Do you perform Manual Handling Risk Assessments? Want to enhance your knowledge and understanding on how Musculoskeletal Disorders (MSDs) happen? Unsure how to incorporate the range of HSE Tools into your CEO Presentation Report? Curious to Osteopathic Solutions' Expertise in Manual Handling & Ergonomic Risk Assessment?
Then this page is a must read! Written by Osteopathic Solutions Director, Osteopath and Author of Sorry! We're Closed Gareth Milner this page is packed with worked examples of the MAC, RAPP, ART and REBA Tools, and the HSE's Manual Handling Risk Assessment Checklists including what MSDs are likely and why, including MSD Risk Reduction Solutions.
Manual Handling Assessment Charts (MAC Tool)
Lifting & Carrying Assessment
The MAC Tool (Manual Handling Assessment Chart) is designed to help understand, interpret and categorize the level of risk of the various known risk factors associated with lifting, carrying and team handling activities, and check the effectiveness of any risk reduction measures.
It incorporates a numerical and a colour-coding score system to highlight high risk Manual Handling tasks. It is appropriate for assessing loads above 8kg.
At this UK Prepared Meals Food Factory the operative lifts 3 sealed bags each weighing 2-3kg from a conveyor at pelvis height and places the 3 bags into trays. Each tray takes 6 bags. Typically, in this task dollies are loaded to 8 trays in height. Approximately head height for the average adult male.
​This line involves a very fast paced, repetitive, high-volume category of tasks. Operatives are involved in packing raw ingredients; bag opening and filling, sealing and labelling, and end of line stacking.
A .. Load weight/frequency
​Note the weight of the load and the frequency (or repetition rate) of the lifting operation. Read the risk band from the graph below and enter the colour band and numerical score onto the score sheet. If the colour band is purple you should examine the task very closely as it may represent a serious risk of injury and must be improved.
Concerning this lowering task, there is approximately one lower every 14 seconds, therefore 250 times per hour. The Colour Band is Green and the Numerical Score is 0 therefore the Load weight/frequency is G=0.
B .. Hand distance from the lower back
The clip only shows the lower, down to the first tray. The lower is also to head height when 8 trays are stacked. This will also involve the upper arms angled away from the torso. With the hands being a moderate distance from the lower back the Colour Band is Amber and the Numerical Score is 3.
C .. Vertical Lift Zones
The clip only shows the lower, down to the first tray. The lower is also to head height when 8 trays are stacked.
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The Colour Band is Red and the Numerical Score is 3.
D .. Torso twisting and sideways bending
Observe the worker’s torso as the load is lifted. If the person twists the torso in relation to the hips OR leans to one side as the load is lifted, the colour band is amber and the score is 1. If the torso both twists AND bends to the side as the load is lifted, the colour band is red and the score is 2.
The task is a lower, but of course the Mac Assessment still applies. We will take a detailed look into his posture and body use later in this assessment; he is forward bending and twisting to lower the bags. With simple spinal biomechanics in mind, this movement also involves a side bend of this back. When he is lowering bags onto the 8th tray at head height, he will likely twist and side bend his spine.
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The Colour Band is Red and the Numerical Score is 2.
E .. Postural constraints
Look for factors that force workers to modify their postures. If their movements are restricted when lifting because of the space available (eg lifting in a narrow aisle or in a crowded or disorganised storage area) or lifting through narrow gaps, the colour band is amber and the score is 1. If the posture is severely restricted (eg lifting in an area with a low ceiling) the colour band is red and the score is 3.
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There are no postural constraints. The Colour Band is Green and the Numerical Score is 0.
F .. Grip on the load
2 lightweight bags are kept together. This will only need light force. There are no handles or handhold areas. The palms and fingers are used to grip the bags. The Colour Band is Red and the Numerical Score is 2.
G .. Floor surface
Look at the condition of the floor where the handling task takes place. Note that for outdoor work this will depend on the weather. Always assess the ‘worst-case scenario’.
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Good floor surface. The Colour Band is Green and the Numerical Score is 0.
H .. Environmental factors
Observe the work environment and score if the handling operation takes place: in extremes of temperature; with strong air movements; or in extreme lighting conditions (dark, bright or poor contrast). If one of the risk factors is present score 1, if two or more of the risk factors are present score 2.
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No factors. The Colour Band is Green and the Numerical Score is 0.
Musculoskeletal Disorders (MSDs)
​With short term practice …
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Neck and Lower Back muscle strains/ ligament sprains/ facet joint dysfunction and facet ‘locks’
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Hip, knee and ankle ligament sprains
With long term practice …
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Neck and Lower Back osteoarthritis and spondylosis
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Hip and knee osteoarthritis
MSD Risk Reduction Solutions
With effective Manual Handling Training, Operatives are upskilled to understand the repercussions of repetitive forward bending and twisting movement patterns.​ Optimal handling practice of simply moving their feet square onto the trays, to avoid spinal twisting, and for the lower trays performing a semi-squat to reduce spinal forward bending. For the highest trays, avoiding backward bending of the spine and raising of the arms is unavoidable.
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Other measures would be job rotation to other tasks that involve different movements or simply working at a standing workstation with no spinal forward bending. 1 hour in the first half of their shift and 1 hour after their break would be recommended. For those who have back pain, a Lumbar Support would help.​
Risk Assessment of Pushing & Pulling (RAPP Tool)
The RAPP Tool is designed to help assess the key risks in manual pushing and pulling operations involving whole-body effort, e.g. moving loaded trolleys or roll cages, or dragging, hauling, sliding or rolling loads. There are two types of pushing and pulling operations you can assess using this tool:
â– moving loads on wheeled equipment, such as hand trolleys, pump trucks, carts or wheelbarrows (Section A);
â– moving loads without wheels, which might involve actions such as dragging/ sliding, churning (pivoting and rolling) and rolling (Section B).
For each type of operation there is a flow chart, an assessment guide and a score sheet.
This RAPP Tool worked example is of the pushing practice the Manual Handling Training Company Pristine Condition negligently teach as CORRECT TECHNIQUE as shown on their website video below. If you use Pristine Condition and have concerns about the 'scientifically unproven' and Biomechanically irresponsible Manual Handling 'Techniques' they are spreading across your Business view Gareth Milner's hyper-credible Blog Post Series ''NOT as Pristine as YOU are Led to Believe'' by clicking here or on the banner below left.​​​​​
As the inanimate load, the Mini Clubman (weighing 685 kg) has wheels we will be using Section A ‘moving loads on wheeled equipment, such as hand trolleys, pump trucks, carts or wheelbarrows’ of the RAPP Tool.
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A-1 Type of equipment/Load weight (kg)​
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This is graded as Medium A/2 as the Mini Clubman weighs over 600kg and under 1000kg.
A-2 Posture
This section says ‘Observe the general positions of the hands and the body during the operation.’ ​This is graded Poor R/6 as Body is severely inclined … Torso is severely bent or twisted … Hands are behind or on one side of body or above shoulder height. ​Looking at basic biomechanics from bottom to top. Her right ankle is in inversion (turned in). Her right knee suffers a valgus strain (with slight flexion). Her right hip will be externally rotated (turned outwards). Her left is dorsiflexed with the achilles tendon under significant tension and strain. Her left knee is flexed with the patella-femoral joint under extreme compression due to the high muscular contraction of the quadriceps muscles. Her left hip is medially rotated (turned inwards). Her lumbar (lower back) and thoracic spine (mid-back) is rotated or twisted to the left. There is significant forward flexion (bending) at L4/L5 and L5/S1 spinal joints. Her lower neck joints (including C5/C6) appear to be slightly extended (backward bent). Her left shoulder is flexed 180 degrees, slightly abducted, and medially rotated. Her left elbow appears straight. Her right shoulder is flexed to 90 degrees with the elbow flexed more than 90 degrees and pronated. Her wrist flexor muscles are maximally contracting to couple her hands with the car. ​There is certainly nothing ‘Reasonable’ about the posture.
A-3 Hand grip
This section says ‘Observe how the hand(s) grip or contact the equipment during pushing or pulling. If the operation involves both pushing and pulling, assess the hand grip for both actions.’
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This is graded Poor R/2 … There are no handles or the hand contact is uncomfortable.
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The load is a car. Handling coupling is not a design feature. Nor are they design to be pushed by humans, that is humans who want a body that doesn’t hurt … every day … or worse every minute of every day like is possible with this practice and technique.
A-4 Work pattern
This section says ‘Observe the work, noting whether the operation is repetitive (five or more transfers per minute) and whether the worker sets the pace of work. Ask workers about their pattern of breaks and other opportunities to rest or recover from the work.’
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As the ‘Can you feel it?’ video clip shows one push, we’ll give this its first G/0.
A-5 Travel distance
This section states …
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Determine the distance from start to finish for a single trip.
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â– If the operation is not repetitive, do an assessment for the longest trip.
â– If the operation is repetitive, determine the average distance for at least five trips.
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As the distance is less than 10 metres, lucky for this lady, this is G/0.
A-6 Condition of Equipment
This section states …
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Enquire about the maintenance programme and observe the general state of repair of the equipment (condition of the wheels, bearings and brakes).
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Well as the Mini Clubman is in the garage, I will grade this A/2 … Maintenance occurs only as problems arise.
A-7 Floor surface
This section states … Identify the condition of the surfaces along the route and determine the level of risk using the following criteria.
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Luckily for her she isn’t performing this practice on a road that could be uphill or full or bumps and potholes.
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In the garage, it’s G/0 .. Dry and Clean, Level and Firm and Good Condition.
A-8 Obstacles along the route
No obstacles are present … G/0
A-9 Other factors
Identify any other factors, for example:
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â– the equipment or load is unstable;
â– the load is large and obstructs the worker’s view of where they are moving;
â– the equipment or load is sharp, hot or otherwise potentially damaging to touch;
â– there are poor lighting conditions;
â– there are extreme hot or cold temperatures or high humidity;
â– there are gusts of wind or other strong air movements;
â– personal protective equipment or clothing makes using the equipment more difficult
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One factor present … A/1
Score sheet: Pushing or pulling loads on wheeled equipment
INCORRECT Technique
Score sheet: Pushing or pulling loads on wheeled equipment
'CORRECT' Technique
Looking at the INCORRECT TECHNIQUE which rightly so is natural, hazardous pushing practice … the interesting thing is that this is deemed lower risk than the pushing practise Pristine Condition stipulate as CORRECT TECHNIQUE.
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INCORRECT TECHIQUE scores 10 and one Red, whereas ‘CORRECT TECHNIQUE’ scores 13 and two Reds.
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​Shouldn’t it be the other way around? If your Business uses Pristine Condition it would be beneficial to throw this point (hopefully not with a forward bend and twist (like they teach with pushing heavy loads … you’ve just seen it with your own eyes) to their CEO and Founder Davy Snowdon MBE, preferably on a phone call or better still on a Video Call.
It will be interesting to see what Davy says? ‘Unprecedented’ might just be heard at least 2-3 times.
What does this negligent ‘CORRECT TECHNIQUE’ all mean?
​With short term practice …
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Neck muscle strains/ ligament sprains/ facet joint dysfunction and facet ‘locks’
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Shoulder muscle strains/ ligament sprains
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Shoulder rotator cuff strains and tendonitis
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Lower back muscle strains/ ligament sprains/ facet joint dysfunction and facet ‘locks’
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Hip, knee and ankle ligament sprains
With long term practice …
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Neck and Lower Back osteoarthritis and spondylosis (below left)
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Spinal stenosis
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Frozen Shoulder (below left)
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Hip and knee (below right) osteoarthritis
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Chronic Achilles Tendonitis
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Bunions (below right)
So how can the Risk of Musculoskeletal Disorders be reduced?
Pretty simple, it’s a 2 person coordinated push with the team leader say ‘Ready, Brace, Push’. The Mini Clubman’s tyres should be fully pumped also to reduce the 2 person pushing forces needs.
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In some ways it would be better to put your back against it. There would be less shoulder and neck joint strain. This practice can sometimes be useful, depending on the load.
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The RAPP Tool on load weight under-scores the risk as Medium. 685kg … MAKE NO MISTAKE! … is a very heavy load and humans on their own … SHOULD NOT BE PUSHING SUCH WEIGHT … let alone on a Manual Handling Training page.
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This clip is from the Pristine Condition ‘Can you feel it?’ series. Can you feel those arthritic hips, arthritic knees, arthritic lumbar and cervical spinal joints and frozen shoulders. Likely you can. Here’s my caricature coming in … Ouch!
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That’s a RAPP!!
