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Back disorders are a common source of pain and disability among warehouse and storage industry employees. These disorders can include:
Chronic back disorders can develop gradually as a result of micro-trauma brought about by repetitive activity over time or can be the product of a single traumatic event. Because of the slow and progressive onset of this internal injury, the condition is often ignored until the symptoms become acute, often resulting in disabling injury.
Acute back disorders, on the other hand, can be the immediate result of improper lifting techniques and/or lifting loads that are too heavy for the back to support. While an acute disorder may seem to be caused by a single well-defined incident, the real cause is often a combined interaction of the observed stressor coupled with years of weakening of the musculoskeletal support mechanism by repetitive micro-trauma. These disorders can arise in muscle, ligaments, vertebrae, and discs, either singly or in combination.
Whether chronic or acute, back disorders have the following signs and symptoms:
Editor’s Note: Sources of the In Depth section are listed in the Acknowledgements section.
Of all the parts of the body affected by injuries and illnesses involving days away from work (DAFW), the back dominates the list, with about 4,420 cases per year in the warehousing and storage industry. That’s 20.7 percent of all DAFW cases affecting the industry annually. In comparison, employees in the industry suffer 2,385 shoulder-related cases and 1,840 hand-related cases each year. Source: Bureau of Labor Statistics 2017 to 2020 average.
The spinal cord consists of 24 vertebrae, each separated from the next by soft discs that act as shock absorbers when the vertebra move. Abdominal muscles, as well as other muscles and ligaments that run along the spinal column, support the spine. However, if an employee’s spine is not properly supported by these muscles, a quick twist or off-balanced lift, for example, can easily result in a low-back injury. Because the lower back (the lumbar area) carries most of an employee’s weight, it is usually the first damaged area of his or her back. However, back disorders can also occur in the upper (cervical) and middle (thoracic) part of the back.
Simply put, back disorders result from exceeding the capability of the muscles, tendons, discs, or the cumulative effect of several contributors, including, but not limited to:
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In broader terms, the major contributing factors associated with the development of back disorders include:
When warehouse or storage facility employees are exposed to more than one of these, the chances of developing back disorders increase. Therefore, identifying all the contributing factors present at your facility is essential to reduce back disorders.
Reaching and lifting, or carrying a 10-pound object that is 10 inches from the spine is equal to 100 pounds of force on the lower back. Reaching and lifting, or carrying a 10-pound object that is 25 inches from the spine is equal to 250 pounds of force on the lower back.
It’s hard to prevent back disorders or control back hazards until you first identify the back hazards in your warehouse or storage facility. However, you don’t want to simply wait for a problem to surface. Be proactive. The following steps may help you determine if you need to look further at back safety and health and to what extent it poses a problem at your location.
A records review can tell you the total number of back disorders reported to management; the date each case was reported; the department or specific job of those who were injured; and the number of employees on the same job or in the same department. This review can also help you spot any trends with back disorders. Records to review might include:
A walk around your warehouse or storage facility should give you firsthand information about back hazards for your employees. During a walkaround:
Also pay attention to warning signs, such as:
Talk to employees, supervisors, and managers about where problems exist. Ask employees about their opinion on the difficulty of tasks as well as personal experiences of back pain. Also, ask them about their ideas for altering work processes, operations, tools, or equipment, and find out how they would make their jobs less physically demanding and more efficient.
Employee surveys may assist in identifying new or early cases of back disorders in the work force. They’re useful in smaller facilities where data gathered from records reviews may be limited or in facilities where reporting disincentives limit the number of reported cases. The major reason for a survey is to collect data on the number of employees that may be experiencing some form of back injury or disorder. This is also a good method for identifying departments or jobs where potential back problems exist. Things to consider in designing a questionnaire or symptom survey, include the following:
Consider asking your employees for examples of tasks they perform that: require lifting at your site or involve ergonomic risk factors.
To determine where problems may arise in work tasks at your warehouse or storage facility, you may want to use a checklist to find problem jobs, screen jobs for risk factors, perform job safety analysis, and/or apply some popular assessment tools.
The NIOSH Hazard Evaluation Checklist for Lifting, Carrying, Pushing, or Pulling can be used as a screening tool to provide a quick determination as to whether or not a particular job task is comprised of conditions that place the employee at risk of developing low back pain. The NIOSH Materials Handling Checklist, on the other hand, is a tool to quickly identify potential problem jobs. Neither checklist is designed to be a comprehensive risk assessment technique. Additional risk factors may exist that are not accounted for in these checklists. It is common practice to follow up checklist observations with more precise techniques to confirm problem risk factors.
NIOSH Hazard Evaluation Checklist for Lifting, Carrying, Pushing, or Pulling | ||
“Yes” responses are indicative of conditions that pose a risk of developing low back pain; the larger the percentage of “YES” responses, the greater the risk. | ||
| Yes | No |
| Yes | No |
| Yes | No |
| Yes | No |
| Yes | No |
| Yes | No |
| Yes | No |
| Yes | No |
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| Yes | No |
| Yes | No |
| Yes | No |
| Yes | No |
| Yes | No |
| Yes | No |
| Yes | No |
NIOSH Materials Handling Checklist | |||
“No” responses indicate potential problem areas which should receive further investigation. | |||
1. Are the weights of loads to be lifted judged acceptable by the workforce? | Yes | No | |
2. Are materials moved over minimum distances? | Yes | No | |
3. Is the distance between the object load and the body minimized? | Yes | No | |
4. Are walking surfaces level? | Yes | No | |
.................... wide enough? | Yes | No | |
.................... clean and dry? | Yes | No | |
5. Are objects easy to grasp? | Yes | No | |
.................... stable? | Yes | No | |
.................... able to be held without slipping? | Yes | No | |
6. Are there handholds on these objects? | Yes | No | |
7. When required, do gloves fit properly? | Yes | No | |
8. Is the proper footwear worn? | Yes | No | |
9. Is there enough room to maneuver? | Yes | No | |
10. Are mechanical aids used whenever possible? | Yes | No | |
11. Are working surfaces adjustable to the best handling heights? | Yes | No | |
12. Does material handling avoid: | Yes | No | |
.................... movements below knuckle height and above shoulder height? | Yes | No | |
.................... static muscle loading? | Yes | No | |
.................... sudden movements during handling? | Yes | No | |
.................... twisting at the waist? | Yes | No | |
.................... extended reaching? | Yes | No | |
13. Is help available for heavy or awkward lifts? | Yes | No | |
14. Are high rates of repetition avoided by job rotation? | Yes | No | |
.................... self-pacing? | Yes | No | |
.................... sufficient pauses? | Yes | No | |
15. Are pushing or pulling forces reduced or eliminated? | Yes | No | |
16. Does the employee have an unobstructed view of handling the task? | Yes | No | |
17. Is there a preventive maintenance program for equipment? | Yes | No | |
18. Are employees trained in correct handling and lifting procedures? | Yes | No |
Efforts to identify jobs or tasks having known risk factors for back disorders can provide the groundwork for changes aimed at risk reduction. Even without clear medical evidence, screening jobs for ergonomic risk factors can offer a basis for early interventions. Remember that the ergonomic risk factors include: repetitive motion, awkward posture, forceful exertion, static posture, vibration, and contact pressure.
The purpose of the following worksheet is to increase basic awareness of potential problems associated with jobs and tasks. This awareness can help provide clues on how to make effective improvements.
Screening Jobs for Back Disorder Risk Factors | ||
Job Title: _____________________________ Job Location: __________________________________ Name of Employee: __________________________________________________________________ Name of Observer: __________________________________ Date: ____________________________ | ||
Risk Factors: | Other clues: | Reasons for Problems: |
Task 1: | ||
Task 2: | ||
Task 3: | ||
Each job in which employees have a greater incidence of back disorders should be subject to a job safety analysis (JSA), also known as a job hazard analysis (JHA). A JSA breaks a job into its various elements or actions, describes them, measures and quantifies risk factors inherent in the elements, and identifies conditions contributing to the risk factors. This information is gathered by talking with employees and observing them at work — much like the work activity observations and employee interviews and surveys discussed earlier. However, JSAs are now focused on a particular job to be analyzed.
Talking to employees to get insight into the job requirements provides information that only those who work at the job can provide. It is often the best way to identify the causes of the problem and to identify the most cost-effective solutions to it. Whether you talk to employees while observing them, talk to them at a staff meeting, or ask them to fill out a questionnaire, any of these methods can be effective. However, be sure to pose the questions in a way to minimize bias. For example, the following questions tend to elicit useful information and do not prejudge the answer:
Another important part of JSA is observing employees performing the job to identify the risk factors in the job and to evaluate the magnitude, frequency, and duration of exposure to those risk factors. Observing employees at work is important because it allows you to see precisely which tasks may be imposing biomechanical stress on the individual. Observation is also necessary because some things may be overlooked in a discussion, or employees may not remember to mention certain activities, particularly those that are short term.
You may wish to use a video camera during observations for subsequent slow-motion analysis later. Use still photos to capture work postures, workstation layouts, tools, etc. While observing an employee perform job tasks, you should:
The following methods are comprehensive tools designed to provide a detailed analysis of various types of manual material handling tasks. They can be used to evaluate lifting, lowering, pushing, pulling, carrying, and other activities:
The National Institute for Occupational Safety and Health (NIOSH) updated its Application Manual for the Revised NIOSH Lifting Equation in September 2021. The update corrects typographical errors from the previous 1994 version, improves graphics and tables, and is reformatted to be searchable. The essential contents of the manual have not changed. Source: DHHS (NIOSH) Publication Number 94-110.
OSHA will cite employers for ergonomic hazards associated with repetitive motion and lifting. That’s the takeaway from a $27K fine issued to an employer in December 2021. Workers in the case were performing repeated manual lifts of boxes 50 to 90 pounds from a conveyor to pallets.
The agency cited under the General Duty Clause of the OSH Act and explained that the NIOSH Revised Lifting Equation revealed a lifting score of 7.8, where scores over 3 are considered hazardous. According to OSHA, the employer also failed to record eight work-related musculoskeletal disorders, a violation of 29 CFR 1904.4.
To reduce or eliminate contributing factors for back disorders and improve the fit between the employee and the task, you will want to make ergonomic improvements. Ergonomics is an applied science concerned with arranging the work environment to fit the person so that he or she will interact most effectively and safely. Work tasks should be designed to limit exposure to ergonomic risk factors and fit the capabilities of your employees.
Decide which tasks to improve and then set priorities. Consider:
OSHA’s preferred approach to prevention of injuries and illnesses, including back disorders, is to eliminate the hazardous condition in the workplace, primarily through engineering controls. These include rearranging, modifying, redesigning, providing or replacing tools, equipment, workstations, packaging, parts, processes, products, or materials. Examples of engineering controls in situations involving lifting or manual handling tasks might include the following:
Raise Height of Loads or Employees |
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When using portable steps, stools, catwalks, or other work platforms, employees should follow all manufacturers’ recommendations for proper use. They should use only equipment appropriate to the weight, size, and shape of the load being handled.
Place Storage at Optimum Heights |
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Add Supports |
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Provide Better Access |
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Use a Tool |
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Use Non-powered Equipment |
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Use Powered Equipment |
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Work with Suppliers |
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Wooden pallets weigh between 40 and 70 pounds and may be lifted several times during a work shift. This repeated lifting can cause stress to the lower back. A plastic pallet weighs about 20 pounds, so the difference is significant.
Other Engineering Control Methods |
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Just because something is called “ergonomic” doesn’t necessarily mean it will work for your situation.
Engineering controls are the most desirable, where possible. However, administrative or work practice controls may be appropriate in some cases where engineering controls cannot be implemented or when different procedures are needed after implementation of the new engineering controls. Administrative controls should not be viewed as primary methods of control.
Consider the following administrative control methods for your warehouse or storage operation:
Administrative controls, such as job rotation, can help reduce employees’ exposures to risk factors by limiting the amount of time employees spend on “problem jobs.” However, these measures may still expose employees to risk factors that can lead to back disorders. Therefore, the most effective way to eliminate “problem jobs” is to change them. This can be done by putting into place the appropriate engineering controls and modifying work practices accordingly.
There are hundreds of ideas for reducing lifting available in the Ergonomics Ideas Bank, found at www.ergoideas.Lni.wa.gov. These ideas have been reviewed by a team of ergonomists, so the ideas have some credibility.
Work practice controls, another method for controlling back hazards, reduce the likelihood of exposure to hazards by addressing the manner in which a task is performed.
To put the least amount of stress and strain on the muscles and bones, warehouse and storage facility employees should use these posture techniques:
Many low back strains and injuries can be avoided by this basic procedure for good lifting:
The proper lifting procedure is slightly different when lifting a heavy sack from the floor:
Beyond proper posture and lifting, other safe work practice controls might include the following:
Advise employees that if it’s a long load, they should get some help. Long objects, such as pipes or lumber, may not be heavy, but the weight might not be balanced and such lifting could result in back sprain.
Also let employees know that very heavy loads should be split into several smaller loads. Or if the load cannot be split, advise them to use the buddy system or a mechanical assist. One person trying to lift a heavy load may be asking for trouble.
Note that while team lifts can reduce the load in half, they also increase the risk of a slip, trip, or fall accident. It’s a good idea to discuss the lift before doing it so team members don’t make surprise movements. If possible, employees should try to find a buddy of similar height to help with the lift.
Gloves have advantages and disadvantages. While gloves with rubber dots or rubber palms/fingers on the surface can increase grip stability on slippery load surfaces, a single pair of heat-resistant gloves can reduce grip strength up to 40 percent. Two pairs at once can reduce grip strength up to 60 percent.
Some employers have instituted a refusal to lift program. You may wish to consider this approach for your warehouse or storage operations. Under this program, an employee may refuse to perform a lift if he or she feels in good faith that:
No disciplinary action would be taken if one of the criteria above are met. However, this employee must immediately notify a designated person of the refusal, so that the designee can determine if the lift is necessary and how the lift can be done safely.
Training alone will not always prevent back disorders. Training should be used together with any workplace controls implemented. Warehouse and storage facility employees need training and hands-on practice with new tools, equipment, or work practices to make sure they have the skills necessary to work safely.
Training on safe lifting techniques and generally safe work practices to protect the back should be an element of any back safety program. Communicating to employees the hazards of certain types of movements and methods to avoid them can significantly reduce those high-hazard practices and cut down on back pain and injury.
Employee training should go over:
Training could also include how to:
Stretching, for example, can make the back stronger, more flexible, and more resistant to injury. Have employees work on these muscles: back, thighs, buttocks, and hamstrings. Have them bend and stretch those muscles, holding them for at least 15 seconds, without bouncing.
A proper diet can also prevent injury. Suggest that employees:
Training is most effective when it is interactive and fully involves employees. Below are some suggestions for training based on adult learning principles:
Make sure that employees have learned what you’re trying to teach them, by having each one of them demonstrate the lifting techniques properly before leaving the class. Also, be sure to follow-up with employees to make sure they are able to use the techniques on the job.
Enforce the lifting methods that are taught. The accident rates for lifting injuries speak for themselves, so employees should be taught to think of improper lifting as a dangerous activity. You don’t allow floors to accumulate grease, and you don’t allow ladders with missing rungs to be used. By the same token, you should not allow poor lifting techniques to pass unnoticed.
Personal protection solutions have only limited effectiveness when dealing with ergonomic hazards. Personal protective equipment (PPE) is used as a barrier between the contributing factors and the employee. PPE should be the last resort used to reduce employees’ exposure to contributing factors and not serve as a substitute for other feasible improvement options. Nevertheless, it is important to provide this type of protection to employees when appropriate.
Obtain the active involvement of employees in the selection, care, and maintenance of PPE. Find out from the employees whether the PPE will interfere with effective workplace performance. Make sure PPE is properly fitted, worn, and maintained.
PPE may include a combination of gloves, safety shoes or boots, and other appropriate protective equipment. Before providing PPE to employees, be sure that they are properly trained in its use.
While gloves can protect the hands from hand injury, it is important to know that:
Provide gloves in different sizes to ensure that each employee can select a pair that fits properly. When employees must grip on a low-friction surface, provide gloves that enhance the grip, such as those with rubber dots or strips. Remember that some employees may have an allergic reaction to gloves made of latex or natural rubber.
Warehouse and storage facility employees may be on their feet for long periods of time, possibly an entire shift. The leg muscles continually support the body, which can cause fatigue. These employees also work on hard concrete surfaces, which can create contact trauma or tendon and muscle problems if proper footwear is not worn.
However, shoes with solid support, flex at the ball of the foot, and adequate padding will maintain foot support and provide shock absorption against foot strike while walking on hard concrete surfaces. Provide employees with padded shoe inserts that support the foot and cushion against foot strike. These anti-fatigue soles and insoles can also reduce fatigue after long hours of standing on hard surfaces.
The National Occupational Research Agenda (NORA) suggests workers check their shoes and replace them before serious wear occurs. NORA explains that if the width of the area of wear on the bottom of a shoe is smaller than the base of a AA battery, the shoe is still good. However, if the worn area is wider than the base of the AA battery, it’s time to replace the shoes, NORA says.
Shoes with non-skid soles are also important, particularly where surfaces are potentially slippery. Several shoe manufacturers have developed rubber-type soles that are specifically designed for working in a wet environment.
Other safety shoes and boots (steel toe, for example) are designed to protect the feet from blunt injury.
In recent decades, back support belts have been introduced to general industry after a history of use in the sport, weight lifting. These belts are also known as weight lifting devices, supports, aids, and abdominal belts. However, according to an April 6, 1998, OSHA letter of interpretation, back belts are not recognized by OSHA as effective controls to prevent back injury. While the belts may be accepted by individual employees because they feel as if they provide additional support, the effectiveness of back belts in the prevention of low back injuries has not been proven in the work environment. The OSHA interpretation adds that the agency does not forbid the use of back belts and similar devices, nor does it endorse their use.
Studies from the NIOSH do not confirm that using back belts are beneficial. In particular, the NIOSH study, “Workplace Use of Back Belts”:
Keep in mind that a back support belt can never take the place of good body mechanics or proper lifting techniques.
Comprehensive injury reporting is important to the success of a back safety program. The goal of this effort is to properly assess, diagnose, and treat back disorders. Early reporting, diagnosis, and intervention can limit injury severity, improve the effectiveness of treatment, minimize the likelihood of disability or permanent damage, and reduce workers’ compensation claims. This will allow the employer to correctly identify work areas or specific tasks where injuries frequently occur or are most severe. This information helps direct your safety efforts, as well as to guide healthcare providers in making return-to-work and light-duty work decisions. OSHA’s injury and illness recording and reporting regulation (29 CFR 1904) requires employers to record and report work-related injuries and illnesses.
Encouraging and utilizing reports of back disorder symptoms:
Healthcare professionals are important because they help injured employees recover more quickly and return to their jobs with appropriate restrictions and less risk for re-injury. Work accommodations and alternative duty tasks will help employees recover faster, so that they can return to their usual job without restrictions and risk of re-injury. It is necessary that healthcare professionals are knowledgeable about the operations and work practices within the warehousing and storage industry. Their knowledge will allow them to assist the injured employee during the healing process and in post-injury work placement.
Back disorders are one of the leading causes of disability for people in their working years.
Whenever you determine that an employee has suffered a back disorder incident, you should follow these steps:
Management leadership and commitment provides the motivating force and the resources for organizing and controlling activities within an organization. In effective back safety programs, management regards the protection of employee health and safety as a fundamental value of the organization, and incorporates objectives for the success of this program into its broader company goals.
It is the employer’s basic obligation to demonstrate leadership by developing ways for employees to report back disorders, responding promptly to those reports, and involving management in the overall back safety program. Ensuring that policies and practices encourage and do not discourage the early reporting of back disorders, their signs and symptoms, back hazards, and employee participation in the back safety program is essential to its success.
Leadership may be demonstrated by participating in plant walkarounds, holding meetings with employees on back safety issues, and monitoring reports on program effectiveness. Involvement that shows commitment to the company’s back safety program can be demonstrated through the following 10 methods:
Examine existing policies and practices to ensure they encourage and do not discourage reporting and participation in the back safety program. This is necessary to ensure the early reporting of the symptoms and signs of back disorders, as well as meaningful employee participation in the back safety program.
The objective is that employees must feel free to report back disorder signs and symptoms as early as possible, because doing so prevents further pain and suffering and averts disability, not only for the employee who reports the back disorder but also for others who have comparable jobs. Early attention to back disorder reports will also reduce workers’ compensation and other related costs for that injury. To achieve this objective, all back disorders must be reported so that they can be promptly assessed to determine whether they are the result of a problem job.
Employees are a vital source of information about hazards in their workplace. Employees help identify hazards and solve problems. Their involvement can enhance job satisfaction, motivation, and acceptance of workplace changes. There are many different ways warehouse and storage facilities can involve employees in their back safety efforts, including the following:
It is important to follow up in order to evaluate if your improvements have worked. After a reasonable adjustment period, set a date to follow up on the changes made. Make sure to evaluate each improvement separately for effectiveness. The following questions may be helpful.
Has each improvement:
If you determine that your improvements have not worked, modify them or try something different until the risk factors have been reduced or eliminated.
Evaluation and follow-up help sustain continuous improvement in reducing back disorders, track the effectiveness of specific back safety solutions, identify new problems, and show areas where further attention is needed. Warehouse and storage facility managers can use the same methods they use to identify back disorder concerns (such as OSHA 300 and 301 injury and illness information, workers’ compensation records, employee interviews, and observation of workplace conditions) to evaluate progress. You can also keep a list of activities and improvements to track what has been accomplished and provide data on the effectiveness of the initiatives.
How often you evaluate the program will vary by the size and complexity of the facility. However, a good rule of thumb is to evaluate every three years. Warehouse and storage facility management should revise the program in response to identified deficiencies and communicate the results of the program evaluation and any program revisions to employees.
Large portions of the ez Explanations™ and In Depth sections of this topic on back safety for warehousing originate from three publications prepared by the Cal/OSHA Consultation Service, Research and Education Unit, Division of Occupational Safety and Health, California Department of Industrial Relations. These publications include:
Similarly, portions also originate from a Washington State Department of Labor & Industries slide presentation, “Lifting Hazards and Some Ideas on How to Reduce Your Risk of Lifting Injury,” created in 2007. In addition, publications and materials from federal OSHA, the National Institute for Occupational Safety and Health (NIOSH), the Bureau of Labor Statistics (BLS), and J. J. Keller & Associates, Inc., are used in this topic.