Managing MSDs

Organisations should already be preventing harm to workers by assessing and controlling risks in the workplace.

The prevention of MSDs should be carried out in the same way — by assessing and evaluating the risks to workers and eliminating or controlling those risks.

Putting controls in place doesn’t have to be costly, but making small or big changes to the workplace will help to prevent workers developing MSDs.

Organisations could think about interventions such as:

• modifying equipment
• making changes in work practices
• purchasing new tools or other devices.

These will help by:

• eliminating unnecessary movements
• lowering injury rates
• reducing worker turnover.

European legislation sets out general principles of prevention. Organisations can use these methods as part of their strategy to prevent MSDs:

• primary prevention, which includes the risk-assessment process and technical, ergonomic, organisational, and person-oriented MSDs
• secondary prevention, which involves the identification and health monitoring of workers at risk
• tertiary prevention, which comprises return-to-work activities.

Organisational benefits

Organisations are to ensure their workers are safe and healthy at work. In some countries this is the law. Managing OSH effectively should be a core value for the business and putting workers at risk could negatively affect the business.

Preventing MSDs in the workplace will:

• lower costs
• improve productivity
• improve quality
• gain worker engagement
• ensure a better safety and prevention culture
• reduce staff turnover
• improve morale
• prevent worker discomfort
• reduce absence rates.

Identifying the risks

Identifying these risks can be challenging for most organisations, as issues are dealt with in a reactive way — an issue is investigated when someone reports it.

However, organisations should be thinking proactively about identifying the possible risks.

How would you proactively identify MSD risks in your workplace?

Fishbone diagram – a common tool to capture the root causes by determining causes and effects

Risk factors

The work environment is a complex set of systems and so is the human body. There are various risk factors that can lead to MSDs, which should be considered as part of the risk assessment:

• task
• individual
• load
• work environment
• other factors.

Task

Consideration of the task should cover anything the workers do for their job. Think about factors such as:

• manual handling activities like lifting of heavy loads or equipment or the type of loads being manoeuvred
• ergonomic risk factors such as high- risk repetition, forceful exertions and repetitive or sustained awkward postures.

Individual

Consideration should be given to individual factors such as:

• not being aware of good overall health habits
• not enough or no rest and recovery
• poor nutrition, fitness and hydration
• pre-existing conditions or predisposition conditions or injuries
• age
• pregnancy
• body impairments
• obesity
• family health history.

As mentioned previously, it’s important to consider the individual and, if available, provide OH support to workers.

An additional factor to consider when looking at individual risk factors is whether the person is right for the job. Some organisations use fit-for-role health checks to assess whether a worker is suitable to do the job they have been hired for. They are sometimes used at recruitment stage and then as part of periodic reviews.

Load

No load should be considered universally safe to lift and it should be remembered that workers’ capabilities differ.

A task involving the movement of a load that is too heavy for a worker and is carried out repeatedly will eventually have a substantial impact on the body, creating a risk of MSDs.

When considering load, the following should be borne in mind:

• shape: if the load is an awkward shape, workers will have to use more effort and so could become tired more quickly
• size: if the load is lifted in a dragging motion, visibility will be affected, increasing the risk of tripping or falling
• centre of gravity: often an overlooked factor, but if most of the weight is on one side it can throw the carrier off balance. The heaviest side should be against the body; this will reduce pressure on the spine
• sudden movements: if the load moves suddenly, workers will be at an increased risk because they will be unprepared for the additional stress this creates
• grasping and moving the load: the outer condition of the load can make it difficult to pick up, and gloves can often impair dexterity, making it even harder to feel and lift. If the load can’t be altered, consider putting it into another container with handles to make it easier to grasp
• labelling: a labelling system to help identify the characteristics of the load will help. Labels should be easy to read, so different languages or symbols may be useful.

Work environment

The work environment should be suitable for workers to carry out their job without risking an MSD. Consider the following:

• space constraints
• variation in levels of work surfaces or floors.

Environmental factors such as:

• temperature
• ventilation
• lighting
• excessive noise
• weather
• air quality
• dust.

Other risk factors

These include the organisation of the work and psychosocial factors. Psychosocial factors such as heavy job demands can lead to stress, which has an effect on musculoskeletal health. Consideration must be given to ensure workers are not carrying out the same monotonous task for their entire shift.

Assessment tools

There are many tools available that have been developed by organisations to assess physical tasks.

Repetitive task assessment tools

Assessment of repetitive tasks (ART) involving the upper limbs, taking into consideration common risk factors in repetitive work. The process involves completing a form which describes the tasks, following a flow chart or assessment and completing a score sheet which will be a guide to making an assessment.

Rapid upper limb assessment (RULA) It was proposed by ergonomics researchers in 1993, this tool evaluates the exposure of individual workers to risk factors associated with ULDs. A single-page worksheet is used to evaluate the required body posture, force and repetition. Once all the data are collated and scored using the worksheet, tables are then used to compile the risk factors, generating a single score representing a level of risk.

Quick exposure checklist

This provides a weighted score that indicates the comparative risk of a body region, task or risk factor. This score can then be used to help identify the needs for adapting certain tasks. The assessment can be used by workers as well as organisations.

Rapid entire body assessment (REBA)

A REBA gives a quick and systematic assessment of the complete body postural risks to a worker. Like RULA, a single-page worksheet is used to evaluate a score for each of the following body regions— wrists, forearms, elbows, shoulders, neck, trunk, back, legs and knees.

Job analysis can also be carried out. This is a process that identifies:

• the content of a job in terms of activities involved
• attributes or job requirements needed to perform the activities.

Lifting tools and guidance

The Great Britain (GB) HSE created guidance for the lifting and lowering of loads, which provides organisations with an indication of how acceptable their own working practices are in terms of the objects they expect operators to move during normal processing or production. These are only guidelines – there is no safe lifting limit. The figure below shows a basic guide, based on assumptions that the worker/operator is using both hands to pick up the load in a safe and reasonable environment using appropriate lifting techniques.

Lifting and lowering – Health and Safety Executive

Organisations should carry out more in-depth assessments depending on the nature of their industry and work and the tasks workers are involved in.

The National Institute for Occupational Safety and Health’s (NIOSH) lifting guide evaluates two-handed lifting tasks. The inclusion of an asymmetry multiplier reduces the recommended weight limit (RWL) by around 10 per cent for each 30 per cent of asymmetry. The RWL is the weight of the load that nearly all healthy workers could handle in a specific set of task conditions over a substantial period (e.g. up to eight hours) without an increased risk of developing lifting-related lower back pain.

Liberty Mutual material handling tables (Snook tables) were originally produced as a way of performing ergonomic assessments of lifting, lowering, pushing, pulling and carrying tasks with the goal of supporting ergonomic design interventions. The tables also provide the proportion of the female and male population capable of performing certain manual material handling tasks without over-exertion, rather than giving maximum acceptable weights and forces.

Pushing and pulling guidance

Instead of lifting and carrying, pushing or pulling motions should be used, as they put less strain on the lower back. When workers use push and pull, less effort is required. However, this still carries risk.

A risk assessment of pushing and pulling (RAPP) tool has been developed by the HSE. It will help organisations to identify high-risk pushing and pulling tasks and check the effectiveness of any risk-reduction procedures. The assessments include a flow chart, assessment guide and score sheet to help determine the level of risk.

Controlling the risk

Once the risk of MSDs has been assessed, the best solution is to eliminate risks. As this isn’t always possible, the next option is to control the risk through:

• engineering: this is the most desirable control method to reduce the risks and involves designing or modifying equipment or machinery to reduce the risk of MSDs at the source of exposure
• administrative and work controls: where engineering controls can’t be implemented or if the risk is still considered to be too high, these types of controls are implemented, for example developing operating procedures and training on MSD hazards
• personal protective equipment (PPE): PPE should only be used as a last resort and considered as the lowest level of protection due to the risks it incurs. Equipment can consist of clothing and other wearable accessories designed to create a barrier against workplace hazards.

Training

Tackling MSDs in the workplace also includes focusing on the attitudes and behaviours of the people involved in the work, through training and education.

Training and education play an important role, but only if they are part of a general prevention objective of reducing MSD risks in the workplace.

Providing workers with knowledge and skills will result in a positive change. There are different categories of training on MSDs.

• Awareness training increases workers’ knowledge of safe working methods and the need to adopt healthy lifestyles. It can include information on ergonomics and biomechanics, which will highlight work-related risks and how to prevent them. It also includes practical on-the-job training, which includes how to use equipment correctly.
• Training and exercise therapy can be used to increase physical capacity to cope with the workload or work environment. This kind of physical training can also help to reduce pain related to an MSD

Following training, monitoring and review of tasks should be carried out. This will help to ensure the right training has been received and workers can correctly apply the knowledge and skills at work.