SAFETY SATURDAY: MANUAL HANDLING

Focus on keeping your spine straight. It is the job of the spine to keep the brain alert.

- B. K. S. Iyengar

Work is often physical, and in ways that are not immediately obvious. When people think about physical work, they might imagine pushing a trolley loaded with goods, lifting planks from a truck, carrying bags of cement, stacking boxes or stacking shelves. Other tasks require less effort but are still physical - someone stacking paper in a printer needs to lift boxes. Refilling the water reservoir in a cooler means handling a drum of liquid that weighs more than ten kilograms. Stacking shelves in the stockroom of an office requires lifting, turning, placing, and holding. All of these individual tasks, regardless of whether the exertion is intense or otherwise, done repetitively or once of, require using strength generated by the human body to do work. Where work requires lifting and lowering, pushing and pulling, or moving something or someone, that job requires manual handling (Worksafe Victoria, 2023). Manual handling requires a worker to use their body to handle goods. Sometimes this is unavoidable - as in the case of a supermarket worker loading bags of groceries into a customer’s car, where a delivery driver needs to carry a parcel up a flight of stairs, or when a removalist needs to move furniture. Sometimes manual handling is incidental, like pushing a computer and projector on a trolley with wheels, or stocking a staffroom fridge with milk, or even just setting up a table for a retirement party. All workers need to use their bodies for work, and so all workers may be exposed to risks arising from or magnified by manual handling. 

Manual handling injuries are physical injuries that affect workers’ bodies as a result of physical and kinetic strain. Safe Work Australia explicitly defines Manual Handling as “some type of manual task using the body to move or hold objects, people or animals,” (Safe Work Australia [SWA], 2018). That same code of practice goes on to state that some manual handling tasks are hazardous and may cause musculoskeletal disorders, which are the most common workplace injuries across Australia. Safe Work Australia’s own work health and safety statistics for the 2022-2023 reporting period report that traumatic joint, ligament, muscle, and tendon injuries together with wounds, lacerations, and fractures made up more than half of all the serious injury claims by common nature groups (SWA, 2024). WIthin this same time period, the most common cause of physical injury was body stressing. This is a consistent trend with the 2021-2022 report, with similar percentages of traumatic injuries and fractures, where body stressing was responsible for 32.6% of all serious claims (SWA, 2023), almost dead-on with the 2024 report at 32.7%. Body stressing is defined as a mechanism of injury arising from the handling, lifting, carrying, or putting down of objects (SWA, 2019), a collective term covering a broad range of health problems associated with repetitive and strenuous work (Comcare, n.d.). Within Safe Work Australia’s 2019 report, when considering body stressing injuries, muscular stress while handling objects as well as muscular stress while lifting, carrying, or putting down objects comprised almost eighty percent of those serious work-related musculoskeletal disorders reported in the 2015-2016 period. In 2020-2021, body stressing again was responsible for 37% of all serious claims by agency (Safe Work Australia, 2022). While the relative proportions of professionals in each occupational group differs, it is usually over 30 percent and concentrated in those body regions most likely to be exerting force, like the trunk, arms, and legs for different industries.

Body stressing as a concept was previously discussed in the context of lifting injuries. In that examination, the relationship between exertional load and physical response was considered - body stress occurs when the demands imposed on a worker’s body exceed the immediate and general ability of the worker’s body to meet the demand. In an acute sense, manual handling injuries including lifting injuries can occur where the demands of a worker’s task exceed the ability of their body in a dramatic, acute fashion, such as when a crate is dropped or a load becomes momentarily unbalanced. Similarly, manual handling injuries can also occur where the dose of physical strain applied to a worker’s body is gradual, but sustained over time (Putz-Anderson, 2017). In each of these circumstances, the physiological load applied to the worker in the short and long term has been sufficient to exceed their performance capacity. Manual handling injuries arising from body stressing develop when the human body is used to interact with physical objects and loads. The likelihood of manual handling injuries increases when the load is dynamic, such as with patients or animals (Johnson et. al., 2023), where the load is unbalanced and where engagement of the load requires awkward posturing (Hanson et. al., 2018), where the handling required is sustained or repetitive (Kamat et. al., 2017), among other factors. The key notion to remember is that manual handling of any kind, whether lifting, pushing, pulling, tilting, carrying, or sliding, relies on the human to generate force. This is understandable, given that many manual tasks are idiosyncratic enough to be irreducible to repetitive movements and therefore mechanised, but it also requires the generation of force from within the human. The effectiveness of this generation and application of force may be influenced by occupational task-specific training (Plamondon et. al., 2010), gender (Orr & Pope, 2016), age (Kudo et. al., 2019), the physical fitness of the worker (Lentz et. al., 2019), and the characteristics of the load itself (Argubi-Wollesen et. al., 2017). Given the number of variables that can affect the relationship between the worker and their manual work, it is little wonder that the most common cause of injury or illness in the 2021-2022 financial year was lifting, pushing, pulling, or bending (Australian Bureau of Statistics, 2023). Worksafe Victoria notes that the most common body areas affected by manual handling injuries are the trunk and lower back, the shoulders, and the arms, hands, and legs, in that order (Worksafe Victoria, 2022). Manual Handling injuries affecting the lower back occur during the lifting of objects as well as the operation of powered tools and equipment and other materials. The arms are injured from lifting, working overhead, from repetitive job tasks, and from handling powered tools. The legs are injured from twisting, turning, squatting, kneeling, and mantling as well as during falls, which have been discussed elsewhere. The concentrations of injuries in different body areas is necessarily informed by the nature of work tasks and the physical exposures to which workers are vulnerable during their shifts as a consequence of work design.

The easiest way to minimise manual handling injuries is to eliminate manual handling. The Hierarchy of Controls recommends that hazards be eliminated at their source where possible, to definitively remove the hazard source as well as eliminate the likelihood of perpetuative residual risk (SWA, n.d.). As has been noted, it is often impossible to avoid interacting with the environment or repositioning the body for physical tasks. The proportion of injuries experienced by Australian workers in 2021-2022 included bending and twisting - these have been included regardless of load. However, by virtue of their being undertaken within an occupational context, they are considered occupational injuries as a result of the engagement of the worker’s body in work-related and work-adjacent tasks. If manual handling injuries arise from accumulative stress, the minimisation of the risk of manual handling injuries can be undertaken with worker physical training to improve physical capacity (Drain & Reilly, 2019). Strength and flexibility training are promising means to minimise the risk of manual handling injuries in workers (Clemes et. al., 2010) however this relies upon the workplace prioritising the physical health of their workforce as a point of intervention by providing the necessary information, training, instruction, and support to facilitate safe worker engagement with both tasks of work and resources that support their ability to engage with job tasks (Bluff, 2019). The potential of this point of intervention is significant, given the contemporarily understood ineffectiveness of current manual handling training (Kugler et. al., 2024). Worker engagement is also a promising point of intervention, where considering worker input and utilising consultation has been found to both mediate the effectiveness of risk management solutions (Wachter et. al., 2014), by involving employees in the business; allowing them to be involved, provide input on their workplaces and work processes, and engage with their feedback to manage risk (Raines, 2011). Workers may even be engaged in participatory problem solving, where leveraging frontline worker knowledge in risk management increases worker buy-in as well as more smoothly facilitate cultural change (DeJoy, 2005). Where it is possible, the minimisation of manual handling, either by adjusting load, rotating shifts, or redesigning work may effectively decrease the cumulative demand imposed on a worker to levels that do not exceed their capacities over a short term and do not degrade their capacities over the long term. However, in doing so, care must be taken to make sure that the adjustment of physical tasks do not generate new risks, such as where lifting smaller objects instead of one larger one does not create additional or multiplicative risk.

Regardless of whether a worker’s job role requires moving things like boxes or products, workers need to interact with their physical environments in their day to day work. Rearranging furniture, cleaning and housekeeping, and navigating workspaces requires some degree of manual handling. This is true for all workplaces, and so all workers, regardless of their age, gender, role, or inclination should take reasonable steps to protect themselves. There is no environment or job task that does not need some kind of physical engagement, and while the likelihood of manual handling injuries is naturally higher for those workplaces and workers who need to use their bodies more regularly in their work, every person working and going through the world should be mindful of the relationship between their bodies and the loads they carry, both physical and otherwise.

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

Argubi-Wollesen, A., Wollesen, B., Leitner, M., & Mattes, K. (2017). Human body mechanics of pushing and pulling: analyzing the factors of task-related strain on the musculoskeletal system. Safety and health at work, 8(1), 11-18.

Australian Bureau of Statistics. (2023). Work-related injuries. Retrieved 16 April 2025 from https://www.abs.gov.au/statistics/labour/earnings-and-working-conditions/work-related-injuries/latest-release

Bluff, E. (2019). How SMEs respond to legal requirements to provide information, training, instruction and supervision to workers about work health and safety matters. Safety science, 116, 45-57.

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.

Comcare. (n.d.). Body Stressing: A Risk Management Snapshot. Retrieved 26 April 2025 from https://www.comcare.gov.au/about/forms-pubs/docs/pubs/safety/body-stressing-risk-management-snapshot.pdf

DeJoy, D. M. (2005). Behavior change versus culture change: Divergent approaches to managing workplace safety. Safety science, 43(2), 105-129.

Drain, J. R., & Reilly, T. J. (2019). Physical employment standards, physical training and musculoskeletal injury in physically demanding occupations. Work, 63(4), 495-508.

Hanson, R., Medbo, L., Berlin, C., & Hansson, J. (2018). Manual picking from flat and tilted pallet containers. International Journal of Industrial Ergonomics, 64, 199-212.

Johnson, K., Swinton, P., Pavlova, A., & Cooper, K. (2023). Manual patient handling in the healthcare setting: a scoping review. Physiotherapy, 120, 60-77.

Kamat, S. R., Zula, N. M., Rayme, N. S., Shamsuddin, S., & Husain, K. (2017, June). The ergonomics body posture on repetitive and heavy lifting activities of workers in aerospace manufacturing warehouse. In IOP Conference Series: Materials Science and Engineering (Vol. 210, No. 1, p. 012079). IOP Publishing.

Kudo, N., Yamada, Y., & Ito, D. (2019). Age-related injury risk curves for the lumbar spine for use in low-back-pain prevention in manual handling tasks. Robomech Journal, 6, 1-10.

Kugler, H. L., Taylor, N. F., & Brusco, N. K. (2024). Patient handling training interventions and musculoskeletal injuries in healthcare workers: Systematic review and meta-analysis. Heliyon, 10(3).

Lentz, L., Randall, J. R., Gross, D. P., Senthilselvan, A., & Voaklander, D. (2019). The relationship between physical fitness and occupational injury in emergency responders: A systematic review. American journal of industrial medicine, 62(1), 3-13.

Orr, R. M., & Pope, R. (2016). Gender differences in load carriage injuries of Australian army soldiers. BMC musculoskeletal disorders, 17, 1-8.

Plamondon, A., Denis, D., Delisle, A., Larivière, C., Salazar, E., & IRSST MMH research group. (2010). Biomechanical differences between expert and novice workers in a manual material handling task. Ergonomics, 53(10), 1239-1253.

Putz-Anderson, V. (2017). Cumulative trauma disorders. CRC Press.

Raines, M. S. (2011). Engaging employees: Another step in improving safety. Professional safety, 56(4), 36.

Safe Work Australia. (n.d.). Managing risks. Retrieved 26 April 2025 from https://www.safeworkaustralia.gov.au/safety-topic/managing-health-and-safety/identify-assess-and-control-hazards/managing-risks

Safe Work Australia. (2018). Model Code of Practice: Hazardous Manual Tasks. Retrieved 26 April 2025 from https://www.safeworkaustralia.gov.au/system/files/documents/1905/model-cop-hazardous-manual-tasks.pdf

Safe Work Australia. (2019). Work-Related Musculoskeletal Disorders in Australia. Retrieved 16 April 2025 from https://www.safeworkaustralia.gov.au/system/files/documents/1912/work-related_musculoskeletal_disorders_in_australia_0.pdf

Safe Work Australia. (2022). Australian Workers' Compensation Statistics 2020-2021. Retrieved 26 April 2025 from https://www.safeworkaustralia.gov.au/sites/default/files/2022-12/australian_workers_compensation_statistics_2020-21.pdf

Safe Work Australia. (2023). Key Work Health and Safety Statistics Australia 2023. Retrieved 26 April 2025 from https://data.safeworkaustralia.gov.au/sites/default/files/2023-09/Key%20Work%20Health%20and%20Safety%20Statistics%20Australia%202023.pdf

Safe Work Australia. (2024). Key Work Health and Safety Statistics Australia 2024. Retrieved 26 April 2025 from https://data.safeworkaustralia.gov.au/sites/default/files/2024-09/Final%20-%20Key%20WHS%20Stats%202024_18SEP.pdf

Wachter, J. K., & Yorio, P. L. (2014). A system of safety management practices and worker engagement for reducing and preventing accidents: An empirical and theoretical investigation. Accident Analysis & Prevention, 68, 117-130.

Worksafe Victoria. (2022). Manual handling. Retrieved 16 April 2025 from https://www.worksafe.vic.gov.au/injury-hotspots-manual-handling

Worksafe Victoria. (2023). Hazardous Manual Handling Safety Basics. Retrieved 26 April 2025 from https://www.worksafe.vic.gov.au/hazardous-manual-handling-safety-basics