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IB9 Musculoskeletal risks and control Element B1: Musculoskeletal risks & control

Learning outcomes: On completion of this element, candidates should be able to:

Outline type causes and relevant work place examples of injuries and ill health conditions associated with repetitive physical activities, manual handling and poor poster. Explain the assessment and control of risks from manual handling,repetitive activities and poor poster.

Minimum hours of tuition: 4 hours.

1.0 Ergonomics
Understanding ergonomics at work You may have come across the term ‘ergonomics’. People sometimes refer to it as ‘human factors’. Not everyone really understands what ergonomics is, what it does, or how it affects people. What is ergonomics? Ergonomics is a science concerned with the fit between people and their work. It puts people first, taking both their limitations and capabilities into account. Ergonomics sets out to ensure that tasks, equipment, information and the environment suit each worker. To assess the fit between a person and their work, ergonomists have to consider many aspects, including:
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the job being done; the demands on the worker; the equipment used (its size, shape, and how appropriate it is for the task); the information used (how it is presented, accessed, and the physical environment (temperature, humidity, lighting, noise, vibration); the social environment (such as teamwork and supportive management). body size and shape; fitness and strength; posture; the senses, especially vision, hearing and touch; the stresses and strains on muscles, joints, nerves. mental abilities; personality; changed);

Ergonomists consider all the physical aspects of a person, such as:
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Ergonomists also consider a person’s psychological aspects, such as:
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knowledge; experience.

Assessing physical aspects, jobs, equipment and working environment and the interaction between them enables ergonomists to design safe, effective and productive work systems. Applying ergonomics to the workplace reduces the potential for accidents, ill-health and injury and improves performance and productivity. Accidents In the design of control panels, consider:
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the location of switches and buttons - switches that could be accidentally knocked on or off might start the wrong sequence of events that could lead to an accident; expectations of signals and controls - most people interpret green to indicate a safe condition. If a green light is used to indicate a ‘warning or dangerous state’ it may be ignored or overlooked; information overload - if a worker is given too much information they may become confused, make mistakes, or panic. In hazardous industries, incorrect decisions or mistaken actions have had catastrophic results.

Ill-health Controls and equipment should be positioned in relation to how they are used. Those used most often should be placed where they are easy to reach without the need for stooping, stretching or hunching. Failure to observe ergonomic principles may have serious repercussions, not only for individuals, but whole organisations. Many well-known accidents might have been prevented if ergonomics had been considered in designing the jobs people did and the systems within which they worked. Ergonomics is typically known for solving physical problems. For example, ensuring that work surfaces are high enough to allow adequate clearance for a worker’s legs. However, ergonomics also deals with psychological and social aspects of the person and their work. For example, a workload that is too high or too low, unclear tasks, time pressures, inadequate training, and poor social support can all have negative effects on the person and the work they do. Here are some examples that highlight typical ergonomic problems found in the workplace: Display screen equipment
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The screen is poorly positioned - it is too high/low/close/far from the worker, or is offset to one side. The mouse is placed too far away and requires stretching to use. Chairs are not properly adjusted to fit the person, forcing awkward and uncomfortable postures. There is glare on the screen from overhead lights or windows, increasing the risk of eyestrain. Hardware and/or software are not suitable for the task or the person using it, causing frustration and distress. Not enough breaks or changes of activity.

g. eye strain. Conflicting demands. trips. The employee has little say in how they organise their work. wet. easy to use Is the person satisfied with their working arrangements? Are there frequent errors? and well maintained? . e. Manual handling        The load is too heavy and/or bulky. These problems may lead to tiredness or exhaustion. The task involves frequent repetitive lifting. Excessive overtime worked by employees. several approaches should be used: Employees should be approached and their views sought. including aches. hands.These problems may result in mistakes and poor productivity. Work-related stress     Work demands are too high or too low. The task is performed on uneven. They are the best-placed to advise on the work they do. Ideally. Managing the working day     Not enough recovery time between shifts. The task is performed under time pressures and incorporates too few rest breaks. the problems they may have and the impact of those problems on health. Poor control of the risks causing work-related stress could lead to ill health and reduced performance and productivity. The load cannot be gripped properly. and falls. or sloping floor surfaces. or fingers. The work system should be assessed. The load has to be lifted from the floor and/or above the shoulders. using a series of simple questions such as     Is the person in a comfortable position? Does the person experience discomfort. The problems may also contribute to the risk of slips. stress. such as bending or twisting. which can increase the likelihood of accidents and ill health. placing unreasonable demands on the person. fatigue. These problems may result in physical injuries such as low back pain or injury to the arms. There are many ways in which ergonomic problems can be identified. safety and performance. The task requires awkward postures. or stress? Is the equipment appropriate. Poorly-scheduled shifts. high productivity and quality. Shifts that clash with domestic responsibilities. Poor support from management and/or colleagues. headaches and other aches or pains. pain.

1 Work-related Upper Limb Disorders and the Risk Factors A Guide to Work-Related Upper Limb Disorders (WRULDs). and stresses at work and improve job satisfaction. Care should also be taken that a change that is introduced to solve one problem does not cause difficulties in another part of the workplace. pains. Examination of sickness. If the employer thinks that an ergonomic problem has been identified. arrange items stored on shelving so those used most frequently and those that are the heaviest are between waist and shoulder height. raise platforms to help change shift work patterns. absence and turnover records may also highlight areas for investigation. 1. Any alterations should be properly evaluated by those who actually do the job. introduce job rotation between different tasks to reduce physical and mental fatigue. It is highly likely that there will be clues to the causes of those incidents in what has happened. It is not always necessary to consult ergonomics professionals. For example:      provide height-adjustable chairs so individual operators can work at their preferred work height. A minor alteration may be all that is necessary to make a task easier and safer to perform. It is possible to eliminate aches. the circumstances surrounding them should be examined thoroughly. professional assistance is often the next step. Definition: The term WRULD is used here as synonymous with Repetitive Strain Injury. Question: Outline the meaning of the term ‘ergonomics’. Accident reports can be very useful in identifying details of incidents and their possible causes. they should look for likely causes and consider possible solutions. Employees should be consulted and their suggestions and ideas solicited. and operators reach badly located controls. this will make it more likely that they will accept any proposed changes.even small changes such as altering the height of a chair can make a considerable difference. Are there signs of poor or inadequate equipment design. and can save money in the long term by reducing injuries and absence from work. Ergonomic solutions can be simple and straightforward to make . If they are involved from the start of the process. Cumulative Trauma Disorder etc. It is a somewhat vague term under which a large variety of conditions and symptoms . and the expense of making changes can often be kept low. if a straightforward solution cannot be found. Outline the ill health effect arise from poor ergonomic design. However. remove obstacles from under desks to create sufficient leg room. An understanding of ergonomics in the workplace can improve the daily work routine. such as plasters on workers’ fingers or ‘home-made’ protective pads made of tissue or foam? If there are frequent errors and incidents where mistakes have occurred and people have been injured. Ergonomics input does not necessarily involve high costs.

Difficulties with diagnostic tests and changing symptoms have in the past led some people to believe that this condition is predominantly 'in the mind' rather than reflecting a physical injury. with prescribed clinical tests and clear-cut associated symptoms. of what the damage consists and how to determine a prognosis. Examples include the reporting of heaviness. the structure at fault is not easily identifiable. . and can be hard to describe by those who experience them. similarities in individuals' symptoms and symptom behaviour. tingling. usually without any visible signs. Those working in an industrial setting seem to be more likely to develop a more specific form of WRULDs. cramps. However. which still lack a clear-cut diagnosis. Another aspect can be the emergence of symptoms generally associated with the sympathetic nervous system. hands feeling hot or cold. tendonitis. In contrast with conditions such as 'tennis elbow' and carpal tunnel syndrome. All these are 'classic' conditions. It is typical for symptoms to 'jump around' and once established. recent research has clearly identified measurable nerve function deficits. Within the first category. intensity and nature. overuse and repetition. Even though psychological factors do play a role. the current medical understanding of exactly how this condition is caused. pain. This is likely to be related to the different 'mix' of risk factors in these settings. to appear spontaneously without obvious trigger or cause. This is in contrast to the diffuse group of conditions which largely escape the clinical tests and sophisticated medical investigation. often disappointing results to non-diffuse type treatment. In spite of the wealth of information and opinions on diffuse WRULDs. tenosynovitis. There is anecdotal evidence to suggest that people using the keyboard and mouse are more likely to develop a diffuse condition. Symptoms are often felt 'deep' in the tissues. swelling and tightness. thoracic outlet syndrome and others. tennis elbow. The diffuse group of conditions is characterised by a range of symptoms (ache. tightness and others) which tend to vary in location. The factors that are consistent in this group are:    similarities in individuals' causative history. A fundamental distinction can be made between those conditions with a specific recognised medical diagnosis and those of a so-called 'diffuse' nature. stress. is still very limited. three groups of risk factors have been identified and are generally accepted as such. heaviness. de Quervain's syndrome. well-recognised. These are:    static muscle loading. These risk factors are identical for both the diffuse and the non-diffuse conditions.are classed. the following conditions are frequently encountered:       carpal tunnel syndrome. numbness. the non-diffuse group.

or on maintaining a certain posture or position which involves little or no movement. which leads to an increased perception of pain. Overuse of specific muscles and repetition of certain activities can carry the risk of straining tissues beyond their normal capacity. This is due to stress causing increased muscle tension and generally sensitising the nervous system. Taking computer work again as our example. which focuses on holding an object. When using the keyboard. the risk of an overuse problem is greatly reduced compared with typing or using the mouse with wrists extended or deviated. this can lead to localised muscle tightness and postural imbalances. the angle of the wrist while typing or using the mouse. Pathology. muscle strain or joint problem may coexist. static muscle work is required to hold the arms and hands in place. Furthermore. A combination of nerve compression. When muscles contract. can play an important part in the onset and experience of WRULDs too. Computer work tends to be more static and less varied than clerical or administration work. tendons or joints. For muscles to be able to contract. family or any other area. Stress and other psychological factors. As a result. As the nervous system itself . they require energy which is delivered to them via the blood circulation. Initially. reduced blood supply and over-excitation through the body's stress response is believed to cause a low-level inflammation of the nerves. perhaps surprisingly. Any repetitive task performed continuously without sufficient breaks or changes in activity will place demands on specific structures and result in a risk of injury. more specifically. whether related to work.Static muscle loading. Overuse and repetition. as during static activity. Which parts of the body are actually affected and how can the often-varying symptoms be explained? Different structures have been suspected of causing the pains associated with WRULDs and now there is strong evidence that the main site of injury and symptom generation is the nerves rather than muscles. they effectively compress the blood vessels which feed them and if a contraction is maintained for any length of time. can therefore be important contributors to WRULDs. and can cause static muscle loading in a variety of body areas unless regular breaks and changes in activity occur. we can see that with wrists in a neutral position. This results in muscle fatigue and can be experienced as an ache or discomfort. relaxed position. their blood supply is reduced and a buildup of waste products can accumulate. which can compromise the blood supply and the nerve function in the arms and hands. Over time. causing minimal compression or stretch and requiring minimal effort and muscle activity. The problem with this form of activity is related to the muscle structure and the way muscles work. pains and injury can result. Although a tendinitis. generating any of the symptoms listed earlier. aches. static muscle activity will occur there and in the muscles of the neck. Stress factors. the real cause of the diffuse pains appears to be located in the nerve structures. fatigue occurs and if demands increase or sufficient changes in activity or breaks are not provided. if the back is not well-supported. The way in which an activity is performed will affect the likelihood of a problem occurring. Stress. This is due to the affected structures working in a neutral. This in turn alters the functioning of these neural structures. normal touch can cause discomfort and gentle movements can become acutely painful. Static muscle loading describes muscular activity.

This can involve gentle gym workouts. three or four sessions are sufficient. The physiotherapy techniques that have been found to be most effective include:    neural and spinal mobilisation. Frequently. yoga. This should include exercises to be used both at home and at work. Before embarking on an exercise regime. it is advisable to have an assessment by a physiotherapist who is specialised in the treatment of these disorders to ensure appropriate exercises are given. However. People with an established and chronic condition will benefit from a formal work rehabilitation programme. The time it takes symptoms to ease when stirred up. the symptoms experienced by the individual often change. This should allow for new postural and work habits to be formed and a set of exercises to be carried out regularly. . From an initial assessment. The intensity and spread of symptoms. but they may distort the messages and can even generate their own. good workstation ergonomics and advice on posture and work pacing. Some need a long time and some might have to limit or space out particularly straining tasks. when a person is first assessed. As a rule swimming. people with WRULDs seek treatment only when the symptoms start to seriously interfere with their work. Rest alone does not cure WRULDs. or when their pains persist even during rest. the therapist should be able to determine the main underlying contributory factors and develop an appropriate treatment programme for each individual. his or her symptoms are quite acute.is affected. gentle stretch classes and walking are preferable to racquet sports and weight training. prolonged rest will lead to a deconditioning and weakening of the muscles and associated structures. relaxation.or six-monthly intervals. In our experience. During the course of treatment. Exercises are a crucial part of treatment and a specific programme should be developed for each individual to follow. treatment can continue over a longer period of time than initially expected. Therefore. it may at best settle the symptoms temporarily. There is no standard treatment period: for some people who seek treatment early. treatment may continue for a number of years with appointments at three. At times. As these disorders take some time to develop. which will progressively increase the tolerance to the critical activity. This is unfortunate as early intervention produces the best and fastest results. they tend to take time to resolve and often require changes in work pattern and in postural or tension habits. An experienced therapist is able to interpret these changes and to adjust and progress the treatment accordingly. the treatments are spread out over time with emphasis being placed on self-management. for others who have developed a more chronic problem. As the symptoms ease. Prognosis. No longer do these nerves simply transmit the information its receptors pick up. exercises. soft tissue techniques. Taking up some form of general exercise is often recommended. symptoms can vary greatly. Factors that affect the prognosis are:    The duration of WRULD symptoms. Treatment. swimming or organised classes. the most effective treatment lies in a combination of hands-on techniques. Most people with WRULD make a good recovery with appropriate treatment. postural and muscle imbalance work.

You may be aware only of chronic fatigue. probably others are more aware of it than you are. ligaments and muscles of the body against injury or progressive deformity. This is called good posture. The work in which people are involved and their ability to manage it. Tighten your stomach muscles as hard as you can without holding your breath. Posture is the position of the parts of your body in relation to each other. When postural habits are good. stiffness of the joints in the mid/upper back and hip. get into the habit of tightening the backside muscles. Try to maintain that level of tension as you go about daily activities. there is a way of holding and moving your body that is balanced and efficient. Poor posture causes muscular strain. If someone has good posture in standing. allowing sufficient rest periods or avoidance of specific tasks. then let them relax by just over half. It produces uneven stress on spinal joints and discs and may cause permanent damage. will also be of importance as may stress or psychological factors.There may also be underlying postural problems such as a long-standing old back injury or an altered spinal curvature that can affect the prognosis. lengthened and weakened muscles or tightened and overly strong muscles. you will find there is almost none to be recorded. Your posture is second nature to you. Hold for 10 to 15 seconds. pressure on nerves. but no matter what you are doing. your clothes fit better. then your bottom muscles will automatically work more when you are walking. Posture. Good posture makes movement more effective and more energy-efficient. headaches or backaches which can stem from poor posture. for example. Try to consciously tighten them a little when walking. Your spine has a chance to develop normally and your internal organs function better. 20 2152 1. whilst minimising stress. then relax. Your posture constantly changes. Allow your shoulders to relax so that the arms hang loosely by your sides. you can work and play longer without fatigue because your muscles work more efficiently. when measuring muscle activity in this position. depending on the activity. All of these can produce pain and disability and destroy the natural balance of the body. This should have the effect of lifting your breast bone up a little and make you stand a bit taller. excessive movement of the joints in the neck and low back. It is a state of muscular and skeletal balance which protects the bones. We talk about the body being in balance.g. a taken-for-granted habit. because the skeletal frame is perfectly balanced and does not require additional support from the muscles. Poor postural habits can lead to secondary problems. . You look healthier and happier. If you have poor posture. You will find that if you use your stomach muscles as suggested. e. particularly of the spinal muscles and therefore wastes energy. and you make a better impression on others. When standing or sitting.2 This state of "perfect balance" is best achieved by:This state of "perfect balance" is best achieved by:Avoiding a poking chin position and keeping your head level so that a perpendicular line dropped from just below your eye will hit your collar bone.

according to the Health and Safety Executive: . called a lordosis. use the height adjustment if available to assure comfortable positioning. Excessive pressure within the discs may. 20 673 Continue 1.When you stand. While driving: Move the seat far enough forward to allow knees and elbows to be slightly bent as you reach for the steering wheel and pedals. Good seats and how to use them. Your weight should be evenly distributed on both legs. Your weight should be evenly distributed on both buttocks. Sit tall with both feet flat on the floor. but this can be avoided through proper posture. Use added low back supports if needed. move your stool close enough to the work surface to allow comfortable positioning. At work: Avoid hunching forward. Look straight ahead. putting seat too far back or forward. Pretend you are balancing a book on your head. This curve. Use arm rests if available. your whole back against the chair back. The discs located between each of the vertebrae act as shock absorbers. instead. using flat stools with hard surfaces and no height adjustments. so as to rest your arms comfortably. shift your position from time to time. reaching for your work.3 Sitting Posture As you sit. Avoid:        using straight-back chairs with no low back support. helps to distribute your weight properly through the spine and pelvis. not as though you are on sentry duty. Good seats and proper sitting posture help reduce this effect and ease the pressure on the discs. if using a stool. such as sofas. your pelvis rotates and the lordosis or low lumbar curve is flattened. your lower back should curve slightly. 1. using soft seats. Your arms should swing freely from your sides. Walk tall with your feet pointing straight ahead. never down. You should be relaxed. The knees should be straight but not locked. cause damage. If you are sitting for long periods. At home: make sure your back is supported comfortably. ribs raised. Also. using flat seat backs unless a supportive cushion can be used. when sitting.4 Managing WRULDs. slouching while driving. and your head erect. stomach flat. place it close to your work surface. shoulders and head erect.

The main areas that are likely to increase the risk of WRULDs are listed in the table below. When someone returns to work. the timing of their return depends on medical advice. it is preferable for them to carry out light duties or reduced hours to start with. People with WRULDs usually completely recover if the problem is recognised early and treated appropriately. So remember:  things can be done to prevent or minimise WRULDs. It is cheaper than redesigning them or purchasing more suitable tools at a later stage. Encourage workers to report any signs and symptoms early before they become too serious. The approach in most cases is for the affected person to rest their arm/hand to reduce inflammation. ¦ Try to consider risk when setting up new workstations. They can interact with each other to increase the risk. ¦ Test any changes on one or two workers before making changes for everyone.5 Reducing the risk of WRULDs If your investigations (known as a risk assessment) show that there is a problem.this means looking around your workplace to see which jobs may cause harm. reducing the risk of WRULDs . Simple and low cost changes can often be effective. But it is possible to return before all the symptoms have cleared up totally. rather than make the worker adapt to fit the task and workstation. A few general tips are: ¦ Changes do not necessarily need to be expensive.WRULDs can be effectively managed in the workplace by:    assessing the risks . Assessing the risks of WRULDs in your workplace To help you find out which tasks are risky.6 Dealing with WRULDs It may not be possible to prevent all cases of WRULDs. and seek medical help if necessary. watch workers as they carry out their jobs. the following section provides some helpful suggestions for reducing the risks. because workers respond differently to the risks. 1. If a worker has been off work suffering from a WRULD. Anyone with a WRULD needs to be helped to prevent it getting worse. . ask them about any problems and check any illness/injury records. ¦ Tackle the serious risks or those that affect a large number of workers first. If you find that a task is causing or contributing to a WRULD. 1.this could mean changing the way work is organised. ¦ Try to make the task and workstation suitable for each worker. you should stop the worker from doing that task. helping sufferers back to work. Physiotherapy may help.

neck and head are known to cause musculoskeletal problems. the main ill-health effects associated with using display screen equipment are: Upper Limb Pains and Discomfort A range of conditions of the arm. The contribution to the onset of any disorder of individual risk factors is not clear. leading to a range of symptoms such as impaired visual performance. a drifting. These range from temporary fatigue or soreness in the limb to chronic soft tissue disorders like peritendinitis or carpal tunnel syndrome. Prolonged static posture of the back. furniture. red or sore eyes and headaches. so early reporting of symptoms. poor positioning of the display screen equipment. Annex B. training. Fatigue and Stress . Eye and Eyesight Effects Medical evidence shows that using display screen equipment is not associated with damage to eyes or eyesight. hand and shoulder areas linked to work activities are now described as work related upper limb disorders. including glare and reflections. proper treatment and suitable rehabilitation is essential. job design and work planning. But some workers may experience temporary visual fatigue. nor does it make existing defects worse.  20 preventative measures are cost-effective. poor lighting. It is likely that a combination of factors is concerned. 676 Continue 2. or adoption of awkward posture which can cause further discomfort to limbs. Awkward positioning of the hands and wrist are further likely factors. Such uncorrected defects can work with display screen more tiring or stressful than would otherwise be the case. Some keyboard operators have suffered from occupational cramp. poor legibility of the screen or source documents.0 Display screen equipment According to the Health and Safety (Display Screen Equipment) Regulations 1992. Outbreaks of soft tissue disorders among keyboard workers have often been associated with high workloads combined with tight deadlines. Like other visually-demanding tasks. flickering or jittering image on the screen. These may be caused by:      staying in the same position and concentrating for a long time. This variety of factors contributing to display screen work risk requires a risk reduction strategy which embraces proper equipment. you cannot prevent all WRULDs. VDU work does not cause eye damage but it may make workers with pre-existing vision defects more aware of them.

Many symptoms described by display screen workers reflect stresses arising from their task. All these have been linked with stress in display screen work. and the advice is summarized as: The levels of ionising and non-ionising electromagnetic radiation which are likely to be generated by display screen equipment are well below those set out in international recommendations for limiting risk to human health created by such emissions and the National Radiological Protection Board does not consider such levels to pose a significant risk to health. under-utilisation of skills. by following good practice techniques such as . there is substantial evidence that these concerns are unfounded. No special protective measures are therefore needed to protect the health of people from this radiation. consultation and involvement of the user. particularly lack of sufficient control of the work by the user. The Health and Safety Executive has consulted the National Radiological Protection Board. These complaints are relatively rare and the limited evidence available suggests they may be associated with environmental factors. which has the statutory function of providing information and advice on all radiation matters to Government Departments. People who suffer from very rare (1 in 10 000 population) photosensitive epilepsy who react adversely to flickering lights and patterns also find they can safely work with display screens. environment and task. good design of the user's workplace. They may be secondary to upper limb or visual problems but they are more likely to be caused by poor job design or work organisation.careful design. However. such as low relative humidity or static electricity near the display screen equipment. People with epilepsy who are concerned about display screen work can seek further advice from local offices of the Employment Medical Advisory Service. selection and disposition of display screen equipment. Facial dermatitis Some display screen users have reported facial skin complaints such as occasional itching or reddened skin on the face and or neck. high-speed repetitive working or social isolation. Electro-magnetic radiation Anxiety about radiation emissions from display screen equipment and possible effects on pregnant women has been widespread. The risks of display screen workers experiencing physical fatigue and stress can be minimised. although clearly they are not unique to it. The regulations also refers to other risks to ill-health: Epilepsy Display screen equipment has not been known to induce epileptic seizures. Effects on pregnant women There has been considerable public concern about reports of higher levels of miscarriage and birth defects among some groups of visual display unit (VDU) workers in particular. however. training. but attributing individual symptoms to particular aspects of a job or workplace can be difficult. due .

such as on a production line where there may be limited opportunity to move around. ·Repetitive movements over prolonged periods such as some manual assembly work. to avoid problems caused by stress and anxiety. since muscles will not be as supple in cold weather as they might otherwise be in warmer environments. However. often on hard surfaces such as concrete floors with little or no cushioning effect. 20 2154 Continue 2. ·Prolonged periods of standing. certain environmental factors such as cold workplaces will exacerbate the problem. to be most closely related with those tasks that involve one or more of the following: ·Prolonged periods of sitting. . working at conveyors. The example of the production/assembly line is useful in helping to show how a number of the above factors may conspire to increase the overall risk to the worker. especially if posture is poor and there are limited opportunities for breaks. especially if the work is repetitious or prolonged. Many scientific studies have been carried out. but taken as a whole their results do not show any link between miscarriages or birth defects and working with VDUs. pregnant women do not need to stop work with VDUs. especially in the lower back. As well as the nature of the task itself.0. The potential for back pain can be made worse by poor task layout that requires the worker to reach over. ·Repeated use of force and especially where that force is applied in an awkward position. They tend. ·Manual handling of loads. Assembling items from small components can cause a number of different health effects over the medium to longer term. however. which will induce muscle fatigue.g. ·Work in restricted work spaces where it is necessary to adopt an awkward posture in order to get at the item being worked on or with e. In light of the scientific evidence. women who are pregnant or planning children and worried about their concerns should be given the opportunity to discuss their concerns with someone adequately informed of current authoritative scientific information and advice.to electromagnetic radiation. say. or to twist or stoop to find component parts. These include: ·Back pain. a conveyor.1Jobs Giving Rise to Risk of Injury Musculoskeletal disorders can be developed from a number of different types of work situations. who require training in specific techniques to move people and especially bariatric patients. bricklaying etc. Manual handling of people is a major issue amongst healthcare workers. caused by prolonged periods of standing in a static position. working under a vehicle in a garage inspection pit.

X-Ray showing poor posture while working at a desktop computer Another example of a type of work that is being increasingly linked to the development and onset of MSDs is work with display screen equipment. often in less than ideal circumstances with regard to location and posture. unless there is a radical change in technology. meaning that many young workers have already begun to develop problems even before starting work. which is related to a lack of breaks or a high work rate (material on stress causation has been covered in element IB8). ·Fatigue and stress. ·Eye strain resulting from excessive ‘screen time’ which can eventually lead to more serious eye problems. has probably already had a number of years of exposure to the use of computers while at school and college. ·Eye strain from having to focus on small component parts. If that is the case then one can easily see that the next generation is storing up a host of problems.·Work-Related Upper Limb Disorders (WRULDs). which is a generic term for any type of upper limb disorder affecting hands. A person joining the workforce today. shoulders and upper back and can be caused in much the same way as back problems and especially by repetitive movements. That same person may now enter a line of work where. During that time. forearms. they may well have fallen into bad habits with regard to use and posture since it is almost certain that they will not have had specific training nor would their usage have been assessed. say at age 18. The rise of computer-based gaming will have added significantly to this exposure in many cases. while the body is still developing. and especially laptop computers. which include:<><> <><> WRULDs from prolonged use of small keyboards and pointing devices. . especially where parts need to be carefully aligned in order to fit together. wrists. they might continue to use computers for the next 50 years.

the assessor may wish to consider whether the task involves: ·Long carrying distances. ·A need to twist from one position to another ·Lifting loads from above shoulder height or from below knee height.g.·Back pain caused by adopting a poor posture and working on a laptop in that position for an extended period. The obvious thing to consider is the weight of the load. ·A requirement to reach into or over something. which is linked to other topics on this course such as dealing with aggressive customers. cryogenic) loads. liquids ·Live loads such as animals.0 Assessing and controlling risks from repetitive activities. boiling water) or cold (e. ·Availability of rest breaks The assessor should also consider the amount of force necessary to complete the task e. ·Availability of hand holds. manual handling and poor posture Factors for consideration when assessing risks The following factors need to be considered as appropriate whenever conducting an assessment of the risks associated with repetitive physical activities. 3.g. Factors to consider include: ·Sharp edges. the first thing that should be considered is the nature of the task itself. ·Fatigue and stress associated with the type of work being conducted. ·Hot (e. . For example. The Load Features of the load also need to be analysed. ·Excessive upward reaching. using manual hand tools such as a screwdriver may require considerably more force that using a powered version. or stooping. ·Significant repetition.g. ·Whether the load has an uneven centre of gravity. ·Difficult to grasp. manual handling and poor posture: The Task When assessing the potential for development of MSDs. ·Unstable loads e. ·Bulky or unwieldy. but just because a load may not weigh much does not always mean that it is going to be free of risk when lifted.g.

·Unmarked changes in level or obstructions that can create trip hazards. In this way. or adoption of a particular technique. to record their findings.g. a number of techniques have been developed that aid the assessor in examining the task in varying degrees of detail. The job can then be broken down into stages and the assessor will then watch it a second time. the assessor. the load. which may work to make it more difficult to grip an object due to sweating.1 Methods of assessing risks Perhaps the simplest way to assess risks associated with tasks involving repetitive physical activity. . ·Lighting levels – are they adequate? Will eyes take a few seconds to adjust when coming indoors from bright sunshine?. however. The workers can be asked about the task and their input can be sought with regard to which are the most problematic aspects of it and what they feel can usefully be done to mitigate the risks. Factors for consideration here include: ·Restrictions on available space e. ·Condition of the floor surface – slippery or uneven. ·Whether the task poses a particular risk to certain groups such as pregnant workers. The assessor will first watch the task to get an idea of how it is done and exactly what is involved. the working environment etc that appear to create risks. Observation is at the heart of any assessment. 20 2042 Continue 3. can come up with control measures that will help in reducing the risk. moving loads from inside cupboards.The Environment The task will be conducted in a workplace. ·Temperature and humidity. Individual Capability The final factor for consideration is the person who will be doing the work. ·Pre-existing injuries and/or ill-health conditions ·Degree of training and experience. manual handling and poor posture is to observe what is being done and make notes on aspects of the task. general fitness and height. which is useful for comparing risks between activities and helps with the prioritisation of resources. using a checklist covering factors like those identified above. which may have aspects that will need to be considered when planning how to move loads around and which may impose certain constraints on the workforce. Most of these approaches offer a form of numerical scoring system. in co-operation with the workforce. ·Clothing being worn – loose clothing is generally better as it allows the worker to adopt a better posture. Considerations include: ·Whether the task calls for unusual ability such as strength. ·Factors such as age. Over the last few years.

·Team handling operations Each operation is divided into different risk factors and presented as a flowchart. It can be used to assess the risks posed by lifting. Therefore. The MAC incorporates a numerical and a colour coding score system to highlight high risk manual handling tasks. . It is designed to help the assessor to understand.Tools of this type that are commonly in use include: ·The HSE Manual Handling Assessment Tool (MAC). carrying and team manual handling activities. The risk factors that are assessed are: A – Load weight/frequency B – Hand distance from the lower back C – Vertical lift region D – Trunk twisting/sideways bending E – Postural constraints F – Grip on the load G – Floor surface H – Other environmental factors To complete the assessment. The appropriate type of assessment (lifting. the assessor will first familiarise themselves with the task by spending some time observing it. Employees and safety representatives should be consulted at this stage and throughout the assessment process. and ·The Quick Exposure Checklist (QEC) The HSE Manual Handling Assessment Tool (MAC) (Source: HSE) The MAC Tool is detailed on the HSE Website and is freely available to users. for the purposes of this description. ‘Single lifting operations’ will be outlined. ·The Rapid Upper Limb Assessment (RULA). carrying or team handling) is then selected and the corresponding assessment guide and flow chart are then followed to determine the level of risk for each risk factor. interpret and categorise the level of risk of the various known risk factors associated with manual handling activities. The levels of risk are classified as in the table below (Source: HSE). The task can be videoed in order to allow it to be studied more closely away from the workplace is necessary. Three types of manual handling operation can be assessed: ·Single lifting operations. ·Single carrying operations. The bulk of the description that follows is taken from the HSE website. which is used to guide the assessor through the process. The MAC tool was developed to help the user identify high risk workplace manual handling activities. only the first. ·HSE ‘ART’ Tool. ·NIOSH Manual Material Handling (MMH) Checklist. A similar methodology is used for the assessment of each of the three types of manual handling operation identified above.

the colour bands and corresponding scores are entered onto a score sheet. representing an ‘Amber’ risk factor. Thus.An example of one of the risk factors and the range of scores that might be allocated is given below: Example Risk Factor Source INDG383. This helps the assessor to then prioritise actions. if the load is to be lifted from a position below the knee. Manual Handling Assessment Charts. The MAC flow diagram for this type of operation is shown below. The total score is added once the end of the flow chart is reached. 2003 The assessor considers what they are observing and scores the task as they see it. HSE. As the assessor works through the flow chart (see example below). . a score of 1 will be given.

To complete the assessment.MAC Flow Chart for a Single Lift Operation Source INDG383. The ART tool is not intended for display screen equipment (DSE) assessments. ART is suited for tasks that involve actions of the upper limbs that repeat every few minutes or even more frequently and which occur for at least 1-2 hours per day or shift. It examines some of the common risk factors in repetitive work that contribute to the development of upper limb disorders. Such tasks are typically found in assembly. packing and sorting work as well as work involving regular use of hand tools. The assessment is split into four stages: . Manual Handling Assessment Charts. the task is observed and workers consulted. The assessor then decides whether to assess just one arm (the one predominately involved in the task) or both. HSE. packaging. production. A task description form is then used to describe the repetitive task to be assessed. The assessment flowchart is used to guide the assessor through the assessment process. 2003 HSE ‘Assessment of Repetitive Tasks’ (ART) Tool This tool was developed to assist in the assessment of tasks that require the repetitive movement of the upper limbs. processing.

Source: HSE. which are categorised according to a traffic light system – Green. ·Stage C: Awkward postures. INDG438 Scores are allocated for each of the risk factors. An example of on risk factor is given below: Example of one risk factor considered by the ART Tool. and ·Stage D: Additional factors.5 where the task is done for more than 8 hours. up to 1. This ‘Duration multiplier’ is found a table at Stage D (D4) and ranges from 0. ·Stage B: Force.5 where less than 2 hours per day is spent doing the task. This figure is then multiplied by a ‘Duration multiplier’ according to the length of time spent doing the task in question. the assessor follows the flow chart to determine the level of risk. Once the exposure score has been calculated (Task score x Duration multiplier). For each stage.·Stage A: Frequency and repetition of movements. . Amber and Red. which are then totalled to give an overall risk score. the score is interpreted by reference to the table below.

RULA is intended to be used as part of a broader ergonomic study. INDG438 NIOSH Manual Material Handling Checklist (MMH) This is published is the USA by the National Institute of Occupational Safety and Health (NIOSH). The assessment can be completed online. Further risk factors not considered in the checklist may also need to be accounted for by the use of other techniques. trunk and upper limbs. ·Using lift-assist devices like scissor lift tables or load levellers. ·Guiding the choice of equipment by analysing and redesigning workstations and workflow. The booklet features a great many photographs to show common manual handling problems and solutions. Source: HSE. selection may be made of the longest held posture or what appears to be the worst posture(s) adopted. The booklet aims to help recognise high risk manual materials handling tasks and to choose effective options for reducing the associated risks. The first step is to observe the task and select the posture for assessment. The checklist itself may be found at Appendix B of the document. The checklist itself is not designed to be a comprehensive risk assessment technique but rather as a tool to quickly identify potential problem jobs. A RULA assessment gives a quick and systematic assessment of the postural risks to workers. Rapid Upper Limb Assessment (RULA) Rapid Upper Limb Assessment (RULA) is a survey method developed for use in ergonomic investigations of workplaces where work related upper limb disorders are reported. . RULA is a screening tool that assesses biomechanical and postural loading on the whole body with particular attention to the neck. Depending upon the type of study. The scoring generates an action list which indicates the level of intervention required to reduce the risks of injury due to physical loading on the operator. ·Using more sophisticated equipment like powered stackers.ART Tool . cranes or vacuum assist devices. hoists. Approaches covered include: ·Eliminating lifting and using trollies etc.Interpretation of exposure scores. including kinetic lifting techniques.

It encourages consideration of changes to workstations. equipment and working methods to eliminate. or at least minimise. tools. QEC assesses the exposure of the four body areas at greatest risk to the most important risk factors for MSDs. the effectiveness of workplace interventions can be evaluated without waiting for changes in the prevalence of WMSDs to become evident. ·Helps persuade organisations to make ergonomic changes ·Is compatible with HSE risk assessment methods ·Involves both the practitioner and the worker in the assessment. right or both upper arms are to be assessed.pdf 20 2043 be found in an HSE paper at Continue . A full description of the tool may http://www. A score is automatically applied for each choice. Quick Exposure Check The Quick Exposure Check (QEC) is similar in many respects to the ART Tool described above.uk/research/rrpdf/rr211.hse. thereby providing a better understanding of working practices. QEC allows safety practitioners to assess exposure and change in exposure to the main risk factors for MSDs. Left: A sample from a RULA for the Upper Right Arm In the third and final step. By assessing exposure as opposed to risk.Step 2 involves scoring and recording the posture. The software is then used to score the posture by asking the assessor to select the image that most closely reflects the working position.gov. Once this process is complete the scores are automatically calculated. The assessor decides whether the left. The main benefits of the Quick Exposure Check (QEC) are that it: ·Is user-friendly ·Is straightforward to use. the total score is compared to the Action Level List which provides a guide for further action. levels of exposure.

In some cases. although it may be possible to do the job in another way. manual handling and poor posture. equipment and machinery used. it may be possible to eliminate manual handling activities by installing automation such as conveyor systems or by mechanising the whole or part of the task e. · The tools. lifting tables etc .3. the task cannot be eliminated then there are still many options available for the reduction of risks. through the use of fork lift trucks. · The workplace environment. pallet trucks. this may not be a practicable solution. control of such risks can be achieved by making alterations to: · The way the task is done. cranes. For example. tasks giving rise to a risk of MSDs can be eliminated in whole or in part. An overview of these options is given below. Other options for mechanisation include use of hoists. however.2 Practical Control Measures The assessment techniques outlined above lead to consideration of control measures to eliminate or reduce the risks associated with repetitive physical activities. Elimination The obvious method of elimination is simply to not do the job at all. However.g. If. Typically.

Use of a scissor Above: Mechanisation . . the load and the working environment as well as individual capability. It may even be possible to break the load down into smaller parts. Eye and Eyesight testing This is commonly applied to those who use display screen equipment as an integral part of their job.Above: Mechanisation . Changes can be made to work routines such that individuals do not spend too long doing a particular task such as working on a supermarket checkout. Job rotation is one method for achieving this. Allowing workers some control over the pace of the task may also help to reduce the risks.Use of a turntable lift table Alternative work methods/Job design One alternative is to automate or mechanise the process as outlined above. Ergonomic design The task and workstation can be evaluated and ergonomic principles can then be applied to help make the job more efficient and less tiring. such as with Display Screen Equipment workstations where much work has been done on designing computers and peripherals such that risks of MSDs are reduced. Another example would be to building different tasks into an office worker’s role so that they do not sit at a computer for the entire day but instead also have to get up to do tasks such as filing or to retrieve printing or copying. which may not only be heavy but are also bulky. The ergonomic approach will also ensure that workstations can be adjusted to suit the individual worker’s needs. Such an approach looks at the job as a whole and takes account of a number of factors including the nature of the task. job rotation to other tasks is commonplace. an ergonomic approach will seek to ensure that all frequently used parts and tools are within easy reach and that the worker does not need to bend or twist to find them. Use of some aids such as sack trolleys is not strictly speaking ‘elimination’ since some manual effort is still needed. Work Routine This can be thought about in order to allow the worker sufficient rest and recovery breaks. the introduction of team handling will help to share the load. In an assembly task for example. which requires some seated handling and twisting and which affords limited opportunity to move around. Ergonomics is the science of ‘fitting the job to the person’. Eye strain can develop over time with heavy use of DSE and so regular testing helps to give an early warning of deterioration in the worker’s sight so that modifications can then be made to their workstation or work routine. Ergonomics can be applied to tools and to workstations. Tools will be as light as possible and will have grips that allow the worker to adopt a neutral position rather than placing stress on the wrists. For large loads. In that case.

For example: Display screen equipment users can be shown exercises that they can do at their desks that will reduce the impact of working in a fixed position for prolonged periods. but should instead lift smoothly and steadily. The worker should consider the size and weight of the load. Those engaged in manual handling activities need to be shown the correct way of lifting a load and how to properly use any handling aids that may have been provided. The worker should avoid twisting or jerking the load. as well as use of the control measures to help avoid such conditions. The back should remain upright and the load should be held close to the body with a firm grip. but these are outside the scope of this course. with the same basic principles applying only this time in reverse. The worker should. The employer should therefore ensure that tasks are only given to those people who have the necessary . One example of a technique that workers who lift loads as part of their job may be shown is the ‘Kinetic lifting method’. face the intended direction of travel when lifting.Training and Information Any employee who may be at risk of developing a MSD should be given information on the types of harm that might arise and the signs and symptoms thereof. He should bend the knees and use the large leg muscles to lift the load. They should also be taught how to adjust screen brightness and contrast and how to adjust their chair and workstation correctly. if possible. Above:The Kinetic Lifting Technique Personal Considerations One consideration in any manual handling assessment is the capability of the individual. Other methods are taught for tasks like moving patients. The basic kinetic lifting technique begins with the assessment of the load. think about its likely centre of gravity and plan the route he or she intends to take to move the load from A to B. Placing the load down is basically the reverse of picking it up.

hse.pdf accessed 17 June 2012 http://www. INDG438 NIOSH.gov/niosh/docs/2007131/pdfs/2007-131. such as those who are pregnant and who may not therefore be able to lift a great deal. Assessment of repetitive tasks of the upper limbs (the ART Tool).ability and physical attributes to perform the lift safely.html accessed 17 June 2012 Quick Exposure Check .http://www. INDG383 HSE. References: HSE. 2003. ttp://www. Ergonomic Guidelines for Manual Material Handling.uk/research/rrpdf/rr211.co. The employer should also consider the needs of more vulnerable workers.rula.pdf accessed 17 June 2012 . patient handling) then only those who have had specific training should be allowed to perform the task.gov.cdc.uk/index. Manual Handling Assessment Charts. 2010.g. if a particular technique needs to be used (e. For example.