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Manual handling training has long been a legal requirement in the workplace in Ireland. Employers have a duty of care under Common Law to provide a safe workspace and appropriate training. Most people have experienced manual handling training in some shape or form, from online slide shows to one day courses, practicing safe lifting and moving techniques. National regulatory bodies are charged with improving our awareness and understanding of movement and handling to help prevent injury. The widespread delivery of manual handling training has been challenged recently with a growing body of research examining the effectiveness of such training courses on reducing the rates of low back pain.
Over the years, our understanding of low back pain, both causes and associated risk factors, has developed due to a growing interest in research in this area. Low back pain is one of the leading causes of disability and work limitations worldwide. Most people will experience an episode of back pain in their lifetime. Manual handling training is a massive industry, aimed at reducing the risk of occupational injury by improving awareness and practice of safe lifting techniques. However, manual handling training aims to “fix” lifting postures, which may only play a small role in the development and persistence of low back pain. It appears being taught how to lift safely does not have long-term benefits, but what matters most is to keep objects close to the body, lift confidently and to avoid lifting in awkward postures or when tired.
There is a common belief that “good” posture protects the spine and prevents injury or pain
Research
Researchers at The University of Limerick, led by physiotherapist Diarmuid Horgan, found that participants of manual handling training were more likely to think that common daily activities that involved loading the spine were harmful. They concluded that a shift of mindset was needed in both manual handling trainers, participants and also employers towards a “safety through exposure” mindset. This shift would echo recommendations already found in injury prevention and rehabilitation in the sporting world. We do not advise people to avoid sport to avoid injury, but rather to ensure they are physically prepared and conditioned to partake in their chosen sport. The same message should be reinforced for manual handling. It is not about avoiding lifting and bending, but making sure you are physically and psychologically ready for the task you want to do.
Posture
There is a common belief that “good” posture protects the spine and prevents injury or pain. Sitting upright, standing tall, bending your knees while lifting and keeping a straight back are all used to define “good” posture, whereas slouching, rounding your back, stooping, or bending over are considered “bad” postures. Little research exists to support the relationship between “good” posture and back pain. No single posture has been found to protect a person from back pain. Researchers from Curtin University in Australia found that people with back pain tend to adopt “straight back” postures, lifting in a manner perceived to be “correct” or “protective”. However, those without back pain, tend to lift with round-back postures. Interestingly, they found that those who lift with rounded stooped postures, don’t have more back pain.
Back injuries account for 20% of worker accidents, making it the most affected region of the body in non-fatal accidents to workers. The common assumption that low back pain is associated with bending your back is not entirely true. Back pain is a much more complex beast. There are lots of factors at play with too much focus on maintaining “good” postures. Our spine was designed to bend and flex, and some research supports the use of flexed postures for lifting.
Important factors
The most important factors for good spinal health are to engage in regular exercise, move freely without overprotecting, and sit and stand in relaxed postures that are comfortable. It is also important to build confidence in your physical ability and if lifting, it is ok to lift naturally with a rounded back once you are strong enough to tackle the task at hand.
It seems it might be time to re-think manual handling training and thoughts around “safe lifting” and low back pain.
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