Professional Documents
Culture Documents
Eckardt Johanning
Columbia University, Center for Family and Community Medicine, New York, NY, and
Workers with whole-body vibration (WBV) exposure likely report non-specific health
complaints. Health and safety providers may not recognize such occupational injuries and
studies show a clear trend: with increasing duration and intensity of occupational WBV
organ damage has also been reported. In some European Union countries, spinal injury
assessment and differential diagnostic evaluation. WBV health surveillance should assess
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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Practitioner Summary:
not recognize such injuries (mainly disorders of the spine), or may be unfamiliar with
exposure assessment and prevention. This review addresses health issues, exposure
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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1) Introduction
It is estimated that more than four million workers in the United States of
America (or 2.7% of the US workforce) are exposed to whole-body vibration (WBV)
every day at work. This include vehicle operators, workers in construction, agriculture,
railroad and fishing industry, forestry, service workers, mechanics and heavy machine
operators. Of these more than half a million are operating engineers in the United States
(U.S.) with exposure to WBV while operating bulldozers, motor graders, backhoes,
cranes and other construction vehicles. Among professional drivers, the rate of
musculoskeletal disorders (MSD) is recognized to be very high. In the U.S. the Bureau of
Labor Statistics (BLS) reported that the rate of MSD cases among industry workers was
33% of all reported injuries and illnesses for 2011. Drivers of road or off-road vehicles
compared to other occupations that sustained MSDs. Although, specific numbers for
WBV caused injuries are not collected in the U.S., the problem of WBV among operators
of construction equipment, mining, transportation and the railroad industry has been
described in the literature. In 2011, the highest proportion accounted for back injuries
with 36% of reported sprain, strain and tear cases followed by body parts such as
shoulder (12%), knee (12%), ankle (9%) and others. (Kittusamy and Buchholz 2004,
Waters et al. 2008) (Mayton 2008) (Tak and Calvert 2011) (Bureau of Labor Statistics
2012) . Although machine operators and professional drivers are likely exposed to
multiple occupational hazards including noise, awkward or static postures, heavy lifting,
etc., WBV exposure represents a constant factor that cumulatively may add up to
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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several Millions of road/track miles or several hundred-thousands of hours during a life-
time of work.
The study of the WBV, exposure and the association of adverse performance,
comfort and health effects and ways to reduce harmful levels of WBV goes back now
more than 60-70 years, but there appears to be a lack of recognition by health care
providers due to the technical complexity and seemingly non-specific adverse medical
outcomes. Some key medical findings and review papers have been published over the
years summarizing the past research history, clinical and epidemiological findings
(Coermann 1938, Coermann, Magid, and Lange 1962), (Von Gierke and Coermann
1961) (Christ and Dupuis 1966) (Seidel and Heide 1986, Heide and Seidel 1978) (von
Gierke 1984, Christ and Dupuis 1966, Dupuis and Zerlett 1987) (Rosegger 1970) (Griffin
1978, Lewis and Griffin 1978, Griffin 1990, Wasserman and Badger 1973, Hulshof and
van Zanten 1987) (Bovenzi and Hulshof 1999, Teschke et al. 1999, Seidel et al. 2008,
Bernard et al. 1997) (Pope et al. 2002). These published studies and reviews in the past
have addressed particular exposure assessments and clinical outcomes related to WBV,
but the majority are now more than a decade old and newer technology and medical tools
have become available to warrant an up-dated review. In particular, these studies often
lack clinical information important for the occupational health provider and a differential
diagnostic approach. The goal of this study is to provide an updated systematic review
scientific clinical studies, address diagnostic medical criteria and differential diagnostic
methods currently in use to establish specific adverse occupational health outcomes and
injuries, as well as examine a medical causation link. This paper will review the
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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recognized harmful effects of acute or long-term WBV exposure in occupational
medicine leading to injury and disability based on expert review. A further goal is to
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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2) Methods
For this systematic review online searches were performed with search terms
related to the topic of published and peer-reviewed studies, case-series reports, evidence
based diagnostic methods and causation analysis, occupational disease claims and
regulations published in English and German until the end of 2013. The following on-line
available literature search engines were utilized: The US National Library of Medicine
(http://www.thecochranelibrary.com/view/0/index.html), DIMDI
the software Endnote X7 was used to process citations. The search terms were: Year(s)
outcome, vibration exposure, occupational statistic(s) and numerical data, diagnostic and
practice guideline, risk assessment, back, spine, low back, lumbar, disc, vertebral,
control and occupational disease. The retrieved citations and articles were sorted and
evidence (considering Hills and Rothmans weight of evidence for causation (Monson
(musculoskeletal disorders and others), available relevant diagnostic and work history
information, causation definition and statistical information provided (i.e., was the
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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general and specific causation analysis based on well-established principles in
disease information and statistics were obtained from national registries or institutes in
(DGUV), St. Augustin, Germany), The Netherlands (Dr. PPFM (Paul) Kuijer and the
Center, Amsterdam), Belgian (Fund for Occupational Disease (O.D.F.)), France (Dr. P.
Donati and INRS) and Italy ( Prof. M. Bovenzi, M.D., (University of Trieste) and Italian
Workers Compensation Authority (INAIL). Limitation of this paper: This is not a meta-
or animal studies are not the focus of this paper. A review of the differences and
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3) Results
In the online citation services over a thousand medical study citations (i.e.,
PubMed citations for whole-body vibration n= > 1200) can be found that report on
naive reader and requires a critical approach. Studies in occupational health of whole-
body vibration exposures goes back more than 60-70 years and are often found in the
specialty journals. While early research concentrated for a variety of reasons primarily on
vertical vibration in military applications and vehicles, farming and heavy equipment
operators (Spear, Keller, and Milby 1976), newer research has studied tri-axial WBV in
the horizontal and vertical direction on a variety of different operator seats and with
different ergonomic designs in automobiles, bus, taxi, trucks, forklifts, light-rail cars,
vehicles), utility vehicles, ATVs, speed boats, helicopters, etc.. Since much of the earlier
research has concentrated on operators of vehicles with mainly vertical (denoted as the z-
axis) vibration much of the evidence relates to vertical spinal impact on the seated
devices also multi-axis (horizontal= for-after (x-axis) and lateral (y-axis)) vibration and
shocks measurements have gained importance in the exposure and health assessment.
Organization (ISO) guideline ISO 2631-1 Mechanical vibration and shock - Evaluation
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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the USA, the American National Standards Organization (ANSI) has adopted key
portions of ISO 2631 as a consensus standard under S3.18. The ANSI S3.18/ISO 2631
standard is strictly voluntary and should not be considered a health standard such as those
issued by the Occupational Safety and Health Agency (OSHA) regulations. The
as industry guidelines for the control of WBV at the workplace, which are also voluntary
In the European Union (EU) legal requirements obligate the employer and others
to investigate and protect workers from harmful and preventable vibration (Directive
2002/44/EC) and certain action limits and exposure limits are recommended to EU
member countries for implementation (Christ 1996). Countries within the EU have
adopted different national exposure limits, worker protection measures and legal
requirements (Griffin 2004, Hulshof et al. 2002). In some European countries injuries and
compensable occupational disease (i.e., Germany, Belgium, The Netherlands, Italy and
education about prevention efforts are in place. The particular criteria for work-place
injuries and occupational disease compensation differ in these countries. The clinical
aspects and the differential diagnostic process will be reviewed in detail below. Several
scientific reviews of the available data and studies have concluded that there is strong and
primarily of the lower spine (the lumbar segment) ( (Bovenzi and Hulshof 1999),
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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(Bernard et al. 1997), (Teschke et al. 1999) (Panel on Musculoskeletal Disorders and the
Workplace 2001) (Notbohm, Schwarze, and Albers 2009). WBV can lead to work-related
disability. In a prospective disability retirement study of Danish workers (n= 4215), self-
reported exposure to WBV was identified as a predictive risk factor for disability pension
retirement after adjustment for various other factors (Tuchsen et al. 2010). In a 3-year
follow-up study of psycho-social and mechanical risk factors in the general working
population of Norway (n=12 550, age 18-66y), WBV was identified as an important risk
factor for work-related disability with an odds ratio of 4.15 (95% CI 1.77 9.71) and
twice higher than other commonly recognized risk factors. Increasing WBV exposure
duration during the work day increased the statistical risk for disability (Sterud 2013).
There are no similar studies for the US or Canada, where WBV related injuries or
musculoskeletal system (especially the lower and cervical spine). Typical health
complaints and concerns reported by patients with WBV exposure are listed in table 1.
Many of the reported symptoms are non-specific and health care providers and safety
professionals may not recognize such WBV related health complaints and occupational
of workers with WBV individual characteristics are important for the physician, such as
age, anthropometric data (body-mass index), smoking habits, other medical conditions
osteoporosis and fibromyalgia) and history of prior injury, psycho-social factors, and
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most importantly prior history of back disorders or complaints. In the general medical
practice the prevalence of a prolapsed intervertebral disk among persons with low back
pain in primary care is low and estimated to be 1 to 3 percent. About 4 percent of patients
with low back pain in primary care settings have a compression fracture, and about 1
the longer and more intensive the exposure is, but definitive threshold limits or a linear
dose-response relationship have not been established for various reasons. It is recognized
that certain ergonomic working conditions are important co-factors in a vibration and
shock exposure risk assessment (Burdorf and Sorock 1997) (Pope, Wilder, and
Magnusson 1999, Pope, Goh, and Magnusson 2002) (Kittusamy and Buchholz 2004).
Furthermore awkward body posture and WBV are likely to have modifying or synergistic
muscular-skeletal stress (Seidel and Heide 1986) (Toren 2001, Skrzypiec et al. 2013,
Huber et al. 2010, Brinckmann, Biggemann, and Hilweg 1989). Nevertheless, there is a
and awkward posture among operators of mobile equipment. Pilot studies have shown
that some vehicle operations may lead to the combined stressors of WBV and awkward
postures (see Figure 1) (Johanning 2011, Schfer and Ellegast 2006, Johanning, Fischer,
and Ellegast 2006, Tiemessen, Hulshof, and Frings-Dresen 2007). Different seating
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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posture and backrest inclination tend to influence the experienced vibration discomfort
the floor-to-seat vibration transfer measurements (SEAT) in the field may indicate that
the seat can magnify the vibration exposure due to defects and insufficient dampening
technology. Other factors that may influence the exposure effects of WBV are climate
conditions, cold temperature, exposure of body parts to draft, noise, air pollutants,
solvents, etc.
vibrations:
whole-body vibration and mechanical shock were significantly associated with the
prevalence of low back pain (LBP) and neck pain in operators of quad bikes
(Milosavljevic et al. 2012). Spinal response to repeated shocks and loading are complex
and should be distinguished from a simplistic prediction of forces in the risk analysis
(Seidel and Griffin 2001). The ISO 2631-1standard for measuring mechanical vibration
and shock evaluation of human exposure to whole-body vibration recognizes that for
(ISO) 1997). A method has been proposed in ISO 2631-5:2004 to quantify vibration
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containing multiple shocks in relation to lumbar vertebral endplates. The underlying
concept and algorithm was originally based on military applications and research ((ISO)
2004) (Cameron et al. 1996) (Alem 2005). However, its validity and lack of supportive
epidemiological data have been questioned for occupational health and safety risk
assessments (Seidel et al. 2006) (Waters et al. 2007) (Hinz et al. 2008) (Seidel et al.
2008) (Seidel et al. 1999). An alternative method (VibRisk model) that estimates
structural failure risk of the lumbar spine from vibration containing repeated shocks and
jolts has been proposed. It incorporates different typical driving body postures and
example, comparing field data using the ISO 2631-5 algorithm and with the VibRisk
model, apparent dissimilarities for spinal injury (endplate failure) predictions were found.
While the ISO 2631-5 risk calculation model suggested for all disk level (T12 to S1), the
same level of failure prediction for the vertebrae endplates, the VibRisk model
showed different risk prediction depending on the different typical driver postures (i.e.,
vehicle group comparison) and the lumbar disk level (L1 to S1), which would be more
consistent with the clinical experience of more frequent defects at lower spine levels.
(Johanning 2011). Further studies are needed to validate the different approaches in an
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complete occupational and medical history, a focused occupational exposure risk
called red flag conditions for underlying serious conditions (i.e., fracture of the
(Williams et al. 2013),(van der Windt et al. 2010), although some specific testing
procedures may have only limited value in predicting specific imaging findings such as
Hendrick 2013). The examiner should recognize key important clinical health outcomes
presenting as pain and sensory or motor abnormalities of the lower extremities that are
related to disc protrusion, disc prolapse, and progressive degenerative changes of the
spine (i.e., endplates of the vertebral body and facet joints) characterized by chondrosis,
evaluation, including a forward flexion, hyper-extension test, and slump test and
Laboratory test blood or urine (i.e., Urinalysis, ESR, ANA, Rheumatoid Factors,
Complement)
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Differential diagnoses considerations
Besides ruling out non-specific or episodic low back pain, one needs to be aware of so-
called red flag conditions that require further evaluations and are part of the differential
abnormalities during the examination. MRI is usually the preferred method for imaging
findings; plain film x-rays are suitable for evaluation of spinal malformation, scoliosis,
osteoporosis, recent acute trauma, or in some cases of non-specific back pain. Some MRI
studies of asymptomatic patients have shown that degenerative findings may be present
without particular identified risk factors and for other reasons. As always, clinical
correlation of imaging studies with the patient history, occupational risk factors,
physiological tests and objective neurological findings are important in the proper
diagnosis.
North-America
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In the USA and Canada, injuries or occupational diseases caused by WBV are not
uniquely recognized. No special OSHA vibration standard has been promulgated under
the United States Occupational Safety and Health Act (OSHA). Vibration like many
other work place hazards is considered to fall under the General Duty Clause of OSHA
mandating that the employer shall provide a workplace free from recognized hazards that
are causing or are likely to cause death or serious physical harm to his employees (29
U.S.C. 654, 5(a)1).l.. In the U.S., the workers compensation system run by the States
injuries if the injury or condition is either caused or aggravated by a job over a period of
recognized under the compensation system by a more likely than not (or more than
50% likelihood) statement by the physician. Railroad workers in the U.S. are covered
under the Federal Employee Liability Act (FELA). This law provides compensation to
injured workers for work-related injuries. The injured worker has to show that the
railroad was negligent in some way in not providing a safe place to work, or that it
violated a safety regulation or rule. The worker has to also show that this negligence
played some part in causing the injury to the worker. These questions will be decided by
European Union
In the European Union several member countries have made great strides to
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road and off-road vehicles. It is recognized that WBV exposure often occurs in
combination with other ergonomic stressors such as heavy lifting, prolonged seating,
awkward postures and other work place hazards. As such the Commission of the
European Communities included in the 2003 list of likely occupational diseases: disc-
related diseases of the lumbar vertebral column caused by the repeated vertical effects of
that the EU member countries have quite different rules and regulations regarding WBV
caused injuries and compensation requirements (Hulshof et al. 2002) (Griffin 2004).
Injured workers in these countries may or may not qualify for disability or financial
compensation depending on where they work, what vehicles they operated and what type
of injuries they report. Nevertheless, there is great emphasis on prevention and hazard
June 2002 on the minimum health and safety requirements regarding the exposure of
workers to the risks arising from physical agents (vibration) (2002/44/EC 2006) .
Germany:
classifications regarding spinal injuries and degenerative effects became law in 1993,
although in the East and West Germany occupational injuries caused by WBV were
recognized well before that. In Germany, compensable spinal injury caused by WBV is
now regulated under the occupational disease regulation No. 2110 (BeK 2110) and
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required. Diseases of the cervical or lumbar spine with disk involvement caused by
excessive and accelerated wear and tear are required for the consideration of a claim. The
clinical findings have to include: disc protrusion, disc prolapse, progressed degenerative
changes of the spine (i.e., endplates of the vertebral body and facet joints) characterized
to qualify for an occupational disease claim, the condition has to result in a total inability
to perform any employment and furthermore an exposure duration of typically more than
10 years on the job has to be documented. Three specific clinical conditions are
diagnosis:
chronic discomfort in the lumbar region due to irritation of the posterior ligament,
often in combination with a lumbar syndrome; caused by nerve root irritation due to
degenerative morphological changes of the spine primarily at level L3 to S1, and less
common at level L1 and L2. Typical are sensory or motor deficits, reflex abnormalities
involving the lumbar plexus with functional abnormities of internal organs (bladder,
colon, erectile dysfunction) and characteristic saddle distribution in the lower pelvis area
and legs. It is caused by a massive median disk prolapse at the L3/L4 or L4/L5 level and
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The diagnosis and assessment focuses on the patients degree of pain, motor-and sensory
deficits, range-of-motion and functional impairment, loss of strength and control of the
lower extremity, and also the psychological status. In addition, radiological imaging are
mechanical changes of the spine caused by inflammatory and genetic conditions, tumors,
of internal organs). The examiner in Germany is advised to also consider typical postural
stress (awkward posture of driver), individual factors (age at exposure onset, gender and
constitutional stamina) and spine resilience (Merkblatt 2005, Seidel 2005). A typical
WBV occupational daily exposure of 0.63 m/s2 (aw(8)), primarily in the vertical z-axis
direction, are required and typically more than 10 years of job seniority. In some cases
lower exposure levels should be considered as health risks according to the 2110 BeK
regulation instructions. The examiner should also consider other factors such as vehicle
type and loading, road and off-road driving conditions, speed and driver experience,
frequency of shocks and jolts, age above 40 years at start of WBV exposure, periods of
short but high exposure to WBV and shocks, strong horizontal vibration and long
The numbers of WBV occupational disease claims and recognized cases under
BeK 2110 in Germany reported by the DGUV (German Social Accident Insurance)
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have continuously dropped. The initial high number of claims with 1000 has now fallen
to about two hundred annually for the time period from 1995 to 2012. A very low number
occupational disease so that the injured workers receive a special disability pension (See
Figure 3).
The Netherlands:
disease, but principally for preventive purposes without any special financial
compensation (Hulshof et al. 2002). Compensation for work-related injuries falls under
general social disability claims. Reporting of such conditions by Dutch physicians was
caused by a load exposure, or burden which predominantly took place in the work or
criteria appear to be less stringent than for example in Germany. Painful conditions
resulting in significant disability are required, but findings of imaging abnormalities (i.e.,
degenerative spinal changes) are not necessary. In the Netherlands vibration in all three
directions (horizontal x- and y-axis, and the vertical z-axis) or the vector sum are taken
into account for the exposure assessment (Hulshof et al. 2002). In any case, comparing
the trends in Germany to the Dutch system it shows that that the absolute number of cases
was similar to Germany, although it appears that proportionately more cases are listed in
the Netherlands (See Figure 4). Comparing the specific medical diagnoses of reported
and recognized WBV injuries and occupational diseases following the ICD-10 Coding
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classification system, we note that most of these claims were related to lumbar disk
disorders (with myelopathy or radiculopathy) coded as M51.- under the ICD-10 coding
France:
including farm tractors. The clinical examination criteria focuses on radicular symptoms
(sciatic pain) due to disc herniation at L4 -L5 or L5-S1, or radicular pain following
consistent with lumbar herniated disc and the documentation of vehicles that have been
listed and recognized to have high vibration levels are required (INRS 1999). Between
400 to almost 500 cases are reported yearly in the general industry and about 280 in the
Belgium
In Belgium, the Fund for Occupational Disease (O.D.F.) handles all occupational
disease claims from the general industry including back disorders due to WBV exposure.
In 1974 Belgium was one of the first countries to recognize the osteo-articular diseases
caused by mechanical vibration"(code 160501). This was revised and updated in 2002
with the premature osteoarthritis caused by mechanical vibration transmitted to the body
through the seat definition (code 160512) (Hutsebaut 2013). Accordingly, all claims for
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a WBV disability and financial compensation must fulfill three steps, an administrative
Current interpretation of the scientific evidence by the O.D.F. (Royal Decree of 2004:
code 160503 regarding mechanical vibration or heavy lifting) favors a physical exam
finding and the diagnoses of radicular symptoms combined with herniated discopathy or
radiological imaging (X-ray, CT or MRI) are now recognized. Five years of WBV
exposure duration are required as the minimum with an average weighted vibration level
of 0.8 m/s2. The number of reported claims reached a high in 2007 with n=3020 and since
then a continuous reduction with n=838 in 2012 for the code 160503 diagnoses. Of
these claims only 14% meet all the criteria and are accepted for compensation by
O.D.F., with almost 2/3 showing premature spondylosis and one third disc lesions
Italy
an entity or separately listed, but are part of a surveillance system for occupational
musculoskeletal disorder. The criteria for vibration-induced lower back disorders are
defined by the Italian Society of Occupational Medicine and Industrial Hygiene (Bovenzi
2007). It is recognized that there is not a specific vibration induced injury and many
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clinical features may also be found in other conditions, requiring a differential diagnostic
physical examination and various clinical and laboratory tests. Since 2006 employers
have to implement the EU directive as per Italian legislative degree 81/08, perform WBV
(Nataletti et al. 2008). In 2008, WBV-caused injuries became legally recognized in Italy
(Legislative Decree 81/2008) (81/2008) 2008), but no specific reporting data is available
as of today. An Italian data base for vibration measurements has been established for
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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3) Discussion
recognizing injuries and diseases that are essentially preventable. This requires detailed
medical knowledge, sufficient education and training and vigilance of the health care
provider and in the case of WBV, often cooperation with technical experts and a
place, however, but only in few countries with a long history of WBV-related research
specifically recognized in the national labor laws. In some of these countries it is defined
spinal injuries with painful neurological complications (i.e., disc herniation and nerve
root disorders), primarily of the lumbar spine. Over the years the number of claims and
compensated conditions look as if they have dropped in many European countries with
the legal definitions, institutional and financial compensation practices. An earlier review
of the national recognition practices had shown similar differences and the establishment
of an uniform internationally accepted criteria was suggested (Hulshof et al. 2002). More
than a decade later it appears that this is still not the case. It may also be explained by
several decades of exposure protection and prevention efforts in these countries, i.e.,
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ergonomic suspension seats (Viikari-Juntura 1997, Christ and Dupuis 1966, Burdorf and
Swuste 1993) (Pope et al. 2002, EU The Directorate-General for Employment 2008,
Hulshof et al. 2002). The considerably higher number of recognized and accepted
diagnosis and causation analysis includes a critical review of the work history, exposure
data assessment and a clinical differential diagnostic evaluation. The medical diagnosis,
treatment and prevention of occupational low back disorders has been reviewed in
(Johanning 2000) (van Tulder et al. 2006). Several well-designed studies have
consistently shown, that WBV is strongly associated with acute or chronic low back pain,
peripheral neuropathy and progressive degenerative changes of the spine and inter-
vertebral disc disorders. This became the basis for the legal definitions of WBV-related
occupational disease in some European countries. WBV exposure may also lead to
other diagnoses and conditions) and supportive work exposure history and if available
definite dose-response relationship or specific threshold limits have not been firmly
established and different health standard levels for action or health limits exist in
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E. Johanning Medical Diagnosis of Whole-body Vibration Disorders-A systematic
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different countries. Nevertheless, it is recommended to maintain exposure levels in the
workplace as low as technically and feasibly possible (Griffin 2004). ISO 2631 part 5
(2004) with its restriction to vertebral endplate fractures and particular seating
requirements appears in its current version not to relate to common diagnoses among
relying on solely numerical risk calculations as suggested by the can realistically and
spectrum of biological variability and different working conditions. Further research and
studies of precise seating posture and WBV are needed to better understand the complex
interactions of spinal movements, posture and vibration or shock and jolts (Halpern 1992)
(Lyons 2002). Limitations of this review and study are the risk of observer and reporting
bias (health care provider, focus on practical approaches), incomplete retrieval of studies
(i.e., reports not listed in the citation search libraries and unknown to the author) and
limiting the review to German and English publications for the most part. Furthermore,
or risk ratios were calculated. Nevertheless, administrative and technical approaches have
been suggested to monitor workers with WBV for early signs of adverse health reactions
and introduce prevention steps to control hazardous exposures (Johanning, Hulshof, and
Christ 1997, Hulshof et al. 2006, Tiemessen, Hulshof, and Frings-Dresen 2009, Pope et
al. 2002). The aims of improved WBV health surveillance are to assess health status and
workers on the potential risk associated with vibration exposure, and to provide guidance
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to employers and employees. The seemingly declining number of reported WBV-claims
and occupational disease cases in some European countries may be a sign that WBV-
exposure reduction and prevention efforts are having positive effects, but it also requires
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29
Table 1: Health complaints and symptoms of vibration exposure by Organ System
Gastro-intestinal system:
Nausea, vomiting, indigestions
Flank pain (renal)
Hemorrhoids related seating discomfort.
Prostate:
Burning sensation, urgency,
Concern for cancer symptoms: hematuria or prostate enlargement / PSA marker elevation
Peripheral veins
classification (ICD 10, 2013) in Germany and the Netherlands (General Industry) for the time period of
2006 to 2012. (Source DGUV, Dr. S. Gravemeyer; Coronel Institute, Dr. PPFM (Paul) Kuijer, Dr. HF
BRD-
Claims BRD = Dutch recognized
recognized
n (BK 2110) cases
ICD - 10 Diagnoses (BK 2110)
M42.- Osteochondrose 7 0 0
M47.- Spondylose, 11 0 7
44.7
Figure 1) Locomotive operator during switching of rail cars. Hands operating controls located
to the left of the seat during WBV exposure. Below: Result of measurements of lateral back
flexion with the CUELA system during coupling maneuver and in comparison with three vector-
sum vibration exposure levels category (low (0), medium (2) and high (3).
WBV occupational disease claims
(BeK 2110) and recognized cases
1200
1000
800
600 Claims
200
0
1995 2000 2005 2006 2007 2008 2009 2010 2011 2012
Figure 2: Numbers of WBV occupational disease claims and recognized cases under BeK 2110
in Germany from 1995 to 2012 (General Industry) (Source: DGUV, Dr. S. Gravemeyer)
600
500 488
422 411
392 381
400 377 379
363
300
200
110
100
Figure 3: Comparison of yearly number of WBV related occupational disease cases in Germany
(BeK 2110), The Netherlands, and France (Tableaux No. 97) (General Industry). (Source
DGUV, Dr. S. Gravemeyer; Coronel Institute, Dr. PPFM (Paul) Kuijer, Dr. HF (Henk) van der
81/2008), (Legislative Decree. 2008. "Legislative Decree 81/2008, Title VIII, Chapter I,
II, III, IV and V on prevention and protection from the risks arising from exposure
to physical agents at workplaces: Operational indications." Source: Regional
Technical Coordinating Committee for safety at workplaces in collaboration with
ISPESL (National Institute for Occupational Prevention and Safety) and
ISTITUTO SUPERIORE di SANITA' Documento n 1-2009
(http://www.portaleagentifisici.it/DOCUMENTI/FAQ_AFisici_web.pdf?&lg=EN
).
2002/44/EC, EU Directive. 2006. "Directive 2002/44/EC of the European Parlament and
of the Council of 25 June 2002 on the minimum health and safety requirements
regarding the exposure of workers to the risks arising from physical agents
(vibration) (sixteenth individual Directive within the meaning of Article 16(1) of
Directive 89/391/EEC)." Official Journal of the European Communities L
177:13-19.
(ISO), International Organization for Standardization. 2004. Mechanical Vibration and
Shock -
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Funding: No special outside funding was received for this systematic review and paper
preparation.
Amsterdam, The Netherlands), Dr. P. Donati (INRS, France) and Prof. M. Bovenzi, M.D.
36