Manual Handling Operations Regulations, 1992 (as amended

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Manual Handling Operations Regulations, 1992 (as amended) (MHOR,1992)

Definitions (Regulation 2)

“manual handling operations” means any transporting or supporting of a load (including the lifting, putting down, pushing, pulling, carrying or moving thereof) by hand or by bodily force.

“Load” is anything which is moveable, e.g. inanimate object, person or animal.

The Regulation imposes duties on:

The Employer (Regulation 4) shall

(1) a. so far as is reasonably practicable, avoid the need for his employees to undertake any manual handling operations at work

which involve a risk of their being injured.(1) b. where it is not reasonably practicable to avoid the need for hisemployees to undertake any manual handling operations at workwhich involve a risk of their being injured:

(i) make a suitable and sufficient assessment of all such manual handling operations to be undertaken by them, having regard to the factors which are specified… and considering the questions which are specified…

(ii) take appropriate steps to reduce the risk of injury to those employees arising out of their undertaking any such manual handling operations to the lowest level reasonably practicable, and

(iii) take appropriate steps to provide any of those employees who are undertaking any such manual handling operations with general indications and, where it is reasonably practicable to do so, precise information on-

(aa) the weight of each load, and(bb) the heaviest side of any load whose centre of gravity is not positioned centrally.

Summary in relation to manual handling:

l Defines manual handlingl Explains the employer’s responsibility with regard to hazardous manual handling in the workplacel Sets out the requirement for risk assessments for hazardous manual handling activities in the workplace


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(2) Any assessment such as is referred to in paragraph (1)(b)(i) of this regulation shall be reviewed by the employer who made it if -

(i) there is reason to suspect that it is no longer valid; or(ii) there has been a significant change in the manual handling

operations to which it relates; and where as a result of any such review changes to an assessment are required, the relevant employer shall make them.

(3) In determining for the purposes of this regulation whether manual handling operations at work involve a risk of injury and in determining the appropriate steps to reduce that risk regard shall be had in particular to – (a) the physical suitability of the employee to carry out the operations; (b) the clothing, footwear or other personal effects he is wearing; (c) his knowledge and training; (d) the results of any relevant risk assessment carried out pursuant to regulation 3 of the Management of Health and Safety at Work Regulations 1999; (e) whether the employee is within a group of employees identified by that assessment as being especially at risk; and (f) the results of any health surveillance provided pursuant to regulation 6 of the Management of Health and Safety Regulations 1999.

The Employee (Regulation 5)

(a) Each employee while at work shall make full and proper use of any system of work provided for his use by his employer in compliance with Regulation 4 (1) (b) (ii) of these Regulations.

Example in relation to manual handling:

Employees must follow policy, comply with risk assessment and attend training as well as report near misses or accidents.

The Self-employed (Regulation 2)

(a) Any duty imposed by these Regulations on an employer in respect of his employees shall also be imposed on a self-employed person in respect of himself.


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Ergonomic factors to consider when undertaking a manual handling risk assessment

Regulation 4 of the ‘Manual Handling Operations Regulations, 1992’ requires employers to make a suitable and sufficient assessment of any hazardous operations that cannot be avoided. The assessment should be carried out by members of staff who are occupationally competent, i.e. familiar with the operations in question. The assessment should be recorded and this record should be made available to anybody at risk from the manual handling activities being undertaken. In considering how best to reduce risks highlighted in the assessment an ergonomic approach is recommended. This approach looks at manual handling as a whole, taking into account five key factors: The nature of the TASK, The LOAD, The working ENVIRONMENT, The INDIVIDUAL CAPABILITY. OTHER FACTORS, for example, equipment.

These factors will be discussed in greater detail later in the course.


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Manual Handling Operations Regulations, 1992(as amended)

Summary

AVOID

Wherever possible, avoiding a hazardous manual

handling situation is always preferable.

Can the client do the activity independently?

Can the operation be automated?

Can the treatment be brought to the client?

ASSESS

If avoidance is not possible, making a ‘suitable and

sufficient’ assessment of the hazards is the next

step.

Consider the task, load, environment, individual

capacity and other factors such as equipment.

REDUCE

By following the risk assessment you are reducing

the risk of injury to all persons involved to the

lowest level reasonably practicable.Training and supervision of staff in safer handling

techniques, introducing appropriate handling aids

and maintaining these in good working order will,

among other things, help reduce the risk.

REVIEW

Risk assessments should be reviewed when

changes occur, or when they are no longer valid.

It should also be reviewed if there is an accident or

a case of ill health as a result of a manual handling

operation.


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Other Legislation

Health and Safety at Work etc. Act, 1974 (HASAWA, 1974)

l Explains the general duty for employers to have in place a safe system of work and what that entails.l Defines the employees’ responsibility for their acts and omissions in the workplace.l Explains the potential outcome if the above statements are not adhered to.

Lifting Operations and Lifting Equipment Regulations, 1998(LOLER, 1998)

l Explains what ‘lifting equipment’ (includes patient hoists and attachments for hoists) is and when it is used for work.l Details the criteria by which lifting equipment should be inspected, frequency of inspections etc.l Sets out the criteria for staff training and supervision when using lifting equipment.

Provision and Use of Work Equipment Regulations, 1998(PUWER, 1998)

l Details the criteria in which work equipment (including handling equipment) should be used only for its intended purpose. l Details the criteria in which work equipment should be maintained in an efficient state and in general good repair and working order. l Sets out the criteria for staff training and supervision when using work equipment.


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An Introduction to Spinal Structure and Function

The human vertebral column or spine runs from the skull to the pelvis supporting the body and skull and enclosing and protecting the spinal cord. Its other features include allowing movement and rotation of the head and neck. Along with the ribs, it protects our major organs. It helps produce red blood cells within the bone marrow.

The adult spine is an elongated ‘S’ shape. In the cervical region there is a slight curve forward; at chest level (thoracic region) there is a curve backward. At the lumbar region the curve is slightly forward again. The thoracic and pelvic curves are termed ‘primary curves’ because they are present during foetal life, that is when a baby is developing during pregnancy. The cervical and lumbar curves are ‘secondary curves’ and are developed after birth. The cervical curve is developed when a child is able to hold up its head (commonly 3-5 months) and further development to sit upright (commonly 6-9 months). The lumbar curves are developed between 10-20 months when a child begins to walk.

Cervical Region

Thoracic Region

Lumbar Region

Vertebra

Coccyx

Sacrum

Intervertebral Disc

Side view - adult spine

The elongated ‘S’ shape construction of the spine increases the load-carrying capability giving it strength and elasticity to absorb the shocks of running, jumping, twisting etc.

Vertebrae (Spinal Bones)

The spinal column is made up of 33 bones or vertebrae of which 24 are moveable.

They are divided into five sections:

7 cervical - neck vertebrae 12 thoracic - chest vertebrae 5 lumbar - lower back vertebrae

5 sacrum

} fused

4 coccyx


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Each vertebra consists of two parts:

l The body which is the main weight-bearing part of the spine;l The vertebral arch which surrounds the spinal cord and offers protection to it.

Two transverse processes and one spinous process are behind the vertebral body. The spinous process emerges from the back, one transverse process comes out to the left and one to the right. The spinous processes can be felt through the skin. The function of the transverse and spinous processes is to provide attachment for muscles and ligaments.

Spinal Facet Joints

Each vertebra has bony prominences on each side that form a spinal facet joint with the vertebra above and below. The function of the spinal facet joint is to link the vertebrae together, limit excessive movement and provide stability for the spine. There is a small protective capsule around each facet joint that provides nourishing lubrication to the area.

Body

Transverse Process

Transverse Process

Spinous Process

Spinous ProcessTransverse Process

Body

Facet Joint

Vertebral Arch


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The spinal facet joints work together alongside the intervertebral discs to form a functional working unit. When functioning correctly, spinal facet joints move freely controlling the movement of the spine.

Intervertebral Discs

The intervertebral discs are soft cushions made from cartilaginous tissue. Their function is to facilitate movement, to separate the individual vertebra and to act as a shock absorber as an individual moves.

The intervertebral discs, which can be likened to a soft-centered sweet, consist of:

l Nucleus pulposus - the jelly-like centre;l Annulus fibrosus - the stronger fibrous ring that attaches to the vertebra.

The disc has a high fluid content (about 90%) and the movement of this fluid within the nucleus allows the vertebrae to rock back and forth on the discs, providing the necessary flexibility to move and bend and absorb the stresses associated with this. At night the discs “reconstitute” and the nucleus refills with fluid which increases the pressure on the outer annulus.

As the day goes on and an individual moves around, the fluid is pushed out of the nucleus and through the annulus affecting our height. It is true, therefore, that people very slightly and gradually get shorter as the day goes on.

As people age (though this process can start during one’s early 40s) the disc begins to degenerate. The ability of the disc to replenish itself with fluid, the mobility of the nucleus pulposus and the disc’s shock absorbing capacity slowly, gradually, decreases over time.

Nucleus Pulposus

Annulus Fibrosus


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Spinal Ligaments, Tendons and Muscles

Ligaments and tendons are fibrous bands of connective tissues that attach to bone. Ligaments connect two or more bones together, tendons attach muscle to bone.

Muscles, tendons and ligaments of the spine are needed to assist in maintaining the position of the ‘S’ shape by holding the vertebrae in proper alignment. Their function then is to stabilise the spine, control movement and help the spine to carry the loads created during normal day-to-day activities.

Although incredibly strong, the back is not designed for lifting very heavy loads. The deep abdominal muscles, together with the muscles in the back make up the core muscles. These help to keep the body stable and balanced, as well as helping to protect the spine when we sit, stand, bend over, pick things up, exercise etc. To move loads, the body relies on the musculature of the abdominals, hips and thighs, as well as other groups, to be strong and flexible enough to provide the power and work of moving and lifting to take the strain off the back.

Muscles, tendons and ligament groups in the back get their strength from thin bands running in different directions, sometimes known as a ‘rigging pattern’. This can be seen in the design of a suspension bridge: in working to maintain

Muscles in the back are layered and striated (striped) in appearance.

Trapezius

Latissimus Dorsi

Deltoid

Rhomboids (cut away)

Tricep

Serratus Posteria Inferia

Thoracolumbar Fascia


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structure, each wire will be able to support a great load if held in the right position. However, if force is applied in the wrong direction then the wires can stretch or, in extreme circumstances break, causing structural failure.

The Spinal Cord and Nerve Roots

The spinal cord passes down through the middle of the spinal column in the spinal canal thus being protected by the vertebrae. It extends from the base of the brain to the area between the bottom of the first lumbar vertebra and the top of the second lumbar vertebra. The spinal cord ends by dividing into many individual nerves that travel out to the lower body and legs.

The nerves in each area of the spinal cord connect to specific parts of the body. Humans have 31 left-right pairs of spinal nerves, each roughly corresponding to a segment of the vertebral column. The spinal cord has three major functions: as a channel for motor information which travels down the spinal cord; as a channel for sensory information in the reverse direction; and, finally, as a sensor for coordinating certain reflexes.

Injury to the spinal cord nerves or nerve roots can lead to symptoms such as pain, tingling, numbness and weakness in the corresponding area of the body. More severe injury (often caused by major trauma such as road traffic accident) to the spinal cord could result in partial or full body paralysis usually below the site of the injury to the spinal cord.

Spinal Cord

Spinal Nerves

Intervertebral Disc

Vertebra


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C4C5

C6

T3

T4

T5

T6T7

T8

T9

T10

T11

T12

L1

L2

L3

L4

L5

T2 T1C7

C1

C3

C2

Eight pairs of cervical nerves (including the brain stem) supply the head, neck, shoulders, arms and hands.

Twelve pairs of thoracic nerves connect to parts of the upper abdomen and to the muscles in the back and chest areas.

Five pairs of lumbar nerves supply the area of the lower back and legs.

Five pairs of the sacral nerves and one pair of coccygeal nerves supply the buttocks, legs, feet, anal and genital areas.

The point at which the nerve exits the spinal cord is called the nerve root. Because of where the nerve root is positioned in relation to the intervertebral disc, this is the area of the nerve that is most commonly damaged by a herniated or prolapsed disc. The nerves then branch out into the many smaller nerves that control the different parts of the body (as detailed in the above diagram) these are called the peripheral nerves.

A nerve is therefore very long, extending from the back down to the toes, as an example, and is made up of one long cell, because of this when they are damaged they tend to heal quite slowly - sometimes taking many months to fully recover from an injury.

The image is illustrating the numbered vertebra.


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Forces Acting on the Spinal Column

There are four types of force acting on the spine:

l Tensionl Compressionl Shearl Torsional/Twisting

Tension

Tension acts in two ways on the disc - by applying compression to one side and tension on the other. This is commonly caused by excessive forward flexion or side flexion.

Compression

A downward force on the vertebrae compresses the discs and causes them to bulge or shorten and widen. The most common cause of this is by falling a significant distance or diving into shallow water.

Image shows side flexion causing tension.


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Shear

Shear forces involve the application of a load parallel to the vertebral surface. On forward movement of the spine there is a tendency for a vertebra to slide forwards on the one below it. A common shearing force is caused by a whiplash type injury.

Torsional/Twisting

Excessive twisting movements of the spine cause the fibres of the intervertebral discs to be stretched and weakened. Some sporting activities or industrial injuries may result in damaging the spine this way.

During manual handling a combination of compression, torsional, tension and shear forces may occur throughout the activity.

Common Causes of Back Pain and Other Musculoskeletal Disorders

The spine is an amazing, robust and adaptable structure capable of safely moving and loading in a variety of postures if the individual remains physically fit and well. Whilst back pain is common (more than 80% of adults experience back pain at some point in their lives) most people recover without the need for treatment.

One of the keys to having a healthy back is understanding that even low-level pain can be the result of the cumulative effects of some of the folllowing factors:

l Poor Physical Fitness and Obesity – Carrying too much weight and poor body fitness coupled with a lack of exercise, causes the muscles in the back, pelvis and legs to become weak. At the same time these areas become inflexible. This weakness and lack of flexibility causes significant


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strain on the lower back. This can cause a chain reaction all the way up the spine, eventually resulting in the entire structure of the spine becoming compromised and weak.

l Decreased Functional Capacity – Age is not an independent risk factor for work related musculoskeletal disorders (MSDs) however older workers can be more susceptible to work related MSDs because of decreased joint mobility, musculoskeletal strength and reduced reaction times.

l Spinal diseases – There are a number of diseases affecting the bones of the spine that range from mild to serious. These diseases can occur at any time in a person’s life from inherited factors, age and environment. Spine disease can also occur spontaneously without any particular cause. These diseases often have pain as a symptom.

Some common examples include:

Sciatica – A common type of pain caused by the compression or irritation of the sciatic nerve. The sciatic nerve being the longest nerve in the body, travels from the pelvis, through the buttocks into

the feet. Osteoarthritis - A degenerative condition in which the protective cartilage that cushions the bones wears down causing stiffness and pain. This condition is more common in women and tends to affect the cervical and lumbar vertebrae. Ankylosing spondylitis - A painful and progressive type of arthritis where vertebrae fuse together causing pain and stiffness particularly on movement. Spondylolisthesis - A vertebra in the lower spine slips out of place and onto the next vertebra. If this misplacement puts pressure on the nearby nerve then it can cause lower back pain. Spinal stenosis – A narrowing of spaces between the vertebrae potentially causing pressure on the spinal cord and/or nerves. This generally affects the lumbar spine and can cause pain along the back of the leg.

Other factors might include smoking (causing tissue damage to the spine due to decreasing the blood flow); stress and depression (causing tension to build up in the muscles of the spine); pregnancy (causing additional weight being put on the spinal structure); inappropriate footwear (causing muscle imbalance).


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What to do if you suffer acute back pain.

Even acute back pain stands a good chance of improvement within a few days or weeks without resorting to drastic measures. Medical intervention would be advised, particularly if pain is not subsiding, but the following may help recovery in some circumstances:l Assess and try, whenever possble to, avoid doing what has caused the pain.l Remember, physical exercise strengthens muscles whereas disuse weakens them.l Rest if absolutely necessary, but try to move normally and exercise when possible.l If you sleep on your side, draw your knees up slightly toward your chest and put a pillow between your legs. One pillow to support your head and neck.l If you sleep on your back, place a pillow under your knees. A small rolled towel under the lumbar curve may give your lower back additional support. One pillow to support your head and neck. l If you sleep on your stomach, place a pillow under your pelvis and lower abdomen. A pillow under your head may or may not feel comfortable.l If the pain continues for several days, consider visiting a chartered physiotherapist, registered chiropractor or your own general practitioner.

Preventing Force Related Tissue Damage

One of the primary reasons for safely moving and handling clients is to protect them from injury. The focus can often be on the damage that can be caused to the musculoskeletal system. It is important to remember the impact that unsafe manual handling has on client’s skin and underlying cellular structures as well. Traditionally in health care environments, tissue viability is taught separately from manual handling. Generally, during manual handling training there is more focus on the risks of musculoskeletal damage, whereas, during tissue viability training there is more focus on the risk to tissue integrity and damage by pressure.

The biomechanical forces of compression, shearing and tension combine when moving and handling a person. These forces will increase the risk of rupture of cells and tissues which are caused prior to the formation of pressure damage and ulcers. Therefore, using the term pressure damage is not wholly accurate, a better description would be ‘force related tissue damage’. Safer manual handling should be firmly linked with protecting tissue viability; they are in fact, two sides of the same coin.

Linking tissue viability with manual handling will help care workers fully understand the importance of safeguarding the client from further harm by using safer manual handling techniques and equipment where appropriate.


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Controversial Techniques

Introduction

Each of the following moves have in the past been commonly seen, and are deemed to be higher risk of harm to both the client and the care worker. Increased risk of musculoskeletal injuries such as back pain, joint dislocation and tissue shearing are not the only concerns with these techniques. The passive nature is likely to restrict the client from assisting, thereby causing distress and loss of independence. Any technique that involves lifting all or most of the client's weight will inherently be higher risk due to the awkward posture of the care worker and the weight of the load. The speed at which these techniques are performed further compounds the risk. This is supported by professional guidance, published professional opinions and evidence based practice.

Good practice indicates that these moves are to be used only in extremely challenging, life-threatening or emergency situations. Check your organisation’s policy/procedure for more detailed guidance.


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The Drag LiftThe Drag Lift

Front Assisted Lift Orthodox Lift

Through-Arm Lift Arm and Leg Lug/Hammock Transfer

The Bear Hug/Pivot Transfer (Arms Around Care Worker’s Neck)

The Bear Hug/Pivot Transfer (Arms Around Care Worker’s Waist)

Documents

Manual Handling Operations Regulations, 1992 (as amended