Manual handling: a suitable case for treatment?

In the UK, incidents of all musculoskeletal disorders (MSDs) are falling. According to HSE there was a fall of 17,000 cases between 2010/11 and 2011/12, to only 141,000 new cases. Back injuries, associated with occupations that typically undertake a lot of manual handling activities, make up a significant number of MSDs. The latest Labour Force Survey estimated that manual handling activities and awkward or tiring positions were major factors in back injuries. This presents two questions: the first, why are MSDs and back injuries in the UK falling? The second, what can we do to ensure that they continue to fall?

Why are manual handling injuries falling?
The Manual Handling Operations Regulations 1992 were introduced on 1 January 1993 and target set back in 2000 by HSE to reduce the number and incidence of MSDs have clearly played a role in the reduction of reported injuries. Many organisations have taken steps to comply with the legislation and have become more sensitised to MSDs. However, there is evidence that a strictly ‘legalistic’ approach to manual handling and associated training, based on fear, does not always yield the benefits organisations have in mind. In 2007, HSE produced a report on what constitutes effective manual handling training, which indicated that:

• There was little evidence that manual handling training, focusing on handling techniques, is effective in promoting safer working practices and reducing manual handling injuries in the workplace
• There is strong evidence that ergonomics interventions adopting a multidimensional approach, involving participation of workers and managers, the tailoring of training to suit the person and specific task requirements, along with equipment or task design/redesign, are effective in  reducing manual handling injuries
• The emphasis in training should be on changing attitudes and behaviour and promoting risk awareness among workers and managers. Yet despite this evidence, many organisations deliver manual handling training that focuses on handling techniques, often based on fear and teaching delegates all about injuries.

This is frequently coupled with management training that is all about blame. The narrative tends to be:

• People get hurt because they don’t follow their training
• We train them how to ‘lift properly’
• Therefore if people get hurt, it is their fault.

Human Applications has worked with a lot of organisations that are taking a fresh approach to dealing with manual handling. We find that these more enlightened organisations are adopting a  better, holistic approach to managing manual handling problems that recognises five basic principles:

• Manual handling activities are not, by themselves, inappropriate or hazardous. We are told that we need to exercise more and get fitter. People use weights and engage in a range of manual handling activities to get fit at the gym
• Manual handling activities do not necessarily lead to catastrophic injuries to the spine and the intervertebral discs
• People who engage in manual handling activities need to be encouraged to change behaviours because they want to, not because they fear horrendous injuries
• Unless the training is bespoke, delivered locally and is part of an integrated manual handling management plan, the interventions will not, ultimately, work
• Back injuries will happen. People will have problems that need to be managed; a target of zero is impossible and inappropriate.

This approach to the management of manual handling is becoming more prevalent and may help account for some of the fall in reported injuries. Another factor that will help reduce reported problems and delay the time between episodes of back problems is the approach many organisations now take to early intervention. The faster organisations can provide help to individuals who are suffering from back pain, the faster the individual will return to full fitness and the less likely an individual is to suffer long term absence from work.

The British Occupational Health Research Foundation (BOHRF) has estimated that 50% of people who are off work for six months with back problems never return to work and only 5% of people who are off after one year ever work again.

HSE’s reports on early intervention make a powerful cases for dealing with back pain as quickly as possible and for effective case management. The approach advocate by these reports has been adopted by a number of companies who have seen significant falls in the costs associated with manual handling injuries, though these tend to be reported by organisations who sell these services.

Overall, it is plausible that a holistic approach to the management of manual handling and early treatment will help to account for the falls in both incidence and prevalence of manual handling-related back injuries.

Actions to manage manual handling issues
From a purely legal perspective and to reduce the likelihood of civil or criminal sanctions, organisations should aim to comply with the manual handling regulations 100% of the time. Organisations need to create a robust documentation system that demonstrates suitable and sufficient risk assessments and appropriate controls. Most organisations do this, and it is worth auditing to check what would happen if a colleague reported a manual handling injury. Can the organisation demonstrate compliance and the application of reasonably practicable controls? Organisations need to be clear that just because someone suffers a back injury, even if work-related or work-exacerbated, this does not necessarily mean that the organisation is negligent.

Moving beyond compliance, the evidence is very powerful. Manual handling training only works if it is part of an integrated management system. The most effective solution to manual handling is to integrate it into existing risk management systems and to deliver a solution that uses:

• Training that is tailored, not based on fear, driven by an understanding of behaviours and supported throughout the organisation. Do not teach people how to lift boxes of paper and tell them how they will destroy the discs in their back, if their job is to move sacks of potatoes or put TVs into boxes
• An effective method of engaging all levels of managers and supervisors in the debate about manual handling, teaching them how to make effective interventions
• Models of intervention and behaviours that explain why someone works in a specific way and provide a solution to encourage them to handle it better
• Trainers and manual handling champions at the coalface. These should be colleagues who are respected by their co-workers who are able to offer support and to teach appropriate techniques
• An early intervention programme. Offer people who have MSDs a fast track to treatment. Consider not just injuries caused by work, but also injuries that might be exacerbated by work. Have appropriate rehabilitation regimes that do not just lump people with back injuries into a pot marked ‘light duties’. Tailor who can do what, based on knowledge of what the job entails and which manual handling activities can be undertaken by people with different types of conditions
• The premise that manual handling done well is a good thing. People are now actively encouraged to lead less sedentary lifestyles and jobs with a significant manual handling component can play a role in delivering a more active, fitter workforce.

Despite having this approach and all these considerations and practices in place, accidents will still happen. So it is better to ensure that you have both a sympathetic management culture and a robust rebuttal system. Our experience is that this way MSDs will fall and manual handling will become just another well-managed health and safety issue.

Manual Handling Regulations: www.hse.gov.uk/msd/pushpull/regulations.htm

MSD injury data: www.hse.gov.uk/statistics/causdis/musculoskeletal/msd.pdf

HSE Manual handling training research (2007): www.hse.gov.uk/research/rrpdf/rr583.pdf

Nigel Heaton is director at Human Applications