{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:09:24Z","timestamp":1790442564533,"version":"4.1.0"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T00:00:00Z","timestamp":1635811200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003407","name":"Ministero dell\u2019Istruzione, dell\u2019Universit\u00e0 e della Ricerca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:p>Lower back pain and musculoskeletal injuries are serious concerns for workers subjected to physical workload and manual material handling tasks. Spine assistive exoskeletons are being developed to support the spine and distribute the spine load. This article presents a detailed up-to-date review on the back support exoskeletons by discussing their type (Active\/Passive), structure (Rigid\/Soft), power transmission methods, weight, maximum assistive force, battery technologies, tasks (lifting, bending, stooping work), kinematic compatibility and other important features. This article also assesses the back support exoskeletons in terms of their ability to reduce the physical load on the spine. By reviewing functional and structural characteristics, the goal is to increase communication and realization among ergonomics practitioners, developers, customers, and factory workers. The search resulted in reviewing 34 exoskeletons of which 16 were passive and 18 were active. In conclusion, back support exoskeletons have immense potential to significantly reduce the factors regarding work-related musculoskeletal injuries. However, various technical challenges and a lack of established safety standards limit the wide adaptation of exoskeletons in industry.<\/jats:p>","DOI":"10.3389\/fbioe.2021.765257","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T05:35:19Z","timestamp":1635831319000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":120,"title":["Systematic Review of Back-Support Exoskeletons and Soft Robotic Suits"],"prefix":"10.3389","volume":"9","author":[{"given":"Athar","family":"Ali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vigilio","family":"Fontanari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Schmoelz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil K.","family":"Agrawal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1016\/j.clinbiomech.2005.12.021","article-title":"An On-Body Personal Lift Augmentation Device (PLAD) Reduces EMG Amplitude of Erector Spinae during Lifting Tasks","volume":"21","author":"Abdoli-E","year":"2006","journal-title":"Clin. Biomech."},{"key":"B2","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.clinbiomech.2007.10.012","article-title":"The Effect of On-Body Lift Assistive Device on the Lumbar 3D Dynamic Moments and EMG During Asymmetric Freestyle Lifting","volume":"23","author":"Abdoli-E","year":"2008","journal-title":"Clin. Biomech."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1694","DOI":"10.1016\/j.jbiomech.2006.09.006","article-title":"Mathematical and Empirical Proof of Principle for an On-Body Personal Lift Augmentation Device (PLAD)","volume":"40","author":"Abdoli-Eramaki","year":"2007","journal-title":"J. Biomech."},{"key":"B4","unstructured":"AWN-03\n            ActivelinkP.\n          2020"},{"key":"B5","volume-title":"Biomechanical Assessment and Metabolic Evaluation of Passive Lift-Assistive Exoskeletons During Repetitive Lifting Tasks. Virginia Polytechnic Institute and State University","author":"Alemi","year":"2019"},{"key":"B6","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.jelekin.2019.05.003","article-title":"A Passive Exoskeleton Reduces Peak and Mean EMG during Symmetric and Asymmetric Lifting","volume":"47","author":"Alemi","year":"2019","journal-title":"J. Electromyogr. Kinesiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s00421-019-04284-6","article-title":"SPEXOR Passive Spinal Exoskeleton Decreases Metabolic Cost During Symmetric Repetitive Lifting","volume":"120","author":"Baltrusch","year":"2020","journal-title":"Eur. J. Appl. Physiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.apergo.2018.04.007","article-title":"The Effect of a Passive Trunk Exoskeleton on Functional Performance in Healthy Individuals","volume":"72","author":"Baltrusch","year":"2018","journal-title":"Appl. Ergon."},{"key":"B9","article-title":"Evaluation of Four Weight Transfer Devices for Reducing Loads on the Lower Back during Agricultural Stoop Labor","author":"Barrett","year":"2001"},{"key":"B10","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.apergo.2015.12.003","article-title":"The Effects of a Passive Exoskeleton on Muscle Activity, Discomfort and Endurance Time in Forward Bending Work","volume":"54","author":"Bosch","year":"2016","journal-title":"Appl. Ergon."},{"key":"B11","volume-title":"Japet Medical Devices, assignee. Vertebral decompression device. United States patent US 10,932,981. 2021 Mar 2","author":"Bratic","year":"2018"},{"key":"B12","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1007\/978-3-319-17314-6_59","article-title":"Development of Wearable Power Assist Wear Using Pneumatic Actuators","author":"Cho","year":"2016","journal-title":"Lecture Notes Electr. Eng."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2539","DOI":"10.1109\/LRA.2019.2908493","article-title":"Soft, Multi-DoF, Variable Stiffness Mechanism Using Layer Jamming for Wearable Robots","author":"Choi","year":"2019","journal-title":"IEEE Robot. Autom. Lett."},{"key":"B14","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1136\/oemed-2014-102346","article-title":"The Effect of Lifting During Work on Low Back Pain: A Health Impact Assessment Based on a Meta-Analysis","volume":"71","author":"Coenen","year":"2014","journal-title":"Occup. Environ. Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1080\/00140139.2015.1081988","article-title":"Exoskeletons for Industrial Application and Their Potential Effects on Physical Work Load","volume":"59","author":"de Looze","year":"2016","journal-title":"Ergonomics."},{"key":"B16","unstructured":"2020"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.2806\/34660","author":"Agn\u2019s","year":"2012","journal-title":"5th European Working Conditions Survey - Techinal Report. Luxemburg: Publications Office of the European Union 2012"},{"key":"B18","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1007\/s12555-016-0487-7","article-title":"Auxilio: A Portable cable-driven Exosuit for Upper Extremity Assistance","volume":"15","author":"Gaponov","year":"2017","journal-title":"Int. J. Control. Autom. Syst."},{"key":"B19","unstructured":"2018"},{"key":"B20","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.robot.2014.08.015","article-title":"A Light-Weight Active Orthosis for Hip Movement Assistance","volume":"73","author":"Giovacchini","year":"2015","journal-title":"Robotics Autonomous Syst."},{"key":"B21","unstructured":"APEX Exosuit2020"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1350035","DOI":"10.4015\/S101623721350035X","article-title":"Investigation on a Developed Wearable Assistive Device (WAD) in Reduction Lumbar Muscles Activity","volume":"25","author":"Heydari","year":"2013","journal-title":"Biomed. Eng. Appl. Basis Commun."},{"key":"B23","doi-asserted-by":"publisher","first-page":"791","DOI":"10.20965\/jrm.2014.p0791","article-title":"Analysis of Trunk Stabilization Effect by Passive Power-Assist Device","volume":"26","author":"Imamura","year":"2014","journal-title":"J. Robot. Mechatron."},{"key":"B24","unstructured":"2020"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1109\/ICRA.2017.7989711","article-title":"Semi-Endoskeleton-Type Waist Assist AB-Wear Suit Equipped With Compressive Force Reduction Mechanism","author":"Inose","year":"2017","journal-title":"Proc. - IEEE Int. Conf. Robotics Automation."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/8849427","article-title":"SIAT-WEXV2: A Wearable Exoskeleton for Reducing Lumbar Load During Lifting Tasks","volume":"2020","author":"Ji","year":"2020","journal-title":"Complexity."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2017\/5813154","article-title":"Bilateral, Misalignment-Compensating, Full-DOF Hip Exoskeleton: Design and Kinematic Validation","volume":"2017","author":"Junius","year":"2017","journal-title":"Appl. Bionics Biomech."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.1109\/TBME.2017.2754922","article-title":"Metabolic Effects Induced by a Kinematically Compatible Hip Exoskeleton during STS","volume":"65","author":"Junius","year":"2018","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"B29","first-page":"1080","article-title":"Evaluation of Trunk-Supporting Exoskeleton","author":"Kazerooni","year":"2019"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1080\/00140139.2010.512983","article-title":"How to Lift a Box That Is Too Large to Fit Between the Knees","volume":"53","author":"Kingma","year":"2010","journal-title":"Ergonomics."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.robot.2018.05.008","article-title":"Waist-Assistive Exoskeleton Powered by a Singular Actuation Mechanism for Prevention of Back-Injury","volume":"107","author":"Ko","year":"2018","journal-title":"Robotics Autonomous Syst."},{"key":"B32","volume-title":"Effect of Low-Profile, Spring-Powered Exosuit on Back Muscle Fatigue during Leaning","author":"Lamers","year":"2019"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1109\/TBME.2017.2761455","article-title":"Feasibility of a Biomechanically-Assistive Garment to Reduce Low Back Loading during Leaning and Lifting","volume":"65","author":"Lamers","year":"2018","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"B34","first-page":"230","article-title":"Wearable Stooping-Assist Device in Reducing Risk of Low Back Disorders during Stooped Work","author":"Luo","year":"2013"},{"key":"B35","doi-asserted-by":"publisher","first-page":"559","DOI":"10.20965\/ijat.2011.p0559","article-title":"Quantitative Performance Analysis of Exoskeleton Augmenting Devices - Muscle Suit - for Manual Worker","volume":"5","author":"Muramatsu","year":"2011","journal-title":"Int. J. Autom. Technol."},{"key":"B36","doi-asserted-by":"crossref","DOI":"10.1109\/EMBC.2013.6610133","article-title":"Improvement and Quantitative Performance Estimation of the Back Support Muscle Suit","author":"Muramatsu","year":"2013"},{"key":"B37","article-title":"Myseismic Powered Clothing Seismic Powered Clothing","year":"2021"},{"key":"B38","doi-asserted-by":"publisher","first-page":"72","DOI":"10.3389\/frobt.2018.00072","article-title":"Passive Back Support Exoskeleton Improves Range of Motion Using Flexible Beams","volume":"5","author":"N\u00e4f","year":"2018","journal-title":"Front. Robot. AI."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1707136","DOI":"10.1002\/adfm.201707136","article-title":"Mechanically Versatile Soft Machines through Laminar Jamming","volume":"28","author":"Narang","year":"2018","journal-title":"Adv. Funct. Mater."},{"key":"B40","unstructured":"Paexo Back2021"},{"key":"B41","doi-asserted-by":"publisher","first-page":"166","DOI":"10.3390\/ACT10070166","article-title":"Soft Exoskeletons: Development, Requirements, and Challenges of the Last Decade","volume":"10","author":"P\u00e9rez Vidal","year":"2021","journal-title":"Actuators."},{"key":"B42","unstructured":"Sankai University of Tsukuba\/CYBERDYNE Inc. HAL Lumbar Type for Labor Support2020"},{"key":"B43","doi-asserted-by":"crossref","DOI":"10.1109\/IROS.2009.5354029","article-title":"Ergonomics of Exoskeletons: Subjective Performance Metrics","author":"Schiele","year":"2009"},{"key":"B44","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1109\/TNSRE.2006.881565","article-title":"Kinematic Design to Improve Ergonomics in Human Machine Interaction","volume":"14","author":"Schiele","year":"2006","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"B45","doi-asserted-by":"crossref","DOI":"10.1109\/ICRA40945.2020.9197359","article-title":"Development of a Twisted String Actuator-Based Exoskeleton for Hip Joint Assistance in Lifting Tasks","author":"Seong","year":"2020"},{"key":"B46","doi-asserted-by":"publisher","first-page":"110317","DOI":"10.1016\/j.jbiomech.2021.110317","article-title":"Kinematic Effects of a Passive Lift Assistive Exoskeleton","volume":"120","author":"Simon","year":"2021","journal-title":"J. Biomech."},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1017\/wtc.2020.7","article-title":"Exoskeleton Kinematic Design Robustness: An Assessment Method to Account for Human Variability","volume":"1","author":"Sposito","year":"2020","journal-title":"Wearable Technol."},{"key":"B48","unstructured":"BackX. 2019, an Effective and Affordable Exoskeleton that Reduc2019"},{"key":"B49","unstructured":"Aldak Exoskeleton\n            SystemsC. H.\n          2020"},{"key":"B50","doi-asserted-by":"crossref","DOI":"10.1109\/ICMA.2009.5246279","article-title":"Development of Muscle Suit and Application to Factory Laborers","author":"Takamitsu Aida","year":"2009"},{"key":"B51","doi-asserted-by":"publisher","first-page":"312","DOI":"10.3389\/fnhum.2018.00312","article-title":"EEG-Based BCI Control Schemes for Lower-Limb Assistive-Robots","volume":"12","author":"Tariq","year":"2018","journal-title":"Front. Hum. Neurosci."},{"key":"B52","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1109\/LRA.2017.2768120","article-title":"A Parallel-Elastic Actuator for a Torque-Controlled Back-Support Exoskeleton","volume":"3","author":"Toxiri","year":"","journal-title":"IEEE Robot. Autom. Lett."},{"key":"B53","doi-asserted-by":"publisher","first-page":"53","DOI":"10.3389\/frobt.2018.00053","article-title":"Rationale, Implementation and Evaluation of Assistive Strategies for an Active Back-Support Exoskeleton","volume":"5","author":"Toxiri","year":"","journal-title":"Front. Robot. AI."},{"key":"B54","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1080\/24725838.2019.1626303","article-title":"Back-Support Exoskeletons for Occupational Use: An Overview of Technological Advances and Trends","volume":"7","author":"Toxiri","year":"2019","journal-title":"IISE Trans. Occup. Ergon. Hum. Factors."},{"key":"B55","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1743-0003-12-1","article-title":"Control Strategies for Active Lower Extremity Prosthetics and Orthotics: A Review","volume":"12","author":"Tucker","year":"2015","journal-title":"J. NeuroEngineering Rehabil."},{"key":"B56","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.jelekin.2012.08.014","article-title":"Effect of a Personal Weight Transfer Device on Muscle Activities and Joint Flexions in the Stooped Posture","volume":"23","author":"Ulrey","year":"","journal-title":"J. Electromyogr. Kinesiol."},{"key":"B57","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.jelekin.2012.08.016","article-title":"Subject-Specific, Whole-Body Models of the Stooped Posture with a Personal Weight Transfer Device","volume":"23","author":"Ulrey","year":"","journal-title":"J. Electromyogr. Kinesiol."},{"key":"B58","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.jocn.2019.01.038","article-title":"Effectiveness of an On-Body Lifting Aid (HAL for Care Support) to Reduce Lower Back Muscle Activity during Repetitive Lifting Tasks","volume":"63","author":"von Glinski","year":"2019","journal-title":"J. Clin. Neurosci."},{"key":"B59","unstructured":""},{"key":"B60","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1109\/TMECH.2019.2893480","article-title":"Electrostatic Layer Jamming Variable Stiffness for Soft Robotics","volume":"24","author":"Wang","year":"2019","journal-title":"Ieee\/asme Trans. Mechatron."},{"key":"B61","first-page":"49","article-title":"Lower Extremity Exoskeleton Reduces Back Forces in Lifting","author":"Wehner","year":"2009"},{"key":"B62","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.ergon.2013.10.002","article-title":"Effect of an On-Body Ergonomic Aid on Oxygen Consumption During a Repetitive Lifting Task","volume":"44","author":"Whitfield","year":"2014","journal-title":"Int. J. Ind. Ergon."},{"key":"B63","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1109\/TRO.2021.3084466","article-title":"Soft Robotic Suits: State of the Art, Core Technologies, and Open Challenges","volume":"37","author":"Xiloyannis","year":"2021","journal-title":"IEEE Trans. Robot."},{"key":"B64","doi-asserted-by":"publisher","first-page":"e0228536","DOI":"10.1371\/journal.pone.0228536","article-title":"Characterizing the comfort Limits of Forces Applied to the Shoulders, Thigh and Shank to Inform Exosuit Design","volume":"15","author":"Yandell","year":"2020","journal-title":"PLoS ONE."},{"key":"B65","doi-asserted-by":"publisher","first-page":"4547","DOI":"10.1109\/LRA.2019.2935351","article-title":"Spine-Inspired Continuum Soft Exoskeleton for Stoop Lifting Assistance","volume":"4","author":"Yang","year":"2019","journal-title":"IEEE Robot. Autom. Lett."},{"key":"B66","first-page":"5103","article-title":"Development of A Soft Power Suit for Lower Back Assistance*","author":"Yao","year":"2019"},{"key":"B67","doi-asserted-by":"publisher","first-page":"463","DOI":"10.3390\/mi10070463","article-title":"Ergonomic Mechanical Design and Assessment of a Waist Assist Exoskeleton for Reducing Lumbar Loads during Lifting Task","volume":"10","author":"Yong","year":"2019","journal-title":"Micromachines."},{"key":"B68","doi-asserted-by":"publisher","first-page":"2609","DOI":"10.2355\/isijinternational.ISIJINT-2015-272","article-title":"Development of a Stand-Alone Powered Exoskeleton Robot Suit in Steel Manufacturing","volume":"55","author":"Yu","year":"2015","journal-title":"ISIJ Int."},{"key":"B69","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1177\/0954411920971401","article-title":"Relevance of a Novel External Dynamic Distraction Device for Treating Back Pain","volume":"235","author":"Za\u00efri","year":"2021","journal-title":"Proc. Inst. Mech. Eng. H."},{"key":"B70","doi-asserted-by":"publisher","first-page":"0","DOI":"10.1115\/1.4031798","article-title":"Design and Preliminary Evaluation of a Passive Spine Exoskeleton","volume":"10","author":"Zhang","year":"2016","journal-title":"J. Med. Devices, Trans. ASME."},{"key":"B71","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1109\/MRA.2018.2815083","article-title":"A Lower-Back Robotic Exoskeleton: Industrial Handling Augmentation Used to Provide Spinal Support","volume":"25","author":"Zhang","year":"2018","journal-title":"IEEE Robot. Automat. Mag."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2021.765257\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T15:10:03Z","timestamp":1636125003000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2021.765257\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,2]]},"references-count":71,"alternative-id":["10.3389\/fbioe.2021.765257"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2021.765257","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,2]]},"article-number":"765257"}}