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ISSN: 0014-0139 (Print) 1366-5847 (Online) Journal homepage: http://www.tandfonline.com/loi/terg20

Current techniques for assessing physical

exposure to work-related musculoskeletal risks,
with emphasis on posture-based methods


To cite this article: GUANGYAN LI & PETER BUCKLE (1999) Current techniques for assessing
physical exposure to work-related musculoskeletal risks, with emphasis on posture-based methods,
Ergonomics, 42:5, 674-695, DOI: 10.1080/001401399185388

To link to this article: http://dx.doi.org/10.1080/001401399185388

Published online: 10 Nov 2010.

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Download by: [Indian Institute of Technology Guwahati] Date: 18 May 2017, At: 21:53
E RGONO M ICS , 1999, VOL . 42, NO. 5, 674 695

Current techniques for assessing physical exposure to work-

related musculoskeletal risks, with em phasis on posture-based


Robens Centre for Health Ergonomics, European Institute of Health and
Medical Sciences, University of Surrey, Guildford, Surrey GU2 5XH, UK

Keywords: Musculoskeletal disorders; Risk factors; Exposure assessment;

Posture; Interaction.

Physical exposure to risks for potential work-related musculoskeletal injuries has

been assessed using a variety of methods, including pen and paper based
observation methods, videotaping and computer-aided analysis, direct or
instrumental techniques, and various approaches to self-report assessment. These
methods are critically reviewed in this paper. The applications of these techniques
in ergonomic and epidemiologic studies are considered, and their advantages and
shortcomings are highlighted. Finally, a strategy that considers both the
ergonomics experts view and the practitioners needs for developing a practical
exposure assessment tool is then discussed.

1. Introduction
W ork-related m usculoskeletal disorders have been found to be associated with
numerous occupational `risk factors , including physical work load factors such as
force, posture, movement and vibration (Gerr et al. 1991 , Burdorf 1992 , Kilbom
1994a) , psychosocial stressors (Bongers et al. 1993 , Bernard et al. 1994 , Eklund
1996), and individual factors (Armstrong et al. 1993). The level of exposure to
physical workload can be normally assessed with respect to intensity (or magnitude),
repetitiveness and duration. Various methods are now availa ble for assessing
exposure to the risks associated with work-related musculoskeletal disorders, or
identifying potentially hazardous jobs or risk factors within a job. These include
observational methods, instrumental or direct m ethods, self-reports and other
psychophysiological methods. The aim of this paper is to give an overview of existing
techniques (largely posture-based), which can be used within the assessment of
physical workload and associated exposure to work-related musculoskeletal risks.
The strategy for assessing physical exp osure in practical work situations is then

2. Observational methods
2.1. Pen-paper based observational methods
From as early as the seventeenth century, methods have become availa ble for
recording human postures (Corlett et al. 1979), but until the development of Priel s
method (Priel 1974), posture recordings had been made by means of drawings or

*Author for correspondence. Now at the Automotive & Ergonomics Research Group,
School of Engineering and Advanced Technology, University of Sunderland, Sunderland SR1
3SD, UK.

0014 0139 /99 $12.00 1999 Taylor & F rancis L td

Physical exposure to W RM D risks 675

photographs and supplementary narratives (Gil and Tunes 1989). Priel s method
involves the use of a paper card called the Posturegram. The analyst is required to
observe, select and then sketch a posture of interest within a job, and then categorize
body posture in term s of 14 dierent upper and lower limb positions relative to three
orthogonal reference planes. The procedure permits adaptation of the recorded
postures to digital data transmission and processing, but takes several minutes to
complete a single posture and is, therefore, unsuitable for dynam ic activities.
A simpler technique for posture recording, as well as for posture classi cation, is
the Ovako W orking Posture Analysing System (OW AS), as developed by the Ovako
Oy Steel Co. in Finland, and described in detail in several papers (Karhu et al. 1977,
von Stoert 1985, Corlett 1995). The system de nes the m ovem ents of body
segments around the lower back, shoulder and lower extremity (including the hip,
knee and an kle) as four types: bending, rotation, elevation and position. To use this
system , the analyst makes an instantaneous observation of the posture and records a
four-digit code, representing the positions of the back (four choices), the arms (three
choices), the legs (seven choices) and force. The recording procedure requires only a
few seconds and can be used in conjunction with a random schedule of observations
to obtain a summ ary description of posture. OW AS also has action categories to
re ect the magnitude of risks. A possible shortcom ing of the system is that the
posture categories are too broad to provide accurate posture description (Keyserling
1986). There have been several variations on the OW AS methodology, mostly by
authors who have automated the data input and output procedure, such as those
reported by G raf et al. (1991), Kivi and M attila (1991), Hignett (1994) and
Fransson-Hall et al. (1995). The OW AS method (or its modi ed form) has been used
in several ergonomic or epidem iologic studies, such as surveillance for ergonomic
hazards at work (Karhu et al. 1981), identi cation of strenuous tasks and activities in
particular jobs (Kant et al. 1990 , Scott and Lambe 1996), characterization of
exposure in epidemiologic studies, and evaluation of the eectiveness of ergonomic
controls (Kivi and M attila 1991).
Another technique for assessing postural stress, known as posture targetting,
was developed by Corlett et al. (1979). W ith this system , the analyst records the
position of the head, trunk, upper and lower arms / legs on a diagram of the body
that has an associated set of segmented concentric circles, similar to a target. The
targets are placed adjacent to each part of the body diagram, and each target has
four circles representing dierent ranges of movem ent (in angles). As the procedure
requires about 30 s or more to complete, it is best suited for jobs where working
postures are reasonably static. In cases where postures are adopted for only a few
seconds and are not repeated, Corlett et al. (1979) suggest alternative methods such
as photographs.
Gil and Tunes (1989) proposed a technique for recording sitting postures. The
posture is recorded on a card that contains four dierent postural con gurations for
thigh-trunk, thigh-leg and trunk-arm angles. The method possesses features allowing
the identi cation of dierent postures, as well as their relative frequency of
occurrence. However, the tim e required to complete the card is more than 40 s,
which can be too long for situations where postures change rapidly. In these cases,
Gil and Tunes (1989) suggest a combination involving the card and lms or video.
The RULA system (Rapid Upper Limb Assessment) is designed for assessing the
severity of postural loading and is particularly applicable to sedentary jobs
(M cAtamney and Corlett 1993). The method adopts the concept of OW AS (Karhu
676 G. Li and P. Buckle

et al. 1977), using numbers to represent postures with an associated coding system.
The range of movement for each upper body part (head, trunk, upper and lower arm,
wrist) is divided into sections that are numbered. Number 1 is given to the range of
movem ent or working posture where risk factors causing load on the structures of the
body segment are minimal, an d higher numbers are given to parts of the movem ent
range with more extrem e postures. If an abduction or rotation is involved, the scoring
is described beside the diagram. In addition to posture recordings, RULA also
considers the load on the musculoskeletal system caused by static or repetitive muscle
work an d force exertion, so that an action list can be produced. This indicates the
level of intervention required to reduce the risks of injury due to physical loading on
the operator. The method has been tested in a laboratory situation relative to VDU
operation (M cAtam ney and Corlett 1993); however, further validation may still be
needed for the system relative to other occupations (M cAtamney 1994). In addition,
its sensitivity, speci city and predictive value for quantifying the actual risk for
musculoskeletal injuries has not yet been assessed.
The HAM A method (Hand-Arm-M ovement Analysis) was developed to analyse
stress on hands and arm s when tasks m ainly consist of movement of the upper lim bs
(Christmansson 1994). This m ethod consists of ve fundam ental parts, related to
dierent risk factors that may in uence work-related stress. These include: type of
basic motion; type of grasp; position of the upper limb; external load; and perceived
exertion. The fundam ental parts are further divided into several sub-categories,
describing dierent types of motion, i.e. grasps, hand position and features of the
external load. Information about hand / arm motion is obtained by videotaping the
task, and information about force exertion is described by the observer and
augm ented by the worker. The major advantage of this m ethod is that the data is
linked to the speci c work activity, thus the relationship between the use of the body
and the design of the workplace and task can be obtained. One possible drawback is
that there is no reference data available for the description of the exposure level (this
is also true for perhaps all observational methods), or the description of stress in
body parts other than upper limbs.
PLIBEL (method for the identi cation of musculoskeletal stress factors that may
have injurious eects) is a screening tool designed to identify `ergonom ic hazards in
the workplace, via the use of a checklist (K emmlert and Kilbom 1987). The checklist
consists of questions regarding work posture, movem ents, workplace or tool design.
These are answered in accordance with the ve body regions concerned, including
neck / shoulders and upper part of back, elbows / forearms and hands, feet /knees and
hips, and low back. The tool is useful for identifying risk factors for musculoskeletal
injuries of a speci c body region, and has been applied in several studies (Vink 1991 ,
Jakobsson 1993). One concern with the checklist is that the inter-observer reliability
is not high (Kemm lert 1995), and it is di cult to justify the magnitude of `risks when
the com bination of several factors is presented within a job.
REBA (Rapid Entire Body Assessm ent) is developed on the basis of the RULA
system (M cAtam ney and Corlett 1993), but it is appropriate for evaluating tasks
where postures are dynam ic, static or where gross changes in position take place
(M cA tamney and Hignett 1995). To use the tool, the observers select the posture or
activity to be assessed and score the body alignm ent using the REBA diagram s. This
is then combined with a load score to form the `coupling scores , which are further
processed into a single combined risk score using the table provided. Action levels
are suggested to indicate necessary ergonomic interventions.
Physical exposure to W RM D risks 677

M ore recently, the QE C system (Quick Exposure Check for work-related

musculoskeletal risks) has been developed by Li and Buckle (1998). The method
includes the assessment of the back, shoulder / upper arm, wrist / hand and neck, with
respect to their postures and repetitive m ovem ent. Inform ation about task duration,
maximum weight handled, hand force exertion, vibration, visual dem and of the task
and subjective responses to the work is also obtained from the worker. The
magnitude of each assessment item is classi ed into exposure levels, and the
combined exposures between dierent `risk factors for each body part are
implem ented by using a score table, in which higher scores are given to the
combination of two higher-level exposure of risk factors than the combination of
two lower-level exposures. Up to ve pairs of combination / interaction are
considered for obtaining overall exposure scores of the back, shoulder / upper arm ,
hand /wrist and neck, i.e. posture versus force, movement versus force, duration
versus force, posture versus duration, movem ent versus duration. The QEC system
has been tested for its sensitivity, usability and inter- /intra-observer reliability for a
variety of simulated and practical tasks, with the help of 150 practitioners. Field tests
have also been conducted with six practitioners using the system to assess 60 tasks in
dierent occupations (Buckle and Li 1997, Li and Buckle 1997a, b, 1998). Studies
indicate that QE C is sensitive to the change in exposure before and after an
ergonomic intervention, and is suitable for the exposure comparison either between
operators performing the same task, or between people performing dierent tasks.
Inter-/ intra-observer reliabilities have been proven to be `fair to good for most of the
assessment items. It was also found that with 10 15 min of training (self-learning)
and some practice, assessm ent could normally be completed within 10 min for each
task. H ow ever, studies have suggested that improvements are needed with the QEC,
particularly for the assessm ent of shoulder /upper arm and wrist / hand repetitive
movements, along with an appropriate training process. In addition, the `score
system is at this time largely hypothetical and needs to be validated through
epidemiological studies.
In general, pen and paper based observational techniques are mainly posture-
based. They are relatively inexpensive to carry out, and the postural assessments can
be made in a con ned workplace without disruption to the workforce. Their main
disadvantage is that the intermittent recording procedures lack precision, therefore
the reliability of the systems has proved to be a problem (Burdorf et al. 1992).
Additional disadvantages include that the optimum num ber of observations may
depend on the exposure variability in relation to measurement duration and
frequency, as well as on the exposure measurement strategy chosen (e.g. individual
or group-based measurement strategy), but the criteria for determining the optimum
number of observations for low and high repetitive tasks are still unclear (Genaidy et
al. 1994). Currently, according to Burdorf (1995), no general guidelines are availa ble
to control and evaluate the trade-o between repeated and prolonged exposure
measurements in a group of workers. A quantitative framework provided by Burdorf
(1995) appears to be useful in the control and evaluation of various design options
related to measurement strategies that can be chosen when using the observational
techniques. However, for most of the observational techniques reviewed in this
paper, the problems still exist and only a few authors have addressed this question
(Kilbom 1994 b). A report by de Looze et al. (1994) indicates that the posture
recordings obtained by a simple direct observational method (Ridd et al. 1989) are
not valid for the dynam ic material handling task simulated in their laboratory. W hile
678 G. Li and P. Buckle

Chen et al. (1989) concluded that the most important shortcoming of the subjective
judgem ent carried out by hum an observers (such as `posture targetting and OW AS)
is that they are not exhaustive in their assessment of the physical workload of the
operator. Burdorf et al. (1992) also maintained that the observation methods lack
precision, are less reproducible in dynam ic work situations, and are subject to intra-
and inter-observer variability. Therefore, the advantages and limitations of pen-
paper based observation techniques has restricted the use of most of these methods
to relatively static jobs, where body postures are held for longer periods of time, or
the body movement follows a simple pattern that is repeated during work. Some
methods are developed to record body movement with special emphasis on
particular segm ents of the body, as summ arized in table 1.
Although work posture has been found to be an important factor associated with
work-related musculoskeletal disorders in some body regions, other workplace
factors such as load / force, repetition an d duration of movement, vibration, as well as
psychosocial and individual factors, an d the interaction / combination of these factors
also contribute to the developm ent of work-related musculoskeletal injuries (NIOSH
1997). One limitation of m ost posture-based observation techniques is that these
factors are not sim ultaneously considered in the assessment process. For the
com bination of risk factors, there is not yet su cient data to prescribe acceptable
exposure limits to individual or combinations of these risk factors. Despite the
epidemiological literature that shows that the greater the level of exposure to a single
risk factor or to the combination of risk factors, the greater the risk of acquiring a
certain type of work-related musculoskeletal disorder (Silverstein et al. 1986, 1987 ,
Burton et al. 1989 , M arras 1992 , Bernard et al. 1997). Additionally, there is not yet
agreem ent on how measures such as repetition, force or posture should be weighted,
and how the magnitude of interactions should be quanti ed (W inkel and W estgaard
1992, Kilbom 1997). Therefore, most score systems adopted in these existing
methods have been largely hypothetical. In their studies, Radwin et al. (1994) and
Lin et al. (1997) demonstrated the concept of `frequency weighted lters for
processing continuous biomechanical measurem ents, such as repetitiveness, posture
and force, under the assum ption that there would be interactions am ong these
factors, with respect to their eects on physical stress. However, these methods have
so far been limited to wrist motion and to the laboratory situation, where physical
stress has to be represented by the short-term responses of the subjects, such as

2.2. Videotaping and com puter-aided observational methods

Observational techniques other than the simple pen and paper based methodologies
have been developed, such as ARBA N (Holzmann 1982), VIRA (Persson and
Kilbom 1983 , K ilbom et al. 1986), RO TA (Ridd et al. 1989), TR AC (van der Beek et
al. 1992), H AR B O (W iktorin et al. 1995), PEO (Fransson-Hall et al. 1995), and
those by Armstrong et al. (1982), Arm strong (1986), Keyserling (1986), W ells et al.
(1994) and Yen and Radwin (1995). These systems record work postures and
activities either on-site with a computer, or on a videotape that is later analysed
using a com puter. Two options can be used for the observation: tim e sam pling and
(sim ulated) real-time. The advantages of these system s include the ability to handle
posture data in real time, and the avoidance of observer bias, as body movem ents
can be recorded without the presence of an observer. However, the analysis of the
tape-recordings requires a well trained analyst so as to characterize the work
Physical exposure to W RM D risks 679

Table 1. Pen-and-paper-based observational techniques for assessing physical strain at work.

Techniques Basic features Field of applications

Posturegram Body postures are categorized and Whole body posture

(Priel 1974) recorded by time sampling on to evaluation for static
cards as digital numbers. tasks
OWAS Categorized body postures in digital Whole body posture
(Karhu et al. 1977) numbers, including force; time analysis
sampling, has action categories.
Posture Targetting Postures are marked as angles and Whole body posture
(Corlett et al. 1979) directions together with work recording for static
activities by time sampling. tasks
Gil and Tunes (1989) Categorized body posture angles and Whole body posture
frequency of occurrence; time recording for seated
sampling. tasks
RULA Categorized body posture as coded Upper limb assessment
(McAtamney and numbers, including force and muscle
Corlett 1993) activities; time sampling, with action
HAMA Record the types of motion, grasps, Upper limb assessment
(Christmansson 1994) hand position and features of load
handled; the data is linked to work
PLIBEL Checklist with questions answered for Identi cation of risk
(Kemmlert and Kilbom dierent body regions. factors
1987, Kemmlert 1995)
REBA Score the body postures, estimate the Risk assessment of the
(McAtamney and load, with action levels. entire body for `non-
Hignett 1995) sedentary tasks
QEC Estimate exposure levels for body Assessing the change in
(Li and Buckle 1998) postures, repetition of movement, exposure for both
force /load and task duration for static and dynamic
dierent body regions, with a tasks
hypothesized score table for their

postures correctly. In addition, if detailed posture information is to be obtained, a

signi cant am ount of time is required to analyse the data. M oreover, in real work
situations, the camera s position in relation to the operator can be continuously
changed owing to operator m ovem ent, therefore the posture angles observed in the
videotape recording m ay not be the same as the one in the real work situation.
Reports have shown that analysts have found it di cult to distingu ish between
adjacent angular sectors (e.g. between `neutral and `non-neutral posture ranges),
and to evaluate upper extremity postures on monitor screens, particularly the elbow
and the wrist; while the postures of the neck and the lower back seem to be relatively
easier to evaluate (K eyserling 1986 , Baluyut et al. 1995). In addition, criteria for
posture or work activity classi cation ap pears to be poorly de ned in some of these
observational methods, resulting in di culties in measurement comparison between
dierent studies (Genaidy et al. 1994 , Juul-K ristensen et al. 1997). Some of the video-
based observational techniques are summ arized in table 2.
The systems for 2-D or 3-D motion recording and analysis are now commercially
available, and the description or application of these systems is widely reported, such
as THE OBSERVER (Noldus 1991 , Rolfe 1992); PEAK M otus System (Frank and
680 G. Li and P. Buckle

Table 2. Videotaping and computer-aided observational methods.

Techniques Basic features Field of applications

Armstrong et al. (1982); Hand position is indicated as several Upper extremity posture
Armstrong (1986) types of grasp or pinch, and contact assessment
area with the hand / nger is recorded
as coded numbers. Time sampling of
the video lms and computerized data
acquisition for both posture and
force (EMG).
ARBAN Code postures and load situations by Whole body physical
(Holzmann 1982) time-sampling the video recordings; stress assessment
Borg s (1985) scale is used to
estimate the posture eort, muscle
stress and vibration; computerized
VIRA Computerized `real time video- Upper body posture
(Persson and Kilbom, recording analysis for frequency analysis
1983, Kilbom et al. and duration of postures and
1986) movements.
Keyserling (1986) Computerized real-time video analysis Repetitive, non-seated
for frequency and duration of jobs
postures in pre-de ned posture
ROTA Computerized real-time or time Static or dynamic tasks
(Ridd et al. 1989) sampling on posture and activity.
TRAC Computerized time sampling or Static or dynamic work
(van der Beek et al. simulated real-time analysis on
1992) posture and activity.
HARBO Computerized real time recording on Continuous long time
(Wiktorin et al. 1995) work postures and activities. The observations for
main features of the method is the various types of jobs
positioning of the hands at three
height levels.
PEO Computerized real time data Upper limbs and the
(Fransson-Hall et al. collection on posture movement trunk posture analysis
1995) and work activity. for dynamic jobs
(manual handling)
Wells et al. (1994) Computerized data analysis on Upper limbs and low
synchronized posture, repetition, back physical
activity and EM G signals. exposure assessment
Yen and Radwin (1995) Analogue data recording synchronized Arbitrary activities and
with video images. repetitive manual

Earl 1990 , Laursen et al. 1993 , W illiams et al. 1993, Rodgers et al. 1998); VICON
(Jarrett et al. 1974 , Pearcy et al. 1987); Kinemetrix 2D / 3D M otion Analysis Systems
(M IE M edical Research Ltd, Leeds, U K); SIM I M otion (Reality M otion System s,
Gm bH, G ermany); and APAS (Ariel Perform ance Analysis System , Ariel Dynam ics
Inc., San Diego, USA). These systems record body posture and movement in two- or
three-dimensional planes through a video-recording system. The recorded data can
be analysed in a computer through either the automatic / sem i-automatic video
tracking of the markers or the manual tracking /digitization of video recordings,
with respect to distance of movement, angular changes, velocities and
Physical exposure to W RM D risks 681

accelerations. Data integration with force and EM G signals is also possible for some
of these systems, such as PEA K and SIM I.
The advantages of the 2-D or 3-D motion analysis system over the other
observational and direct measurement methods are that several joint segment
movements can be recorded simultaneously for dierent jobs; data analysis is
simpli ed with the help of the sophisticated software; and the recorded data can be
linked to particular activities. The possible limitations of these systems m ay be
similar to that of video-based observation techniques and the costs are usually quite
high. In addition, for data analysis, the computer system can be quickly lled up with
data, therefore m ost systems can collect data for only a few minutes, and longer
work cycles have to be monitored in part. Besides, image digitization can be very
time-consuming, an d the m arkers or positions of body joints can be blocked or
obscured by body segment or object handled, increasing di culties for digitizing the
recordings, particularly in 3-D analysis. Therefore, selecting and positioning of joint
markers is essential for reducing the measurement error (Bauman et al. 1998).
Studies on the accuracy and performance for some of the 3-D motion analysis
system s have been reported (Scholz 1993 , Ehara et al. 1995). However, these were
based purely on simple movement in laboratory settings (e.g. recording the
movement of a bar using dierent systems), conclusions can hardly be made as to
which system(s) is better than others in its practical use.
In general, almost all of the observational methods to date concentrate on
working postures / movement, with the addition of other factors such as force and
task duration considered in some methods. Although som e of the drawbacks of the
observational techniques have been widely recognized, such as the problems with
time consumption (Punnet and Keyserling 1987 ) and reliability (Burdorf et al. 1992),
it has been suggested that the observation m ethods for assessing physical exposure
will still have a de nite place in epidemiologic studies of musculoskeletal disorders
(Kilbom 1994b).

3. Direct methods
3.1. Posture assessment
Body postures can also be described using direct methods, either manually with
hand-held devices or continuously with electric equipment. W ith m anual devices,
such as the goniometer or inclinometer (Loebl 1967 ) and the exicurve (Burton
1986), the device is attached to the body segm ent and the angular measure of the
body section is either indicated by the device (inclinom eter) or obtained by drawing a
trace on paper ( exicurve). The apparent advantages of these techniques are that
they are inexpensive and easy to use, and the body posture (regional exibility, curve
shape) can be described in detail. H ow ever, these methods are normally used in
static / clinical settings for the assessment of range of joint motion, but are not
suitable for dynam ic situations where continuous motion m onitoring may be needed.
M ore details of these techniques are reviewed in M au d and Cortez-Cooper (1995).
W ith electric instrumental methods, an electric output signal is generated that is
proportional to an intersegmental displacement. Five typical types of direct methods
have been developed goniom etric system, optical scanning system, sonic system,
electromagnetic system and accelerometer-based systems. In the family of gonio-
metric systems, goniometers are attached at the joints of interest and the angle
between two adjacent segments is recorded continuously. Several types of
goniom etric systems have been developed since K arpovich et al. (1960) rst
682 G. Li and P. Buckle

published their electrogoniometer study of joint motion during walking. However,

the recording capability of their device was limited to a single plane. Lam oreux
(1971) described a goniometric device that could simultaneously record motion at
three joints, while O Brien and Paradise (1976) developed a goniom etric system
(UNIM A N-system) that is fully portable and allows the subject to move about freely
in carrying out their normal daily activities. Hannah et al. (1979) developed a
lightweight three-dim ensional goniom eter for measuring the motion of three joints.
Several other types of electrogoniom eter system have been extensively described by
Chao (1978). A newer electrogoniom eter system is from Penny and Giles (Penny &
Giles Biometrics Ltd, Blackwood, Gwent, UK). The goniometers are light and
exible, and permit the simultaneous measurement of body movement in two
directions. The posture data is recorded by a com pact and portable data logger,
which enables extensive data acquisition without in uencing the users performance.
The data is transferred to a host computer for analysis. This system has now been
widely used in ergonomic studies, sports biomechanics and clinical practice (Nicol
1989, Rowe et al. 1989 , Parsons and Thom pson 1990, Smutz et al. 1994). W ith the
electrogo niometer system, Radwin and Lin (1993) developed a `spectral analysis
method for quantifying the rate of wrist repetition, as well as indicating the
magnitude of postural stress corresponding to wrist movem ents at dierent
repetition rates. Aara s and Stranden (1988) reported another direct method of
similar type for the continuous measurement of postural angles. The method
involves the attachment of potentiometer pendulums (Physiometer) to the head,
shoulder and back. These are then connected to electronic circuits for calculating
output values.
The lumbar motion monitor (LM M ) is a triaxial electrogoniom eter that was
developed to record three-dim ensional components of trunk position, velocity and
acceleration (M arras et al. 1992). The system is designed to be worn on the back of
the worker and to track the worker s trunk motion during work. M arras et al. (1992)
reported that the LM M is about twice as accurate as a video-based m otion
evaluation system. A possible shortcoming of the system is that the maximum
duration for continuous data collection is lim ited (about 30 s), therefore tasks
involving long cycle times have to be divided into short sessions. In addition, the
LM M does not pick up m ovement at the hip joint, which contributes greatly to the
movem ent of the back. In general, the electrogoniometer system adopts a simple
concept, i.e. direct measurem ent of joint angles. It is easy to use and the recording
has been found to be su ciently accurate and reliable for epidemiologic studies
(Smutz et al. 1994). However, the attachment of goniometric devices to a body
segment m ay cause some discom fort and potential changes in postural behaviour
(Chao 1978). The system is limited to planar movem ents and has di culty with
com plex joints, such as the shoulder / upper arm. In addition, mounting, aligning and
calibrating the system are tedious tasks that require extra care to minimize error.
In optical scanning systems, light-re ecting markers are placed at speci c
anatomic points and the displacement of these markers is detected by light scanning
units, such as mirror scanners or electric image detectors. A typical system of this
kind is COD A-3 M ovement M onitoring System (M ovement Techniques Ltd,
Loughborough, U K), in which three fan-shaped beams of polarized white light are
swept across the eld of view by three multi-faceted polygonal mirrors. W hen a beam
crosses a landmark in the form of a sm all pyramidal assembly of four retro-re ecting
prism s, a brief pulse of light is re ected back along the same path and is ultimately
Physical exposure to W RM D risks 683

detected by photodiodes in the scanner unit. The phase of the returning pulse in
relation to the mirror rotation indicates the position of a landmark in the angular
eld of view. The three-dimensional coordinates of all landmarks are computed in
real tim e through an IBM PC or compatible computer. The main advantages of the
system are its convenience of immediate, real tim e, three-dim ensional data output
and the need for only infrequent calibration. A problem with this system is that
markers can be blocked or obscured; therefore the applicability of the system to the
measurement of three-dim ensional body segm ent rotations can be limited by the
occurrence of con ict between the prism s (Pearcy et al. 1987). In addition, recordings
are not directly linked to motion activities, thus the analyst m ay not know what the
subject is doing at a certain data point, as compared to 2-D / 3-D videotaping
system s.
M ore recently, there appears to be a trend tow ards combining observational
methods with direct recording methods for body motion studies, with a powerful
computer interface support. An exam ple is from W ells et al. (1994), who reported an
approach to assessing the exposure to risk factors for the development of work-related
musculoskeletal disorders of the upper limbs and low back. The instrumentation they
used was to combine a video image of the worker performing the task with
superimposed quantitative information on risk factors. D ata on muscle activity
(EM G), posture, repetition and activity was synchronized, and availa ble on-line upon
playback of the videotape. The multiplexed signals were decoded and converted on a
portable computer, and the information was presented in various types of graphics.
Some videotaping and computer-aided systems described earlier also have the nature
or function of `direct posture / motion measurement , such as AutoGait 3D
(M acRe ex M otion Analysis Systems, Qualisys Inc., Glastonbury, USA) and PEAK
M otus Real-Time Analog Acquisition M odule (Peak Perform ance Technologies Inc.,
Englew ood, USA). In these systems, the data acquisition is achieved by using special
digital cameras with integrated infrared light sources. The cameras register the
position of re ective body markers at a high frequency (e.g. once every 1 / 60 s) and x,
y, z positions of the markers are calculated for each tim e interval of the event. These
time-based coordinates can be integrated with analogue signal sources such as force
platforms, EM G and other inputs.
A sonic system was developed by Goldm an and Nadler (1956) to measure
displacem ents, velocities and accelerations of a body segment. It consisted of a small
cylindrical emitter strapped to the subject, an oscillator, three microphones, and
various instruments. Ultrasonic waves generated by the oscillators and transmitted
by the emitter were picked up by the microphones. The frequency of the ultrasonic
waves received by each microphone varied from the emitted frequency according to
the Doppler eect received frequency was proportional to velocity. Kattan and
Nadler (1969) have reported an ap plication of this system for hand motion. Another
sonic method was reported by Fleischer and Lange (1983), and Fleischer and Becker
(1986) for hand motion studies. In their system , three pairs of transmitters and
receivers were used. The time delay from transmission to reception determined the
distance from the transm itter to each receiver. Hsiao and Keyserling (1990, 1991)
developed a three-dim ensional ultrasonic system by using eight receivers, which were
set around the operator so that the signal generated from each transmitter (up to 14
transmitters can be mounted) could be received by at least three receivers, the
necessary number to obtain the spatial coordinates of a transmitter. The system uses
a personal computer interface to determine the positions of the transmitters mounted
684 G. Li and P. Buckle

at body joints and gives spatial coordinates and joint angles. The system has
overcome shadow problems where one joint position is obscured by a body segment,
and has been tested, according to the authors experiment, for accurate measure-
ments of static posture in a laboratory setting. A possible limitation of the system is
its recording speed. Since the processing rate of the system is 34 signals /s, 0.23 to
3.3 s are required for a single posture measurement, depending on how many
transmitters are used. Besides, the system requires that the transmitters be attached
to the skin rather than to the joint centres and `marker movem ent must always be
considered. In addition, environmental noise may also aect the m easuring
capabilities of the system. Temperature, air density, hum idity, and atmospheric
pressure also aect the velocity of sound, thus a careful calibration must be
perform ed if data is collected in dierent environm ental conditions. Therefore, the
systems are mostly limited to use in laboratory settings.
In electromagnetic systems, such as Flock of Birds (Ascension Technology Co.,
Burlington, VT), 3SPACE Isotrak and Fastrak (Polhemus Inc., Colchester, VT),
pulsed magnetic elds are emitted by a transm itter to track the position and angular
orientation of dierent lightweight receivers. Receivers are mounted at body points,
and inputs from the sensors are sent to the com puter, where the position and
orientation of the sensors with respect to the transm itter are calculated. The major
advantages of these systems are that joint motion can be continuously measured
again st x, y, z axis in six degrees-of-freedom, and several joint movements can be
recorded sim ultaneously, without `blocking problems . Therefore, it is possible to
measure complex joint movement such as the shoulder with such a system (Johnson
and Anderson 1990). One possible shortcoming is that the `receiver tracking is
limited within a certain range (e.g. 1.2 3.0 m), and the stability of tracking data may
be aected by the magnetic eld produced by surrounding equipment if the system is
used in practical work sites. The application of electrom agnetic motion tracking
systems has been reported (Hindle et al. 1990 , Slobounov et al. 1996 , 1998 ) and the
test results for the comparison of these systems are described in Adelstein et al. (1996).
Accelerometer-based devices have been used to discriminate static postures such
as lying, sitting or standing, and dynam ic activities such as walking or cycling, over a
prolonged period of time (Tulen et al. 1997 , W alker et al. 1997). D ierent types of
accelerometer are currently availa ble, and am ong them piezoelectric / piezoresistive
accelerometers appear to have been the preferred choices in some recent studies
(Fahrenberg et al. 1996, 1997). These acceleration-sensitive sensors are small
monolithic silicon bridges acting like a weight on a spring, with thin beams that are
resistively sensitive serving as springs. The device responds to changes in
acceleration, but is sensitive only in one direction. The system allows for continuous
measurement of posture variation (patterns and periods of activity) and data is
stored in a lightweight recorder that can be carried around by the subject. This
method does not directly indicate detailed angular changes of body segments.
Besides, recordings can be in uenced by environmental conditions such as dam ping
and temperature, and by passive m otion such as riding in a vehicle.

3.2. Postural strain or local muscle fatigue assessment

Although there is no `ideal posture, some postures are more desirable than others,
and the incidence of particular postures has been associated with physical discomfort
(Duncan and Ferguson 1974 ; Hu nting et al. 1980), and permanent dam age (K eegan
1962). The positions associated with the least stress on spinal muscle are standing
Physical exposure to W RM D risks 685

and lying on one side (Scalet 1987). In the seated position, the lumbar spine
straightens from its normal lordotic curve and this increases the force on the
intervertebral discs of the spine (Andersson 1980). The assessment of relatively less
stressful postures has been approached from a num ber of perspectives, including
physiological/ anatom ical, subjective, and performance-based methods.
Electromyography has been widely used to evaluate postural strain (Bendix and
Hagberg 1984, Soderberg et al. 1986 , Schuldt et al. 1987). M uscle tension can be
predicted by the recording and processing of myoelectric signals (the recorded EM G
voltage), an increase in muscle tension is paralleled by an increase in myoelectric
activity, although the relationship is non-linear under many circum stances (Cha n
and Andersson 1991). However, it can be di cult to compare relative m uscle activity
between two dierent postures, owing to the muscle length changes and surface
electrode placem ent shifts. Therefore, interpretation of EM G am plitudes has to be
based on posture and electrode location as well as individual factors (M outon et al.
1991). In addition to using EM G to evaluate relative muscle activity, it has also been
used to evaluate local muscle fatigue, which relies on changes in the spectral
characteristics of the myoelectric signal, i.e. its am plitude increases and frequency
decreases with fatigue (Stern 1971 , Cha n 1973 , Andersson et al. 1977), although
contradictory results have been reported, as reviewed by Roy et al. (1989). Some of
the factors in uencing EM G measurements are discussed in Aara s et al. (1996).
The stadiometer has also been used to assess loads imposed on the spine by
measuring stature changes in a controlled posture (Fitzgerald 1972). W ith this
method, Corlett and Eklund (1983) found signi cantly greater shrinkage of the spine
when subjects sat without back-rest supports. However, the stadiometer is insensitive
to determ inants of physical load, and the technique needs to be chosen with care to
match the type of task involved and to m inimize m ovem ents and postural
adjustments involved (Jafry and Haslegrave 1992).
Nachem son and Elfstrom (1970) have described the construction of a needle
containing a pressure transducer that is inserted into the intervertebral disc to
measure spinal pressures. Intradiscal pressure measurement is the most direct and
reliable method to assess loads on the spine (Cha n and Andersson 1991), and the
measurement technique has been used for laboratory measurement of many types of
activities and postures, as reviewed by Andersson (1982). However this method is
invasive, can be risky to the subject and can only be used in strict laboratory
Other techniques developed for estimating the load on the spine include the
wireless radio pill and the wire-connected pressure transducer that are either
swallowed or inserted intrarectally, emitting radio waves that are measured rem otely.
Spinal pressures are then inferred from these ab dom inal pressures (Ridd and Davis
1981). Intra-abdominal pressure recording is a safe and simple measurement method
causing little discomfort to the subject tested. However, the relationship between the
pressure recorded and spinal compression is still uncertain (Nachemson et al. 1986),
and the validity of the intra-abdom inal pressure technique for assessing spinal load is
still under investigation, as summ arized by Cha n and Andersson (1991).

4. Self-report on physical work load

The assessment of physical work load, body discom fort or work stress may be
approached through self-report methods, taking such forms as `body map (Corlett
and Bishop 1976), rating scales (Shackel et al. 1969 , Borg 1985 , 1990), questionnaires
686 G. Li and P. Buckle

or interview s (Kuorinka et al. 1987 , Bigos et al. 1991 , Dickinson et al. 1992,
W iktorin et al. 1993) an d checklists (Shackel et al. 1969 , Drury and Coury 1982, Cox
and M ackay 1985, HSE 1990, Keyserling et al. 1992 , 1993). The methodology of
detailed subjective and performance-based measurement has been reviewed by
several authors (Lueder 1983 , W ilson and Corlett 1995). The general ndings of
these reviews are that the subjective assessment of body strain and discomfort has
been the most frequently used form due to the ease of use and apparent face validity.
A questionnaire approach appears to be the most common method used within
epidemiological studies that attempted to assess postural load on the back (Burdorf
1992). Subjective perception methods are so popular that some authors even
maintain that `If the person tells you that he is loaded and eortful, then he is loaded
and eortful whatever the behavioural and performance measures may show
(M oray et al. 1979 : 105). However, subjective ratings are prone to m any in uences
other than the task or workplace investigated (Rantanen 1981). Localized comfort
ratings, for example, may reduce response variability and obscure the overall
experience of the user. Studies have also shown that the self-report approach has a
too low validity (Burdorf and Laan 1991 ) and reliability (W iktorin et al. 1993) in
relation to the needs for ergonomic interventions.

5. Discussion
This paper has reviewed the techniques for assessing physical load in the
musculoskeletal system. M ost observational methods developed so far are posture-
based techniques and concentrate on the measurement of the back, neck, shoulders
and arms. This is understandable because the ergonomic investigations and
epidemiological studies conducted to date have been mainly on the association
between occupational risk factors and the development of musculoskeletal disorders
in these body regions (W inkel and W estgaard 1992 , Kilbom 1994a) , and the
prevalence of the work-related musculoskeletal problems of the lower extremity is
not as frequently reported as those of the upper body segments.

5.1. Problems with the assessment of the work-related musculoskeletal risks

Although it has been widely acknowledged that constrained working postures are
one of the important factors associated with various work-related musculoskeletal
disorders (Hu nting et al. 1980, W estgaard and Aara s 1984), other occupational risk
factors, such as force, frequency or repetitiveness of movement, task duration and so
on, are also believed to be im portant (K ilbom 1994a , W inkel an d M athiassen 1994).
Ideally, in the assessm ent of work-related musculoskeletal risks, all possible m ain
risk factors should be m easured. However, this is problematic as little is known
about the relative importance of each risk factor. Therefore, the weighting of the
dierent risk variables describing the exposure is di cult. Further, existing
knowledge is limited about the `safe exposure level from which an exposure can
be measured against. As a consequence of this, there is no consensus on how
dierent exposure variables should be pooled an d interpreted as the `dose (Hagberg
1988), and there exists a variety of classi cation in such variables as body posture,
movem ent (repetition) and external load am ong dierent methods, resulting in
di culties in comparison between dierent methods.
It is widely acknowledged that dierent risk factors almost always interact in real
tasks, thus they cannot be assessed totally independently. However, little is known
about the interactions between the exposure risk factors (W inkel and W estgaard
Physical exposure to W RM D risks 687

1992). Therefore, in epidemiological studies, dierent exposure variables are rarely

considered simultaneously. The `score systems adopted in some of the observation
techniques are at this stage largely hypothetical, and the assessment results can only
be interpreted or compared within the same system used. Although some systems,
such as RU LA and QEC, have attem pted to quantify the combination or interaction
of dierent `risk factors in the hope of obtaining an overall exposure score,
epidemiological evidence is still insu cient to support the pattern of the
combinations between risk factors as suggested in these systems. However, some
supporting evidence can be found in the current literature and this evidence is
building rapidly. It is di cult (or even impossible) to determ ine whether these score
system s are `true or `correct , and equally di cult to determine whether they are
`untrue or `incorrect (it is perhaps a signi cant achievement if one can do so in
either way). At this time these score systems serve as a comprom ise between the
`known and `unknown concerning the `weighting and `interaction of the `risk
factors , and may only be taken as a reference.
Another problem with the application of the existing risk assessm ent tools is that
in many cases a risk assessment method is developed for a particular research
purpose, therefore the tool may m ainly focus on the situation it is originally aimed
for. As a result, these tools can be `wrongly used in a situation where the tool is not
developed for the purpose. Categories for the classi cation of postures for standing
tasks may not be adequate for sedentary jobs. A 20 8 back exion from the vertical in
standing work, for example, is dierent (as the posture loading is concerned) from a
20 8 back inclination in sedentary jobs where the lumbar spine has already lost its
normal lordotic curve even with an `upright sitting position. Therefore, we cannot
observe a `severe back exion in sedentary jobs in the same way as those de ned for
standing tasks (Li et al. 1995).
Task identi cation is another important issue that needs bearing in mind when
making an exposure assessment. W ith the same observational m ethod, for example,
dierent observers may still get dierent assessment results of the same job, because
they pick up the assessment aspects for dierent tasks within that job. Job title has
been frequently used as an exposure variable (Burdorf 1992), but studies have shown
that risk estimates in terms of job titles cannot oer a practical basis for ergonomic
interventions (W inkel et al. 1995). This does not mean, however, that the nature of a
job is not important in the exposure assessment. On the contrary, it is essential rst
to understand the nature of the work, for example, whether the work is highly
dynam ic or static, whether the work involves manual handling or repetitive
movement of the segments. M oreover, it is also essential to understand whether the
work has several sub-tasks, and if so, whether these tasks should be assessed
separately, before applying the exposure assessment technique.

5.2. Experts / practitioner-orientated procedure for an exposure tool

It may be reasonable to say that most of the existing methods developed so far for
assessing exposure to potential m usculoskeletal risks are research-orientated. In
other words, they are based on the experts view of what occupational risk factors
should be considered (scienti c literature) and how these should be m easured,
resulting in methods that are sometimes so sophisticated that only researchers or
well-trained analysts are able to use them. W hile these methods have been found
useful for research and, in some cases, for the evaluation of real workplace / tasks,
they have also been found to be unsuitable for e ciently reducing and quantifying
688 G. Li and P. Buckle

physical stress exposure (Radwin et al. 1994); in addition, practitioners have found
them to be unsuitable for making exposure assessment in many real work situations
(Buckle and Li 1996).
Experts views about the features of methods used for assessing the physical
exposure at work have been reported (Colombini et al. 1985, Aara s and Stranden
1988). Studies from the practitioners viewpoint about their purposes and needs for
making the exposure assessment, however, are still rare in the ergonomics literature.
Investigations am ong British health an d safety personnel have revealed some
preliminary ndings with respect to their requirements for making the exposure
assessment in practical work situations (Buckle and Li 1996). These form
preliminary usability criteria for the development of an exposure assessment tool
for these users. Am ong the criteria, the practitioners want a tool that should be quick
and easy to use (preferably the assessment should be completed within 10 min), the
tool should be user friendly, exible to accommodate the numerous and complex
tasks that they m ay encounter, no unnecessary data collection, very simple, but
com prehensive and reliable. Besides, the practitioners have been found to have their
own way when making a risk assessment. For exam ple, they preferred to use
descriptive words rather than de ne speci c angles in posture assessment; they also
paid more attention to the physical exposure to the back than the other parts of the
body (Li and Buckle 1997b).
In general, practitioners are inclined to focus on surveillance and / or identi cation
of problematic jobs / activities so as to decide whether ergonomic interventions are
needed, and if this is the case, whether the interventions are eective; researchers on
the other hand, although they som etimes also have similar purposes for their
research aims, would normally need much more detailed information about the job
than the practitioners do. Thus, the am ount of detail needed drives the choice of the
exposure assessment method. Looking for a `safe physical exposure level for each
job ap pears to be a di cult issue, and this also calls for detailed information that has
to be collected; while focusing on the change or direction of change in exposure may
be a more realistic approach. Nevertheless, the exposure assessment should be able
to tell two things: whether an ergonomic intervention is necessary for the job (risk / no
risk), and if so, whether the intervention is eective. It is considered that the future
developm ent of the exposure assessment method will need to com bine both the
experts views and the practitioners needs aiming at a method that is practical and
valid for its purpose.
In conclusion, it is obvious that ergonomic practice has provided various types of
methods for the assessment of exposure risks relating to work-related musculoske-
letal disorders. Despite the usefulness of these tools in many cases, their lim itations
are also widely recognized. M ost of the observational methods reported to date have
been in some way in uenced by, or have re ected an image of, the principles of those
methods developed in the 1970s . To meet the wider needs of practical users as well as
those of the ergonomics experts for the exposure assessment an d workplace
evaluation, the requirements of both user groups have to be considered. Future
developm ent of m ethods will require the combination of traditional ergonomics
knowledge with greater user input.

The authors wish to thank Dr Christine M . Haslegrave at the Institute for
Occupational Ergonom ics, University of Nottingham , for her helpful comments on
Physical exposure to W RM D risks 689

an earlier transcript of this paper and the Health and Safety Executive for funding
the research. Valuab le comments from anonym ous referees on a previous manuscript
are also gratefully acknowledged. The authors also wish to thank M ary Hall for
reviewing the manuscript.

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