1. International Module W506 Ergonomic Essentials Day 3

2. MUSCULOSKELETAL DISORDERS (MSDs)

3. Outline MSDs –Definition –Parts of body at risk –Impact of MSDs on industry –Risk factors –Low back disorders –Risk management WRULD –Definition –Risk Factors –Injury mechanisms –Risk management

4. Nature & Causes of Manual Handling Disorders 4 key physical risk factors: –Repetition –Force –Posture –Vibration –Combination of factors Cumulative damage

5. Low Back Disorders The spine –Function Facilitates movement Protects spinal cord Protects vital body organs

6. Low Back Disorders Structures of the spine –Muscles, tendons and ligaments –Vertebrae –Discs McPhee

7. Low Back Disorders Injury Mechanisms of the Spine –Lifting/forceful movement –Awkward postures –Heavy physical work –Whole body vibration –Personal variables (strength, age, gender, abdominal girth HOW?

8. Risk Identification Indicators for risk in manual handling tasks: –Weight & load (force) –Frequency of lift (repetition) –Distances moved (force, posture) –Workplace layout (posture, vibration) –Personal variables (abdominal girth, age, gender, strength and mobility)

9. Risk Assessment Strategies Review work tasks to identify ‘risky’ tasks/personnel –Physical demands –Psychological demands –Individual risk factors Undertake formal manual task risk assessment –Legislative requirement to use specific tool? MAC (UK) COP Risk Assessment Tool (Australia) OCRA (EU standard)

10. Detailed Ergonomics Methods Biomechanical –‘risk’ at max. compression force of 3.4 kN at L4/L5 or L5/S1 joints Physiological –‘risk’ at max. energy expenditure of 2.2 – 4.7 kcal/min Psychophysical –‘risk’ at max. acceptable weight (75% female & ~ 90% male workers) Combination Approach

11. Examples of these ergonomics methods (1) Biomechanical –2D & 3D static strength models –Lumbar Motion Monitor Source: http://www.nexgenergo.com/ergonomics/lumbarmm.html

12. Examples of these ergonomics methods (2) Physiological –HR monitoring –Borg rating of perceived exertion scale (RPE) 6No exertion at all 7Extremely light 8 9Very light 10 11Light 12 13Somewhat hard 14 15Hard 16 17Very hard 18 19Extremely hard 20Maximal exertion Borg’s RPE (15 level scale)

13. Examples of these ergonomics methods (3) Psychophysical Methods –Snook Tables Designing manual tasks for more than 75% female work population reduces risk of injury Tables provide information on object weight, distances load is lifted from and to, and frequency of lift. Useful for running ‘what if’ scenarios. Useful web link: http://libertymmhtables.libertymutual.com/CM_LMTablesWeb/pdf/LibertyMutualTables.pdf

14. Examples of these ergonomics methods (4) Combination Approach –NIOSH equation Biomechanical, physiological, psychological criteria to determine lifting limits 3 indices: –lifting index »Ratio of load to recommended weight limit –Job severity index »Measurement of job demands –Lifting strength rating »Strength requirements

15. Other Ergonomics Methods (1) Epidemiological –Nordic Questionnaire

16. Other Ergonomics Methods (2) Postural methods –OWAS –RULA –REBA Combination postural methods –QEC –ManTRA UOW

17. Risk Control 1.Eliminate manual handling activity 2.Redesign to eliminate risk 3.Reduce the risk 1.Redesign load 2.Redesign work area 3.Use mechanical aids &/or equipment 4.Training in risk assessment and ergonomic principles

18. Example of Workplace Modification This workplace washes hospital linen. Linen bags are suspended on a conveyor system and delivered to worker who unties the bottom of the bag and directs washing into chute, eliminating need to manually handle the bag. UOW

19. Use of mechanical aids Use of bin lifter to assist with emptying large and or heavy bins. Backwatch collections WorkCover NSW

20. Principles of manual handling Commit to risk management approach (eliminate manual handling risk!) When lifting & handling a load –Plan the lift/handling activity –Keep the load close to waist (centre of gravity) –Keep stable position –Ensure good grip –‘good posture’ (head up, keep the curves0 –Avoid twisting/sideways bending –Move smoothly –Know your capacity –Adjust the load position AFTER putting it down – e.g. sliding

21. General Guidance for Lifting & Handling Source: HSE: Getting to Grips with Manual Handling

22. Lifting & Lowering Mass Guidance Source: HSE: Getting to Grips with Manual Handling

23. WORK-RELATED UPPER LIMB DISORDERS (WRULDs) CTD RSI OCD OOS WRULD! BP

24. WORK-RELATED UPPER LIMB DISORDERS (WRULDs) Increasing occurrence of WRULDs Risk Factors: Physical Risk Factors Psychosocial Risk FactorsIndividual Risk Factors RepetitionJob demandsAge ForceJob controlGender PostureSocial relations at workSocioeconomic status VibrationPre-existing musculoskeletal disorders

25. The Upper Limb (1) Shoulder Upper arm Forearm Wrist Hand BP

26. The Upper Limb (2) Function of the arm and hand –Mechanical power (large muscles) –Manipulation (small muscles of hand) BP

27. Types of grip Pinch/PrecisionPower/Palmar McPhee

28. UL: Injury Mechanisms (1) Shoulder –High moments at shoulder –Static load on shoulder –Awkward shoulder posture –No time for tissue recovery BP

29. UL: Injury Mechanisms (2) Hand & Forearm –High forces + repetitive work –High forces required by task –Non-optimal postures –Static loads –Use of power tools High vibration High/poor torques –High levels of precision placement in task Increases time Increases static loading Increases force requirements

30. WRULD: Risk Identification Risk Identification –Force (weight and load) –Repetition (frequency of activity) –Posture (workplace layout: distances, forces) –Duration –Psychosocial factors –Work organisational factors (e.g. shift work) –Personal variables (e.g. age, gender)

31. WRULD: Risk Assessment Risk Assessment Techniques –Simple e.g. HSE risk Assessment Worksheet –Complex e.g. RULA, OWAS, OCRA (ISO 11228-3:2007)

32. WRULD: Risk Control (1) Risk Control –Structural modifications Use of ‘ergonomic’ work tools –Bend tool handles to 5 o -10 o –Avoid extreme ulnar/radial deviation –Use low forces when rotating or flexing wrist –Minimise forces for finger pinch movements (<10N (20% of weakest operator max. pinch strength)) ASCC 2007 Stevenson

33. WRULD: Risk Control (2) Risk Control –Structural modifications (cont.) Appropriate workstation layout & equipment –Facilitates optimal postures Reduce excessive force, awkward postures and any compression of tissues while working –Use large muscle groups, not small Stevenson

34. WRULD: Risk Control (3) Organisational modifications –‘Ergonomically’ designed job (pace, variation, etc) Rotate between high and low repetition jobs Use machinery for repetitive jobs and workers for variable tasks Allow self pacing Utilise ergonomic criteria in planning work systems and purchasing equipment –Reduce duration of frequent & repetitive movements Design out repetitive tasks/jobs (esp. < 30 second cycle time) –Ensure adequate recovery time Eliminate unnecessary overtime Avoid repetitive work in extreme tempts. Pauses in work cycles Training & Retraining

35. Summary MSDs –Definition –Parts of body at risk –Impact of MSDs on industry –Risk factors –Low back disorders –Risk management WRULD –Definition –Risk Factors –Injury mechanisms –Risk management