Biomechanics of Lifting and

Lower Back Pain: part 2

S.N. Robinovitch
Outline
Spinal stability
Shear forces
Effect of abdominal pressure on
lifting mechanics
Cantilever model of lifting
 Forces on the lumbar spine
Moment due to applied
load

Disc shear force

(perpendicular to long axis
of vertebrae)
Erector Spinae Force

Disc compressive force

(parallel to long axis of
vertebrae)
 Definition of stability
Engineering definition of
stability: system is in a state
of stable equilibrium if, for all
possible small displacements
from equilibrium, restoring
force arise which accelerate
the system back toward the
equilibrium position
Clinical definition of spinal
instability: loss of the spines
ability to maintain its patterns
of displacement under
physiologic loads
Effect of co-contraction on spinal
stability
Spine with ligaments but
no muscle will buckle
under 90 N force
Co-contracted muscles
act like cables to stabilize
the spine. Increasing the
force or stiffness in both
cables:
increases the load-carrying
capacity of the spine
Increases ability to
withstand perturbations
(surprise loads) from both
directions
Reduces risk for buckling
Shear Forces
Shear forces act parallel to the
vertebral end plate and promote relative
sliding between vertebrae
Shear forces at the L4-L5 arise from
(1) weight of the HAT, (2) hand forces (if
any), and (3) forces in muscles and
ligaments that connect to the spine
If the erector spinae line of action is
parallel to the long axis of the vertebrae,
it does not contribute to disc shear force

As the lumbar spine becomes fully

flexed, the contribution of ligaments to
the supportive moment increases.While
this increases spinal stability, it also
increases disc shear forces.
Shear force convention
By convention, positive
shear (or anterior shear)
indicates a tendency for L4
to move forward on L5, as
when the trunk is flexed
forward (Figure A). A
Negative (or posterior)
shear indicates a tendency
for L4 to move backward on
L5, as when a person
pushes forward with their
hands (Figure B). B
Shear force affects injury risk
In the Ontario Back
Pain Study, injured
workers had workloads
that involved: 1.00

Higher peak hand 0.80

Probability
forces 0.60

0.40
Higher peak L4-L5 0.20
shear forces 0.00

Higher cumulative 0 500 1000

Peak Reaction Shear (N)
1500

moments (time
integrated) Norman et al, 1998

Higher peak trunk

velocities
 Chaffins Cantilever Low-back Model
of Lifting
Toppling moments due to comp
axis
HAT weight and hand force
are balanced by supporting
moments from erector spinae
and abdominal pressure
Includes abdominal
pressure, and allows that shear

long axis of L5/S1 may be axis

different than long axis of

torso.
Related reading: Chaffin
and Andersson, Occupational
Biomechanics, Chapter 6:
Section 6.5.1
 Governing equations: cantilever
model Step 3.
Let
Step 1.
v FA = PA * A
" M L 5 / S1 = 0 gives : where A is the diaghram area,
b * (mg) HAT + h(mg) load # D( FA ) # E ( Fm ) = 0.
assumed equal to 465 cm2 .
Let
v Note :1 mm Hg = 0.0133 N/cm2 = 133 Pa
( L 5 / S1 ) external = b * (mg) HAT + h(mg) load
M
and
v
( M L 5 / S1 ) internal = #D( FA ) # E (Fm ). !
Use E = 0.05 m and D = 0.11 m.

Step 2.
Define abdominal pressure PA (in mm Hg) as
v
depending on hip flexion and ( M L 5 / S1 ) external :
#4 v 1.8
PA = 10 [ 43 # 0.36 * (180 # $ H )](( M L 5 / S1 ) external )
where $ H is the included hip angle (knee -
hip - shoulder).
Abdominal pressure

Abdominal pressure (PA) is developed through

contraction of the diaphragm and abdominal
wall muscles.
Abdominal pressure is higher in fast than slow
lifts.
The internal force (FA) created by the
abdominal pressure is estimated using the
following two assumptions (Morris et. al., 1961)
average diaphragm area (A) of 465 cm2
a line of action parallel to the compressive
forces on the lumbar spine
Disc axes for compression and shear
to calculate disc
compression and shear
force, the plane of L5/S1
must be determined.
spinal curvature will
cause each intervertebral
joint to have unique
coordinate axes
the longitudinal axis of
L5/S1 will differ from the
angle T of the torso
Sacral joint rotation
Angle (!) between the plane of
L5/S1 and the horizontal is
assumed to depend on posture as
follows:
! = 40o + "
Where " depends on the included
knee angle K and the torso angle
T as follows:
" = -17.5 - 0.12T + 0.23K +
0.0012TK + 0.005T2 - 0.00075K2
Alternatively, ! can be estimated
from spinal curvature
For erect posture, ! ! 0 and ! !
40o
Sacral joint rotation (") scales with
torso and knee angle

When the torso flexes beyond 20-30 deg, pelvis rotates

forward (cw) at a rate of 2 deg for each 3 deg of forward torso
flexion (T)
When the knee flexes beyond 45 deg, pelvis rotates backward
(ccw) at a rate of 1 deg for each 3 deg of knee flexion (K)
 Calculation of compression and
shear force

" F comp = 0 :
cos# ( mg) HAT + cos# ( mg) load
$FA + FM $ FC = 0 (Eqn 6.51)

" F shear = 0 :
sin # ( mg) HAT + sin # ( mg) load
$FS = 0 (Eqn 6.52)
Assumptions in the Cantilever Model
As discussed in Ch. 53 & 54, assumptions in this model
include:
1.2D analysis is valid
2.static (vs. dynamic) analysis is valid
3.ligament forces are negligible
4.single equivalent muscle for erector spinae
5.assumptions regarding muscle force direction and
moment arm
6.assumptions regarding abdominal pressure and surface
area
7.assumptions regarding orientation (rotation) of vertebral
joints