Back Injury Prevention

• What is the most likely kind of injury resulting from manual materials handling?
• How can we prevent back injury resulting from MMH?
• How does organization of the work flow reduce the risk for back injury due to MMH?
• How does job design/redesign reduce the risk for back injury due to MMH?
• How do you eliminate heavy MMH?
• How can we decrease MMH demands?
• How can we reduce stressful body movements in MMH?
• How can we improve the environment to reduce the risk for injury due to MMH?
• How effective is pre-placement screening in back injury prevention?
• Does training reduce back injuries?

What is the most likely kind of injury resulting from manual materials handling?

It is probably fair to say that every worker who lifts or does other manual handling tasks is at some risk for musculoskeletal injury. Low back injury is the most likely kind of injury. The complete elimination of this risk is not realistic because MMH usually involves awkward postures and repeated forceful movements. However, people can reduce the number and the severity of manual handling-related injuries substantially by using safe work practices.

To prevent occupational back injuries, it is essential to identify the factors of MMH that make the worker more susceptible to injury or that directly contribute to injury.

When efforts to prevent injuries from MMH focus on only one risk factor, they do not significantly reduce the injury rate. A more successful approach such as the one offered by ergonomics combines knowledge of engineering, environment, and human capabilities and limitations. The following aspects should be considered:

• organization of work flow
• job design/redesign (including environment)
• pre-placement procedures, where necessary
• training

Often, poor planning of the work flow results in needless or repeated handling of the same object. When articles are temporarily stored in one place, moved to another, stored again, and moved again, a more efficient work flow can eliminate many potentially harmful MMH tasks.

The design or redesign of jobs involving MMH should be approached in the following stages:

• eliminate heavy MMH
• decrease MMH demands
• reduce stressful body movements
• improve environmental conditions

Consider using powered or mechanical handling systems if eliminating MMH tasks completely is not possible. Mechanical aids lower the risk for back injury substantially by reducing the worker's physical effort required to handle heavy objects.

Manual handling such as lifting and carrying can be easier and safer if mechanized by using lift tables, conveyors, yokes or trucks. Gravity dumps and chutes can help in disposing of materials. Mechanical aids also reduce the need to select workers for the task, but it is essential that the worker is properly trained in the safe use of the available equipment.

If mechanical aids cannot eliminate manual handling, decrease the MMH demands. There are several ways to achieve this:

• Decrease the weight of handled objects to acceptable limits.
• Reduce the weight by assigning two people to lift the load or by splitting the load into two or more containers. Using light plastic containers also decreases the weight of the load.
• Change the type of MMH movement. Lowering objects causes less strain than lifting. Pulling objects is easier than carrying. Pushing is less demanding than pulling.
• Change work area layouts. Reducing the horizontal and vertical distances of lifting substantially lowers MMH demands. Reducing the travel distances for carrying, pushing or pulling also decreases work demands.
• Assign more time for repetitive handling tasks. This reduces the frequency of handling and allows for more work/rest periods.
• Alternate heavy tasks with lighter ones to reduce the build-up of fatigue.

It is important that the design of MMH allows the worker to do tasks without excessive bending and twisting. These body motions are particularly dangerous and can cause back injury even when not combined with handling loads.

• Provide all materials at a work level that is adjusted to the worker's body size.
• Eliminate deep shelves to avoid bending.
• Ensure sufficient space for the entire body to turn.
• Locate objects within easy reach.
• Ensure that there is a clear and easy access to the load.
• Use slings and hooks to move loads without handles.
• Balance contents of containers.
• Use rigid containers.
• Change the shape of the load so the load can be handled close to the body.

The design of the work environment is an important element of back injuries prevention.

• Keep the temperature of the working area between 18C and 21C when practical.
• Ensure an adequate work/rest schedule. In extreme cases that require heavy MMH in temperatures above 30C, rest periods or light work load tasks may account for 75 percent of the work time.
• Wear properly designed clothing to decrease the heat absorption by the body and to increase evaporation. This is particularly important for people required to work in high temperature environment.
• Encourage using proper protective clothing for people working in a cold environment. This is essential to protect the worker from hypothermia and to preserve dexterity needed for safe work.
• Illuminate the work area for MMH tasks at the level of 200 lux.
• Use task lights or other additional light sources to improve the ability to see clearly where MMH requires fine visual discrimination.
• Use angular lighting and colour contrast to improve depth perception. This helps the worker where MMH involves climbing stairs or moving in passageways.

When the MMH tasks are done outdoors, the temperature conditions including the humidex (in hot weather) or wind-chill factor (in cold weather) have to be monitored very closely.

• Reduce MMH tasks by half when the temperature exceeds 28^oC.
• Stop MMH when the temperature exceeds 40^oC.
• Restrict MMH to the minimum possible when wind-chill drops below -25^oC.
• Stop MMH when wind-chill drops to -35^oC.

More details about working and doing MMH activities in hot and cold environments are available in CCOHS publications Groundskeepers Safety Guide and Cold Weather Worker's Safety Guide.

The objective of pre-placement screening is to select individuals less likely to be injured in work involving MMH. X-rays, medical examination, physiological testing may be hazardous under certain circumstances or may not be specific enough to achieve the intended objective. They do not reduce the occurrence of occupational back injury among selected individuals. Worse, the selection procedures can be abused when applied as a substitute for work design.

The only situation where pre-placement screening may be justified as a preventive measure is where a job involves heavy MMH in an unpredictable and uncontrollable environment. Examples of these are firefighting, mine and water rescue, and police work. Even here, the selected tests should closely reflect with the anticipated requirements of the job. By far the best pre-selection method, if one must be used, is performance of the actual task.

There is little evidence to indicate that training alone reduces the number of MMH injuries. When combined with work design, training is an important element in the prevention of injuries. Proper training also shows the worker how to actively contribute to the prevention of injuries. A good training program should:

• make the worker aware of the hazards of MMH
• demonstrate ways of avoiding unnecessary stress
• teach the worker to handle materials safely

Instruction on how to lift "properly" is the most controversial issue concerning training in MMH. There is no single correct way to lift because lifting can always be done in several ways. Because of this, on-site, task specific training is essential. In fact, it is sometimes safer to allow the worker to use common sense acquired by experience rather than to force new biomechanically correct procedures. But there are some general lifting rules.

• Prepare to lift by warming up the muscles.
• Stand close to the load, facing the way you intend to move.
• Use a wide stance to gain balance.
• Ensure a good grip on the load.
• Keep arms straight.
• Tighten abdominal muscles.
• Tuck chin into the chest.
• Initiate the lift with body weight.
• Lift the load close to the body.
• Lift smoothly without jerking.
• Avoid twisting and side bending while lifting.
• Do not lift if you are not convinced that you can handle the load safely.

It is also important that workers:

• take advantage of rest periods to relax tired muscles; this prevents fatigue from building up
• report discomforts experienced during work; this may help to identify hazards and correct working conditions.

Finally, there is an aspect of training that cannot be overlooked if training is to be part of an effective prevention program.

Workers should be educated that muscles, tendons and ligaments are not prepared to meet the physical stress of handling tasks when they are not "warmed up." They are more likely to pull, tear or cramp when stretched or contracted suddenly under such conditions. This, painful enough by itself, can lead to more serious and permanent injury if physically stressful work is continued. Warming up and mental readiness for physically demanding tasks are important for any kind of MMH, but particularly for occasional tasks where the worker is not accustomed to handling loads. Workers are more likely to have "ready-to-go" attitude for the task ahead when they understand that other preventive measures are also tried.