Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
Introduction to Manual Handling
Please click on the image above to play the video (you’ll need an internet connection)
Why is manual handling training
important to us as physiotherapists?
Main reason?! To keep ourselves and our patients safe
Boston patient death: hoist instructions 'not enough’
Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
Relevant legislation for us: Manual Handling
Operations Regulations 1992 (MHOR)
• This defines manual handling: ‘ “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’
• Explains the employer’s responsibility with regard to hazardous
manual handling in the workplace and sets out the requirement for risk
assessment for hazardous manual handling activities in the workplace
• Load: anything that’s moveable – inanimate object, person or animal
Responsibilities: The Employer and
the Employee
Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
The Employer:
• As far as is reasonably practicable, AVOID the need for employees to
undertake manual handling operations at work which involve a risk of
injury
• Where it is not reasonably practicable to avoid the need, ensure:
o A suitable and sufficient assessment of all manual handling
operations is undertaken
o Take appropriate steps to reduce the risk of injury when manual
handling operations do need to be undertaken
o Ensure employees who are involved in manual handling have
precise information on:
The weight of each load
The heaviest side of any load with a centre of gravity not
positioned centrally
• Regular reviews needed if there has been significant change in
manual handling operations, or regulations are no longer valid.
• Appropriate steps taken to reduce risk with regards to:
o Physical suitability of employees to carry out operation
o Clothing, footwear, personal effects
o Knowledge and training
o Results of any relevant risk assessment
o Whether employee is identified as being especially at risk
An example in our line of work? The use of height adjustable
plinths to avoid compromising the physio: it is reasonably
practicable to use a pedal to take into account physios of different
heights.
Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
• Individual risk assessments
o Under 18 yr olds
o Pregnant/new mothers
• Equipment
• Mandatory training
• Policies and procedures
• Reporting accidents/incidents
• Everything needs to be documented – ‘if it hasn’t been
documented, it hasn’t been said’
So….. what does our employer put
in place?
• Follow policy, comply with risk assessment, attend training, report near
misses/accidents
Factors to consider when undertaking manual handling risk assessment:
Think of manual handling as a whole:
• Nature of the TASK
o Unplanned? Emergency?
• The LOAD
o Size? Weight? Mobility?
• The working ENVIRONMENT
o Confined areas?
• The INDIVIDUAL CAPABILITY
o MSK condition? General health? Capabilities?
• OTHER FACTORS, for example, equipment
o Is equipment safe to use? Maintained? Appropriate for task?
And the Employee must:
Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
AVOID
• Avoid hazardous manual handling where possible
• Can the patient do the activity independently?
• Can the treatment be brought to the patient?
ASSESS
• If avoidance is not possible, making a ‘suitable and sufficient’ assessment of the
hazards
• Considering task, load, environment, individual capacity, equipment
REDUCE
• Can only reduce risk if staff follow assessment guidelines
• Need appropriate training and supervision, maintaining all equipment in good
working order
REVIEW
• Review risk assessments when changes occur on regular basis, or when there is an
accident or case of ill health from a manual handling operation
Summary of MHOR, 1992
Other Legislation
Health and Safety at Work Act, 1974 (HASAWA 1974)
• Explains the general duty for employers to have in place a safe system of work and what that
entails
• Defines the employees’ responsibility for their acts and omissions in the workplace
• Explains the potential outcome if the above statements are not adhered to
Lifting Operations and Lifting Equipment Regulations, 1998 (LOLER, 1998)
• Explains what ‘lifting equipment’ (includes patient hoists and attachments for hoists) is and when
it is used for work
• Details the criteria by which lifting equipment should be inspected, frequency of inspections etc.
• Sets out criteria for staff training and supervision when using lifting equipment
Provision and Use of Work Equipment Regulations, 1998 (PUWER, 1998)
• Details the criteria in which work equipment (including handling equipment) should be used only
for its intended purpose
• Details the criteria in which work equipment should be maintained in an efficient stage and in
general good repair and working order
• Sets out the criteria for staff training and supervision when using work equipment
Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
Quick gloss over forces!
Anatomy section not needed.
Relevant forces acting on spinal column from a manual handling
perspective (a combination may occur throughout the activity).
• Tension: compression one side of disc, torsion the other
(excessive forward/side flexion)
• Compression: downward force compresses disc (fall)
• Shear: application of load parallel to vertebral surface
(whiplash)
• Torsional: excessive twisting (sporting/industrial accidents)
Biomechanics for efficient body
movement
Centre of gravity (COG) – imagine a box drawn around you – COG should be in
the middle if you draw diagonal lines across – think about where COG is i.e. when
patient may be slumped in a chair.
3 Key Principles:
1. Use COG to initiate movement i.e. bring head and chest forward for sit to stand
(consider ‘plus sizes’ and subsequent change in COG)
2. Use base of support (BOS) and line of gravity (LOG) for stability i.e. LOG
should be within BOS
We are most stable with feet placed shoulder width apart, or with one foot in
front of the other with knees slightly bent
3. Avoid tension in muscles, tendons, ligaments
Keep external levers (arms) as short as possible, keeping load close to body
Think about COG, LOG when moving a load
Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
Basic Inanimate Load Handling –
Potential Hazards!
ENVIRONMENT
• Are there constraints on posture? Variations in levels? Poor floors? Restrictions on
movement from clothes (PPE)?
LOAD
• Is it heavy? Bulky? Difficult to grasp? Unstable/unpredictable? Sharp/hot? Handles/straps?
Too large to see over?
INDIVIDUAL CAPABILITY
• Does the job present a hazard to those with health problems/disabilities/who are pregnant?
TASK
• Does it involve holding loads away from the body? Twisting? Reaching upwards? Long
carrying distances? Repetitive handling? Insufficient rest or recovery? Strenuous
pushing/pulling?
EQUIPMENT
• Is the handling equipment clean? In good working order? Appropriate for the
task/user/environment?
Key points to remember:
“Keep your nose in line with your toes”
• Avoid ‘top-heavy’ moves – bend your knees not your back
• Avoid static postures, holding loads for a length of time
• Keep load close to your body – the further it is away from your
trunk, the heavier it will feel to move
• Ensure you can see where you are going
• Reposition the load once down, not while you are carrying it
• Keep both feet flat on floor whenever possible
• Avoid twisting your neck – “Keep your spine in line”
Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
Child’s play YouTube
From 21 seconds
1. Prepare your environment
Enough space, no floor hazards, good lighting
2. Select appropriate handling aid/equipment if required
3. Communicate with patient and other people assisting
Ensure you get permission, somebody takes the lead, keep language clear
and concise
4. Start/finish move with stable base
Keep both feet flat on the ground, feet shoulder width apart
5. Keep knees/shoulders relaxed
Softening knees brings COG closer to floor and increases stability
10 basic principles for practical techniques
Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
6. Keep LOG within BOS
Keep ‘spine in line’ and avoid twisting
7. Adopt a ‘palmar hold’ (flat hand hold and fingers flexed slightly)
8. Give support from hips and thighs
Use strongest muscles in your body to ‘power’ the move
Move your body as patient moves, keeping close to their COG (pelvis)
9. Lead with head
Keep eyes forward and move head, then shoulders and trunk in line of
movement
10. Completion of move
Ensure patient safe and comfortable
Looking for maximum effort from the patient!
• Make sure they have any appropriate communication aids i.e. hearing aids
• Make sure the key focus is the patient, not the task
• Ensure instructions are clear and concise
• Avoid negative instructions e.g. ‘don’t sit down!’
• Use the patient’s preferred name when addressing them
• Ask their permission before commencing any handling tasks
• Limit distractions
• Use a gentle positive tone of voice
• Get eye contact when giving directions
• Listen to your patient and react to their needs
• If necessary, show them what you want them to do
• Reassure them through the task
• Give positive feedback
Effective communication
Cambridgeshire Community Services NHS Trust: delivering excellence in musculoskeletal services and pelvic health physiotherapy across Cambridgeshire and Peterborough
