ARTICLE IN PRESS

Applied Ergonomics 34 (2003) 303–307

Investigation of work-related disorders in truck drivers

using RULA method
M. Massaccesia,*, A. Pagnottaa, A. Soccettia, M. Masalib, C. Masieroc, F. Grecoa
a
Institute of Orthopaedics of the University of Ancona, Via Conca-Torrette, Torrette, 60020 Ancona, Italy
b
Department of Animal Biology and Man, University of Torino, Torino, Italy
c
Department of Education Studies, University of Torino, Torino, Italy
Received 1 January 2002; accepted 21 March 2003

Abstract

A high incidence of spinal disorders is observed in professional drivers; in particular, back and neck pain result in high rates of
morbidity and low retirement age. A sample of 77 drivers, of rubbish-collection vehicles who sit in a standard posture and of road-
washing vehicles, who drive with the neck and trunk flexed, bent and twisted, was studied using RULA, a method for the evaluation
of the exposure to risk factors associated with work-related upper-limb disorders. Results showed a significant association between
trunk and neck scores and all self-reported pains, aches or discomforts in the trunk or neck regions in all subjects. In particular, the
neck score was significant in both postures, reflecting high loading of the neck. Significantly different posture scores were also
recorded for drivers using an adjustable vs. a non-adjustable seat.
In this first RULA study of the working posture of professional truck drivers, the method proved to be a suitable tool for the
rapid evaluation of the loading of neck and trunk.
r 2003 Elsevier Ltd. All rights reserved.

Keywords: RULA; Truck drivers; Posture

1. Introduction Unspecific symptoms, including diffuse aches and

Professional drivers are a high-risk group for muscu-
lo-skeletal disorders involving the spine (Magnusson
et al., 1996; Hildebrandt, 1995), shoulder and knee
joints (Van der Beek and Frings-Dresen, 1995); in
particular, the incidence of early degenerative changes of
the spine is high among truck drivers (Gruber, 1977).
These disorders result in high morbidity and low
retirement age (Gobel et al., 1998). The driver’s work-
place, which includes the environmental condition
within the cabin, exposure to vibration and noises, the
varying climatic conditions and the driving posture,
needs to be considered as a stress factor contributing to
the his/her health status (Gobel et al., 1998).
Job-related psychosocial factors have been receiving
increasing attention as potential significant etiologic
factors of musculo-skeletal disorders and morbidity.
*Corresponding author. Tel.: +39-071-7109029; fax: +39-071-
7201014.
E-mail address: massimo.bar@tiscalinet.it (M. Massaccesi).
pains, tend to be good indicators of work-related
stress (Adamson and Thompson, 1992). The presence
among urban drivers of strong associations between
psychosocial risk factors such as job dissatisfaction,
poor supervisor support, high levels of stress and
strain, and extended uninterrupted driving periods
and back or neck pain has also been suggested (Krause
et al., 1997b).
The driver’s position in the cabin is closely related to
the dimension of the workstation and to the adjust-
ability of the seat; in particular, standard seats have
been seen to be unsuitable for both small and heavy
drivers (Thompson, 1991).
A sample of truck drivers working in two different
sitting positions was studied with RULA (rapid upper-
limb assessment), a tool which allows to evaluate the
loads sustained by the musculo-skeletal system due to
work posture, muscle use and force exerted and to
calculate the exposure to risk factors associated with
work-related upper limb disorders (McAtamney and
Corlett, 1993).

0003-6870/03/$ - see front matter r 2003 Elsevier Ltd. All rights reserved.
doi:10.1016/S0003-6870(03)00052-8
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304 M. Massaccesi et al. / Applied Ergonomics 34 (2003) 303–307
2. Materials and methods
2.1. Subjects
Subjects were 77 male truck drivers (mean age
37.476.6 years) employed by a rubbish-collection and
street-cleaning contractor and driving two types of
vehicle.
A complete job history was obtained through a
voluntary occupational questionnaire eliciting informa-
tion on vehicle type driven and years worked in the
company (seniority status), weekly driving hours and
previous jobs held that required regular driving of
trucks, buses, trains, taxicabs and other motor vehicles.
The lifetime years of professional driving (seniority risk)
were calculated.
Age and anthropometric data including height, weight
and upper-limb length were determined by physical
examination. Pearson correlations were used to investi-
gate relationships between RULA scores and age,
anthropometric data, seniority status and seniority risk.
2.2. Vehicle types
Two types of vehicles were included in the study:
1. trucks with posterior mechanism for rubbish collec-
tion (type 1)
2. street-cleaning vehicles (type 2)
In type 1 vehicles, the seat suspension was endowed with
a gas spring and seat height and depth, backrest and
steering wheel were adjustable. The cabin was fitted with
air conditioning and sound-proof lining. In type 2
vehicles the (non-adjustable) steering wheel was on the
right side; there were two models of street-cleaning
vehicles, one with and one without adjustable driver
seat.
There were 38 operators driving type 1 trucks and 39
driving type 2 trucks (of the latter, 18 drove the model
with the adjustable seat, the other 21 the model with the
fixed seat). All worked 36 h/week, but the effective
driving was of about 5 h/day (30 h/week) considering the
stops for rubbish collection and dumping (drivers of
type I vehicle), for instructions, and 2–3 breaks.
Two driving postures were analysed:
1. two hands on the sides of the wheel and the back
against the backrest. Drivers sat in this position while
operating the rubbish-collection mechanism and in
the street-washing cars only during transfers to and
from the deposit (posture 1);
2. neck and trunk bent laterally, rotated and flexed
forward. The drivers of street-washing trucks sat in
this position during cleaning operations to monitor
the action of the rotating brush (posture 2).
3. The drivers of street-cleaning trucks were evaluated
for both postures.
Student’s t-test for paired comparisons was used to
analyse the difference between the scores associated with
each driving posture.
2.3. RULA method
The driving posture adopted by each subject was
evaluated using RULA (McAtamney and Corlett, 1993)
and all data were collected by the first author (MM).
According to this method a score is calculated for
the posture of each body part. A score of 1 indicated
the ‘‘best’’ or most neutral posture, e.g. arms by the
sides, elbows in approximately 90 flexion, wrists in
neutral position, forearms mid-way between pronation
and supination, neck in 10 flexion, trunk and legs
sitting and well supported. A score of 4 indicated the
worst position: e.g. shoulder flexion above 90 or
flexion between 45 and 90 and abduction. The
combined individual scores for shoulder, elbow and
wrist gave score A and those for neck, trunk and legs
gave score B. Muscle use and force exerted in each
driving position were attributed a score of 1 and 0,
respectively, because they are static postures without
loading; these scores were added to scores A and B to
obtain scores C and D, respectively (McAtamney and
Corlett, 1993) (Table 1).
Based on the design of the RULA method, each
combination of scores C and D (a number of 1–7),
called grand score, reflects the musculo-skeletal
loading associated with the worker’s posture. Whereas
low grand scores (of 1 or 2) indicate that the work
posture is acceptable, action is suggested for the
higher scores: further investigation and changes if
required, for grand scores of 3 or 4; prompt investiga-
tion and changes for grand scores of 5 or 6 and
immediate investigations and changes for a grand
score of 7.
2.4. RULA validation
To establish whether RULA scores provided a good
indication of the musculo-skeletal loading sustained by
these workers, the w2-test was used to determine whether
individual body-part scores were significantly associated
with reported pains, aches or discomfort in the
corresponding body region. The presence of pains,
aches or discomfort was recorded as ‘‘pain’’, their
absence as ‘‘no pain’’. Self-report charts (Body Dis-
comfort Chart)—which have been shown to provide a
valid measure of body discomfort (Corlett and Bishop,
1976) - were given to all subjects to establish the pattern
of body discomfort while at work.
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M. Massaccesi et al. / Applied Ergonomics 34 (2003) 303–307 305

Table 1
The RULA scoring sheet

The RULA method scoring sheet as described by McAtamney and Corlett (1993).

3. Results Table 2
Rubbish-collection vehicles
3.1. Rubbish-collection vehicles (posture 1) Body part Pain Posture score w2 P

1 >1
The neck posture score was >1 in 65.8% of these
drivers, while neck pain or discomfort was reported by Neck No 10 5 11.57 0.001
60.5%, yielding a significant association between score and Yes 3 20
Trunk No 17 0 3.59 0.1
self-reported pain (w2=11.57; p=0.001). The trunk
Yes 17 4
posture score was 1 in 89.4% of drivers: this score Upper arm No 15 3 3.5 0.1
corresponds to the most neutral posture (sitting and well Yes 11 9
supported, with a hip-trunk angle X90 ). As trunk pain or Lower arm No 6 24 0.23 0.75
discomfort was reported by 58%, there was no association Yes 1 7
Wrist No 8 25 0.03 0.9
between score and trunk pain (w2=3.59; p=0.1); similarly,
Yes 1 4
no association was found between upper arm, lower arm
or wrist scores and reported pain (Table 2). w2-analysis of RULA body-part score and number of drivers reporting
pain, ache or discomfort in that region. The presence of pains, aches or
discomfort was recorded as ‘‘pain’’, their absence as ‘‘no pain’’. The
3.2. Street-washing vehicle (posture 2) posture neck, trunk and upper arm scores ranged between 1 and 6, the
lower arm scores ranged between 1 and 2, and the wrist score ranged
Whereas the scores for the sitting posture of drivers between 1 and 4.
during transfers from and to the deposit were similar to
those measured in the drivers operating the rubbish-
collection vehicles (posture 1), the posture of drivers 3.3. Grand scores
during street-cleaning operations yielded a score >1 in
94.8% and caused neck pain or discomfort in 87.1%, The grand scores are obtained by adding posture
the association being significant (w2=14.6; p=0.001). scores to the muscle use and force scores.
The trunk score was >1 in 92.3% of drivers, with The mean grand scores of the drivers of type 1 trucks
82.05% reporting pain in the trunk region, with a and those of type 2 truck drivers during transfers were
significant association (w2=15.2; p=0.001). With refer- 4.71 (71.19) and 4.53 (71.03), respectively, the differ-
ence to seat adjustability, neck and trunk pain were ence between them being non-significant (po0.44). By
reported, respectively, by 88.8% and 72.2% of drivers contrast, the difference between the former and the work
who drove the truck fitted with an adjustable seat and posture 2 (mean grand score of 6.6770.53) was highly
by 85.7% and 90.4%, respectively, of those who had a significant (po0.001). With reference to adjustable seats,
fixed seat on their vehicle. No association was shown by the mean grand scores were not significantly different
the w2-test between upper arm, lower arm and wrist (po0.78) between the trucks endowed and not endowed
score and the number of drivers reporting pain in those with them for posture 1, but they were significant when
regions (Table 3). posture 2 was considered (po0.01) (Table 4).
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306 M. Massaccesi et al. / Applied Ergonomics 34 (2003) 303–307

Scores C and D contributed differently to the grand rubbish-collection vehicles they drove in a standard
score. Score C, which includes the upper and lower arm position, whereas in street-washing trucks they drove
and wrist scores did not yield significant differences with the trunk flexed, bent and rotated. RULA allows to
(p>0.1), whereas score D—which includes neck, trunk perform a rapid evaluation of work-related loads to
and legs—was significantly higher in posture 2 (po0.001). which operators’ musculo-skeletal systems are exposed
due to posture, muscle use and the force exerted in
3.4. Correlation between grand scores and age, weight, performing their tasks (McAtamney and Corlett, 1993).
height, arm length seniority risk and seniority status RULA has been applied to evaluate the posture of VDU
operators (McAtamney and Corlett, 1993), computer
When the grand scores were correlated with age and users (Cook and Kothiyal, 1998) and biomedical
anthropometric data, seniority status and seniority risk, scientists (Kilroy and Dockrell, 2000) and its repeat-
Pearson analysis revealed no correlations between grand ability and reliability has been already proved (McA-
score and age (r= 0.058), grand score and weight tamney and Corlett, 1993). This is the first investigation
(r=0.126), grand score and height (r=0.133), grand of the driving posture of truck drivers using RULA.
score and arm length (r= 0.017), grand score and Results showed a significant association between trunk
seniority status (r=0.014) and grand score and seniority and neck scores and any reported pain, ache or
risk (r=0.022). discomfort in the trunk or neck regions. In particular,
the neck score was statistically significant for both
groups of drivers, reflecting high neck loading. Drivers
4. Discussion have a high incidence of spinal disorders in terms of
back and neck pain (Fishbein, 1950; Frymoyer et al.,
A population of 77 truck drivers who worked on two 1980; Anderson, 1992). In the present sample, cervical
different types of vehicles were studied with RULA. In pain affected 60.5% of the drivers of rubbish-collection
truck, consistent with the need for turning as they drive,
and to the right as they lift bins, as reported by
Table 3 Anderson (1992). Moreover, in 88.8% (adjustable seat)
Street-washing vehicles (position during cleaning operations)
and 85.7% (fixed seat) of drivers of street-washing
Body part Pain Posture score w2 P trucks drivers complaining of cervical pain, an addi-
1 >1
tional component was the unnatural posture during
cleaning operations.
Neck No 2 3 14.6 0.001 The adjustability of the driver’s seat influenced
Yes 0 34
posture, as suggested by the significant difference of
Trunk No 3 4 15.2 0.001
Yes 0 32 the grand scores obtained in the same vehicle type with
Upper arm No 21 5 0.7 0.5 and without adjustable seat: the higher/ST grand score
Yes 9 4 was recorded for the posture adopted during street-
Lower arm No 3 14 0.47 0.5 washing operations with non-adjustable seats.
Yes 6 16
It has been demonstrated that postural disorders are
Wrist No 10 22 0.8 0.5
Yes 2 5 relieved by changes in posture and it has been suggested
that the workstations of heavy trucks be evaluated
w2-analysis of RULA body part score and the number of drivers
ergonomically (Anderson, 1992). The driver’s seat needs
reporting pain, ache or discomfort in that region. The presence of
pains, aches or discomfort was recorded as ‘‘pain’’, their absence as to be adjustable, comfortable and must absorb vibration
‘‘no pain’’. The posture neck, trunk and upper arm scores ranged (Brunswick, 1982).
between 1 and 6, the lower arm scores ranged between 1 and 2, and the In the present study, the grand scores did not
wrist score ranged between 1 and 4. correlate with age, anthropometric data (height, weight,

Table 4

Type 1 vehicles Type 2 vehicles (during transfers) Type 2 vehicles (during cleaning operations)
n
Score C 4.61 (70.94) 4.42 (70.82) 4.5 (70.95) 4 (70.71) 4.36 (70.72)n
Score D 4.11 (71.18) 4.11 (70.98) 3.97 (71.05)n 7.86 (70.54) 7.97 (70.16)n
Grand Score 4.71 (71.19) 4.53 (71.03) 4.47 (71.08)n 6.67 (70.53) 6.89 (70.31)n

Mean score C (posture score A+muscle use score+force score), score D (posture score B+muscle use score+force score) and the respective grand
score were calculated in type 1 (N=38) and type 2 (N=39) vehicles. Street-washing vehicles fitted with adjustable or fixed seats were evaluated
separately.
n
Fixed seat.
 ARTICLE IN PRESS
M. Massaccesi et al. / Applied Ergonomics 34 (2003) 303–307
upper limb length) nor with seniority status and seniority
risk. In line with Krause et al. (1997a), age and heavy
weight did not relate to back and neck pain. Positive
associations between greater height and low back pain
have been found in some studies (Kelsey and Golden,
1988), but not in others (Bigos et al., 1986). The lifetime
years of professional driving were not significantly related
to back pain in some samples (Anderson, 1992), whereas
a significant correlation was observed between duration
of past driving and current driving hours and back-neck
pain in other studies (Krause et al., 1997a).
In conclusion, the RULA method applied to truck
drivers’ work postures allowed to perform a rapid and
correct evaluation of the loading to which neck and
trunk are exposed while driving.
RULA evidenced that the posture adopted in street-
washing trucks during cleaning operations was asso-
ciated with a major risk for back pain, especially whit
non-adjustable seats. Ergonomic interventions aiming at
modifying the truck’s workstation are recommended
with a view to helping prevent musculo-skeletal dis-
orders.
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