{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:54:54Z","timestamp":1777510494317,"version":"3.51.4"},"reference-count":40,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,8,5]],"date-time":"2023-08-05T00:00:00Z","timestamp":1691193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"publisher","award":["201906840121"],"award-info":[{"award-number":["201906840121"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>The prevalence of musculoskeletal symptoms (MSS) like neck and back pain is high among open-surgery surgeons. Prolonged working in the same posture and unfavourable postures are biomechanical risk factors for developing MSS. Ergonomic devices such as exoskeletons are possible solutions that can reduce muscle and joint load. To design effective exoskeletons for surgeons, one needs to quantify which neck and trunk postures are seen and how much support during actual surgery is required. Hence, this study aimed to establish the biomechanical profile of neck and trunk postures and neck and lumbar joint loads during open surgery (training). Eight surgical trainees volunteered to participate in this research. Neck and trunk segment orientations were recorded using an inertial measurement unit (IMU) system during open surgery (training). Neck and lumbar joint kinematics, joint moments and compression forces were computed using OpenSim modelling software and a musculoskeletal model. Histograms were used to illustrate the joint angle and load distribution of the neck and lumbar joints over time. During open surgery, the neck flexion angle was 71.6% of the total duration in the range of 10~40 degrees, and lumbar flexion was 68.9% of the duration in the range of 10~30 degrees. The normalized neck and lumbar flexion moments were 53.8% and 35.5% of the time in the range of 0.04~0.06 Nm\/kg and 0.4~0.6 Nm\/kg, respectively. Furthermore, the neck and lumbar compression forces were 32.9% and 38.2% of the time in the range of 2.0~2.5 N\/kg and 15~20 N\/kg, respectively. In contrast to exoskeletons used for heavy lifting tasks, exoskeletons designed for surgeons exhibit lower support torque requirements while additional degrees of freedom (DOF) are needed to accommodate combinations of neck and trunk postures.<\/jats:p>","DOI":"10.3390\/s23156974","type":"journal-article","created":{"date-parts":[[2023,8,5]],"date-time":"2023-08-05T10:25:36Z","timestamp":1691231136000},"page":"6974","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Biomechanical Load of Neck and Lumbar Joints in Open-Surgery Training"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3092-4904","authenticated-orcid":false,"given":"Ce","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6489-6967","authenticated-orcid":false,"given":"Charlotte Christina","family":"Roossien","sequence":"additional","affiliation":[{"name":"Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gijsbertus Jacob","family":"Verkerke","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7069-1973","authenticated-orcid":false,"given":"Han","family":"Houdijk","sequence":"additional","affiliation":[{"name":"Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juha M.","family":"Hijmans","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Greve","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"},{"name":"Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.apergo.2017.09.011","article-title":"Work-Related Physical, Psychosocial and Individual Factors Associated with Musculoskeletal Symptoms among Surgeons: Implications for Ergonomic Interventions","volume":"67","author":"Dianat","year":"2018","journal-title":"Appl. Ergon."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.jss.2014.03.013","article-title":"Musculoskeletal Occupational Injury among Surgeons: Effects for Patients, Providers, and Institutions","volume":"189","author":"Davis","year":"2014","journal-title":"J. Surg. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ijsu.2009.11.008","article-title":"The Pain of Surgery: Pain Experienced by Surgeons While Operating","volume":"8","author":"Soueid","year":"2010","journal-title":"Int. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1007\/s00268-016-3449-6","article-title":"Quantifying Intraoperative Workloads Across the Surgical Team Roles: Room for Better Balance?","volume":"40","author":"Yu","year":"2016","journal-title":"World J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.berh.2012.03.005","article-title":"The Need to Address the Burden of Musculoskeletal Conditions","volume":"26","author":"Woolf","year":"2012","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1007\/s40279-016-0507-z","article-title":"Resistance Training as a Tool for Preventing and Treating Musculoskeletal Disorders","volume":"46","author":"Ciolac","year":"2016","journal-title":"Sports Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6335","DOI":"10.1007\/s00464-020-08085-3","article-title":"Intraoperative Musculoskeletal Discomfort and Risk for Surgeons during Open and Laparoscopic Surgery","volume":"35","author":"Yang","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_8","first-page":"190","article-title":"Musculoskeletal Pain in Resident Orthopaedic Surgeons: Results of a Novel Survey","volume":"34","author":"Knudsen","year":"2014","journal-title":"Iowa Orthop. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"573","DOI":"10.3233\/WOR-172588","article-title":"Assessment of Risk Factors and Preventive Measures and Their Relations to Work-Related Musculoskeletal Pain among Dentists","volume":"57","year":"2017","journal-title":"Work"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jamcollsurg.2016.09.013","article-title":"Do No Harm, Except to Ourselves? A Survey of Symptoms and Injuries in Oncologic Surgeons and Pilot Study of an Intraoperative Ergonomic Intervention","volume":"224","author":"Voss","year":"2017","journal-title":"J. Am. Coll. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/iej.12219","article-title":"Musculoskeletal Disorders amongst Greek Endodontists: A National Questionnaire Survey","volume":"47","author":"Zarra","year":"2014","journal-title":"Int. Endod. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"109795","DOI":"10.1016\/j.jbiomech.2020.109795","article-title":"Biomechanical Evaluation of a New Passive Back Support Exoskeleton","volume":"105","author":"Koopman","year":"2020","journal-title":"J. Biomech."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jbiomech.2018.11.033","article-title":"Effects of a Passive Exoskeleton on the Mechanical Loading of the Low Back in Static Holding Tasks","volume":"83","author":"Koopman","year":"2019","journal-title":"J. Biomech."},{"key":"ref_14","doi-asserted-by":"crossref","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":"ref_15","doi-asserted-by":"crossref","first-page":"109486","DOI":"10.1016\/j.jbiomech.2019.109486","article-title":"Effects of a Passive Back Exoskeleton on the Mechanical Loading of the Low-Back during Symmetric Lifting","volume":"102","author":"Koopman","year":"2020","journal-title":"J. Biomech."},{"key":"ref_16","doi-asserted-by":"crossref","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":"ref_17","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.humov.2017.11.006","article-title":"Changes of Lumbar Posture and Tissue Loading during Static Trunk Bending","volume":"57","author":"Alessa","year":"2018","journal-title":"Hum. Mov. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.apergo.2017.02.003","article-title":"Kinematic and Ergonomic Assessment of Laparoendoscopic Single-Site Surgical Instruments during Simulator Training Tasks","volume":"62","author":"Hallbeck","year":"2017","journal-title":"Appl. Ergon."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ergon.2018.01.003","article-title":"Differences in Postural Loading between Primary and Assistant Surgeons during Vaginal Surgery","volume":"65","author":"Zhu","year":"2018","journal-title":"Int. J. Ind. Ergon."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/alr.22353","article-title":"Estimation of Surgeons\u2019 Ergonomic Dynamics with a Structured Light System during Endoscopic Surgery","volume":"9","author":"Lobo","year":"2019","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1002\/lio2.901","article-title":"Surgical Ergonomics: Assessment of Surgeon Posture and Impact of Training Device during Otolaryngology Procedures","volume":"7","author":"Leung","year":"2022","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s11701-019-00996-1","article-title":"Ergonomic Assessment of Robotic General Surgeons: A Pilot Study","volume":"14","author":"Dwyer","year":"2020","journal-title":"J. Robot. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103344","DOI":"10.1016\/j.apergo.2020.103344","article-title":"Intraoperative Posture and Workload Assessment in Vascular Surgery","volume":"92","author":"Norasi","year":"2021","journal-title":"Appl. Ergon."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zhang, C., Greve, C., Verkerke, G.J., Roossien, C.C., Houdijk, H., and Hijmans, J.M. (2022). Pilot Validation Study of Inertial Measurement Units and Markerless Methods for 3D Neck and Trunk Kinematics during a Simulated Surgery Task. Sensors, 22.","DOI":"10.3390\/s22218342"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"081003","DOI":"10.1115\/1.4030408","article-title":"Development and Validation of a Musculoskeletal Model of the Fully Articulated Thoracolumbar Spine and Rib Cage","volume":"137","author":"Bruno","year":"2015","journal-title":"J. Biomech. Eng."},{"key":"ref_26","unstructured":"Xsens Technologies B.V. (2020). MT Manager User Manual Revision 2020.A, Xsens Technologies B.V."},{"key":"ref_27","unstructured":"Paulich, M., Schepers, M., Rudigkeit, N., and Bellusci, G. (2018). Xsens MTw Awinda: Miniature Wireless Inertial-Magnetic Motion Tracker for Highly Accurate 3D Kinematic Applications, Xsens."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1109\/TBME.2007.901024","article-title":"OpenSim: Open-Source Software to Create and Analyze Dynamic Simulations of Movement","volume":"54","author":"Delp","year":"2007","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12984-022-01001-x","article-title":"OpenSense: An Open-Source Toolbox for Inertial-Measurement-Unit-Based Measurement of Lower Extremity Kinematics over Long Durations","volume":"19","author":"Ibarra","year":"2022","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.piutam.2011.04.021","article-title":"OpenSim: A Musculoskeletal Modeling and Simulation Framework for in Silico Investigations and Exchange","volume":"2","author":"Seth","year":"2011","journal-title":"Procedia IUTAM"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"103869","DOI":"10.1016\/j.apergo.2022.103869","article-title":"Using Static Postures to Estimate Spinal Loading during Dynamic Lifts with Participant-Specific Thoracolumbar Musculoskeletal Models","volume":"106","author":"Banks","year":"2023","journal-title":"Appl. Ergon."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.jamcollsurg.2019.12.035","article-title":"Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort","volume":"230","author":"Yang","year":"2020","journal-title":"J. Am. Coll. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","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":"Koopman","year":"2018","journal-title":"Front. Robot. AI"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"103156","DOI":"10.1016\/j.apergo.2020.103156","article-title":"Biomechanical Assessment of Two Back-Support Exoskeletons in Symmetric and Asymmetric Repetitive Lifting with Moderate Postural Demands","volume":"88","author":"Madinei","year":"2020","journal-title":"Appl. Ergon."},{"key":"ref_35","first-page":"1404","article-title":"A Neck Support for Alleviating Occupational Neck Pain","volume":"59","author":"Yee","year":"2015","journal-title":"Proc. Hum. Factors Ergon. Soc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"102515","DOI":"10.1016\/j.jelekin.2021.102515","article-title":"A Novel Passive Neck Orthosis for Patients with Degenerative Muscle Diseases: Development & Evaluation","volume":"57","author":"Mahmood","year":"2021","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1080\/10255842.2018.1564819","article-title":"Validation of an OpenSim Full-Body Model with Detailed Lumbar Spine for Estimating Lower Lumbar Spine Loads during Symmetric and Asymmetric Lifting Tasks","volume":"22","author":"Robertson","year":"2019","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1080\/00140139.2016.1191679","article-title":"Estimation of Lumbar Spinal Loading and Trunk Muscle Forces during Asymmetric Lifting Tasks: Application of Whole-Body Musculoskeletal Modelling in OpenSim","volume":"60","author":"Kim","year":"2017","journal-title":"Ergonomics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1080\/00140139.2017.1365950","article-title":"Effects of Backpack Load on Critical Changes of Trunk Muscle Activation and Lumbar Spine Loading during Walking","volume":"61","author":"Li","year":"2018","journal-title":"Ergonomics"},{"key":"ref_40","unstructured":"Vicon Motion Systems Ltd (2017). Vicon\u00ae Plug-in Gait Reference Guide, Vicon Motion Systems Ltd."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/15\/6974\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:26:34Z","timestamp":1760127994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/15\/6974"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,5]]},"references-count":40,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["s23156974"],"URL":"https:\/\/doi.org\/10.3390\/s23156974","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,5]]}}}