A critical review of Le and Marras, 2016, Evaluating the low back biomechanics

of three different office workstations: seated, standing ad perching, Applied

Ergonomics, Vol. 56, pp 170 178 by Anna Liza Cao Nacion

Le and Marras conducted an experimental study for one hour to twenty subjects
performing a typing task in three different workstations. This study is intended to
evaluate the biomechanical cost-benefit of each of the different workstation. The
study reveals that among the three workstations, standing had the most amount
of motion resulting for highest report of discomfort and highest spinal loads while
sitting incurred the least report. It was been noted that spinal loads were lower
during sitting as a backrest was used to which the load is distributed into the
backrest during reclining. Furthermore, perching was associated with lower
spinal loads compared to sitting and standing. Since, the study is conducted in a
laboratory, the experiment environment may have affected the subjects
performance such of which are the presence of electromyography (EMG)
sensors in the body and the heart rate monitor placed in the chest and rib cage of
the subjects. Moreover, the findings of this study are based only to the
contextual analysis and due to some notable limitations as cited by the
researchers it cannot generate a broad-spectrum inference.

The study focused on the low back biomechanics of different workstations:

seated, standing, and perching. Low back pain (LBP) has been well researched
over a couple of decades, including epidemiological studies looking at the
association between prolonged standing and low back pain (Gallagher, 2014;
Soliday, 2015), biomechanical effects of prolonged sitting (De Carvalho, 2015;
Dunk, 2009; Makhsous et.al., 2009; Graf, 2004; Salvendy, 2001, Hartvigsen,
et.al., 2000), and predictors (Adams, 2004; de Wet, 2003; Salvendy, 2001) and
prevalent cases (Selvan, 2013; Hesbaek, 2003) of low-back pain.

The researchers made used of variety of methods to collect the necessary data
for the study. One of which is the Heart Rate Variability (HRV) to objectively
quantify the physiological discomfort of the subjects in relation to the
workstations during the experiment. Though it was been admitted by the
researchers that HRV is not commonly used in ergonomics studies, various
studies in medical field often used HRV to monitor occupational studies relative
to stress (Fohr, et.al. 2015; Rau, et.al., 2015; Tonello, et.al., 2014; Uusitalo, et.al.
2011) and pain (Nordstoga, 2014; Faye, et.al, 2010; Oberlander, et.al, 2002) as
pain is synonymously used to discomfort. Furthermore, Hallman and colleagues
(Hallman, et.al. 2014) concluded in their study that HRV can be used as a
reliable and feasible marker of automatic activity in occupational studies of
repetitive low-force work. Thus, the application of HRV to assess the discomfort
level of the subjects in the study is a valid and a reliable tool.

One of the results of the study reveals that prolonged sitting incurred reports of
the least discomfort, the least motion and lower spinal load. This claim is
supported by the study conducted by Hartvigsen and colleagues
(Hartvigsen,et.al., 2000), showing that sitting-while-working is not a risk factor for
LBP. However, as stated by Salvendy (2001) in the evaluation of working
posture, prolonged sitting leads to increased risk of low back pain and muscle
fatigue. Furthermore, prolonged sitting has the potential to generate body
discomfort (Dunk, 2009; Graf, 2004) low back pain (Karakolis, 2014; Selvan,
2013; Makhsous, et.al. 2009) through spinal loading, strain and compression
force (Adams, 2016; De Carvaldo, 2015) leading to high risk of musculoskeletal
symptoms (Sirge, et.al. 2014). Hence, the result of the study in this particular
workstation is not conclusive and a further study in an actual workstation, such
as in a customer service profession that requires prolonged sitting, is highly
recommended.

The significant difference between the HRV records of seated and standing
condition in this study showing that sitting having the least discomfort is an
indication that subjects are more comfortable doing the task performance during
the experiment in a seated workstation rather than in a standing condition. This
result could also be due to the ergonomically designed experimental chair that
was used in the experiment. Many studies prove that the use of an ergonomically
designed chair reduces the risk of LBP (De Carvalho, 2015; Le, et.al. 2014;
Makhsous, et.al., 2009; Graf, 2004; Deursen, 2003).

During the standing condition, the study shows that there is an increase motion
among the participants as a result of an increased discomfort. This workstation
has the highest report of discomfort, the most overall motion, and highest spinal
loads indicating that there is a strong association between the prolonged
standing and LBP which is evident in some researches (Soliday, 2015; Gallagher,
2014; Karakolis, 2014). Moreover, previous study points the pre-disposing factor
to LBP is due to the lack of movement during prolonged standing (Gallagher,
2014).

As to the perching workstation, discomfort reports of the subjects during the

experiment are between seated and standing conditions. Literature suggests
that sit-stand workstation effectively reduce low back discomfort does increased
workers productivity (Karakolis, 2014; Karakolis, et.al., 2011).

Despite the fact that the study comprehensively presented the results on the
cost-benefit of the three workstations, the data collected on the typing
performance was not presented as to speed, accuracy and the number of errors
committed. Moreover, the profile of the participants where not implicitly presented
which is very vital in experimental study. According to Leboeuf-Yde and kyvik
(1998) as cited by Hartvigsen and colleagues (Hartvigsen, et.al. 2000), the
lifetime prevalence of LBP is very high at the age of 18 years (female) and 20
years (male). Considering the participants age, there is a high probability that
they will experience LBP during the course of the experiment. Also, the study
made no mention about the normality of the Body Mass Index (BMI) of the
participants which is important information in the study. As the result of the study
conducted by Selvan (2013) an abnormal BMI status is significantly related to
lower back pain. Thus, the BMI of the participants could also be a contributing
factor in the prevalence of LBP.

In general, the study presents the highlights of the biomechanical cost-benefits of

the three different workstations. Both prolonged sitting and prolonged standing
have been explicitly associated with increased low back pain due to increasing
discomfort. However, findings of this study suggest that perching is the most
beneficial among the three workstations for a profession whose primary task is
typing. Being in one position, whether sitting or standing, for long periods can
lead to discomfort and ultimately may cause long-term ill-effect. To avoid
discomfort, it is recommended to changing position or moving around during the
course of the task performance. Moreover, the results provide valuable
information about low back biomechanics and a further study must be conducted,
consider other dimensions, working conditions, and an actual workstation to have
an in-depth analysis on the biomechanics of low back pain.

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