The Working Back: A Systems View / Edition 1

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Low back pain affects 80% of the population at some point during their lifetime; it is responsible for over 40% of the compensation costs for work-related injuries. This book provides an understanding of the mechanisms influencing low back pain in the workplace and indicates how low back pain might be prevented, saving employers extraordinary amounts in medical costs and protecting workers from the most common on-the-job injury. With a unique, multidisciplinary perspective that shows how various influences or risk factors can be considered collectively, The Working Back: A Systems View: Explains basic concepts in anatomy and physiology that are essential to understanding and preventing low back pain, Provides a systems perspective on the occupational causes of back pain, not only addressing factors such as spine loading, but also considering the potential impact of psychosocial and organizational interactions, genetics, and physiology, Discusses implementing preventive engineering and administrative controls and integrating risk interventions into the workplace, Offers an expert analysis of current medical research on low back pain in one comprehensive, accessible reference.

This book gives readers the knowledge to assess a work environment and prescribe effective interventions. It is a hands-on reference for ergonomists, manufacturing engineers, process engineers, industrial engineers and managers, safety engineers, nurses, therapists, chiropractors, physicians, and workers with back pain. It is also an excellent resource for graduate or undergraduate students of kinesiology, physiology, ergonomics, physical therapy, nursing, industrial design, engineering, and generalmedicine.

About the Author:
William S. Marras, PhD, is a Professor in the College of Engineering and the College of Medicine at The Ohio State University, a certified professional ergonomist, and a fellow of the American Institute of Medical and Biological Engineers, the Human Factors and Ergonomics Society, the International Ergonomics Society, and the Ergonomics Society

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Editorial Reviews

From the Publisher
"Since low back pain is one of the most common reasons for short and long term absence from work, a book which clearly explains its causes and makes practical suggestions for preventing it deserves a wide readership." (The RoSPA Occupational Safety & Health Journal, June 2009)
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Product Details

  • ISBN-13: 9780470134054
  • Publisher: Wiley
  • Publication date: 3/7/2008
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 309
  • Sales rank: 1,027,760
  • Product dimensions: 7.26 (w) x 10.22 (h) x 0.81 (d)

Meet the Author

William S. Marras PhD, is a Professor in the College of Engineering and the College of Medicine at The Ohio State University, a certified professional ergonomist, and a fellow of the American Institute of Medical and Biological Engineers, the Human Factors and Ergonomics Society, the International Ergonomics Society, and the Ergonomics Society. He holds two patents for devices for monitoring motion of the spine. He is an ergonomic consultant for the U.S. Department of Labor, Ford Motor Company, RCA, Honda, and other corporations and associations. He has had over 180 articles published in various medical and ergonomic journals and has coauthored several books on occupational ergonomics. He is currently the chair of the Human Factors Committee within the National Academy of Sciences.

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Table of Contents

Acknowledgments     ix
Introduction     1
Audience for the Book     3
Apolitical Causality Assessment     4
A Systems View of Low Back Pain Causality     4
The Reality of Work     5
How Might the Different Aspects of Work Be Associated with Back Pain     6
Organization of the Book     8
Back Pain Magnitude and Potential Risk Factors     11
What is Back Pain?     11
How Common is Back Pain?     11
Back Pain at Work     12
Epidemiology of Work Risk Factors     13
Epidemiology of Physical Risk Factors     16
Epidemiology of Individual (Personal) Risk Factors     18
Age     18
Gender     18
Anthropometry     19
Fitness/Strength     20
Alcohol     20
Smoking     21
Heredity/Genetics     21
Social Class and Psychological Factors     21
Epidemiology of Work-Related Psychosocial/Organizational Factors     22
Potential Interaction of Physical and Psychosocial Factors     23
Key Points     25
Function, Structure, and Support of the Back     29
BodyCoordinates     29
Bony Structures of the Spine     29
The Disc (and the Spinal Joint)     31
Functional Spinal Unit     31
Spine Support     32
Ligaments     32
Muscles     35
Fascia     35
Nerves     37
Blood Vessels     39
End Plates and Nutrition     40
Facets     40
The System     41
Key Points     41
The Process of Pain     43
What is Pain?     43
Origins of Pain     44
Pain Transmission     44
The Pain Process     46
The Inflammatory Process (Cytokines)     48
Peripheral Nervous System Sensitization     50
Neuropathic Pain: The Cytokine Cascade and Nerve Sensitization     51
Pain Mechanisms of the Central Nervous System     51
Role of the Environment in Central Sensitization     52
Implications for Low Back Pain     53
Nerves at Risk of Sensitization     53
Tissues at Risk of Sensitization     53
Disk and Nerve Roots     54
Facet Joints     54
Muscular-Based Pain      55
Lumbar Nerve Roots     56
Relationship between Tissue Loading and Pain     56
Conclusions     56
Key Points     56
Potential Pathways to Back Pain     60
Views of Back Pain Causality     60
A Unifying Model of Low Back Pain Pathways     63
The Support Structure Disruption Pathways     65
Support Structure Tolerance     66
Disc Tolerance Summary     73
Pain Tolerance     74
The Muscle Function Disruption Pathway     74
The Role of Individual Differences in the Pain Pathways     79
System Feedback     81
Summary     81
Key Points     82
The Assessment of Biomechanical Forces Acting on the Low Back     87
Biomechanical Concepts Applicable to the Back     88
Load Tolerance     88
Moments and Levers     89
External Versus Internal Loading     90
How can we Modify Internal Spine Loads?     92
Biomechanical Arrangement of the Musculoskeletal Lever System     92
Length-Strength Relationship     92
The Impact of Velocity on Muscle Force     93
Temporal Relationships     94
Incorporating Spine Load Reductions into the Work System     95
Loading of the Lumbar Spine     95
Spine Load Assessments     96
Models of Spine Load     97
Biologically Driven Modeling of Spine Loading     100
Stability-Driven Spine Loading Models     106
Predictions of Muscle (Motor) Control within Torso     108
What Drives Motor Control? The Mental Model     110
Summary     112
Key Points     112
The Influence of Physical Work Factors on Muscle Activities and Spine Loads     117
Introduction     117
Industrial Quantitative Surveillance of Physical Exposure     118
Strength Capacity Assessments of Work Load     119
Static Analyses of Work Load     120
Dynamic Analyses of Work Load     121
Surveillance Conclusions     127
Spine Loading and Task Performance     127
Spine Loading and Primary Physical Workplace Factors     128
Moment Exposure     128
Role of Trunk Muscle Cocontraction in Spine Loading     129
Trunk Motion     130
Nonsagittal Plane Loading     133
Lateral Motion     134
Twisting Motion     136
Task Asymmetry     138
Lift Height     139
One-Handed Versus Two-Handed Lifting     142
Lifting Versus Lowering     146
Cumulative Exposure     147
Duration of Exposure to Lifting Tasks     148
Worker Experience, Task Frequency, and Moment Exposure     150
Spine Loading Associated with Modification of Physical Workplace Factors     154
Handles     154
Lifting While Supporting the Body     156
Team Lifting     158
Pushing and Pulling     160
Seated and Constrained Work Postures     164
Physical Work Factor Summary     166
Summary     169
Key Points     170
Psychosocial and Organizational Factor Influence on Spine Loading     174
Introduction     174
Psychosocial and Organizational Interactions     175
Biomechanical Responses to Psychosocial Environment     176
Biomechanical Responses to Mental Stress at Work     178
Expectation     182
Conclusions     183
Key Points     183
Individual Factors Role in Spine Loading     187
Introduction     187
Gender      187
Personality     193
Experience     196
Conclusions     198
Key Points     198
Physical, Individual, and Psychosocial/Organizational Risk Factor Interactions     200
When Risk Factors Collide     200
The Magnitude of Influence of the Three Risk Factor Categories     201
Can Risk Factor Interactions be Predicted?     206
Conclusions     207
Key Points     208
Engineering Controls to Mediate Back Pain at Work: Tools for the Assessment of Physical Factor Impact on Spine Loads and Intervention Effectiveness     210
Introduction     210
Static Strength Prediction Programs     211
Psychophysical Tolerance Limits     212
Job Demand Index     214
NIOSH Lifting Guide and Revised Equation     214
The 1981 Lifting Guide     214
The 1993 Revised Equation     216
Video-Based Biomechanical Models     218
Lumbar Motion Monitor Risk Assessment     219
Lifting Threshold Limit Values (TLVs)     222
Workplace Assessment Comparisons     226
Conclusions     229
Key Points     229
Administrative Controls for the Workplace: Psychosocial and Organizational Interventions     232
Implementing Psychosocial and Organizational Change     232
Elements of the Process     234
Traditional Administrative Controls     236
Worker Selection     236
Worker Rotation     236
Training     237
Stretching Programs     237
Back Belts     238
Summary     239
Key Points     240
Integrating Risk Interventions into the Workplace     242
Introduction     242
Systems Intervention     242
Examples of Intervention Effectiveness     243
Patient Handling Interventions     243
Types of Physical Interventions     246
Implementing Both Physical and Psychosocial Interventions     247
Distribution Center Interventions     248
Summary     248
Key Points     249
Understanding Recurrent Low Back Pain and Implications for Return to Work     251
Introduction     251
The Natural History of Low Back Pain Recovery     252
How can One Quantify the Extent of Low Back Pain?     253
Impairment Assessment     254
Effort Sincerity     267
Spine Loading of those Experiencing Low Back Pain     272
Can Kinematic Impairment Assessments Predict Changes in Spine Loading?     281
Lifting Exposure Limits for Workers with LBP     285
Recurrence of LBP and Work     286
A Return-to-Work Strategy     292
Conclusions     292
Key Points     293
Conclusions     298
Summary     301
Index     303
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