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491-494,1996
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POSTURAL CHANGES DUE TO FATIGUE

Marc Resnick

Industrial and Systems Engineering Department, Florida International University

University Park, Miami, FL 33199

ABSTRACT

One of the most critical risk factors contributing to injury of the low back is posture, specifically of the torso.
Though considerable time and expense is directed towards training workers to use postures which minimize
biomechanical stress, there is a growing body of evidence suggesting that this training may not be effective over
shifts of extended duration. This may be due to a combination of fatigue and loss of concentration. Ten healthy
subjects who had been previously trained in proper lifting technique lifted a load of 120% of their maximum
acceptable weight of lift (MAWL) at a frequency of three lifts per minute for two hours or until they were no
longer able to continue due to fatigue, whichever came first. Subjects' self-selected postures were quantified in
terms of maximum torso flexion and the distance between the hands and the L4/L5 spinal disc. Changes in
posture were evaluated as a function of time, heart rate and perception of fatigue.

KEYWORDS

Fatigue; lifting strategies; energy expenditure; biomechanics.

INTRODUCTION

Lifting posture can be a critical factor in determining whether a worker suffers a back injury due to repetitive
lifting (NIOSH, 1981). The compression force at the L5/S1 disc, a factor which has often been used to quantify
the stress at the low back (Chaffin et al, 1977), is directly related to the distance from the lifters' hands to the
L5/S 1. NIOSH (1981) summarizes a body of literature which claims that straight back/bent leg lifting postures
usually minimize stress at the low back. For these reasons, many employers advocate the use of lifting postures
which use techniques that minimize the distance from the hands to the back and which maintain upright postures.
Training, through back schools or internal training programs, are often used to encourage workers to utilize these
techniques.

However, there is a tradeoff in using these postures. Garg, Chaffin, and Hen'in (1978) calculated the energy
expenditure of several lifting tasks and found that squat lifts require significantly more energy than stoop lifts.
Kumar (1984) found that fatigue is significantly greater for subjects who use recommended bent-knee postures
compared to those who use stooped postures, which cause more low back stress. Barker and Atha (1994) report
that subjects who received training had higher perceptions of fatigue than those with little or no training,
suggesting that the trained postures, though limiting the stresses at the low back, required more energy
expenditure. Training workers to use postures which minimize back stress may be increasing fatigue. Workers
may be reluctant to maintain these recommended postures for long durations if they become fatigued. This may
be a result of a conscious change in the lifter's self-selected technique, or as a result of a loss of concentration
due to fatigue.

Fogleman and Smith (1995) had six subjects perform a lifting task over an extended period. Over the duration
of this task, the postures chosen by most subjects shifted from a straight back posture to a straight leg posture.
This was indicated by reduced movement of the hip and lower minimum height of the hip joint. They also
491
492 19th International Conference on Computers and Industrial Engineering

describe a study by Lewis (1982) in which subjects shifted from a bent leg/straight back lift to a straight leg/bent
back lift as they began to fatigue. Waersted and Westgaard (1991) found that the frequency of muscuioskeletal
disorders and back pain increased significantly as a function of longer workdays. Whether these increases are
due to changes in technique, overwork of muscles and joints, or both was not determined. St. Vincent, Tellier
and Lortie (1989) investigated epidemiological, psychophysical and inter-abdominal pressure data and
concluded that ultimately, training fails to reduce back injuries. This result may be due to the fact that workers
do not maintain the trained postures, eventually returning to the less fatiguing but more stressful bent back
postures.

1. Investigate whether changes occur in lifting posture over time during fatiguing tasks

2. Quantify any changes in lifting posture, measured in terms of hand-L4/L5 distance and torso angle, as a
function of heart rate and perception of fatigue.

METHODS
P..art.icipants

Ten participants were recruited from the Industrial and Systems Engineering Department at Florida International
University. Subjects were trained in proper lifting through an ergonomics course which included basic
biomechanics and work physiology. All subjects were selected from the same training course to insure standard
knowledge in lifting technique. Subjects were compensated for their participation. Informed consent was
obtained prior to the study.

ADDarams

The task was a sagittally symmetric lift of a closed pine box containing standard steel weights. The handle on
the box was a 1" diameter steel rod extending horizontally out 6" from each side. Participants grasped the
handle at a comfortable separation, slightly narrower than their inter-acromial distance.

Retroreflective markers were placed on the major articulating joints of each subjects' body, as well as the L4/L5
spinal disc. Postures were recorded on a professional quality VHS video recorder. A two-dimensional video
digitization system was used to digitize the video recordings. Two electrodes were placed on the chest of the
subject to record heart rate. Subjective reports of fatigue were collected on a psychophysical scale modified
from the Borg CR-10 scale.

Procedure

At the beginning of each session, subjects were instrucre,,don the details of the experimental task. The body
weight and height of each subject was recorded prior to lifting. Using the Maximum Acceptable Weight of Lift
(MAWL) method described by Snook (1978), the maximum lifting strength from floor to elbow height of each
subject was determined at a frequency of three per minute.

Retroreflective markers were attached to the right ankle, knee, hip, shoulder, elbow and wrist of the subject. An
additional marker was placed at the L4/L5 spinal disc. A load equal to 120% of the determined MAWL was
placed in the closed pine box. Subjects were not told the magnitude of the load. Subjects were instructed to use
the safe lifting methods they were taught in a previous ergonomics course to lift the box at a rate of three lifts per
minute for five minutes to practice the exertion and become familiar with the procedure. The technique trained
in the ergonomics course stressed minimizing the horizontal distance between the load and the low back as the
primary objective and maintaining an upright posture (bent legs, straight back) when this does not conflict with
the first objective. After the completion of the training trials, the subject continued the lifting task for two hours
or until he/she was unable to continue due to fatigue, whichever came first. Subjects were not reminded of the
safe lifting procedure at any time during data collection. Every ten minutes, the subjects rated their subjective
perception of fatigue on the psychophysical scale. At this time, the heart rate of the subject was recorded.
 19th International Conference on Computers and Industrial Engineering 493

RESULTS

Only data from those subjects who exhibited fatigue during the course of the task were included. This was
established through the trend of the heart rate and psychophysical perception reports over time. Data was
included if either heart rate or perception of fatigue significantly increased over the two hour task duration.

Lifting postures were quantified using the maximum torso angle and the maximum hand-L4/L5 distance.
Postures were compared to the subjects' perception of fatigue and heart rate. The effect of fatigue perception on
torso angle was significant at the p < 0.01 level, however two groups of subjects were identified. As shown in
Figure 1, some subjects significantly increased their torso angle after the fatigue perception exceeded '6' on the
modified Borg scale. Other subjects had no such increase, and in fact decreased slightly. A similar result was
found for hand-LA/L5 distance. The lifting postures of some subjects showed increased hand-L4/L5 distance
after becoming fatigued, while others did not change (see Figure 2).

A similar evaluation was conducted to investigate the effects of heart rate. Some subjects used postures with
significantly greater torso angles when their heart rates had increased above their base rate, while others did not
(Figure 3). An additional finding was that it tended to be the subjects with lower base rates that showed this
increase. As with torso angle, some subjects had a significant increase in hand-L4/L5 when heart rate exceeded
their base rates (see Figure 4), while others did not. The relationships between heart rate and torso angle and
hand-L4/L5 distance were significant (p < 0.05).
100
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60 ]2o
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Fatigue (Borg scale) Figme 2. Hand-L4/L5 distance versus fatigue

for two groups o f subjects
Figure I. T o ~ o angle versus perception of fatigue for two
groups of subjects
8O

70 :'3

l l [ I 80 ~I 100 JlU 120 130 140 lSO

80 100 120 140 160
bean rate (bpm) heart rate (bpm)

figure 4. Hand-L4R.5distanceversusheartrate for

Figure 3. Torso angle versus heart rate for two
two groupsof subjects
groups of subjects

DISCUSSION

The results of this study provide insight into two critical areas of ergonomics. The effectiveness of training
proper lifting techniques in jobs of long duration was tested. Even after training, fatigued workers may use
biomechanically non-optimal postures. Two groups of subjects were identified in the current study. One group
consistently used a squat posture throughout the study. The second group shifted from the squat posture to a
stooped posture. If workers do not maintain the use of safe techniques, the effectiveness of training is severely
diminished. The reason for this divergence needs to be identified. One hypothesis suggested by the results is
that subjects with lower base heart rates (more fit) are more likely to use biomechanically stressful posture. This
may be a personality effect where people who are fit are less concerned about back injury. This finding is
especially important considering that fitness is not a substantial protector against back injury.

The design of proper training methods must consider the entire workday. Preventing this second group of
workers from shifting to a more stressful posture would reduce their risk of injury. However, current training
494 19th International Conference on Computers and Industrial Engineering

methods, which concentrate on explaining proper lifting techniques, without consideration of fatigue, may be
inadequate. Further methods must be developed.

Many biomechanical models of the back use optimization techniques to predict the recruitment of torso muscle
during lifting tasks. This research shows that there may be an effect of fatigue on these recruitment strategies.
These optimization models may need to adjust their optimization functions based on worker fatigue. Lifting
technique may explain the differences found in comparisons of these models ability to explain empirical EMG
data (such as in Hughes et al 1994). The balance between back safety and energy expenditure in workers'
instinctive lifting techniques can provide insight into the relationship between perceptions of exertion and actual
physiological responses to strain in the musculature and in the spine.

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