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Introduction: Physical and medical readiness have emerged as a top priority in the army over the last decade. With this emphasis on deployment readiness, it is important to understand key risk factors attributed to common medical problems that arise in our soldiers, including low back pain. The purpose of this study is to elucidate demographic and lifestyle risk factors which would result in seeking medical care for musculoskeletal low back pain among active duty army personnel., Materials and Methods: A cross-sectional retrospective study investigating all active duty soldiers between October 1, 2016 and September 30, 2018 was performed using the existing Military Health System Data Repository to retrospectively review administrative claims data. Our study queried 39 unique International Classification of Disease codes, 10th Revision codes for low back pain to determine a positive case. We compared those with and without back pain across all variables using a chi-square analysis in SAS. Multivariate logistic analysis was performed to adjust for confounding within any single proposed risk factor and the six other proposed risk factors., Results: Six hundred fifty seven thousand and six thirty soldiers met inclusion criteria; 228,184 of whom had a medical encounter for low back pain (34.7%). All of the proposed risk factors included statistically significant unadjusted and adjusted odds ratios (ORs) with age conferring the greatest risk in soldiers aged 50-59 with an OR of 2.89 (2.73-3.05) compared to those aged 20-29. Obesity-adjusted OR was 1.77 (1.74-1.80) compared to those who were normal weight. Senior Enlisted status-adjusted OR was 1.34 (1.32-1.36). Females were 66% more likely to have low back pain compared to males with an OR of 1.66 (1.63-1.68)., Conclusion: Disease burden for low back pain tends to be high in the U.S. Army with 34.7% of service members experiencing low back pain. Older age, obesity, and being an enlisted, female service member are risk factors for these musculoskeletal injuries, which is in agreement with previously reported literature on the topic. To mitigate the burden of low back pain, policies and incentives to encourage healthy body mass index and lifestyle are needed. The results of this work inform future studies aimed at further delineating the risk factors found in this study., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Pitching motion requires whole-body coordination; therefore, poor control of the lower extremities, pelvis and trunk may cause shoulder and elbow injuries. However, few studies have described the relationship between the shoulder joint function and low back injury in high-school baseball pitchers. A total of 128 healthy high school pitchers underwent pre-season medical checkups, where their shoulder range of motion and shoulder strength were measured. The participants completed a self-recorded daily questionnaire regarding the presence of low back pain. Pitchers were divided into injured and non-injured groups. Low back injury was observed in 13 participants (13.4%). In the injured group, horizontal adduction on the dominant shoulder was significantly less than in the non-injured group. A logistic regression analysis showed that horizontal adduction on the dominant side was a significant independent risk factor for low back injury during the season. It is important to recognize that restriction of the shoulder function not only causes shoulder and elbow injuries but can also risk low back injury.

Objective: The purpose of this study is to summarize the evidence for the association between exposure to a motor vehicle collision (MVC) and future low back pain (LBP)., Literature Survey: Persistent low back pain (LBP) is a relatively common complaint after acute injury in a MVC, with a reported 1 year post-crash prevalence of at least 31 % of exposed individuals. Interpretation of this finding is challenging given the high incidence of LBP in the general population that is not exposed to a MVC. Risk studies with comparison control groups need to be examined in a systematic review., Methodology: A systematic search of five electronic databases from 1998 to 2019 was performed. Eligible studies describing exposure to a MVC and risk of future non-specific LBP were critically appraised using the Quality in Prognosis Studies (QUIPS) instrument. The results were summarized using best-evidence synthesis principles, a random effects meta-analysis and testing for publication bias., Synthesis: The search strategy yielded 1136 articles, three of which were found to be at low to medium risk of bias after critical appraisal. All three studies reported a positive association between an acute injury in a MVC and future LBP. Pooled analysis of the results resulted in an unadjusted relative risk of future LBP in the MVC-exposed and injured population versus the non-exposed population of 2.7 (95 % CI [1.9, 3.8]), which equates to a 63 % attributable risk under the exposed., Conclusions: There was a consistent positive association in the critically reviewed literature that investigated the risk of future LBP following an acute MVC-related injury. For the patient with chronic low back pain who was initially injured in a MVC, more often than not (63 % of the time) the condition was caused by the MVC. These findings are likely to be of interest to clinicians, insurers, patients, governments and the courts. Future studies from both general and clinical populations would help strengthen these results., Competing Interests: Declaration of Competing Interest Dr. Michael D Freeman does medicolegal consultations pertaining to traffic crash-related injuries., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To examine the level of evidence for an association between external bowling workload and lower-back injuries in cricket fast bowlers., Methods: Six online databases were searched using four sets of keywords (relating to cricket, bowler, lumbar, workload). Risk of bias was assessed using the NIH quality assessment tool, while quality of evidence was assessed according to the Cochrane Back and Neck (CBN) group guidelines., Results: Eight articles were found to fit the inclusion/exclusion criteria. It was found that overall, there was a low quality of evidence amongst the included studies. A high risk of bias was present - both in the measurement of external workload and lower-back injuries., Conclusion: The association between external workload and lower-back injuries has minimal strength. Technological advancements that allow total workload to be measured accurately would potentially allow the association between workload and lower-back injury to be examined more precisely, possibly leading to effective injury prevention interventions in fast bowlers., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Heavy physical effort at work has been linked with disability pension, but the contribution of other ergonomic job exposures is less studied. We studied the independent and joint contributions of long-term exposure to (i) rotation of the back and (ii) repetitive movements to disability pension, particularly due to musculoskeletal disorders., Methods: Exposures were measured with the Helsinki Health Study Job Exposure Matrix during 1996-2005 and linked to register data on employees of the City of Helsinki, Finland (n = 18 585). Outcomes were followed up during 2006-2015. Competing risk survival analyses were performed and synergy indices computed, adjusting for sociodemographic factors., Results: Long-term exposure to rotation of the back was associated with disability pension due to any cause [age and sex-adjusted subhazard ratio (SHR) 2.39, 95% confidence interval (CI) 1.73-3.30], and specifically disability pension due to musculoskeletal disorders (SHR = 3.39, 95% CI 1.52-7.56) when compared to employees exposed to neither of the two exposures. Repetitive movements alone did not increase the risk of disability pension (all-cause SHR = 1.08, 95% CI 0.84-1.38, musculoskeletal SHR = 1.65, 95% CI 0.91-2.97). Employees with exposure to both rotation of the back and repetitive movements had the highest risk of disability pension due to musculoskeletal disorders (SHR = 5.98, 95% CI 3.85-9.28), but the interaction between exposures was additive rather than synergistic. Adjustment for education diluted the associations by 42-108%., Conclusion: Long-term exposure to awkward work postures increased the risk of disability pension. Educational inequalities largely account for differences in occupational exposures., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Low back disorders (LBD) are the most common musculoskeletal problem among farmers, with higher prevalence than other occupations. Although studies of the general population have shown an association between LBD and awkward working posture, farmers have unique work context and exposures that may modify this relationship. This review aimed to 1) identify published research studies investigating posture as a risk factor for LBD in farmers/agricultural workers, and 2) determine the strength of the relationship between postural exposure and LBD risk of bias assessment., Method: Comprehensive electronic searches of Medline, Web of Science, CINAHL, SCOPUS, PubMed, and EMBASE were carried out with combined conceptual groups of search terms for 'farming' and 'LBD.' After screening, data were extracted to summarize the study design, sample characteristics, exposure assessment methods, LBD risk factors, demographic information, data collection methods, farm commodities, job context, and sampling strategy. Data were synthesized to determine the weight of evidence for awkward working posture as a risk factor for LBD among farmers., Results: Nine studies were included in this review. All studies used self-report; there were no field-based studies including direct measurement of awkward posture. There was diversity in exposure definition, exposure assessment, LBD definition, worker characteristics, and analytical approaches. There was evidence to support association between awkward working posture and LBD among farmers., Conclusion: Despite the diversity, the weight of evidence supported a relationship between awkward posture and LBD. Well-designed epidemiological studies with quantitative physical workload assessments, consistent and valid LBD definitions, and longitudinal designs are recommended to clarify the relationship between awkward posture and LBD.

Increasing numbers of people are playing golf. Golf is a unique sport in that the ability to participate at a high level is not limited by age. In addition, participants tend to play more rather than less as they grow older. Injuries can occur at any point during the golf swing, from takeaway through follow-through. Upper extremity injuries can affect the hands, elbow, and shoulder and are usually a result of the golf swing at impact. Injuries are also common in the lower back as well as the lower extremities. Most injuries are the result of overuse and poor swing mechanics. When treating golfers, it is important to have a good understanding of the biomechanics and forces of the golf swing to diagnose and manage the vast spectrum of injuries incurred in this sport.

This investigation examined interactions between the magnitude of external load, movement speed and (a)symmetry of load placement on estimates of in vivo joint loading in the lumbar spine during simulated occupational lifting. Thirty-two participants with manual materials handling experience were included in the study. Three-dimensional motion data, ground reaction forces, and activation of six bilateral trunk muscle groups were captured while participants performed lifts with two loads at two movement speeds and using two load locations. L4-L5 joint compression and shear force-time histories were estimated using an EMG-assisted musculoskeletal model of the lumbar spine. Results from this investigation provide strong evidence that known mechanical low back injury risk factors should not be viewed in isolation. Rather, injury prevention efforts need to consider the complex interactions that exist between external task demands and their combined influence on internal joint loading., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This month, we celebrate nurses for their dedication to patient well-being and safety. The American Nurses Association has declared National Nurses Week 2017, May 6-12, the "Year of the Healthy Nurse." This special Nurses Week tribute reminds us that although patient health and safety is the goal of every nurse, it's important to remember our own health as well.

Large spinal compressive force combined with axial torsional shear force during asymmetric lifting tasks is highly associated with lower back injury (LBI). The aim of this study was to estimate lumbar spinal loading and muscle forces during symmetric lifting (SL) and asymmetric lifting (AL) tasks using a whole-body musculoskeletal modelling approach. Thirteen healthy males lifted loads of 7 and 12 kg under two lifting conditions (SL and AL). Kinematic data and ground reaction force data were collected and then processed by a whole-body musculoskeletal model. The results show AL produced a significantly higher peak lateral shear force as well as greater peak force of psoas major, quadratus lumborum, multifidus, iliocostalis lumborum pars lumborum, longissimus thoracis pars lumborum and external oblique than SL. The greater lateral shear forces combined with higher muscle force and asymmetrical muscle contractions may have the biomechanical mechanism responsible for the increased risk of LBI during AL. Practitioner Summary: Estimating lumbar spinal loading and muscle forces during free-dynamic asymmetric lifting tasks with a whole-body musculoskeletal modelling in OpenSim is the core value of this research. The results show that certain muscle groups are fundamentally responsible for asymmetric movement, thereby producing high lumbar spinal loading and muscle forces, which may increase risks of LBI during asymmetric lifting tasks.

Objective: Lower back problems are a common cause of sick leave of employees in Dutch care homes and hospitals. In the Netherlands over 40% of reported sick leave is due to back problems, mainly caused by carrying out heavy work. The goal of the iLift project was to develop a game for nursing personnel to train them in lifting and transfer techniques. The main focus was not on testing for the effectiveness of the game itself, but rather on the design of the game as an autogenous trigger and its place in a behavioral change support system. In this article, the design and development of such a health behavior change support system is addressed, describing cycles of design and evaluation., Methods: (a) To define the problem space, use context and user context, focus group interviews were conducted with Occupational Therapists (n=4), Nurses (n=10) and Caregivers (n=12) and a thematic analysis was performed. We interviewed experts (n=5) on the subject of lifting and transferring techniques. (b) A design science research approach resulted in a playable prototype. An expert panel conducted analysis of video-recorded playing activities. (c) Field experiment: We performed a dynamic analysis in order to investigate the feasibility of the prototype through biometric data from player sessions (n=620) by healthcare professionals (n=37)., Results: (a) Occupational Therapists, Nurses and Caregivers did not recognise a lack of knowledge with training in lifting and transferring techniques. All groups considered their workload, time pressure and a culturally determined habit to place the patient's well being above their own as the main reason not to apply appropriate lifting and transferring techniques. This led to a shift in focus from a serious game teaching lifting and transferring techniques to a health behavior change support system containing a game with the intention to influence behavior. (b) Building and testing (subcomponents of) the prototype resulted in design choices regarding players perspective, auditory and visual feedback, overall playability and perceived immersiveness. This design process also addressed the behavior shaping capacities of the game and its place within the health behavior change support system. An expert panel on lifting and transferring techniques validated the provoked in-game activities as being authentic. (c) Regression analysis showed an increase of the game score and dashboard score when more sessions were played, indicating an in-game training effect. A post-hoc test revealed that from an average of 10 playing sessions or more, the dashboard score and the game score align, which indicates behavioral change towards executing appropriate static lifting and transferring techniques., Conclusions: Data gathered in the final field test shows an in-game training effect, causing players to exhibit correct techniques for static lifting and transferring techniques but also revealed the necessity for future social system development and especially regarding intervention acceptance. Social system factors showed a strong impact on the games persuasive capacities and its autogenous intent., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: With the removal of gender restrictions and the changing nature of warfare potentially increasing female soldier exposure to heavy military load carriage, the aim of this research was to determine relative risks and patterns of load carriage related injuries in female compared to male soldiers., Methods: The Australian Defence Force Occupational Health, Safety and Compensation Analysis and Reporting workplace injury database was searched to identify all reported load carriage injuries. Using key search terms, the narrative description fields were used as the search medium to identify records of interest. Population estimates of the female: male incident rate ratio (IRR) were calculated with ninety-five percent confidence interval (95% CI) around the population estimate of each IRR determined., Results: Female soldiers sustained 10% (n = 40) of the 401 reported injuries, with a female to male IRR of 1.02 (95% CI 0.74 to 1.41). The most common site of injury for both genders was the back (F: n = 11, 27%; M: n = 80, 22%), followed by the foot in female soldiers (n = 8, 20%) and the ankle (n = 60, 17%) in male soldiers. Fifteen percent (n = 6) of injuries in female soldiers and 6% (n = 23) of injuries in males were classified as Serious Personal Injuries (SPI) with the lower back the leading site for both genders (F: n = 3, 43%: M: n = 8, 29%). The injury risk ratio of SPI for female compared to male soldiers was 2.40 (95% CI 0.98 to 5.88)., Conclusions: While both genders similarly have the lower back as the leading site of injury while carrying load, female soldiers have more injuries to the foot as the second leading site of injury, as opposed to ankle injuries in males. The typically smaller statures of female soldiers may have predisposed them to their observed higher risk of suffering SPI while carrying loads.

The drag flick is the preferred method of scoring during a penalty corner in field hockey. Performing the drag flick requires a combination of strength, coordination and timing, which may increase susceptibility to injuries. However, injury prevalence in drag flickers has not previously been investigated. Therefore, this study compared the injury prevalence and severity of lower limb and lower back injuries between drag flickers and non-drag flickers in field hockey. A total of 432 local, national and international adult field hockey players (242 males, 188 females) completed an online questionnaire to retrospectively determine the 3-month prevalence and severity of ankle, knee, hip and lower back injuries. Of this group, 140 self-identified as drag flickers and 292 as non-drag flickers. The results showed that drag flickers had significantly higher prevalence of hip (OR: 1.541; 95% CI: 1.014, 2.343) and lower back injury (OR: 1.564; 95% CI: 1.034, 2.365) compared to non-drag flickers. No significant differences were observed between drag flickers and non-drag flickers in injury prevalence at the ankle and knee. There were no significant between-group differences in injury severity scores. Overall, the prevalence of hip and lower back injuries was significantly higher in drag flickers compared to non-drag flickers.

The aims of this prospective school cohort study were to describe the epidemiology of diagnosed back pain in childhood, classified as either nontraumatic or traumatic back injury, and to estimate the association with physical activity in different settings. Over 2.5 years, 1240 children aged 6-12 years were surveyed weekly using mobile text messages to ask about the presence or absence of back pain. Pain was clinically diagnosed and injuries were classified using the International Classification of Diseases version 10. Physical activity data were obtained from text messages and accelerometers. Of the 315 back injuries diagnosed, 186 injuries were nontraumatic and 129 were traumatic. The incidence rate ratio was 1.5 for a nontraumatic back injury compared with a traumatic injury. The overall estimated back injury incidence rate was 0.20 per 1000 physical activity units (95% confidence interval 0.18-0.23). The back injury incidence rates were higher for sports when exposure per 1000 physical activity units was taken into consideration and especially children horse-riding had a 40 times higher risk of sustaining a traumatic back injury compared to the risk during non-organized leisure time physical activity. However, the reasonably low injury incidence rates support the recommendations of children continuously being physically active., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Manual handling injuries can occur almost anywhere in a healthcare environment, and most staff perform a variety of moving and handling tasks every day. Heavy lifting, awkward posture, and previous or existing injury can increase the risk of musculoskeletal disorders. A healthcare professional's involvement in moving and handling is more widespread than it might appear, and their actions and understanding of techniques, legislation and guidelines have a direct effect on patient care. Every situation that involves the handling, or partial handling, of a person presents varying levels of risk to the patient and the carer. Maintaining a good level of patient mobility and independence is an essential part of care delivery and can reduce the risk of long-term physical and psychological effects. Delivery of care should focus on the individual's capacity, not their incapacity, to ensure that they are treated with dignity and respect.

Background: Tablet users may be at high risk of developing physical discomfort because of their usage behaviors and tablet design., Objective: Investigate the usage of tablets, variations in head and neck posture associated with different tablet tilt angles, and the association of tablet use with users' musculoskeletal discomfort., Methods: A survey of users' subjective perceptions conducted by questionnaire and measurements of users' postures by a 3D Motion analysis system was used to explore the effects of tablet use., Results: The questionnaire results indicated that over half of the participants reported physical discomfort after using tablets, with the most prevalent discomfort in the neck and shoulders, and more intensity of discomfort for the back although only few participants experienced it. Chi-squared tests indicated that significantly more participants who tended to use tablet computers to play games reported having musculoskeletal discomfort after using a tablet. In addition, preferences for tablet tilt angles varied across tasks (reading and game playing). The results from the 3D motion analysis revealed that head and neck flexion angles were significantly reduced when the tablets were positioned at relatively steep tilt angles. Neck flexion angle was significantly higher in game playing., Conclusions: These data add information regarding to the usage of tablet and its associations with physical discomfort (significantly more participants who tended to use tablet computers to play games reported having musculoskeletal discomfort after using a tablet). Steep tilt angles (such as 60°) may cause tablet users to decrease their head and neck flexion angles, which could lead to a more neutral, effortless, and ergonomically correct posture. Maintaining proper neck posture during active activities such as game playing is recommended to avoid neck discomfort.

Objectives: This study aimed to identify modifiable mechanisms associated with low back injury in adolescent cricket fast bowlers., Design: A prospective study design examined the association between intrinsic risk factors, workload, bowling kinematics, lumbar load and low back injury incidence., Methods: Twenty-five injury free fast bowlers, aged 14-19 years, were assessed prior to the start of a cricket season and observed during the season for low back injuries., Results: The twelve bowlers who suffered a low back injury displayed; decreased hip flexion at front foot contact (46±6° vs 51±6°), increased pelvis rotation (287±11° vs 277±11°) increased thorax lateral flexion (50±6° vs 40±8°) at ball release, and larger peak lumbar flexion (10.5±4.9Nmkg(-1)m(-1) vs 6.9±2.5Nmkg(-1)m(-1)) and lateral flexion moments (12.5±2.6Nmkg(-1)m(-1) vs 10.6±1.9Nmkg(-1)m(-1)). They also exhibited reduced muscular endurance of the back extensors (103±33s vs 132±33s) and increased knee valgus angle during a single leg decline squat on the dominant (9±3° vs 5±4°) and non-dominant leg (9±4° vs 6±3°) in comparison to uninjured bowlers., Conclusions: Bowlers who experience greater lumbar loads during bowling, have reduced back extensor muscle endurance, and demonstrate impaired control of the lumbo-pelvic-hip complex, are at increased risk of low back injury. This combination of strength, control and biomechanical factors may be key mechanical elements of low back injury causation in adolescent fast bowlers., (Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.)

African hair braiders are potentially subject to work-related musculoskeletal disorders (WMSDs) because they perform repetitive hand motions for many hours a day together with prolonged standing and/or prolonged sitting. A complete enumeration of African hair braiders was attempted in Oklahoma City (OKC) and Dallas/Fort Worth (DFW). Braiders were identified through the channels they typically use to offer services to clients. Potential risk factors and symptoms of WMSDs were assessed using an oral interview. Participation rates were 95% (18/19) in OKC and 83% (83/101) in DFW. More than 75% of braiders reported discomfort in the fingers, wrist/hand, upper back, and lower back. In multivariate analysis, years worked as a braider but not age was a significant risk factor (p < 0.005) for reported pain in the wrist/hand, time spent sitting during the work day was found to be a significant predictor (p < 0.05) of upper back pain and lower back pain, and time spent sitting and time spent standing during the work day were both significant predictors (p < 0.05) of shoulder pain. Braiders in OKC, where licensing requirements were stricter, were significantly more likely than braiders in DFW to work at home (67% vs. 4%, p < 0.001) and to report pain in the lower leg (p < 0.005) and ankle/foot (p < 0.05). The close-knit nature of the African hair braiding community makes it an appealing candidate for community-based participatory research aimed at further elucidating occupational health concerns and reducing risk.

A complete rupture of the teres major is an extremely rare injury and rarely described in the literature. We report the first case of an isolated rupture of the teres major in a professional football goalkeeper. The diagnosis requires a high degree of suspicion and complementation by image examinations. Conservative treatment has a high success rate with early return to sport., (2015 BMJ Publishing Group Ltd.)

Lifting is a major risk factor for low back injury. Lifters experience small continual perturbations, because moving a load provides a disturbance to the lifter׳s equilibrium. The goal of the present study was to examine the relationship between local and global trunk/spine stabilities during external perturbations introduced at the foot-floor interface. 12 healthy males were recruited to participate in this study. Participants completed a freestyle lifting protocol on a perturbation treadmill, under three randomized load conditions: ~0, 4, and 8 kg. Participants performed a total of 40 lifts under each load condition; no perturbations occurred during the first 20 lifts. During the last 20 lift cycles (in blocks of 5) the participants were randomly perturbed. Local dynamic trunk stability was quantified using the local divergence exponent (λmax) of the first 20 lifts. In addition, the distance traveled from the unperturbed lifting pattern (B), the time to max distance (Tau), the relaxation distance (A), and the rate of return toward the normal lifting pattern (Beta) were analyzed following each external perturbation. An increase in lifted load lead to significantly increased local trunk stability (p=0.046). Higher load also lead to decreased distance (B) traveled away from the unperturbed trajectory (p=0.023). Results agree with previous research that increasing load lifted significantly improves local trunk/spine stability during lifting. Here we have shown that altered local stability also translates into a greater ability to resist external global perturbations, which may reduce injury risk and should be explored in the future., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Traffic collisions often result in a wide range of symptoms included in the umbrella term whiplash-associated disorders. Mid-back pain (MBP) is one of these symptoms. The incidence and prognosis of different traffic injuries and their related conditions (e.g. neck pain, low back pain, depression or others) has been investigated previously; however, knowledge about traffic collision-related MBP is lacking. The study objectives were to describe the incidence, course of recovery and prognosis of MBP after traffic collisions, in terms of global self-reported recovery., Methods: Longitudinal data from a population-based inception cohort of all traffic injuries occurring in Saskatchewan, Canada, during a 2-year period were used. Annual overall and age-sex-specific incidence rates were calculated, the course of recovery was described using the Kaplan-Meier technique, and associations between participant characteristics and time-to-self-reported recovery were explored in 3496 MBP cases using Cox proportional hazards models., Results: The yearly incidence rate was 236 per 100,000 population during the study period, and was highest in women and in young persons. The median time-to-first reported recovery was 101 days (95% CI: 99-104) and about 23% were still not recovered after 1 year. Participant's expectation for recovery, general health, extent of severely affecting comorbidities and having experienced a previous traffic injury were some of the prognostic factors identified., Conclusions: These findings show that MBP is common after traffic collisions, may result in a long recovery process and that a range of biopsychosocial factors are associated with recovery., (© 2015 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.)

Background: Little is known about the rate and pattern of injuries in international volleyball competition., Objective: To describe the risk and pattern of injuries among world-class players based on data from the The International Volleyball Federation (FIVB) Injury Surveillance System (ISS) (junior and senior, male and female)., Methods: The FIVB ISS is based on prospective registration of injuries by team medical staff during all major FIVB tournaments (World Championships, World Cup, World Grand Prix, World League, Olympic Games). This paper is based on 4-year data (September 2010 to November 2014) obtained through the FIVB ISS during 32 major FIVB events (23 senior and 9 junior)., Results: The incidence of time-loss injuries during match play was 3.8/1000 player hours (95% CI 3.0 to 4.5); this was greater for senior players than for junior players (relative risk: 2.04, 1.29 to 3.21), while there was no difference between males and females (1.04, 0.70 to 1.55). Across all age and sex groups, the ankle was the most commonly injured body part (25.9%), followed by the knee (15.2%), fingers/thumb (10.7%) and lower back (8.9%). Injury incidence was greater for centre players and lower for liberos than for other player functions; injury patterns also differed between player functions., Conclusions: Volleyball is a very safe sport, even at the highest levels of play. Preventive measures should focus on acute ankle and finger sprains, and overuse injuries in the knee, lower back and shoulder., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: Many injuries experienced by soldiers can be attributed to the occupational loads they are required to carry., Purpose: The aim of this study was to determine whether contemporary military load carriage is a source of injuries to Australian Regular Army soldiers and to profile these injuries., Methods: The Australian Defence Force 'Occupational Health, Safety and Compensation Analysis and Reporting' database was searched to identify all reported injuries sustained during load carriage events. Key search terms were employed and narrative description fields were interrogated to increase data accuracy., Results: A total of 1,954 injury records were extracted from the database. Of these, 404 injuries were attributed to load carriage. The majority of these load carriage injuries involved either the lower limb or back, with bones and joints accounting for the most frequently reported body structures to be injured. Field activities were the leading activities being performed at the time that load carriage injuries occurred, and muscular stress was identified as the mechanism of injury for over half of reported load carriage injuries., Conclusion: This study suggests that load carriage is a substantial source of injury risk to Australian Army soldiers. Physical training may fail to adequately prepare soldiers for load carriage tasks during field training exercises.

Background: Although pole vaulting has been a sanctioned collegiate event since the 1920s, little is known about the injury patterns observed in the sport., Purpose: To describe injury incidence, patterns, and risks in collegiate pole vaulters., Study Design: Descriptive epidemiology study., Methods: This was a prospective cohort study of collegiate athletes participating in pole vault over a single track-and-field season. Baseline athlete information was collected on study enrollment. Injuries were recorded in a standardized form to document diagnosis and event circumstances. A log of practice and competition exposures was maintained for each athlete. Injury incidence was reported as the proportion of injured vaulters and number of new injuries per 1000 athlete-exposures. Regression analysis on baseline variables was performed to determine risks for injury., Results: A total of 135 vaulters from 15 universities took part in the study. There were 70 injury events reported during 8823 exposures. Forty-one percent of vaulters sustained injury, and there were 7.9 injuries per 1000 athlete-exposures. The low back was the most common injury location (16.7%), followed by the hamstrings and lower leg (13.9% each). Overall, 60% of injuries were to the lower extremities, 21% to the upper extremities, and 18% to the back. No head or neck injuries were reported. Injuries were most commonly muscular strains (39.2%) or overuse type (25.5%). Thirty percent, including 83% of low back injuries, occurred during the plant/takeoff phase of the vault. One-third of lumbar injuries were spondylolysis, with 75% of these being season ending. The odds of injury were 2.7 (95% CI, 1.1-7.1) times greater in vaulters with multiple prior injuries., Conclusion: This is the first prospective study of injury patterns in collegiate pole vaulters. The results indicate that injuries are very common in experienced vaulters. Medical personnel and coaches should be aware of the propensity for overuse-type injuries and institute activity modification to reduce time lost. In addition, coaches and athletes should focus on proper technique, particularly during the plant/takeoff to help minimize back injury. Medical providers should maintain a high level of suspicion for symptomatic spondylolysis in any vaulter complaining of frequent or persistent low back pain. Detailed medical histories are important to identify prior injuries, and coaches should focus on changing technical flaws or behaviors that may contribute to reinjury., (© 2015 The Author(s).)

Nursing care involves complex patient handling tasks, resulting in high musculoskeletal injury rates. Epidemiological studies from the 1980s estimated a lifetime prevalence of lower back injuries for nurses between 35 and 80%. National and international studies continue to mirror these findings. Despite the development of programs intended to reduce manual handling injuries, sustainable solutions remain elusive. This paper reports on a study of nurses speaking about their perspectives on current manual handling practices. Qualitative research conducted in 2012 investigated nurses' perceptions and experiences relating to manual handling in the healthcare context and their participation in injury prevention programs. There were two research methods: semi-structured interviews and researcher reflective journaling. The research was framed in critical emancipatory methodology. Thirteen nurses from two Australian states participated in the study. Thematic analysis revealed an overarching theme of 'power relations' with a subcategory of '(mis)power' that comprised two subthemes, these being 'how to practice' and 'voicing practice issues'. Specifically, this paper explores nurses verbalising their views in the workplace and responses which left them feeling silenced, punished and disillusioned. The findings suggest that the sociopolitical context within which nurses practice impacts upon their ability to voice concerns or ideas related to manual handling. Inclusion of nurses in the manual handling dialogue may generate an expanded understanding of, and the potential to transform, manual handling practices in healthcare environments.

Background: Linking firefighter injury reporting to general motion patterns may provide insight into potential injury mechanisms and the development of prevention strategies., Objective: To characterize the injuries sustained by members of a large Canadian metropolitan fire department over a 5-year span., Methods: Data were taken from injury reports filed by career firefighters between 2007 and 2011. Injuries were described by job duty, type, body part affected, and the general motion pattern employed at the time of injury (e.g. lifting)., Results: Of the 1311 injuries reported, 64% were categorized as sprains and strains (musculoskeletal disorders -MSDs), the most frequent of which affected the back (32%). Categorized by job duty, 65% of MSDs were sustained while working at the fire station or during physical training-related activities. Only 15% were attributed to fireground operations. Furthermore, the associated job duty could not differentiate the types of injuries sustained; back injuries occurred primarily while lifting, knee injuries while stepping, and shoulder injuries during pushing/pulling-related activities., Conclusions: Firefighter injuries are not just a fireground problem. Injury causation may be better understood by linking the injury location and type with motion patterns rather than job duties. This information could assist in developing general prevention strategies for the fire service.

Low back pain is highly prevalent in nurses. This study aimed to determine which physical fitness, physical activity (PA) and biomechanical characteristics most clearly distinguish between nurses with [recently injured (RInj)] and without [not recently injured (NRInj)] a recent back injury. Twenty-seven (8 RInj, 19 NRInj) female nurses completed questionnaires (pain, work, PA), physical fitness, biomechanical and low back discomfort measures, and wore an accelerometer for one work shift. Relative to NRInj nurses, RInj nurses exhibited reduced lumbopelvic control (41.4% more displayed a moderate loss of frontal plane position), less active occupational behaviours (less moderate PA; less patient lifts performed alone; more sitting and less standing time) and more than two times higher low back discomfort scores. Despite no physical fitness differences, the lumbopelvic control, occupational behaviours and discomfort measures differed between nurses with and without recent back injuries. It is unclear whether poor lumbopelvic control is causal or adaptive in RInj nurses and may require further investigation. Practitioner Summary: It is unclear which personal modifiable factors are most clearly associated with low back pain in nurses. Lumbopelvic control was the only performance-based measure to distinguish between nurses with and without recent back injuries. Future research may investigate whether reduced lumbopelvic control is causal or adaptive in recently injured nurses.

This article looks at healthcare professionals, in particular midwives, and considers how to maintain back health and prevent injury through principles of good practice. Knowledge of back pain, mindfulness in working conditions and modifications of current practice will reduce the risk of repetitive injury, and present management options in the short- and long term. Considerations on improving the 'working lifestyle' rather than quick fixes are ultimately the long-term goal.

We have limited insight into how injuries occur in professional ski racing. The aim of this study was to describe the injury situations in World Cup alpine skiing. Injuries reported through the International Ski Federation Injury Surveillance System for three consecutive World Cup seasons (2006-2009) were obtained on video. In total, 69 injuries and 124 runs of matched controls were analysed by five experts to evaluate the skiing situation, skier behavior, as well as piste-related factors. A chi-square test (95% CI, P ≤ 0.05) was used to examine whether there was a difference between course sections regarding where the injury situation occurred. The skier was most frequently turning (n = 55) or landing from a jump (n = 13) at the time of injury. Most of the injuries to the head and upper body (96%) resulted from crashes, while the majority of knee injuries (83%) occurred while the skier was still skiing. Gate contact contributed to 30% of the injuries, while 9% occurred at contact with safety nets/material. Almost half of the injuries (46%) occurred in the final fourth of the course. A particular concern was the high contribution of inappropriate gate contact and the high-energy impacts to the body when crashing., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

A decade ago, cricket has traditionally been regarded as relatively injury free, although it has been classified as having a "moderate" injury risk. At present, cricket has evolved into shorter and more competitive versions involving greater aggression and often played for long periods of time. This has expectedly ensued in an increase in the number of cricketing injuries similar to those seen in other sports which involve running, throwing, or being hit by a hard object. However, there are some injuries to look out for especially in cricket players. In this article, we have reviewed information about cricket injuries that will help orthopaedists make the correct diagnoses and initiate appropriate treatment. Orthopaedic surgeons and physiotherapists should work as a team to detect treatable cricket injuries at an early stage and ensure that every precaution is taken to minimize the risks of injury., (© 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.)

While the workers of the Wholesale and Retail Trade industrial sector suffer from musculoskeletal disorders at an alarming rate, there have been few investigative studies into potential effective interventions to reduce the ergonomic stress. The objective of the study was to determine whether a cart with an adjustable shelf could reduce awkward postures and motions while stocking products in a grocery store. Fifteen workers at a small grocery store in Puerto Rico completed stocking tasks with two types of carts: traditional and adjustable height cart or Ergo Cart. Trunk kinematics, LBD risk index, NIOSH lifting index, subjective ratings, and productivity indicators were collected during four typical stocking tasks. The Adjustable Ergo Cart reduced the sagittal trunk flexion by 7° and velocity by about 5°/s but increased twisting by about 2° and twist velocity by 4°/s as compared to the traditional cart. The LBD risk index was reduced by a small 2.4% in probability although greater reductions were found for larger items (e.g. bags of dog food and 2-L of Soda). The consensus among workers was that the adjustable cart would be easier to use. Overall, the study provides objective evidence that an ergonomically designed cart (e.g. adjustable height) has some potential to reduce sagittal trunk flexion, LBD risk index, and the NIOSH lift index. Overall, the results indicate that any intervention such as an adjustable cart can only have marginal effectiveness unless the entire systems perspective is considered., (Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Objective: To investigate if running distance to first running-related injury varies between foot postures in novice runners wearing neutral shoes., Design: A 1-year epidemiological observational prospective cohort study., Setting: Denmark., Participants: A total of 927 novice runners equivalent to 1854 feet were included. At baseline, foot posture on each foot was evaluated using the foot-posture index and categorised into highly supinated (n=53), supinated (n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18). Participants then had to start running in a neutral running shoe and to use global positioning system watch to quantify the running distance in every training session., Main Outcome Measure: A running-related injury was defined as any musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least 1 week., Results: During 1 year of follow-up, the 1854 feet included in the analyses ran a total of 326 803 km until injury or censoring. A total of 252 participants sustained a running-related injury. Of these, 63 were bilateral injuries. Compared with a neutral foot posture, no significant body mass index-adjusted cumulative risk differences (RD) were found after 250 km of running for highly supinated feet (RD=11.0% (-10% to 32.1%), p=0.30), supinated feet (RD=-1.4% (-8.4% to 5.5%), p=0.69), pronated feet (RD=-8.1% (-17.6% to 1.3%), p=0.09) and highly pronated feet (RD=9.8% (-19.3% to 38.8%), p=0.51). In addition, the incidence-rate difference/1000 km of running, revealed that pronators had a significantly lower number of injuries/1000 km of running of -0.37 (-0.03 to -0.70), p=0.03 than neutrals., Conclusions: The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners taking up running in a neutral running shoe. More work is needed to ascertain if highly pronated feet face a higher risk of injury than neutral feet.

This narrative review examines injuries sustained by soldiers undertaking occupational load carriage tasks. Military soldiers are required to carry increasingly heavier occupational loads. These loads have been found to increase the physiological cost to the soldier and alter their gait mechanics. Aggregated research findings suggest that the lower limbs are the most frequent anatomical site of injury associated with load carriage. While foot blisters are common, other prevalent lower limb injuries include stress fractures, knee and foot pain, and neuropathies, like digitalgia and meralgia. Shoulder neuropathies (brachial plexus palsy) and lower back injuries are not uncommon. Soldier occupational load carriage has the potential to cause injuries that impact on force generation and force sustainment. Through understanding the nature of these injuries targeted interventions, like improved physical conditioning and support to specialised organisations, can be employed.

Introduction: Early in their careers, as an important part of their training to become fighter pilots, pilots undergo centrifuge training in order to learn effective anti-G straining maneuvers (AGSM) and to test their G tolerance. The exposure of pilots, especially early in their careers, to training that could lead to injuries should be avoided. This is a report of four cases of neck pain experienced during G-tolerance training, some of which may have caused ongoing problems for the pilot., Cases: Four cases, describing four different injuries experienced during G-tolerance training, are presented, including the history of the incident, radiographic description, and physical examination., Discussion: Three main questions were identified in regards to the training of fighter pilots in centrifuges: 1) should the seat be positioned to imitate a specific aircraft's seat? 2) should the pilot wear a helmet and a mask? 3) what is the appropriate amount of head support? Based on the four cases reported it is recommended that pilots should be given the best possible conditions concerning neck support and load on the neck and the back for G-tolerance testing. Training the pilot in an anatomical neutral sitting position, without a helmet, and with maximal neck support minimizes head movements in cases of conscious or unconscious loss of muscle control. To test the stability of the neck in a setup similar to the environment where the pilot is going to operate, the pilot should be given the opportunity to prepare himself or herself accordingly in advance.

Background: Upper body musculoskeletal injuries are often attributed to rapid work pace and repetitive motions. These job features are common in poultry processing, an industry that relies on Latino immigrants. Few studies document the symptom burden of immigrant Latinos employed in poultry processing or other manual jobs., Methods: Latino poultry processing workers (n = 403) and a comparison population of 339 Latino manual workers reported symptoms for six upper body sites during interviews. We tabulated symptoms and explored factors associated with symptom counts., Results: Back symptoms and wrist/hand symptoms lasting more than 1-day were reported by over 35% of workers. Poultry processing workers reported more symptoms than comparison workers, especially wrist and elbow symptoms. The number of sites at which workers reported symptoms was elevated for overtime workers and workers who spoke an indigenous language during childhood., Conclusion: Workplace conditions facing poultry processing and indigenous language speaking workers deserve further exploration., (Copyright © 2012 Wiley Periodicals, Inc.)

Despite the evidence suggesting that between 8% and 55% of manual labourers experience thoracic pain, research on spinal loading during occupational tasks has been almost invariably limited to the lumbar spine. In this study, we determined the ratio of thoracic to lumbar compression force and the relative risk of injury to each region in various postures. Compressive forces on the spine were calculated based on previously reported thoracic and lumbar intradiscal pressures and disc cross-sectional areas. Flexion postures were associated with an approximate doubling in lumbar compression force but only small increases (or even decreases) in thoracic compression. The ratio of thoracic to lumbar compression was above the tolerance ratio (i.e. the ratio of thoracic to lumbar compressive strength) during upright postures and below the tolerance ratio during flexion postures, indicating that upright postures may pose a greater relative risk of injury to the thoracic spine than to the lumbar spine. Practitioner summary: Previously reported thoracic and lumbar in vivo disc pressures during various postures were compared. The ratio of thoracic and lumbar compression increased during upright postures and decreased in flexed postures, indicating that upright postures may pose a greater risk of injury to the thoracic spine than to the lumbar spine.

Twenty-one risk factors affecting laborers in manual materials handling tasks were analyzed to determine what, if any, statistically significant relationships existed between the factors and the emergence of occupational back injury. The statistically significant risk factors (p ≤ .05) in the univariate analysis were determined to be weight lifted per hour (work intensity), trunk twists per hour, weight lifted per day, frequency of lift, trunk motions per hour, and trunk flexions per hour, with odds ratios (ORs) of 1.28-2.88. In addition, self-reported discomfort in the neck, middle back, knees, and lower back was associated with the outcome of back injury (p ≤ .05, OR 1.75-2.66). In the multivariate analysis, the statistically significant risk factors (p ≤ .05) were weight lifted per hour (work intensity), average weight of lift, and number of trunk twists per hour, with ORs of 1.74-4.98.

This study aimed to assess changes in bowling technique and lumbar load over the course of a bowling spell in adolescent fast bowlers, and to investigate the relationship between lumbar loads during fast bowling and kinematic factors which have previously been associated with low back injury. Three-dimensional motion analysis was carried out on forty participants who performed an 8-over bowling spell. There were no significant changes in bowling technique or lumbar loads over the course of the spell. Bowling with a more extended front knee, faster ball release speed and increased shoulder counter-rotation were related to increased lumbo-pelvic loading - in particular peak transverse plane rotation moments and anterior-posterior shear forces. These lumbar loads may be a factor in low back injury aetiology and future studies should investigate the relationship between lumbar loading, injury incidence and other risk factors.

The aim of this study was to evaluate the benefits and limitations of using three dimensional (3D) musculoskeletal modelling (LifeModeler) in assessing the safety and efficacy of exercising on an abdominal crunch resistance training machine. Three anthropometric cases were studied, representing a 5th percentile female, and 50th percentile and 95th percentile male. Results indicated that the LifeModeler default model was capable of solving the forward dynamics simulations without adjustments. The modelling was able to indicate high risk for back injury when performing the abdominal crunch exercise as a result of the unacceptable intervertebral joint loading that occurs during the exercise. Individuals with small anthropometric dimensions such as some females and children cannot be accommodated suitably on the abdominal crunch machine which negatively impacts exercise posture and technique. Hip flexor muscle contribution in the execution of the exercise for the 5th percentile female was substantial thus reducing the efficacy of the exercise in isolating the abdominal muscles.

Objective: To determine the utility of a safe lifting program index and a measure of lift inventory to predict workers' compensation claim frequency and costs in long-term care facilities in 23 states., Methods: Workers' compensation claims and cost data were matched to Center for Medicare and Medicaid Services (CMS)-certified facilities (N = 656). Facility safe lifting program index were derived from interviews with directors of nursing in a subset (N = 271)., Results: The higher the safe lift index score, the lower the claims and costs. An increase of one lift per 100 residents is associated with a 5% decrease in claims frequency and an 11% decrease in total costs on average., Conclusion: In this national study, we find that a comprehensive safe lift program, endorsed and promoted by directors of nursing, reduces caregiver injury as measured by workers' compensation claims frequency and costs.

The purpose of this study was to assess the physical demands, injuries, and conditioning practices of stock car drivers. Forty stock car drivers from 27 states in the United States participated in the interviews for 43.9 ± 13.9 minutes. The interviews examined background information, the physical demands of racing, injuries associated with racing, and the athletic and fitness background and practices of the subjects. Numerical data were analyzed using Pearson's correlation coefficients. Responses to open-ended questions were analyzed using inductive content analysis. Results revealed significant correlation between track points standings and the length of the resistance training sessions (R = -0.71, p = 0.002) and subject self-assessment of their fitness (R = -0.53, p = 0.045). Results also revealed that "upper-body strength" was identified as the most important physical demand. Extreme fatigue was the most common feeling after a demanding race. Subjects reported that shoulder fatigue was the most common form of muscle soreness experienced after a race. Back and torso injuries were the most common injury, although head injuries most frequently required medical attention. The subjects' biggest fear was fire, followed closely by head and neck injury. The bench press and running were the most commonly performed resistance training and cardiovascular exercises, respectively. Subjects reported that their highest motivation for training was to improve their racing performance. Many subjects had athletic backgrounds with football identified as the sport they had most commonly participated in. This study provides additional detailed information. Results of this study can assist strength and conditioning professionals in the development of strength and conditioning programs for performance enhancement and injury prevention that are specific to the needs of this population of athletes.