'' Challenging HSE Guidance on Safer Lifting Practice ''
Osteopathic Solutions Gareth Milner
Written by
30 Minute Read
BSc. (Hons) Ost.
What is the Core Message of this Blog …
The UK’s Health & Safety Executive is failing People who perform Manual Handling Tasks, as their guidance for lifting is NEGLIGENT! Now using their colour in the MAC Tool for Unacceptable Level of Risk … NEGLIGENT!
Your possible immediate thoughts (or maybe out loud) … ‘Whoa Mr Milner! You are talking about the Great Britain’s Authority on Health & Safety. That’s a bold statement you make there?!’
My reply … ‘In work and personal life, it pays to be open-minded*. Willing to consider new ideas. Unprejudiced by others, and the common consensus.’
*If you are open-minded you can skip to where the THUMBS UP IMAGE
is below.
Let me pose the following question … ‘Do you know how to lift an inanimate load correctly?’ … nah that’s not right … ‘Do you know how to lift an inanimate load with body use and positioning bang on?’
‘What do you mean bang-on Mr Milner?’
​
‘So that you maximise body power and minimise musculoskeletal strain.’
‘YES Mr Milner … don’t discredit my NEBOSH Diploma.’
‘Ok, what about advising People when they have knee pain, a back injury, an old ankle fracture from a motorcycle accident et cetera. Can you prescribe them Best Practice Lifting Technique?’
​
'Well ...'
‘Are you 100%, categorically, no-doubts, your life depends on it …. SURE?’
​
'If you are SURE, have you studied Human Biomechanics? If you are learnt in Manual Handling Technique, having attended an Instructor/ Train the Trainer Course. Was the Instructor an Expert in Human Biomechanics. A Physiotherapist? A Chiropractor? Or like myself a Qualified Osteopath?'
We can always #ProfessionallyDevelop. If you feel you can’t you have reached your Profession’s zenith. Even if you have reached this Mount Everest of your Profession, here’s why you should CARE about my Core Message of this Blog post.
You have a body. Your only body for your life. A body that when damaged, with the constraints of current Medical Practice, cannot be un-damaged. You lift inanimate loads every day, don’t you. You want an un-damaged body. Reason 1 to CARE.
As a Professional in your Industry, you clearly went into it with a mind-set of ‘I want to feel respect from others.’ And to get this respect you will need to give the right advice in a varied subject matter. You need to be armed with Knowledge, but not it’s curse. Reason 2 to CARE.
You are responsible for the Health & Safety of . . . People. Insert the amount in the DOT, DOT, DOT. These People care, just like you, that they go home with an undamaged body. One that doesn’t hurt. One that doesn’t need the help of an Orthopaedic Surgeon. One that doesn't get them addicted to Opiate/ Narcotic Prescription Pain Killers. Reason 3 to CARE.
Is that enough Reasons?
Negligently taught Manual Handling ‘techniques’ cause chronic musculoskeletal pain.
Negligently taught Manual Handling ‘techniques’ cause debilitating Spinal Disc and Joint Injuries.
I qualified as an Osteopath in 2004 at The European School of Osteopathy.
One of the skill bases I learnt, both theoretically and practically, was the Clinical Diagnosis and Physical Therapeutic intervention of Osteopathic Manipulative Techniques to improve the lives of people who had suffered prolapsed discs in their lower backs.
Within this Degree I studied the Pre-Eminent Biomechanics Publications Joint Structure & Function written by Biomechanics Experts Cynthia Norkin and Pamela Levangie, as well as The Physiology of the Joints written by A I Kapandji.
Whilst writing this insightful* post I read Made to Stick by American Brothers Chip and Dan Heath. In fact exchange ‘reading’ to read it 5 times and listened to the AudioBook 5 times. Their messages … have stuck. The content of my Blog post has the following inherency:
1. My messages are SIMPLE. Zero human biomechanics jargon. Understandable for ALL.
2. UNEXPECTED. There will be points, themes and ideas that surprise you.
3. CONCRETENESS. Facts and visuals that are as concrete as mixing portland cement, water, sand and gravel.
4. Written by someone who has read the most Pre-Eminent Biomechanics Publications the World has so far seen. Not forgetting an #Osteopathy Bachelor of Science 4 Year Degree. CREDIBLE.
5. EMOTION. Chronic pain creates an emotion. If YOU experience chronic pain, you will know all too well that this emotion is as far away from positive … as Land’s End is from John O’Groats. Negligently taught Manual Handling ‘techniques’ cause chronic musculoskeletal pain.
6. STORIES. We will hear Real Life People’s accounts of what their body was telling them when they perform HSE Guidance Lifting and Best Practice Homo Sapien** Lifting.
*My prediction as to what many will describe it.
**As should have been performed since Lucy, the homonid, was roaming the Jungles.
What are my intentions with this post?
It is NOT to ruffle any feathers at the HSE. I have no interest in this. They can decide if they want their feathers ruffled. I have passion in this subject. It is personal to me. What being an (accident caused) chronic neck pain sufferer, every day.
My crusade since founding Osteopathic Solutions in 2010, has been to spread the Back (and Musculoskeletal) Health bug to as many adults as is possible. In being involved in this industry since 2007, I have met 100s of Health of Safety Professionals who don’t take this subject seriously. Yes … DON’T. I know. Think a job change is needed for them. I don't say Career. If they are reading this, here’s Tip 2 from Sorry! We’re Closed.
Written for Health, Safety & Wellbeing Professionals and Business Owners in Sorry! We're Closed, Osteopathic Solutions Ltd Director & Osteopath Gareth Milner puts his 17 years of Manual Handling Risk Management experience into his first Book. Through real life Business trauma of Injury at Work Claim payouts and 50 hand-picked, Manual Handling Risk Management gems of actionable Tips, Gareth presents a remarkable recipe for ensuring your Business stays open, profitable and not supplying that former Employee with a 5 star, all inclusive holiday to the Maldives.
Hello, to the Open Minded.
My core message .... ‘The UK’s HSE is failing people who perform Manual Handling Tasks, as the guidance for lifting is NEGLIGENT!’
Fact. Evidenced. Genuinely. Certainly. Gospelly. Is that even an adverb?!
In writing this 'Very Helpful*' Blog post I referred to numerous Research Papers on Lifting Practice on PubMed. The best being ‘Lifting Techniques: Why Are We Not Using Evidence To Optimize Movement?’ You can read this here (but not yet!).
The Summary of this Paper was that ...
‘Clinicians must find the optimal dosage of physical stress to address all aspects of the movement system to minimize the risk of injury.’
​
*Thanks to Yvonne Newell, Expert Moving and Handing Advisor at Salisbury NHS Foundation Trust for her positive comment about this post.
This paper, written by Nick Washmuth, Professor (pictured) in Physical Therapy at Samford University consistently mentioned Physical Therapists as the go-to Professionals in giving advice/ teaching best practice lifting; Physical Therapists being Osteopaths, Chiropractors and Physiotherapists.
​
What I read in Nick’s paper validated what myself and our Team of Occupational Osteopaths & Physiotherapists have been teaching for years across the UK.
Tip 10 - Recognise Experts from the
Jack of All Trades
In Tip 10, I give Health & Safety Professionals more awareness in detecting whether a Supplier is a Manual Handling Risk Management Expert ... or not.
The UK’s Health & Safety Executive, with Head Office in Bootle (Merseyside) is currently headed up by Sarah Albon (since 2019).
Of course, Sarah has had a lot to do over the last 4 years, what with The Elites’ (manipulating Bullying People in Power) bug thing, you know the C-word.
​
She heads up a Management Board that simply saves lives. Many young lives I am sure. They represent good. They do good.
When going on holiday, you would have seen the same if not similar. You know, the Construction sites where workers wear little PPE. No hard hats. The Construction sites where falling to die, is possible from many jumping points. The Holiday transfer/ Coach Operators where men stand on top of the coach lowering your luggage (with a top-heavy forward bend of the truck I must add). Ferries in the Med where gaps ARE THERE … I repeat ARE THERE … for parents to suffer life long despair. So I make the following statement LOUD and CLEAR, perhaps even with an electric megaphone (that's not me to the right)…
‘The UK’s HSE do a GREAT Job when it comes to preventing deaths in Industry and in normal day-to-day Life’
I hope this statement unruffles feathers. It should.
But …. and it needs to be a bigger ‘but’ than that … BUT regarding Manual Handling, the importance for them is just not there. Look at their Timeline here.
I mean, during the early 90s they are more interested in 1991 when The World Wide Web was created. Of course, helpful if you happen to stumble across this page when writing a dissertation on the ‘History of the Internet’, which you likely won’t.
No mention of the Manual Handling Operations Regulations.
​
No mention of the MAC Tool … well perhaps better that way.
Tip 18 - Ditch the Tools
Feathers ready to be ruffled … This is why.
The HSE have an Ergonomics Team at their Science and Research Centre. Here are a few definitions of Ergonomics from the 1991 started World Wide Web …
1. Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system.
​
2. Ergonomics is the process of designing or arranging workplaces, products and systems so that they fit the people who use them. Most people have heard of ergonomics and think it is something to do with seating or with the design of car controls and instruments – and it is… but it is so much more. Ergonomics applies to the design of anything that involves people – workspaces, sports and leisure, health and safety.
The first part of my ‘Louis Theroux’ style HSE investigation started here on their Training Arm, now re-branded (after a week of all day meetings brainstorming names) as 'Solutions from HSE'. Wouldn’t you love to know what that Government re-brand cost the public … actually, well … maybe not.
​
The HSE Course focuses on Risk Assessment and the use of the MAC and RAPP Tools. Manual Handling is a physical subject, right? People at your Business, lift and lug sh#t all day, every day, don’t they? They don’t push a pencil. They don’t push and pull a mouse.
​
The HSE definition of Manual Handling on their website states ‘Manual handling means transporting or supporting a load by hand or bodily force. It includes lifting, putting down, pushing, pulling, carrying or moving loads. A load can be an object, person or animal.’
So therefore, I ask the HSE a reasonable, valid question ...
Why, as the UK’s Authority on Health & Safety, including Manual Handling, do you not provide a Course that has Practical Handling Techniques Focus?
​
In fact, wearing my punchy Journalist hat (like the one he's wearing) minus the cigarette, I posed this question on a LinkedIn direct message to Matt Birtles, Principal Ergonomics Consultant at the HSE's Science and Research Centre; and this was his reply ...
'' Yes, I can, although it is purely my opinion rather than HSE's corporate opinion if that makes sense. There are a couple of reasons we don't deliver Manual Handling (MH) technique training. The first is that the scientific evidence base for MH technique training doesn't show that it's beneficial for reducing the prevalence of injuries. This may be a problem with the training or perhaps a problem with the science, but HSE are a science led organisation it (the scientific evidence) just doesn't enable us to demonstrate that this would be a good use of HSE time.
MH technique training needs to be specific and tailored for each organisation, showing the workers how to do their tasks in their work environment using their tools and work pieces. It should also incorporate the specific outcomes of risk assessments for their work. Employers often don't wish to share all of this information with HSE due to our regulatory role, and there are others in the UK who can (and do) do this better than we could.
We purposely attempt to have a more direct impact at the risk assessment/risk reduction stage which is higher in the hierarchy or controls. This is why we develop simple and effective risk assessment tools and run MH Risk Assessment Training to show how to use them and then provide the guidance on what technique training should incorporate. ''
Tip 3 -
Do a Branson!
For me, this was a rather Politician style of reply. As the HSE are, in Matthew’s words, a ‘Science led organisation’ …. would it not then be simple for them to action a Scientific Study into Best Practice Biomechanics of Lifting? .... You would think so.
Simply put, if the HSE’s Team were Experts in Manual Handling, surely they would actually have Courses that contain the content of physical moving of stuff, or in the words of the majority of Manual Operatives across the UK … ‘We generally handle heavy sh!t’.
There is an avoidance of Practical Handling Courses. There are NO clear, biomechanically sound guidelines when it comes to Practical Handling Techniques.
Returning to the title of this Blog post '' Challenging HSE Guidance on Safer Lifting Practice ''
Load up the following page with a nice cup of tea, perhaps with a cheeky biscuit. Have a read through the written content and watch the video (shown below).
In the words of Catchphrase’s Roy Walker ‘Say what you see!’
So, you saw that the first part was a man in a very awkward working environment, under racking in a warehouse. A hazardous Manual Handling task that cannot be performed safely for the body, unless the pallet is removed from under the racking. Concur? …. Good.
​
Next, a Delivery Operative (shown in the gallery to the right) lifting a boxed load from the van, likely with a spinal twist to the left. He lowers it onto the sack barrow with a side bend (to the right) of his back, as he didn’t move his feet. He then pushes the sack barrow, predominantly by using his trunk bodyweight, with minimal PUSH-OFF with the leg muscles.
With these examples, I will cut the HSE and NEBOSH some slack. They are showing real Iife Manual Handling examples, done in a way People do, naturally.
But now I will join together that slack. You know the one I just cut.
​
In the same Course Explainer Video (above), the man is lifting from racking. This is simply a statement of what they believe is safer handling technique and practice for this task. As in Tip 17 Open Your Eagle Eyes from Sorry! We’re Closed, with your Eagle Eyes opened this is what you will see.
Left rotation (twist) through his neck. Imbalanced loading onto the left leg with a medial (internal) left hip rotation* and torsion through the knee, strain into the cruciate ligaments*. Compression through left sacro-iliac* and overstretching the right ilio-lumbar ligament* and lower back muscles*.
​
*All shown in the gallery below. Click to view images.
The NEBOSH HSE Certificate in Manual Handling Risk Assessment Course, as the website page states, has been ‘developed by NEBOSH and Ergonomists from Great Britain’s Health & Safety Regulator.’
Let’s move on in this Course's Explainer Video. At 35 seconds, you will see the left foot is angled away from the right foot, with the feet at slightly wider than hip width apart. It is an awkward load that does enforce some unavoidable spinal twisting. However, if you have read my IHASCO Blog (further insightful reading after this!) you would have understood why this Base of Support has Biomechanical lifting (and lowering) errors a plenty. We will revisit the HSE Guidance for Base of Support shortly.
At 44 seconds in this Course Explainer Video, the position for lifting the load is different. Is this intentional? He is closer to the load. But still twisting his neck and spine. Nonetheless, not much good there, when it comes to Best Practice Biomechanics.
And now at 47 seconds (shown below right) please for the Lord of God tell me that they are saying this is hazardous handling practice. Here lowering a load to ground level with a huge spinal twist, and trunk forward bend.
​
Yet again, in this UK seriously flawed industry, conflicting advice, now from the worst possible sources ... NEBOSH and The UK’s Health & Safety Regulator. OMG!
In the last statement on this Explainer Video it is stated ‘Protect your people from some of the most common workplace injuries with the NEBOSH HSE Certificate in Manual Handling Risk Assessment.’
I know this is a bold statement and not entirely correct, but I feel it could be written ‘Harm your people … from some of the most common workplace injuries …’ Wouldn’t sell many Courses that statement, would it?!
We’re gonna take a break from all this HSE bashing as I feel a headache coming on. Did you know headaches can be caused by strained/ damaged neck structures? Yes, actually! The phenomenon is called Cervicogenic Headaches. The sort you would get if you handled loads like this video shows. Whoops … that was a bash wasn’t it.
Phewwwwwwwwww! Let another Expert in Human Biomechanics join the discussion.
Frankly, I bow down to Nicholas. 1. He’s a Professor. 2. He wears Professor’s glasses. Mine are only from Specsavers.
I have 2 things in common with him though @gosc_uk , like me he’s an Expert in Physical Therapy. Armed with my Osteopathy degree, I have some back up to state that. Also, I have the same number of letters after my name. Look we are more equal now. Let’s delve into Nicholas' insightful paper published on PubMed which you can read here.
The Paper swiftly discusses standard lifting techniques (shown above from the PubMed Paper) being A. The Stoop. B. The Squat. C. The Semi-Squat.
​
Professor of Physical Therapy and Paper Author, Nicholas Washmuth rightly describes The Stoop as ‘lifting with your back’; The The Squat as ‘lifting with your legs’ and The Semi-Squat as ‘midway between stoop and squat’ with this meaning lifting with both your back and your legs.
​
One technique he doesN’T discuss is a technique we teach for loads with moderate weight and size; especially for People who have suffered disc injuries, called The Lunge Lift. This is a technique we generally include in our Bespoke 3 Hour Practical Skills Course and Bespoke Instructor Programmes.
Instructor
Programmes
Workforce
Programmes
Humans are lazy animals … especially since the C-word. Don’t you think? Nicolas states ‘stoop lifting is more metabolically efficient and less challenging to the cardiopulmonary system.’ This also goes for pushing and pulling of loads with overuse of bodyweight. Click the image of this PubMed paper below to read it (but don't forget to come back!)
Not up for stretching the grey matter today? Fair enough, life's tiring. Here are the key points from Professor Nicholas' paper:
1. There is a common belief among clinicians that stoop technique leads to intervertebral disc herniations, which is a primary reason clinicians oppose stoop lifting.
​
2. Clinicians must find the optimal dosage of physical stress to address all aspects of the movement system to minimize the risk of injury.
3. There is no universal consensus on the optimal lifting technique which will satisfy every situation; however, there may be a lifting technique that optimizes movement to achieve a specific outcome.
4. Lifting is also a documented risk factor for low back pain (LBP) ... Therefore, it is essential that Physical Therapists provide lifting education and interventions for our patients.
5. Evidence suggests subjects with LBP, when asked to lift, utilize the squat technique
6. “What is the optimal lifting technique” is that “it depends.” The authors suggest a more appropriate, alternative question that should be asked: “which lifting technique optimizes movement to complete the task as hand?”
7. If the goal is to optimize movement by calming tissue down, the therapist should prescribe the lifting technique that incorporates kinematic patterns that do not excessively load tissues that may not be able to currently handle the stress.
8. Those patients with high levels of knee cap pain may benefit from stoop lifting, where the knee flexion angle is minimal and remains relatively static, while those patients with resolving or lower pain may benefit from squat lifting for optimal quadriceps activation.
​​
9. A patient presents with a discogenic LBP, where their pain is reproduced with prolonged sitting, forward bending, and lifting anything heavier than 10 pounds. In an acute case, this patient would benefit from a lifting technique that prevents exacerbation of symptoms (calm tissue down), and in a chronic case, a lifting technique should be used that allows the patient to control or manage their symptoms while maintaining their independence (improving work capacity). Evidence suggests that patients with LBP prefer the squat technique, indicating that squat lifting may be best indicated for this patient while in the acute stage.
10. Evidence supports each technique in different scenarios; therefore, clinicians need to start asking alternative questions: How can movement be optimized by calming tissue down, building tissue up, or improving work capacity? This question cannot be answered without in depth, integrative knowledge of the movement system and its component elements.
We will revert back to these points later in this Blog post, simplifying them; removing the medical jargon.
​
Professor Nicholas, states consistently that only Physical Therapists, being Experts in Human Biomechanics, should be giving Patients, and when they are not in Clinic ... now People; individually prescribed Lifting advice.
​
I agree with all of Nicholas' points above, from an Osteopath’s perspective. For me professionally and personally, reading the range of PubMed Papers, but most notably Nicholas’, underpinned what we have been teaching since 2010.
Here is our Lifting Manifesto:
''At Osteopathic Solutions we teach a prescriptive, individualised lifting technique that is relevant to the individual’s body, within the context of flexibility, strength and associated musculoskeletal disorders, there and then, alongside the size, weight and shape of the inanimate load, maximising lifting power and minimising musculoskeletal strain.''
Further down this Blog post you can read specific content about our Lifting Manifesto, and view photos and videos of it in action.
The Burger Analogy
Who doesn't love a Burger? The meaty (or Beyond Meaty) taste. The crisp lettuce. The tangy pickles and ketchup. The runny cheese. The flavoursome bun.
Now let's run the Burger through your 'What is Healthy Food?' schema filter. The result, they are unhealthy. We all know that. The high saturated fat and salt content. The high calorific content.
Now I propose the following situation. You have a 24 hour period. You have only 1 meal you can eat. You have the following choice. 1. You DON'T eat anything 2. You eat a McDonald's Burger (which one would choose?). 3. You eat a Salad box with life enriching avocado, quinoa and lean chicken. Unless you are a Vegetarian (like I was for many years), it goes without saying, be honest you would chose 2)., meat or soya based. Now, let's look at the health side of the three options. 1. VERY UNHEALTHY 2. UNHEALTHY (but certainly better than eating nothing) 3. SUPER HEALTHY.
Now with this Burger Analogy at the forefront of your mind, now the three Lifting options detailed in this Blog post.
1. A STOOP Lift is VERY UNHEALTHY
2. Lifting with HSE GUIDANCE is UNHEALTHY
3. AN OPTIMISED BIOMECHANICS SQUAT LIFT is the HEALTHIEST* of the three
​
*Of course I agree with this HSE Guidance ... 'Each employer shall, so far as reasonably practicable, avoid the need for his employees to undertake any Manual Handling operations at work which involve a risk to their being injured.'
​
An Osteopath's Perspective
PART 2
When I was a practising Osteopath, working in Clinics in Surrey and West London, as you expect People would consult me with Lower Back Pain. Looking back, I would say out of 100 new Patients (or People as I prefer to call them), around 20 People would directly say that lifting was the cause of their pain, and the reason they booked their appointment. Let’s look at a few examples.
​
Jim the 45 year old Mechanic reporting ‘I bent over and lifted a tyre all wrong, and my back went into spasm gov. I’ve ad to cancel all me work now. A sh!tshow! Can you fix me back today gov?’
Philip, 35 years old; a keen golfer ... ‘I can’t believe that I went to pick the ball out of the hole*, I must add, got a birdie, and BOOM, an extremely painful shooting pain went down my right leg, like a bolt of lightning.’ This is a classic case of The Straw that Broke the Camel’s Back. Philip had been lifting his golf bag for 17 holes, repeatedly rapidly yanking it up from the ground with a forward bend, side bend and twist, gripping with the right arm all the time and ‘locked up’ his Sacro-Iliac joint irritating the right spinal nerve. It took the final bend forward (as photo below) standing on the right leg, counterbalancing with the left leg, to make the lower back muscles spasm.
Margaret, the 60 year old enthusiastic gardener ... ‘Dear, I was getting the perennials ready for summer and lifted the watering can. My back immediately slipped out of position, and I immediately called my Husband telling him to get the Gardener round sharpish. He’s in the waiting room. Not the Gardener Dear.’
​
OK, so a quick snippet of a day in the life of a Physical Therapist. It didn’t take long on the 1991 started World Wide Web to find out that the UK is facing a Back Pain epidemic. It’s almost as if Back Pain is infectious it is so bad that this Guardian article states … ‘Almost a million people in the UK are too sick to work because of back or neck ailments, according to official data, which threatens to derail ministers’ efforts to expand the workforce and grow the economy. According to a Guardian analysis of publicly available figures, the welfare bill for people with back problems alone has tripled in two decades to £1.4bn a year, and is up by more than a quarter compared with before the pandemic.’
Back Pain has been a problem for us humans for 1000s of years. It isn’t a new thing. Going from quadrupeds to bipedalism put more strain on our lower backs as the lower lumbar spine had more compressional loading into the discs and joints.
Sorry my phone's ringing. I better take it. ‘Hello, who’s this? Sorry, was that David Attenborough? Leave it to me, did you say?’
Swiftly returning to the Core Message of this Blog Post. The negligence of the HSE regarding Lifting guidance. Take a break for 5-10 minutes and visit www.hse.gov.uk/msd/backpain
​
What did you see? What did you NOT see?
I then saw this page www.hse.gov.uk/msd/manual-handling/good-handling-technique
​
If you can’t take your eyes off this Blog Post I have screenshotted the HSE’s Grade D attempt at giving visible Lifting advice in the gallery below.
I will be direct on this one. Are the HSE, and their Chief Ergonomist Matthew Birtles taking Manual Handling seriously?
​
Now I am left scratching my head, rather like the HSE mannequin approaching that box to lift. Think he doesn’t know how to lift.
If the HSE's Chief Exec Sarah Albon and Matthew Birtles are reading this, from my Book Sorry! We're Closed here’s:
Tip 2 - Take Manual Handling Fucking* Seriously
Tip 13 - Suffer a MSD, Yourself!
I think my 2 year old boy Tate Milner could do a better job with the lifting advice. Tate does a serious squat when lifting the medicine ball. He's a Beast of a Boy. A World Strong Man in the making.
​
*Swearing frees us of the feelings of anger or frustration we hold and allows expression for them.
Let’s look at the positives of the HSE guidance.
​
-
Recommendations for lifting aids, or making improvements to the task, load or working environment. Of course if a load is too heavy/ bulky for one person; the task for example is extremely high repetition; and the working environment enforces hazardous lifting posture then no matter how much OPTIMAL* Handling Technique is performed MSDs will happen.
-
A mini-risk assessment before the lifting task is best practice for the individual.
-
'If you can't get close to the load, try to slide it towards your body before you try to lift it.' Solid advice there.
-
And solid advice here ... 'Slight bending of your back, hips and knees at the start of the lift is preferable to either fully flexing your back (stooping) or fully flexing your hips and knees (full/deep squatting).'
-
This was a common one I saw when delivering Training amongst those who 1. Didn't Listen 2. Didn't Understand .... 'Don't flex your back any further while lifting. This can happen if your legs begin to straighten before you start to raise the load.' If you encounter this, to help your message stick, tell the Person .... 'The load must come off the ground as you straighten your legs.'
-
The guidance on avoiding twisting; using the feet to move (once lifted); lifting smoothly and within your capabilities is all good advice.
​
*Notice the use of Optimal as opposed to Good.
.jpg)
That’s it. Hardly ground breaking.
There should be a Scientifically Researched Paper by the HSE on Lifting Practice (underpinned by a Consultancy Team of UK Physical Therapists being Osteopaths, Chiropractors and Physiotherapists) encompassing common tasks, loads and environments, as well as advice for People with common MSDs including Lower Back and Knee injuries, featuring images to support learning, all downloadable for free. Something we have done actually.
LinkedIn connect with me and I will email you our 'Setting UK Standards' Manual Handling Instructor (Risk) Assessor Course Booklet in PDF format. Please also feel free to join me on my Q&As at 3pm each Friday.
Let’s take a short break from the core message of this Blog post. When writing my post DigiTrain®. A Health & Safety Professional's Must Have! back in 2022, there were 11 topics (shown below) that were taught in the NEBOSH Diploma.
Out of the topics, don’t you agree that Psychological Health, Chemical and Biological agents, Fire, and Electricity represent a clear and potentially immediate risk of serious harm or even death to a person, within the working environment. Of course, as you are most likely NEBOSH and/ or IOSH qualified yourself, reading this, you will know what you need to know about these subjects, maybe not about Psychological Health (as you are not a qualified Psychiatrist) if you are being honest, but you will know how to prevent serious harm and death in your employees’ operational environments. With these subjects, let me pose the following questions …
​
Are there any subjects where there is conflicting messages or ambiguity?
​
Are there any subjects where the advice/ best practices you have been taught are wrong?
I ask these questions as I don’t know myself if there are. Assumptions are never really good, but I assume there aren’t, or if there are, they aren’t that important.
1. Why we should manage workplace health & safety
2. How health & safety management systems work & what they look like
3. Managing risk – understanding people & processes
4. Health & safety monitoring & measuring
5. Physical & psychological health
6. Musculoskeletal health
7. Chemical & biological agents
8. General workplace issues
9. Work equipment
10. Fire
11. Electricity
If there were subjects where (seriously) wrong Health & Safety advice was given then working in a UK manufacturing site, warehouse, airport, food production factory, school etc. could be a potential minefield for the employees. You might just see Diana raising awareness (God bless her soul).
​
Certain wrong procedures with Chemical and Biological agents could cause serious burns, lung disease and maybe immediate death, as some practices were not best practice. Working at heights; some recommendations could increase the risk of fatal falls. Fires could more likely happen in certain situations and environments.
Physics could show us the power of electricity, to the detriment of human beings. What I am saying is, if these subjects are sown up, nothing to question there, written in stone, then why is there so much ambiguity and lack of Expertise when it comes to Manual Handling, a practical … practice. It is lucky for the HSE that having a back spasm can’t lead to death. Although a prolapsed disc can through kidney failure, which is extremely scary, in fact. It is lucky for the HSE that the person walking, or perhaps hobbling around with an arthritic knee (caused by their bad … wait a minute … negligent lifting advice) won’t die because they have bone contacting bone, and minimal joint cartilage, in one or both knees. These sorts of stories don’t make the papers, do they? It’s like, if it isn’t brought to the media’s attention, or maybe your attention, it isn’t happening or going on. With this though in mind, in order to help Health & Safety Professionals have more awareness on what is happening in the joints of their employees, I produced our MSD Score Form. Click the image to the right to read the 19th Tip from Sorry! We're Closed ... Download MSD Score Form.
LinkedIn connect with me asking 'Gareth, can I have your MSD Score Form, please*' and I will reply 'Of course you can as you were so polite, here it is.' If you say 'Gimme that MSD Form' ... I might not reply.
​
*From what I have seen, since 2020 across the UK, there has been a distinct drop in the highly favorable attribute of 'Gratitude'. Possibly a highly contagious virus called 'Ungrateful-20' was let out into the world by The Elites. When Sorry! We're Closed was published in 2022 we gave 100 copies out FREE in the following months. Only a handful of People within Health & Safety showed gratitude. Some complained on the phone that they didn't get their copy on time. Have you seen cases of 'Ungrateful-20'? If you have, share them with me on LinkedIn.
In the Book Upstream: The Quest to Solve Problems Before They Happen, New York Times bestselling Author Dan Heath (who also co-wrote Made to Stick) explores how to prevent problems before they happen, drawing on insights from hundreds of interviews with unconventional problem solvers.
So often in life, we get stuck in a cycle of response. We put out fires. We deal with emergencies. We stay downstream, handling one problem after another, but we never make our way upstream to fix the systems that caused the problems. Cops chase robbers, doctors treat patients with chronic illnesses, and call-center reps address customer complaints. But many crimes, chronic illnesses, and customer complaints are preventable. So why do our efforts skew so heavily toward reaction rather than prevention?
​
Visit AudioBooks.com
Our MSD Score Form is the 'upstream' approach to Manual Handling Risk Management and preventing Workplace Musculoskeletal Disorders. Try this approach.
1. Firstly, purchase Sorry! We're Closed for only £14.99 here. As this is a serious #PersonalProfessionalDevelopment Publication and bespoke to 'YOUR Health & Safety Industry', don't wait for your Employer's Credit Card. For only £14.99 you will become an Expert in prevention of MSDs. Not just at work. At home too.
​
2. Read it front to back. Recommended in a Starbucks; on a park bench; at your favourite local pub etc. i.e. NOT at work ... you won't get the chance.
​
3. Risk Assess your Manual Handling Operations (remember Ditch The Tools!). If you don't have time, our Expert Occupational Osteopath can do it for you. MSD Risk Reduction Solution a plenty! Check this out here.
​
4. At the same time, action the MSD Score Form for all manual Operatives. And with the results, focus your immediate attention to the People who are suffering most with a Musculoskeletal Disorder (or Disorders) i.e. those who score highest for pain levels. The ones with current Back and/ or Neck Pain should be urgent focuses for you.
​
When writing Sorry! We're Closed I interviewed 7 People who suffered debilitating MSDs caused in most part by the negligence of their Employer with respect to managing Manual Handling risks. This formed the True Stories of Business Regret section of the Book. One of these People was paid out to the tune of £160,980. Ouch! You can listen to this Story below.
& here Judge Rinder is our damning evidence of the UK HSE's Manual Handling Negligence ...
We have all heard the idiom one step forward, two steps back ... meaning you make progress but then experience events that cause you to be further behind than you were when you made the progress.
​
With the HSE guidance on foot position/ base of support you are taking one step forward and one step back, both literally and metaphorically. Their guidance states ... 'Adopt a stable position. Your feet should be apart with one leg in front of the other (alongside the load if it is on the ground) to increase stability. You should be prepared to move your feet during the lift to keep a stable posture.'
Now, a mini Anatomy Lesson on the human pelvis. On the right drawing the 2 bones with a light grey are called the Iliac bones. We have a left 'Ilium' and right 'Ilium', that make up the Iliac bones. The dark grey bone is called the Sacrum. You will see 2 lumbar vertebrae sitting on top of the sacrum. Connected to the left Ilium is the left hip joint (between the left femoral bone and the left Ilium). Connected to the right Ilium is the right hip joint (between the right femoral bone and the right Ilium).
​
Now, a mini Biomechanics Lesson on the human pelvis, taking place at The European School of Osteopathy, where I studied. Emma Farrell's illustration below from Tip 11 - Train as a Bio-Mechanic.
With thanks to Joint Structure & Function by Levangie & Norkin ... and my Osteopathy Degree ... for giving me this Expertise. More concreteness with this statement ...
​
If you have one foot in front of the other as your Base of Support you will cause an Iliac counter torsion and Sacral side bending and rotation, causing the opposite side bend and rotation in the 5th lumbar vertebrae, and resulting facet joint strain at the L5/S1 joints.
Now you have been upskilled and educated in some basic Human Anatomy and Biomechanics, I will now talk a basic Osteopathic Philosophy. Within our body we have the occurrence of what us Osteopaths call Somatic Dysfunctions. These are the same as what Chiropractors call Subluxations. Within the spine, this is when a vertebrae becomes significantly misaligned, compressing spinal nerves and disturbing optimal nerve function.
​
Simply put the HSE's guidance of 'one leg in front of the other' WILL cause a Somatic Dysfunction at the L5/ S1 spinal joint.
So what does this L5/ S1 Joint Somatic Dysfunction cause?
​
I will just address the Biomechanical/ Musculoskeletal results:
​
1. Generalised Lower Back Pain
2. Back Muscle Spasms
3. Sciatica
4. Herniated* L5/ S1 intervertebral disc
5. Prolapsed* L5/ S1 intervertebral disc
6. Spondylosis and Joint Osteoarthritis
7. Spinal Stenosis (X-ray image below)
8. Back Surgery (hopefully just one trip to the Surgeon's knife)
9. Chronic high levels of pain, every day
10. Reliance on Opiate/ Narcotic Painkillers
11. Possible addiction to Alcohol
12. Depression
13. SUCCESSFUL INJURY AT WORK CLAIM PAYOUT
14. INABILITY TO WORK
​
*Commonly referred in layman's terms as a Slipped disc.
​
Harsh but true.
​
For you, as the Responsible Health & Safety Manager, numbers 13. and 14. are on YOUR watch.
​
Now here's where the HSE's contradictions start. In the image of the feet, shown again below, taken from the HSE's Good Handling Techniques page, the feet appear more or less level. The left hip is rotated outwards (externally in biomechanical parlance). In fact around 45 degrees outwards, approaching its full range of outwards rotation.
With this left hip position, the ball of the hip joint is jammed again the front hip ligament. Anatomy lesson continued ... a ligament joins bone to bone giving joint stability. Repetition of this foot position, with heavy inanimate loads, day in day out, WILL cause Hip Osteoarthritis and place the Person on an Orthopaedic Surgeon's LONNNNNNNNNNNG waiting list. In the image below it states Femoral Retroversion, which Google defines as 'a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee.' I underlined deformity. Whoops, I did it again. Now what does deformity mean ... the state of being deformed. Not very useful that one. I will just get to the point. Lift heavy sh!t every day like this and you will have a knackered hip.
OK, so the HSE are stating in written text that one leg (i.e. foot) should be in front of the other. But then at the same time show on their image (above left) the feet basically level but with both hips rotated outwards. What's that noise? It sounds like an alarm. And it's getting louder. OMG! My ears are in agony. That was the NOVICE ALERT ALARM!!
​
The HSE guidance mentions 'your feet should be apart'. How much apart? Hip width? Slightly wider than hip width? Shoulder width? Slightly wider than shoulder width? In the image above left, it looks like slightly wider than hip width apart. This is simply too narrow to enable in their words ... 'Keep the load close to your waist.'
A good question for you to ask is 'So, what will happen with the Spinal position, say with a bulky and heavy load?'
​
That's a good question. It will pull the Spine forward into a forward bent or stooped position, hazardous for the neck and lower back. The HSE say 'Don't flex your back any further while lifting.' Lifting with your feet this narrow enforces a flexed back.
​
Avoiding fully flexing of your hips and knees (full/ deep squatting) is rightly stated. This part of the HSE guidance hasn't stuck with the Online Course Provider IHASCO. Below right is a still from their frightfully negligent Online Manual Handling Training Programme. Sadly for the UK's population, a Programme that has been very successful in this digital era. In Part 3 of this Blog post we will be looking at what so-called Manual Handling Experts are teaching across the UK.
Head and Neck HSE lifting guidance states ‘Keep your head up when handling. Look ahead not down at the load once it is held securely.’
​
Everybody has seen the Child's Play Video. While we are here Safetycare describes as ... 'Child's Play delivers the powerful yet simple message that correct lifting and carrying techniques are essential if injury is to be avoided. The program is a fun, fresh and entertaining way to explore the fundamentals of correct lifting and carrying as practiced by the experts: Children. Safetycare. The experts in Manual Handling Safety Training DVDs and Videos.'
​
I don't want to burst their bubble but Safetycare is a Manual Handling novice with a capital n. Of course, I expect they will be an Expert in other subjects. Just not this one.
Their Video shows the little boy looking ahead (presumably at the camera crew thinking 'Am I getting paid for this?') damaging his poor little neck. Tantamount to child abuse this. The lower neck joints' cartilage (C4, C5, C6) is being compressed, creating micro-trauma. If he practices this throughout his teens, he will set up a painful future with the need to regularly consult Physical Therapists for chronic neck and shoulder pain.
​
Now an exercise. I ask you to get out of your chair, stand up and do the following … although don’t if you get easily dizzy. Simply bend you neck backwards (like the young man to the right). What do you feel? A crack or click sound? A sharp pain? Or just uncomfortable? Take a seat again. You might need to take those pain killers on your desk now or in your Man/ Woman bag. What you have just done is put your neck joints against each other. Joints, in their wisdom, won’t thank you for this. Now when you are lifting a sh!t heavy load next time, not only will you be putting your head in an Osteoarthritis causing position, but you will also increase the risk of a seriously painful neck muscle spasm, the type that needs us Osteopaths to immediately fix. This quite obvious hazardous practice, like the full squatting IHASCO (and many other Manual Handling novices teach), always baffles me. It just looks painful doesn’t it. Sort of stares you in the face when you see it.
These Authoritative Officials may argue, maybe backed up by data, that their presence reduces accidents or more rightly called collisions. But in my eyes, and the majority* they are a nuisance and make things worse. Every day I come across 2 Traffic Wardens at a roundabout who jam up the traffic. Long lines of frustrated commuters who can't decide themselves when to go at the roundabout. Traffic Wardens must have one of the highest incidence of Upper Limb RSI, what with all that arm waving.
​
The HSE, when it comes to Manual Handling, are rather like Traffic Wardens ... they are trying to make things better, but are blindly making things (i.e. levels of MSDs) worse.
​
*If we did an Opinion Poll
The Traffic Warden Analogy
Most people who pass their driving test, know what to do on the road. At a roundabout, we wait for a safe gap to go. It's very simple isn't it, whether we face rush hour or not.
​
The jobsworth Traffic Warden. What feeling do you have when you come across one of these 'officials who uphold petty rules even at the expense of humanity or common sense?' Ok, a bit deep but that's what Google calls them. That feeling? Irritance?
PART 3
Now we are going to take a look at what 5 Training Providers teach for Manual Handling. None of them brand themselves as Manual Handling Experts, as they are all involved in other Health & Safety topics. 2 of them clearly Manual Handling Training is their focus. Before we start I have something to say.
'' Some people have the opinion that commenting about another company, a competitor for example is immoral, of low values. We all see this every day. Political adverts before elections. Supermarkets about other supermarkets. Football Managers about other Football Managers … et cetera. In this case I am now looking at, some of these Manual Handling Training Providers state data on the effectiveness of their Programme. Any Manual Handling Training Programme will reduce incidence of MSD Lost Time Accidents. Employee awareness has been raised. The most simple of factors ‘reduce your twisting postures’ will reduce back spasms and days off of work. However, we must remember that at the same time this data is gathered when other Manual Handling Risk Management procedures are taking place. Maybe more job rotation. Supply of Lumbar Supports perhaps. Mechanical equipment investments. Job redesign. Provision of Physical Therapy etc. No Manual Handling Training provider can claim to be the only reason for the reduction. This would be an arrogant and misleading statement. Tantamount to the Advertising Standards Authority being informed. With each of these Providers I am 100% NOT saying they are poorly managed Businesses. I am NOT saying their employees and most notably their Directors are dishonourable people. From a Physical Therapist’s, in fact an Osteopath’s … BSc (Hons) Ost. Degree ‘Expert’ standpoint I am saying what they are teaching for Lifting will injure people’s bodies and why it will; something NONE of these providers have the Professional Expertise and necessary Scientific Degree Level Qualifications … to be aware of.''
Now that I have got that off my chest let me start.
First up ... Elite Force Safety. This Company brand themselves as a ‘Tailored Health & Safety Training’ provider delivered by Military Veteran Instructors. They are headed up by Harold Floyd. Clearly, like me, he is passionate about the subject. Of course I commend that. Ex-Military also … more respect given. In my only time paintballing, I got hit in the head after 1 minute. Harold Floyd was previously an Instructor at Pristine Condition, who we will be looking at next. Harold looks like he could bench some serious weight. A lifting Expert you would think. I like the style of their onsite Videos, but there are many Videos of no real value, just lots of laughing from their Team. See for yourself. I will get on with it and Biomechanically critique what they are teaching for Lifting.
On this Video you will see he talks about other Training Providers. I concur with him regarding Providers who fill their Courses with Classroom Theory. These types are as novice as you can get. Elite Force Safety are providing Practical Training in the Working Environments keeping it simple with some banter. This is nothing groundbreaking. It is what all Manual Handling Training providers should be doing, worldwide.
In their Videos Harold talks about the ‘Fighting Stance’. I agree with this when a load is being pushed or pulled, and of course when …. Fighting. Elite Force Safety teach the HSE lifting guidance. Sounds right, doesn’t it? It has that ring to it. Let’s delve deeper. Take a look at this Video. Firstly, you may want to read my Blog about an Osteopathic Treatment of the Knee which contains basic knee anatomy and basic knee biomechanics.
​
Armed with this understanding of the knee you can just see (and possibly personally feel) the strain on the left knee medial collateral ligament, the middle ligament of the knee (shown to the left).
​
Joints in the human body all have certain ranges of movement. Move any of them into a zone where the ligaments are overstretched and with repetition, these ligaments will become permanently overstretched which leads to joint instability, reduction in joint cartilage (the soft, shock absorbing ‘sponge’ that lines all joints). Once cartilage goes it's chronic pain time, every day.
We have discussed earlier what having one foot forward, and one foot back does to the lower back. As shown above (and in the gallery to the right throughout), with the hips both externally (outwards) rotated, and external rotation through both knees, with this low level of squatting i.e. high amount of knee bending (flexion), long term practice of this with heavy loads, maybe some very awkward, bulky heavy loads; potentially crippling Osteoarthritis awaits for practitioners of this i.e. your workforce. Maybe you?
​
I recommend to Harold Floyd that he speaks to a Chronic Knee Pain sufferer; observe in an Osteopath's Clinic for a week; and (like I have) watch a knee replacement in an Operating Theatre, taking a very close look at the bony surfaces of the end-stage osteoarthritic knee (shown below ... turn away if you are squeamish). Knee osteoarthritis is debilitating. Elite Force Safety are keeping Orthopaedic Knee Surgeons in private practice.
Looking at the Elite Force Safety Team who are ‘Military Veteran Instructors’ none of them are Physical Therapists including their Director Harold Floyd. Do you recall earlier Professor Nicholas Washmuth (pictured) advised that Manual Handling Technique should be taught by Physical Therapists and Physical Therapists only. Elite Force Safety’s Team are indeed Experts, but in fighting wars, peacekeeping and staying alive.
We now move onto Pristine Condition.
​
This Company brand themselves as 'a world leading organisation specialising in Manual Handling solutions.’ They no longer provide Manual Handling Risk & Ergonomic Assessments. Their products are essentialy hoodies and bottles with the Pristine Condition logo, not a Product Ecosystem of Digital Manual Handling Products and not a Publication of Real Value on this subject.
Last time ... 'World leading' ... That’s some kind of statement and a lot to live up to. It’s a big world. Justification of this would be hard if not impossible to back up. They again have an Instructor Team who are Ex-Military, headed by Former Guinness Book World Weightlifting Record Holder Davy Snowdon. He's even met the Queen and given an MBE! With a 'World Leading' CV like this, this guy's gotta know how to lift. Hasn't he? .................. Hasn't he?
Again, like me, he is passionate about this subject. That's where the similarity ends. Davy Snowdon has no education in Human Biomechanics, even though he claims to have an Advanced Anatomy and Physiology Certificate issued by the UK Home Office in 1986. A classic Davy Snowdon fabrication. Why would the UK Home Office offer such a Course? I will answer that question. Because they didn't. Google the UK Home Office and they define their role as 'keeping citizens safe and the country secure.' Perhaps if the Queen knew of his lies, Davy would not have got his MBE.* Davy has no BSc after his name. He is not a Physical Therapist. He is not a Scientist. He is not a Manual Handling Expert, in fact a Cowboy** and One Trick Pony**. We will see why shortly. ​Pristine Condition state ‘Scientifically proven principles born from Olympic weight lifting’. Where is the scientific proof? It certainly isn’t visible on any papers or articles on their website. Because there are NO articles and papers on their website. Just Snowdon fabrication.
​
*Majorly Big Ego​.
**As described by 2 Group Health & Safety Directors over the phone to me in 2024.
They talk about bringing Olympic lifting to the workplace. When I was a teenager and in my early 20s, I lived the Bodybuilder life. Arnold Schwarzenegger was my Idol. 5 days a week heavy weights. 120kg of 8 reps of Deadlifts*. 110kg on my shoulders and 8 reps of squats. I recall many a time when I would rush to the toilet and vomit, after the sheer physical effort of that last rep. Heavy stuff, putting immense strain on my young body. In my teens I didn’t know about Biomechanics. As I progressed through my Osteopathy degree, my practice of such heavy weights, its volume and intensity significantly reduced as my knowledge and expertise about musculoskeletal disorders and their Clinical Treatment** grew.
*After this Blog Post, why not have a read of my 2019 Blog Post '' Deadlifting, A Best Practice or Hazardous Lifting Exercise ''
**With Osteopathic Manipulative Techniques.
So with enough experience of the Weights/ Bodybuilding Gym, I racked my brain as to what Squat Lifting practices there are, and I came up with these.
1. Squat Lifting Barbell.
2. The Clean and Jerk.
3. Lifting dumbells from the rack, a bench or the floor.
​
No 1. and 2. Putting it mildly, are bad for your back. Oh ok, I will ramp that up. Squat Lifting with a heavy barbell on your shoulders will cause significant damage to your neck and lower back.
Disc degeneration, prolapses. Nerve entrapment. Osteoarthritis. Spondylosis. Spinal stenosis. Lots of medical terms there. I will keep it simple and summarise … an irreparably damaged spine that gives you daily, severe pain only made better for narcotic painkillers, alcohol and a rigorous daily rehabilitative programme. Next the Clean and Jerk. Just take a look at this Video below. Never going to be good for the back that one is it? Lifting dumbbells is awkward too. They force you to grip with one hand which enforces a spinal twist when lifting. I hear you saying ‘What is your point Gareth?’
​
'MY POINT IS THAT SAFE LIFTING IN THE GYM DOES NOT EXIST. THEREFORE OLYMPIC WEIGHT LIFTING 'TECHNIQUES' MUST NOT BE BROUGHT INTO THE WORLD OF INDUSTRY. THEY SHOULD STAY IN THE GYM AND ON THE POWERLIFTING COMPETITION STAGE.'
Fair point this. Don’t you agree?
​
Let’s take a look at what Pristine Condition teach for lifting. On their home page we have Davy Snowden performing a team lift. Do you remember earlier that the HSE state ..… ’Keep your head up when handling. Look ahead not down at the load once it is held securely.'
​
As you will see in the below Mr Snowden (on the left below) is doing just that. But what does this mean for the neck?
It means* ...
​
- Neck muscle strain/ spasm
- Neck joint 'facet lock'/ Somatic Dysfunction
- Early Neck joint Osteoarthritis (X-Ray shown below)
- Neck Nerve Root Compression giving Arm 'Sciatica'
- At the very worst Spinal Stenosis
... CHRONIC, EVERY DAY, SEVERE NECK PAIN!
​
*Remember, I am a Qualified Osteopath. Credible.
You will recall at Osteopathic Solutions we have a 'Lifting Prescription'. Lifting advice for the Individual being taught. We will see later the neck position we recommend for People who have suffered a Neck Disc Herniation, a debilitating condition I suffered from during my 20s and early 30s.
​
Let's now move onto the Base of Support Pristine Condition non-prescriptively teach. A one size fits all. Firstly click the photo gallery immediately below before you read on.
​
Pristine Condition adopt the HSE Guidelines. They claim to bring Olympic Lifting to your working environment. We saw earlier Olympic Lifting should stay in the gym and on the Olympic Powerlifting Competition stage. Pristine Condition teach HSE negligent guidance.
Gallery Photo 1. The feet are shoulder width apart. More narrow compared to Elite Force Safety. The feet are going off in opposite directions. A Pristine recipe for medial knee ligament sprains and cartilage tears. Coming from the Powerlifting background, there is more use of the back muscles to lift, compared to Elite Force Safety. Of course, the back muscles do have strength. They can be trained in the gym to be powerful. However there is an insufficient squat. If you have opened your Eagle Eyes, you will notice a spinal twist to the left.
​
Gallery Photo 2. A forward spinal bend and side bend and twist to the left. A disc herniation in the making.
Gallery Photo 3 & 4. A spinal twist and side bend to the right. Lack of moving the feet. This is how you would expect an Operative to handle this load WITHOUT being trained in Manual Handling.
​
Gallery Photo 5. This poster is most interesting. Inside Base ... only achievable for most loads with the feet slightly wider than shoulder width apart. Big Engines ... In Gallery Photo 1, the Big Engines are not being used sufficiently. The width of the feet are slightly wider than shoulder width apart. What are they teaching with the base of support foot position? There seems to be conflicting advice. The HSE guidance is shown with the feet off in opposite directions. Turn Not Twist ... in Gallery Photos 3 & 4 are ... Don't move your feet and side bend and twist. That certainly wouldn't be stated on their Marketing/ Training posters.
The most worrying of all the 'World' visible Pristine 'techniques' is shown in the above left photo. Pristine Condition CEO in Chief Davy Snowden MBE observes a woman perform what is an awkward lifting task in the Aviation setting. This is painful for any Physical Therapist to watch, but more painful for her if she repeats this every day. Insufficient squat. Right knee torsion creating ligament and cartilage strain. Load held outside of the Inside Base. Spinal forward bend and twist to the left. All observed by Davy Snowden. MAKE NO MISTAKE. This is what Pristine Condition is stating as best lifting practice for this task. It is shocking. And it should shock you, that a Company like this boasts such scientifically unfounded statements.
Pristine Condition, within the UK Health & Safety Industry, have been very successful over the last 27 years spreading their incorrect Biomechanics of Lifting. They are rather like the major British Jewellery Company Ratners … If you were born in the 70s or 80s you will recall their product quality.
Looking at the Pristine Condition Team who are ‘Military Veteran Instructors’ and Mr Snowden, an Ex-Weightlifter, none of them are Physical Therapists. Do you recall earlier Professor Nicholas Washmuth advised that Manual Handling Technique should be taught by Physical Therapists and Physical Therapists only. Pristine Condition are indeed Experts, but in lifting weights on a stage in front of a crowd.
The Golf Analogy
​
In Golf*, there are many parts that you have to be great at to score well. There is driving the ball (Scottie expertly demonstrating below), using a titanium or carbon headed club to smash the little white ball as far as you can hit it, hopefully with a bit of accuracy. There is iron-play, aiming for the flagstick with accuracy and shot length.
.jpeg)
​
If you hear PGA Tour Golfers' interviews the Interviewer will ask 'What have you got to do well on this Course?' ... to which the Pro replies commonly in an American twang 'I gotta drive the ball well, hit the fairways.' Driving the ball well has utmost importance to them.
​
And now the same question for Manual Handling Training Providers ... 'What have you got to do well on this Course?' ... with their reply 'We have to give correct Lifting advice, period.'
​
And ending this Analogy, this goes for all Experts in their Field. They have to become remarkable at every facet .... all possible.
If you are a Golf-nut like me, after you have read this Blog check out my 2019 posts ''Biomechanics of a BackSafe Golf Swing'' and ''Improve Your Manual Handling Handicap - Safer Manual Handling for Golfers '' here.
Next up in this 'Do they follow HSE Lifting Guidance?' appraisal ... IHASCO ... who have dominated the Online Manual Handling Training Programme industry in the UK ... very, very sadly for the UK population.
​
In this Blog, we won't be looking in depth at what they beyond negligently teach. You can view how they cause MSDs in their Students ... if you dare ... on my Blog posts '' IHASCO Exposed - The Truth about their Manual Handling Training '' and '' The Perils of IHASCO for your Manual Workforce '' here.
​
Firstly so you are briefed, view the gallery to the left. Now, a brief summary of what IHASCO are spreading around the UK ... rather like COVID-19.
​
A question. Do IHASCO follow HSE Lifting Guidance? Yes ... and No. Here is why. The Yes. Looking at the IHASCO Programme's lead technique demonstrator (to the left), Radio Presenter Michelle Livings (yes your eyes are indeed working correctly ... Radio Presenter)
her feet are following the HSE Lifting Guidance when it comes to one foot going one way (turned outwards) and the other foot the opposite way (again turned outwards) and with one foot in front of the other. Earlier we saw this is a recipe for Chronic Knee Pain, an extremely common affliction amongst humans.
The No. The feet are placed no real width more than hip width apart, which is not in line with the HSE's correct statements of 'Adopt a stable position' and 'Keep the load close to your waist for as long as possible while lifting.' As shown in the first gallery to the left, her knees are locked in full knee flexion i.e. her bum is on her heels. The HSE quite rightly stipulate 'Slight bending of your back, hips and knees at the start of the lift is preferable to either fully flexing your back (stooping) or fully flexing your hips and knees (full/deep squatting). IHASCO are teaching full/ deep squatting. This practice should almost be outlawed. It is catastrophic for the integrity of the knee structures. Practitioners will soon have daily knee pain with this.
​
The Learner (and IHASCO) Confusion. As IHASCO sought NO Experts in Manual Handling for their deplorable Programme, there are inconsistencies in the messages. First in the gallery above left you will see the woman with her feet level for the lower. Lifting and Lowering positioning and body use should be the same. You lift a load up. You put it down. It's just reverse. Now in the gallery to the immediate left, you will see differences. Spot the differences! Her feet are now (correctly) slightly wider than shoulder width apart. The knees are not overflexed in her and the man to the left. The man to the right is overflexing his knees. If you are a Learner working your way through this Programme, and you are concentrating on what you are seeing, you would ask ... 'What the hell do I do for Lifting IHASCO? You teach one thing and then the opposite.'
IHASCO are part of Citation. Pristine Condition state they have Citation ISO Certification (a screenshot from their website footer).
​
Seeing what you have just been made aware of by the Citation owned IHASCO, does this not call into question the ISO Certification process and quality assurance?
The IHASCO Team, when viewing their LinkedIn Business page, appear to be all Sales and Business Development Managers, and Presenters ... where are the Technical Instructors? None of them are Physical Therapists. Do you recall earlier Professor Nicholas Washmuth advised that Manual Handling Technique should be taught by Physical Therapists and Physical Therapists only. IHASCO are indeed Experts. IHASCO have expertise in being a Jack of All Trades, master of none. They should stick to selling Courses like their Delivering Bad News Training. They should leave Manual Handling Training ... well alone!
The Builder Analogy
​Fawlty Towers needs a new door. Basil Fawlty wants his go-to provider Mr. O’Reilly, whereas his beloved Sybil wants ‘Stubbs, Basil!!’. Always wanting to save a penny, Basil instructs Mr. O’Reilly and his team who somehow get the job wrong and block off the dining room doors. O’Reilly returns to rectify his bad workmanship ... ‘lick of paint, lick of paint’.
The result is even worse as he puts a door in a load bearing wall. Sybil takes over and calls in the Expert ... Stubbs ... who does what Experts do and gets the job done well, at a higher cost, but first time round and to the highest standard. Not only did this cost Basil more money, taking on the Jack of All Trades in Mr. O’Reilly (and then having to pay for it again with Mr. Stubbs), but it also caused him much anxiety and stress.
​
Let's look at this in more depth. Mr. O’Reilly is 100% oblivious, 100% unaware that his work is negligent. And consumers like Basil Fawlty are too as they are spending money with them.
​
IHASCO is clearly a Jack of All Trades Online Training Provider. The HSE, ROSPA and Evolve Training are Jacks of All Health & Safety Trades. Pristine Condition and Elite Force Safety clearly market themselves as Manual Handling Experts ... that's the most worrying thing about them.
​
In Tip 10 in Sorry! We're Closed, I give Health & Safety Professionals more awareness in detecting whether a Supplier is a Manual Handling Risk Management Expert ... or not.
Click one of Emma Farrell's remarkable illustrations to the left to read the full Tip.
​
*Appraisals following after this Analogy.
Next up is ROSPA. Sorry, my phone's ringing again ... let's hope it's not David Attenborough again. It's the Royal Household. Better put on my most Surrey of voices. 'How can I help? Did I hear you say we can't write about ROSPA because they're Royal?! And the King wouldn't be amused. Don't worry!! Princess Eugenie is the Patron of the European School Osteopathy, where I studied. She will get the story cleared by Grandad Charles, who is The Patron for Osteopathy in UK.'
​
So 'ROSPA follows the HSE model for Lifting'. This statement now discredits ROSPA's Professional integrity. Have a look at this image to the right. This is a ROSPA Approved E-Learning Course supplied by the CPD Online College. So from what you have read about HSE Lifting Guidance, is the man lifting the box performing the HSE's guidance for the amount of squatting? No, he isn't. This practice is what IHASCO disastrously spread across the UK. I don't say teach. Therefore ROSPA is approving an E-Learning Course that doesn't follow HSE Guidance, when straight from the Horse's mouth, well from ROSPA's Harry McQuigg mouth, they follow the HSE model for lifting.
As ROSPA follow HSE Lifting Guidance (when they choose to), they are teaching negligent practice. I hope you have seen and understood enough that this statement has been validated. In Part 4 of this Blog post, I will provide a framework for Optimised Lifting Biomechanics, on an individual (with specific MSDs) prescriptive level; at the same time offering you the opportunity to compare this framework with HSE Lifting Guidance. With concrete images and real Operative Case Studies, Part 4 will further validate the Core Message of this insightful Blog.
​
And lastly on ROSPA. With their approval of Lifting Practices that are outside of the HSE model*, but state in writing that they follow the HSE model, is this statement reasonable (with their Logo behind)?
*But still practices that will cause debilitating musculoskeletal disorders, including Knee Osteoarthritis and Bunions (check out the left foot position above). You can read more about the disability Bunions cause to people on my IHASCO Blog.
ROSPA is a novice in Manual Handling. Looking at the ROSPA Instructor and Technical Team none of them are Physical Therapists. Do you recall earlier Professor Nicholas Washmuth advised that Manual Handling Technique should be taught by Physical Therapists and Physical Therapists only. ROSPA should stick to what they are good at. Let's hope their CEO Becky Hickman recognises and actions this.
Workforce
Programmes
Instructor
Programmes
Last, but not least in this 'Has the HSE's Negligent Lifting Guidance stuck across the UK?' appraisal. In this Health & Safety Jack of All Subjects provider Evolve Training ... it has stuck, but at the same time it hasn't. Like many Manual Handling novices' websites across the UK, ROSPA and IHASCO included, there is very little photographic evidence of what they teach in their Manual Handling Courses.
I have not come across Evolve Training much in my 14 years spreading Osteopathic Solutions Ltd's word across the UK. Not surprising as they are NOT Manual Handling Experts. Their Course gallery is the one photo to the right. I have included them in this appraisal as they are standard for what exists in the UK for Manual Handling Training provision. Depressing, isn't it? Therefore not only do the HSE provide negligent Lifting practice, I have long thought they provide zero administering and quality assurance of Manual Handling Training Providers. Zero.
​
Let's summarise this Back Pain causing practice that Evolve Training, remember 100% blissfully unaware spread across ... we hope just Aberdeen. That is no offence to Aberdeen. Evolve Training is based there. Phew, got that one out quickly as to not offend. Evolve teach a bit of the Davy Snowden neck arthritis position we saw earlier, with a touch of IHASCO. That's a physically painful recipe.
The base of support is different to what we have seen so far. His feet are only hip width apart. That enforces the load's Centre of Gravity to be relatively far from his Centre of Gravity i.e. this will pull/ lever on his lower back joints, with the lower back muscles working serious overtime to lift the load, as well as stop him from falling over.
What is better is the hip to knee position i.e. the amount of squatting. The hips and knees are slightly too flexed, however this is more in line with a Biomechanically sound Full Squat Lift, and in line with the correct HSE guidance of 'Slight bending of your hips and knees at the start of the lift is preferable to fully flexing your hips and knees (full/deep squatting).' We will see in Part 4 how wide boxes like this should be Expertly lifted.
Even as a NEBOSH and IOSH Learning Partner, Evolve Training is a novice in Manual Handling. None of their Key Staff are Physical Therapists. Do you recall earlier Professor Nicholas Washmuth advised that Manual Handling Technique should be taught by Physical Therapists and Physical Therapists only. Evolve Training should steer well clear of Manual Handling (or Kinetic Handling* as they call it) .... and UK Health & Safety Professionals should steer well clear of them when they have Manual Handling Training needs.
*Read 'The Loch Ness Monster Analogy' below
The Loch Ness Monster (affectionately known as Nessie), is a mythical creature in Scottish folklore that is said to inhabit Loch Ness in the Scottish Highlands. It is often described as large, long-necked, and with one or more humps protruding from the water.
Popular interest and belief in the creature has varied since it was brought to worldwide attention in 1933. Evidence of its existence is anecdotal with a number of disputed photographs and sonar readings.
My belief is that the Loch Ness Monster was an invention of the Inverness Tourism Board. Why am I using this story (we ALL know) as an Analogy? Nessie was clearly a fabrication. A hoax. A deception. A hoodwink ... that's a fun word! When I did the Rat Race Coast to Coast in 2017 and 2019, whilst on the kayak, I certainly didn't see Nessie!
​
Now with this Analogy in mind I want you to think about the phrase or concept, you have likely heard .... KINETIC HANDLING. Many Jack of All Trades Training Providers including Evolve Training use this as one of the topics covered.
Firstly let's get a definition of Kinetic .... relating to or resulting from motion.
​
Like me, you will recall Kinetic Energy from your school Science Classes.
​
Now let's see what Google (seeing that it's all knowing) states for Kinetic Handling ... Kinetic lifting is a technique of manual handling which reduces the risk of injury while lifting heavy objects.
​
Before I give you my Physical Therapist Verdict on Kinetic Handling, a short anecdote.
​
Man walks into a GP Practice. Sits in front of the Dr. looking at his computer. 'What's the problem, he asks the Man?' ... 'It's my back Doc, it's giving me pain!'
​
After asking the Man a few simple questions like 'Where does it hurt?' ... 'What do you think has caused it?' ... 'Are you taking any Painkillers' ... not much more etc., the Dr. diagnoses the Man as having Lumbago, defined as 'an outdated medical term that describes pain in the lower back region.' Let's summarise this little anecdote. Man visits Dr. knowing he has lower back pain. Dr. diagnoses him with pain in the lower back region.
Returning to Kinetic Handling ... with the Nessie Analogy and this Dr. anecdote in mind ... Kinetic Handling is a made up concept. More bluntly, it is MUMBO-JUMBO!!
​
Jack of All Trades Training Providers use it as a marketing ploy, to make you think 'Wow, they use terms like this, they must be good.' There is no such thing as Kinetic Handling. In fact there is NO rightful classification or special name for Lifting or Manual Handling. So when you see this phrase from a Provider you are looking at ... run a country mile!
Afford me one more anecdote, as I want to stick it in your head, as stuck as superglue. Alison, HR Officer meets Philip, Goods-In Supervisor in the staff canteen before work. Alison says to Philip ... 'What's your morning look like?' whilst sipping her latte ... to which Philip replies ... 'Got some Course at 9.30am. It's called Kinetic Handling' ... to which Alison replies ... 'Yeah, I'm on training this morning too at 9.30am. Some Manual Handling Course.'
​
At 9.30am in the Training Room, Alison turns her head to the right. At 9.30am, Philip turns his head to the left. They lock eyes. This isn't a Love Story. You get my point.
Has the HSE Lifting Guidance stuck?
In 1993, the Teenage Mutant Ninja Turtles were a favourite of mine coming home from school. As we saw earlier, or actually we didn't see on the HSE's timeline, the Manual Handling Operations Regulations came into place in 1992. Have a look now at my Donatello Ninja Turtle figure standing on our 'World Standard' ... no, I can't justify* that ... ok 'Setting UK Standards** Manual Handling Training DVD.
​
Do you see that Donatello is performing the HSE Lifting Guidance base of support? Both feet turned outwards with one foot in front of the other.
​
My point is that yes the HSE Lifting Guidance ... has generally stuck. A year after the HSE's Regulations and Guidance were released, Ninja Turtles were being sold across the UK fixed in this Knee Osteoarthritis causing position. It's well overtime to unstick it.
​
**Google 'UK Manual Handling Training DVD'. You will be able to compare our Expert offering and the novices' offerings.
.png)
Of course my critiques (using my credible Professional position as a Qualified Osteopath and Professor Nick Washmuth's PubMed paper), and yes the critiques, and not appraisals, were cutting. I am aware of that. However this style grabbed your attention and you are still reading. The HSE is a Government Agency, and we all know that Government Agencies don't always get things right, do they? But to the defense, the HSE is also not there to profit financially.
​
The 5 Providers above, and 100s of others across the UK, do NOT deserve to make £1 from delivering Manual Handling Training. Nor did Mr. O'Reilly deserve to make £1. As we move into Part 4, we leave you with this proverb shown to the left ....
'' Wrong is wrong, even if everyone is doing it. Right is right, even if no one is doing it. ''
.jpg)
You have been listening to me for a while now. I thank you for continuing your attention. Now, stop listening to me, but please, please listen to Professor in Physical Therapy Nick Washmuth.
​
I can’t imagine the amount of study one would have to do to become a Professor. The Osteopathic Degree was certainly enough. 4 years of daytime lectures, practical lessons, Clinical Consultations at the Maidstone European School of Osteopathy Student Clinic, trips to Canterbury for X-Ray reading lectures and trips to London’s Guy’s Hospital to the mortuary to see the anatomy we were learning .... in the flesh. That smell of formaldehyde still lingers in my brain. Evening studying, weekend studying, holiday studying. It was 4 years of brain (synaptic) relentlessness.
The Bachelor of Science Degree was broad in its coverage. You can read more in my Blog ''The Professionalism of an Osteopath'' after this. We learnt Human Biomechanics but it wasn’t the whole 4 years. Otherwise we wouldn’t know how to diagnose musculoskeletal disorders and effect a Clinical Treatment Plan. What I am saying is that my knowledge of Biomechanics is super solid, however if Nick Washmuth was to play some sort of drinking game with me with Biomechanics questions, I would be flat on my face pretty darn quick with 10 double rums of inaccurate* answers. *Not incorrect
​Nick Washmuth (and myself) extensively studied how the human body's joints move, how much they move, in what ways they move; what muscles move them, which muscles first move a joint so that other muscle can have a mechanical advantage. What forces cause injury to the soft tissue structures of the joint. Which soft tissue structures (like ligaments) get damaged and from what movements. I could go on and on about what the study of Biomechanics entails. Sure you get my point. Physical Therapists and Professors of Physical Therapy like Nick are subject Experts.
That’s why I politely request you now listen to him. Let’s go back to his PubMed® Research Paper ''Lifting Techniques: Why are we Not using Evidence to Optimise Movement?'' Over to Professor in Physical Therapy Nick Washmuth.
As the Core Messages of this Blog have been strategically designed as ‘Made To Stick’, in Dan & Chip Heath’s Book of the same title Made To Stick, the Heath Brothers discuss Concreteness.
This basically means that abstract ideas, can be constructed so that they mean the same thing to everyone. Using a universal language with an intense sensory experience (Visual, Hearing, Smell, Taste, Touch). Of course, in this context I am not going to use smell and taste. That would be weird. We will address ‘Touch’ later in Part 4 with a ‘Testable Credential’ for you … see what that is later!
​
Let’s take a look (i.e. visual) at this image we saw earlier from Nick Washmuth’s paper.
Glasses on? Mine are.
​
(A) Stoop Lift. I hear you say …
​
‘His feet are hip width apart. The feet are in the anatomical position (shown immediately to the right). There is a small about of knee bending. There is significant flexion of the hips (hip flexion shown below). There is significant flexion (forward bending) of the lower back (lumbar spine) and moderate flexion (forward bending) of the mid-back (the thoracic spine). There is surprisingly some extension (backward bending) of his neck. Talking about kinematics, certainly not Kinetic Handling Gareth, I heard that nonsense term earlier; he will lift the load using predominantly his lower back muscles in what is an overstretched position for them. With the forward bend of the lower back, this position weakens the lower back muscles as they are in a position of over-stretch. The inanimate load pivots about his 5th Lumbar joint, the L5/S1 between the 5th Lumbar Vertebrae and the Pelvic Bone called the Sacrum. The leg muscles are only involved in stopping him from falling over. The back of the thigh muscles (hamstrings) are offering a small mechanical steering of the lift. If I practised this lifting position, I would increase the risk that I will suffer a debilitating spinal injury including disc herniation and prolapse, osteoarthritis and spondylosis, and eventual spinal stenosis. The strongest painkillers needed everyday with those frightful spinal conditions.’
My comment ‘Wow, your basic Biomechanics of the human body and anatomy is very good. You must have read Tip 11 - Train as a Bio-Mechanic from Sorry! We’re Closed.'​
​As an aside, in Osteopathic Solutions' Bespoke Manual Handling Courses we follow Chapter 1 of Made to Stick … which is Simple. The above description of the Stoop Lift is very detailed. Simplicity is inherent in all our Expert Programmes … synonyms for Simple are …. uncomplicated … straightforward … clear … i.e. we achieve our Learning Outcomes (as an Accredited Training Course Provider). Medical jargon … beyond FREE! Just like our Team of Physical Therapists do when they Clinically treat their Patients … avoiding medical/ Osteopathic terms … simple and concrete language that everybody understands.​
​
​Next from Nick Washmuth’s Research Paper image is (C) Semi-Squat Lift. We will come to (B) shortly. Back to you … in Catchphrase Roy Walker’s words ...
‘Say what you see … for (C)!’
​‘OK Gareth I will. His feet look slightly wider than hip width apart. I don’t see any of that HSE negligence you have educated me in Gareth. Insomuch that his feet are level, like if he was hitting a 3-iron golf shot, The load is within his base of support as close to his Centre of Gravity as it can be. Professor Nick describes this as a Semi-Squat although I feel the hip and knee bending are deeper than a Semi-Squat (although words can be limiting). You can see the tightening of the side tendon*, the Iliotibial Band. He is maintaining his lower back curve by consciously stick his bum out.
From the lower back to his lower neck (the 7th Cervical Vertebrae in fact) he is maintaining the natural spinal curves, reducing strain on the spinal muscles, ligaments, tendons, joints, discs and nerves. However, as I saw earlier his neck position is extended or backward bent (mainly through the C5 and C6** vertebral joints) which I understand will damage the soft joint cartilage over time leading to chronic, daily neck pain. Again needing narcotic pain killers every day and possibly ‘wheelchair risking’ neck surgery. Apart from this biomechanically flawed neck position, overall it looks a very strong lifting position biomechanically, using the gluteal thigh muscles as the main powerhouses, positioning the body so that musculoskeletal strain is minimised.’
​
*Tendons join muscles to bone
**C5 and C6 vertebral joints
(B). Squat Lift.
​
‘Here Gareth, this young man is doing what I would call a Full-Squat Lift. However, from what I have learnt so far his hips are too low, which creates biomechanical strain in his knees joints. The knee ligaments that are integral to the knee’s stability, are being over-stretched. The soft cartilage of the knee is being compressed excessively. His feet are now rotated outwards, affected by the squat being too low. His back does look to be slightly too erect, slight too upright. After just copying this position, I felt my back muscles were working too hard. His neck, although not backward bent as much as in (C) ... his head position is still placing biomechanical strain on his lower neck joints.’
​
In Tip 17 from Sorry! We’re Closed I demonstrated how you can ‘Open Your Eagle Eyes’. You certainly opened them there with you excellent analysis of these lifting positions.
​
As you have seen so far there have been many Professionally respectful ego-massages for Professor Nick Washmuth. He is a Professor in Physical Therapy which is defined as … the treatment of disease, injury, or deformity by physical methods such as manual manipulation, massage, heat treatment, and exercise rather than by drugs or surgery.
​
Now as a Qualified Physical Therapist, an Osteopath myself with (as of 2024 when this was written) over 17 years experience of Musculoskeletal Disorder (MSD) & Manual Handling Risk Management including Design of Courses, Onsite Delivery of Courses upskilling 1000s of People (pictured to the left in 2016), Course Literature writing, training of our Team, management of Client delivery, Authoring a Book (on the subject), writing of MSD/ Ergonomic/ Manual Handling Risk Reduction Reports, production of Digital Products including Videos et cetera … you get my point … I will give my Expert opinion on (B) and (C).
Using my BSc (Hons) Degree in Osteopathy encompassing extensive Biomechanics study including Professor Pamela Levangie’s Joint Structure & Function: A Comprehensive Analysis (pictured below right) and Dr. Adalbert Kapandji’s The Physiology of the Joints (pictured below right) … here is my Credible and Professional position on the Squat Lifting positions in Professor Nick Washmuth’s PubMed paper.
-
His feet are level*. An Optimal Handling Position.​
​​
-
The Load is correctly positioned within his Base of Support.​
​​
-
His feet are NOT wide enough at slightly wider than hip width. Optimal Handling involves slightly wider than shoulder width apart (as we will discover more in Part 4 b). where Optimal Lifting Practice is uncovered further).
​​
-
In B). the Squat is around 20 degrees of hip and knee flexion TOO much. The lowest the Squat should be is the hip joints being position just above the knees.
​​
-
In C). when lifting from ground level, the hips and knees need to be flexed around 10 more degrees, to reduce spinal strain. However, this is an excellent Squat position for lifting inanimate loads from ground and/ or pallet level.
​​
-
In B). his Spine is too upright. This will cause joint compression in the lower back and increase chances of debilitating Back Spasms (such that can put an Employee on sick-leave for 5-8 weeks, without Osteopathic intervention that is). This goes back to the terribly old and terrible saying ‘Bend your Knees, Keep your Back Straight’. Straight but no longer upright. Maintain your spinal curves. Avoid bending your back forwards. These phrases are what I use when teaching people the spinal position they must have, to protect their backs.
​​
-
In both B). and C). his neck is in an Osteoarthritis causing position. Chronic pain. Chronic reliance on Narcotic Pain Killers. Possible Alcohol addiction (to help with the pain). High chance of Neck Surgery. High Risk of Spinal Cord damage and Tetraplegia. With this you unfortunately won’t be SuperMan or SuperWoman … Rest in Peace Christopher Reeve.
​
*No HSE, Pristine Condition, Elite Force Safety, RoSPA and IHASCO ZERO-Knowledge and ZERO-Understanding of Human Biomechanics ... Lifting negligence.
And finally for Part 4 a). of this Blog post I will address (and comment on) each of the Key Points (numbered below and in bold font) from Professor Nick Washmuth’s paper (shown in Part 1). In Part 4 b). you will discover Optimal Lifting Practice and Individualised Lifting Prescriptions.
1. There is a common belief among clinicians that stoop technique leads to intervertebral disc herniations, which is a primary reason clinicians oppose stoop lifting. ​100% concur with this. The only time Stoop lifting should be practised is when your hips and knees don’t bend, which is never. In the real world, say Food Factories for example, forward bending or stooping can be enforced by the task e.g. lifting from a dolav.
​
2. Clinicians must find the optimal dosage of physical stress to address all aspects of the movement system to minimize the risk of injury. In some ways this is a very Osteopathic ‘whole body’ stance on Lifting Practice from Nick Washmuth. The majority, if not all, of Companies who provide Manual Handling Training focus the prevention of Back Injury within their ‘Best Practices’ taught. At Osteopathic Solutions, we take a holistic approach to Manual Handling being mindful that other joints can give chronic pain and disability. Focusing load weight on the legs during Optimal Lifting Practice, but not placing excessive strain on the hips, knees and ankles. It’s quite important these joints aren’t damaged, isn’t it? … Seeing that we walk with them everyday.
3. There is no universal consensus on the optimal lifting technique which will satisfy every situation; however, there may be a lifting technique that optimizes movement to achieve a specific outcome. ​Well, every situation is different isn’t it? Depending on the load’s shape, size, weight and where it is being lifted from or at what level in relation to your legs, we will uncover this in Part 4 b). ‘There may be a lifting technique that optimizes movement to achieve a specific outcome’ … this statement is a little abstract, a little vague. But it is about adapting the human body to fit the task, individual (physical constraints), the load and the environment.
4. Lifting is also a documented risk factor for low back pain (LBP) ... Therefore, it is essential that Physical Therapists provide lifting education and interventions for our Patients. Although time was always short, this was always a focus for me at the end of an Osteopathic Consultation with my Patient, when they had a physical job involving much Manual Handling. As written earlier, so many People who consulted me with Back Pain said the onset was immediately during lifting or shortly after. The Video to the right features Osteopath John Gibbons. Later this year, this will be replaced by a Video of myself performing the Osteopathic Spinal Thrust Manipulation.​
​
5. Evidence suggests subjects with LBP, when asked to lift, utilize the squat technique. It’s almost common sense. Which muscles are the biggest in the body? Who was stronger, David or Goliath? Lifting with the legs with the spinal joints in positions that do not overstretch their ligaments* and overload the lower back discs. *Ligaments provide joint stability preventing excessive joint movements.
6. “What is the optimal lifting technique” is that “it depends.” The authors suggest a more appropriate, alternative question that should be asked: “which lifting technique optimizes movement to complete the task as hand?” Generic Manual Handling Training Providers teach a one-size all approach to Lifting Practice advice and that’s the majority of the UK’s provision. Physical Therapists teach Lifting Prescription. I will be prescribing in Part 4 b).
7. If the goal is to optimize movement by calming tissue down, the therapist should prescribe the lifting technique that incorporates kinematic* patterns that do not excessively load tissues that may not be able to currently handle the stress.
This details why a Physical Therapist should be the only Professional giving Lifting advice. Not an Ex-Weightlifter. Not a Personal Trainer. Not a Health & Safety Professional** with a little understanding of Manual Handling and Human Biomechanics. We will see this point 7 in Part 4 b). with knee injuries.
*This does not mean Kinetic Handling. Remember the Jack of All Trades Training Companies that use this ‘We are trying to sound like we are Experts in this subject … but really we are NOT. Hope you don’t find out.’ Kinematic is the Professor’s way of saying ‘movement’.
**Being mindful one can be upskilled to prescribe Optimal Lifting Practice. #ManualHandling #TrainTheTrainer #InstructorCourse
8. Those patients with high levels of knee cap pain may benefit from stoop lifting, where the knee flexion angle is minimal and remains relatively static, while those patients with resolving or lower pain maybenefit from squat lifting for optimal quadriceps activation. As a Professor in Physical Therapy, Nick Washmuth is prescribing Optimal Lifting Practice here. Firstly I concur with this recommendation for Lifting when suffering from a knee injury. Reducing the strain on the knee (s) and using the back muscles to lift.* Patellofemoral means the pain in or around the knee cap. Any soft tissue injury affecting the knee will cause pain around the knee cap, generally below it when the tendon inserts into the lower leg bone. We will see our recommendations for hip and knee bending, when suffering a knee injury, later in Part 4. We will also look at a few types of knee injury.
​​*But what if the person suffers from Lower Back Pain AND Knee Pain at the same time? I will answer this question later in Part 4.
In Point 8 ‘Optimal quadriceps activation’ is mentioned. The quadriceps are the 4 front of thigh muscles which extend the knee joint. In the Squat lift they combine with all leg muscles to lift the load. With Lower Back Pain you will have an amount of muscle spasm. Even with engaging the legs in the position that maximises lifting power, the Lower Back muscles will be contracting. When Lower Back pain is suffered, Physical Therapists will indicate to the Patient that lifting should be 100% avoided and reintroduce gradually when symptoms reduce. We all know in the real world a reduction is only possible. Of course, severe back spasms and/ or Sciatica needing diazepam* administration by a Medical Doctor, will enforce a no lifting policy.
*Not forgetting Osteopathic (or Chiropractic) Manipulative Therapy.
9. A patient presents with a discogenic LBP, where their pain is reproduced with prolonged sitting, forward bending, and lifting anything heavier than 10 pounds. In an acute case, this patient would benefit from a lifting technique that prevents exacerbation of symptoms (calm tissue down), and in a chronic case, a lifting technique should be used that allows the patient to control or manage their symptoms while maintaining their independence (improving work capacity). Evidence suggests that patients with LBP prefer the squat technique, indicating that squat lifting may be best indicated for this patient while in the acute stage.
Discogenic means coming from the spinal discs. Prolonged sitting involves compression through the lower back discs. I recommend anyone suffering with lower back disc injury, whose job role involves use of an office computer, to seek investment for an electric rising desk that gives them the opportunity to stand up whilst working at the computer. Having a strong abdominal core supporting the spine whilst standing, through say Pilates would support the improvement of the symptoms.
Calm tissue down means reduce the inflammation and swelling in any of the spinal structures including the ligaments, tendons, joint cartilage, muscles and discs. This can also mean reducing or removing muscle spasm.
An acute case means the person is in a lot of pain, with the spinal nerves being compressed by swelling around the disc. A chronic case means a Spinal Disc Injury that gives daily pain.
.jpg)
10. Evidence supports each technique in different scenarios; therefore, clinicians need to start asking alternative questions: How can movement be optimized by calming tissue down, building tissue up, or improving work capacity? This question cannot be answered without in depth, integrative knowledge of the movement system and its component elements. The entirety of this point is not for this Blog. We will be touching upon it in Part 4 b). where we look at Lifting Prescriptions. I welcome you to join me on my Friday BackCare Questions & Answers that I host on Teams every Friday at 1pm. You can find out more and book your place here. As a Qualified Osteopath I can help you reduce your Back Pain or perhaps never suffer it from some simple practices you can build into your life.
Ok, so this section has been quite Clinical with a degree of Physical Therapy terms. However, I hope you feel I have put it in a context that is as simple as it can be explained.
In Part 4 b). we delve into what ACTUALLY is Optimal Lifting Practice. This is NOT a one size fits all. I will be presenting personalised Prescriptive Techniques and Practices.
​
In Part 5 we will be looking at the Legal aspect of your Employees NOT performing HSE recommended Lifting Practice; following Optimal Lifting Biomechanics that our UK Team of Physical Therapists expertly teach within our Bespoke Accredited Manual Handling Courses. With regards to the Legal aspect ... how you can protect your Business if an Employee does put in any form of Musculoskeletal Injury at Work Claim, being mindful following our Optimal Lifting Biomechanics will make this less likely than following the HSE's (and the Part 3 Companies critiqued) negligent guidance.
Share and provide a Review of this Blog on LinkedIn tagging @OsteopathicSolutions and you will go into the hat for our Quarterly 'Win an Osteopathy Treatment' Competition. The next Winner will be announced on the 1st October 2024.
