Is hazardous manual handling the only enemy?

As an occupational health physiotherapist, I spend much of my time assessing and managing workers who have sustained musculoskeletal disorders (MSDs) whilst performing workplace manual tasks. The consequences of such MSDs in the workplace are well documented, with significant social and economic burdens for the injured worker, employer and healthcare system.

MSDs are the most common cause of workers compensation claims in Australia. According to a 2016 research report from the Institute for Safety, Compensation and Recovery, MSDs accounted for 59.5% of all accepted workers compensation claims, meaning that they would account for a significant proportion of the $61.8 billion that work-related injury and illness cost the Australian economy in 2012–2013.

Under workplace health and safety (WHS) law, employers have a duty of care, so far as is reasonably practicable, to ensure the health and safety of their workers in the workplace. Prevention of work-related MSDs should therefore form an integral component of any WHS system.

The gold standard approach for preventing MSDs should focus on the effective implementation of a risk management approach. In applying this, it is imperative that an organisation has a thorough understanding of all possible contributing hazards that may contribute to the development of MSDs.

In many instances, the risk management approach is directed to eliminating or reducing physical hazards directly related to the inherent characteristics of manual tasks (such as the level of exertion or repetition associated with a task). However, research suggests that workplace psychosocial and organisational factors also present as risk factors for work-related MSDs. Furthermore, individual worker characteristics including age, previous injury, fitness level and lifestyle factors (such as smoking) can all have a contributory effect to the risk of an individual sustaining an MSD in the workplace. 

Having a thorough understanding of all possible risk factors that can lead to MSDs is therefore imperative. After all, you cannot prevent what you don’t fully understand. 

Manual handling hazards

The most common mechanism of injury for work-related MSDs is considered ‘body stressing’, which can occur from performing hazardous manual tasks. So what is hazardous? As defined in the WHS Regulations 2011, a hazardous manual task is a task that “requires a person to lift, lower, push, pull, carry or otherwise move, hold or restrain any person, animal or thing involving one or more of the following: repetitive or sustained force, high or sudden force, repetitive movement, sustained or awkward posture and exposure to vibration”.

For most people, targeting control measures to reduce or eliminate exposure to such task characteristics seems intuitive. Reducing a worker’s exposure to force, awkward posturing and repetitive or sustained movements will help reduce physical stress on the body and help curtail injury. 

Being able to effectively identify and assess what characteristics of a manual task are hazardous is essential to ensuring the most effective control measures are implemented. To achieve this, there are many reliable and validated risk assessments tools which could be used. Commonly used tools include the Risk Matrix, ManTRA, PerFORM, RULA, REBA and Liberty Mutual Tables, with all these tools available online. 

Each tool has its pros and cons, and each tool tends to have specificity to assessing certain types of manual tasks. For instance, the RULA and REBA are effective for tasks where posture might be the main concern and the Liberty Mutual Tables are more specific to lifting, pushing and pulling tasks. Developing a general understanding of and familiarity with a number of risk assessment tools can help ensure the most appropriate tool is applied. Furthermore, engaging the help of a suitably qualified health professional such as an occupational physiotherapist, occupational physician or certified practising ergonomist to conduct a formal risk assessment can help streamline and simplify the process. Using a participative approach that involves consultation with all key stakeholders, including frontline workers, is of course also essential.

Once the contributing physical risk factors are identified and the risk assessed, effective prevention of work-related MSDs can be achieved through the elimination or reduction of exposure to these factors. The hierarchy of risk control highlights that level one elimination control measures provide the highest level of health and safety protection and are the most reliable. The reliability and level of health and safety protection then declines with level two and three control measures. The Hazardous Manual Task Code of Practice 2011 and Safe Work Australia website provide strong guidance materials and practical examples of how to implement effective control measures.

Psychosocial risk factors

By definition, work-related psychosocial risks concern aspects of the design and management of work and its social and organisational contexts that have the potential for causing psychological or physical harm. 

When it comes to understanding MSDs, these risk factors are often less tangible and less obvious, and are often not considered or easily accepted by workplaces as potential hazards that contribute to musculoskeletal injury. Despite this, research highlights that workplace psychosocial, organisational and cultural factors are independent risk factors for the development of musculoskeletal disorders.  

Examples of workplace psychosocial hazards that can contribute to MSDs include but are not limited to: time pressures; cognitive demands; hours of work; poorly defined work roles; poorly managed change; poor conflict management; lack of job control; lack of supervisor and/or co-worker support; organisational injustice; and inadequate reward and recognition.

Such workplace psychosocial risk factors may not only lead to occupational stress, but can promote a wide variety of mental and behavioural responses within a worker. A growing body of evidence now exists, highlighting how occupational stress can increase a worker’s risk of tissue damage and pain.

In the case of work-related low back injuries, evidence has highlighted that poor supervisor and manager support, lack of social support from colleagues, low job control and poor job satisfaction are all independent risk factors for low back pain. These psychosocial risk factors have also been shown to be causative to work-related upper limb MSDs, as has a lack of task variation, job insecurity and working under time pressure and deadlines.

Similar to managing physical risk factors, a risk management approach to psychosocial hazards should also be employed. Recently, Workplace Health and Safety Queensland released its ‘People at Work Project’. This tool promotes a risk assessment process which helps business understand and manage their psychosocial risks. It promotes appropriate prioritisation of risks and provides direction for the implementation of appropriate prevention strategies. Such strategies may need to be tailored at the job design, organisational or individual level.

Job design strategies might focus on changes to rostering, shift patterns or job rotation. Effective controls at the job design level may not only help reduce psychosocial hazards related to performing tasks, but also have a direct effect on reducing exposure to hazardous manual tasks.

At the organisational level, strategies to foster an improved WHS culture may need to be considered. This may include greater worker consultation in health and safety issues or ensuring supervisors and managers set the standard by role modelling correct processes and procedures, whilst also employing transparent, honest communication.

At an individual level, providing appropriate training, education and support — tailored toward each worker — can help improve a worker’s capacity to cope. This is discussed in more detail below in the wellness program section.

Regardless of where the intervention is directed, the success of controlling psychosocial risk is, however, contingent on several variables.

Overt and visible senior management involvement is required. This can signal the importance of the process and can directly impart a sense of ‘support’ for the workforce. Such involvement may include senior management being active in workplace health and safety committees or attending toolbox meetings.

In line with this, supervisor commitment and engagement is also needed. Supervisors are often the direct link between workers and senior management. Supervisors who commit to a risk management process, role model correct processes and procedures, and are approachable, supportive and non-judgemental not only instil a positive health and safety culture, but will often be the first person to identify psychosocial risks for individual workers, or for the workplace as a whole.

Direct and consistent organisational communication is also required to ensure that management commitment to addressing psychosocial issues is conveyed, and to help promote worker engagement. This may be achieved through focus groups, noticeboards, broadcast emails and management participation in WHS committees and toolbox meetings.

Worker participation and engagement is also crucial to managing psychosocial risks. This can foster a greater sense of ‘work control’ and ‘support’, and may in fact assist in reducing the very stressors that contribute to psychosocial hazards. Furthermore, worker input ensures any interventions are specifically tailored to workers’ concerns.

Although these variables have been discussed in the context of effective management of psychosocial risk, they are equally important in the risk management process for hazardous manual tasks. The two are not mutually exclusive.

Wellness programs

The concept that ‘good health is good business’ underpins a strong business case for investing in worker health and wellbeing. In fact, implementation of workplace health and wel-being initiatives has been shown to reduce workers compensation costs and premiums, whilst improving productivity.

With respect to MSDs, evidence exists that lifestyle-related factors, including smoking and high body mass index, along with co-morbidities such as depression, stress and diabetes, are all independent risk factors for MSDs.

Initiatives such as regular health screenings, delivery of health seminars on smoking cessation, exercise, diet and sleep hygiene, 12-week challenges, 10,000-step challenges, mental health first aid and manual handling training can empower workers to be proactive with their health and work habits, giving them tools and strategies to work smarter to avoid injury, while encouraging them to use their work as an opportunity to move meaningfully. 

Programs tailored to improve the general health and wellbeing of workers help promote a fitter, healthier workforce and can arm workers with more physical and psychological capacity to adequately cope with their job demands. Such programs also foster an improved health and safety culture within an organisation, which, as previously mentioned, can have an overflow effect on improved risk management of possible psychosocial hazards and hazardous manual tasks.

In summary, effective risk management of MSDs in the workplace is complex and requires more than just consideration of hazardous manual tasks. Understanding the nature and effect of psychosocial risk factors, as well as individual health and lifestyle risk factors, is critical. Furthermore, implementation of an effective risk management program that considers all possible risk factors requires strong leadership and workforce engagement — from frontline workers through to senior management.

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