Skip to main content
IOSH Magazine: Safety, Health and Wellbeing in the world of work - return to the homepage IOSH Magaazine logo
  • Visit IOSH Magazine on Facebook
  • Visit @ioshmagazine on Twitter
  • Visit IOSH Magazine on LinkedIn
Gender equality
Practice meets perfect
May/June 2023 issue

Main navigation

  • Home
    • Browse previous issues
    • Member accolades
    • Member tributes
  • Health
    • Mental health and wellbeing
      • Bullying
      • Drugs and alcohol
      • Mental health
      • Stress
      • Wellbeing
    • Musculoskeletal disorders (MSDs)
      • Ergonomics
      • Manual handling
      • Vibration
    • Occupational cancer
      • Asbestos
      • Hazardous substances
      • Radiation
  • Safety
    • Incident management
      • Chemicals
      • Electricity
      • Fire
      • First aid
      • Slips and trips
    • Non-health related fatalities
      • Road safety
      • Work at height
    • Risk management
      • Confined spaces
      • Disability
      • Legionella
      • Lifting operations
      • Lone workers
      • Noise
      • Personal protective equipment
      • Violence at work
      • Work equipment
      • Workplace transport
  • Management
    • Human factors
      • Accident reduction
      • Behavioural safety
      • Control of contractors
      • Migrant workers
      • Older workers
      • Reporting
      • Safe systems of work
      • Sickness absence
      • Young workers
    • Leadership and management
      • Employee involvement
      • Management systems
    • Management standards
      • ISO 45001
      • ISO 45003
    • Planning
      • Assurance
      • Compliance
      • Emergency planning
      • Insurance
    • Rehabilitation
      • Personal injury
      • Return to work
    • Strategy
      • Corporate governance
      • Performance/results
      • Regulation/enforcement
      • Reputation
    • Sustainability
      • Human capital and Vision Zero
  • Skills
    • Communication
    • Personal performance
      • Achieving Fellowship
      • Career development
      • Competencies
      • Personal development
      • Professional skills
      • Qualifications
    • Stakeholder management
    • Working with others
      • Leadership
      • Future Leaders
  • Jobs
  • Covid-19
  • Knowledge Bank
    • Back to basics
    • Book club
    • Infographics
    • Podcast
    • Reports
    • Webinars
    • Videos
  • Products & Services
  • Management
    • Human factors
      • Sickness absence
      • Accident reduction
      • Behavioural safety
      • Control of contractors
      • Migrant workers
      • Older workers
      • Reporting
      • Safe systems of work
      • Young workers
    • Leadership and management
      • Employee involvement
      • Leadership
      • Management systems
    • Management standards
      • ISO 45001
      • ISO 45003
    • Planning
      • Assurance
      • Compliance
      • Emergency planning
      • Insurance
    • Strategy
      • Corporate governance
      • Performance/results
      • Regulation/enforcement
      • Reputation
    • Sustainability
      • Human capital and Vision Zero
  • Health
    • COVID-19
    • Mental health and wellbeing
      • Bullying
      • Drugs and alcohol
      • Mental health
      • Stress
      • Wellbeing
    • Musculoskeletal disorders (MSDs)
      • Ergonomics
      • Manual handling
      • Vibration
    • Occupational cancer
      • Asbestos
      • Hazardous substances
      • Radiation
  • Safety
    • Incident management
      • Chemicals
      • Electricity
      • Fire
      • First aid
      • Slips and trips
    • Non-health related fatalities
      • Road safety
      • Work at height
    • Risk management
      • Confined spaces
      • Disability
      • Legionella
      • Lifting operations
      • Lone workers
      • Noise
      • Personal protective equipment
      • Violence at work
      • Work equipment
      • Workplace transport
  • Skills
    • Communication
    • Personal performance
      • Career development
      • Competencies
      • Personal development
      • Qualifications
      • Professional skills
      • Achieving Fellowship
    • Stakeholder management
    • Working with others
      • Leadership
      • Future Leaders
  • Transport and logistics
  • Third sector
  • Retail
  • Mining and quarrying
  • Rail
  • Rehabilitation
    • Personal injury
    • Return to work
  • Utilities
  • Manufacturing and engineering
  • Construction
  • Sector: IOSH Branch
    • Sector: Northern Ireland
    • Sector: Midland
    • Sector: Merseyside
    • Sector: Manchester and North West Districts
    • Sector: Ireland East
    • Sector: Ireland
    • Sector: Edinburgh
    • Sector: Desmond-South Munster
    • Sector: Qatar
    • Sector: Oman
    • Singapore
    • Sector: South Coast
    • Sector: South Wales
    • Sector: Thames Valley
    • Sector: Tyne and Wear
    • Sector: UAE
    • Sector: West of Scotland
    • Sector: Yorkshire
  • Healthcare
  • Sector: Fire
  • Sector: Financial/general services
  • Sector: Energy
  • Education
  • Sector: Communications and media
  • Chemicals
  • Sector: Central government
  • Catering and leisure
  • Agriculture and forestry
  • Sector: Local government
  • Sector: IOSH Group
    • Sector: Financial Services
    • Sector: Sports Grounds and Events
    • Rural industries
    • Sector: railway
    • Public Services
    • Sector: Offshore
    • Sector: Hazardous Industries
    • Sector: Food and Drink
    • Sector: Fire Risk Management
    • Education
    • Construction
    • Sector: Aviation and Aerospace
Quick links:
  • Home
  • Categories
  • Features
Personal injury
Ergonomics
Manual handling
Slips and trips
Disability
Lifting operations
Lone workers
Work equipment
Transport and logistics
Manufacturing and engineering
Construction
Healthcare
Agriculture and forestry

The train drain

Open-access content Dr Andrew Pinder — Thursday 19th July 2018
From the archive:  Just so you know, this article is more than 3 years old.

manual-handling-the-train-drain

The Health and Safety Executive (HSE) guidance on the Manual Handling Operations Regulations (L23) (bit.ly/2uDfmhH) says that "providing information and training alone will not ensure safe manual handling" and that "a good handling technique is no substitute for other risk-reduction steps".

But training in manual handling is still the first resort of many dutyholders trying to control the risk. The HSE's new health priority plan for musculoskeletal disorders (MSDs) (bit.ly/2IW3bYP) aims for a shift in emphasis away from manual handling training and up the hierarchy of control towards risk elimination or reduction through work design and organisation.

Advice to "lift with your legs, not your back" goes back to the 1950s at least. It is often associated with six key factors linked to the concept of kinetic handling developed by the physiotherapist Thomas McClurg Anderson, which emphasised straight back, chin in, positioning of the feet, arms in to the body and use of body weight.

In 1978, Dr Stover Snook reviewed Workers' Compensation claims for low-back injuries in the US and found no evidence that organisations that provided training in manual handling had lower rates of back injuries than those that did not. But he found that ergonomic redesign of tasks partly controlled the risk of such injuries.

Research base

The HSE has emphasised the need for an ergonomics approach to assessing and controlling risks from manual handling in L23 from the first edition in 1992 to the most recent update in 2016. In 2006 it commissioned Loughborough University to review training as a control measure for manual handling risk. This resulted in an HSE research report (bit.ly/2v7Eqxb) that was summarised in two papers in peer-reviewed scientific journals.

The first part of the study was a systematic review of the literature that found little evidence that either technique- or education-based manual handling training were effective at reducing the risk of MSDs. It also found that the principles learned during training could not often be applied in the workplace.

The other part of the study was a survey of companies and trainers to find the factors believed to make manual handling training effective. The researchers summarised these as:

  • Tailoring to industry needs and individual task demands. (External trainers found it helpful to do site visits before tailoring training.)
  • Familiar language to which trainees can relate.
  • Taking account of different learning styles.
  • A practical element, with trainees practising their normal manual handling tasks with equipment relevant to their work.
  • A process that is reinforced regularly with refresher courses, though this was rare in practice.

Recent work

The Loughborough review is now more than ten years old, so the HSE felt it was important to look for more recent scientific studies to see whether new evidence had emerged to challenge the scientific consensus. A search of the literature from 2006 found 39 relevant studies. Of these, five were newly reported intervention studies of manual handling training and seven were systematic reviews in English that pulled together the evidence from the various intervention studies. Most of the 39 papers (25) concentrated on patient/people handling in healthcare.

Training in manual handling is still the first resort of many dutyholders trying to control the risk

High-quality studies to test back pain prevention interventions have to be large, complex, time- consuming and expensive and are difficult to carry out in workplaces. So it follows that few have been reported recently. Systematic reviews make judgements about the quality of published studies. They look for the high-quality studies, such as randomised controlled trials in which researchers take care to reduce the risk of bias distorting the findings. They then draw conclusions about the strength of the evidence for the effectiveness of an intervention and categorise it as strong, moderate, weak or inconclusive. They can also conclude that there is evidence that a particular intervention is not effective.

Carrying out the task the wrong way may be quicker and easier than the right way prescribed by a trainer

The individual intervention studies included a randomised controlled trial that provided bespoke education and training in lifting techniques to 258 workers in the Netherlands but found the method was not effective compared with a similarly sized control group.

A study that used audible feedback from a wearable device to train workers to reduce spine stress found that people who learned not to twist reported significantly fewer low back injuries than ones who were still twisting and untrained people. In another, 12 months after a group of hospital nurses were trained in patient transfer techniques, there were no statistical differences in self-reported lower-back pain, pain level, disability and sick leave between them and those in an untrained control group. However, in another study researchers found training had led to improved knowledge, greater use of safer patient handling techniques (use of handling aids) and the workers doing the handling had improved their perceptions of safety.

Another study of hospital staff who regularly handled patients and a similar control group found a multifactorial injury prevention programme significantly reduced both lost-time injuries and no-time-loss injuries and disability related to patient handling as well as reducing claim costs per injury.

Of the systematic reviews, one concluded that manual handling training for nurses was not effective by itself and was unworthy of further examination but multidimensional strategies were effective. Another found that only exercise was effective in preventing back problems. The other interventions studied were ineffective and included programmes for reducing lifting (no-lift policies, ergonomic training, and mechanical lifting aids), ergonomic/back education alone, stress management, lumbar supports and shoe inserts.

A third review found moderate evidence that a multi-component patient handling intervention improved musculoskeletal health and moderate evidence that patient handling training alone had no effect on musculoskeletal injuries. Another found moderate quality evidence that manual handling advice and training, with or without assistive devices, did not prevent back pain or back pain-related disability when compared with no intervention or different interventions.

Few studies have considered whether manual handling training changes the behaviour of employees. Some research suggests that training improves understanding and awareness but does not always lead to changes in behaviour.

So, though the evidence still suggests that manual handling training is not effective by itself, multi-component programmes can be valuable, especially in healthcare. These programmes need management commitment to reducing injuries, investment in handling equipment and broad-based ergonomics training on safe handling and use of equipment.

Still with us

Manual handling training remains popular because it seems an obvious way to control risk. Since we can teach people complex physical skills such as swimming, we should be able to teach them to lift and carry objects safely. It is also quick, easy and cheap compared with more complex controls such as redesigning processes. Training can result in immediate improvements in handling techniques.

But it does not by itself reduce MSDs, because they have complicated causes and may involve many risk factors. Focusing on a single intervention at the bottom of the hierarchy of control -- such as training in handling techniques -- is always going to be unlikely to control many of the risks.

The trainees may not see any benefit from changing their handling techniques so are not ready for the messages. The "stages of change" model (bit.ly/1koigSu) suggests interventions must take into account an individual's readiness for change.

Research into why training does not work suggests multiple reasons. Courses may be badly delivered and are often too general. They can be shorter in delivery than recommended or planned. Most ergonomists who carry out manual handling training regard the courses they deliver (typically less than half a day) as no more than exercises in raising awareness. Training is often implemented as a one-off event with no follow-up to check that the techniques are being followed.

Those attending the courses may not understand the training and may not develop the correct skills or may lose them later, especially if the training is not reinforced or consolidated. They may not understand how to transfer the techniques to the workplace or may even be taught methods they cannot transfer. Carrying out the task the wrong way may be quicker and easier than the right way prescribed by a trainer. More experienced colleagues may set them a bad example and continue to use unsafe methods.

The HSE's message continues to be that risks from manual handling must be controlled and that dutyholders should eliminate risk at source where possible. Training in manual handling techniques has a place as part of wider safety training in a workplace once risks have been reduced as far as is reasonably practicable. But using it as your main control measure is likely to be ineffective and a poor investment.

This article was funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the author alone and do not necessarily reflect HSE policy.

You may also be interested in...

 GB workplace fatality rate continues to plateau, says HSE

Thursday 5th July 2018
This corresponds to a rate of 0.45 deaths per 100,000 workers and reflects the average five-year (2013-14 to 2017-18) rate of 0.45 per 100,000 workers, or 141 deaths. Statisticians focus on the rate of accidents rather than the absolute total because it is not distorted by variations in numbers employed in the economy year to year.
Open-access content

 HSE business plan targets mental health, ISO 45001 and major hazard industries

Tuesday 3rd July 2018
The plan, which maps out action over the next 12 months, identifies four priority areas.Under leading and engaging with others to improve OSH, the HSE plans to deliver the next phase of the Health and Work programme, with a focus on work-related stress, reducing levels of occupational lung disease and musculoskeletal disorders.In Q4, the HSE says it will publish revised guidance for employers on how to assess and manage work-related mental ill health, which includes links to the new mental healthcare standards.
Open-access content
The overhead conveyer carried materials to platform level. Image credit, © Freyssinet

 Noise and vibration special: Glasgow Subway, on the rigs

Friday 22nd June 2018
In early 2015, the Glasgow Subway’s operator, Strathclyde Partnership for Transport (SPT), engaged civil engineering company Freyssinet UK for a £16m programme to modernise 10 km of tunnels.Appointed as principal contractor and principal designer, Freyssinet had 22 months from the April 2015 start date to complete the works, which posed significant challenges from the outset.
Open-access content

 Formula E Operations: Circuit testing

Friday 10th August 2018
ABB Formula E Championship E-Prix races involve a civil engineering feat unlike any other.
Open-access content
Image credit: ©kynny

 Golf course manager fatally claimed competence with chainsaw

Friday 3rd August 2018
Douglas Johnstone, 56, sustained a fatal brain injury while he was working at the Hinckley Golf Club in December 2013. Leicester Crown Court was told that Johnstone was believed to have been using a chainsaw to clear a heavy branch that had broken off a poplar tree during a storm and was lying in an unstable position across several smaller trees. He died alone at the scene and his body was found by a colleague the morning after the accident, on 28 December.
Open-access content

 Network Rail: Fast track to recovery

Thursday 19th July 2018
In the 12 months to April 2017, the Office of Rail and Road reported 273 suicides and suspected suicides on the UK’s railways. For Network Rail’s mobile operations managers and other frontline workers who respond to such potentially traumatic events, post-incident support is essential to address the ripple effect, as Dr Richard Peters, the rail infrastructure operator’s chief medical officer, describes it.“[While] someone from our team is going to be a first responder, there are also going to be individuals who are involved indirectly.”
Open-access content
Topics
Features
Personal injury
Ergonomics
Manual handling
Slips and trips
Disability
Lifting operations
Lone workers
Work equipment
Transport and logistics
Manufacturing and engineering
Construction
Healthcare
Agriculture and forestry
Share
  • Twitter
  • Facebook
  • Linked in
  • Mail
  • Print

Latest Jobs

Health and Safety Improvement Manager

Leeds
£35000 - £50000 per annum
Reference
5452992

SHEQ Systems Advisor

Up to £40000.00 per annum + Car Allowance
Reference
5452988

Senior Health and Safety Manager

Reading
Up to £65000.00 per annum + Great Car Allowance & Benefits
Reference
5452983
See all jobs »

Sign up for regular e-alerts

Receive the latest news and features, free to your inbox

Sign up

Subscribe to IOSH magazine

Receive the print edition straight to your door

Subscribe
IOSH Covers
​
FOLLOW US
Twitter
LinkedIn
YouTube
CONTACT US
Contact us
Tel +44 (0)20 7880 6200
​

IOSH

About IOSH
Become a member
IOSH Events
MyIOSH

Information

Privacy Policy
Terms & Conditions
Cookie Policy

Get in touch

Contact us
Advertise with us
Subscribe to IOSH magazine
Write for IOSH magazine

IOSH Magazine

Health
Safety
Management
Skills
IOSH Jobs

© 2023 IOSH • IOSH is not responsible for the content of external sites

ioshmagazine.com and IOSH Magazine are published by Redactive Media Group. All rights reserved. Reproduction of any part is not allowed without written permission.

Redactive Media Group Ltd, 71-75 Shelton Street, London WC2H 9JQ