Work-related musculoskeletal disorders (MSDs) are among the most frequently reported causes of lost or restricted work time. Nearly 500,000 workers suffer from work-related MSDs, which account for over one-third of all workplace injuries. (1) Before the coronavirus pandemic, work-related MSDs followed a flat trend. However, the current work-related non-fatal injury rate surpasses pre-pandemic levels. (2)
Over seven million working days are lost annually due to work-related MSDs, accounting for 24% of all lost workdays. These lost workdays negatively impact productivity and profitability. Back injuries comprise almost half of all work-related MSDs. When severe, they can be life-changing and significantly impact the quality of life for workers. (1)
The most common causes of workplace MSDs include lifting. The Occupational Safety and Health Administration (OSHA) recommends training as an important intervention for these disorders. (3) However, some studies show that training alone may not prevent the occurrence of MSD among frontline workers. (4) One systematic literature review found no evidence to support training in working techniques for preventing back pain or consequent disability. (5)
Lifting technique training is often reduced to “bend the knees and keep the back straight.” While that advice is helpful in the most basic way, it does not address some important nuances of proper lifting. Another problem is that correct lifting is taught using generic online or classroom training. While that information is a start, it is rarely sufficient to change lifting behavior. As it turns out, lifting in the real world is more complicated than that.
Let me count the ways….
When considering all these factors, teaching safe lifting with one technique and a generic lift box often does not suffice.
The optimal lifting method is the method that achieves the following goals:
All these factors reduce the strain on the lumbar spine and avoid creating sudden uncontrolled forces on the spine's muscles, ligaments, joints, and discs. Avoiding twisting while lifting is important because the spinal discs are designed to withstand compression but not rotary forces, which happens when we twist with a load.
Pulling your navel toward your spine before any significant lifting is important because this action engages the transverse abdominal muscles that support your spine without causing it to flex. Breathing out reduces the elevation in blood pressure caused by holding your breath.
Following these techniques will reduce the wear and tear on ligaments, muscles, and joints, minimizing the deterioration of these structures over time.
As a physical therapist focused on workplace injury prevention, I have spent much of my career observing lifting occurring in the workplace. Often, we see the following problems, making a lift more stressful on the body:
The US Army has published an extremely comprehensive bulletin on safe lifting. (6) This communication relies heavily on their descriptions and diagrams combined with our 30+ years of teaching lifting techniques as physical therapists.
Let’s break it down, principle by principle.
To keep the load close, one must get the load between the knees. So, the feet must be placed wide enough apart to make this happen. Often, this requires a wider stance than most people are accustomed to. Also, the feet need to be staggered, with one foot slightly ahead of the other, so that you can use the body’s momentum in a smooth and controlled way to assist with the lift.
Most objects being lifted don’t have handles. To assist with keeping the load close, reach out with the same hand as the forward foot to grasp the front corner of the box/load. Put the opposite hand on the corner of the load closest to you.
Look up as you lift, drawing your navel into your spine. Keep your back as straight as possible while pushing your buttocks out behind you. Breathe out as you lift rather than hold your breath.
https://www.sfdph.org/dph/files/OSH/armylift.pdf (6)
The power lift is similar to the lift that professional weightlifters use. As with the squat lift, the feet are far apart and staggered, and the back is straight with the buttocks out. The grasp is also similar. The difference is that the knees and ankles do not bend as much. This is a good technique for those who lack knee and ankle flexibility.
https://www.sfdph.org/dph/files/OSH/armylift.pdf (6)
Keeping the load close with the tripod lift.
The tripod lift can be good for several situations, such as if the load is uneven or odd-shaped or if knee and ankle mobility or arm strength are limited. However, it may not be the best technique for people with painful and tender knees. At least one knee must tolerate being on the ground in the initial phases of the lift.
https://www.sfdph.org/dph/files/OSH/armylift.pdf (6)
Use the same principles of back straight, buttocks out, navel in, and abdominals tightened. One knee is on the ground, touching the object, the other out to the side or as close to the outside as possible. Slide or lift the object onto the “up” knee. Hug the object close to your chest with your forearms underneath. Look forward and breathe out as you lift.
What’s the purpose of doing it? The purpose is to create a brace for your back by drawing your navel backward toward your spine and tensing the transverse stomach muscles. This increases the pressure inside your abdomen and protects the joints, ligaments, and discs in your back. (7)
Contracting the transverse abdominal muscles during lifting also helps activate the small multifidus muscles in your back, creating additional spine stability. When you do it correctly, your waist becomes smaller. You can get the feel of it by blowing air out through your mouth like you are blowing out birthday candles on a cake.
https://www.stacydockins.com/posture-lab/2019/4/30/say-hello-to-your-transverse-abdominis (8)
For one-handed lifting of an object with handles, use a partial squat: When lifting lighter objects with a handle, it’s tempting to revert to the stoop lift (straight knees, bent back). Instead, protect your back with a partial squat even in these less demanding tasks. Remember that back injuries are often cumulative, and you save your back any time you reduce the stress.
Stand with the object parallel to your side, with your feet shoulder-width apart and staggered as in the previous lifts. You can place one hand on your thigh for support as you lift. Keep your back straight and buttocks out (this should sound familiar by now), stomach tight, and breathe out as you lift.
https://www.sfdph.org/dph/files/OSH/armylift.pdf (6)
Sometimes the straight leg lift is unavoidable – especially when obstacles prevent you from bending your knees. However, it is recommended that you use this technique only when there is no other way. The example below of a lift from the trunk of a car provides one such example.
https://www.sfdph.org/dph/files/OSH/armylift.pdf (6)
Instead of locking your knees out straight, stand so that the knees can bend at least a little. Push your buttocks out and keep your back straight (yes, you can do this even if your knees are only bent a little). Try to drag the load as close as possible before you start the lift. Look forward, breathe out, and tighten your navel to your spine.
This is especially important when a load has to be moved from one location to another or when you pick up a load from a shelf and start carrying it. Most of the time, people plant their feet, pick up the load, and twist with their spines instead of moving their feet in the direction that they’re placing or carrying the load. The diagram below shows a better technique for moving the feet toward the direction in which you are moving.
https://www.sfdph.org/dph/files/OSH/armylift.pdf (6)
In the example above, the worker moves the box from the right to the left. He holds the load close and turns the left foot 90 degrees towards the left. Simultaneously, he can pivot on the ball of his right foot during the turn, which takes the spinal twisting out of the movement. This is important because our spinal discs weren’t designed to tolerate twisting forces. The more we force them to twist under a load, the faster they will wear out or tear.
Above-shoulder lifting is especially stressful for your shoulders and wrists, putting significant compression forces through the spine. If the materials to be lifted can be moved to the “Golden Zone” (between knees and shoulders), the stress of the lift can be significantly reduced.
https://www.sfdph.org/dph/files/OSH/armylift.pdf (6)
The same principles for safe lifting below the waist apply to above-waist lifting: Keep the load close, keep feet shoulder-width apart and staggered, look forward and upward to the above-shoulder location, and breathe out as you lift with the navel pulled in.
As you reach the upper shelf, shift your weight toward the front foot, keeping your back straight throughout the lift. Once the front edge of the load is on the shelf, you can push it forward, reducing the overall load of the lift.
If the load is too bulky to fit safely between the knees or if the load is heavier than your abilities, then a two-person lift is required. With the two-person lift, designate one person to coordinate the lift who counts out loud to coordinate the lift. It is optimal if both people are about the same height and have similar strength.
Despite lifting injuries accounting for about 1/3 of all non-fatal work-related injuries and costing employers over $60,000 in direct and indirect costs per lost time injury, lifting or body mechanics training is often relegated to the back burner of safety training priorities.
Why? One of the reasons is that there are no compliance requirements for safe lifting training.
Most companies bring employees into a live lecture or send them to online training. The training is general and has no content or examples related to their specific jobs. And there is typically no follow-up to see if the “training” has inspired any changes in lifting behaviors. The training is typically done at the time of hire and may be repeated annually, at best.
In our experience, this general/generic training does little to modify day-to-day, real-world lifting behavior. It’s a starting point to communicate the principles but needs to be followed by safety audits focused on materials handling.
(9) Here’s where technology can make all the difference in the world. Using a camera-enabled device, safety professionals or supervisors can video employees as they perform the lifting tasks of their jobs. When the videos are uploaded to computer vision software, a hazard score is calculated in minutes. Sharing the videos and scores can be a great teaching tool. Employees see themselves as they perform the task and see the objective risk score associated with their performance.
The safety professional or supervisor can then coach the employee through a better lifting technique specific to the employee’s strength, flexibility, and the task at hand. A second video of the improved technique can be used to compare hazard scores before and after the teaching session.
Compare that training approach to having the safety professional or supervisor observe the lifting and then begin coaching the employee. This observation approach feels much more subjective to the employee and has less credibility because the safety professional may have never done the task about which they are coaching. In general, we find that employees are more engaged and receptive to training when computer vision AI is used.
When was the last time you learned a new sport? Did you get one session of training and then play like a pro? Doubtful. But that’s what we’re expecting industrial athletes to do. Realistically, it just doesn’t happen that way. But it’s also unrealistic to think that the safety professional or supervisor can stand by and coach the industrial athlete throughout the day.
(10) Behavioral change requires practice and feedback and changing lifting technique is no exception. However, practice with real-time feedback is rarely feasible in most work settings. According to Industrial Safety and Hygiene News report, “the median ratio of EHS department staff members per 100 employees is 0.3 per 100, or about one EHS staffer for every 300 employees.” (11) Hardly a ratio that allows for individualized behavioral assessments and feedback.
However, wearable ergonomic sensors combined with customized microlearning video training changes all that. Wearable sensor technology, a cutting-edge approach, has become a valuable tool for monitoring worker posture and trunk movement to combat MSDs. A 2021 study suggests sensor data can help identify faulty movement patterns and prevent low back injuries. Realtime alerting and leading indicator safety metrics allow frontline workers and their managers to intervene early and often when workers demonstrate patterns of poor body mechanics and/or lifting techniques.
Combining the sensors with digital micro-learning delivered directly to employees trains them to apply more nuanced and sophisticated lifting principles across all job tasks, including teaching employees the correct stance, correct use of core muscles, and proper foot placement.
Ergonomic wearable sensors provide haptic (vibration) feedback when the body bends too far forward during lifting and can be the “always on” ergo coach. A variety of sensor configurations are available. (See figure below.) Data dashboards are sent to the supervisor or safety professional, who tracks whether workers improve their lifting technique. Worn over time, lifting improves, and lifting injuries decrease. If workers fail to improve, further assessment and training can be used to assist. Perhaps the worker has physical limitations, which makes proper lifting difficult. Perhaps the task can be modified to make proper lifting easier.
The important takeaway is that with technology, proper lift training can be more effective, and lasting change can be sustained.
In this comprehensive guide, we’ve delved into the art and science of safe lifting. Proper lifting technique matters when handling heavy materials, regardless of the industry. There are unwavering principles…but the nuances depend on the worker, the situation, the environment, and the task. And the nuances are important.
One technique does not fit all situations. The principles can be applied regardless of the specific technique being used. Following them will protect your back and joints and enhance your overall well-being. If you are in the role of teaching or reinforcing proper lifting techniques, we encourage you to explore the latest computer vision and wearable technology to enhance your efforts. Your training will be more efficient and more effective with these new technologies.
(1) https://www.hse
(2) https://www.ioshmagazine.com/2022/11/29/work-related-ill-health-and-non-fatal-injuries-have-risen-hse-stats-reveal
(3) https://www.osha.gov/ergonomics
(4) https://link.springer.com/article/10.1007/s00420-012-0775-3
(5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249682/#:~:text=In%20this%20systematic%20review%20we,in%20lifting%20and%20handling%20techniques.
(6) https://www.sfdph.org/dph/files/OSH/armylift.pdf
(7) https://www.nytimes.com/2024/08/07/well/move/activating-core-exercise-tips.html?unlocked_article_code=1.CE4.ogWu.lOJxQKGaOVqj&smid=url-share
(8) https://www.stacydockins.com/posture-lab/2019/4/30/say-hello-to-your-transverse-abdominis
(9) https://www.tumeke.io/
(10) https://www.strongarmtech.com/
(11) https://www.ishn.com/articles/86206-in-search-of-benchmarks-1#:~:text=From%20the%20free%20executive%20summary,Washington%2Dbased%20EHS%20consulting%20services.
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