defects and frac-
tures in subchondral trabeculae. The rotational and transla-
tional resonance found by Panjabi et a131 indicates that the
combination of torsional stresses with axial loading are like-
ly to cause anular ruptures or spondylolytic fractures, as
hypothesized by Froom et a144 in 1984. Although it might

Fig 4. 1974 car seat simtdatot: Five items are aclfltstable when
measuring disc pressure and EMG recordings: 1, seat back inclina-
tion, 2, honbar sttpport height at~d depth, 3, seat bottom height
above the floot; 4, seat distance to dash. and 5, depth of brake pedal
displacement.
seem a large step to apply experimental results in the labora-
tory to real-work environments, the autopsy evidence of
increased occurrence of ruptures of the anulus fibrosus in
driving occupations 45 seems to unite both experinaental and
epidemiologic studies.
Magnusson et a134 used a uniaxial accelerometer between
truck drivers' seats and buttocks to record vertical accelera-
tions of the truck seat during normal working conditions. A
typical vertical vibrational spectrum from a truck ride is
illustrated in Fig 3. Note that only 2 of the 3 human spine
resonate frequencies (4.74 Hz, 9.7 Hz, 12.7 Hz) are directly
being affected by the truck vibrations.
In Sweden, truck seats are damped between 4.0 and 6.0 Hz
to reduce the human spine natural frequency with the largest
amplitude during vibrations (ie, 4.75 Hz). Magnusson et a134
have reported a significant difference in reported injury com-
plaints between US truck drivers (no dampening) and
Swedish truck drivers (with seat dampening at 4.0 to 6.0 Hz).
The spectrum in Fig 3 clearly shows the dampening of the
Swedish truck seat at 4 to 6 Hz.
A voluminous amount of material has been reviewed from
the literature on the biomechanics of seated posture, effects
of seat design, and ergonomics of sitting. 46 Our focus is on
car driver's seats. With these ideas from the li~terature, it is
possible to discuss specific aspects of an optimal driver's
spinal model and an optimal design for an automobile seat.
Automobile Drivers
A review of the extensive literature on sitting biomechan-
ics reveals only a few papers in which with automobile dri-
vers are the subjects.13"4749 In 1974, Andersson et a113 stud-
ied 4 adult subjects in a Volvo seat adapted for adjustion. Fig
4 illustrates this car seat. They studied 3 support parameters:
seat back inclination, seat bottom inclination, and lumbar
support. They determined that the lowest level of myoelec-
Journal of Manipulative and Physiological Therapeutics 39
Volume 23 • Number 1 • January 2000
Sitting B i o m e c h a n i c s , P a r t II • H a r r i s o n et at
Frequency(Hz)
Effects 0.1 10 15 20 100 10~ 104 l0s
Tactile Sensation
Giddio~s & Instability
Motion Sickness
Hand Toot Dt,~eases
Body R e s o n ~ c ~ iltl m l ~
Respiration Dilliculties m
Abdominal Pain I
Muscle Tone
Lumbosacral Pain
Sensations
Vision 1~ stm'banc~.s
SpeechDifficulties
Defecate & Unnam Urges
Fig 5. Physiological effects at different frequencies. Besides the
vibrational resonance found in humans in the 0 to 20 Hz range,
there are a multitude of other vibrational side effects.
tric activity was at 120 ° backrest inclination, horizontal lum-
bar" support of 5 cm, and seat bottom inclination of 14 °.
In 1986, Hosea et a149 studied the myoelectric activity of
12 men who were driving automobiles. They claimed that
the Andersson et a159 study was limited by the small number
of subjects (4), small time period studied (12 seconds), fixed
position of subjects (arms on steering wheel, head forward,
eyes fixed straight ahead), and use of a car simulator. The
Hosea et a149 EMG recordings were obtained for 12 back
muscle groups, including the lumbar, thoracic, cervical, and
trapezius areas. Over a 3.5-hour period, they varied the
backrest inclination at 100 °, 110 °, 120 °, and 130°; seat bot-
tom inclination was varied at 14.5 ° and 18.5°; and lumbar
support was varied at 3 cm, 5 cm, and 7 cm of horizontal
movement. All EMG readings were small and decreased
with increasing seat back inclination and increasing lumbar
support except (1) a slight increase in EMG readings in the
lumbar area at 130 ° compared with 120 ° , (2) an increase in
thoracic and lumbar EMG values for the 7-cm lumbar sup-
port, and (3) a slight increase in EMG values for the seat
bottom inclination at 18.5 ° compared with 13.5 ° in the tho-
racic and lumbar regions.
In 1997 Fubini 47 presented a review of the technical re-
quirements versus the comfort in automobile seats. He
stressed safety and comfort. He suggested that it was possi-
ble to extend to car seat design the validity of some basic er-
gonomic requirements that Occhipinti et als0 have applied to
the design of office seats. The seat with seat belts must re-
strain driver and passengers, provide comfort, and protect oc-
cupants from injury such as whiplash. The seat structure
should absorb energy with deformation such as front, rear,
and side impacts. The seat adjustment switches and safety
belt attachments must not conflict. A number of international
regulations and standards are set forth in the Society of Au-
tomotive Engineer's (SAE) Motor Vehicle Seating Manual. 51
40 Journal of Manipulative and Physiological Therapeutics
Volume 23 • Number I • January 2000
S i t t i n g B i o m e c h a n i c s , P a r t II • Harrison et al
Fig 6. SAE automobile seat mannequin. This mannequin is known
as the H-Point machine. It is used to check for the size of the dri-
ver's space, fit of the seat, and ability of seat foam to resist the load
applied as weights.
The goal of increasing comfort aims to reduce driver
fatigue and avoid musculoskeletal disorders. 52 To do so, the
seat shape, upholstery characteristics (contour, firmness,
etc) and covering materials, seat bottom height, seat bottom
tilt, seat back angle and contour, lumbar support, head rest
support, and arm rests must be as important as the ergonom-
ics for office chairs. 53 These factors contribute to dynamic
comfort, which is very important. However, there are many
more effects than just the resonant frequencies. Cole 54 dis-
cussed 13 human disorders caused by frequencies between 0
and 105 Hz; these are illustrated in Fig 5.
The majority of physiologic effects from vibration occur
below 20 Hz (Fig 5). To reduce these vibrations in car seats,
the trend has been to reduce the use of seat springs and use a
thick, firm foam. However, the best method is the additional
use of shock absorbers to eliminate certain frequencies, such
as is done in Sweden (Fig 3). In Sweden it has been the
accepted practice to use such shocks only on truck seats, in
which much driving is done during the workday. Why isn't
this practiced more widely?
It is reasonable to suggest that all automobile seats be
damped with shock absorbers, at least in the 3 resonate fre-
quencies of the human spine. The evidence suggests there are
benefits from dampening all frequencies from 0 to 20 Hz.
Fiat marketing research 47 found that during the workweek,
90% of cars have only the driver's seat occupied. During hol-
idays, 64% of vehicles have only the driver and one passen-
ger: Only medium-sized cars have a third passenger, who
77% of the time sits behind thepassenger. Thus it would ap-
pear that at least the front seats and perhaps the rear seat be-
hind the front passenger should have shock absorbers. Be-
cause the space below the front seats must be sufficient to
-- -- " Lo_L¢_
Fig 7. Changes in the angle of pelvic tilt when standing (50°), when
rotated 40° posterior in middle sitting, and in driver's seat with 120 °
seat backrest incline. A, The standing average angle of pelvic tilt,
measured as inclhle of postero-inferior $1 to a horizontal at the top
of the fenuw head, is 50 °. B, The pelvis rotates 40 oposteriorly on the
x-axis (extension) fit the middle sitting position, whereas the lumbar
lordosis is flattened. C, The lumbar stlpport increases pelvic rota-
tion and lumbar lordosis. The ideal pelvic rotated position is 35 ° on
a filvn seat with htmbar support, with 10 ° seat bottom incline, 5 ° de-
pression into the seat bottom, and 120 ° seat backrest inclhle.
accommodate the feet of the rear passengers, the extra height
needed to fit shock absorbers to the front seats is not a prob-
lem, except possibly for the 95th percentile male driver's
head room.
Optimal Sitting Spinal Model
Because numerous authors discuss changes in the posi-
tion of the spine and pelvis during sitting from a beginning
standing position, an optimal automobile seat design will be
suggested to accommodate an ideal sitting spinal model and
human posture. The beginning standing position will be the
Harrison normal spinal modelY which is the only standing
model in the literature with precise segmental spinal angles
and pelvic position. This position will be altered as changes
are made to the car seat and supports.
To begin, a firm seat bottom foam is needed, but it should
not be determined from the SAE's mannequin (Fig 6). This
mannequin spreads the weight into the seat bottom in a dif-
ferent manner (more extensively) than human buttocks,
which spread the weight through the ischial tuberosities.14
The SAE's mannequin does not sink into the seat bottom
nearly as far as a human being would (ie, firmer foam is
needed). 14
Once the proper seat pressure distribution is established
with firm foam and lumbar support (Fig 1, B) rather than a
soft foam seat (Fig 1, A), the pelvic angle to the seat bottom
 Journal oJ M;inipulative and Fhysiological Iherapcutles
Volume 23 ° Number 1 ° January 2000
Sitting Biomechanics,P a r t II ° Harrison et at

\\
\

35* 15* 42*

Fig 8. Ideal backrest angle o f 120 ° causes abnormal 30 ° head flex-

ion o f the drivel:

Fig 9. Changing the backrest angle from 120 ° to I 0 0 ° and thigh-

can be established and the amount of lumbar support deter- horizontal angle (seat bottom inclh~e) from 15 ° to 5 ° reduces head
mined. Harrison et a155 have defined the normal pelvic rota- flexion from 30 ° to 10 °.
tion (arcuate line compared with horizontal) while standing
at 50 ° between posterior-inferior SI to top margin of the ac-
etabulum on the lateral radiograph (Fig 7, A). In the middle not reduce the head flexion necessary for proper vision
sitting position (Fig 7, B), Schoberth 56 reported that the mean through the windshield. Fig 8 illustrates that the head would
posterior rotation of the pelvis was 40 ° when changing from be flexed an abnormal amount (30 °) in the seat position sug-
standing to relaxed middle sitting. Thus this Harrison et a155 gested in Fig 7, C.
arcuate line would be 10° from horizontal before addition of Williams and Lissner 65 demonstrated that neck muscle
a lumbar support. Fig 7, C illustrates this pelvic position in a forces needed to keep the head in a balanced position
slightly depressed position as a result of firm foam on a typ- increased proportionally with the sine of the angle of for-
ical car seat. The apparent angle of seat bottom to floor and ward inclination of the head. In an effort to determine neu-
seat bottom to seat back angle are altered as a result of the tral resting head posture and direction of view angle,
pelvic depression into the seat bottom and seat back. Snijders et a166hypothesized that a 15° gaze angle below the
Use of a 4- or 5-cm (adjustable) lumbar support will horizontal was a neutral position. With a computer program,
rotate the pelvis forward and increase lumbar lordosis. they calculated that a retroflexed (extension) angle of 30 °
Keegan 57 showed that sitting with a lumbar support resulted from this neutral position is where the neck muscle effort
in a lumbar curve value between the values for standing and was at a minimum. To check this theoretical head position,
erect middle sitting. However, without exact values, it can de Wall et a167 calculated the expected and actual head posi-
only be determined that erect middle sitting has a larger tions of 10 subjects connected to electronic goniometers
arcuate pelvic angle than relaxed middle sitting. The needed when their computer screens were 15° inferior to horizontal
size of the lumbar support will depend on the size of the per- and 15° above horizontal over an 8-hour period. They found
son. However, taking a conservative 35 ° angle for the arcu- that subjects preferred the computer screens to be at eye
ate line to be horizontal with a 5-cm lumbar support, the level and adjusted their gaze position instead o f their head
result would be a lumbar curve with a Cobb angle larger position when the computer screen was high or low.
than 34 ° between L1 and S1. 58 However, they noted that the subjects' whole body postures
To preserve a trunk-thigh angle of at least 105 °, an angle were more normal when using the horizontal or high posi-
necessary to preserve lumbar lordosis, 57 the seat back angle tion of the computer screen. 67 This suggested that the inferi-
to seat bottom must be at least 110 ° as a result of pelvic de- or 15 ° head flexion position was not normal. This negates
pression into the foam. If the seat bottom is 10° to the floor, the theoretical 30 ° inferior flexed head position Suggested
then the seat back will be 120° to the floor (adjustable). These by Vital and Senegas:68
ideas are illustrated in Fig 7, C. In consideration of the large head-flexion angle causedby
The seat back angle of 120 ° has been reported as the opti- the ideal backrest angle of 120 ° from horizontal suggested
mum. 59-6j Because the knee flexion angle 62-64 has affected by Andersson et al, 59"6t it becomes apparent.that this back-
lumbar lordosis and because drivers sit with a small knee rest angle must be reduced to lessen the loss ofcervieal~lOr-
flexion angle (approximately slightly less than 45°), then dosis caused by such a large flexion of the ~headto: thoracic
one might believe that the seat backrest angle should be cage (30*). As shown on the Andersson et al~a~graphs,~th~r~
greater than 120 ° to preserve lordosis. However, this does is not much difference in EMG readings~between a.baekrest
42 Journal of Manipulative and Physiological Therapeutics
Volume 23 • Number I ° January 2000
Sitting Biomechanics, P a r t II • Harrison et at
I \
Fig 10. Design and position of the adjustable head rest attached to
the top of the seat back.
angle of 100 ° and 120 °. Also there is not a large change in
disc pressure from a backrest angle of 100 ° to 1 2 0 ° . 59"61 The
seat bottom inclination did not affect the disc pressure in a
significant manner, and the use of arm rests made a signifi-
cant difference in disc pressure (lower).
Thus the seat back angle can be reduced to 100 °, the seat
bottom incline to 5 ° , and arm rests added while maintaining
low E M G readings for the postural muscles, and low disc
pressure values while driving. This will cause only a small,
well-tolerated, I0 ° head flexion angle, but a reduced knee
flexion angle will occur unless the seat is raised (Fig 9).
Because the seat bottom cushion depresses more than the
seat back in near upright sitting, the trunk-thigh angle is
close to 95 °. To reduce the disc pressure and EMG recorded
values, armrests are needed, but at what height and lateral
distance? To discover an upper arm position that reduced
sick leave, employee turnover, and rehabilitation costs at a
telephone factory in Norway, Aaras 69 determined that the
arm flexion (humerus) should be less than 15 ° and arm
abduction less than I0 °. Of course, many drivers will grip
the upper half of the steering wheel so the arms are in a state
o f relaxed hanging. One could argue that humerus angles
need to be directly studied in drivers.
However, if the armrests, when used, are adjusted to allow
the normals determined by Aaras, 69 then static trapezius
load is at a minimum and disc pressure is reduced (Fig 9).
With arms bent and elbows on armrests, the steering wheel
must be adjustable.
F r o m the preceding information, several recommenda-
tions can be made for different-sized adults to accommodate
the position depicted in Fig 9. Before doing so, it should be
mentioned that shorter persons would have the back of the
Fig I I. Normal sitthzg spinal model hz an ideal driver's seat.
knees in contact with the front edge of the seat bottom when
the 95th percentile of human weight is used for seat design,
according to anthropometic studies. Therefore, one of our
recommendations will be that the seat back be able to move
forward-backward in relation to the seat bottom to alter the
front-back depth of the seat bottom. In addition, adjustable
armrests bilaterally are needed on most vehicles. If present,
usually only the right armrest is attached to the driver's seat,
and it is not adjustable. An armrest is often considered to be
present on the driver's door where the window and door lock
switches are located. However, this is not a suitable armrest.
It is never adjustable and is usually too low to be used.
Head Restraint
One of the final recommendations in this paper concerns
the headrest, which is missing from the optimal car seat and
optimal seated position of an automobile driver in Fig 9. The
headrest should be adjustable, not only vertically, but hori-
zontally. It is uncomfortable to sit in a car seat with a head-
rest that pushes the head forward into an anterior translated
position. The headrest should have a convex surface similar
to the lumbar support. Whereas the lumbar lordosis has been
modeled with an ellipse with deeper curve at L3-S 155,70.71
the cervical lordosis has been modeled successfully with an
arc of a circle. 72-75Thus the contour of the cervical support
on the head rest will be smaller and more uniform in shape
compared with the lumbar support. It must still be composed

of a soft enough foam density to be comfortable when fully
leaning tbe head backward for rest.
The human body has a vertical vector component of force
during whiplash. Thus the head tends to translate above the
height of a low headrest and then be left behind, as a result
of inertia, as the car seat system moves forward. This causes
the head to extend around the headrest and be more vulnera-
ble to traction and shear forces. From the tractioned posteri-
or translated, extended position the head has higher acceler-
ation, and the anterior compression, as the head flexes, is
greater as the chin strikes the chest or the head hits the steer-
ing wheel or dashboard. To avoid this situation, the headrest
must extend above the driver's head. Fig I0 illustrates the
necessary headrest height and adjustable circular horizontal
support for the cervical lordosis.
As shown in Fig 9, the change in the seat backrest angle
from 120 ° to 100 ° and the change in seat bottom incline by
5 ° has caused a change in the pelvic angle of tilt (arcuate)
from 35 ° to 50 ° . This angle is the normal pelvic tilt found in
standing posture. 55'7°'71 If the lumbar support is somewhat
elliptical in shape and is applied approximately 5 cm at the
top of posteroinferior lilac spine area of the pelvis, then the
driver's sitting lumbar curve will be close to the normal
curve while standing. If the head rest is circular in shape and
applied at mid neck with a concave identification for the
back of the head, then the sitting spinal model in an ideal
driver's seat will be nearly identical to the standing spinal
model determined by several other studies. 7°75 The average
cervical, thoracic, and lumbar posterior tangents at C2-C7,
T3-T10, and LI-L5 measure 34 °, 35 °, and 40 °, respectively.
Fig 11 illustrates the normal sitting spinal model in an ideal
driver's seat with adjustable lumbar and cervical supports.
The head nods 10 ° on the top vertebra to bring the line of
eyesight to horizontal without flexing the neck. This is also a
comfortable position, which a person should be able to
maintain for long periods without fatigue.
Seat DesignAspectsto Protect the OccupantDuring
The term "whiplash" was coined in the 1920s to describe
the resulting injury from violent head and neck retraction,
and over the years our understanding of this commonly
maligned and misunderstood condition has continued to
evolve.
"Whiplash" describes the mechanism more than the clini-
cal nature of the problem, but the search for a more accurate
term was hampered by early theories about oc6upant kine-
matics that were simplistic and incomplete. This led to a
number of cumbersome and inaccurate terms, such as
"hyperextensi0rdhyperflexion injury?' More recently, "cervi-
cal acceleration/deceleration injury" has been suggested. 77
Pioneered by early crash test researchers, 78"8° head re-
straints made a late entrance into federal motor vehicle safety
standard law in 1969 in the United States. However, they var-
ied widely in design from one manufacturer to another and
were developed in a near vacuum of biomechanic and clini-
cal understanding. Consequently, large epidemiologic stud-
ies consistently reported only marginal (11% to 14%) suc-
Journal of Manipulative and Physiological Therapeutics 43
Volume 23 Number 1 ° January 2000
•
Sitting Biomechanics, P a r t II • Harrison et al
cess in reducing injuries to occupants in rear impact
crashes. 8~-84 Several factors account for this dismal result.
Chief among them is the failure of 83% of drivers and pas-
sengers to properly adjust the adjustable head restraint. 85An-
other is the inherent difficulty in designing seats for the ma-
jority of occupant statures. The male driver whose stature is
in the 50th percentile is usually chosen as a compromise,
leaving drivers in the 95th percentile (more than 6 feet 2
inches in height) grossly unprotected even with the restraints
in the optimal position. Yet another variable is occupant pos-
ture and position.
When the driver slouches, as studies have shown many
do, the backset--the distance between the head and the
restraint--increases markedly. Backset also increases as seat
back inclination increases. Moreover, on rear impact the
occupant's torso will impact the seat back and ramp up a
variable distance depending on numerous factors, including
the frictional interactions between seat material and occu-
pant clothing, occupant weight, the use or nonuse of lap
belts, and the inclination and stiffness of the seat back.
Forward-slouching occupants will interact more violently
with the seat back and have more even ramping, s6"91
Full-scale crash tests with human volunteers have demon-
strated that the overall vertical motion of the lap-belted
occupant's head in rear impacts as low as 8 km can be as
much as 3.50. 92 Part of this rise is thought to be the result of
a straightening of the lumbar, thoracic, and cervical curves
caused by the rearward thrusting of the seat back. Thus a
head restraint height that appears adequate in the resting
position may be too low when ramping occurs. This was, in
fact, observed by McConnell et al92: the heads of the volun-
teers ramped above the restraints, striking them on their tops
and driving them into the lowered position. Thus analysis of
the restraint, once adjusted, is another important design fea-
ture currently lacking in many passenger vehicles.
As recently as 1997, the Insurance Institute for Highway
Safety evaluated the geometry (ie, height and backset) of the
head restraints of 167 modern passenger cars, light trucks,
and minivans and rated only 5 as "good," whereas 117
received "poor" ratings even when adjusted to optimal posi-
tions. 93 However, geometry is only one of the considerations
in the design of head restraints. Because the head can strike
the restraint with considerable force, the head may rebound
with sufficient force to aggravate the injury kinematics, s6
Indeed, as a result of the interactions between occupant and
vehicle, significant occupant overspeeds of up to 70% are
possible: the occupant's speed change is usually significant-
ly higher than that of the vehicle, while the head linear
acceleration is usually 2 to 3 times that of the vehicle. 78"
80,92,94-96 Ideally, the mechanic properties of both head
restraint and seat back should be tuned so that the energy
imparted (vis-a-vis coefficient of restitution) from tiffs head
restraint/seat back system will be uniform.
For many years, authors have debated the relative merits
of stiff versus flexible seat backs as they concern the poten-
tial for injury in low-speed, rear-impact clTashos.97=99Recent
human volunteer crash tests at low speeds (4 to 8 km/h)~h_nve
44 Journal of Mnslipulative and Physiological Therapeutics
Volume 23 • Number I • January 2000
Sitting Biomechanics,P a r t II • Harrison et al
demonstrated that seat back stiffness plays an important role
in injury mechanics, 95 with stiffer seat backs resulting in
greater compressive forces in the cervical spine and more
flexible seat backs resulting in greater shear stress in the cer-
vical spine. Based on our current knowledge, it would
appear that the trade-off would favor a stiffer seat because
the neck is more resilient to compressive forces than to shear
forces.
However, innovative designs have been suggested in
which a fluid damped seat system would allow controlled
rearward motion in the event of rear impact. ~°° Such a
design has recently been incorporated into the Volvo $80.
Saab has also developed an integrated seat in which a cam
device is actuated in the seat back by rearward torso dis-
placement. The head restraint is moved into opposition to
the head by the cam to prevent rearward head motion.
Neither seat, however, has been extensively tested in human
volunteer crash tests.
Many current head restraint designs consist of a simple
cylinder of foam wrapped around a metal framework. When
the rear of the head---anywhere from the lambda to the
inion--strikes the restraint, the inertia of the neck will carry
the head into flexion, imparting a strong bending moment
through the upper cervical spine. Thus it is important to
design a restraint that achieves support of both the head and
the neck simultaneously.
The seatpan should also be designed to deform under a
vertical load to reduce the effect of ramping and consequent
spinal compression. Such a design would not interfere with
the ability of the seatpan to prevent submarining in frontal
impacts and, in fact, may enhance this safety feature. Belt
pretensioners have been designed and implemented in many
newer passenger vehicles. Under crash level loads detected
by sensor arrays arranged on the front of the vehicle,
pyrotechnic devices cause cables to tighten lap and shoulder
belts in an effort to snug the occupant into the seat. Although
these systems can reduce occupant loads significantly, ~°~
current units are designed to deploy only in frontal crashes.
Based on our current knowledge, it would seem highly prob-
able that such systems would also reduce loads to the occu-
pant if rear sensor arrays allowed deployment in injury-
threshold rear crashes.
Several recent studies have provided a clear picture of
occupant kinematics in rear impact crashes. 92.95,96,t°2,]°3 On
average, the head moves forward only after the torso begins
to move forward, a lag resulting from the head's inertia. The
net result is a retraction of the neck (shear), coupled with
very high compression. Only then does the head begin to
extend rearward. Contact with the head restraint occurs
between 80 ms and 100 ms after hyperextension of the joints
of the lower cervical spine has occurred. Thus it is likely that
injury occurs in many cases within a tenth of a second and
before head contact occurs. This underscores the need to
minimize initial backset. Taking all the foregoing into con-
sideration, the following recommendations are made.
Optimal design of the seat for minimizing injury from rear
impact crashes will require the following:
1. A seat back of mid-range stiffness.
2. A method of dampening such that a controlled rearward
motion of the seat of up to 3 cm is possible, with a minimal
rebound (ie, a coefficient of restitution approaching 0).
3. A head restraint that is tuned to the seat back (ie, one that
possesses similar mechanical properties of restitution)
and mutually supports both the head and the neck.
4. A head restraint with enough adjustability to allow for
minimal backset over a broad range of occupant statures.
5. A mechanism for locking the head restraint in position
once adjusted.
6. A seatpan designed to deform under loading conditions
to reduce vertical occupant motion (ramping).
7. A belt and shoulder harness pretensioner system with
rear array actuation.
8. A torso seat back element designed to deform under load-
ing conditions to reduce straightening of the thoracic
kyphosis which contributes to ramping and compression
of the spine.
PulsatingLumbarSupport
From references presented in this review, we have shown
that compared with unsupported sitting, the use of lumbar
lordotic support pads reduces disc pressure and paraspinal
myoelectric activity. Repetitive spinal motion improves
metabolism and nutrient transfer in animal discs, 1°4 and sim-
ilar benefits are thought to occur for human discs. ]°5 To
determine if continuous passive motion could be incorporat-
ed into a car seat lumbar support in 1994, Reinecke et a148
studied 28 drivers who routinely drive more than 2 hours per
workday. They reported that drivers were more comfortable
and had less back pain and less stiffness after using a pres-
sure controlled pulsating pneumatic lumbar support in their
automobile seats. They thought they were the first to suggest
such a device. However, Hetzberg had made one for air
force pilots in 1949. t°6
CONCLUSION
It might be thought that some of these recommendations
will be too costly. However, what price should be affixed to
activities of daily living, quality of life, and possibly life
itself?.
In addition to the recommendations for safety of the seat
design, it is recommended that: °
1. All automobile front seats should be damped, at least in
the 3 resonant frequencies of the human spine, with
shock absorbers.
2. Dense foam be used in the seat bottom cushion.
3. The backrest must be adjustable in the incline angle.
4. Backrest must have an adjustable lumbar support (up-
down translation and in-out translation).
5. Seat height must be adjustable.
6. Seat bottom incline must be adjustable.
7. Seat bottom linear translation for shorter persons to
reach gas and break pedals.
8. Seat back be linearly adjustable (forward-backward) to
the seat bottom (for shorter and taller persons).

9. Bilateral adjustable arm rests are needed.
10. Adjustable steering wheel (forward tilt rotation and for-
ward-backward translation are needed).
11. Seat back incline is recommended to be maintained at a
10W angle to reduce the risk of rising up this ramp dur-
ing cervical acceleration-deceleration injuries.
12. Seat backs must be damped to absorb some of the com-
pression forces applied to the torso during rear-end im-
pacts to reduce torso rebounding during rear-end impacts.
13. Pulsating lumbar supports should be made available on
car seats to reduce static load, and therefore, perhaps
low-back disorders.
ACKNOWLEDGMENTS
We thank Chiropractic BioPhysics Nonprofit, Inc, for
support and Sanghak O. Harrison, DC, for her artwork.
REFERENCES
1. Damkot DK, Pope MH, Lord J, Frymoyer JW. The relationship
between work history, work environment and low-back pain in
men. Spine 1984;9:395-9.
2. Majeske C, Buchanan C. Quantitative description of two sitting
postures. Phys Ther 1984;64:1531-3.
3. Anderson GBJ, Chaffin DB, Pope MH. Occupational biome-
chanics of the lumbar spine. In: Pope MH, Anderson GBJ,
Frymoyer JW, Chaffin DB, editors. Occupational low back
pain. St Louis (MO): Mosby-Year Book; 1991:20-43.
4. Hildebrandt V. Back pain in working populations. Ergonomics
1995;38:1283-98.
5. Kelsey JL. An epidemiological study of acute herniated lumbar
intervertebral discs. Rheumatol Rehabil 1975; 14:144-59.
6. Kelsey JL, Hardy RJ. Driving of motor vehicles as a risk factor
for acute herniated lumbar intervertebral disc. Am J Epidemiol
1975; 102:63-73.
7. Krause N. Driving motor vehicles--a risk for low back pain
and herniated lumbar discs? A review of the literature. Center
for Municipal Occupational Health and Safety and School of
Public Health. University of California'-Berkeley; 1991.
8. Netterstrom B, Juel K. Low back trouble among urban bus dri-
vers in Denmark. Scand J Soc Med 1989; 17:203-6.
9. Polatin PB. Predictors of low back pain disability. In: White
AH, Anderson RT, editors. Conservative care of back pain.
Baltimore (MD): Williams & Wilkins; 1991:265-73.
10. Rossignol M, Suissa S, Abenhaim L. Working disability due to
occupational back pain: three year follow up of 2,300 compen-
sated workers in Quebec. J Occup Med 1988;30:502-5.
I 1. Rosegger R, Rossegger S. Health effects of tractor driving. J
Argic Eng Res 1960;5:241-76.
12. Backman AL, Jarvinen E. Turnover of professional drivers.
Scand J Work Environ Health 1983;9:36-41.
13. Andersson BJG, Ortengren R, Nachemson A, Elfstrom G.
Lumbar disc pressure and myoelectric back mtiscle activity
during sitting. IV studies on a car driver's seat. Scand J Rehab
Med 1974;6:128-33.
14. Jurgens HW. Seat pressure distribution. Coll Antropol 1997;
21:359-66.
15. Brienza DM, Chung KC, Brubaker CE, Wang J, Karg TE, Lin
CT. A system for the analysis of seat support surfaces shape
control and simultaneous measurement of applied pressures.
IEEE Transact Rehabil Engin 1996;4:103-13.
16. Fishbein WI, Salter LC. The relationship between truck and
tractor driving and disorders of the spine and supporting struc-
tures. Indust Med Surg 1950;19:444-5.
17. Rosegger R, Rosegger A. Arbeitmedizinisch erkenntnisse beim
schlepperfahren. Lantechn 1960;2:3-65.
Journal of Manipulative and Physiological Therapeutics 45
Volume 23 ° Number I ° January 2000
Sitting giomechanics, Part II • H a r r i s o n et at
18. Miwa T, Yonekawa Y. Evaluation methods for sinusoidal vibra-
tions [in Japanese]. J Acoustical Soc Japan 1971 ;27:11-20.
19. Dupuis H, Christ W. Untersuchung der moglichkeit von
gesundheits-schadigungen, bereich der wirbelsaule bei schlep-
perfahren. Max Palnk Inst, Bad Kreuznach, Heft A 72/2; 1972.
20. Gruber G J, Ziperman HH. Relationship between whole-body
vibration and morbidity patterns among motor coach opera-
tors. Washington, DC: HEW (NOISH); 1974.
21. Heide R, Seidel H. Folgen langzeiter beruflicher ganzkoerper-
vibrationsexposition. Z ges Hyg 1978;245:153-9.
22. Gearhart JR. Response of the skeletal system to helicopter
unique vibration. Aviat Space Environ Med 1978;49:253-6.
23. Okada A. Sense of vibration of man [in Japanese]. J Soc Auto
Eng Japan 1980;34:443-50.
24. Wilder DG, Woodworth BB, Frymoyer JW, Pope MH.
Vibration and the human spine. Spine 1982;7:243-54.
25. Wilder DG, Frymoyer JW, Pope MH. The effects of vibration
on seated individuals. Automedica 1985;6:5-35.
26. Yoshida Y, Machida N. Physiological and psychological
responses to low frequency whole-body vertical vibration in
man [in Japanese]. Jap J Erg 1985;2 I: 117-24.
27. Seidel H, Heide R. Long term effects of whole body vibration:
a critical survey of the literature. Int Arch Occup Environ
Health 1986;58:1-26.
28. Heliovaara M. Occupation and risk of herniated lumbar inter-
vertebral disc or sciatica leading to hospitalization. J Chronic
Diseases 1987;40:259-64.
29. Bovenzi M, Zadini A. Self-reported low back symptoms in
urban bus drivers exposed to whole-body vibration. Spine
1992;17:1048-59.
30. Pope MH, Wilder DG, Jorneus L, Broman H, Svensson M,
Andersson G. The response of seated human to sinusoidal
vibration and impact. J Biomech Eng 1987; 109:279-84.
31. Panjabi MM, Andersson GBJ, Jorneus L, Hult E, Mattsson L.
In vivo measurements of spinal column vibrations. J Bone
Joint Surg 1986;68A:695-702.
32. Althoff I, Brinckmann P, Frobin W, Sandover J, Burton K. An
improved method of stature measurement for quantitative
determination of spinal loading. Application to sitting postures
and whole-body vibration. Spine 1992; 17:682-93.
33. Liu JZ, Kubo M, Aoki H, Liu N, Kou PH, Suzuki T. A study on
the difference of human sensation evaluation to whole-body
vibration in sitting and lying postures. Appl Human Sci
1995;14:219-26.
34. Magnusson ML, Pope MH, Wilder DG, Areskoug B. Are occu-
pational drivers at an increased risk for developing muscu-
loskeletal disorders? Spine 1996;21:710-7.
35. Pope MH, Wilder DG, Frymoyer JW. Vibration as an aetiologic
factor in low back pain. In: Proceedings of Institution of
Mechanical Engineers, Conference on Engineering Aspects of
the Spine, Westminister, London: May 1980.
36. Dieckmann D. Einfluss vertikaler mechanischer schwingungen
auf den menschen. Intemat ZeitschrAng Physio11957;16:519-64.
37. Coermann RR. The mechanical impedance of the human body
in sitting and standing position at low frequencies. Human
Factors 1962;4:227-53.
38. Christ W, Dupuis H. Uber die beanspruchung der wirbelsaule
unter dem einfluss sinusformiger und stochastischer schwin-
gungen. Intemat Zeitschr Ang Physiol 1966;22:258-78.
39. Seidel H. Myoelectric reactions to ultra-low frequency and
low-frequency whole-body vibrations. Eur J Appl Physiol
1988;57:558-62.
40. Seroussi RE, Wilder DG, Pope MH. Trunk muscle electromyo-
graphy and whole-body vibration. J Biomech 1989;22:219-29.
41. Sandover J, Dupuis H. A reanalysis of spinal motion during
vibration. Ergonomics 1987;30:975-85.
42. Brinckmann P, Biggermann M, I-T_ilwegD. Fatigue fracture o f '
human lumbar vertebrae. Clin Biomech 1988;Suppl 1:S1-$23,
46 Journal of Manipulative and Physiological Therapeutics
Volume 23 • Number I o January 2000
Sitting Biomechanics,Part II • Itarrison et al
43. Hansson TH, Keller TS, Spengler DM. Mechanical behavior of
the human lumbar spine. II. Fatigue strength during dynamic
compressive loading. J Orthop Res 1987;5:479-87.
44. Froom P, Froom J, Van Dyke D. Lytic spondylolisthesis in heli-
copter pilots. Aviat Space Environ Med 1984;55:556-7.
45. Videman T, Nurminen M, Troup JDG. Lumbar spinal patholo-
gy in cadaveric material in relation to history of back pain,
occupation, and physical loading. Spine 1990; 15:728-40.
46. Harrison DD, Harrison SO, Harrison DE, Troyanovich SJ. Sit-
ting biomechanics part I: review of the literature. J Manipula-
tive Physiol Ther 1999;22:594-609.
47. Fubini E. The interaction between technical requirements and
comfort in car seating. Coil Anthropol 1997;21:405-27.
48. Reinecke SM, Hazard RG, Coleman K. Continuous passive
motion in seating: a new strategy against low back pain. J
Spinal Disord 1994;7:29-35.
49. Hosea TM, Simon SR, Delatizky J, Wong MA, Hsieh CC.
Myoelectric analysis of the paraspinal musculature in relation
to automobile driving. Spine 1986; 11:928-36.
50. Occhipinti E, Colombini D, Molteni G, Grieco A. Criteria for
the ergonomic evaluation of work chairs. Medicina del Lavoro
1993 ;84: 274-85.
51. SAE. Society of Automotive Engineers motor vehicle seating
manual. SAE J782-02, Warrendate, (PA); 1980.
52. Bellina G. Evolution of the car seat as a system. In: Proceed-
ings of 4th International ATA Conference. New design fron-
tiers for more efficient, reliable, and ecological vehicles.
Florence, Italy; 16-18 Mar 1994.
53. Akioka T, Harada H, Katsuura T, Kikuchi Y. Ergonomic evalu-
ation of automobile driver's seat. In: Proc Intern Congress on
Physiological Anthropology Kiel; 1994.
54. Cole S. Vibration and linear acceleration. In: Singleton WT,
editor. The body at work. Cambridge: Cambridge University
Press; 1982.
55. Harrison DD, Calliet R, Janik TJ, Troyanovich SJ, Harrison DE.
Elliptical modeling of the sagittal lumbar lordosis and segmen-
tal rotation angles as a method to discriminate between normal
and low back pain subjects. J Spinal Disord 1998;11:430-9.
56. Schoberth H. Sitzhaltung, sitzschaden, sitzmobel. Berlin:
Springer Veflag; 1962.
57. Keegan JJ. Alterations of the lumbar curve related to posture
and seating. J Bone Joint Surg 1953;35A:589-603.
58. Lord MJ, Small JM, Dinsay JM, Watldns RG. Lumbar lordosis.
Effects of sitting and standing. Spine 1997;22:2571-4.
59. Andersson BJG, Ortengren R, Nachemson A, Elfstrom G.
Lumbar disc pressure and myoelectric back muscle activity
during sitting. I. Studies on an experimental chair. Scand J
Rehab Med 1974;6:104-14.
60. Andersson BJG, Ortengren R, Nachemson A, Elfstrom G.
Lumbar disc pressure and myoelectric back muscle activity
during sitting. II. Studies on an office chair. Scand J Rehab
Med 1974;6: t 15-21.
61. Andersson BJG, Ortengren R. Lumbar disc pressure and myo-
electric back muscle activity during sitting. III. Studies on a
wheel chair. Scand J Rehab Med 1974;6:122-7.
62. Yasukouchi A, Isayama T. The relationships between lumbar
curves, pelvic flit, and joint mobilities in different sitting pos-
tures in young adults. Appl Human Sci 1995;14:15-21.
63. Stokes IAF, Avery JM. Influence of the hamstring muscles on
lumbar spine curvature in sitting. Spine 1980;5:525-8.
64. Bridger RS, Wilkinson D, Houweninge van T. Hip joint mobil-
ity and spinal angles in standing and in different sitting pos-
tures, Human Factors 1989;31:229-41.
65. Williams M, Lissner HR. Biomechanics of human motion.
Philadelphia: Saunders; 1977. p. 90-2.
66. Snijders CJ, Hock van Duke GA, Roosch ER. A biomechanical
model for the analysis of the cervical spine in static posture. J
Biomech 1991;24:783-92.
67. de Wall M, van Riel MPJM, Aghina JCFM. BurdorfA, Snijders
CJ. Improving sitting posture of CADfCAM workers by increas-
ingVDU monitor working height. Ergonomics 1992;35:427-36.
68. Vital JM, Senegas J. Anatomical bases of the study of the con-
straints to which the cervical spine is subject in the sagittal
plane. A study of the center of gravity of the head. Surg Rad
Anat 1986;8:169-73.
69. Aaras A. The impact of ergonomic intervention on individual
health and corporate prosperity in a telecommunications envi-
ronment. Ergonomics 1994;37:1679-96.
70. Troyanovich SJ, Calliet R, Janik TJ, Harrison DD. Harrison DE.
Radiographic mensuration characteristics of the sagittal lumbar
spine from a normal population with a method to synthesize
prior studies of lordosis. J Spinal Disord 1997; 10:380-6.
71. Janik TJ, Harrison DD, Calliet R, Troyanovich SJ, Harrison
DE. Can the sagittal lumbar curvature be closely approximated
by an ellipse? J Orthop Res 1998; 16:766-70.
72. Harrison DD, Janik TJ, Troyanovich SI, Holland B. Compar-
isons of lordotic cervical spine curvatures to a theoretical ideal
model of the static sagittal cervical spine. Spine 1996;21:667-75.
73. Harrison DD, Janik TJ, Troyanovich SJ, Harrsion DE, Colloca
CJ. Evaluation of the assumptions used to derive an ideal nor-
mal cervical spine model. J Manipulative Physiol Ther 1997;
10:202-13.
74. Harrison DD, Janik TJ. Clinical validation of an ideal normal
static cervical spine model. In: Witten M, editor. Computational
medicine, public health, and biotechnology. Vol 2. Austin (TX):
World Scientific Publishing; t 995. p. 1047-56.
75. Janik TJ, Harrison DD. Prediction of 2-D static normal position
of the cervical spine from mathematical modeling. In: Witten
M, editor. Computational medicine, public health, and biotech-
nology. Vol 2. Austin (TX): World Scientific Publishing; 1995.
p. 1035-46.
76. Harrison DE, Harrison DD, Troyanovich SJ. Reliability of
spinal displacement analysis on plane x-rays: a review of com-
monly accepted facts and fallacies with implications for chiro-
practic education and technique. J Manipulative Physiol Ther
1998;21:252-66.
77. Foreman SM, Croft AC. Whiplash injuries: the cervical acceler-
atiorddeceleration syndrome. 1st ed. Baltimore (MD): Willaims
& Wilkins; 1988.
78. Severy DM, Mathewson JH, Bechtol CO. Controlled automo-
bile rear-end collisons, an investigation of related engineering
and mechanical phenomenon. Can Services Med J 1955;
I 1:727-58.
79. Severy DM, Mathewson JH. Automobile barrier and rear-end
collison performance. Paper presented at the Society of Auto-
motive Engineers summer meeting, Atlantic City, N J, June 8-13;
1958.
80. Severy DM, Mathewson JH, Bechtol CO. Controlled automobile
rear-end collisons--an investigation of related engineering and
medical phenomena. In: Medical aspects of traffic accidents,
Proceedings of the Montreal ConferenCe, Nov. 1956. p. 152-84.
81. Nygren A. Injuries to car occupants--some aspects of interior
safety of cars. Acta Oto-Larygologica 1984;(suppt)395:l- 164.
82. Hohl M. Soft tissue injuries to the neck. Clin Orthop Rel Res
1975; 109:42-9.
83. Thomas C, Faverjou G, Hartemann F, et al. Protection against
rear-end accidents. Proceedings of the 7th International IRCOBI
Conference on Biomechanics of Impacts, Brou, France, 17, 1982.
84. Larder DR, Twiss MK, Mackay GM. Neck injury to car occu-
pants using seat belts. Proceedings of the 29th Annual Congress
of the American Association for Automotive Medicine; 1985. p.
153-65.
85. Nygren A, Gustafsson H, Tingvall C. Effects of different types
of head restraints in rear-end collisions. 10th International Con-
ference on Experimental Safety Vehicles, Oxford, England;
1985. p. 85-90.
 Journal of IVlanipulative and Physiological Therapeutics 47
Volume 23 • Number I • January 2000
Sitting Biomechanics, Part II • Harrisonel at

86. Romilly DP, Thomson RW, Navin FPD. Macnabb MJ. Low
speed rear impacts and the elastic properties of atttomobiles.
Proceedings of the 12th International Conference of Experi-
mental Safety Vehicles, Gothenburg. May/June I-14, 1989.
87. Hu AA, Bean SP, Zimmerman RM. Response of belted dummy
and cadaver to rear impact. SAE 770929, in Proceedings of the
Twenty-First Stapp Car Crash Conference, Society of Automo-
bile Engineers; 1977. p. 587-635.
88. Berton RJ. Whiplash: tests of the influential variables. SAE
680080, Automotive Engineering Congress, Detroit. MI; Jan,
1968.
89. Foret-Bruno JY, Tarriere C, LeCoz JY, et al. Rish of cervical
lesions in realworld and simulated collisions. 34th AAAM
Conference Proceedings, Scottsdale, Ariz: 1990. p. 373.
90. Olsson I. Bunkertop O. An in-depth study of neck injuries in
rear end collisions. International Research Council on the
Biomechanics of Impact (IRCOBI) 199(I. p. 269.
9 I. Severy DM. Brink HM. Baird JD. Preliminary findings of head
support designs. SAE 670921 in Proceedings of the 1I th Stapp
Car Crash Conference; 1967.
92. McConnell WE, Howard RE Poppel JV. et al. Human head and
neck kinematic after low velocity rear-end impacts: understand-
ing "whiplash." 39th Stapp Car Crash Conference Proceedings
952724: 1995. p. 215-38.
93. Status Report. Special issue: head restraints. Insurance Institute
for Highway Safety 1997;32:1-8.
94. West DH, Gough JP. Harper TK. Low speed collision testing
using human subjects. Accid Reconstr J 1993:5:22-6.
95. Ono K, Kaneoka K. Wittek A, Kajzer J. Cervical injury mecha-
nism based on the analysis of human cervical vertebral motion
and head-neck-torso kinematics during low speed rear impacts.
41st Stapp Car Crash Conference Proceedings. SAE paper
973340, 1997. p. 339-56.
96. Siegmund GP, King DJ. Lawrence JM, Wheeler JB, Brault
JR, Smith TA. Head/neck kinematic response of human sub-
jects in low-speed rear-end collisions. SAE Technical Paper
97334 I, 1997. p. 357-85.
97. Strother CE, James MB. Evaluation of seat back strength and
seat belt effectiveness in rear end impacts. Proceedings, 31
Stapp Car Crash Conference SAE 872214, Detroit, MI,
Society of Automotive Engineers; 1987.
98. Mertz HJ Jr, Patrick LM. Investigation of the kinematics and
kinetics of whiplash. In: Proceedings, 1lth Stapp Car Crash
Conference. SAE 670919, Detroit MI, Society of Atuomotive
Engineers; 1967,
100. Croft AC. Biomechanics. In: Foreman SM, Croft AC, editors.
Whiplash injuries: the cervical acceleration/deceleration syn-
drome. Baltimore (MD): Williams & Wilkins; 1988. p. 68-9.
101. Mitzkus JE, Eyrainer H. Three-point belt improvements for
increasing occupant protection. SAE 1984; 141:245.
102. Linder A. Svensson MY, Davidsson J, Flogard A, Haland Y,
Jakobsson L, et al. The new neck design for rear-end impact
dummy, BioRID I. 42nd Annual Proceedings of the Associa-
tion for the Advancement of Automotive Medicine 1998. p.
179-92.
103. Panjabi MM, Cholewicki J, Nibu K, Babat LB, Dvorak J.
Simulation of whiplash trauma using whole cervical spine
specimens. Spine 1998;23:17-24.
104. Holm S, Nachemson A. Variations in the nutrition of the
canine intervertebral disc induced by motion. Spine 1983;
8:866-74.
105. Grandjean E. Fitting the task to the man. 3rd ed. London:
Taylor and Francis; 1980.
106. Hetzberg HTE. Comfort tests of a pulsating seat cushion and
lumbar pad. MCREXD 695-82. Air Material Command,
Wright-Patterson AFB, Ohio; 1949.

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