Are we really doing enough to address MSDs and manual handling injuries

at work or are we just paying lip service to the subject?


This article should not be read as a criticism undermining the good work done by health and safety professionals, trainers, employees or managers in industry. This was written with a view to opening minds to explore areas of the handling regulations in more detail which could have a significant impact on reducing injury rates and self-awareness of our employees.

According to research funded by the Institution of Civil Engineers the cost of ill health in the UK construction industry alone exceeds £848 million per year. Three quarters of this figure, £646 million, is attributed to MSDs. And this is just construction!

These are not insignificant numbers and on a scale which offer genuine scope for businesses to save cost and benefit profitability, productivity, and employee engagement.


The current Manual handling regulations are a well-constructed and evolved publication, adopted and utilised throughout industry. But there are pieces that really require a deep dive into their meaning, and how they could be interpreted when viewed from a different angle and armed with different knowledge. In particular:

“the posture adopted”

workers’ strength, fitness and underlying medical conditions (for example a history of back problems)”

These are potential game changers if viewed and addressed from a different perspective.

 extract from HSE guidance on manual handling at work:



30 years of “Manual handling Operations Regulations 1992”

The original manual handling regulations are now 30 years old and mentioned phrases such as:

  • The employee is physically unsuited to carry out the tasks in question
  • Individual capability.
  • The evidence suggests that techniques taught in training programmes often fail to be applied in the workplace.
  • The emphasis in training should be on changing attitudes and behaviour and promoting risk awareness among workers and managers.


These are still very valid areas for employers to focus on now as they were 30 years ago when the words were first written. I would like to discuss what each of these statements meant 30 years ago and about how they could be interpreted, and what we can do differently in 2022.


Let me start by questioning some of the original words and statements from 1992.

“The employee is physically unsuited to carry out the tasks in question”

Is this alluding to the employee being of a stature not suitable to the task. Perhaps a taller person required to lift a load to a position a shorter person might not be able to reach? What if the tall person lacks the physical strength for the task? Perhaps it is guiding employers to consider registered physical disabilities in an employee? These words certainly lead us to consider the individual…..but to what degree?


 ”The evidence suggests that techniques taught in training programmes often fail to be applied in the workplace.”

 There are numerous studies suggesting manual handling training doesn’t work to protect individuals from sustaining manual handling injuries.

 Even the HSE themselves wrote in 2018 “Our research shows that simplistic training involving bending your knees to lift a cardboard box is just a waste of time and money, it just doesn’t make any difference.”

We have to ask why this is the case? Are our trainers not delivering the correct material? Is the task so far removed from the training that it becomes irrelevant? Does the trainee not pay attention to the training, so not take it back to their workplace? Perhaps there is something missing from the training that we just don’t consider?

 Based on the two definitions below I would rather call training education. In particular “discussion and directed research” provides a much-needed additional element to “training” of employees. I’ll explain further in a short while


Training – the process of learning the skills you need to do a particular job or activity.

Education – Education is the process of facilitating learning, or the acquisition of knowledge, skills, values, morals, beliefs, habits, and personal development. Educational methods include teaching, training, storytelling, discussion and directed research.

Even these words from 1992 are closer to the education definition.

“The emphasis in training should be on changing attitudes and behaviour and promoting risk awareness among workers and managers.”


From my experience being on both ends of manual handling training, as trainer and trainee, it is very easy to fall into the “telling –  being told” type style and just going through the motions with the trainees.

Interestingly whilst conducting manual handling risk assessments we learn significant detail about the load and task, the working environment, handling aids and equipment required. But too often we learn very little about the individuals conducting the work. This is where “discussion and directed research” could play a significant role in educating the trainee in self-awareness.

We all have long histories of physical experiences stacked up with layers of broken bones, soft tissue injuries, bumps and bruises, operations, heavy falls and crashes, childbirth, sporting incidents and our work experiences.  The problem is we quickly forget about these incidents once they “heal”. Let me give you a couple of work-based examples I came across during my time as a health and safety manager.

 Both these examples are valued, committed, experience and well-trained employees with service exceeding 10 years each. They both had their own quirky posture and walking pattern, which as far as I am aware hadn’t been considered during their employment service.

Case 1 Ian – Fork truck operator involved daily in truck operations, manual handling tasks and some desk-based administration. A physically very capable 40-year-old male, standing 1.9m tall and weighing 110kg. He was a keen golfer away from work but on occasions complained of minor lower back discomfort. This wouldn’t stop him from turning up to work and there were no significant concerns from him or his employers.

One thing we did know about this person was that he wore out his safety shoes more frequently than other employees, and it was just one shoe.

Case 2 Mick – Distribution operative whose daily tasks were predominantly office-based administration but did also include some manual handling of materials. A very capable man of 50 years old weighing 85kg who would choose more responsible office-based tasks over physical handling if given the choice.

Mick was popular amongst his work colleagues and would be the butt of shop floor banter due to his gait pattern resembling a penguin waddling. I appreciate that this behaviour could be regarded as bullying and unwelcome, but this is how it was at that time amongst the team that worked together.


I engaged both these guys in safety-based conversation discussing several topics about their work. In the case of the Ian, I discovered that the excessive way his shoe wore out was due to a sporting injury as a teenager. His ankle and foot were seriously injured resulting in a plate being screwed into his ankle. His foot and ankle didn’t function optimally, which he was very aware of, and this caused a shift in his bodyweight altering pelvis position and disrupting his whole-body movement.

In Mick’s example we discussed his use of lifting aids which he always used during handling tasks. We discussed use of lifting techniques and principles, which he was honest enough to admit he did not use…. hence using scissor lifts and work benches. It was only during this conversation did we explore why he didn’t use the manual handling principles training he had frequently received. His answer was simple……he couldn’t do it ongoing. He reported he could demonstrate a version of correct lifting for the benefit of passing the training but physically unable to use the techniques day to day.

Intrigued I had to ask further questions and understand what was behind this lack of compliance. There was a simple answer, that following a motorcycle accent 25 years previously he had shattered his pelvis. The reconstructive surgery had impacted his walking and movement patterns.

Both these guys had consciously and subconsciously modified and altered their postures, behaviours, and attitudes to manage their daily life.

Not every worker has suffered such significant single life changing incidents. Most of us will however experience minor broken bones, minor soft tissue injuries, small operations, low impact collisions/falls/car crashes, which heal quickly and are forgotten as distant memories without question.

These minor incidents will stack up, and when combined with physical activities of our daily lives will lead to modified movements. The modified movement patterns cause overwork and underwork of body structures, muscle, and joints. Over time these modified movements can leave employees unknowingly predisposed to suffering a MSK injury whilst carry out a work-related task. Equally they could be playing a round of golf, gardening, climbing into the loft at home or embarking on the first weeks of couch to 5K. Which ever of these activities is the perceived direct cause of the injury, we don’t often start to discuss the injury history of the IP 20 or 25 years previously.


So, to sign off this short exploration of manual handling and what we can learn, and do better, perhaps we should be helping trainees explore their own injury history to potentially predict and prevent further injuries in the future whatever physical activities they take part in?


Darren Kerr DipNebosh – Gait and Posture Specialist