title: Sudden and unexpected loading generates high forces on the lumbar spine.
abstract: METHODS
  A cross-sectional study of spinal loading in healthy volunteers.
  
  
  OBJECTIVE
  To measure the bending and compressive forces acting on the lumbar spine, in a range of postures, when unknown loads are delivered unexpectedly to the hands.
  
  
  BACKGROUND
  Epidemiologic studies suggest that sudden and unexpected loading events often lead to back injuries. Such incidents have been shown to increase back muscle activity, but their effects on the compressive force and bending moment acting on the spine have not been fully quantified. Furthermore, previous investigations have focused on the upright posture only.
  
  
  METHODS
  In this study, 12 volunteers each stood on a force plate while weights of 0, 2, 4, and 6 kg (for men, 40% less for women) were delivered into their hands in one of three ways: 1) by the volunteer holding an empty box with handles, into which an unknown weight was dropped; 2) by the same way as in 1, but with volunteer wearing a blindfold and earphones to eliminate sensory cues; or 3) by the volunteer sliding a box of unknown weight off a smooth table. Experiments were carried out with participants standing in upright, partially flexed, and moderately flexed postures. Spinal compression resulting from muscular activity was quantified using electromyographic signals recorded from the back and abdominal muscles. The axial inertial force acting up the long axis of the spine was calculated from the vertical ground reaction force. The bending moment acting on the osteoligamentous spine was quantified by comparing measurements of lumbar curvature with the bending stiffness properties of cadaveric lumbar spines.
  
  
  RESULTS
  The contribution from abdominal muscle contraction to overall spinal compression was small (average, 8%), as was the axial inertial force (average, 2.5%), and both were highest in the upright posture. Peak bending moments were higher in flexed postures, but did not increase much at the moment of load delivery in any posture. Peak spinal compressive forces were increased by 30% to 70% when loads were suddenly and unexpectedly dropped into the box, and by 20% to 30% when they were slid off the table, as compared with loads simply held statically in the same posture (P < 0.001). The removal of audiovisual cues had little effect.
  
  
  CONCLUSIONS
  Sudden and alarming events associated with manual handling cause a reflex overreaction of the back muscles, which substantially increases spine compressive loading. Manual handling regulations should aim to prevent such events and limit the weight of objects to be lifted.
authors.affiliation: Schulthess Klinik, Zürich, Switzerland, and the University of Bristol, Bristol, United Kingdom. afm@kws.ch
authors.forename: A F
authors.initials: AF
authors.lastname: Mannion
authors.forename: M A
authors.initials: MA
authors.lastname: Adams
authors.forename: P
authors.initials: P
authors.lastname: Dolan
mesh_terms: D000009:Abdominal Muscles / Q000502:physiology; D000328:Adult; D003430:Cross-Sectional Studies; D004576:Electromyography; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000502:physiology*; D008297:Male; D011187:Posture / Q000502:physiology; D013314:Stress, Mechanical; D016474:Weight-Bearing / Q000502:physiology