Lifting, Carrying, Pushing, Pulling By: Phil Dunn Duncan Hutchinson Jason Moore Bryce Rudland

A brief history of manual handling Late 17th Century – Bernardino Ramazzini founded occupational medicine based on low back pain injuries sustained at work. Between 1900-2000, the manual handling of objects accounted for 20-25% of all occupational injuries, exceeding MVA as a cause of lost time and expense

A brief history manual handling During WWII, U.S. Dept. of Labour enacted Bulletin 11 – A guide to the prevention of weight lifting injuries In 1964, the International Labour Organization published the ‘Maximal Permissible Weight to be Carried by One Worker

A brief history of manual handling In 1970, Snooker&Irvine published the ‘Ergonomics Guide to Manual Lifting’ In 1970, Tichaur published ‘A Pilot Study of the Biomechanics of Lifting in Simulated Industrial Work Situations’ - this showed that severity of a lifting task cannot be measured by the Weight lifted, but by the Torque involved.

A brief history of manual handling At present, the current authority for the general evaluation of workplace lifting hazards is the NIOSH Guide (1981) Provides a tool for managers to use in determining acceptable weights of lift Provides criteria for administrative and engineering control of lifting hazards

RMA Maximal Isoinertial Testing Developed by Roy Matheson & Assoc. (1998) Tests client’s maximum or ‘occasional’ lifting carrying, pushing, pulling capacity

Lifting

RMA Lifting Test Equipment: A square box measuring 34 cm with handles at 4” and 12”. The box should be designed to secure the weights; a lid may be used to conceal from client. Instructions should be given before tests are performed.…

RAM Lifting – Leg Lift Position: full squat with knees fully flexed, partially sitting on heel of back foot Place one foot 6-10” in front of the other, front foot flat. Client grasps lower handles 4” off floor with elbows fully extended and box pulled between legs, close to torso. Torso remains as vertical as possible

RAM Lifting – Leg Lift Action: The client raises to the standing position by coming up with his head/shoulders first. - Arms remain fully extended - Resistance can be increased in 5-10lb. Increments, or perhaps 20lbs in rare cases of adequate strength

RAM Lifting – Leg Lift Keep an eye out for: - Lumbar spine Kyphosis - Tight clothing could inhibit performance - Parallel feet could affect balance - Kyphotic horizontal trunk - Box joints – equipment maintenance - Signs of biomechanical overload

RAM Lifting – Knee Lift Position: Lower extremities are flexed at the hips and knees approx. 30-50%, or to comfort; hips rotated outward to allow knees to flex around the box - upper extremities are extended at elbow - client grasps upper handles 1ft. from floor - Torso is halfway between vertical and horizontal to maintain lumbar lordosis

RAM Lifting – Knee Lift Action: client lifts up with head/shoulders first until they have reached knuckle position, with arms extended - Resistance can be increased in 5-10lb; increments of 20lbs in cases of adequate strength.

RAM Lifting – Knee Lift Keep an eye out for: - ‘Torso’ posture: Horizontal spine even if knees are flexed - Signs of overload - Box Joints

RAM Lifting – Waist to Shoulder Lift The client is asked to move in a lateral direction in order to diminish possibility of change in lever arm length Position: The feet are in comfortable parallel position with straight lower extremities - client grasps box at knuckle level with arms fully extended at elbows - The torso is upright

RAM Lifting – Waist to Shoulder Lift Action: Box is lifted up to the shoulder level by stepping sideways and keeping the box just in front of chest; lower box similarly - Resistance can be increased in 5-10 lb. increments, or in 20 lb increments in cases of adequate strength.

RAM Lifting – Waist to Shoulder Lift Keep an eye out for: - Over torque at wrists and fingers - Secure box joints - secure shelves that won’t collapse if bumped - signs of overload - horizontal distance between box and trunk - twisting action

RAM Lifting – Shoulder to Overhead Wrist-Hand considerations: using the handles on the regular 14” box will place abnormal stress on the client’s hands and fingers, which can be decreased by utilizing a special box with a dowel rod. - Ensure dowel-hole is placed above midline of the box to avoid rollover

RAM Lifting – Shoulder to Overhead Position: feet are parallel, legs straight, with hands grasping the box in pronated position at shoulder height. - Torso is upright

RAM Lifting – Shoulder to Overhead Action: box is lifted from shoulder height to 8-10” overhead - the client should sidestep as they are lifting in order to keep weight anterior to body - resistance can be increased in 5 lb. increments

RAM Lifting – Shoulder to Overhead Keep an eye out for: - signs of overload: tippy toes or leaning too far back - secure box joints - secure shelves - torque at the wrist - tilting box, which may suggest weakness - tight clothing (wear mirrored sunglasses)

RMA Carrying Test – for the client’s maximum or ‘occasional’ carrying capacity Position: client stands with normal posture, grasps the box using the lower handles in the standing knuckle position - torso remains vertical

RMA Carrying continued… Action: The client keeps the weight in front of their body, carries it the required distance and returns to the starting position. Resistance can be increased in 5-10lb increments

RMA Carrying cont… Keep an eye out for: - signs of overload like backward leaning and short steps - excessive trunk twisting - check box joints for disassembly - a Symptom Magnifier or Phoneyus Baloneyus may fake a wipeout and actually injure themselves or others.

RMA Pushing Test – for client’s maximum or occasional pushing capacity Position: the client uses a normal walking movement and applies forward pressure on handle 3 feet off the floor with the elbows slightly flexed the torso is straight or in slight kyphosis, but angled toward sled

RMA Pushing cont…. Action: client pushes sled at their own pace as they walk predetermined distance. Resistance is increased in 35-40lb. increments to increase pushing force by 10-15 lbs Measure the pushing force using dynamometer; NOT the weight in box

RMA Pushing cont… Keep an eye out for: - Adopted posture: whether it demonstrates maximal effort - Length of stride: helps determine overload

RMA Pulling test – for client’s maximum or ‘occasional’ pulling capacity Position: the client uses a normal walking posture while pulling sled handles at 3 ft. from the floor with elbows extended or slightly flexed. Client leans backward angling torso away from sled, but the spinal curves should be kept in normal posture

RMA Pulling cont… Action: using both hands, client pulls on cart handle while walking backwards at a distance predetermined by Snooker Resistance can be added in 25-40lb. Increments to increase pulling force by 10-15lbs Measure pulling force using Dynamometer and NOT the weight in the sled

RMA Pulling cont… Keep an eye out for signs of overload: - short strides - excessive flexion at the waist - sled ‘fish tailing’ - jerky motion