Protect|ng Workers'

Hea|th Ser|es
No 5
Prevent|ng Muscu|oske|eta| D|sorders
|n the Workp|ace
Prot. Dr. rer. nat. A|w|n Luttmann
PD Dr.-lng. Matth|as |ger
Prot. Dr. med. 8arbara Gr|etahn
lnst|tute tor Occupat|ona| Phys|o|ogy
at the Un|vers|ty ot Dortmund
lnst|tut tur Arbe|tsphys|o|og|e
an der Un|vers|tt Dortmund
Ardeystrasse 7
D-44139 Dortmund
Germany
and
Dr. med. sc. Gustav Catt|er
Dr. med. la|k L|ebers
D|p|.-lng. U|t Ste|nberg
ledera| lnst|tute tor Occupat|ona|
Satety and Hea|th/
8undesansta|t tur Arbe|tsschutz
und Arbe|tsmed|z|n
No|dnerstrass|e 40-42
D-10317 8er||n
Germany
Cover page |ayout
Juu|a So|asaar|-Pekk|
l|nn|sh lnst|tute ot Occupat|ona| Hea|th
Des|gn and |ayout
M/s Sat|re Graph|x, New De|h|, lnd|a
C:ct IooIIc:s Iton :c Pto:cc:Iny VotIcts HcaI: SctIcs.
No.1 : Prevent|ng hea|th r|sks trom the use ot pest|c|des |n agr|cu|ture
No.2 : Understand|ng and pertorm|ng econom|c assessments at the company
|eve|
No
.
3 : Work organ|zat|on and stress at work
No
.
4 : ka|s|ng awareness ot Psycho|og|ca| Harassment at Work
WHO L|brary Cata|ogu|ng-|n-Pub||cat|on Data
Prevent|ng muscu|oske|eta| d|sorders |n the workp|ace/A|w|n Luttmann ... [et a|.J
Protect|ng workers' hea|th ser|es ; no. 5.
1. Muscu|oske|eta| d|seases - prevent|on and contro| 2. Workp|ace
3. k|sk tactors 4. Gu|de||nes l. Luttmann, A|w|n. ll. Ser|es
lS8N 92 4 159053 X (LC/NLM c|ass|t|cat|on: WA 440)
Wor|d Hea|th Organ|zat|on 2003
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Pretace
D|sorders ot the muscu|oske|eta| system represent a ma|n cause tor
absence trom occupat|ona| work. Muscu|oske|eta| d|sorders |ead to
cons|derab|e costs tor the pub||c hea|th system. Spec|t|c d|sorders ot the
muscu|oske|eta| system may re|ate to d|tterent body reg|ons and
occupat|ona| work. lor examp|e, d|sorders |n the |ower back are otten
corre|ated to ||tt|ng and carry|ng ot |oads or to the app||cat|on ot v|brat|on.
Upper-||mb d|sorders (at t|ngers, hands, wr|sts, arms, e|bows, shou|ders,
neck) may resu|t trom repet|t|ve or |ong-|ast|ng stat|c torce exert|on or
may be |ntens|t|ed by such act|v|t|es. Jhe sever|ty ot these d|sorders
may vary between occas|ona| aches or pa|n to exact|y d|agnosed spec|t|c
d|seases. Occurrence ot pa|n may be |nterpreted as the resu|t ot a
revers|b|e acute over|oad|ng or may be a pre-symptom tor the beg|nn|ng
ot a ser|ous d|sease.
Jhe purpose ot th|s document on the prevent|on ot muscu|oske|eta|
d|sorders |s to |ntorm about r|sk tactors and to |nt|uence the act|ons ot
emp|oyers and the behav|our ot workers |n such a way that r|sks ot
phys|ca| |oad|ngs, dangerous to hea|th or unnecessary tat|gu|ng, are
avo|ded or d|m|n|shed. Jhe document has been prepared |n such a way
that |t can be used by emp|oyers, superv|sors, and occupat|ona| hea|th
tra|ners when des|gn|ng work and work env|ronment or tor prepar|ng
|ntormat|on mater|a|s and tra|n|ng programs. ln consequence, app||cat|on
ot the gu|de shou|d be he|ptu| to reduce harm to |nd|v|dua|s, to |nt|uence
the ett|c|ency ot work pos|t|ve|y, and to reduce costs on the pub||c hea|th
system.
lt |s |ntended that th|s book|et be used by emp|oyers, superv|sors and
occupat|ona| hea|th tra|ners to he|p them recogn|se r|sks that may |ead
to muscu|oske|eta| d|sorders, as we|| as to des|gn work |tse|t and the
work env|ronment |n a way wh|ch |s sate tor the emp|oyee.
Acknow|edgement |s expressed to the to||ow|ng rev|ewers: Jhomas k.
Waters, Ph. D., Nat|ona| lnst|tute tor Occupat|ona| Satety and Hea|th,
C|nc|nnat|; Dr. H|sash| Ogawa, Wor|d Hea|th Organ|zat|on, keg|ona|
Adv|ser tor Occupat|ona| Hea|th, keg|ona| Ott|ce tor the Western Pac|t|c,
Man||a; and fve|yn Kortum-Margot, Occupat|ona| Hea|th Programme,
Wor|d Hea|th Organ|zat|on, Geneva, Sw|tzer|and.
fxamp|es ot phys|ca| |oad|ngs at work wh|ch may be dan-
gerous to hea|th:
Knee||ng tor |ong durat|on
Man|pu|at|on ot heavy |oads
S|tt|ng tor |ong durat|on
Who|e-body v|brat|on
Stat|c work and awkward
posture
Contents
Part 1: Object|ves
1.1 Work-re|ated muscu|oske|eta| d|sorders - a det|n|t|on 1
1.2 Character|st|c hea|th prob|ems 2
1.3 8as|c r|sk tactors tor the deve|opment ot 3
muscu|oske|eta| d|sorders
1.4 lactors to be cons|dered |n prevent|on 12
Part 2: Gu|dance
2 Gu|dance on ma|n r|sk tactors 15
2.1 k|sk tactor: Man|pu|at|on ot heavy |oads 15
2.2 k|sk tactor: Work w|th h|gh torce exert|on 18
2.3 k|sk tactor: Work|ng |n untavourab|e body postures 19
2.4 k|sk tactor: Monotonous repet|t|ve tasks 22
2.5 k|sk tactor: Long-|ast|ng |oad|ngs 23
2. k|sk tactor: Phys|ca| env|ronmenta| cond|t|ons 25
Append|x: 8as|c ru|es tor prevent|ve act|ons |n pract|ce 27
Summary 29
Conc|us|on 30
lurther read|ng and reterences 31
1
Object|ves
1.1 VotI-tcIa:cc nuscuIosIcIc:aI cIsotccts - a det|n|t|on
Jhe term nuscuIosIcIc:aI cIsotccts denotes hea|th prob|ems ot
the |ocomotor apparatus, |.e. ot musc|es, tendons, the ske|eton,
cart||age, ||gaments and nerves. Muscu|oske|eta| d|sorders |nc|ude
a|| torms ot |||-hea|th rang|ng trom ||ght, trans|tory d|sorders to
|rrevers|b|e, d|sab||ng |njur|es. Jh|s book|et tocuses on
muscu|oske|eta| d|sorders, wh|ch are |nduced or aggravated by
work and the c|rcumstances ot |ts pertormance. Such work-re|ated
muscu|oske|eta| d|sorders are supposed to be caused or |ntens|t|ed
by work, though otten act|v|t|es such as housework or sports may
a|so be |nvo|ved.
os: Inpot:an: IocaIIza:Ion oI
votI-tcIa:cc nuscuIosIcIc:aI
cIsotccts
Upper extrem|t|es (shou|der
arm hand)
Ma|n art|cu|at|ons (e.g. knee)
Part
1
2
1.2 Catac:ctIs:Ic caI: ptoIIcns
Hea|th prob|ems occur, |n part|cu|ar,
|t the mechan|ca| work|oad |s h|gher
than the |oad-bear|ng capac|ty ot the
components ot the muscu|oske|eta|
system. lnjur|es ot musc|es and
tendons (e.g. stra|ns, ruptures),
||gaments (e.g. stra|ns, ruptures),
and bones (e.g. tractures, unnot|ced
m|crotractures, degenerat|ve changes) are typ|ca| consequences.
ln add|t|on, |rr|tat|ons at the |nsert|on po|nts ot musc|es and
tendons and ot tendon sheaths, as we|| as tunct|ona| restr|ct|ons
and ear|y degenerat|on ot bones and cart||ages (e.g. men|sc|,
vertebrae, |ntervertebra|
d|scs, art|cu|at|ons) may
occur.
Jhere are two tunda-
menta| types ot |njur|es,
one |s acute and pa|ntu|,
the other chron|c and
||nger|ng. Jhe t|rst type |s
caused by a strong and
short-term heavy |oad,
|ead|ng to a sudden
ta||ure |n structure and
tunct|on (e.g. tear|ng ot
a musc|e due to a heavy
||tt, or a bone tracture due
to a p|unge, or b|ock|ng
ot a vertebra| jo|nt due to
a vehement movement). Jhe second resu|ts trom a permanent
over|oad, |ead|ng to cont|nuous|y |ncreas|ng pa|n and dystunc-
t|on (e.g. wear and tear ot ||gaments, tendovag|n|t|s, musc|e
spasm and harden|ng). Chron|c |njur|es resu|t|ng trom |ong-term
|oad|ng may be d|sregarded and |gnored by the worker because
the |njury may seem|ng|y hea| qu|ck|y and |t may not resu|t |n an
actua| s|gn|t|cant |mpa|rment.
Jo prevent muscu|oske|eta| d|sorders, a
ba|ance between mechan|ca| |oad at work
and |oad-bear|ng capac|ty ot the muscu|o-
ske|eta| system |s most |mportant.
Lower back
3
Jhe number ot such |njur|es |s substant|a|. ln |ndustr|a||zed countr|es,
about one-th|rd ot a|| hea|th-re|ated absences trom work are due
to muscu|oske|eta| d|sorders. 8ack |njur|es (e.g. |ower back pa|n,
|sch|ad|cs, d|sc degenerat|on, hern|at|on) have the h|ghest
proport|on (approx|mate|y 0%). Jhe second pos|t|on |s taken by
|njur|es ot the neck and the upper extrem|t|es (e.g. pa|n syndromes
ot the neck, shou|ders, arms, tenn|s e|bow", tend|n|t|s and
tendovag|n|t|s, carpa| tunne| syndrome, syndromes re|ated to
cumu|at|ve traumata, the so-ca||ed cumu|at|ve trauma d|sorders
(CJDs) or repet|t|ve stra|n |njur|es (kSls)), to||owed by |njur|es ot
knees (tor examp|e, degenerat|on ot men|sc|, arthros|s) and h|ps
(e.g. arthros|s). lt |s genera||y accepted that work|ng cond|t|ons
and work|oad are |mportant tactors tor the deve|opment and
cont|nuance ot these d|sorders.
1.3 8as|c r|sk tactors tor the deve|opment ot muscu|oske|eta|
d|sorders
!.3.! ccanIcaI ovctIoac, tcpc:I:Ion Itcucncy, cposutc :Inc,
pos:utc anc accIccn:s
Work-re|ated muscu|oske|eta| d|sorders are supposed to be causa||y
||nked to phys|ca| |oad resu|t|ng trom occupat|ona| act|v|t|es.
D|sorders or |njur|es attect|ng musc|es, tendons, jo|nts, ||gaments
and bones are ma|n|y caused by nccanIcaI ovctIoac ot the
respect|ve b|o|og|ca| structures. Potent|a| over|oad ot t|ssues resu|ts
trom h|gh |ntens|ty torces or torques act|ng on and |ns|de the body.
fxamp|es ot occupat|ona| act|v|t|es co|nc|d|ng w|th h|gh mechan|ca|
requ|rements are hand||ng ot objects, as |n transportat|on jobs, or
the app||cat|on ot push|ng or pu|||ng torces to too|s or mach|nes.
Jhe detr|menta| ettect ot mechan|ca| over|oad depends ma|n|y on
the magn|tude ot the torce.
lurthermore, the durat|on ot exposure |s an |mportant tactor |n the
deve|opment ot muscu|oske|eta| d|sorders. lt |s ma|n|y determ|ned
by the nunIct oI tcpc:I:Ions pct unI: :Inc (c.y. pct cay) as we|| as
by the :o:aI cposutc :Inc (c.y. ts pct cay ot cays pct non:).
kegard|ng the character ot exposure, occas|ona| vocat|ona| |oad|ng
4
events can be d|scr|m|nated trom |ong-|ast|ng act|v|t|es occurr|ng
over many years dur|ng the ent|re occupat|ona| ||te. Short-term
|oad|ngs may pr|mar||y |ead to acute hea|th d|sturbances whereas
|ong-|ast|ng exposure may, |n a t|na| stage, cause chron|c d|sorders.
Jhe r|sk tor the muscu|oske|eta| system depends to a great extent
on the pos:utc ot the operator. fspec|a||y, tw|st|ng or bend|ng the
trunk can resu|t |n an |ncreased r|sk tor the deve|opment ot d|seases
at the |ower back. Postura| demands p|ay an |mportant ro|e,
part|cu|ar|y, when work|ng |n cont|ned spaces.
8es|des such types ot occupat|ona| |oad|ng resu|t|ng trom usua|
work-s|te cond|t|ons, muscu|oske|eta| d|sorders can a|so be caused
by un|que, untoreseen and unp|anned s|tuat|ons, e.g. by accIccn:s.
Jhe or|g|n ot d|sorders due to acc|dents |s character|zed by a sudden
overstra|n ot the organs ot |ocomot|on.
!.3.2 1o:aI nccanIcaI IoacIny
Jhe tota| |oad attect|ng the
muscu|oske|eta| system depends on
the |eve| ot the d|tterent |oad tactors,
ment|oned betore, such as
the |eve| and d|rect|on ot torces,
the durat|on ot exposure,
the number ot t|mes an exert|on
|s pertormed per un|t ot t|me,
postura| demands.
!.3.3 RIsI uaII:Ics
Accord|ng to the tactors ment|oned betore, d|tterent r|sk categor|es
can be der|ved us|ng d|tterent comb|nat|ons or qua||t|es thereot,
such as
h|gh |ntens|ty torces,
|ong exposure durat|on,
Acc|dent due to an unp|anned
s|tuat|on
5
h|gh|y repet|t|ve exert|ons,
strong postura| demands,
strong or |ong-|ast|ng muscu|ar stra|n,
d|sadvantageous env|ronmenta| or psychosoc|a| cond|t|ons.
!.3.4 Fac:ots con:tIIu:Iny :o :c ccvcIopncn: oI nuscuIo-
sIcIc:aI cIsotccts
ln the to||ow|ng, muscu|oske|eta| |oad |s character|zed w|th respect
to the ma|n |nt|uences, such as the |eve| ot torce, repet|t|on and
durat|on ot execut|on, postura| and muscu|ar ettort as we|| as
env|ronmenta| and psychosoc|a| tactors.
1. fxert|on ot h|gh-|ntens|ty torces may resu|t |n acute
over|oad|ng ot the |oaded t|ssues. H|gh-|ntens|ty torces are
act|ve w|th|n the body t|ssues part|cu|ar|y dur|ng ||tt|ng or
carry|ng heavy objects. lurthermore, push|ng, pu|||ng,
ho|d|ng or support|ng an object or a ||v|ng be|ng are a matter
ot h|gh-|ntens|ty torces.
2. Hand||ng |oads over |ong per|ods ot t|me may |ead to
muscu|oske|eta| ta||ures |t the work |s cont|nued tor a con-
s|derab|e part ot the work|ng day and |s pertormed tor severa|
month or years. An examp|e |s pertorm|ng manua| mater|a|s-
hand||ng act|v|t|es over many years, wh|ch may resu|t |n
degenerat|ve d|seases, espec|a||y ot the |umbar sp|ne. A
cumu|at|ve dose can be regarded as an adequate measure tor
the quant|t|cat|on ot such types ot |oad|ngs. ke|evant tactors
tor the descr|pt|on ot the dose are durat|on, trequency and
|oad |eve| ot the pertormed act|v|t|es.
3. Muscu|oske|eta| d|sorders may a|so resu|t trom trequent|y-
repeated man|pu|at|on ot objects, even |t the we|ght ot the
objects hand|ed or the torces produced are |ow. Such jobs
(e.g. assemb||ng sma|| workp|eces tor a |ong t|me, |ong-t|me
typ|ng, supermarket checkout work) may |nduce

d|sadvantages tor the

muscu|ature, even |t the
torces app||ed to the
hand|ed objects are |ow.
Under such cond|t|ons, the
same parts and t|bres ot a
musc|e are act|vated tor
|ong per|ods ot t|me or
w|th a h|gh trequency
and may be subject to
over|oad. far|y tat|gue, pa|n,
and poss|b|e |njur|es are
the consequences.
4. ln a we||-des|gned workstat|on, work can be pertormed most
ot the t|me |n an upr|ght posture w|th the shou|ders unra|sed
and the arms c|ose to the trunk. Work|ng w|th a heav||y bent,
extended or tw|sted trunk can resu|t |n an over|oad ot sp|na|
structures and |ncreased act|v|ty ot ent|re musc|es. lt the trunk
|s s|mu|taneous|y bent and tw|sted the r|sk ot sp|na| |njury |s
cons|derab|y |ncreased. lt
movements or postures w|th the
hands above shou|der he|ght,
be|ow knee |eve| or outstretched
are pertormed over pro|onged
per|ods or recurrent|y, work|ng
cond|t|ons shou|d be changed.
Work|ng |n a knee||ng, crouch|ng
or squatt|ng pos|t|on augments
the r|sk ot over|oad|ng
muscu|oske|eta| e|ements. A|so,
|ong-t|me s|tt|ng |n a t|xed
posture |s accompan|ed by |ong-
|ast|ng muscu|ar act|v|ty wh|ch may |ead to an over|oad w|th|n
muscu|ar structures. Such work|ng pos|t|ons shou|d be avo|ded
and the t|me tor work|ng |n such pos|t|ons shou|d be kept to
a m|n|mum, |t such work |s not comp|ete|y avo|dab|e.
kepeated man|pu|at|on ot objects
Cont|nuous s|tt|ng |n a t|xed
posture: d|sadvantageous tor
muscu|ature
7
5. Stat|c muscu|ar |oad |s tound under cond|t|ons where musc|es
are tensed over |ong per|ods ot t|me |n order to keep a certa|n
body posture (e.g. dur|ng work w|th the hands overhead |n
dr||||ng ho|es |nto the ce|||ng, ho|d|ng the arms abducted |n
ha|r dress|ng, ho|d|ng the arms |n typ|ng pos|t|on above the
keyboard, work|ng |n a cont|ned space). A character|st|c ot
stat|c muscu|ar |oad |s that a musc|e or a group ot musc|es |s
contracted w|thout the movement ot the correspond|ng jo|nts.
lt the musc|e has no opportun|ty to re|ax dur|ng such a task,
muscu|ar tat|gue may occur even at |ow-torce |eve|s, and the
tunct|on ot musc|es may be
|mpa|red and |t may hurt. ln
add|t|on, stat|c |oad |eads to a
det|c|ency |n b|ood c|rcu|at|on |n
musc|es. Under norma|
cond|t|ons, the permanent
change between contract|on and
re|axat|on acts as a c|rcu|at|on-
support|ng pump. Cont|nuous
contract|on restr|cts the t|ow ot
b|ood trom and to the contracted
musc|e. Swe|||ng ot |egs, tor
examp|e, |s an |nd|cator ot such a |ack |n b|ood c|rcu|at|on.
. Muscu|ar |nact|v|ty represents
an add|t|ona| tactor tor the
deve|opment ot muscu|o-
ske|eta| d|sorders. Musc|es
need act|vat|on to ma|nta|n
the|r tunct|ona| capac|ty, and
the same |s true ot tendons
and bones. lt act|vat|on |s
|ack|ng, a decond|t|on|ng w|||
deve|op, wh|ch |eads to
tunct|ona| and structura|
det|c|ts. As a resu|t, a musc|e
|s no |onger ab|e to stab|||ze jo|nts and ||gamenta| structures
Stat|c work w|th ho|d|ng the hands
overhead
Decond|t|on|ng due to |ow
muscu|ar demand and |ong-
|ast|ng phys|ca| |nact|v|ty
8
adequate|y. |o|nt |nstab|||t|es and ta||ures, |ncoord|nat|on
connected w|th pa|n, movement abnorma||t|es and
over|oad|ng ot jo|nts may be the consequences.
7. Monotonous repet|t|ve man|pu|at|ons w|th or w|thout an
object over |ong per|ods ot t|me may |ead to muscu|oske|eta|
ta||ures. kepet|t|ve work occurs when the same body parts
are repeated|y act|vated and there |s no poss|b|||ty ot at |east
a short per|od ot re|axat|on, or a var|at|on |n movement |s not
poss|b|e. ke|evant determ|n|ng tactors are the durat|on ot the
work|ng cyc|es, the|r trequency and the |oad-|eve| ot the
pertormed act|v|ty. fxamp|es ot repet|t|ve work are keyboard
use wh||e typ|ng, data entry, c||ck|ng or draw|ng a computer
mouse, meat cutt|ng, etc. Unspec|t|c comp|a|nts due to
repet|t|ve movements ot the upper extrem|t|es are otten
summar|zed |n the term repet|t|ve stra|n |njury - kSl".
8. Stra|n on the |ocomotor system may a|so occur due to the
app||cat|on ot v|brat|on. v|brat|on may resu|t trom hand-he|d
too|s (e.g. rock dr|||) and, theretore, exert v|brat|on stra|n on
the hand-arm system. Hand-arm v|brat|on may resu|t |n the
dystunct|on ot nerves, reduced b|ood c|rcu|at|on, espec|a||y
|n the t|ngers (wh|te t|nger syndrome) and degenerat|ve
d|sorders ot bones and jo|nts ot the arms. Another r|sk concerns
Monotonous repet|t|ve man|-
pu|at|ons
Cont|nuous keyboard and mouse
use dur|ng data entry
9
who|e body v|brat|on generated
by v|brat|ng veh|c|es and
p|attorms such as earth-mov|ng
mach|nes, |ow-||tt p|attorm
trucks or tractors and trucks
dr|v|ng ott-road. Jhe v|brat|on |s
transterred to the dr|ver v|a the
seat. Who|e-body v|brat|on can
cause degenerat|ve d|sorders,
espec|a||y |n the area ot the
|umbar sp|ne. Jhe ettect ot
v|brat|on may be |ntens|t|ed |t the veh|c|e |s dr|ven |n a tw|sted
body posture. A v|brat|on-attenuat|ng dr|v|ng seat may he|p
to reduce the ettect ot v|brat|on.
9. Phys|ca| env|ronmenta| tactors
such as unsu|tab|e c||mat|c
cond|t|ons can |nteract w|th
mechan|ca| |oad and aggravate the
r|sk ot muscu|oske|eta| d|sorders.
ln part|cu|ar, the r|sk ot v|brat|on-
|nduced d|sorders ot the hands |s
cons|derab|y enhanced |t |ow
temperature co|nc|des w|th the use
ot hand-he|d v|brat|ng too|s.
Another examp|e ot env|ron-
menta| tactors |nt|uenc|ng the
muscu|oske|eta| stra|n |s the
||ght|ng cond|t|ons: lt ||ght|ng and
v|sua| cond|t|ons are det|c|ent, musc|es are stra|ned more
|ntens|ve|y, part|cu|ar|y |n the shou|der and neck reg|on.
10. 8es|des the mechan|ca||y-|nduced stra|n attect|ng the
|ocomotor organs d|rect|y, add|t|ona| tactors can contr|bute
to the beg|nn|ng or aggravat|on ot muscu|oske|eta| d|sorders.
Psychosoc|a| tactors can |ntens|ty the |nt|uence ot mechan|ca|
fxposure to v|brat|on: Use
ot v|brat|ng too|s
Phys|ca| env|ronmenta|
tactors:Work at heat
10
stra|n or may |nduce muscu|oske|eta| d|sorders by themse|ves
due to |ncreas|ng musc|e tens|on and by attect|ng motor co-
ord|nat|on. lurthermore, psychosoc|a| |nt|uences such as t|me
pressure, |ow job dec|s|on |at|tude or |nsutt|c|ent soc|a| support
can augment the |nt|uence ot phys|ca| stra|n.
A summary ot the ma|n tactors contr|but|ng to the r|sk ot
deve|op|ng work-re|ated muscu|oske|eta| d|sorders |s prov|ded
|n the tab|e.
11
Jab|e : Ma|n tactors contr|but|ng to muscu|oske|eta| d|sorders
lactor Poss|b|e resu|t fxamp|e Good pract|ce
or consequence examp|e or so|ut|on
fxert|on ot h|gh- Acute over|oad|ng L|tt|ng, carry|ng, Avo|d manua|
|ntens|ty torces ot the t|ssues push|ng, pu|||ng hand||ng ot heavy
heavy objects objects
Hand||ng heavy Degenerat|ve Manua| mater|a|s- keduce mass ot
|oads over |ong d|seases espec|a||y hand||ng objects or number
per|ods ot t|me ot the |umbar sp|ne ot hand||ngs per day
lrequent|y lat|gue and Assemb|y work keduce rep|t|t|on
repeated over|oad ot |ong t|me typ|ng, trequency
man|pu|at|on muscu|ar structures check-out work
ot objects
Work|ng |n Over|oad ot Work|ng w|th Work|ng w|th an
untavourab|e ske|eta| and heav||y bent or upr|ght trunk and
posture muscu|ar e|ements tw|sted trunk, or the arms c|ose to
hands and arms the body
above shou|ders
Stat|c muscu|ar Long-|ast|ng Work|ng overhead, kepeated change
|oad muscu|ar act|v|ty work|ng |n a between act|vat|on
and poss|b|e cont|ned space and re|axat|on ot
over|oad musc|es
Muscu|ar Loss ot tunct|ona| Long-term s|tt|ng kepeated stand|ng
|nact|v|ty capac|ty ot musc|es, w|th |ow muscu|ar up, stretch|ng ot
tendons and bones demands musc|es, remed|a|
gymnast|cs, sports
act|v|t|es
Monotonous Unspec|t|c com- kepeated act|vat|on kepeated |nterrupt|on
repet|t|ve p|a|nts |n the upper ot the same musc|es ot act|v|ty and pauses
man|pu|at|ons extrem|t|es (kSl) w|thout re|axat|on a|ternat|ng tasks
App||cat|on ot Dystunct|on ot Use ot v|brat|ng Use ot v|brat|on-
v|brat|on nerves reduced hand-too|s, s|tt|ng attenuat|ng too|s
b|ood t|ow, degene- on v|brat|ng and seats
rat|ve d|sorders veh|c|es
Phys|ca| lnteract|on w|th Use ot hand-he|d Use g|oves and
env|ronmenta| mechan|ca| |oad too|s at |ow heated too|s at |ow
tactors and aggravat|on temperatures temperatures
ot r|sks
Psychosoc|a| Augmentat|on ot H|gh t|me pressure, |ob rotat|on, job
tactors phys|ca| stra|n, |ow job dec|s|on enr|chment,
|ncrease |n |at|tude, |ow soc|a| reduct|on ot negat|ve
absence trom work support soc|a| tactors
12
1.4 lactors to be cons|dered |n ptcvcn:Ion
!.4.! 1c IccaI IaIancc
W|th regard to ma|ntenance and promot|on ot hea|th, a we|ghed
ba|ance between act|v|ty and rest |s necessary. kest pauses are a
prerequ|s|te tor recovery trom |oad-|nduced stra|n and tor pre-
vent|ng accumu|at|on ot tat|gue. Movement shou|d be preterred
to stat|c ho|d|ng, the a|m shou|d be a comb|nat|on ot act|ve per|ods
w|th |oad|ng and |nact|ve per|ods ot re|axat|on. Jhe |nd|v|dua|
tavourab|e |oad" can vary trom subject to subject depend|ng on
tunct|ona| ab|||t|es and |nd|v|dua| resources. Over|oad as we|| as
|nact|v|ty shou|d be avo|ded. Appropr|ate |oad ettects tra|n|ng ot
musc|es |ead|ng to adaptat|on and thus an |ncrease |n the capac|ty
ot musc|es, tendons and bones. Jh|s |s essent|a| tor hea|th and
we||-be|ng.
CAvfAJ: Jh|s genera| v|ew, however, needs ret|nement |n spec|a|
cases, s|nce parts ot the muscu|oske|eta| system may not adapt to
|oads |n the same way. lor examp|e, repet|t|ve ||tt|ng ot heavy
|oads probab|y does |ncrease musc|e capac|ty, but probab|y does
not |ncrease the capac|ty ot the sp|na| d|scs to w|thstand mechan|ca|
|oad|ng. As a consequence, strength tra|n|ng cou|d m|s|ead |nd|-
v|dua|s to be||eve they cou|d sate|y ||tt greater |oads and thus r|sk
back prob|ems. |obs shou|d, theretore, be so des|gned that most
peop|e are ab|e to carry them out, rather than on|y a tew strong
|nd|v|dua|s.
!.4.2 1c ptIncIpIc oI ctyononIcs
A r|sk tor d|sorders ot the muscu|oske|eta| system appears |t the
|oad and the tunct|ona| capac|ty ot the work|ng person are not
ba|anced. Jhe bas|c pr|nc|p|e ot ergonom|cs |s to create an
appropr|ate ba|ance between the requ|rements ot the work and
the capac|ty ot the work|ng person, by e|ther adapt|ng the work to
the person by des|gn ot the respect|ve work, or by deve|op|ng the
13
capac|ty ot the humans to the work by tra|n|ng and vocat|ona|
adjustment.
Jhe pr|mary a|m shou|d be the adaptat|on ot work|ng cond|t|ons
to the capac|ty ot the work|ng persons, whereby |t |s ot part|cu|ar
|mportance to cons|der the dependency ot |nd|v|dua| capac|ty on
age and gender. Jhe adaptat|on ot human be|ngs to work shou|d
not be preterred, as here the work cannot be pertormed by a||
persons, but on|y by se|ected and spec|t|ca||y tra|ned groups.
Add|t|ona||y, the poss|b|||ty ot deve|op|ng human ab|||t|es dur|ng
work execut|on shou|d not be m|sused as a pretence tor ma|nta|n|ng
poor|y des|gned cond|t|ons ot work or work env|ronment.
!.4.3 VotI pctIotnancc s:ta:cyIcs
A r|sk tactor tor over|oad|ng the muscu|oske|eta| system resu|ts
trom the method ot pertorm|ng the work by the worker. Jhere are
r|sky and |ess r|sky strateg|es to execute the task. An examp|e |s
||tt|ng heavy objects hav|ng the centre ot grav|ty near the body. Jo
tu|t|| th|s demand, heavy objects shou|d be ||tted, whenever
poss|b|e, by bend|ng the knees |nstead ot bend|ng the back. lurther
measures to reduce over|oad|ng r|sk are avo|d|ng tw|sted and
|atera||y bent postures, work|ng cont|nuous|y at a moderate pace
and not dur|ng short t|me-per|ods w|th h|gh t|me-pressure. Jhe
worker must be |ntormed about those poss|b|||t|es and shou|d be
mot|vated to use them.
!.4.4 AvoIc accIccn:s anc In]utIcs
Jhe avo|dance ot acc|dents |s another |mportant t|e|d tor the
prevent|on ot muscu|oske|eta| d|sorders. Hazardous s|tuat|ons, |n
part|cu|ar tor p|unges, can occur dur|ng work at greater he|ght, tor
examp|e on a |adder, a scatto|d or a construct|on s|te. Jhe r|sk tor
p|unges can be reduced by secur|ng the stand|ng pos|t|on and by
stab|||z|ng the equ|pment on wh|ch the worker c||mbs. ln part|cu|ar,
the use ot steady |adders and t|x|ng the |adders to the t|oor or on
14
stab|e objects |s |nd|spensab|e. On|y sutt|c|ent|y stab|e and steady
scatto|ds shou|d be used and these shou|d be t|xed to the bu||d|ng.
lurthermore, secur|ng the pos|t|on ot the worker by rop|ng to the
c||mb|ng a|d (|adder; scatto|d) or bu||d|ng |s an |mportant measure
tor prevent|ng p|unges.
lnjur|es to head, hand and toot can be avo|ded by us|ng protect|ve
he|mets, g|oves or shoes, respect|ve|y. Another |mportant measure
|s to avo|d objects trom ta|||ng down by tasten|ng or cover|ng them
|n an appropr|ate manner. ln part|cu|ar, dur|ng the transportat|on
ot goods w|th cranes or other ho|st|ng dev|ces, goods shou|d be
t|xed by cover|ng them or by spread|ng a p|ane underneath.
15
2 Gu|dance on ma|n r|sk tactors
ln th|s part, some ot the ma|n r|sk tactors tor the deve|opment ot
muscu|oske|eta| d|sorders are ||sted, and examp|es ot tasks and
work|ng cond|t|ons are prov|ded. Add|t|ona||y, potent|a| causes
tor hea|th d|sturbances and |njur|es as we|| as suggest|ons as to
how to avo|d these are made.
k|sk trequent|y resu|ts trom exposure to mechan|ca| |oad|ng. Jhe
ma|n |nt|uenc|ng tactors are h|gh torces resu|t|ng trom ||tt|ng and
push|ng or pu|||ng heavy objects, h|gh repet|t|on trequency, |ong
durat|on ot torce execut|on, untavourab|e posture, un|nterrupted
musc|e torce exert|on or work|ng on or w|th v|brat|ng mach|nes.
ln some cases, the degree ot hand||ng prec|s|on, rather than the
actua| torce exerted, const|tutes an add|t|ona| hazardous tactor.
Gu|dance
2.1 k|sk tactor: Man|pu|a-
t|on ot heavy |oads
2.!.! Vctc atc cavy Ioacs
nanIpuIa:cc7
fxamp|es are:
||tt|ng and carry|ng ot heavy
objects |n transportat|on
jobs, construct|on s|tes, etc.,
Man|pu|at|on ot heavy |oads:
Jransportat|on job at construc-
t|on s|tes
Part
2
1
transterr|ng persons |n hea|th protess|ons, |n o|d-age care and
hosp|ta| care.
2.!.2 Vy atc cavy Ioacs atnIuI7
Ho|d|ng and mov|ng ot heavy
|oads requ|res h|gh muscu|ar
torce; th|s may |ead to acute
over|oad and/or tat|gue ot
nuscIcs. fxamp|es: kepeated
man|pu|at|on ot heavy br|cks |n
construct|on work, |oad|ng ot
cottee sacks, cement bags or
other |oads |n sh|ps, conta|ners
or |orr|es.
Dur|ng ho|d|ng and mov|ng ot
heavy |oads, h|gh torces occur
|n the sIcIc:aI sys:cn, too.
k|sk ot acute over|oad|ng and
damage may resu|t. Load|ngs be|ng |ncurred over a |ong per|od
ot t|me may cause or promote degenerat|ve d|sorders, espec|a||y
|n the |ow-back area (e.g. when hand||ng |oads w|th a bent
back).
lor the |nd|v|dua| r|sk ot manua| mater|a|s-hand||ng act|v|t|es, the
tunct|ona| capac|ty ot the work|ng person p|ays an |mportant ro|e.
2.!.3 Hov can cavy Ioacs Ic ancIcc vI: Iov tIsI Iot atn7
Jhe most |mportant tactors concern|ng the r|sk are the vcIy: oI
:c oI]cc: to be man|pu|ated, the otIzon:aI cIs:ancc between
the |oad and the body and the cuta:Ion and tcpc:I:Ion Itcucncy
ot task execut|on. Jh|s |eads to some |mportant measures tor
hand||ng objects.
Jhe r|sk tor muscu|oske|eta| d|sor-
ders depends on the re|at|on be-
tween the |oad-we|ght and the
tunct|ona| capac|ty ot the
work|ng person
17
Adv|ce to the emp|oyee:
L|tt |oads c|ose to the body.
L|tt w|th both hands, symmetr|ca||y to the m|d-sag|tta| p|ane,
br|ng the |oad as c|ose as poss|b|e to the body.
L|tt heavy |oads w|th an upr|ght trunk by extend|ng the |n|-
t|a||y t|exed |egs and avo|d man|pu|at|on ot |oads |n untavour-
ab|e postures (e.g. |atera| bend|ng or tw|st|ng).
Use cranes, ||tters, do|||es, ho|sts, pa||et jacks, mob||e e|eva-
tors, or s|m||ar dev|ces, |t ava||ab|e, tor ||tt|ng and transport|ng
heavy |oads.
Carry heavy and/or unw|e|dy |oads w|th two persons.
Adv|ce to the emp|oyer:
Avo|d manua| hand||ng tasks, espec|a||y ot heavy |oads. lt
manua| hand||ng |s st||| necessary, |ntroduce ergonom|c meas-
ures to m|n|m|ze the resu|t|ng r|sk.
Avo|d mov|ng |oads over obstac|es.
Avo|d carry|ng over uneven or s||ppery routes, over steps or
sta|rs.
Avo|d h|gh or trequent hand||ng procedures.
Avo|d |arge masses (e.g. |nstead ot one heavy sack use two
sacks ot sma||er we|ght).
Prov|de a|ds (ho|sts, or s|m||ar dev|ces).
Mark heavy |oads.
Mark non-symmetr|ca| |oad d|str|but|on w|th|n the object. Mark
conta|ners or barre|s w|th movab|e content (t|u|ds, granu|es, etc).
Suggest and carry out tra|n|ng on hand||ng".
18
H|gh torce exert|on: Push|ng ot
heavy objects
2.2 k|sk tactor: Work w|th h|gh torce exert|on
2.2.! Vctc Is Iy Iotcc cct:Ion Iounc7
fxamp|es are:
push|ng or pu|||ng ot heavy
objects
pu|||ng ot tro||eys and other
means ot transportat|on
pos|t|on|ng ot packages |n
a transportat|on veh|c|e
man|pu|at|on ot scatto|d
parts
transter ot pat|ents.
2.2.2 Vy Is Iy Iotcc cct:Ion atnIuI7
Jhe exert|on ot torce requ|res h|gh musc|e torces. Jh|s may |ead to
an acute over|oad|ng and/or tat|gue ot musc|es.
Dur|ng such work h|gh torces a|so occur |n the sIcIc:aI sys:cn.
Jh|s may |ead to an acute over|oad|ng and |njury ot the ske|eta|
structures. lorce exert|on, where the torce acts d|stant|y trom the
body, bears a h|gh r|sk ot damage to the |umbar sp|ne t|ssues. lor
tasks w|th |ong-|ast|ng or trequent|y repeated h|gh torce exert|on,
there |s r|sk ot degenerat|ve d|seases espec|a||y ot the |umbar sp|ne.
Jh|s |s true, |n part|cu|ar, |t torce exert|on |s carr|ed out |n unta-
vourab|e body postures.
2.2.3 Hov can Iy Iotcc cct:Ion Ic avoIccc7
Adv|ce to the emp|oyee:
Carry out push|ng and pu|||ng |n such a way that the torce
acts c|ose to the body.
19
Avo|d push|ng or pu|||ng w|th on|y one hand.
Avo|d push|ng or pu|||ng w|th strong |atera| bend|ng and/or
tw|sted trunk.
Adv|ce to the emp|oyer:
Prov|de cond|t|ons tor secure stand|ng.
Prov|de whee|ed veh|c|es, tro||eys, do|||es, or s|m||ar dev|ces.
Avo|d push|ng or pu|||ng |n cont|ned rooms because ot con-
stra|ned postures.
Avo|d obstac|es and uneven ground.
2.3 k|sk tactor: Work|ng |n untavourab|e body postures
2.3.! Vctc co unIavoutaIIc pos:utcs occut7
fxamp|es are:
work overhead
work |n constra|ned pos|t|ons
work |n cont|ned rooms
work |n extreme|y bent, tw|sted or extended postures
work |n a cont|nuous|y |nc||ned posture (e.g. construct|on work,
concrete re|ntorcement work)
work out ot reach
work |n a knee||ng, |y|ng, crouch|ng or squatt|ng pos|t|on.
2.3.2 Vy atc unIavoutaIIc pos:utcs atnIuI7
Jhe keep|ng up ot a certa|n body posture demands h|gh musc|e
torce; acute over|oad and/or tat|gue ot musc|es can, theretore, be
the resu|t.
20
fxamp|es are:
Construct|on work tar trom the body demands h|gh act|vat|on
ot muscu|ature tor ho|d|ng the arms
Jw|sted or extended body postures demand h|gh muscu|ar
stra|n and tens|on ot trunk musc|es.
Dur|ng untavourab|e body postures, h|gh torces occur a|so |n
the ske|eta| system. Jh|s may |ead to acute over|oad|ng and
damage ot ske|eta| structures.
lor |ong-|ast|ng act|v|t|es w|th an
|nc||ned trunk, degenerat|ve
d|sorders, espec|a||y |n the
|umbar reg|on, can ar|se |t such
work |s executed over a per|od
ot many years.
Ma|nta|n|ng untavourab|e body
postures tor |ong per|ods ot t|me
|s connected w|th |ong-term
act|vat|on ot certa|n musc|es
wh|ch may |ead to muscu|ar tat|gue and cons|derab|e reduct|on |n
b|ood c|rcu|at|on. Such part|a| decrease |n the tunct|ona| ab|||ty ot
the muscu|ature |eads to a reduced ab|||ty to react on sudden
|mpacts and may theretore resu|t |n |ncreased accIccn: tIsI.
2.3.3 Hov can unIavoutaIIc pos:utcs Ic avoIccc7
Adv|ce to the emp|oyee:
8r|ng body c|ose to the pos|t|on where the object must be
hand|ed, or where torce app||cat|on |s pertormed.
Avo|d strong |atera| bend|ng or tw|st|ng ot the trunk.
Approach the work|ng area and body c|ose enough to enab|e
carry|ng out the task w|th|n reach; use a|ds such as scatto|ds
and |adders, |t su|tab|e.
8ody posture: Avo|d untavourab|e
postures
21
Change posture otten to act|vate d|tterent musc|es a|ternate|y
wh||e carry|ng out tasks; cons|der a|ternat|ng between stand|ng
and s|tt|ng postures.
Adv|ce to the emp|oyer:
Otter adjustab|e equ|pment: cha|rs, tab|es, scatto|ds, etc.
Supp|y rooms ot sutt|c|ent s|ze to avo|d constra|ned postures.
Arrange too|s w|th|n reach.
Set t|me-||m|ts when constra|ned postures are unavo|dab|e
and/or a|ternate tasks ot d|tterent nature.
Avo|d g|v|ng tasks that requ|re a knee||ng, |y|ng, crouch|ng,
or squatt|ng pos|t|on.
Use ot adjustab|e equ|pment:
P|attorm
Use ot adjustab|e tab|e
22
2.4 k|sk tactor: Monotonous repet|t|ve tasks
2.4.! Vctc co nono:onous tcpc:I:Ivc :asIs occut7
fxecut|on ot s|m||ar or |dent|ca| movements dur|ng a |arge part ot
the work|ng t|me w|th a h|gh rate ot repet|t|on (|.e. severa| t|mes
per m|nute). Dur|ng the course ot work the work|ng person
has otten ||tt|e |nt|uence on the work|ng pace, speed, task sequence
and work and break schedu|e.
Common|y, the work|ng person
cannot abandon the workp|ace
w|thout be|ng rep|aced by
another person.
fxamp|es are:
assemb|y ||ne
cash reg|strat|on
|oad|ng ot pack|ng mach|nes.
2.4.2 Vy atc nono:onous tcpc:I:Ivc :asIs atnIuI7
Long-|ast|ng repet|t|ve musc|e |oad |eads to nuscIc Ia:Iyuc, wh|ch
- |t sutt|c|ent recovery |s not guaranteed - may |ead to |rrevers|b|e
canycs In :c nuscuIat s:tuc:utc. Not on|y h|gh-|eve| torces but
a|so |ow-|eve| torces may cause such an ettect. kepet|t|ve
movements are otten super|mposed w|th stat|c |oad|ng, |n
part|cu|ar postura| |oad.
2.4.3 Hov can nono:onous tcpc:I:Ivc :asIs Ic avoIccc7
Adv|ce to the emp|oyee:
Avo|d cont|nuous |oad|ng ot the same musc|es tor |onger
per|ods ot t|me.
Str|ve tor changes |n mot|on |n order to avo|d |dent|ca|
muscu|ar act|vat|on patterns. lor strong|y monotonous work,
changes |n the execut|on ot movements may be ||m|ted.
Monotonous repet|t|ve task:
Assemb|y ||ne
23
Change body posture trequent|y |n order to reduce stat|c |oad-
|ng.
Use rest pauses.
Adv|ce to the emp|oyer:
Prov|de tor organ|zat|ona| changes, such as job rotat|on, job
d|vers|t|cat|on or job enr|chment, to reduce the extent ot task
repet|t|on tor |nd|v|dua|s.
fnab|e autonomous dec|s|ons about the t|m|ng ot breaks.
Mechan|ze unavo|dab|e monotonous tasks w|th h|gh |oad.
2.5 k|sk tactor: Long-|ast|ng |oad|ngs
2.5.! Vctc co Iony-Ias:Iny
IoacInys occut7
fxamp|es are:
ma|nta|n|ng a stat|c posture
(e.g. dur|ng br|ck|ay|ng at
t|oor |eve|; concrete re|n-
torcement work; p|ck|ng ot
tru|ts and vegetab|es at t|oor
|eve|; wr|t|ng; typ|ng; work
w|th computer mouse).
ho|d|ng ot objects or too|s (e.g.
dr||||ng |n a ce|||ng; overhead
pa|nt|ng; ho|d|ng ot operat|on
|nstruments |n surgery, carry|ng a tray
un|nterrupted|y).
Long-|ast|ng |oad|ng: P|ck|ng
up vegetab|es at
t|oor |eve|
Long-|ast|ng |oad|ng:
Hawker's tray
24
2.5.2 Vy atc Iony-Ias:Iny IoacInys atnIuI7
Long-|ast|ng musc|e |oad |eads to nuscIc Ia:Iyuc. lat|gue w|thout
sutt|c|ent recovery can |ead to |rrevers|b|e canycs |n the muscu|ar
structure. fven the exert|on ot |ow-|eve| torces (tor examp|e, |ong-
|ast|ng t|xed posture) can |ead to over-exert|on and tat|gue ot sma||
musc|es or musc|e groups. Long-|ast|ng contract|on ot musc|es
may resu|t |n |nsutt|c|ent b|ood c|rcu|at|on.
ln the ske|eta| system |ong-|ast|ng |oad|ng (e.g. due to |ong-|ast-
|ng work |n an |nc||ned posture) can |ead to det|c|ent nutr|t|on ot
the sp|na| d|scs.
2.5.3 Hov can Iony-Ias:Iny IoacIny Ic avoIccc7
Adv|ce to the emp|oyee:
Move |nstead ot ho|d|ng a stat|c pos|t|on.
Use too|s tor ho|d|ng objects.
Str|ve tor trequent change |n body pos|t|on.
Str|ve tor trequent upr|ght pos|t|ons trom |nc||ned pos|t|ons.
Stand up trom t|me to t|me when work|ng |n a s|tt|ng pos|-
t|on, tor examp|e, wh||e mak|ng a te|ephone ca||.
Adv|ce to the emp|oyer:
Prov|de too|s tor ho|d|ng (e.g. screw-c|amps; hand|es, wh|ch
enab|e ho|d|ng w|th |ow musc|e torce).
Prov|de scatto|ds, |adders, or s|m||ar dev|ces.
Supp|y arm supports at computer workp|aces.
Supp|y hand|es or gr|ps wh|ch can be used w|th r|ght as we||
as |ett hand.
P|ace hand|es/gr|ps to enab|e use |n a neutra| pos|t|on ot wr|st
and arm.
25
2. k|sk tactor: Phys|ca| env|ronmenta| cond|t|ons
2..! Vctc Is :c tIsI on accoun: oI pysIcaI cnvItonncn:aI
concI:Ions7
v|brat|on:
Hanc-atn vIIta:Ion encountered through hand-he|d too|s may |ead
to degenerat|ve d|sorders or to b|ood c|rcu|at|on prob|ems |n the
hand (espec|a||y the t|ngers - wh|te t|nger syndrome).
VoIc-Iocy vIIta:Ion |n veh|c|es may |ead to degenerat|ve
d|sorders, |n part|cu|ar, ot the |umbar and thorac|c sp|ne.
C||mate:
HIy :cnpcta:utcs dur|ng the man|pu|at|on ot heavy |oads may
|ead to b|ood pressure prob|ems and to an |ncrease |n body
temperature. At Iov :cnpcta:utcs, a decrease |n dexter|ty may
occur.
L|ght|ng:
InsuIIIcIcn: IIy:Iny or dazz||ng may
|nduce constra|nt postures.
lurthermore, |t may |ncrease the danger
ot stumb||ng or ta|||ng.
S||ps and ta||s:
UnsuI:aIIc, uncvcn, uns:cacy ot sIIppcty votIIny sutIaccs anc
IIoots can cause tense, strenuous work|ng postures and move-
ments, |n part|cu|ar, |n tasks enta|||ng the hand||ng ot |oads.
Phys|ca| env|ronmenta|
cond|t|ons: L|ght|ng
2
2..2 Hov can :c tIsI oI pysIcaI cnvItonncn:aI concI:Ions Ic
tccuccc7
v|brat|on:
Jhe ettect ot anc-atn vIIta:Ion can be reduced by us|ng too|s
w|th |ow v|brat|on, reduc|ng the t|me ot usage ot v|brat|ng
equ|pment, wear|ng g|oves and avo|d|ng co|nc|d|ng |nt|uence ot
|ow temperatures.
Jhe ettect ot voIc-Iocy vIIta:Ion can be reduced by us|ng
v|brat|on-absorb|ng seats and reduc|ng the t|me dur|ng wh|ch
v|brat|on |s app||ed to the body.
C||mate:
Wear|ng ot appropr|ate garments, regu|ar
change ot stay |n rooms w|th h|gh and |ow
temperatures, ||m|ted stay |n rooms w|th h|gh
or |ow temperature.
L|ght|ng:
Supp|y|ng sutt|c|ent and undazz||ng ||ght|ng equ|pment.
S||ps and ta||s:
Avo|d unsuI:aIIc, uncvcn, uns:cacy ot sIIppcty votIIny sutIaccs,
IIoots anc :tanspot:a:Ion tou:cs whenever |t |s poss|b|e.
Phys|ca| env|ronmenta|
cond|t|ons: C||mate
27
Append|x
8as|c ru|es tor prevent|ve act|ons |n pract|ce
A r|sk tor d|sorders ot the muscu|oske|eta| system appears |t the
|oad and the tunct|ona| capac|ty ot the worker are not |n ba|ance.
W|th regard to ma|ntenance and promot|on ot hea|th, the to||ow|ng
po|nts have to be cons|dered:
Jhere |s a need tor a we|ghed ba|ance between phys|ca| ac-
t|v|ty and recovery.
Movement shou|d be preterred to stat|c ho|d|ng. Jhe a|m
shou|d be a comb|nat|on ot act|ve per|ods w|th h|gher |oad
and per|ods ot re|axat|on.
Over|oad shou|d be avo|ded. fttect|ve measures tor prevent|ng
over|oad are reduc|ng the requ|red torces and repet|t|ons.
Manua| hand||ng shou|d be avo|ded. lt avo|dance |s not
comp|ete|y poss|b|e, |t shou|d be restr|cted by app|y|ng ergo-
nom|c and organ|zat|ona| measures; the emp|oyees shou|d
be educated and tra|ned so that they can he|p to m|n|m|ze
the overa|| r|sks.
Joo |ow |oad shou|d be avo|ded. An appropr|ate |oad tor the
organs ot |ocomot|on |s essent|a| |n order to keep up the|r
tunct|ona| ab|||ty.
Jhe |nd|v|dua| tavourab|e |oad" can vary trom person to
person depend|ng on tunct|ona| ab|||t|es and |nd|v|dua|
resources.
Jhe pr|mary a|m ot ergonom|cs |s the adaptat|on ot work|ng
cond|t|ons to the capac|ty ot the worker. H|gh human capab|||t|es
ot the emp|oyees shou|d not be m|sused as a pretence tor
ma|nta|n|ng poor|y des|gned cond|t|ons ot work or work
env|ronment. Jhus |t |s |mportant to take |nto account |nt|uenc|ng
tactors such as age, gender, the |eve| ot tra|n|ng, and the state ot
know|edge |n an occupat|on. Jhe work|ng cond|t|ons shou|d be
28
arranged |n such a way that there |s no r|sk trom phys|ca| |oad tor
anyone at the workp|ace.
lundamenta| po|nts |nt|uenc|ng the phys|ca| |oad tunct|ons ot an
emp|oyee at works|te are:
requ|rements ot work w|th respect to body pos|t|ons and pos-
tures ot the emp|oyee
des|gn ot work|ng area
cont|gurat|on ot body supports
||ght and v|sua| requ|rements
arrangement ot contro|s and d|sp|ays
movement sequences ot operat|ons
des|gn ot work-rest reg|men
type ot energet|c |oads w|th respect to torce, repet|t|on and
durat|on ot work
magn|tude ot menta| |oads by |ncreas|ng the |at|tude and con-
tro| ot work or job enr|chment.
A secondary way |s to deve|op the capac|ty ot the humans to the
work by tra|n|ng and vocat|ona| adjustment. Jhe poss|b|||ty ot
deve|opment ot human ab|||t|es wh||e execut|ng work shou|d not
be the pretence tor keep|ng a poor|y des|gned cond|t|on ot work
or the work env|ronment. Jhe se|ect|on ot workers accord|ng to
|nd|v|dua| capac|ty shou|d be ||m|ted to except|ona| s|tuat|ons.
Successtu| prevent|on ot work-re|ated hea|th r|sks requ|res a
schedu|ed and stepw|se procedure:
ana|ys|s ot the work|ng cond|t|ons
assessment ot the protess|ona| r|sk tactors
cons|derat|on/prov|s|on ot measures tor d|m|n|sh|ng the r|sk
tactors by ergonom|c des|gn ot the workp|ace (prevent|on |n
the t|e|d ot work|ng cond|t|ons)
29
|ntroduct|on ot measures tor the d|m|nut|on ot the r|sk tactors
by |nt|uenc|ng the behav|our ot emp|oyees (prevent|on |n the
t|e|d ot behav|our)
coord|nat|on ot the prevent|on measures w|th a|| subjects |n-
vo|ved
d|scuss|on ot a|ternat|ve prevent|on approaches
spec|t|c and schedu|ed app||cat|on ot the prevent|on ap-
proaches
contro| and assessment ot the resu|ts.
Summary
D|sorders ot the muscu|oske|eta| system are a major cause ot
absence trom work and |ead, theretore, to cons|derab|e cost tor
the pub||c hea|th system. Hea|th prob|ems ar|se |t the mechan|ca|
work|oad |s h|gher than the |oad-bear|ng capac|ty ot the
components ot the muscu|oske|eta| system (bones, tendons,
||gaments, musc|es, etc). Apart trom the mechan|ca||y-|nduced
stra|n attect|ng the |ocomotor organs d|rect|y, psychosoc|a| tactors
such as t|me-pressure, |ow-job dec|s|on |at|tude or |nsutt|c|ent soc|a|
support can augment the |nt|uence ot mechan|ca| stra|n or may
|nduce muscu|oske|eta| d|sorders by |ncreas|ng musc|e tens|on and
attect|ng motor coord|nat|on.
A reduct|on ot the mechan|ca| |oad|ng on the muscu|oske|eta|
system dur|ng the pertormance ot occupat|ona| work |s an
|mportant measure tor the prevent|on ot muscu|oske|eta| d|sorders.
Jhe ma|n r|sk tactors are h|gh torces resu|t|ng trom ||tt|ng and
push|ng or pu|||ng heavy objects, h|gh repet|t|on trequency or |ong
durat|on ot torce execut|on, untavourab|e posture, stat|c musc|e
torces or work|ng on or w|th v|brat|ng mach|nes. fttect|ve measures
tor the reduct|on ot torces act|ng w|th|n or on the ske|eta| and
muscu|ar structures |nc|ude adopt|ng tavourab|e postures, reduc|ng
|oad we|ght, ||m|t|ng exposure t|me and reduc|ng the number ot
repet|t|ons.
30
Conc|us|on
Prevent|on ot muscu|oske|eta| d|sorders can be ach|eved by
eng|neer|ng contro|s and appropr|ate organ|zat|ona| arrangements.
Jhe t|rst-ment|oned aspect |nvo|ves the who|e work|ng
env|ronment and dea|s w|th the ergonom|c des|gn ot too|s,
workp|aces and equ|pment. Jhe |atter concentrates upon tactors
such as tra|n|ng, |nstruct|on and work schedu|e. Jhe pr|mary a|m
ot ergonom|c work des|gn |s the adaptat|on ot the work|ng
cond|t|ons to the capac|ty ot the worker. lt |s supp|emented by a
secondary way, wh|ch |s based on the deve|opment ot the persons'
capac|ty to the work|ng requ|rements by tra|n|ng and vocat|ona|
adjustment.
31
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