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Objective: To develop modular software to assess angular impulse and to determine the effect of a reduced dataset on the net angular impulse acting at the L5/S1 joint. Background. With the prevalence and incidence of lower back pain increasing annually, accurate assessment of physical job demands is needed. Many lab based approaches exist to measure the moments acting on the lower back, but require advanced and sensitive testing equipment. Of the methodologies currently used in industrial settings, most require significant contributions of time or money to be implemented. There is a need for cost and time effective methods to record a worker’s kinematic data over their whole shift. Methods: Twelve participants performed 12 consecutive lifts under five lifting conditions: SQ00 (squat 0kg); SQ04 (squat 4kg); SQ10 (squat 10kg); FP04 (fast squat 4kg); ST04 (stoop 4kg). Kinematic data of the upper limbs, head, and trunk was recorded with external load data and kinetic analysis was performed by implementing an extension of the Hof (1992) method called the lined-segment engine (LSE) to calculate the angular impulse (N•m•s) acting on the L5/S1 joint. Results: The LSE was sensitive to changes in load, lifting speed, and lifting posture (p < 0.05). There was no difference in dynamic, quasi-static, or static models when calculating angular impulse, but there was a difference in the L5/S1 angular impulse when the upper limbs were removed from the dynamic LSE model (p < 0.05). Conclusion: The LSE requires further refinement, but could be a generic approach to kinetic calculations. A scaled no-arms model for calculating the angular impulse acting on the low back could be used to assess field based lifting studies with 5.8% error. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2013-08-03 15:05:03.257

ABSTRACT Aim: The aim of this study was to determine the most effective exercise program for the management of occupational lower back pain. Background: Occupational lower back pain accounts for 25% of workdays lost. The annual occurrence of occupational related lower back pain among blue collar workers in South Africa has shown to be between 55,7% and 63,9%. Methodology: Primary studies were searched with the use of the Entrez-cross-database search tool. Methodologies were assessed and critiqued. Data which included exercise detail, outcome measures of lower back pain intensity, painful episodes, sick leave and physical measures with statistical p-values was then extracted. Results: Nine primary studies, which included 11 exercise groups, complied to the inclusion and exclusion criteria. These studies proved to be of high methodology quality with quality scoring 70% on the quality assessment checklist. Exercise regimes, which included stretching, strengthening, endurance exercises and the combination use of stretching, strengthening and endurance exercises were identified and grouped according to the corresponding outcome measures. No meta-analysis could be done as no similar exercises with similar outcome measures could be found. Discussion: The limitations in the nine selected studies methodological quality were the lack of blinding of the assessors and subjects, and in six of the nine studies the lack of adequate participation rate among the intervention subjects. The validation process is acknowledged as a weakness within this study. Stretching, dynamic strengthening and endurance exercises were not statistically significant. Isometric exercise was statistically significant for lower back pain relief when the control group (p<0,0001) was compared to the experimental group. Isometric exercise however had no significant effect on abdominal strength at 9 months follow up period. Functionalexercises were statistically significant when the exercise group was compared to the control group with lower back pain intensity relief (p<0,018), painful episodes (p<0,018), sick leave (p< 0,0044). Functional exercises also had a long-term statistically significant effect on back muscle strength. A meta analysis could not be done due to insufficient similar studies. Conclusion: Although the methodology quality of the nine primary studies showed to be of high quality the validation process was a weakness within this study. Functional strengthening exercises were the most effective type of exercise for the management of occupational lower back pain among blue-collar workers. Future similar randomized control trials on exercise as an intervention to occupational lower back pain are needed to conduct a meta analysis. A meta analysis will be able to provide more evidence to establish which exercise regime is most effective for the management of occupational lower back pain.

Non-specific low back pain (LBP) has been associated with alterations in the biomechanical properties and muscle activities of the trunk, but it is unclear how these changes are related to the dynamic stability of the trunk. During sitting, the structures of the trunk stabilise the upper body counterbalancing external moments acting on the trunk. The aim of this research was to evaluate a range of biomechanical variables including the hip and lumbar spine joints range of motions, moments and powers the viscoelastic properties of the trunk, and the role of the muscles while a participant was performing a balancing task in sitting and to compare results between healthy and LBP subjects. A custom-made swinging chair was used to perform the balancing task. It was designed to challenge primarily the trunk and to minimise the effect of the lower limbs so that the role of the trunk could be examined in isolation. Twenty-four participants with LBP and thirty healthy participants were requested to sit on the custom-made swinging chair and to regain the balance after tilting the chair backward for 10° and 20º. Electromagnetic motion track system sensors were placed on the participants’ back, one at the sacrum level and one at the first lumbar vertebral level to measure hip and lumbar kinematics. One further sensor was placed on the chair to track its rotation, which was also the rotation of the lower limbs. Forces data were taken from a force-plate which was mounted at the bottom of the chair. Inverse dynamic equations were used to derive the muscle moment acting at the hip and lumbar spine joints using data from the force platform and the motion tracking system. Muscle power was then calculated by multiplying the muscle moment and the corresponding joint angular velocity. Trunk viscoelastic parameters were derived using a second order linear model combine trunk moment and motion. Chair motion and trial duration were used to evaluate dynamic stability and task performance, in particular, the angular displacement of the chair was fitted in an equation describing the underdamped second-order response to a step input to derive natural frequency and damping ratio and to evaluate possible differences between groups. Activities, reaction times and co-contraction of the trunk muscles were evaluated using surface electromyography (EMG). The surface electrodes were placed bilaterally on the erector spinae , rectus abdominus, external and internal oblique. Kinematic analysis showed that the hip range of motion increased whereas spine range of motion angle decreased in participants with LBP for both tilt angles (p. < 0.05). No significant differences were found in muscle moment and power between healthy and LBP subjects (p > 0.05). The duration of contraction of various trunk muscles and co-contraction were significantly longer in the LBP subjects (p < 0.05) when compared to healthy subjects, and the reaction times of the muscles were also significantly reduced in LBP subjects (p<0.05). Trunk stiffness was found increased for LBP subjects (p < .05) while no difference was found for damping coefficient. There were no significant differences between the 2 subject groups in the time required to regain balance, and in the dynamic stability parameters, the natural frequency and damping ratio. The present study showed LBP was associated with alterations in biomechanical variables; in particular stiffness, hip and lumbar spine joints kinematic and muscle responses were altered in subjects with LBP when compared with healthy group. However, these alterations did not affect dynamic stability and moment developed at joints level, suggesting that LBP subjects adopted a different strategy to maintain balance but with the same effectiveness as the healthy subjects without any worsening of the symptoms. This may suggest to clinicians to encourage patients to remain active rather than to avoid movements. On the other hand, compensatory strategies were achieved with increased co-contraction at the expenses of muscle efficiency. This may lead to muscle fatigue and increase in spinal stress. Future research should clarify if the observed biomechanical alterations in this study are consequences or causes of LBP; or if the biomechanical changes and pain operate in a vicious circle, reinforcing each other leading to chronic conditions. This would help achieve our ultimate goal of developing effective treatment strategies, and it is hoped that the work of this thesis has helped us take a significant forward towards this goal.

MSc Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2009 / The use of reliable and valid outcome measures in clinical research as well as clinical practice is very important. Self reported questionnaires are widely used as outcome measures to assess the subjective perception of disability caused by low back pain (LBP). The Roland Morris Disability Questionnaire (RMDQ), Quebec Disability Scale (QDS) and Waddell Disability Index (WDI) have been identified as reliable and valid instruments for assessing disability caused by LPB in English speaking patients. The three questionnaires were translated, back-translated and tested in a final version for use with Tswana speaking subjects. The questionnaires were tested on one hundred respondents, who met the inclusion criteria, at five hospitals in Tswana speaking areas. Of the one hundred respondents 31 were retested 24 hours later. No significant floor or ceiling effects were found for all three questionnaires. There was moderate correlation between the RMDQ, WDI and the DRI (0.74 and 0.63, respectively). The correlation between the QDS and the Disability Rating Index (DRI) was strong (0.85). The RMDQ, QDS and WDI correlated moderately with the VAS (pain) (0.63, 0.68 and 0.74, respectively). The RMDQ, QDS and WDI appeared to be internally consistent scales with Cronbach’s alpha values of 0.92, 0.95 and 0.75, respectively. The RMDQ, QDS and WDI showed excellent test-retest reliability with intra-class correlation coefficient values of 0.93, 0.91 and 0.84, respectively. The results suggest that the Tswana versions of the RMDQ, QDS and WDI validated in this study are easy to understand, valid and reliable instruments for the measurement of functional disability caused by LBP in a Tswana speaking population. Therefore, these translated instruments may be useful clinical methods for collecting standardised data on activity limitations resulting from LBP in a Tswana speaking population.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Lower back pain (LBP) is one of the most common work-related health problems in economically developed countries and the most prevailing musculoskeletal condition that causes disability in the developing nations. School teachers are susceptible to LBP due to the nature of their daily work routine which is physically demanding and include common activities such as long hours of sitting, standing and bending that have been identified as risk factors for LBP. The aim of the study was to determine the role of work-related activities in the prevalence of LBP amongst primary school teachers in the Dar-es-Salaam region of Tanzania. To achieve this goal, the study sought to meet the following three objectives: to determine the prevalence of LBP among primary school teachers; to determine the work-related physical activities contributing to LBP among primary school teachers, and to determine and explore the application of kinetic handling principles in their daily work environment. The study was conducted in eighty randomly selected primary schools from the Temeke, Ilala and Kinondoni districts. A sequential explanatory mixed method approach was utilised. A cross-sectional descriptive design was employed. A self-administered questionnaire consisting of three sections (socio-demographic information; the Nordic Back Pain Questionnaire and the Oswestry Lower back pain Questionnaire) was completed by two hundred and eighty six primary school teachers with a mean age of 41.2 years (SD=9.9), 78.7% female and 21.3% male. Thirty primary school teachers participated in the participant observation of the application of kinetic handling principles in their daily work environment and focus group discussions. Results of the study found that 17.1% of the teachers had LBP during the past week while 82.9% experienced LBP during the past year. In addition, 30.8% of the teachers had referred pain, mostly to the thigh area (43.9%). Less than fifty percent (43.5%) of the participants had severe pain in sitting (76 – 100mm on the VAS scale) while 26.9% was not able to sit for more than an hour while teaching due to LBP. A significant relationship was found for severe functional disability and gender (p=0.032). The study demonstrated poor application of kinetic handling principles at work. Factors impeding teachers’ efforts to implement best practices and back care techniques in their daily teaching activities were work environment (poor facilities and equipment; heavy workload and staff shortage) and uncertainty about desired practice. In order to address the higher prevalence of lower back pain the study recommended, inter alia, improvement of the work environment for teachers by providing proper office furniture, re-assessment of education standards such as students /class ratio, students/desk ratio and number of teachers for schools and lastly, the implementation of health education and health promotion strategies to prevent LBP amongst primary school teachers.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Lack of adherence to the correct working conditions exposes workers to ergonomics-related hazards and eventually work-related musculoskeletal disorders (WRMDs) which are estimated at 160 million per year globally. Literature shows that with modernization by use of computers, administrators are exposed to prolonged sitting and long working hours which predisposes them to ergonomic hazards. Low back pain and neck pain are the leading work-related musculoskeletal disorders with a lifetime prevalence of 70 - 80% and 50 - 60% respectively.Both low back pain and neck pain have a multifactorial aetiology that includes work-related and individual related factors. Lack of reporting of work-related injuries has led to paucity of statistical literature with regards to work-related low back pain and neck pain, especially in the developing countries. The aim of this study was to determine the prevalence of ergonomics related low back pain and neck pain, and describe the effect of a knowledge-based ergonomic intervention among administrators in Aga Khan University Hospital, Nairobi (AKUH, N). A mixed method design was used in this study using a survey and two focus group discussions(FGD). A self-administered questionnaire that is in four sections was administered to 208 participants. The questionnaire sought the prevalence of musculoskeletal disorders, the knowledge of participants with regards to low back pain and neck pain as well as the work-related and individual risk factors related to the same. The dissemination of the study results involved a one hour knowledge-based ergonomic session given to all interested participants, based on the information from the survey. Two FGD with purposive selection of eight participants were held to explore their experience on the value of the information provided.The statistical package for social sciences (SPSS) version 20 was used to capture and analyze the quantitative data. Descriptive statistics was used to summarize the study findings in the form of means, frequencies, standard deviations and percentages. Inferential statistics (chi-square) was used to test the associations between different categorical variables (p<0.05). For the qualitative data, the tape recorded interviews were transcribed verbatim, field notes typed, sorting and arranging data was done and themes were generated. Thematic content analysis was used to generate the themes. The aim of the study, confidentiality and the participants‘ freedom to withdraw from the study were explained. Informed consent was also obtained before the survey and FGD and referral was made where necessary. The findings of the current study revealed that the study participants were knowledgeable about ergonomics-related low back pain and neck pain however this knowledge was not directly translated into behaviour. Low back pain (LBP) had the highest twelve month prevalence at 75.5% followed by neck pain at 67.8%, and LBP showed significant associations at p< 0.05 with some work-related and individual risk factors. The results of the FGDs showed that most participants had positive behavioural and attitudinal change post the knowledge-based ergonomic intervention despite the challenges they met in implementing the behavioural change. These results therefore show the need for continual education about ergonomics to create awareness on the predisposing factors to work-related LBP and neck pain, hence promoting a healthier quality of life amongst employees through adherence to healthy work behavioural practice.

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Lifting weights, moving large, heavy objects, or maintaining same posture for extended periods of time exposes workers, mostly in the industrial sector, to pressure on their lower backs, which can have a significant negative impact and result in a variety of musculoskeletal problems and discomfort. The use of an exoskeleton can help to protect workers against lower back injuries of this kind. Past studies have been conducted to study the impact of the exoskeleton on upper body and legs with different exoskeleton, while this study will be an additional study which covers the impact on the most essential and used part of human body i.e., lower back (Thoracolumbar fascia). Workers working in the industrial sectors face more health issues and disabilities because of working on uneven surfaces, under uncomfortable positions like bending, squatting, twisting, and stretching which might impose adverse impact on lower back resulting in a higher number of sick leave.  If more people are impacted by disorders caused by lower back pain, the lesser would be the healthy workers available for work leading to shortage of competent workers in the industry. Back discomfort can affect a person's capacity to work; in fact, it's one of the most prevalent causes of temporary or permanent exclusion from the labor force when it comes to sick leave. The total estimated societal costs of low back pain in Sweden in 2001 was €1860 million, which included all medical expenditures as well as lost productivity as a result of the ailment. Estimates place the total economic cost of LBP in Sweden at €740 million, or €78 per person, for all episodes that started in 2011. [1].  This research study used a passive exoskeleton, namely “BackX”, developed by SUITX Inc. and its impact was measured on the body’s lower back in deep squatting and virtual chair position. Electromyography (EMG) sensors were deployed onto the participant's body as a measuring gadget. The investigations also examined the body muscle data of the various volunteers as recorded by the EMG sensors embedded in the thoracic-lumber fascia, a muscle in the lower back with and without exoskeleton.  The 3DSSPP model has also been used in this research to study the impact of force vs angle relation. It showed how much force was exerted on the human's lower back when lifting weights without wearing the exoskeleton.  In addition, using the proper data processing techniques, the signals from the acquired data will be filtered and processed. According to this study, it is possible to minimize skeletal muscle (Thoracolumbar fascia) activity by up to 60% by using these exoskeletons, which will improve the working conditions for the workforce by easing physical strain. The findings of this study will help small and medium enterprises (SMEs) spread the word regarding the advantages of exoskeletons, which will help to increase public awareness.

Bakgrund: Manuella behandlingstekniker såsom stretching och ledmobilisering används inom veterinärmedicinsk fysisk rehabilitering av hund. Det råder inte konsensus angående vid vilka indikationer som mobilisering och manipulation kan användas med förväntad positiv effekt eller med vilken dosering. Det saknas också evidens för bland annat effekten av stretching av muskulatur på ledrörlighet och smärta hos hund med ospecificerade smärttillstånd i rörelseapparaten. Syfte: Syftet var att undersöka den akuta effekten av statisk stretching av m.iliopsoas och hamstrings på muskellängd, funktion och smärta hos hund med ospecificerad ländryggssmärta. Metod: Studien genomfördes som en Single-Case Experimental Design (SCED). De tre deltagande hundarna med av veterinär diagnostiserad ospecificerad ländryggssmärta rekryterades via författarens verksamhet. Deltagande hundägare utförde interventionen i form av statisk stretching under tre veckor. Datainsamlingen utfördes medelst mätningar av muskellängd två gånger per vecka under baslinje- och interventionsfas samt att hundägarna fick fylla i enkäten Canine Brief Pain Inventory – S (CBPI – S) en gång per vecka. Resultaten presenterades i diagramform och text.  Resultatsammanfattning: Hos en av tre deltagare uppmättes ökad muskellängd och för två av tre deltagare visade resultaten minskad skattad smärtintensitet och ökad skattad funktion. Slutsats: Statisk stretching som intervention för hundar med ospecificerad ländryggssmärta kan i den aktuella studien inte visa på entydig effekt vad gäller förändring av muskellängd, skattad smärtintensitet och skattad funktion. / Background: Manual therapies such as stretching and joint mobilization are used in veterinary physical rehabilitation of dogs. No consensus exists in which indication mobilization and manipulation can be used with expected positive effect or in what dosage. There is a lack of evidence regarding the effects of stretching of musculature on joint mobility and pain in dogs with unspecified pain conditions in the musculoskeletal system. Objective: The aim of this study was to explore the acute effect of static stretching of m.iliopsoas and hamstrings on muscle length, function and pain in dogs with unspecified lower back pain.  Method: This study was conducted as a Single-Case Experimental Design (SCED). The three participating dogs, veterinary diagnosed with unspecified lower back pain, were recruited through the author’s business. The participating dog owners carried out the intervention consisting of static stretching during three weeks. The data collection was conducted by measuring muscle length twice a week during baseline and intervention phases and the participating dog owners filling in the questionnaire Canine Brief Pain Inventory – S (CBPI –S) once a week. The results were presented in diagrams and text. Results: Increased muscle length was measured in one out of three participants and two out of three participants showed reduced estimated pain intensity and increased estimated function. Conclusion: The current study showed no conclusive results regarding the effect of static stretching on muscle length, estimated pain intensity and estimated function in dogs with unspecified lower back pain.