Lower back pain

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# Back Injury Prevention (cont.) ## Why is the pace of work important? (cont.) For example, the pace of work is related to the frequency of a lift. Lifting equations, such as the Revised NIOSH Lifting Equation, use this factor as one of the ways to determine the impact of a lift. Assessments include not just how many lifts are preformed, but the amount of time there is to rest between lifts. It would be ideal if workers could work at their own pace and have some freedom to take a rest break when they start feeling the effects of fatigue. However, this option might be impractical. It seems reasonable to incorporate two additional 15-minute breaks, mid-morning and mid-afternoon, in addition to the 30-minute lunch break. If that schedule is still not feasible, shorter but more frequent breaks can do as well. It is also important that people new to a particular job or task be given time to adjust by allowing them more breaks. ## How can we improve the environment to reduce the risk for injury due to material handling? The design of the work environment is an important element for back injury prevention. - Illuminate the work area at a level of 200 lux. - Use task lights or other additional light sources to improve the ability to see clearly where the material handling requires fine visual discrimination. - Use angular lighting and colour contrast to improve depth perception. This lighting technique helps the worker where the material handling involves climbing stairs or moving in passageways. When the material handling tasks are done outdoors, the temperature conditions including the humidex (in hot weather) or wind-chill factor (in cold weather) have to be monitored very closely. - Reduce tasks by half when the temperature exceeds 28°C. - Stop when the temperature exceeds 40°C. - Restrict to the minimum possible when wind-chill drops below -25°C. - Stop when wind-chill drops to -35°C. - Wear properly designed clothing to decrease heat absorption by …

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# Work-related Musculoskeletal Disorders (WMSDs) (cont.) ## Application of Heat or Cold (cont.) Heat is recommended for muscle pain relief. It increases the flow of blood, which facilitates the elimination of lactic acid buildup. However, it is not recommended for injuries with significant inflammation and swelling. ## Exercise Stretching is beneficial because it promotes circulation and reduces muscle tension. However, people suffering from WMSDs should consult a physical therapist before exercising. Stretching or exercise programs can aggravate the existing condition if not properly designed. ## Medication and Surgery Anti-inflammatory drugs can reduce pain and inflammation. If all other approaches fail, a doctor may try more elaborate treatments or even surgery. ## How can we prevent WMSDs? Hazards are best eliminated at the source; this approach is a fundamental principle of occupational health and safety. In the case of WMSDs, the prime source of hazard is the repetitiveness of work. Other components of work, such as the applied force, fixed body positions, and the pace of work, are also contributing factors. Therefore, the main effort to protect workers from WMSDs should focus on avoiding repetitive patterns of work through job design, which may include mechanization, job rotation, job enlargement and enrichment or teamwork. Where elimination of the repetitive patterns of work is not possible or practical, prevention strategies involving workplace layout, tool and equipment design, and work practices should be considered. Job Design ## Mechanization One way to eliminate repetitive tasks is to mechanize the job. Where mechanization is not feasible or appropriate, other alternatives are available. ## Job Rotation Job rotation is one possible approach. It requires workers to move between different tasks at fixed or irregular periods of time. But it must be a rotation where workers do something completely different. Different tasks must engage differe…

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# Back Injury Prevention (cont.) ## How can we prevent back injury resulting from manual materials handling? (cont.) - job design and redesign (including the work environment) - pre-placement procedures, where necessary - education and training The design or redesign of jobs involving materials handling should be approached in the following stages: - eliminate the need for heavy manual materials handling - decrease the demands - reduce stressful body movements - pace of work and rest breaks - improve environmental conditions ## How do you eliminate the need for heavy manual materials handling? Consider using powered or mechanical handling systems if eliminating the tasks completely is not possible. Mechanical aids lower the risk of back injury by reducing the worker's physical effort required to handle heavy objects. Manual handling such as lifting and carrying can be easier and safer if mechanized by using lift tables, conveyors, yokes, or trucks. Gravity dumps and chutes can help in disposing of materials. However, it is essential that the worker is properly educated and trained in the safe use of the available equipment. ## How can we decrease the demands? Where possible, use mechanical aids. The next step is to decrease the manual material handling demands. There are several ways to achieve this: - Plan the workflow. Often poor planning of the workflow results in repeated handling of the same object (e.g., when articles are temporarily stored in one place, moved to another, stored again, and moved again). - Decrease the weight of handled objects to acceptable limits. - Reduce the weight by assigning two people to lift the load or by splitting the load into two or more containers. Using light containers may also decrease the weight of the load versus other containers. Back Injury Prevention CCOHS

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# Work-related Musculoskeletal Disorders (WMSDs) (cont.) ## Job Rotation (cont.) However, job rotation alone will not be effective in reducing WMSDs if it is not combined with the proper design of workstations. It will also not be effective while the high pace of work persists. ## Job Enlargement and Enrichment Another approach is job enlargement. This option increases the variety of tasks built into the job. It breaks the monotony of the job and avoids overloading one part of the body. Job enrichment involves more autonomy and control for the worker (e.g. when to take a break or change tasks). ## Team Work Teamwork can provide greater variety and more evenly distributed muscular work. The whole team is involved in the planning and allocation of the work. Each team member carries out a set of operations to complete the whole product, allowing the worker to alternate between tasks, hence reducing the risk of WMSDs. ## Workplace Design The guiding principle in workplace design is to fit the workplace to the worker. Evaluation of the workplace can identify the source or sources of WMSD. Proper design of the workstation decreases the effort required of the worker to maintain a working position. Ideally, the workstation should be fully adjustable, providing a worker with options to work in standing, sitting or sitting-standing positions, and fitting the worker's body size and shape. Detailed information about proper workplace design can be found in the OSH Answers documents Working in a Standing Position and Working in a Sitting Position. ## Tools and Equipment Design Proper design of tools and equipment significantly decreases the force needed to complete the task. Providing the worker with the proper jigs or fixtures for tasks that require holding elements saves a lot of muscular effort in awkward positions. Good tools maintained carefully and, where necessary, frequently changed, can also save a lot of muscle strain. More information about hand tools and p…

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# Back Injury Prevention (cont.) ## How can we decrease the demands? (cont.) - Change the type of movement required. Lowering objects causes less strain than lifting. Pulling objects is easier than carryingthem. Pushing is less demanding than pulling. - Change work area layouts. Reducing the horizontal and vertical distances of lifting substantially lowers handling demands. Reducing the travel distances for carrying, pushing or pulling also decreases work demands. - Assign more time for repetitive handling tasks. More time reduces the frequency of handling and allows for more work/rest periods. - Alternate heavy tasks with lighter ones to reduce the build-up of fatigue. ## How can we reduce stressful body movements when handling materials? It is important that tasks are designed to allow the worker to do tasks without excessive reaching, bending, and twisting. These body motions are particularly dangerous and can cause back injury even when not combined with handling loads. - Provide all materials at a work level that is adjusted to the worker's body size. - Eliminate deep shelves to avoid bending. - Ensure sufficient space for the entire body to turn. - Locate objects within easy reach. - Ensure that there is clear and easy access to the load. - Use handles or have a good grip whenever possible. - Use slings and hooks to move loads that do not have handles. - Balance contents of containers. - Use rigid containers. - Change the shape of the load so the load can be handled close to the body. ## Why is the pace of work important? Pace of work, particularly when externally imposed, may significantly contribute to the worker's discomfort, and consequently to the onset of musculoskeletal injuries. Generally speaking, pressure to work at a certain pace creates the mental need to work in a hurry. This perception, in turn, creates tension not only in the mind but also in the body. Tensed muscles are much more prone to injury. Back Injury Prevention CC…

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# Back Injury Prevention (cont.) ## How can education and training be used to help prevent back injuries? (cont.) - Lift the load close to the body. - Lift smoothly without jerking. - Keep the load close to the body, where possible. - Breathe through the lift. - Do not tense muscles. - Do not twist or side bend while lifting. - Do not perform the lift if you are not certain that you can handle the load safely. It is also important that workers: - Take advantage of rest periods to relax tired muscles; this rest prevents fatigue from building up. - Report discomforts experienced during work; reporting will help to identify hazards and correct working conditions. Know how to recognize a manual material handling hazard and report concerns. Finally, there is an aspect of training that cannot be overlooked if training is to be part of an effective prevention program. Workers should be educated that muscles, tendons and ligaments are not prepared to meet the physical stress of handling tasks when they are not "warmed up." Pulls, tears or cramps are more likely when stretched or contracted suddenly under such conditions. These injuries can lead to more serious and permanent injury if physically stressful work is continued. Warming up and mental readiness for physically demanding tasks are important for any kind of material handling, but particularly for occasional tasks where the worker is not accustomed to handling loads. Fact sheet last revised: 2023-01-18 ## Disclaimer Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information. Back Injury Prevention CCOHS

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# SÉCURITÉ ET HYGIÈNE DU TRAVAIL (cont.) WORKPLACE SAFETY AND HEALTH W210 M.R. 217/2006 # PART 8 # PARTIE 8 # MUSCULOSKELETAL INJURIES ## Risk assessment - 8.1(1) When an employer is aware, or ought reasonably to have been aware, or has been advised, that a work activity creates a risk of musculoskeletal injury, the employer must (a) ensure that the risk is assessed by a competent person; and (b) on the basis of the assessment, implement control measures to eliminate or reduce, so far as is reasonably practicable, the risk of musculoskeletal injury to the worker. - 8.1(2) The control measures may include one or more of the following: (a) providing, positioning and maintaining equipment that is designed and constructed to reduce or eliminate the risk of musculoskeletal injury; (b) developing and implementing safe work procedures to eliminate or reduce the risk of musculoskeletal injuries; (c) implementing work schedules that incorporate rest and recovery periods, changes to workload or other arrangements for alternating work: (d) providing personal protective equipment in accordance with Part 6 (Personal Protective Equipment). ## 8.1(3) An employer must (a) monitor the effectiveness of any control measure implemented to eliminate or reduce the risk of musculoskeletal injury; and # BLESSURES MUSCULOSQUELETTIQUES ## Évaluation des risques - 8.1(1) L'employeur qui est au courant, qui aurait normalement dû être au courant ou qui est informé qu'un travail comporte des risques de blessure musculosquelettique a les obligations suivantes a) faire évaluer les risques par une personne compétente; b) selon les résultats de l'évaluation, mettre en œuvre des mesures de contrôle visant à éliminer ou à réduire, dans la mesure du possible, les risques de blessure musculosquelettique pour les travailleurs. - 8.1(2) Les mesures de contrôle peuvent comprendre ce qui suit a) fournir, placer et entretenir l'équipement conçu pour réduire ou éliminer les ris…

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# Back Injury Prevention (cont.) ## How can we improve the environment to reduce the risk for injury due to material handling? (cont.) More details about working and doing manual material handling activities in hot and cold environments are available in CCOHS publications Groundskeepers Safety Guide, Working in Hot Environments, and Cold Weather Worker's Safety Guide. ## How effective is pre-placement screening in back injury prevention? The objective of pre-placement screening is to try to determine if an individual is likely to be injured by activities of their work. There is limited research available to help determine the effectiveness of these measures. In general, it appears that the screening is more accurate when job specific tasks can be included or evaluated. ## How can education and training be used to help prevent back injuries? When combined with work design, education and training are an important element in the prevention of injuries. Part of this education and training also includes showing the worker how to actively contribute to the prevention of injuries. A program should: - Make the worker aware of the hazards of manual material handling. - Demonstrate ways to reduce unnecessary stress. - Train workers in appropriate material handling techniques Instruction on how to lift "properly" can be a controversial issue. While there are many guidelines there is no single correct way to perform a lift. Because of this fact, on-site, task specific training is essential. Some general lifting techniques include: - Plan the lift- remove obstacles from the path that will be travelled. - Prepare to lift by warming up the muscles. - Stand close to the load, facing the way you intend to move. - Use a wide stance to gain balance. - Ensure a good grip on the load. - Maintain the natural curve in the back (helps the mechanical forces to be distributed more evenly over the spine). - Tighten abdominal muscles. - Bend the knees (removes forces …

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CCOHS CCHST Canadian Centre for Occupational Health and Safety Centre canadien d'hygiène et de sécurité au travail # Manual Materials Handling (MMH) # MMH - Health Hazards ## On this page Can MMH affect your health? What are the immediate health effects of MMH? What are the long-term effects of MMH? Which work factors contribute to back injury during MMH? Are there environmental factors that contribute to back injury? Are female workers at greater risk for back injury? Is age a risk factor for back injury? ## Can MMH affect your health? Manual material handling (MMH) is the most common cause of occupational fatigue and low back pain. This document focuses on preventing back injuries caused by MMH in the industrial workplace and only covers the handling of inanimate objects. ## What are the immediate health effects of MMH? Immediate and short-term effects include injuries and fatigue. Sharp or rough surfaces, falling and flying objects are common causes of wounds, lacerations (cuts), or bruises during MMH. The worker can also experience these injuries by falling or by colliding with objects. MMH - Health Hazards CCOHS

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# MMH - Health Hazards (cont.) ## Which work factors contribute to back injury during MMH? (cont.) For most workers, lifting loads over 20 kilograms results in an increased number and severity of back injuries. While the weight of the load is the most obvious factor, it is not the only one that determines the risk of injury. The location of the load is also important. A load lifted far from the body imposes more stress on the back than the same load lifted close to the body. A bulky object is harder to lift than a compact one of the same weight because it (or its centre of gravity) cannot be brought close to the body. Lifting a bulky object also forces a worker into an awkward and potentially unbalanced position. The preferred range for lifting is between knee and waist height. Lifting above and below this range is more hazardous. How often the worker performs MMH tasks and for how long are extremely important factors. Frequently repeated and long-lasting tasks are the most tiring and, therefore, the most likely to cause back injury. Highly repetitive MMH tasks also make the worker bored and less alert. This fact, in turn, can affect safety. Workers need rest breaks to prevent excessive fatigue. Frequency and duration of rest breaks are important factors to be considered. Poor layout of the workplace also increases the risk of injury. For example, shelving that is too deep, too high, or too low causes unnecessary bending or stretching. Lack of space to move freely increases the need for twisting and bending. Unsuitable dimensions of benches, tables, and other furniture force the worker to perform MMH tasks in awkward positions that add stress to the musculoskeletal system. Similar stressful body movements occur where work areas are overcrowded with people or equipment. Training is a very important component of back injury prevention. Workers must be educated about correct lifting techniques for the tasks they do. New employees, those changing jobs, or those ret…