MUSCULAR WORK

Juhani Smolander, Veikko Louhevaara

Muscular Work in Occupational Activities In industrialized countries around 20% of workers are still e !lo"ed in #o$s re%uirin& uscular effort 'Rutenfranz et al( )**0+( ,-e nu $er of con.entional -ea." !-"sical #o$s -as decreased/ $ut/ on t-e ot-er -and/ an" #o$s -a.e $eco e ore static/ as" etrical and stationar"( In de.elo!in& countries/ uscular work of all for s is still .er" co on(

Muscular work in occu!ational acti.ities can $e rou&-l" di.ided into four &rou!s0 -ea." d"na ic uscle work/ anual aterials -andlin&/ static work and re!etiti.e work( 1ea." d"na ic work tasks are found in forestr"/ a&riculture and t-e construction industr"/ for e2a !le( Materials -andlin& is co on/ for e2a !le/ in nursin& / trans!ortation and ware-ousin&/ w-ile static loads e2ist in office work/ t-e electronics industr" and in re!air and aintenance tasks( Re!etiti.e work tasks can $e found in t-e food and wood3!rocessin& industries/ for e2a !le(

It is i !ortant to note t-at anual aterials -andlin& and re!etiti.e work are $asicall" eit-er d"na ic or static uscular work/ or a co $ination of t-ese two(

Physiology of Muscular Work

Dynamic muscular work In d"na ic work/ acti.e skeletal uscles contract and rela2 r-"t- icall"( ,-e $lood flow to t-e uscles is increased to atc- eta$olic needs( ,-e increased $lood flow is ac-ie.ed t-rou&- increased !u !in& of t-e -eart 'cardiac out!ut+/ decreased $lood flow to inacti.e areas/ suc- as kidne"s and li.er/ and increased nu $er of o!en $lood .essels in t-e workin& usculature( 1eart rate/ $lood !ressure/ and o2"&en e2traction in t-e uscles increase linearl" in relation to workin& intensit"( Also/ !ul onar" .entilation is -ei&-tened owin& to dee!er $reat-in& and increased $reat-in& fre%uenc"( ,-e !ur!ose

of acti.atin& t-e w-ole cardio3res!irator" s"ste is to en-ance o2"&en deli.er" to t-e acti.e uscles( ,-e le.el of o2"&en consu !tion easured durin& -ea." d"na ic uscle work indicates t-e intensit" of t-e work( ,-e a2i u o2"&en consu !tion indicates t-e !erson4s a2i u ca!acit" for aero$ic work( O2"&en consu !tion .alues can $e translated to ener&" e2!enditure ') litre of o2"&en consu !tion !er inute corres!onds to a!!ro2i atel" 5 kcal6 in or 2) k76 in+(

In t-e case of d"na ic work/ w-en t-e acti.e uscle ass is s aller 'as in t-e ar s+/ a2i u workin& ca!acit" and !eak o2"&en consu !tion are s aller t-an in d"na ic work wit- lar&e uscles( At t-e sa e e2ternal work out!ut/ d"na ic work wit- s all uscles elicits -i&-er cardio3res!irator" res!onses 'e(&(/ -eart rate/ $lood !ressure+ t-an work wit- lar&e uscles 'fi&ure 2*()0+(

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Figure 29.10.

Static versus dynamic work

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Static muscle work In static work/ uscle contraction does not !roduce .isi$le o.e ent/ as/ for e2a !le/ in a li $( Static work increases t-e !ressure inside t-e uscle/ w-ic- to&et-er wit- t-e ec-anical co !ression occludes $lood circulation !artiall" or totall"( ,-e deli.er" of nutrients and o2"&en to t-e uscle and t-e re o.al of eta$olic end3!roducts fro t-e uscle are -a !ered( ,-us/ in static work/ uscles $eco e fati&ued ore easil" t-an in d"na ic work(

,-e ost !ro inent circulator" feature of static work is a rise in $lood !ressure( 1eart rate and cardiac out!ut do not c-an&e uc-( A$o.e a certain intensit" of effort/ $lood !ressure increases in direct relation to t-e intensit" and t-e duration of t-e effort( 9urt-er ore/ at t-e sa e relati.e intensit" of effort/ static work wit- lar&e uscle &rou!s !roduces a &reater $lood !ressure res!onse t-an does work wit- s aller uscles( 'See fi&ure 2*()0(+

In !rinci!le/ t-e re&ulation of .entilation and circulation in static work is si ilar to t-at in d"na ic work/ $ut t-e eta$olic si&nals fro t-e uscles are stron&er/ and induce a different res!onse !attern(

Consequences of Muscular Overload in Occupational Activities ,-e de&ree of !-"sical strain a worker e2!eriences in uscular work de!ends on t-e size of t-e workin& uscle ass/ t-e t"!e of uscular contractions 'static/ d"na ic+/ t-e intensit" of contractions/ and indi.idual c-aracteristics(

W-en uscular workload does not e2ceed t-e worker4s !-"sical ca!acities/ t-e $od" will ada!t to t-e load and reco.er" is %uick w-en t-e work is sto!!ed( If t-e uscular load is too -i&-/ fati&ue will ensue/ workin& ca!acit" is reduced/ and reco.er" slows down( :eak loads or !rolon&ed o.erload a" result in or&an da a&e 'in t-e for of occu!ational or work3related diseases+( On t-e ot-er -and/ uscular work of certain intensit"/ fre%uenc"/ and duration a" also result in trainin& effects/ as/ on t-e ot-er -and/ e2cessi.el" low uscular de ands a" cause detrainin& effects( ,-ese relations-i!s are re!resented $" t-e so3called e !anded stress"strain conce!t de.elo!ed $" Ro- ert ')*;<+ 'fi&ure 2*())+(

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Figure 29.11.

#he e !anded stress"strain model modi$ied $rom %ohmert &19'()

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In &eneral/ t-ere is little e!ide iolo&ical e.idence t-at uscular o.erload is a risk factor for diseases( 1owe.er/ !oor -ealt-/ disa$ilit" and su$#ecti.e o.erload at work con.er&e in !-"sicall" de andin& #o$s/ es!eciall" wit- older workers( 9urt-er ore/ an" risk factors for work3related usculoskeletal diseases are connected to different as!ects of uscular workload/ suc- as t-e e2ertion of stren&t-/ !oor workin& !ostures/ liftin& and sudden !eak loads(

One of t-e ai s of er&ono ics -as $een to deter ine acce!ta$le li its for uscular workloads w-ic- could $e a!!lied for t-e !re.ention of fati&ue and disorders( W-ereas t-e !re.ention of c-ronic effects is t-e focus of e!ide iolo&"/ work !-"siolo&" deals ostl" wit- s-ort3ter effects/ t-at is/ fati&ue in work tasks or durin& a work da"(

Acceptable Workload in Heavy Dynamic Muscular Work

,-e assess ent of acce!ta$le workload in d"na ic work tasks -as traditionall" $een $ased on easure ents of o2"&en consu !tion 'or/ corres!ondin&l"/ ener&" e2!enditure+( O2"&en consu !tion can $e easured wit- relati.e ease in t-e field wit!orta$le de.ices 'e(&(/ =ou&las $a&/ Ma2 :lanck res!iro eter/ O2"lo&/ Cos ed+/ or it can $e esti ated fro -eart rate recordin&s/ w-ic- can $e ade relia$l" at t-e work!lace/ for e2a !le/ wit- t-e S!ort,ester de.ice( ,-e use of -eart rate in t-e esti ation of o2"&en consu !tion re%uires t-at it $e indi.iduall" cali$rated a&ainst easured o2"&en consu !tion in a standard work ode in t-e la$orator"/ i(e(/ t-e in.esti&ator ust know t-e o2"&en consu !tion of t-e indi.idual su$#ect at a &i.en -eart rate( 1eart rate recordin&s s-ould $e treated wit- caution $ecause t-e" are also affected $" suc- factors as !-"sical fitness/ en.iron ental te !erature/ !s"c-olo&ical factors and size of acti.e uscle ass( ,-us/ -eart rate easure ents can lead to o.eresti ates of o2"&en consu !tion in t-e sa e wa" t-at o2"&en consu !tion .alues can &i.e rise to underesti ates of &lo$al !-"siolo&ical strain $" reflectin& onl" ener&" re%uire ents(

%elative aero*ic strain 'RAS+ is defined as t-e fraction 'e2!ressed as a !ercenta&e+ of a worker4s o2"&en consu !tion easured on t-e #o$ relati.e to -is or -er easured in t-e la$orator"( If onl" -eart rate easure ents are a.aila$le/ a close a!!ro2i ation to RAS can $e ade $" calculatin& a .alue for !ercenta&e -eart rate ran&e '% 1R ran&e+ wit- t-e so3called Kar.onen for ula as in fi&ure 2*()2(

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Figure 29.12.

+nalysis o$ acce!ta*le workloads

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is usuall" easured on a $ic"cle er&o eter or tread ill/ for w-ic- t-e ec-anical efficienc" is -i&- '20325%+( W-en t-e acti.e uscle ass is s aller or t-e static co !onent is -i&-er/ and ec-anical efficienc" will $e s aller t-an in t-e case of e2ercise wit- lar&e uscle &rou!s( 9or e2a !le/ it -as $een found t-at in t-e sortin& of !ostal !arcels t-e of workers was onl" >5% of t-e a2i u easured on a $ic"cle er&o eter/ and t-e ec-anical efficienc" of t-e task was less t-an )%( W-en &uidelines are $ased on o2"&en consu !tion/ t-e test ode in t-e a2i al test s-ould $e as close as !ossi$le to t-e real task( ,-is &oal/ -owe.er/ is difficult to ac-ie.e(

Accordin& to ?strand4s ')*>0+ classical stud"/ RAS s-ould not e2ceed 50% durin& an ei&-t3-our workin& da"( In -er e2!eri ents/ at a 50% workload/ $od" wei&-t decreased/ -eart rate did not reac- stead" state and su$#ecti.e disco fort increased durin& t-e da"( S-e reco ended a 50% RAS li it for $ot- en and wo en( Later on s-e found t-at construction workers s!ontaneousl" c-ose an a.era&e RAS le.el of <0% 'ran&e 253 55%+ durin& a workin& da"( Se.eral ore recent

studies -a.e indicated t-at t-e acce!ta$le RAS is lower t-an 50%( Most aut-ors reco @03@5% as an acce!ta$le RAS le.el for t-e entire workin& da"(

end

Ori&inall"/ t-e acce!ta$le RAS le.els were de.elo!ed for !ure d"na ic uscle work/ w-ic- rarel" occurs in real workin& life( It a" -a!!en t-at acce!ta$le RAS le.els are not e2ceeded/ for e2a !le/ in a liftin& task/ $ut t-e local load on t-e $ack a" &reatl" e2ceed acce!ta$le le.els( =es!ite its li itations/ RAS deter ination -as $een widel" used in t-e assess ent of !-"sical strain in different #o$s(

In addition to t-e easure ent or esti ation of o2"&en consu !tion/ ot-er useful !-"siolo&ical field et-ods are also a.aila$le for t-e %uantification of !-"sical stress or strain in -ea." d"na ic work( O$ser.ational tec-ni%ues can $e used in t-e esti ation of ener&" e2!enditure 'e(&(/ wit- t-e aid of t-e ,dholm scale+ 'Ad-ol )*>>+( %ating o$ !erceived e ertion 'R:A+ indicates t-e su$#ecti.e accu ulation of fati&ue( Bew a $ulator" $lood !ressure onitorin& s"ste s allow ore detailed anal"ses of circulator" res!onses(

Acceptable Workload in Manual Materials Handling Manual aterials -andlin& includes suc- work tasks as liftin&/ carr"in&/ !us-in& and !ullin& of .arious e2ternal loads( Most of t-e researc- in t-is area -as focused on low $ack !ro$le s in liftin& tasks/ es!eciall" fro t-e $io ec-anical !oint of .iew(

A RAS le.el of 203@5% -as $een reco ended for liftin& tasks/ w-en t-e task is co !ared to an indi.idual a2i u o2"&en consu !tion o$tained fro a $ic"cle er&o eter test(

Reco endations for a a2i u !er issi$le -eart rate are eit-er a$solute or related to t-e restin& -eart rate( ,-e a$solute .alues for en and wo en are *03))2 $eats !er inute in continuous anual aterials -andlin&( ,-ese .alues are a$out t-e sa e as t-e reco ended .alues for t-e increase in -eart rate a$o.e restin& le.els/ t-at is/ @0 to @5 $eats !er inute( ,-ese reco endations are also .alid for -ea." d"na ic uscle work for "oun& and -ealt-" en and wo en( 1owe.er/ as entioned !re.iousl"/ -eart rate data s-ould $e treated wit- caution/ $ecause it is also affected $" ot-er factors t-an uscle work(

,-e &uidelines for acce!ta$le workload for anual aterials -andlin& $ased on $io ec-anical anal"ses co !rise se.eral factors/ suc- as wei&-t of t-e load/ -andlin& fre%uenc"/ liftin& -ei&-t/ distance of t-e load fro t-e $od" and !-"sical c-aracteristics of t-e !erson(

In one lar&e3scale field stud" 'Lou-e.aara/ 1akola and Ollila )**0+ it was found t-at -ealt-" ale workers could -andle !ostal !arcels wei&-in& < to 5 kilo&ra s durin& a s-ift wit-out an" si&ns of o$#ecti.e or su$#ecti.e fati&ue( Most of t-e -andlin& occurred $elow s-oulder le.el/ t-e a.era&e -andlin& fre%uenc" was less t-an ; !arcels !er inute and t-e total nu $er of !arcels was less t-an )/500 !er s-ift( ,-e ean -eart rate of t-e workers was )0) $eats !er inute and t-eir ean o2"&en consu !tion )(0 l6 in/ w-iccorres!onded to @)% RAS as related to $ic"cle a2i u (

O$ser.ations of workin& !ostures and use of force carried out for e2a !le accordin& to OWAS et-od 'Kar-u/ Kansi and Kuorinka )*CC+/ ratin&s of !ercei.ed e2ertion and a $ulator" $lood !ressure recordin&s are also suita$le et-ods for stress and strain assess ents in anual aterials -andlin&( Alectro "o&ra!-" can $e used to assess local strain res!onses/ for e2a !le in ar and $ack uscles(

Acceptable Workload for tatic Muscular Work Static uscular work is re%uired c-iefl" in aintainin& workin& !ostures( ,-e endurance ti e of static contraction is e2!onentiall" de!endent on t-e relati.e force of contraction( ,-is eans/ for e2a !le/ t-at w-en t-e static contraction re%uires 20% of t-e a2i u force/ t-e endurance ti e is 5 to C inutes/ and w-en t-e relati.e force is 50%/ t-e endurance ti e is a$out ) inute(

Older studies indicated t-at no fati&ue will $e de.elo!ed w-en t-e relati.e force is $elow )5% of t-e a2i u force( 1owe.er/ ore recent studies -a.e indicated t-at t-e acce!ta$le relati.e force is s!ecific to t-e uscle or uscle &rou!/ and is 2 to 5% of t-e a2i u static stren&t-( ,-ese force li its are/ -owe.er/ difficult to use in !ractical work situations $ecause t-e" re%uire electro "o&ra!-ic recordin&s(

9or t-e !ractitioner/ fewer field et-ods are a.aila$le for t-e %uantification of strain in static work( So e o$ser.ational et-ods 'e(&(/ t-e OWAS et-od+ e2ist to anal"se t-e !ro!ortion of !oor workin& !ostures/ t-at is/ !ostures de.iatin& fro nor al iddle !ositions of t-e ain #oints( Dlood !ressure easure ents and ratin&s of !ercei.ed e2ertion a" $e useful/ w-ereas -eart rate is not so a!!lica$le(

Acceptable Workload in !epetitive Work Re!etiti.e work wit- s all uscle &rou!s rese $les static uscle work fro t-e !oint of .iew of circulator" and eta$olic res!onses( ,"!icall"/ in re!etiti.e work uscles contract o.er @0 ti es !er inute( W-en t-e relati.e force of contraction e2ceeds )0% of t-e a2i u force/ endurance ti e and uscle force start to decrease( 1owe.er/ t-ere is wide indi.idual .ariation in endurance ti es( 9or e2a !le/ t-e endurance ti e .aries $etween two to fift" inutes w-en t-e uscle contracts *0 to ))0 ti es !er inute at a relati.e force le.el of )0 to 20% 'Lauri& )*C<+(

It is .er" difficult to set an" definiti.e criteria for re!etiti.e work/ $ecause e.en .er" li&-t le.els of work 'as wit- t-e use of a icroco !uter ouse+ a" cause increases in intra uscular !ressure/ w-ic- a" so eti es lead to swellin& of uscle fi$res/ !ain and reduction in uscle stren&t-(

Re!etiti.e and static uscle work will cause fati&ue and reduced work ca!acit" at .er" low relati.e force le.els( ,-erefore/ er&ono ic inter.entions s-ould ai to ini ize t-e nu $er of re!etiti.e o.e ents and static contractions as far as !ossi$le( Eer" few field et-ods are a.aila$le for strain assess ent in re!etiti.e work(

Prevention of Muscular Overload Relati.el" little e!ide iolo&ical e.idence e2ists to s-ow t-at uscular load is -ar ful to -ealt-( 1owe.er/ work !-"siolo&ical and er&ono ic studies indicate t-at uscular o.erload results in fati&ue 'i(e(/ decrease in work ca!acit"+ and a" reduce !roducti.it" and %ualit" of work(

,-e !re.ention of uscular o.erload a" $e directed to t-e work content/ t-e work en.iron ent and t-e worker( ,-e load can $e ad#usted $" tec-nical eans/ w-ic- focus on t-e work en.iron ent/ tools/ and6or t-e workin& et-ods( ,-e fastest wa" to re&ulate uscular workload is to increase t-e fle2i$ilit" of workin& ti e on an indi.idual $asis( ,-is eans desi&nin& work3rest re&i ens w-ic- take into account t-e workload and t-e needs and ca!acities of t-e indi.idual worker(

Static and re!etiti.e uscular work s-ould $e ke!t at a ini u ( Occasional -ea." d"na ic work !-ases a" $e useful for t-e aintenance of endurance t"!e !-"sical fitness( :ro$a$l"/ t-e ost useful for of !-"sical acti.it" t-at can $e incor!orated into a workin& da" is $risk walkin& or stair cli $in&(

:re.ention of uscular o.erload/ -owe.er/ is .er" difficult if a worker4s !-"sical fitness or workin& skills are !oor( A!!ro!riate trainin& will i !ro.e workin& skills and a" reduce uscular loads at work( Also/ re&ular !-"sical e2ercise durin& work or leisure ti e will increase t-e uscular and cardio3 res!irator" ca!acities of t-e worker(