In Australia, the highest number of workplace injuries are due to musculoskeletal disorders like sprains, strains, and dislocations, with manual handling workers being particularly vulnerable.
Actions like lifting, pushing, pulling, bending, repetitive movements, and falling accounted for nearly half of all Australian workplace injuries during the 2020-2021 period. In this article, we explore five prevalent manual handling injuries, and share actionable strategies that will help safeguard your workforce.
Low Back Pain (Lumbar Disc Lesion)
The presence of low back pain may indicate an injury to the disc in the low back. Disc injuries can be a tear, bulge, or more serious protrusion. This injury may also cause pain down the leg.
Common signs and symptoms:
- Sharp sudden pain, usually precipitated by a bending and lifting or twisting movement through the low back
- Pain down the leg, which can be worse than the back pain (this is called referred pain)
- Pain with forward bending activities, lifting, coughing, sneezing, sitting for long periods
- Numbness, tingling, and/or pins and needles local to the low back, or down the painful leg
- Consistent low back discomfort. The workers will be very guarded and slow with their movements
- Poor sleep quality due to discomfort
- May be relying on heavy painkillers or anti-inflammatories to get through the day
If the worker is under care and looking after their injury, a graded return to full duties can occur over six to 10 weeks. If the injury is more severe, or their condition worsens, recovery will take months, and they may require surgery. In that scenario, they are unlikely to be able to return to their regular duties.
- Check in with the worker to see how they are coping with their set tasks
- Ensure co-workers understand the significance of the injury and are not having the worker perform tasks they shouldn’t be doing
- The injured worker will likely require light duties or even time off work
- If the worker is in a role that requires bending or lifting, they will need to be transferred off this immediately and will require a graded return to full duties
- The worker will likely require more frequent breaks and understanding that they will be moving slower than usual
- A qualified healthcare professional will need to assess and accurately diagnose before providing treatment and advice
- A back support brace may help to alleviate the pain
- Exercise physiologists, personal trainers or manual therapists can help rebuild muscles around the injury
- General practitioners may be able to provide relief with a strong anti-inflammatory prescription or a cortisone injection
- Pain management clinics if the pain persists longer than six months
Tennis Elbow (Lateral Epicondylitis)
Tennis Elbow is often a result of tasks that require repetitive gripping activities and involves pain in muscles and tendons of the elbow region. Causes can include muscular tightness, tendon inflammation and nerve entrapment. There can be large variability in causes for this pain, including:
- Not physically suited to the role
- General health factors (ie. diet, sleep, alcohol, smoking, obesity, diabetes)
- Lack of task rotation (daily fatigue of the same muscles, no chance to recover)
- Poor self-care (ie. lack of stretching, general fitness)
Common signs and symptoms:
- Sharp pain when gripping, lifting or twisting the forearm
- Weakness
- Dull ache through the forearm region at rest
Workers often find that they are unable to participate in their usual recreational activities outside of work. Tennis Elbow can also impact their ability to perform household chores.
Tennis Elbow can usually be resolved in 3–6 weeks for pain resolution, if compliant with stretches and exercises. Smoking and other poor lifestyle factors can contribute to a longer recovery.
- A qualified healthcare professional will need to assess and accurately diagnose before providing treatment and advice
- Consider rotating the injured worker to a different task that keeps them on full/ normal duties. Often workers will know which jobs they can perform without aggravating their elbows.
- Ensure the worker is wearing their brace (if prescribed) before starting work
- Encourage stretching during work breaks. YouTube can be a great resource for general shoulder, elbow and forearm stretching routines
- Positively reinforce any progress they have made
- Manual therapists can provide strength and conditioning programs to reduce elbow strain and rehabilitate the injury
Nerve Entrapment
Nerves provide sensation to all areas of our body, including the shoulders, elbows and wrists. Repetitive movements can cause muscles to become tight, which can irritate the nerve, resulting in numbness, tingling and in severe cases, muscular weakness. Numbness in the fingers is commonly misdiagnosed as Carpal Tunnel Syndrome, which is a bony impingement of the median nerve rather than compression from a soft tissue structure.
Common signs and symptoms:
- Numbness and tingling (pins and needles)
- Cold hands/fingers
- Deep aching sensation that can cause difficulty in sleeping
In most cases, workers should be able to work through these symptoms. However, there is some variance in how resilient certain workers are and how anxious they can be if they know co-workers who have previously had surgery for the same complaint.
With treatment and good compliance with stretching advice, these complaints often resolve in 3–6 weeks. Complex health issues, such as diabetes and thyroid dysfunction may influence the prognosis.
This condition is often misdiagnosed as Carpal Tunnel Syndrome. Some workers are fearful of surgery as this is the primary way that it is treated medically. Try to reinforce that surgery is rare and is always the last option. Connect workers to others who have had similar symptoms and responded favourably to conservative management.
- A qualified healthcare professional will need to assess and accurately diagnose before providing treatment and advice
- Light massage throughout the arm, above and below the affected area
- Stretching and nerve flossing exercises.
- Check in daily and encourage them to perform their stretches
- Discuss which tasks don’t aggravate their symptoms. If work duties are significantly impacting their symptoms and treatment cannot provide suitable relief quickly, light duties may be needed
- If symptoms are one-sided, consider single-handed duties, or roles that require reduced repetition or reduced weight.
- Ensure supervisors/teams are aware of their restrictions so they aren’t asked to perform tasks outside their restrictions.
- Understand that people with Nerve Entrapment often have poor sleep, significant sensitivity, and difficulty with precise finger movements
- Plenty of sleep, water, and a healthy diet with fresh fruit and vegetables
Shoulder bursitis
Inflammation of the bursa (a fluid-filled sac that sits between the bony part of the shoulder and the muscles or tendons to stop them from rubbing on each other).
Common signs and symptoms:
- Pain when using their arm above shoulder height
- Poor sleep quality due to pain associated with pressure on the shoulder
- Fear-avoidance behaviour – unwilling to use their affected limb in case they bring the pain on
- Decreased participation in household and outside-of-work activities
If the worker is managing their injury appropriately, they should be able to perform minimally restrictive duties in two to three weeks (still a restriction against overhead movements). If they continue to progress, within six weeks the worker should be able to resume regular duties without restriction. Smoking, an inflammatory diet, and lack of exercise outside of work can inhibit recovery.
- A qualified healthcare professional will need to assess and accurately diagnose before providing treatment and advice
- Ensure the worker is not required to perform any arm movements that go above shoulder height
- Offer the worker alternate duties if their task is aggravating their shoulder
- Encourage the worker to perform their self-care routine and take breaks when required
- Help co-workers understand that the worker has an active injury and is not simply ‘slacking off.’
- Exercise physiologists or manual therapists can help with rehabilitating the shoulder
- General practitioners may be able to provide relief with a strong anti-inflammatory prescription or a cortisone injection
- YouTube videos – ensure they are attached to a physical therapist’s name or clinic instead of someone without a health practitioner background
Intersection Syndrome or “Squeaker’s Wrist”
Intersection Syndrome is a condition on the back of the wrist where tendons can become inflamed and swollen with repetitive wrist movement. It is very common for new starter manual handling workers, workers returning from holidays or those learning a new role with a large amount of wrist movement. As the tendons become accustomed to a new movement, they can become swollen.
Common signs and symptoms:
- There is an obvious swelling on the back of the wrist, which is very painful to touch.
- Workers will avoid moving their wrists due to discomfort.
- A creaking or grinding sensation on the back of the wrist is often felt with movement.
If managed well in the early stages, workers will often only take one to two weeks to fully recover. If treatment or advice is delayed, the worker returns to full duties too quickly, or there are underlying health issues, recovery can take longer.
- A qualified healthcare professional will need to assess and accurately diagnose before providing treatment and advice
- First aid officers, or onsite workplace health providers can assist with strapping, anti-inflammatory creams and gentle stretching advice to reduce pain and swelling
- Self-massage and ice packs
- Act quickly and place the worker on light duties as this complaint is quick to resolve once the aggravating activity is removed
- Reducing repetitive wrist movement will dramatically improve recovery time
- Intersection syndrome often affects one side only, so single-handed duties using the other side is a good idea while the injury recovers
- Daily check-ins to ensure the pain and swelling is reducing
- Reinforce to the injured worker that this injury often resolves quickly if the correct protocols are followed.
Strategies for supporting your employees
Onsite allied health treatment and advice in the workplace are extremely effective at reducing the severity of symptoms and the duration of the complaint. Having allied health professionals onsite means workers can receive a diagnosis and commence treatment sooner, without having to leave the premises.
Consult with your allied health team about any specific stretches workers can perform before, during and after their shifts.
New workers are especially known to avoid reporting injuries until they are much more advanced as they are afraid of losing their job or looking ‘weak’. It’s important to instil a safety culture where workers feel they are supported and can seek help when they need it. Finding other staff members who have previous experience with manual handling conditions can be helpful to reduce fear and anxiety.
Very rarely will a worker need surgery to resolve musculoskeletal conditions if managed through onsite allied healthcare and early intervention. The faster we can reduce the severity of symptoms; the less likely workers will seek ultrasounds and nerve scans. Scans can often negatively impact the worker’s mindset and commonly lead to surgery.