Relative Contribution of Lower Body Work as a Biomechanical Determinant of Spine Sparing Technique During Common Paramedic Lifting Tasks.

Paramedics represent a unique occupational group where the nature of their work, providing prehospital emergency care, makes workplace modifications to manage and control injury risks difficult. Therefore, the provision of workplace education and training to support safe lifting remains a viable and important approach. There is, however, a lack of evidence describing movement strategies that may be optimal for paramedic work. The purpose of this study was to determine if a strategy leveraging a greater contribution of work from the lower body relative to the torso was associated with lower biomechanical exposures on the spine. Twenty-five active duty paramedics performed 3 simulated lifting activities common to paramedic work. Ground reaction forces and whole body kinematics were recorded to calculate: peak spine moment and angle about the L4/L5 flexion-extension axis as indicators of biomechanical exposure; and, joint work, integrated from net joint power as a measure of technique inclusive of movement dynamics. Paramedics generating more work from the lower body, relative to the trunk, were more likely to experience lower peak L4/L5 spine moments and angles. These data can inform the development of workplace training and education on safe lifting that focuses on paramedics generating more work from the lower body.

[1]  Robin Burgess-Limerick Squat, stoop, or something in between? , 1999 .

[2]  S. Genevay,et al.  Effectiveness of preventive back educational interventions for low back pain: a critical review of randomized controlled clinical trials , 2012, European Spine Journal.

[3]  G. Salem,et al.  The Limiting Joint During a Failed Squat: A Biomechanics Case Series , 2015, Journal of strength and conditioning research.

[4]  Youngho Kim,et al.  Lower extremity joint kinetics and lumbar curvature during squat and stoop lifting , 2009, BMC musculoskeletal disorders.

[5]  Bruce Abernethy,et al.  Self-Selected Manual Lifting Technique: Functional Consequences of the Interjoint Coordination , 1995, Hum. Factors.

[6]  S. Flanagan,et al.  The validity of summing lower extremity individual joint kinetic measures. , 2005, Journal of applied biomechanics.

[7]  Bryan Buchholz,et al.  ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion--Part II: shoulder, elbow, wrist and hand. , 2005, Journal of biomechanics.

[8]  Denys Denis,et al.  Relative importance of expertise, lifting height and weight lifted on posture and lumbar external loading during a transfer task in manual material handling , 2012, Ergonomics.

[9]  Steven L. Fischer,et al.  A physical demands description of paramedic work in Canada , 2016 .

[10]  William S Marras,et al.  Spine Loading as a Function of Gender , 2002, Spine.

[11]  Jack P Callaghan,et al.  Physical fitness improvements and occupational low-back loading – an exercise intervention study with firefighters , 2014, Ergonomics.

[12]  P. Corbeil,et al.  Paramedics on the job: dynamic trunk motion assessment at the workplace. , 2014, Applied ergonomics.

[13]  C. Shea,et al.  Motor skill learning and performance: a review of influential factors , 2010, Medical education.

[14]  A Garg,et al.  Revised NIOSH equation for the design and evaluation of manual lifting tasks. , 1993, Ergonomics.

[15]  G Cooper,et al.  Risk assessment of patient handling with ambulance stretcher systems (ramp/(winch), easi-loader, tail-lift) using biomechanical failure criteria. , 2007, Medical engineering & physics.

[16]  Michael I. Jordan,et al.  Optimal feedback control as a theory of motor coordination , 2002, Nature Neuroscience.

[17]  Hartmut Witte,et al.  ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine. International Society of Biomechanics. , 2002, Journal of biomechanics.

[18]  William S Marras,et al.  Gender influences on spine loads during complex lifting. , 2003, The spine journal : official journal of the North American Spine Society.

[19]  R W Norman,et al.  Biomechanical and psychosocial risk factors for low back pain at work. , 2001, American journal of public health.

[20]  Karl M. Newell,et al.  Constraints on the Development of Coordination , 1986 .

[21]  J H van Dieën,et al.  Stoop or squat: a review of biomechanical studies on lifting technique. , 1999, Clinical biomechanics.

[22]  Steven L Fischer,et al.  Patient acuity as a determinant of paramedics' frequency of being exposed to physically demanding work activities. , 2016, Applied ergonomics.

[23]  S A Lavender,et al.  Biomechanical analyses of paramedics simulating frequently performed strenuous work tasks. , 2000, Applied ergonomics.

[24]  A Plamondon,et al.  Sex differences in lifting strategies during a repetitive palletizing task. , 2014, Applied ergonomics.

[25]  W. G. Allread,et al.  The Role of Dynamic Three-Dimensional Trunk Motion in Occupationally-Related Low Back Disorders: The Effects of Workplace Factors, Trunk Position, and Trunk Motion Characteristics on Risk of Injury , 1993, Spine.

[26]  S. Nadeau,et al.  Work and energy transfers in maximal pushing of loads , 1996 .

[27]  A Plamondon,et al.  Lifting strategies of expert and novice workers during a repetitive palletizing task. , 2014, Applied ergonomics.

[28]  R. Norman,et al.  A comparison of peak vs cumulative physical work exposure risk factors for the reporting of low back pain in the automotive industry. , 1998, Clinical biomechanics.

[29]  D. Krebs,et al.  Lifting Strategy and Stability in Strength-Impaired Elders , 2001, Spine.

[30]  Keith Davids,et al.  Dynamics of skill acquisition : a constraints-led perspective , 2008 .

[31]  Kevin J Deluzio,et al.  Differentiating lifting technique between those who develop low back pain and those who do not. , 2005, Clinical biomechanics.