1. Plenary 3: Strategies to prevent back injuries, a priority problem in the automotive industry Best Practices in Ergonomics in the Automotive Industry Richard Wells, Jack Callaghan and Mardy Frazer Centre of Research Expertise Department of Kinesiology University of Waterloo, Canada and Centre of Research Expertise for thePrevention of Work-RelatedMusculoskeletal Disorders and Disability (CRE-PREMUS) for the Prevention of Work-Related Musculoskeletal Disorders and Disability (CRE-PREMUS)

2. Outline Strategies to address root causes of low back pain at work Root causes of low back pain at work and intervention examples Strategies revisited

3. Approaches to Prevention of Low Back Pain in the Automobile Industry Many approaches are talked about… Back belts? Product redesign? Job enlargement? Rebalancing? Exercise programs? Back school? Platforms? Stretching programs? Job rotation? Hoists? Health promotion? Teams?

4. Eliminate/ Substitute Engineering Controls Administrative Controls Personal Protective Equipment Training Increase workers’ capacity Redesign (Product) Platforms, Hoists, Rebalancing (Process) Job enlargement, Job rotation, Teams, etc Back belts, etc Back school, etc Health Promotion, Exercise programs, Stretching programs, etc Strategies to prevent back injuries ExampleGeneral Strategy

5. Root Causes of Low Back Pain at Work An epidemiological study of low back pain in a large Canadian auto assembly plant revealed these mechanical risk factors: High peak loads on the low back High cumulative loads on the low back Large degree of trunk motion These complement the more common approach of thinking about force, posture and repetition but better inform interventions Norman, R., Wells, R., Neumann, P, Frank, J., Shannon, H. and Kerr, M. A Comparison of Peak vs Cumulative Physical Loading Factors for Reported Low Back Pain in the Automobile Industry, Clinical Biomechanics, 13(8): 561-573, 1998. Kerr, M.S., Frank, S.W., Shannon, H.S., Norman, R.W., Wells, R.P., Neumann, W.P., and Bombardier, C. and the OUBPS group. Biomechanical and psychosocial risk factors for low-back pain at work. American Journal of Public Health, 91:1069-1075, 2001.

6. Root Causes of Low Back Pain at Work I High peak loads on the low back Lifting/pushing/pulling large loads Lifting/pushing/pulling loads in disadvantageous postures This is the factor most people recognize Norman, R., Wells, R., Neumann, P*., Frank, J., Shannon, H. and Kerr, M. A Comparison of Peak vs Cumulative Physical Loading Factors for Reported Low Back Pain in the Automobile Industry, Clinical Biomechanics, 13(8): 561-573, 1998. Kerr, M.S., Frank, S.W., Shannon, H.S., Norman, R.W., Wells, R.P., Neumann, W.P., and Bombardier, C. and the OUBPS group. Biomechanical and psychosocial risk factors for low-back pain at work. American Journal of Public Health, 91:1069-1075, 2001. 23+ kg

7. Interventions for Low Back Pain at Work I High peak loads on the low back Lifting/pushing/pulling large loads Interventions Force/ insertion Limits and Weight Limits e.g. 40lb (~18kg) PRODUCT+PROCESS Hoist and lift assists PROCESS

8. Lifting/pushing/pulling large loads ManualWith lift assist

9. Root Causes of Low Back Pain at Work I High peak loads on the low back Lifting/pushing/pulling large loads Lifting/pushing/pulling moderate loads in disadvantageous postures Norman, R., Wells, R., Neumann, P*., Frank, J., Shannon, H. and Kerr, M. A Comparison of Peak vs Cumulative Physical Loading Factors for Reported Low Back Pain in the Automobile Industry, Clinical Biomechanics, 13(8): 561-573, 1998. Kerr, M.S., Frank, S.W., Shannon, H.S., Norman, R.W., Wells, R.P., Neumann, W.P., and Bombardier, C. and the OUBPS group. Biomechanical and psychosocial risk factors for low-back pain at work. American Journal of Public Health, 91:1069-1075, 2001. F

10. Interventions for Low Back Pain at Work I High peak loads on the low back Lifting/pushing/pulling moderate loads in disadvantageous postures Interventions Position of load/force application PRODUCT+PROCESS Force magnitude PRODUCT Hoist and lift assists PROCESS F

11. Root Causes of Low Back Pain at Work II High cumulative loads on the low back Lifting/pushing/pulling light to moderate loads for long duration Lifting/pushing/pulling of light to moderate loads many times per shift Holding non-upright trunk postures for long duration Long shifts Norman, R., Wells, R., Neumann, P*., Frank, J., Shannon, H. and Kerr, M. A Comparison of Peak vs Cumulative Physical Loading Factors for Reported Low Back Pain in the Automobile Industry, Clinical Biomechanics, 13(8): 561-573, 1998. Kerr, M.S., Frank, S.W., Shannon, H.S., Norman, R.W., Wells, R.P., Neumann, W.P., and Bombardier, C. and the OUBPS group. Biomechanical and psychosocial risk factors for low-back pain at work. American Journal of Public Health, 91:1069-1075, 2001. x 500+

12. Interventions for Low Back Pain at Work II High cumulative loads on the low back Lifting/pushing/pulling light to moderate loads for long duration Interventions Position of load/force PRODUCT- PROCESS Reduce forces PRODUCT -PROCESS Reduce proportion of cycle loaded or total time loaded PRODUCT-PROCESS-ADMIN Reduce number of movements PRODUCT-PROCESS-ADMIN x 500+

13. Root Causes of Low Back Pain at Work II High cumulative loads on the low back Lifting/pushing/pulling light to moderate loads for long duration Lifting/pushing/pulling of light to moderate loads many times per shift Holding non-upright trunk postures for long duration Long shifts Norman, R., Wells, R., Neumann, P*., Frank, J., Shannon, H. and Kerr, M. A Comparison of Peak vs Cumulative Physical Loading Factors for Reported Low Back Pain in the Automobile Industry, Clinical Biomechanics, 13(8): 561-573, 1998. Kerr, M.S., Frank, S.W., Shannon, H.S., Norman, R.W., Wells, R.P., Neumann, W.P., and Bombardier, C. and the OUBPS group. Biomechanical and psychosocial risk factors for low-back pain at work. American Journal of Public Health, 91:1069-1075, 2001.

14. Interventions for Low Back Pain at Work II High cumulative loads on the low back Holding non-upright trunk postures for long duration Interventions Position of load/force PRODUCT - PROCESS Reduce force PRODUCT –PROCESS Reduce time loaded PRODUCT- PROCESS-ADMIN If force small, limited benefit to reducing force as trunk so heavy

15. Holding non-upright trunk postures for long duration OldNew

16. Root Causes of Low Back Pain at Work III Large degree of trunk motion Many trunk motions Large trunk motions Norman, R., Wells, R., Neumann, P*., Frank, J., Shannon, H. and Kerr, M. A Comparison of Peak vs Cumulative Physical Loading Factors for Reported Low Back Pain in the Automobile Industry, Clinical Biomechanics, 13(8): 561-573, 1998. Kerr, M.S., Frank, S.W., Shannon, H.S., Norman, R.W., Wells, R.P., Neumann, W.P., and Bombardier, C. and the OUBPS group. Biomechanical and psychosocial risk factors for low-back pain at work. American Journal of Public Health, 91:1069-1075, 2001. many

17. Interventions for Low Back Pain at Work III Large degree of trunk motion Many trunk motions Interventions # Parts handled PRODUCT- PROCESS- ADMIN Position of part/load/force PRODUCT-PROCESS x 500+

18. Root Causes of Low Back Pain at Work III Large degree of trunk motion Many trunk flexion/extension motions Large trunk motions Norman, R., Wells, R., Neumann, P*., Frank, J., Shannon, H. and Kerr, M. A Comparison of Peak vs Cumulative Physical Loading Factors for Reported Low Back Pain in the Automobile Industry, Clinical Biomechanics, 13(8): 561-573, 1998. Kerr, M.S., Frank, S.W., Shannon, H.S., Norman, R.W., Wells, R.P., Neumann, W.P., and Bombardier, C. and the OUBPS group. Biomechanical and psychosocial risk factors for low-back pain at work. American Journal of Public Health, 91:1069-1075, 2001.

19. Interventions for Low Back Pain at Work III Large degree of trunk motion Large trunk motions Interventions Position of part/load/force PRODUCT-PROCESS

20. Eliminate/ Substitute Engineering Controls Administrative Controls Personal Protective Equipment Training Increase workers’ capacity Redesign (Product) Platforms, Hoists, Rebalancing (Process) Job enlargement, Job rotation, Teams, etc Back belts, etc Back school, etc Health Promotion, Exercise programs, Stretching programs, etc Strategies to prevent back injuries ExampleGeneral Strategy

21. Research Based Approaches to Interventions More Basic More Applied Knowledge Generation and Synthesis Outreach and Application: Getting the Knowledge Out Evaluation: What Works and Why (not) Human Characteristics and Capabilities Related to the Development of WMSD Outcome, Exposure, Hazard and Risk Assessment for the Development of WMSD Development of Appropriate Interventions to Prevent WMSD Processes to Make Workplace Changes to Prevent WMSD Evaluation of WMSD Prevention Programs Laboratory studies show belts have little effect on spinal loading Epidemiological studies show belts have little or no effect on low back pain Back Belts

22. Eliminate/ Substitute Engineering Controls Administrative Controls Personal Protective Equipment Training Increase worker capacity Design (Product) Platforms, Hoists, Rebalancing, (Process) Job enlargement, Job rotation, Teams, etc Back belts, etc Back school, lift training etc Health Promotion, Exercise programs, Stretching programs, etc Strategies to prevent back injuries ExampleGeneral Strategy

23. Centre of Research Expertise for the Prevention of Work-Related Musculoskeletal Disorders and Disability receives substantial funding through a grant provided by the Workplace Safety and Insurance Board The Centre of Research Expertise for the Prevention of Work-Related Musculoskeletal Disorders and Disability receives substantial funding through a grant provided by the Workplace Safety and Insurance Board wells@uwaterloo.ca