Applied Ergonomics 43 (2012) 876e882

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Applied Ergonomics
journal homepage: www.elsevier.com/locate/apergo

Inuence of automobile seat lumbar support prominence on spine and pelvic

postures: A radiological investigation
Diana E. De Carvalho, Jack P. Callaghan*
Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada N2L 3G1

a r t i c l e i n f o

a b s t r a c t

Article history:
Received 28 September 2010
Accepted 22 December 2011

Background: The use of lumbar supports has been associated with decreased reports of low back pain
during driving exposures. However, there has been limited work investigating whether lumbar supports
actually change spine and pelvic postures at the level of the vertebrae.
Purpose: To investigate the effectiveness of a lumbar support in changing radiological measures of lumbar
spine and pelvic postures and to examine the impact of support excursion magnitudes on these postures.
Methods: Eight male subjects were recruited with no history of back injury, pathologies or low back pain
within the past 6 months. Radiographs were taken in four postures: standing, and sitting with 0 cm, 2 cm
and 4 cm lumbar support prominence (LSP).
Results: Lumbar lordosis angle increased from 20
with no support to 25
with 2 cm support and 30
with
4 cm support. Lumbar lordosis angles were signicantly different between 0 cm support and 4 cm
support (p < 0.0001) and between 2 cm support and 4 cm support (p 0.0256). Increasing lumbar
support reduced the exion at intervertebral disc joints throughout the lumbar spine, however, these
remained signicantly different from upright standing (p > 0.001) with the exception of L1/L2 in 4 cm
support (p 0.1381) and L5/S1 for all seated postures (p 0.0687). All measures of pelvic posture were
signicantly different in sitting compared to standing (p < 0.0001), however, the lumbar support had no
signicant impact on seated pelvic posture.
Conclusions: Lumbar supports were shown to impact the vertebral rotations of the lumbar spine yet had
no effect on pelvis postures. Increasing support from the current maximum of 2 cme4 cm resulted in
increased lumbar lordosis. The changes were mostly imparted at the upper lumbar spine joints with the
most marked change being exhibited at the approximate level of the lumbar support apex: in the L2/L3
joint.
2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Keywords:
Automobile seats
Low back pain
Lumbar spine biomechanics

1. Introduction
The optimal lumbar support design for driver seats has been
a hot topic in the automobile industry over the past decade. Better
support designs still need to be developed and this has been
reected in a summary of quality surveys consistently reporting
inadequate or uncomfortable lumbar supports as one of the top ten
vehicle issues in North America (Kolich, 2009). Uncomfortable
lumbar supports were more frequently identied by bus drivers in
a low back pain group in cross sectional survey-based study conducted in Israel (Alperovitch-Najenson et al., 2010). Qualitative
ndings link lumbar support usage with decreased reports of low

* Corresponding author. Tel.: 1 519 888 4567x37080; fax: 1 519 746 6776.
E-mail addresses: ddecarva@uwaterloo.ca (D.E. De Carvalho), callagha@
uwaterloo.ca, callagha@healthy.uwaterloo.ca (J.P. Callaghan).

back pain (Chen et al., 2005a) and they have been shown to
increase the lumbar lordosis in both ofce chairs and wheelchairs
(Lin et al., 2006; Makhsous et al., 2003). Active and pneumatic
lumbar support systems have also been shown to reduce discomfort experienced by occupants in eld studies (Donnelly et al.,
2009; Reed and Schneider, 1996; Reinecke et al., 1994). Despite
these ndings, there has been limited work done to determine if
lumbar supports are actually capable of altering spine and pelvic
posture at the level of the vertebrae. Therefore, the purpose of this
study was to investigate the effectiveness of a lumbar support in
changing radiological measures of lumbar spine and pelvic
postures.
The existing literature points toward an association between
driving and low back pain (Andrusaitis et al., 2006; Bovenzi, 2010;
Chen et al., 2005b; Costa et al., 2001; Gyi and Porter, 1998; Jin
et al., 2000; Keyserling, 2000; Krause et al., 2004; Magnusson
et al., 1996; Mendelek et al., 2011; Okunribido et al., 2007; Pietri

0003-6870/$ e see front matter 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.
doi:10.1016/j.apergo.2011.12.007

D.E. De Carvalho, J.P. Callaghan / Applied Ergonomics 43 (2012) 876e882

et al., 1992; Plouvier et al., 2008; Porter and Gyi, 2002; Prado-Len
et al., 2008; Robb and Manseld, 2007). Krause et al. (2004) and
Mendek et al. (2011) have found that even after adjusting for
psychosocial factors, time spent driving and seat design issues are
risk factors for low back injury. Back supports have been targeted as
a possible intervention for the most likely mechanical explanation
for increased risk of back pain in driving: loss of the lumbar lordosis.
This attening of the lumbar spine and posterior rotation of the
pelvis has been documented radiologically in sitting in an automobile seat (De Carvalho et al., 2010; Hazard and Reinecke, 1995)
unsupported (Andersson et al., 1979) and in regular chairs (Lord
et al., 1997). The posture of the lumbar spine is quantied radiographically as the lumbar lordosis angle: the angle between
perpendicular lines drawn from the superior endplate of the L1
vertebral body and either the inferior endplate of L5 or the superior
endplate of S1 (Yochum and Rowe, 1996). Andersson et al. (1979)
found an average loss of 38
in the lumbar lordosis angle from
standing to unsupported sitting as measured on radiographs, which
was supported by Lord et al. (1997) who demonstrated a reduction
of half of the lumbar lordosis when assuming a seated position. The
attening of the lumbar spine in sitting has been shown to induce
a signicant posterior migration of the nucleus measured by MRI
(Alexander et al., 2007). These medical imaging ndings were for
seated positions on either chairs or stools. There has been limited
examination of automotive seating specically. Similar to ofce
seating, the lumbar lordosis angle was shown to decrease from 63

in standing to 20
in a car seat with no lumbar support (De Carvalho
et al., 2010). Previously, Hazard and Reinecke (1995) demonstrated
radiographically that a pneumatic continuous passive motion
lumbar support in a car seat was able to cycle lumbar lordosis angles
between 21
and 41
for two participants. A number of physiological and biomechanical side effects have been linked to this exed
posture including: increased disc pressure (Andersson et al., 1977;
Sato et al., 1999; Wilder et al., 1985; Wilke et al., 1999) increased
muscle activity (Andersson and Ortengren, 1974) and passive strain
of posterior elements of the spine (Adams and Dolan, 1996; McGill
and Brown, 1992; Solomonow et al., 2003; Twomey and Taylor,
1982). Compounding these responses are the potential for viscoelastic creep in the passive elements of the spine and vibration
associated with prolonged driving exposures, which have been
shown to accelerate injury in the spine (Wilder et al., 1985).
There is little available information regarding the effect of
lumbar support prominence on lumbar spine and pelvic postures in
automobile seats with a lumbar support. Specically, in order to
assist novel designs of lumbar supports, the horizontal excursion
necessary to effect a change in lumbar and pelvic posture are
critical. Results from Hazard and Reinecke (1995) encouraged the
hypothesis of this study that increasing lumbar support will change
radiological measures of lumbar spine and pelvic posture. Further,
it is expected that excursion values over and above 2 cm, a recommendation for a xed automobile lumbar support (Reed et al., 1994)
will be required to effect a change in spine posture.
2. Methods
2.1. Participants
Eight male subjects were recruited from a student population
(average age 27 years /3, height 1.82 m /0.11 and mass
90.6 kg /12.0). Potential participants were excluded from the
study if they had a history of severe back injury such as fracture or
disc herniation, known spinal deformity or a recent (within the past
six months) episode of non-specic low back pain. To minimize
health risks associated with elevated ionizing radiation exposure,
participants were also excluded from this study if they had

877

a radiographic investigation within the past year (excluding dental

x-rays) or if they were exposed to radiation for occupational
purposes. The study received ethics approval from both the
University of Waterloo and the Canadian Memorial Chiropractic
College. Informed consent was completed in writing after the
experimental protocol was completely explained.
2.2. Radiographs
In order to replicate in-vehicle driving posture as closely as
possible, a driving simulator, consisting of a modied automobile
seat (Crown Victoria Model #EN114 2007, Lear Seating Corporation,
Southeld, MI) with an increased lumbar support prominence (LSP)
(4 cm), 43 cm steering wheel and two foot pedals was used for
radiographic measures. LSP was determined using an HPM-II
mannequin and is measured in millimeters of horizontal shell
deection (SAE, 2005; Schneider et al., 1999). The automobile seat
frame was modied with the lateral frame of the seatback being cut
and welded to allow a posterior offset of the side pillars such that
they would not obstruct the radiographic eld of view in the
lumbar region. The height of the lumbar support was set with the
apex centered at the level of L3 of each participant (Reed and
Schneider, 1996). Participants were able to adjust the seat fore
and aft in order to ensure a typical driving position when interacting with the pedals and steering wheel. These adjustments were
made at the start of the protocol for each participant individually
and the settings were not changed throughout the experiment. The
seat back angle was xed at 100
relative to the seat pan
(Andersson and Ortengren, 1974) and the seat pan angle was xed
with the front edge of the seat pan at 10
above horizontal.
Participants were radiographed in two whole body postures:
standing and sitting in the automobile seat. Since it has been shown
that slight alterations in arm exion can have signicant effects on
the radiographic measurement of lumbar lordosis angle (Stagnara
et al., 1982) the subjects were instructed to lightly grip a steering
wheel at the 11oclock and 1oclock positions such that the arms
were forward exed with respect to the trunk, measured by goniometer, to simulate a driving posture. Thus, the same shoulder and
elbow angles were used in both standing and seated postures on an
individual basis. In the standing posture subjects were instructed to
stand with their feet shoulder width apart and lightly grip the
steering wheel (Fig. 1). To sit down in the simulator, the subject was
instructed to place their buttock as far back in the seat as possible
and then to extend their back to rest on the backrest and place their
right foot on the accelerator pedal. Then they were instructed to
lightly grip the steering wheel mounted on the driving simulator
and to place their right foot on the accelerator pedal (Fig. 2). Three
LSP settings were tested: 0 cm, 2 cm and 4 cm.
All subjects were tted with thyroid and gonadal lead shielding
to protect these radiosensitive tissues from x-ray scatter. Radiographs were taken with a diagnostic x-ray high voltage generator
machine (HFQ-12050P, Toshiba, Bennett X-ray Technologies Inc.,
Copiague, NY, USA) by experienced technicians (minimum 37
years) with a 36 by 43 cm lm size using 400 speed screen
cassettes. For all lms, breathing instructions were given such that
the lm was taken on suspended expiration in order to decrease the
superimposition of the diaphragm over the vertebral bodies of the
upper lumbar spine. The central ray of the x-ray tube was directed
perpendicular to the subject 2.5 cm superior to the iliac crest
slightly posterior to the mid-axillary line and the focal eld
distance was set to 1.02 m (Botranger, 2002). The collimation was
set superiorly to include T12, inferiorly to include S3 and slightly
lateral to include the greater trochanter. Technique factors,
adjusted to the sagittal thickness of the subject, were 100 KVP and
40 MAS on average.

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D.E. De Carvalho, J.P. Callaghan / Applied Ergonomics 43 (2012) 876e882

Fig. 1. Representative photo of a participant being radiographed in the upright

standing condition.

2.3. Data analysis

Digital copies of the plain lm radiographs were made with
a high resolution scanner (Kodak LS75 Film Digitizer, Eastman
Kodak Co., Rochester, NY). Radiographic measures of lumbar
lordosis, intervertebral disc angles (L1/L2 e L5/S1), lumbosacral
lordosis, lumbosacral angle and sacral tilt were completed using
eFilm Workstation software (v 3.0, Merge Healthcare, Milwaukee,
USA) according to Yochum and Rowe (1996) and shown in Fig. 3.
The lumbar lordosis measure used in the seated posture has been
shown to be reliable and repeatable (De Carvalho et al., 2010).
2.4. Statistics
One-way repeated measures analyses of variance (standing and
3 seated conditions) with a level of signicance p < 0.05 were
conducted for the outcome measures of lumbar lordosis, intervertebral disc angles (L1/L2eL5/S1), lumbosacral angle, lumbosacral
lordosis and sacral tilt. Tukeys Studentized Range Test post hoc was
used on all signicant effects. Effect size (h2) for each measure was
calculated by dividing the condition sum of squares by the total
sum of squares.
3. Results
Signicantly greater lumbar lordosis angles were produced with
the participants seated in the 4 cm lumbar support condition
compared to no support (p 0.0256). There were no signicant
differences between 0 cm and 2 cm (p 0.4265) or 2 cm and 4 cm
support (p 4625). As shown in Fig. 4, on average, mean lumbar

Fig. 2. Representative photo of a participant being radiographed a seated condition.

Arrow points to the portion of the seat back frame that was modied (offset) to
prevent obstruction of the radiograph. This frame modication had no impact on the
functionality of the lumbar support or the surface of the user interface.

lordosis increased from 20
(SD 13
) with no support to 25
(SD 15
)
with 2 cm support and 30
(SD 10
) with 4 cm support. All seated
lumbar angles were signicantly different from standing
(p < 0.001), thus even with added support the lumbar spine remains
considerably exed compared to upright standing (average lumbar
lordosis 63
SD 15
). The effect size for the lumbar lordosis measure
was large: 0.65. A second measure of lumbar spine posture, the
lumbosacral angle, was found to be signicantly different between
standing and all three seated conditions regardless of support
(p < 0.001). No signicant differences in lumbosacral angle were
found between the 3 magnitudes of lumbar support. The effect size
for the lumbosacral angle was large: 0.73.
While increased magnitudes of LSP created a trend of returning
individual intervertebral joint and lumbar spine angles closer to
upright standing values, for the most part the postures remained
signicantly different from upright standing (p > 0.001) (Fig. 5). The
4 cm support condition resulted in intervertebral joint angles that
were closest to those observed in upright standing. Note that the
mean intervertebral disc angle at L5/S1 was not signicantly
different between standing or sitting (14
SD 3
in standing, 10
SD
10
sitting with no support, 7
SD 7
sitting with 2 cm support and
9
SD 6
sitting with 4 cm support, p 0.0687) and that the mean
intervertebral disc angle at L1/L2 was returned to an angle not
signicantly different than standing with 4 cm support (5
SD 3
in
standing and 3
SD 1
with 4 cm support, p 0.1381). Effect sizes for
the intervertebral angles ranged from small (IVD L1/L2 0.24 and IVD
L5/S1 0.14) to large (IVD L2/3 0.54, IVD L3/L4 0.62), IVD L4/L5 0.80).

D.E. De Carvalho, J.P. Callaghan / Applied Ergonomics 43 (2012) 876e882

879

Fig. 3. Schematic of radiological measures: (from left to right) lumbar lordosis angle, intervertebral disc angles, lumbosacral lordosis angle, sacral tilt, lumbosacral angle.

The lumbar support had no impact on the pelvic posture, with

the amount of lumbar support excursion producing no change in
either of the pelvic angles measured (Fig. 6). Specically, lumbosacral and sacral tilt angles remained signicantly different from
standing in all seated postures (p < 0.0001). Effect size for both
pelvic angles was large: lumbosacral angle 0.74 and sacral tilt 0.85).
4. Discussion
Increasing the amount of lumbar support in a car seat directly
impacts the lumbar spine and vertebral joint rotations. The rst
hypothesis of this study, that increasing lumbar support will
change radiological measures of lumbar spine and pelvic posture,
can be accepted for the lumbar lordosis and intervertebral disc
angles and rejected for the lumbosacral lordosis angle and both
pelvic measures. The second hypothesis expected that excursion
values over and above that of the industry standard (2 cm) would
be required to effect a change in spine posture. This was found to be
true as the 4 cm support condition, was the level of support that
returned some measures of intervertebral disc angles to those not
signicantly different than standing, and resulted in trends toward
more extended values for all other lumbar angles.

Fig. 4. Lumbar lordosis (black) and lumbosacral lordosis (gray) measures for all
postures tested. Standing was found to be signicantly different than sitting regardless
of support. Between sitting conditions, lumbar lordosis was signicantly greater in the
100% condition compared to 0%.

While seated postures in this study are compared to upright

standing, returning seated posture to values in standing should not
be the goal of a lumbar support. Standing, in itself is an extended
posture, and has been shown to place increased load on the
apophyseal joints (Adams and Hutton, 1985) and have a strong
association with low back pain (Andersen et al., 2007; Roelen et al.,
2008; Tissot et al., 2009). Maintenance of a neutral spine, where
minimal strains are placed on the spine, has been suggested as
a healthier posture for the low back during sitting (Keegan
Nebraska, 1953; OSullivan et al., 2010; Scannell and McGill,
2003). Therefore, by extending the lumbar spine away from the
end ranges of exion, but not replicating a standing posture, the
lumbar support tested in this study might be appropriate in
magnitude despite the signicant differences from standing that
remain even at the greatest level. Future studies evaluating objective and subjective user responses to prolonged exposures to this
support are indicated to test this speculation.
While the use of radiographs allowed us the best possible data
regarding vertebral spine position changes in response to the
lumbar support, it does come with some limitations. Due to the
ethics of taking non-medically necessary radiographs, we only
received ethics clearance for 8 male participants. Female participants were not permitted to participate in the study due to
concerns of adequate lead shielding of gonadal tissue. While the
sample size is small, the large differences between the means and
low variance of the measures resulted in large effect sizes of every
variable tested with the exception of the intervertebral disc angles
at L1/L2 and L5/S1. Therefore, we can condently say that this
limitation is negligible. Another shortcoming of plain lm imaging
is the short duration of radiographic exposure is not necessarily
representative of regular activity. Radiographs were taken at the
end of a 2 min acclimatization period for each posture, which could
somewhat lessen this limitation. Since it has been shown that
minimal postural movements of the lumbar spine and pelvis are
made in car seat sitting the duration of exposure should not vary
much from those postures captured over a longer period of time
(Callaghan et al., 2010; De Carvalho and Callaghan, 2011). Specic
breathing patterns were required of the participant at the time of
exposure in order to ensure the diagnostic quality of the image.
Therefore, it was impossible to have the radiographs taken with the
subjects unaware of the exact instant of capture and this could have
affected the results. However, the risk of a subject altering their
spine posture because they were conscious of the data collection

880

D.E. De Carvalho, J.P. Callaghan / Applied Ergonomics 43 (2012) 876e882

Fig. 5. Intervertebral joint angles (L1/L2 - L5/S1 from left to right) for each posture with signicant differences italicized in the corresponding table of p-values.

occurs in any laboratory based study where a participant is tted

with measurement equipment. Further, securing the radiographic
quality of the image with the least numbers of exposures far
outweighs any negative.
Favorable comparisons can be made between the results of this
study and previous radiographic data. The average lumbar lordosis
in standing (62.88
/15
) is slightly greater than reported values
in the literature 40e60
(Lord et al., 1997; Saraste et al., 1985;
Stagnara et al., 1982). However, these past studies all had
included larger subject numbers (greater than 100) which likely
accounts for this difference. In a study of two participants sitting in
an automobile seat, Hazard and Reinecke (1995) found lumbar
lordosis angles of 21
with maximum deation (0.32 cm excursion)
and 41
at maximum ination (11.5 cm excursion) of a pneumatic
continuous passive motion lumbar support. The lumbar lordosis
angles found in the current investigation were 20
/13
with no
lumbar support and 30
/3
with maximum lumbar support.
Lumbar support excursion was measured differently in these two
cases: lumbar support prominence in this study is a standardized
measure using the ASPECT II manikin (Reed et al., 1999; Schneider

Fig. 6. Lumbosacral Angle (black) and sacral tilt (gray) angles for each posture.
Standing angles were signicantly different than all seated postures (p < 0.001) and no
differences were found between levels of lumbar support.

et al., 1999) compared to ination diameter used by Hazard and

Reinecke (1995). However, the resulting lumbar lordosis
measures with respect to increasing magnitudes of lumbar support
are in agreement. Other studies using various types of upright seats
with backrests have found sitting lumbar lordosis values of 47.9
/
11.9
(Makhsous et al., 2003: prototype seat), 34
/15
(Lord
et al., 1997), 30.2
/13.6
and 43.3
/11.8
(Lin et al., 2006:
normal and prototype seat respectively). Andersson et al. (1979)
found increasing lumbar lordosis angles in occupants sitting in an
upright seat with increasing levels of back support: 22.2
/5.9

with no back support, 28.1
/3.1
with back support and 46.8
/
5.1
with lumbar support. The magnitudes found in the current
study are in line with these other seating studies.
Standing measures of sacral inclination in this study (42.50
/
10
) fall within the reported range from the literature: 30e46

(Andersson et al., 1979; During et al., 1985; Itoi E, 1991; Saraste
et al., 1985). Quite different from previous literature, however,
was the relatively greater posterior rotation of the pelvis in the
three sitting conditions (indicated by lower values of sacral inclination angles): 1.63
/7
in 0% LSP, 1.25
/7
in 50% LSP and
3.13
/8
in 100% LSP. At this point, there are no other studies to
compare radiographic measures of pelvis posture in automobile
seats. Sacral inclination angles in chair sitting have been reported to
be much more anteriorly rotated: 25.0
/9.5
(Makhsous et al.,
2003), 16
/8.4
and 22.8
/8.9
(Lin et al., 2006: normal and
prototype seat respectively). Andersson et al. (1979) found
increasing sacral inclination angles (increasing anterior rotation)
with increasing amounts of lumbar support as follows: 17.1
/4.1

(no back support), 20.5
/2.4
(with back support) and 28.3
/
4.7
(with lumbar support).
The inability of the lumbar support to impart a change in pelvic
posture combined with the decreased lumbar lordosis in sitting
provides an interesting point of discussion with respect to intervertebral joint motion. Past research has shown that the lower
intervertebral joints are responsible for a large portion of the
lumbar lordosis angle taken between L1 and S1 (Andersson et al.,
1979 and Makhsous et al., 2003). In this study, standing intervertebral disc angles fall within the range of reported values for L1/L2
and L5/S1 (Note: where authors presented segmental lumbar
lordosis angles only, intervertebral joint angles were calculated
by taking differences): 2
e8
and 14
e21
respectively
(Busche-McGregor et al., 1981; Dunk et al., 2009; Lin et al., 2006;
Lord et al., 1997; Makhsous et al., 2003; Stagnara et al., 1982). The

D.E. De Carvalho, J.P. Callaghan / Applied Ergonomics 43 (2012) 876e882

values for the remaining intervertebral segments were slightly

smaller in this study compared to the range of reported values:
7
e10
L2/L3, 8.5
e12
L3/L4 and 3
e15.6
L4/L5 (BuscheMcGregor et al., 1981; Dunk et al., 2009; Lin et al., 2006; Lord
et al., 1997; Makhsous et al., 2003; Stagnara et al., 1982) but still
display the same pattern of increasing exion toward the sacrum.
Also well described is the increased exion at the intervertebral
joints in sitting compared to standing (Andersson et al., 1979; De
Carvalho et al., 2010; Dunk et al., 2009; Makhsous et al., 2003). To
date, there is no corresponding literature in automobile sitting to
compare the intervertebral joint angles found in this study.
However, it should be highlighted that they are more exed with
the exception of L1/L2 and L5/S1compared to ranges reported in
ofce chair sitting conditions: 0.1
e5
L1/L2, 2.8
e7.6
L2/L3,
5
e12
L3/L4, 7
e18.3
L4/L5 and 13.4
e17.7
L5/S1 (Dunk et al.,
2009; Lin et al., 2006; Lord et al., 1997; Makhsous et al., 2003).
We were unable to obtain radiographic measures of full exion
conditions to present these angles as a percentage of range of
motion. However, considering Dunk et al. (2009) found intervertebral joint angles to approach their limit of range of motion in
slouched sitting on a stool, we can speculate that these joints would
be likely reaching their end range of motion in automobile seats as
well. Since signicant tension has been shown to develop in the
spine with greater than 75% range of motion (Adams et al., 1994),
we could expect increased strain of the posterior passive elements
especially between the levels of L2 and L4. We are also particularly
concerned with developing strains at L5/S1, considering the
amount of posterior rotation of the pelvis with respect to standing
(39.38
e44.13
depending on the level of lumbar support).
Increasing the levels of lumbar support was able to introduce some
extension at the intervertebral joints; however, the motion was
mainly imparted between L1 and L4, with the greatest change in
joint rotation being 3.6
at the level of L2/L3 compared to no lumbar
support.

5. Conclusions
The radiograph measures in this study provide a comprehensive
summary of the effect of sitting in an automobile seat with varying
amounts of lumbar support. The results support that the prototype
lumbar support tested is capable of affecting lumbar spine posture,
especially at the upper lumbar segments. Increasing lumbar
support from the current excursion of 2 cme4 cm resulted in
a trend of returning radiographic measures of the lumbar spine to
more extended values. More neutral spine postures are typically
associated with lowered risk for injury and discomfort; therefore,
the change toward increased lumbar spine extension imparted by
the support creates a healthier scenario for the low back. However,
due to the inability of the support to affect pelvic posture, one must
question the potential for increased strains at the lumbosacral
junction when such a support is used statically for prolonged
periods of time. Also worthy of consideration is the focal effect of
the support, the greatest postural changes were created at the level
where the support was centered, with decreasing changes to the
intervertebral joints as the distance from this contact point
increased. The signicant differences in radiographic measures
from standing to sitting presented in this paper further emphasize
the range of motion experienced at different vertebral levels in car
seat sitting and the importance of returning the spine and pelvis to
a less exed posture with a lumbar support. Further investigations
should determine the impact these postural changes have on the
risk of injury and low back discomfort during a prolonged driving
scenario.

881

Funding
Diana De Carvalho is supported by a CIHR Doctoral Research
Award and a FCER Fellowship Award. Dr. Jack Callaghan is supported by a NSERC Canada Research Chair in Spine Biomechanics
and Injury Prevention. Schukra of North America provided nancial
support as well as the prototype automobile seat. These funding
sources were not involved in the study design, collection, analysis,
data interpretation, report writing or decision to submit this paper
for publication.
Acknowledgments
The authors wish to thank radiology technologists Linda Tanner
and Jane Hillier, Drs. Andrew Bidos and Ryan Larson for assistance
during data collection and Erin Harvey for statistical advice.
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