Epidemiology of low back pain

Papageorgiou et al. (1995) estimated the one-month prevalence of low back pain to

be between 35% and 37% in the adult population, with peak prevalence among the 45–59-

year age group. Miedema et al. (1998) followed up 444 patients who had consulted their

doctor because of an episode of back pain. After 7 years, 28% had developed chronic

problems. Chronic sufferers were more likely, subsequently, to consult a doctor, had poorer

general health and poorer physical and social functioning. McFarlane et al. (1997) found

an increased risk of pain among those whose jobs involved lifting, pulling or pushing

objects over 11 kg or whose jobs required long periods of standing or walking, but there

was no clear relation with years of exposure, suggesting that a simple ‘dose-response’

model does not apply. Richardson et al. (1997) investigated the prevalence of discogenic

back pain in the relatives of patients who had received surgery for lumbar intervertebral

disc lesions and in a comparison group of patients with upper-limb problems. Relatives of

‘disc’ patients were over 16 times more likely to have discogenic pain than controls,

suggesting a genetic predisposition towards lumbar pain and intervertebral disc lesions.

Volinn (1997) investigated low back pain prevalence in low- and middle-income

countries. Contrary to his hypothesis, that rates would be lower in more affluent societies

because of the unavoidable demands for hard physical work in poorer Anatomy, posture

and body mechanics 45 countries, he found that rates were 2–4 times higher among the

populations of Germany and Belgium than those of Nigeria, Southern China, Indonesia

and the Philippines. There are many possible explanations for this finding, perhaps

subsistence farmers in low-income countries have a higher pain threshold or exercise more.
Within low-income countries, rates were higher in urban than in rural areas, particularly

among groups such as sewing machine operators in small factories. This draws attention

to work organisation factors and task variety – industrial jobs being far more restricted,

physically, than small-scale farming actitivities that vary throughout the day and with the

season.

Risk factors for musculoskeletal disorders in the workplace

Marras and Schoenmarklin (1993) investigated the wrist motions of workers

engaged in jobs entailing high or low risk of contracting carpal tunnel syndrome. Wrist

position was characterised in terms of flexion/extension, pronation/supination and

ulnar/radial deviation. The angular velocity and accelerations of the wrist when moving in

the corresponding spatial planes were also recorded. No significant differences were found

between the high- and low-risk groups in wrist posture. However, wrist movements in the

high-risk group had greater velocity and acceleration. The findings were interpreted by the

authors in terms of Newton’s second law of motion (force = mass × acceleration). In order

to produce greater accelerations of the wrist, larger muscle forces are required, which are

transmitted to the bones via the tendons. The tendons will also be exposed to greater friction

by contact with surrounding structures.

Marras and Mirka (1993) investigated trunk motion in relation to the risk of low back

disorder in a variety of jobs. As might be expected, high-risk jobs were associated with

high load moments and lifting frequencies and large trunk Anatomy, posture and body

mechanics 49 flexion angles. In addition, lateral trunk velocity and twisting trunk velocity

were also associated with high-risk jobs – the faster these movements were, the greater was
the risk of injury. This finding can be explained by recalling that a major function of

muscles is to stabilize joints. When a body part has to be moved rapidly, in a controlled

way, greater coactivation of synergistic and antagonistic muscles is needed to stabilize the

joints involved. Since many of the muscles involved will be working against one another,

the result is a magnification of the joint loading.

Snook et al. (1998) report significant reductions in back pain in a group of sufferers trained

to avoid early morning flexion of the spine. Examples of avoidance strategies were;

techniques of rising from bed without flexion, avoidance of sitting or squatting for two

hours after rising, the use of reaches to pick things up, etc.

Anthropometry

It is the measurement of the human body. It is derived from the Greek words

‘anthropos’ (man) and ‘metron’ (measure). Anthropometric data are used in ergonomics to

specify the physical dimensions of workspaces, equipment, furniture and clothing to ensure

that physical mismatches between the dimensions of equipment and products and the

corresponding user dimensions are avoided.

Designing for a population of users

The first step in designing is to specify the user population and then to design to

accommodate as wide a range of users as possible – normally 90% of them. Well-designed

products acknowledge and allow for the inherent variability of the user population. In

ergonomics, the word ‘population’ is used in a statistical sense and can refer to a group of

people sharing common ancestors, common occupations, common geographical locations

or age groups. A user population may consist of people from different races (i.e. groups

differing in their ancestry) or different ethnic groups (different cultures, customs, language,
 and so on). For design purposes, the criteria for deciding what constitutes a ‘population’

are functional and are related directly to the problem at hand.

Anthropometric surveys

World Health Organization recommends (WHO, 1995) that, if anthropometric data

are to be used as reference standards, a minimum sample size of 200 individuals is needed

(this gives a standard deviation around the 5th percentile of about 1.54 percentiles, a 95%

probability that the true 5th percentile falls within plus or minus 2.25 percentiles of the

estimate, approximately).

ISO List of Anthropometric Variables (ISO/DIS7250)

Variable Methods of Measurement

Body Weight
Stature
Eye height
Shoulder height
Elbow height
Spina iliaca height
Tibial height
Sitting height (erect)
Eye height (sitting)
Shoulder height (sitting)
Elbow height (sitting)
Cervical height (sitting)
Shoulder breadth
Lower leg length
Knee height
Hand length
Subject stands on weighing scale
Vertical distance to highest part of head. Subject stands
erect, with feet together with heels, buttocks, shoulders,
back of head touching a vertical surface
Vertical distance floor to inner corner of eye. Subject stands
as above
Vertical distance from floor to acromium. Subject stands as
above
Vertical distance from floor to lowest bony point of elbow.
Upper arm hangs freely and elbow is flexed 90 degrees
Height of anterior superior iliac spine above floor
Height of anterior head of tibia above floor
Distance of highest point of head to horizontal sitting
surface. Subject sits against a vertical surface, thighs fully
supported and lower legs hanging freely
As for standing but in the seated posture above
Vertical distance from horizontal sitting surface to acromion
As for standing, but in the sitting position above.
Vertical distance from seat surface to skin overlying tip of
7th cervical vertebra
Distance between the acromions
Vertical distance from floor to lowest part of thigh behind
knee (90 degrees of knee flexion)
Vertical distance from floor to upper surface of thigh
(90 degrees of knee flexion)
Distance from the tip of the middle finger to the most distal
point of the styloid process of the radius with the hand
 outstretched
Hand breadth (at Distance between the radial and ulnar metacarpals
metacarpal)
Index finger length Distance from tip of 2nd finger to the proximal skin furrow
between the digits
Index finger breadth Distance between the medial and lateral surfaces of the 2nd
finger in the region of the joint between the proximal and
medial phalanges (first knuckle)
Index finger breadth (distal) As above but medial and distal phalanges
Foot length Maximum distance from the back of the heel to the tip of
the longest toe
Foot breadth Maximum distance between the medial and lateral surfaces
of the foot
Head length Distance along a straight line from the glabella to the
rearmost point of the skull
Head breadth Maximum breadth of the head above the ears
Head circumference Maximum circumference of the head over the glabella and
the rearmost point of the skull
Sagittal arc The arc from the glabella to the inion (protrusion where the
back of the head meets the neck in the mid-sagittal plane)
Bitragion arc Arc from one tragion over the top of the head to the other
Face length Distance between the sellion and the menton with the mouth
closed
Forward reach Maximum distance from a wall against which the subject
presses the shoulder blades to the grip axis of the hand
Forearm–hand length Distance from the back of the upper arm at the elbow to the
grip axis of the hand (90 degrees of elbow flexion)
Fist height Vertical distance from the floor to the grip axis of the hand,
with the arms hanging freely
Crotch height Distance from the floor to the distal part of the pubis
Hip breadth (standing) Maximum horizontal distance across the hips
Hip breadth (sitting) As Above
Elbow to elbow breadth Maximum distance between the lateral surfaces of the ebows
Waist circumference Trunk circumference in the region of the umbilicus
Body depth (sitting) Horizontal distance from the rear of the knee to the back of
the buttock
Buttock–knee length Horizontal distance from the front of the kneecap to the
rearmost part of the buttock
Wrist circumference The circumference of the wrist between the styloid process
and the hand, with the hand outstretched