Back injury in nursing is a significant concern for the health of the worker, the costs to the healthcare system, and the safety of the patients. Current injury prevention measures include ergonomic adjustments to the work environment, the use of mechanical lifting equipment, policies to limit manual handling of patients, and the teaching of lifting techniques. These measures have been met with limited success in reducing injury rates. Little is known about whether changing the lifting biomechanics used in the healthcare setting can lower high injury rates across the profession. The purposes of this dissertation were to: 1) identify the biomechanical risk factors routinely encountered by healthcare workers during the performance of their daily job tasks and 2) determine whether nurses with formal training in weightlifting have better biomechanical performance during routine nursing tasks than nurses with no training. This dissertation included the development of a conceptual model to guide the research. The framework identified the impact of muscle fatigue on the biomechanics used in lifting and moving of heavy equipment and patients. The worker characteristics that affect muscle fatigue include age, gender, height, BMI and the type of recreational activities outside of the workplace. These characteristics were controlled for in two studies aimed at providing a greater understanding of biomechanics used by nurses during routine patient care related activities. The first study addressed a gap in knowledge related to the biomechanics of lifting techniques used by nurses in the work environment, specifically of the anterior rotation of the trunk and pelvis, angles of the hips, knees, and lumbar spine, and muscle activation of core and leg muscles used during patient care activities. We analyzed the biomechanics used by 11 senior level nursing students lifting a simulated patient attached to a rigid spine board from the floor to a standing height. Previous studies have identified that a lumbar spine angle in excess of 22.5 degrees flexion when performing a lift places a worker at a greater risk for back injury. Biomechanical risk factors effecting this lumbar spine angle identified in this study included the anterior rotation of the trunk and pelvis in the starting position of the lift, the angle of the hips and knees during the lifting cycle, the dominate muscle activation of the rectus femoris during the lifting cycle influencing the anterior pelvic rotation, and minimal activation of the core muscles required to add stability to the spine during the lift. This dissertation identifies common biomechanical risk factors routinely encountered by healthcare workers, and gives indication of differences between nurses with formal weightlifting training and those that have not received formal weightlifting training. The differences in body positioning and core stabilization can help reduce the biomechanical risks of back injury in nursing.

The aim of this study is to develop a set-up that can be used by patients performing posterior pelvic tilt exercises to assess and improve the effectiveness of the exercise by visual feedbacks. Lifetime of low back pain prevalence is between %60 and %90. In other words almost everyone encounters the problem of low back pain sometime during their life. Therapeutic and protective exercises are the most important components of treatment for the low back pain. People who have mechanical based low back pain due to postural disorders, have weakness of abdominal and back muscles. Posterior pelvic tilt exercises are one of the effective types of exercises to solve this problem. These can be done standing against a wall or lying on a surface. These exercises are advised to patients generally as home exercise programs. However most patients cannot do their exercises effectively due to lack of training and control. In posterior pelvic tilt exercise, the patient is asked to straighten his/her lumbar lordosis and exert as much pressure as possible to the surface he/she is lying on. It is believed that the efficiency of the exercise is correlated with the amount of this pressure. Entertaining visual feedback may increase patient&amp / #8217 / s motivation and consequently quality of the exercise. In this experimental set-up, pressure variations were determined by three receivers which were placed under the back of the patient to provide feedback for proper posterior pelvic tilt exercises. By means of this experimental set-up training for these exercises was achieved easily and the quality of exercises was improved.

The aim of this study was to determine the concurrent validity, test-retest intra-rater reliability, and test-retest inter-rater reliability of photographic measures of anterior pelvic tilt range of motion (APT ROM) and hip extension ROM range of motion (HE ROM) during a constrained forward lunge test (CFLT) in healthy adult runners. Measurements of start, end, and range of motion (ROM) variables for APT and HE motion were taken from an Optorak kinematic measurement system and from printed photographs extracted from digital video footage using a protractor. A total of 13 healthy adult male and female recreational runners participated in the study. Measures of APT ROM and HE ROM were found to be valid compared to Optorak measures, with intraclass correlation coefficients (ICC) of 0.94 and 0.99 respectively, and limits of agreement of -1.42 ± 1.99 degrees and 0.41 ± 2.13 degrees respectively. APT ROM and HE ROM demonstrated high between-day intra-rater reliability with ICCs ranging from 0.75 to 0.91 and within-day inter-rater reliability with ICCs ranging from 0.86-0.90. For between day intra-rater measurements smallest detectable differences (SDDs) ranged from 5.59 to 4.12 for APT ROM and from 9.08 to 11.08 for HE ROM. The present study suggests that photographic measurements of APT ROM and HE ROM during a CFLT are valid and reliable in healthy adult runners; however, these measurements display a low sensitivity with respect to detecting changes between trials.

Hyperlordosis or anterior pelvic tilt is a common non-neutral spinal posture associated with weak core stability, low back pain and altered lumbopelvic muscle activation patterns. Yet the effects of altered lumbopelvic posture and core stability on muscle activation patterns have not been evaluated during a functional movement. The main purpose of this study was to determine the relationship between pelvic tilt, core stability and muscle activation patterns during non-weighted squats in U/19 university-level rugby union players. A total of 49 rugby union players participated in this study. Pelvic tilt (dominant side) was measured from a digital photo with clear reflector markers on the anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) using the Kinovea video analysis software programme (version 0.8.15). Flexibility of the hamstrings, hip flexors and knee extensors was assessed with goniometry. Core stability was assessed using the pressure biofeedback unit and muscle onset times during the ascent phase of non-weighted squats. The onset times of the transverse abdominis (TrA), erector spinae (ES), gluteus maximus (GM) and biceps femoris (BF) muscles were measured using electromyography (EMG). Players were then grouped according to pelvic tilt (anterior and neutral) and by playing position (forwards and backs). The between group differences were evaluated for the abovementioned variables using p-value (statistical significance) and d-value (practical significance) measures. Muscle activation patterns and firing order were determined using descriptive statistics. The mean pelvic tilt of all participants (N=49) was an anterior tilt of 15.35°. When grouped by pelvic tilt, the anterior tilt group showed a mean pelvic tilt of 17.83° (n=27) and the neutral pelvic tilt group showed a mean pelvic tilt of 11.75° (n=22). Despite the differences in pelvic tilt, there was no significant difference in flexibility between the groups. Another controversial result is that the anterior tilt group showed practical significantly better core stability (d=0.54) than the neutral tilt group (46.93° vs 56.3°). During the double leg squat the muscle activation patterns were consistent between the groups. TrA activated first, followed by ES. Thereafter, the BF muscle activated, followed by the GM. The first place activation of TrA is consistent with the literature stating that the deep abdominal stabilisers of individuals with good core stability activate before the movement is initiated. The early onset of muscle activity of ES points to a focus on back extension during the ascent of the squat. Because the pelvic tilt was measured during static standing only, it is unclear whether the players in the neutral tilt group were able to hold the neutral pelvic tilt posture throughout the movement. Research has shown that there is an increased focus on trunk extension during the ascent phase of the squat which is not present during the descent. Future research should focus on assessing the pelvic tilt at the beginning of the ascent phase of the squat to ensure accurate results. The delay in GM activation during the ascent of the squat is concerning. GM acts as a lumbopelvic stabilizer, and its slow activation points to a decrease in lumbopelvic stability. This is very important in weight training, because weight training increases the strain on the lumbar spinal structures, which decreases performance and increases the risk of injury. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2014

Hyperlordosis or anterior pelvic tilt is a common non-neutral spinal posture associated with weak core stability, low back pain and altered lumbopelvic muscle activation patterns. Yet the effects of altered lumbopelvic posture and core stability on muscle activation patterns have not been evaluated during a functional movement. The main purpose of this study was to determine the relationship between pelvic tilt, core stability and muscle activation patterns during non-weighted squats in U/19 university-level rugby union players. A total of 49 rugby union players participated in this study. Pelvic tilt (dominant side) was measured from a digital photo with clear reflector markers on the anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) using the Kinovea video analysis software programme (version 0.8.15). Flexibility of the hamstrings, hip flexors and knee extensors was assessed with goniometry. Core stability was assessed using the pressure biofeedback unit and muscle onset times during the ascent phase of non-weighted squats. The onset times of the transverse abdominis (TrA), erector spinae (ES), gluteus maximus (GM) and biceps femoris (BF) muscles were measured using electromyography (EMG). Players were then grouped according to pelvic tilt (anterior and neutral) and by playing position (forwards and backs). The between group differences were evaluated for the abovementioned variables using p-value (statistical significance) and d-value (practical significance) measures. Muscle activation patterns and firing order were determined using descriptive statistics. The mean pelvic tilt of all participants (N=49) was an anterior tilt of 15.35°. When grouped by pelvic tilt, the anterior tilt group showed a mean pelvic tilt of 17.83° (n=27) and the neutral pelvic tilt group showed a mean pelvic tilt of 11.75° (n=22). Despite the differences in pelvic tilt, there was no significant difference in flexibility between the groups. Another controversial result is that the anterior tilt group showed practical significantly better core stability (d=0.54) than the neutral tilt group (46.93° vs 56.3°). During the double leg squat the muscle activation patterns were consistent between the groups. TrA activated first, followed by ES. Thereafter, the BF muscle activated, followed by the GM. The first place activation of TrA is consistent with the literature stating that the deep abdominal stabilisers of individuals with good core stability activate before the movement is initiated. The early onset of muscle activity of ES points to a focus on back extension during the ascent of the squat. Because the pelvic tilt was measured during static standing only, it is unclear whether the players in the neutral tilt group were able to hold the neutral pelvic tilt posture throughout the movement. Research has shown that there is an increased focus on trunk extension during the ascent phase of the squat which is not present during the descent. Future research should focus on assessing the pelvic tilt at the beginning of the ascent phase of the squat to ensure accurate results. The delay in GM activation during the ascent of the squat is concerning. GM acts as a lumbopelvic stabilizer, and its slow activation points to a decrease in lumbopelvic stability. This is very important in weight training, because weight training increases the strain on the lumbar spinal structures, which decreases performance and increases the risk of injury. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2014

Hamstring injuries have a high prevalence in rugby union players. Delayed transverse abdominus activation as well as lordosis is associated with hamstring injuries. No literature regarding this relationship in rugby players could have been found. The main purpose of this study was therefore to determine the relationship between pelvic biomechanics (transverse abdominus activation and pelvis tilt) and gluteus maximus, hamstring and erector spinae activation patterns in semi–professional rugby union players as well as the relationship of the above mentioned variables and hamstring injuries. A total of 65 players voluntarily participated in this study. Pelvis tilt (left and right) was assessed by Dartfish version 4.06.0 (Dartfish, Switzerland). Transverse abdominus activation (TrA) was assessed by pressure biofeedback and the mean onset times of the left and right gluteus maximus (GM), biceps femoris (BF), semitendinosus (ST) and lumbar erector spinae (LES) was measured with electromyography (EMG). In order to determine the role of the pelvic biomechanics and activation patterns on hamstring injuries, players were retrospectively grouped in injured and uninjured groups. Differences between the groups were determined with regards to the variables determined. Activation patterns were determined by means of descriptive statistics. The between–group pelvic biomechanic (pelvic tilt and TrA) differences in the muscle (GM, LES and hamstrings) onset times were analysed by determining practical significance by means of effect sizes. An anterior pelvic tilt on the left side was observed in 64.6% of the participants and on the right side in 83.1% of the participants. TrA testing indicated that 68.4% of participants were classified with bad activation and 31.6% with good activation. No practical significant difference was found in the mean onset times of each muscle relative to the other in the normal and anterior tilted pelvis groups as well as in the bad and good TrA groups. A total of 24.6% of the rugby players previously suffered from hamstring injuries, 37.5% of those injured participants were suffering from re–injury. No practical significant between group differences were found when the injured and uninjured groups were compared with regards to anterior pelvis tilt values (d=0.061) and TrA values (d=0.189). EMG results on the right and left side of the injured and uninjured participants present a pattern of the following activation order: LES, GM, BF and lastly ST. No practical significant between groups differences were found in the onset times of the muscles relative to each other in the injured compared to uninjured groups. The conclusions that can be drawn from this study is that semi–professional rugby union players (injured and uninjured) are prone to postural defects such as anterior tilt of the pelvis and bad TrA. Anterior pelvic tilt and bad TrA may be the reason for the earlier activation of the LES and hamstrings muscles relative to the GM in the prone hip extension to stabilize the lumbar spine. These activation patterns were however not influenced by previous hamstring injuries. / Thesis (M.A. (Biokinetics))--North-West University, Potchefstroom Campus, 2011.

Hamstring injuries have a high prevalence in rugby union players. Delayed transverse abdominus activation as well as lordosis is associated with hamstring injuries. No literature regarding this relationship in rugby players could have been found. The main purpose of this study was therefore to determine the relationship between pelvic biomechanics (transverse abdominus activation and pelvis tilt) and gluteus maximus, hamstring and erector spinae activation patterns in semi–professional rugby union players as well as the relationship of the above mentioned variables and hamstring injuries. A total of 65 players voluntarily participated in this study. Pelvis tilt (left and right) was assessed by Dartfish version 4.06.0 (Dartfish, Switzerland). Transverse abdominus activation (TrA) was assessed by pressure biofeedback and the mean onset times of the left and right gluteus maximus (GM), biceps femoris (BF), semitendinosus (ST) and lumbar erector spinae (LES) was measured with electromyography (EMG). In order to determine the role of the pelvic biomechanics and activation patterns on hamstring injuries, players were retrospectively grouped in injured and uninjured groups. Differences between the groups were determined with regards to the variables determined. Activation patterns were determined by means of descriptive statistics. The between–group pelvic biomechanic (pelvic tilt and TrA) differences in the muscle (GM, LES and hamstrings) onset times were analysed by determining practical significance by means of effect sizes. An anterior pelvic tilt on the left side was observed in 64.6% of the participants and on the right side in 83.1% of the participants. TrA testing indicated that 68.4% of participants were classified with bad activation and 31.6% with good activation. No practical significant difference was found in the mean onset times of each muscle relative to the other in the normal and anterior tilted pelvis groups as well as in the bad and good TrA groups. A total of 24.6% of the rugby players previously suffered from hamstring injuries, 37.5% of those injured participants were suffering from re–injury. No practical significant between group differences were found when the injured and uninjured groups were compared with regards to anterior pelvis tilt values (d=0.061) and TrA values (d=0.189). EMG results on the right and left side of the injured and uninjured participants present a pattern of the following activation order: LES, GM, BF and lastly ST. No practical significant between groups differences were found in the onset times of the muscles relative to each other in the injured compared to uninjured groups. The conclusions that can be drawn from this study is that semi–professional rugby union players (injured and uninjured) are prone to postural defects such as anterior tilt of the pelvis and bad TrA. Anterior pelvic tilt and bad TrA may be the reason for the earlier activation of the LES and hamstrings muscles relative to the GM in the prone hip extension to stabilize the lumbar spine. These activation patterns were however not influenced by previous hamstring injuries. / Thesis (M.A. (Biokinetics))--North-West University, Potchefstroom Campus, 2011.

The subject of this dissertation was the creation of the adapted exercise program for unilateral transfemoral amputees and its verification in practice. The content of this program was chosen based on the practical experience and theoretical background in the field of anatomy, kinesiology, rehabilitation, lower- limb amputations and Motion Capture technologies. The four-month intervention program was designed as an adapted corrective exercise aimed at the major muscle groups influencing the posture, especially the position of the pelvic segment, which is the dominant element in the kinematic chain. The aim of this project was to ascertain whether this intervention can affect the pelvic tilt (in frontal and sagittal plane) of unilateral transfemoral amputees and so improve their quality of life. This was a project based on combination of quantitative and qualitative research methods. The measurement of the size of angles determining the pelvic tilt by Qualisys optoelectronic system was the essence of the quantitative part of the research. Qualitative data were collected through semi-structured in-depth interviews from persons who completed whole project. This research is by its nature and focus characterized as a set of case reports and as a pilot study, proof of concept respectively. 10 unilateral...