Don't put the world on your shoulders
'Cause you know it ain't your load to bear
Don't put the world on your shoulders
'Cause you know it ain't your load to bear alone
- Atlas, by The Dip
Manual handling and hazardous manual tasks require the use of force by a person to do work (Victorian Government, 2024). Human muscle power was once the primary means of undertaking work prior to the domestication of beasts of burden and the development of mechanical aids in labour. The invention and use of the Steam Engine meant that one machine could do the work of many people consistently, repetitively, and on demand - the Industrial Revolution and its consequences for the human race notwithstanding. Yet despite technological advancement there are some tasks that, due to their specificity, nuance, or labour requirements, are done with human muscle. Lifting loads remains one of those tasks. Even outside of an occupational context, lifting injuries can occur and be irritated when handling infants (Vincent & Hocking, 2013), cooking (Chen et. al., 2024), laundering clothes (Zaheer et. al., 2015), and during recreational physical activity (Sidorkewicz & McGill, 2014).
In Australia, during the period of 2021-2022, sprains, strains and dislocations as well as chronic joint and muscle conditions accounted for 46% of the most common occupational injuries during the reporting period (Australian Bureau of Statistics (ABS), 2023). In the same reporting period, the most common causes of work-related injuries were lifting, pushing, pulling or bending, at 23.5% of all total reported injuries. Safe Work Australia (SWA) report that 37% of serious claims made during the 2020-2021 period were due to body stressing (2023a). Body stressing is described as arising from the handling, lifting, carrying, or putting down of objects (Oakman, Clune & Stuckey, 2019). Within that report, the number of serious Work-Related Musculoskeletal Disorder Claims by Mechanism of Injury explores the notion of body stressing as including muscular stress while handling objects, in dynamic postures, with no objects, and with low muscle loading, as below in figure 1.
Figure 1.
Serious Work-Related Musculoskeletal Disorder Claims by Mechanism of Injury, 2015-2016
Note. Reproduced from Oakman, J., Clune, S., Stuckey, R. (2019) Work-related Musculoskeletal Disorders in Australia, Table 2.7
The mechanisms of injury and disease that resulted in a serious claim during the period 2020-2021 are reported in the Australian Worker’s Compensation statistics published by SWA, reproduced in Figure 2 below.
Figure 2.
Number and Percentage of serious claims by mechanism of injury or disease and gender, 2020-2021p.
Note. Reproduced from Safe Work Australia. (2022a). Australian Workers’ Compensation Statistics, 2020-2021, Table 10.
This data is further developed by examining the number and percentage of serious claims by nature of injury, as has been reproduced in Figure 3.
Figure 3.
Number and Percentage of serious claims by mechanism of injury or disease and gender, 2020-2021p.
Note. Reproduced from Safe Work Australia. (2022a). Australian Workers’ Compensation Statistics, 2020-2021, Table 11.
The location of these injuries is further developed in the report, reproduced in Figure 4.
Figure 4
Number and percentage of serious claims by mechanism and bodily location of injury or disease, 2020–21p.
Note. Reproduced from Safe Work Australia. (2021). Australian Workers’ Compensation Statistics, 2020-2021, Table 14.
In 2019-20, the compensation paid for body stressing injuries is provided in Table 40, reproduced in Figure 5.
Figure 5
Serious claims: median compensation paid by mechanism of injury or disease, 2000−01 and 2014−15 to 2019–20
Note. Reproduced from Safe Work Australia. (2022a). Australian Workers’ Compensation Statistics, 2020-2021, Table 40.
Injuries that arise from body stressing correspond to those undertaken during manual handling, where the definition of manual handling is provided by WorkSafe Victoria (2023) as being “work where you have to lift, lower, push, pull, carry, move, hold or restrain something.” This is concordant with the definition of manual handling provided by Safe Work Australia (n.d.b) where manual handling is referred to as manual tasks, which include “lifting, pushing, pulling or carrying.” SWA guidance reports that musculoskeletal disorders may include sprains, back injuries, joint and bone injuries and degeneration, as well as chronic and acute pain (2023b). That guidance goes on to report that musculoskeletal disorders arising from hazardous lifting can happen slowly through accumulated fatigue and static body positions, or rapidly through strenuous activity or unexpected movements. However, Oakman, Clune & Stuckey (2019) note that repetitive movement and low muscle loading accounted for 4.4% of the total Work-related Musculoskeletal Disorders in Australia during the reporting period. This may be due to proportional representation, or it also may be due to the difficulty of establishing linear cause between chronic repetitive movement and musculoskeletal pain where the mechanism of injury has a time component. This is a dose-response variable and will be discussed further elsewhere.
Body stressing muscular injuries including those from lifting and carrying impose significant costs in terms of workers’ compensation, time lost, and health impact. In 2020-2021, the median time lost for injury and musculoskeletal disorders ranged from 6.7 weeks for traumatic joint/ ligament and muscle/ tendon injury to 9.4 weeks for musculoskeletal and connective tissue diseases (SWA, 2022a). Disability resulting from injury has significant consequences for individuals and families, such as mental health, reduced quality of life, increased financial stress, higher rates of marital separation, and increased rates of complication in the return to work plan (Monash Centre for Occupational and Environmental Health (MonCOEH), 2024). Put simply, the longer someone is off work from an injury, the less likely they are to return to work (The Royal Australasian College of Physicians and The Australian Faculty of Occupational and Environmental Medicine, 2010.) This can be complicated by age, gender, prior disability, depression, physical demands at work, previous time off work, and activity limitations (Cancelliere et. al., 2016), but there are also means by which an employer can support an injured worker to return to work swiftly and in a supported, sustainable, and successful trajectory (SWA, 2022b). Regardless of the factors affecting return to work, consideration of these factors is moot if the worker does not get injured in the first place. This requires proactive management of the practices, environment, and training surrounding manual handling.
Managing lifting injuries at work can be thought of as a layered process. If work is being done, make sure that it’s done in a way that minimises the need to engage in manual handling. If something needs to be lifted, carried, or transported, make sure it’s moved safely and have a management plan in place if required. If something happens during the transfer, make sure it doesn't give rise to an adverse event. If an adverse event occurs, make sure the worker doesn’t get injured. If an injury occurs, minimise its severity. If a serious injury occurs, respond immediately. Prevention of lifting injuries begins at the design phase where job and process analysis can be undertaken to assess the exposure of workers to activities which may increase their risk of experiencing a lifting injury and to intervene at the task level as is appropriate (Nelson et. al., 2006; Rozenfeld et. al., 2010). This “Onion” of lifting injury prevention should be applied in line with the Hierarchy of Controls (SWA, n.d.b.). The Hierarchy recommends elimination of the hazard as the most effective form of control possible, but in reality, this is often not possible.
Preventing lifting injuries is a matter of awareness, experience, preparedness, and appropriateness. A worker must be aware of the task they are performing and consciously attend to that task. This can be difficult if the worker is distracted, tired, or under time pressure (Van Poppel et. al., 1998). A worker must understand the task at hand and how to undertake it - even something as simple as moving a box has inherent risk which, under the right circumstances, can precipitate an adverse event or an injury. This is especially important for workers new to lifting tasks (Chaiklieng & Suggaravetsiri, 2020). The environment must be appropriate for the work being done - it must be adequately lit, without excess heat, cold or excessive noise or vibration. The surface upon which the lifting is being undertaken must be clean, slip-risk free, and the worker should be wearing appropriate clothes, shoes, and gloves if necessary, especially if they are lifting something hot, caustic, or chemically volatile. The load itself must be prepared - a box of paper reacts differently to being disturbed than a bucket of water, and rocking, tilting, swilling, or agitating of the load should be minimised. Lastly, the task should be appropriate to the worker - has the worker received appropriate safety training, can they assess their own risk, has job training been provided, and can these workers actually lift the load required? More appropriately, the question should be asked if something needs to be lifted at all - where lifting and manual handling can be removed entirely, the risk of a lifting injury may either be significantly or definitively mitigated.
However, the solution is more elusive than simply training. Academic review of the effectiveness of “safe lifting training” indicates no significant statistical effect on the incidence or consequence of back pain in workers who received training (Martimo et. al., 2008), manual handling behaviours following training or of the incidence of work-related musculoskeletal disorders (Hogan et. al., 2014), and this phenomenon is observed in technique and education based manual handling training (Clemes et. al., 2010). Clemes et. al. (2010) do suggest that priority should be given to developing and evaluating multidimensional interventions, incorporating exercise training to promote strength and flexibility, which are tailored to the industrial sector, but this again is reactive, not proactive. Denis et. al. (2020) notes that, on examining stereotypical lifting training focusing on safe technique, “such training approach principally focuses on the trainee's behaviours, while paying little (to no) attention to the work conditions that might condition correct behavioral display.” This is broadly noted, with Haslam et. al., (2007) recommending that lifting training is best effected when undertaken using participatory ergonomics with sufficient manager buy-in to design a program as part of a larger risk management matrix, which should also be tailored to the specific organisational needs of a business and industry (Mcdermott et. al., 2012).
The most effective means of protecting against lifting injuries is to adjust work, tasks, and environments to eliminate worker exposure to activities that expose them to uncontrolled or unstable risk. The worker doing the lifting is at the receiving end of physical and environmental forces which can either be protecting or degrading to health depending on their design and arrangement. Ergonomic investigation of work tasks and worker participation in the development of safety programs is necessary, not simply as a means of developing effective training to manage lifting injuries but to change the physical parameters of the task, which can be as simple as adjusting the relative heights of loads (Kuijer et. al., 2014). Work is the point at which a worker must meet the demands of a task in an environment with the resources of their body, their energy, and their wits. Human technological development has made moot the limitations of human muscle power, joint flexibility and cognitive exhaustion in so many industries and in so many processes, but there will always come a time when that human must pick up a load and move it from point A to point B, and the worker will always be a human.
Lifting injuries are the most prevalent workplace injury experienced by Australian workers. Though the incidence of injuries due to body stressing is highest in those industries whose workers are necessarily required to exert themselves more vigorously, over longer periods of time, and in more testing physical circumstances, every worker who either lifts, pushes, pulls, or otherwise handles an external load experiences risk of injury. Every worker who works experiences some measure of risk which, in large immediate doses or in small accumulated doses, has the potential to cause an adverse event. Proper control of lifting injuries comes down to work design, and the nested means of protection by which the propagated risk of a work task is mitigated so that it is either negligible or handily controlled by common sense at the level of the worker.
None of this information constitutes medical, legal, occupational health and safety, best guidance, standard, or other guidance, instruction, or prescription.
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References:
Australian Bureau of Statistics. (2023). Work Related Injuries. Retrieved 8th January 2025 from https://www.abs.gov.au/statistics/labour/earnings-and-working-conditions/work-related-injuries/2021-22
Cancelliere, C., Donovan, J., Stochkendahl, M. J., Biscardi, M., Ammendolia, C., Myburgh, C., & Cassidy, J. D. (2016). Factors affecting return to work after injury or illness: best evidence synthesis of systematic reviews. Chiropractic & manual therapies, 24, 1-23.
Chaiklieng, S., & Suggaravetsiri, P. (2020). Low back Pain (LBP) incidence, ergonomics risk and workers’ characteristics in relations to lbp in electronics assembly manufacturing. Indian Journal of Occupational and Environmental Medicine, 24(3), 183-187.
Chen, H., Anton, I. N., Holden, I. R., & Yu, I. D. (2024). Kitchen ergonomics in health and healthcare: A rapid scoping review. Human Factors in Healthcare, 100069.
Clemes, S. A., Haslam, C. O., & Haslam, R. A. (2010). What constitutes effective manual handling training? A systematic review. Occupational medicine, 60(2), 101-107.
Denis, D., Gonella, M., Comeau, M., & Lauzier, M. (2020). Questioning the value of manual material handling training: A scoping and critical literature review. Applied Ergonomics, 89, 103186.
Haslam, C., Clemes, S., McDermott, H., Shaw, K., Williams, C., & Haslam, R. (2007). Manual handling training: investigation of current practices and development of guidelines. Retrieved 8th January 2025 from https://repository.lboro.ac.uk/articles/journal_contribution/Manual_handling_training_investigation_of_current_practices_and_development_of_guidelines/9341756?file=16950473
Hogan, D. A., Greiner, B. A., & O'Sullivan, L. (2014). The effect of manual handling training on achieving training transfer, employee's behaviour change and subsequent reduction of work-related musculoskeletal disorders: a systematic review. Ergonomics, 57(1), 93-107.
Kuijer, P. P. F., Verbeek, J. H., Visser, B., Elders, L. A., Van Roden, N., Van den Wittenboer, M. E., Lebbink, M., Burdorf, A., & Hulshof, C. T. (2014). An evidence-based multidisciplinary practice guideline to reduce the workload due to lifting for preventing work-related low back pain. Annals of occupational and environmental medicine, 26, 1-9.
Martimo, K. P., Verbeek, J., Karppinen, J., Furlan, A. D., Takala, E. P., Kuijer, P. P. F., Jauhiainen, M. & Viikari-Juntura, E. (2008). Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review. Bmj, 336(7641), 429-431.
McDermott, H., Haslam, C., Clemes, S., Williams, C., & Haslam, R. (2012). Investigation of manual handling training practices in organisations and beliefs regarding effectiveness. International Journal of Industrial Ergonomics, 42(2), 206-211.
Monash Centre for Occupational and Environmental Health (MonCOEH). (2024). Retrieved 8th January 2025 from https://www.safeworkaustralia.gov.au/sites/default/files/2024-04/early_intervention_in_the_workers_compensation_process_-_final_report.pdf
Nelson, A., Matz, M., Chen, F., Siddharthan, K., Lloyd, J., & Fragala, G. (2006). Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. International journal of nursing studies, 43(6), 717-733.
Oakman, J., Clune, S., Stuckey, R. (2019) Work-related Musculoskeletal Disorders in Australia. Retrieved 8th January from https://www.safeworkaustralia.gov.au/system/files/documents/1912/work-related_musculoskeletal_disorders_in_australia_0.pdf
The Royal Australasian College of Physicians and The Australian Faculty of Occupational and Environmental Medicine. (2010). Helping people return to work: Using evidence for better outcomes - A Position Statement. Retrieved 8th January 2025 from https://www.racp.edu.au/docs/default-source/policy-and-adv/afoem/hbgw/helping-people-return-to-work-using-evidence-for-better-outcomes.pdf?sfvrsn=57ae3e1a_10
Rozenfeld, O., Sacks, R., Rosenfeld, Y., & Baum, H. (2010). Construction job safety analysis. Safety science, 48(4), 491-498.
Safe Work Australia. (2022a). Australian Workers’ Compensation Statistics, 2020-2021. Retrieved 8th January 2025 from https://www.safeworkaustralia.gov.au/sites/default/files/2022-12/australian_workers_compensation_statistics_2020-21.pdf
Safe Work Australia. (2022b). Managing the relationship with an injured or ill worker during return to work. Retrieved 8th January 2025 from https://www.safeworkaustralia.gov.au/sites/default/files/2024-06/rtw_supervisor_guide_for_publication-updated-final-jun24-v2.pdf
Safe Work Australia. (n.d.a). Lifting, pushing and pulling (manual tasks). Retrieved 8th January 2025 from https://www.safeworkaustralia.gov.au/safety-topic/hazards/lifting-pushing-and-pulling-manual-tasks
Safe Work Australia. (n.d.b). Managing risks. Retrieved 8th January 2025 from https://www.safeworkaustralia.gov.au/safety-topic/managing-health-and-safety/identify-assess-and-control-hazards/managing-risks
Safe Work Australia. (2023a). Key Work Health and Safety Statistics Australia 2022. Retrieved 8th January 2025 from https://www.safeworkaustralia.gov.au/sites/default/files/2023-01/key_whs_stats_2022_17jan2023.pdf
Sidorkewicz, N., & McGill, S. M. (2014). Male spine motion during coitus: implications for the low back pain patient. Spine, 39(20), 1633-1639.
Van Poppel, M. N. M., Koes, B. W., Deville, W. L. J. M., Smid, T., & Bouter, L. M. (1998). Risk factors for back pain incidence in industry: a prospective study. Pain, 77(1), 81-86.
Victorian Government. (2024). Manual handling. Retrieved 8th January 2025 from https://www.vic.gov.au/safework/safework-general-module/manual-handling
Vincent, R., & Hocking, C. (2013). Factors that might give rise to musculoskeletal disorders when mothers lift children in the home. Physiotherapy Research International, 18(2), 81-90.
Worksafe Victoria. (2023b). Hazardous manual handling: Safety basics. Retrieved 8th January 2025 from https://www.worksafe.vic.gov.au/hazardous-manual-handling-safety-basics
Zaheer, A., Carre, M., Yoxall, A., & Rowson, J. (2015). Evaluation of adopted postures and the hardest part of the domestic laundry task. In Proceedings of the Third European Conference on Design4Health.
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