Introduction-

The lifetime occurrence of low back pain is reported to be 84% and that of chronic
back pain is reported to be 23% as stated by non specific low back pain article(
Federico Balagu, Anne F Mannion, Ferran Pellis, Christine Cedraschi).low back
pain is catregorised in 3 categories -acute(<6 weeks),sub-acute(6-12
weeks),chronic back pain(>12 weeks).non specific back pain may be caused to over
stress on spine of human body causing wear and tear of
ligaments,tendons,muscles,nerves while specific chronic back pain may be caused
due to rupture of discs,misalignment of spine .low back pain is either a pain
related to lumbar region or sacral spinal region or combination of both.the health
burden on economy due to back pain is increasing year by year as a study
conducted in us analysed and came to conclusion from1997 -2005 there was 71.9%
to 73.37% increase in expenses related to people having spine related problems as
compared to people not having it as stated by (expenditures and Health Status
Among Adults With Back and Neck Problems)

Low back pain has been related to smoking and obesity.(the association between smoking and
low back pain-a meta analysis),( Body Mass Index as a Risk Factor for Developing Chronic Low
Back Pain: A Follow-up in the Nord-Trndelag Health Study)

some researches have conducted studies and related occupation to low back pain.eg (ergonomics
and muscular disorder as an occupational hazard,work related muscular disorder among dental
professional,a systematic review of musculoar disorder among dental professional,muscolurar
disorder in dentists).these studies indicate the long static and awkward posture int the dentistry
profession as the cause of back pain as it involves little movement due to demand of
profession.back pain has also been prevalent in young age between 11-14 years.some related
akward postures in the classroom to be the reason(classroom posture and self related back and
neck pain in school children) other related the weight of backpacks to be the reason(back pain
and back pack in school chidren),while one study disassociated the relationship between weight
of bag and back pain(the weight of schoolbags and occurrence of neck,shoulder and back pain in
yound adolescents.physiotherapists and nurses themselves know the postures that may cause
back pain but some studies(back pain physiotherapists involved in back care
education,prevalence of low bck pain among physical therpists in Edmonton Canada,work relate
disability n nurses)show that back pain due to lifting,bending,twisting,pushing,pulling,lifting is
high in them speciaaly in the early years of job.body vibration along with one of the
tposture(flexion,Lateral bending,rotation,twsting) show prevalence of back pain(back pain and
exposture to whole body vibration in helicopter pilots,self reported back pain in tractor drivers to
whole body vibration,comparison of spine motion in elite golfers with and without back pain).

low back pain is either a pain related to lumbar region or sacral spinal region or
combination of both.the main areas is the L4-L5 vertebrae in the lumbar region of
spine and c4 region in the cervical spine for cause of neck pain.bad postures are
often related to be one of the reason for low back pain.

(seeking the optimal posture of the seated lumbar spine) stated that a kyposed
sitting posture compared to lumbar sitting posture is more prone to back pain.this
study was in accordance with (effect of different sitting upright postures on spinal
pelvic curvature and trunk muscle in a pain free population)who compared different
sitting postures and gave the inactivity of lumbar multifidus muscle responsible for
supporting spine during pressure as the reason behind increased disc pressure
during slump sitting as compared to erect sitting.this was also in accordance (effect
of different standing and sitting posture on trunk muscle activity in pain free
population ) who conducted emg reading of back muscles and found least activity
during slump sitting and sway standing as compared to erect sitting and standing
posture.(association between sitting and occupational low back pain) while one
study concluded that sitting alone will not be responsible for back pain but a
combination of sitting ,awkward posture and vibration may be a contributing factor
in pain.while one study(is sitting while at work associated with low back pain)
concluded that sitting was not at all related to back pain.the reason may be that
sedentary jobs were compared with those related to health care sector (nurses) or
jobs requiring akward posture(crane operators,plumbers etc) which obviously are
more prone to back pain as compared to just sitting which must have mitigated the
effects of sitting alone.(low back pain and everydat activities)also came to the
conclusion that sitting was the highest cause of increase in backpain as compared
to dynamic activities.as the number of axial spinal rotations decrases as pain
increases.e/f ratio is also considered a relative measure to indicate the risk of low
back pain coming in future.the e/f ratio is normally 1.3(trunk muscle weakness as a
risk factor for low back pain)(influence of trunk muscles and lumbar lordosis and
sacral angle)it is lower in people having low back pain which means the extensor
muscle strength is weakened as compared to flexor muscle strength. This
study(review biomechanics and epidemiology of working posture)says that
continuous sitting in one posture for long duration or picking heavy objects are
more prone to neck and spine injury.

Some authors)concluded that thre is more intradiscal pressure in sitting than on

standing which is proved by (review biomechanics and epidemiology of working
posture) stating that 40%intradiscal pressure in more in sitting than in standing
while some reflected decrease in intradiscal pressure.The different may be because
of different ways employed in sitting i.e erect,slump.forward bending and lifting
activity have often been the cause of increase of forces in bending moment(acti
cvities of everyday life with high spinal loads).The weight of object and bending
angle of spine are responsible for increase in stress over the spine loading of
lumbar spine (mechanical loading of spine during forward bending). the pressure on
spine also increases.the pressure is more in stoop lifting as compared to squat
lifting.
Along with trunk pain ,neck pain is also prevalent in many people coming in the
category of non specific pain.many researchers have concluded that neck pain is
more prevalent in women than in men(3 dimensional isometric strength of neck
muscles in human).the conclusion was validated by calculating the strength of neck
muscles in all three axis which was higher for men then compared to women.the
strength of moments decreases as we move to lower levels of vertebrae
concluding high stresses in the lower portion of cervical spine.neck disorders have
also been related to occupation for e.g (neck disorders among construction workers)
conducted study to find the prevalence of neck disorders in construction workers.he
came to conclusion increase of weight on the shoulder level leads to increase in
emg levels of muscles relating to cervical spine.

Related work-

Non specific back and neck pain are not dangerous symtoms of diseases which
needs all time monitoring of patient in the hospital.yet cannot be ignored as this
continuous problem if not rectified may lead to worsen the condition of patient.A lot
of research has been done in the area of measuring the postural requirements of
back and neck with the help of wearable devices.some are as follows-massod and
chhikara used inertial sensors such as accelerometers and gyroscopes embedded
on human body to measure the movement of spine during specific tasks.while larry
and Baquapuri used these same sensors for measurement but embedded them on
garment to measure angles of different spinal levels(lumbar,thoracic,cervical)
which could be easily seen through mobile based application.

We all have studied earlier in the paper that posture kept for a long period of time
may lead to problems in neck and back .so going by this Nourra and haider
developed a system which measured time spent in a particular posture with help of
load cells connected to the sole of shoes which when exceeded from a limit will
issue a warning to the user via sms.luo and yu made a device which could reduce
the stress or strain in back muscles by using tension bands clung at the back of
body from the shoulder to the feet level. During bending a whole circuit of
pulley,sevomotors and tension bands operate together to reduce the strain occurred
during bending.its advantage was it weight which was lighter than earlier
measuring devices around 400gm.the disadvantage was the battery which has to
be recharged every 1.625hrs.also the system was curbomesome to wear for all day
activity.

The concept of smart garments was also employed by many researchers in this
area.mokhespour and moshri made use of flexible textile sensors for measurement
of human spine.due to change in different postures of upper body the clothes
stretch and compress which produces change in the resistance and help in
determining the strain at different spinal levels.it is a comfortable and light weight
system as compared to former devices discussed in the paper.but no proper
calculation was done for placement of sensors.marco also developed a system
called smartvest in which inductive sensors were employed on to the t shirt to
measure the change in resistance due to strain applied.it would also provide
feedback system by alarm or vibration or may send data through internet to
medical examiner.zawawi used a plastic fibre optic sensor to measure the tilt angle
of spine for self correcting of posture.the range of sensor for measurement was
limited to low range of bending angle i.e -10 degree to 19 degree.after this the
sensor showed inaccuracy in sensor readings .also the output would be deviated
due to temperature changes in the sensor.this was followed by walsh using a
plastic fibre optic sensor

For measurement of spine.here also no specification were given regarding a good

posture.also the shirt was one size which could take the region of sacral for shorter
people and for taller people the incomplete assessment of spine would be taken.

As we will see later that forward head posture is bad for cervical region of neck .so
hosub designed a system smartpose in which first the facial features of face are
extracted using an algorithm to detect whether the user is looking on to the phone
.if confirmed then the tilt angle of mobile is measured using orientation sensor as a
person goes on to a foraward head posture while looking on to the phone which
generates a alarm on exceeding a level which was verified by 3-d motion analysis of
whole body movements.

Methodology-

(seeking the optimal posture of the seated lumbar spine) stated that a lordosed
sitting posture decreases disk pressure and disc generation causing less ingury to
ligament tension as compared to kyphosed sitting posture which increases
intradiscal pressure ,loss of nutrition ,disc degeneration causing low back pain.this
study was in accordance with (effect of different sitting upright postures on spinal
pelvic curvature and trunk muscle in a pain free population)who compared different
sitting postures and gave the inactivity of lumbar multifidus muscle responsible for
supporting spine during pressure as the reason behind increased disc pressure
during slump sitting as compared to erect sitting.

This sitting posture finds a difference in people having back pain as their lumbar
lordosis angle in erect and slump sitting has little difference as compared to p eople
not having back pain(relationship between posture and back muscle endurance in
industrial workers with flexion related back pain) which means their was greater
posterior pelvic tilt in back pain people.(lumbar lordosis and pelvic inclination of
asymtotatic adults)related the weakness in trunk muscles to decrease in lumar
lordosis angle.
So decrease in lumbar lordosis angle dring slump sitting as compared to erect
sitting can be a measure of back pain.

The lumbar angle while standing is between 40-60 degree for all range of
people.The difference in variation may be due to measurement taken between
different spinal levels but the measurement between L1-S1 is taken as the more
accurate measure for lumbar curve as all levels of vertebrae contribute to lumbar
lordosis curve as stated by(lumbar lordosis:a study of angle values and of vertebral
bodies) .50% of value in standing becomes in sitting(lumbar lordosis effect of sitting
and standing).

//Take 10 people calculate values using flexi sensor in erect sitting and slump
sitting.take the mean values of it.the lowest value in slump sitting will be the limit of
erect sitting beyond that value I not a good posture which could be indicative or
posses a risk factor for low back pain.

Forward bending and Lifting-

The flexation relaxation is an important phenomenon differentiating low back pain

versus healthy people(the biomechanical and clinical significance of lumbar erctor
spinae muscles).FRP means silence of erector spinae muscles when going from
upright to fully flexed positon.their will be a point during flexing that the emg
activity of back mucles will be very low and the pressure will be taken on to passive
structures(bones,ligaments,tendons).this is present in healthy people but is absent
in low back pain patients as these muscles are all way active when moving from
upright to flexed posture.this is further validated by( muscular and kinematic
behavior of lumbar spine during flexion-extension) which concludes that 78%
decrease in FRR is observed at full flexion as compared to only 13% decrease in
muscle activity in back pain people .

//determine the point during forward bending at which silence of muscle activity
takes place.take 10 people and make them move from upright to fully flexed
position .detemine the angle with the help of sensor the position at which silence of
muscles take place.if bending at that angle the value of voltage measured is greater
compared o mean value of voltage at that angle then means the absence of FRR
and beginning of low back pain.

Lifting-

The cumulative effect of bending as well as compression contribute to injury of

spine.they may vary depending on type of lifts(squat or stoop),speed of
picking,mass of object and distance of object from foot(bending and compression
stresses on lumbar spine during lifting activity).the bending moment to pick a object
should be equilavent to equal and opposite forces by the back muscles(spinal
erector muscles).

//the concept of calculating bending moment can be done as stated by Mechanical Load of the
Lumbar Spine During Forward Bending Motion of the TrunkA Biomechanical Study

Neck pain-

The most common posture for strain in daily life activity is the forward head
posturefor e.g which we do while looking down to our phones.this strain would
further in increase as weights increase for e.g various studies were conducted which
showed that occurrence of this forward head posture in teenagers increases while
carrying backpacks (effect of backpack weight on postural angles in preadolescent
children)this phenomenon is also prevalent in people with older age.

Cranivertebral angle (cv)is often a validated measure of forward bending posture.cv

is calculated as the angle measured between horizontal line passing throuch c7
spinous processes and line passing through tragus of ear to c7 processes(the
correlation between cranivertebral angle ,backpack weights and disability ddue to
neck pain in adolescents).samaller the CV angle the more the body is inclined to
forward head posture(relationship between head posture and disability of patients
with pain).

//so we will be using a flexi sensor to measure the forward head posture.various
studies conducted range the optimal value of cv to be 48-60 degree.so the value
of sensor going below 48 degree will be leading forward head posture which will act
as limit for danger to neck muscles.

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COMPRESSIVE STRESSES ACTING ON
THE LUMBAR SPINE DURING LIFTING ACTIVITIES
P. DOLAN, M. EARLEY and M. A. ADAMS BENDING AND COMPRESSIVE STRESSES
ACTING ON
THE LUMBAR SPINE DURING LIFTING ACTIVITIES
P. DOLAN, M. EARLEY and M. A. ADAMS