Whole-Body Vibration Related Disorders in Occupational

Whole-Body
Vibration Related
Disorders in
Occupational
Clinical Setting –
An International
Comparison..
Dr med. Eckardt Johanning,
M.D., MSc
Occupational and
Environmental Life Science
– Albany, New York
2
The medical “outcome” is the patient

The occupational medicine perspective:
 The

patient and the occupations with exposure
The injured worker: “doc I have back aches- and I can’t do
it”

Professional Drivers







Truck and bus drivers, earthmoving engineers
Mining vehicles
Railroad workers, subway operators
Construction
Agriculture, fishing industry,
Forestry
Service workers
Johanning - 5th International Conference on
Whole Body Vibration Injuries
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Whole Body Vibration:
the good and the bad on
medline
The good :









“Training & exercise”
Geriatric patients
Wound care
Fractures-bone growths
Osteoporosis
Menopause
reflex muscle activation
Back pain
COPD – lung disease
The bad:

Orthopedic and neurological
system:
 Lumbar spine and nervous
system



low back pain, sciatic pain,
degenerative changes
Neck & shoulder
Gastro-intestinal
system
Female reproductive
organs
 Prostate
 Peripheral veins
 Cochlea-vestibular
Johanning
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system

Whole Body Vibration Injuries
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Occupational medicine causation analysis
 Can
it, did it ?
 Medical-legal
Standard: “more likely than
not” (> 50%) FELA “in whole or in part”
exposure
Link ?
Injury /
illness
Johanning - 5th International Conference on
Whole Body Vibration Injuries
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Occupational - Medicine diagnosis –
“real life”
often by doctors with No/little occupational medicine training
 Patient
history, symptoms, prior medical care
 Physical examination
 Laboratory test
 Imaging studies: x-ray, CT, MRI, myelogram
etc.
 Neurological studies: EMG/NCS
 Differential diagnoses
 Other
medical conditions
Johanning - 5th International Conference on
Whole Body Vibration Injuries
 Both occupational and non -occupational factors
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CLINICAL EXAMINATION OF a WORKERS
WITH LOW BACK COMPLAINTS
Diagnoses depends on individual
characteristics:
 Age?
– Latency
 Co-morbidity (Osteoporosis, diabetes, arthritis)?
 Anthropometric data ?
 Smoking ?
 Susceptibility?
 Genetics/family history
 Psycho-social factors?
Johanning - 5th International Conference on
Whole Body Vibration Injuries
 Prior history of back injuries/problems?
Differential Diagnosis of Low Back Pain in General
medical Practice
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Mechanical






low back pain (97%)
Lumbar strain or sprain (≥ 70%)
Degenerative disk or facet process (10%)
Herniated disk (4%)
Osteoporotic compression fracture (4%)
Spinal stenosis (3%)
Spondylolisthesis (2%)
Non-mechanical


Neoplasia (0.7%)
Inflammatory arthritis (0.3%)
spinal conditions (1%)
Nonspinal/visceral





disease (2%)
Pelvic organs—prostatitis, pelvic inflammatory disease, endometriosis
Renal organs—nephrolithiasis, pyelonephritis
Aortic aneurysm
Gastrointestinal system—pancreatitis, cholecystitis, peptic ulcer
Shingles Unilateral
Johanning - 5th International Conference on
Whole Body Vibration Injuries
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Anatomy of the human spine
Johanning - 5th International Conference on
Whole Body Vibration Injuries
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Herniated disc and nerve root
compression
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Whole Body Vibration Injuries
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Disc herniation & Lumbar
stenosis
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Whole Body Vibration Injuries
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Lumbar herniated disc.
Videman, Battie et al “Twin
studies” argument:
Asymptomatic subjects:
n=31
Disc bulge
DJD
HNP
65%
45%
33%
“Defense “ Argument:
• Key: Hereditary (genetics)
vs. leisure time or
work
• Smoking
• BMI
• Muscle strength
• No! Whole-body vibration
Johanning - 5th International Conference on
Whole Body Vibration Injuries
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Vertebra
Facet joints
Lordotic curve
Intervertebral
foramen
Degenerative
Spinal changes
 Decreased disc
space height
 Osteophytes
 Misalignments
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Whole Body Vibration Injuries
Spondylolisthesis
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Anterior slippage () of the fifth lumbar
vertebra on the sacral base can be identified in lateral views
Johanning - 5th International Conference on
Whole Body Vibration Injuries
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Aging and degeneration
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Whole Body Vibration Injuries
Anatomical model
MR image
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Visco-elastic Disc and Degeneration
J Wendlová: Wien Med Wochenschr (2010) 160/17–18: 464–469
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Whole Body Vibration Injuries
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Endplate changes over time
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SJ Furgosen, T Steffen: Eur Spine J (2003) 12 (Suppl. 2) : S97–S103
Whole Body Vibration Injuries
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Vertebral Endplate &
Degeneration
J Wendlová:
Med Wochenschr
(2010) 160/17–18:
464–
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on
469
Whole Body Vibration Injuries
SJ Furgosen, T Steffen: Eur Spine J (2003) 12 (Suppl. 2) : S97–S103
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Fusion Surgery
in locomotive engineer 59y
Johanning - 5th International Conference on
Whole Body Vibration Injuries
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“Much Ado About Nothing” ? by Shakespeare
Commercial
Industry and Public
Service claimed
/recognized
occupational
disease
(BK 2110)
for 2006-2011
and
Comparison with
Netherland
Source:
DGUV
Coronel Institute , Amsterdam
All claims & recognized WBV-BK
2110
1200
1000
800
Claims
600
WBV BRD
400
200
0
25
20
1995 2000 2005 2006 2007 2008 2009 2010 2011
recognized claims:
15
WBV BRD
10
WBV Dutch
5
0
Johanning - 5th International Conference on
Whole Body Vibration Injuries
1995 2000 2005 2006 2007 2008 2009 2010 2011 2012
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Spinal disorders ICD 10(BK 2110 )
2006-11
4% 1% 1% 1%
M42
Osteochondrose
M47 Spondylose,
M50 Zervikale
Bandscheibenschäd
en
93%
M51 Sonstige
Bandscheibenschäd
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Source: DGUV
Whole Body Vibration Injuries
M42 Osteo-chondrose
M47 Spondylosis,
M50 Cervical disc disorder
M51 Lumbar disc disorder
M54 Lumbar Pain
Total = n
year
7
11
13
1089
51
1171
200611
0
0
0
48
0
48
200611
0
7
1
25
26
64
200612
0
0
72
59
5
73
Surgery
Rail n=103
Dutch
recognized
BRDrecognized
ICD - 10 Diagnoses
Claims BRD
=n
WBV Exposure related
Diagnoses
Raillocomotive
n=103
22
10
36
200613
Johanning - 5th International Conference on
Whole Body Vibration Injuries
Sources: DGUV, Coronel Institute (Amsterdam), Johanning MD PC
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Railroad Train worker diseases grouped by age
and number of major diagnoses
(MSD, CDV, Metabolic, GI, Psychiatric, other)
100%
12
90%
80%
31
15
70%
60%
50%
31
35
40%
30%
20%
20
38
10%
0%
18
30y to 49y
50y to 64y
US Railroad Train Operator
5
Diagnoses
4
Diagnoses
3
Diagnoses
2
Diagnoses
1
Diagnosis
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Whole Body Vibration Injuries
German population (Fuchs et. al.
Bundesgesundheitsblatt 4/ 2012)
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“Shock & Jolts”
ISO 2631-1 – Vibration measurement standard

Crest Factor


+


(ISO 2631-1: >9 ACGIH-TLV (2012): >6)
VDV
> 1.5
> 1.75
MTVV
aw
VDV
aw ⋅ T 1/ 4
Additional methods suggested for risk
assessment
Johanning - 5th International Conference on
Whole Body Vibration Injuries
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ISO 2631-5
Background:
 Military
research and application:
 Blood in Urine of Tactical Ground Vehicle
Operators

“hematuria observed in 50% of the company” (Alem
2005)
 Health
Hazard assessment (HHA) –US
Army-Aeromedical Research Laboratory
(USAARL), Fort Rucker, Al. conducts
experimental research:
54 healthy, 19-40 y US Army Soldier Volunteers
 Up to 7 h/d or 4 h/d for 5 d TGV ride signature
exposure
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 some tolerated VDV(8)Johanning
of 66 over
a 7 h period

Whole Body Vibration Injuries
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Spine compression fracture risk according with
calculation of R –values according to ISO 2631-5 (2004)
from locomotives and other vehicle data *
2.5
2
1.5
1
0.5
0
R - ISO 2631-5
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Whole Body Vibration Injuries
* In cooperation with Herrn J. Hofmann (Woelfel AG)
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3
“Instationaritaets factor” (IF) according to DIN
SPEC 45697:2012-06
– if present calculate according to DIN SPEC
2.5
2
1.5
IF ax
1
IF ay
IF az
0.5
UP 6886
(1h 37min)
UP 6886
(1h 34min)
UP 6886
(3h 18min)
CSX F350
off-road
(12min)
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Whole Body Vibration Injuries
CSX F350
road (11
min)
BNSF 7355
(2h 30min)
BNSF 7355
(1h 42min)
BNSF 1942
(2h 20min)
Audi A3
(11 min)
0
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Spine compression fracture risk according the to
alternative DIN SPEC 45697:2012-06 method*
(by spinal level T12 to L4/S1)
1.6
Audi A3 (11 min)
1.4
1.2
BNSF 1942 (2h
20min)
1
BNSF 7355 (1h
42min)
0.8
0.6
BNSF 7355 (2h
30min)
0.4
0.2
0
R T12-L1
L1-L2
L2-L3
L3-L4
L4-L5
L5-S1
CSX F350 road (11
min)
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* In cooperation with Herrn J. Hofmann (Woelfel AG) Whole Body Vibration Injuries
CUELA posture & VIBRATION measurement &
analysis
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Johanning - 5th International Conference on
Whole Body Vibration Injuries
WBV-CUELA posture analysis detail:
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RED: Head forward angle YELLOW:Johanning
Back forward
angle BLUE:30vibration/shock
Conference on Whole Body
signal
Vibration Injuries
Yard switching extreme postures
% of time
Comments
Cervical rotation
right
9.4
Looking into mirror
Cervical flexion
10.4
Control panel /
communication radio
Lumbar rotation
right
3.5
Looking out of window
Lumbar forward
flexion
47.1
Control levers operation
Vibration: 0.5 to 1
m/sec2
15.9
1 to 1.5 m/sec2
3
> 1.5 m/sec2
17.2
Johanning - 5th International
Conference on Whole Body
Vibration Injuries
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Outlook
 Is
it the bone
 Is it the muscle
 Is it the soft-tissue (collagen fibers?)
 Is it the posture
 Is it the genetics/ hereditary
 Is it the compensation system
 What
ever - Go for it:
 Prevention opportunities
Johanning - 5th International Conference on
Whole Body Vibration Injuries
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