Driving for work and MSDs

Introduction

Musculoskeletal disorders (MSDs) are the most common work-related health problem in Europe^[1], affecting millions of workers. MSDs represent one of the most frequent causes of work-related incapacity to work in Europe and cover a broad range of health problems: from discomfort, minor aches and pains, to more serious medical conditions which can lead to permanent disability. The most well-known MSDs are low back pain and work-related upper limb disorders. Poor ergonomic work factors increase the load or strain on the back. This may arise from many situations, for example lifting, twisting, bending, awkward movements, stretching, and static postures.

Professional drivers have been found to be at high risk of developing health problems (see table 1). This is unsurprising, since they spend most of the day sitting in a relatively confined space behind a wheel and exposed to driving vibrations. Low back pain is a major cause of disability among professional drivers. In addition, they face time pressure and stress, which may also lead to muscle tensions. Many professional drivers have to load or unload goods (e.g. truck drivers), baggage handling or handling wheel chairs without any assistance (e.g. taxi and bus drivers) and more. This is further aggravated by unhealthy diet, insufficient exercise and smoking as they may increase the susceptibility to low-back pain^[2][3].

Motor vehicle drivers have to coordinate many complex muscular movements in order to control the vehicle. Sustained posture when controlling the steering wheel and the control pedals require static muscle activities in the cervical and lumbar spine, as well as in the large joints such as the shoulders, hips and knees. Studies^[2] showed that low back, neck, shoulders and knees were the four most common areas of discomfort in bus drivers with the low back and neck having the highest level of discomfort^[2].

Table. 1 Driving activities that increase the risk of back pain and musculoskeletal disorders. Source: Mallat.B., 2000^[4]

Truck and bus drivers suffer from low back pain as a result of prolonged sitting, poor posture, poor ergonomics, manual handling of luggage and whole-body vibration^[5].

Delivery and courier service workers, travelling sales workers, and taxi drivers are exposed to a number of risk factors for low-back pain. These include^[6]:

• Prolonged sitting posture, as influenced by drivers’ cab and seat design;
• Cumulative exposure to whole-body vibration;
• Static and awkward postures.
• Psycho-social factors; such as stress.
• Cumulative exposure to other manual handling activities, such as assisting passengers with items of baggage;
• Assisting wheelchair users.

Employers responsibilities to assess MSD and manual handling risks

Musculoskeletal disorders result in loss of function and pain. Employers have a legal obligation to protect the health and safety of their workers and other people who might be affected by what they do. To prevent musculoskeletal disorders effectively, the risk factors in the workplace must be identified and then practical measures taken to prevent or reduce the risks^[7][8]. Employers are required to assess the risks that their workers face, including the risk of injury from hazardous manual handling in the workplace as well as the risk of developing MSDs, and act on them.

Various European legal requirements concern directly or indirectly to work-related musculoskeletal disorders (MSDs)

For example:

90/269/EEC - manual handling of loads^[9]

90/270/EEC - display screen equipment^[10]

2002/44/EC – vibration^[11]

2002/15/EC - working time - mobile road transport activities^[12]

2003/88/EC - working time^[13]

2006/42/EC - new machinery directive^[14]

2009/104/EC - use of work equipment^[15]

Good musculoskeletal health is an important component to a healthy working life. It supports people with mobility, balance and co-ordination, and ensures functional abilities, essential to nearly all forms of work. Action should be taken to inform and raise awareness among drivers and employers in understanding good musculoskeletal health and on how MSDs can be prevented in the workplace^[16].

For prevention of work-related MSDs risk assessment of physical workloads is an important part of the risk management process. It comprises a multistep approach to improve workplace health and safety and productivity. The general five steps of the risk assessment procedure involve identifying hazards and those at risk, evaluating and prioritising risks, decisions on preventive actions, executing actions and finally monitoring and reviewing at regular intervals. Employers must also provide workers with health and safety training and consult them on health and matters.

Prolonged sitting

Prolonged driving of motor vehicles has been found to increase the risk of low-back pain. Already in 2010 EU OSHA highlighted that prolonged sitting is a significant, but underestimated risk^[17][18]. Sitting for extended periods of time without any posture changes can be harmful. Sitting puts more pressure on the spine than standing, the disks become compressed and may lose flexibility. Prolonged sitting and sitting in an awkward position cause strain on muscles, tendons and ligaments and may also increase the risk of developing ruptured disks.

Sitting for very long periods of time is linked to a number of health problems and other health related issues, including obesity, heart problems, high blood pressure, diabetes and back-pain Poor seating and cab design can cause musculoskeletal disorders and expose drivers to vibration^[19].

If the design of the cabin is poorly fitted to the driver, the road may be less visible, driving controls may be more difficult to reach, and seat belts may be less comfortable and make them less likely to be used. An ergonomically designed truck cabin can prevent musculoskeletal disorders and driver fatigue. The driver’s cabin must be comfortable and ensure good visibility for all drivers,

irrespective of the driver’s weight and size. The cabin needs to be adapted to the driver’s behaviour to make it easy to use.

Truck drivers have limited scope to stand-up and move during the working day. They sit for a long time in a static position, especially drivers of long distance tours with two drivers (double manned). They are sitting for a long time as driver and then as co-driver! This makes truck drivers susceptible to musculoskeletal disorders.

Bus drivers are at risk of musculoskeletal disorders for the shoulders that is not just related to actual driving. There is also a risk of musculoskeletal damage to the neck, due to the carriage of passengers (torsion movements when passengers get off the bus, extension movements when looking at the central rear-view mirror during the opening and closing of the doors)^[5]. There is some evidence that work-related ergonomic and psychosocial factors are associated with low back pain in bus drivers^[20].

Taxi and delivery drivers spend most of their time confined in the seat of the taxi or van. Awkward position in combination with vibration and prolonged sitting may put taxi drivers at great risk for low back pain.

In addition, prolonged sitting may also occur during leisure time, for instance when going by car, watching TV, or playing video games.

Preventing MSD from prolonged sitting –Tips for workers and employers

Employers must conduct suitable risk assessments and put in place the necessary measures to ensure that work-related journeys are safe, drivers are fit, and the vehicles used are in a safe condition and appropriately designed for purpose. The ergonomics of the cab and seating are important for preventing MSDs.

Drivers should be able to enter the cabin safe, easily reach and operate all instruments, pedals, and the steering wheel, and have good visibility through the windows and mirrors^[21].

Long journeys should be planned to allow for breaks, when drivers can move and stretch.

A detailed risk assessment should look at the following issues related to the ergonomic cabin design:

• Safe entry and access to the cabin; including steps and grips.
• A seat that is adjustable to the driver’s needs
• Instruments which are easily visible and easy to reach,
• Acceptable ride quality and cabin noise levels
• Easily adjusted ventilation and climate controls.
• Comfortable pedal locations and angles.
• Wide visibility angles
• Easily adjusted mirror to enhance road vision
• Compliance with vibration standards

Much of driving-related back pain has to do with the position of the driver’s seat. There are several ergonomic adjustments one can make in a vehicle to reduce stress and musculoskeletal disorders^[22]. Employers should provide training to make sure everyone can find their correct driving posture.

Tips for workers/drivers

Seat adjustment (taken from^[23])

• Start by getting the seat into the ‘initial set up position’,
• Raise the seat as high as is comfortable to improve your vision of the road.
  • Check you have adequate clearance from the roof.
  • Ensure you have maximum vision of the road.
• Move the seat forwards until you can easily fully depress the clutch pedal and accelerator pedal.
  • Adjust seat height as necessary to give good pedal control.
• Adjust cushion tilt angle so that the thighs are supported along the length of the cushion.
  • Avoid pressure behind the knees.
• Adjust back rest so it provides continuous support along the length of the back and is in contact up to shoulder height.
  • Avoid reclining the seat too far as this can cause excessive forward bending of the head and neck and you may feel yourself sliding forwards on the cushion.
• Adjust the lumbar support to give even pressure along the length of the back rest.
  • Ensure lumbar support ‘fits’ your back, is comfortable with no pressure points or gaps.
• Adjust steering wheel rearwards and downwards for each reach.
  • Check for clearance for things / knees when using pedals.
  • Ensure panel display is in full view and not obstructed.
• Adjust the head restraint to ensure the risk of injury is reduced in the event of a car accident

While driving^[24][25]

• Try to maintain a good driving posture but also try to move in your seat and change posture from time to time
• Avoid leaning into the wheel when driving
• If your vehicle is stuck in traffic and stationery, this may provide a safe opportunity for you to move your shoulders and your neck

Take breaks

Take a short break for every hour of driving. Get out of the vehicle to use the phone, eat lunch or do ‘paper’ work. Walk around and do some stretches, don’t stay in the vehicle or seated in a restaurant or rest area.

Day-to day activities^[26][24]

• Do truck-stop gyms - try to exercise for 15 minutes a day (e.g. push-ups, planks, or crunches on the ground).
• Work out while driving: You can do a few exercises while driving (e.g. shoulders lifting).

Whole-body vibration (WBV)

Vibration is a contributing factor in the development of musculoskeletal disorders and has various health effects depending on its direction and the body part affected. Effects of whole body vibration are often underestimated, because health effects are often long term and therefore insufficiently noticed during exposure. Drivers are mainly exposed to vibration in the vertical direction, which is known to be the most severe for the driver. Sitting postures aggravate the pressure within the intervertebral disc. Driver’s exposure to whole body vibration is influenced by a variety of factors e.g. vehicle speed, vehicle age, layout of the cab, seat design and suspension, road condition e.g. jolts from rough roads^[4][22]. Intense long-term whole-body vibration can adversely affect the spine and can increase the risk of low-back pain. In addition, poor postures and manual handling of loads may contribute to the low-back pain of professional drivers.

Sudden stopping and starting of the vehicle may increase the mechanical stress on the spine. The longer a worker is exposed to WBV the greater the risk of musculoskeletal disorders.

European Directive 2002/44/EC sets the minimum health and safety requirements regarding the exposure of workers to the risks arising from mechanical vibration. Employers must assess the risk of vibration and take action to prevent risk from exposure to vibration. Employers must be aware of vulnerable groups: older people, young people and pregnant women are more likely to be at risk from exposure to whole-body vibration. During pregnancy there is the risk of harming the foetus and placental abruption. Safe Work Australia has reported a link between noise and whole body vibration: exposure to both vibration and noise is also understood to increase musculoskeletal problems^[27]. Noise stress may affect occupational musculoskeletal disorders, vibration is considered to be more burdensome if vibrations and noise act simultaneously^[28]. Whole-body vibrations may also impair the senses and the fine motor skills^[29].

Truck drivers and bus drivers

The amount of vibration in trucks and busses is less than that occurring with agricultural or industrial vehicles. However, drivers may be exposed above the limit value if driving on a rough surface, or if driving trucks and lorries all day long^[30]35. Long periods of driving on the road make the accumulated exposure very high and many drivers exceed the daily exposure action value defined by the European Directive 2002/44/EC (see box 1)^[31][32][33], especially on long distance tours when two drivers are on board.

Taxi drivers and delivery drivers

A study carried out by Funakoshi et al. showed that taxi drivers were exposed to serious magnitudes of WBV^[34]. The amount of WBV in taxi and delivery driver may not exceed the exposure limit and action values defined by the European Directive 2002/44/EC, but taxi and delivery drivers are at risk of musculoskeletal disorders from WBV due to driving in an unfavourable or twisted body position e.g. when reversing.

Preventing MSD from whole-body vibrations –Tips for workers and employers

It is important to provide for ergonomically designed driver’s seats that reduce whole body vibrations to a minimum. Vehicles and seats have to be maintained properly. It is also possible to avoid badly maintained roads by planning the journey well in advance. By minimising vibration exposure the risk of musculoskeletal disorders can be reduced.

Tips for employers

• Provide seats that effectively reduce WBV;
• Set appropriate maintenance programmes for the vehicle and the driver seat including the suspension.
• Ensure tyre and suspension systems are maintained.
• Provide suitable and sufficient information and training for drivers about correct work procedures.
• Test various measures before deciding and ask the opinion of the workers
• Limit the duration and intensity of the exposure
• Ensure that the work schedules have adequate work schedules and rest periods.
• Protect drivers from cold and damp40

Tips for workers

• Adjust the seat properly to your needs
• Check tyre pressure bevor starting
• Take regular breaks to move around and do some stretches
• Provide driving in an unfavourable or twisted body position
• Reduce speed of travel
• Take care of a healthy lifestyle (eating, drinking)
• Don’t leave the engine idling when stopped

Manual handling – loading and unloading

Manual handling covers a wide range of activities including lifting, lowering, pushing, pulling and carrying. If manual handling is poorly designed or not carried out appropriately there is a risk of injury. Drivers are exposed to ergonomic risks from manual handling freights such as heavy lifting, awkward postures and long periods doing the same movements.

Truck drivers do not only transport goods from one place to another, very often they also have to load and unload these goods, securing and covering loads, decoupling trailers, and mounting and dismounting heavy equipment. Research shows that lifting heavy loads may have a substantial impact on musculoskeletal health and might cause musculoskeletal disorders (MSD), back problems, etc.

Associated with loading and unloading is getting down from the cab. Jumping from the cab can create an impact force of five to seven times the weight of the driver and may hurt the lower back, knees, and ankles.

Bus drivers often have to carry out manual handling of loads, e.g. when they lift or hold luggage, when they help support people with a disability^[36].

Taxi drivers, delivery drivers and couriers often have to carry out manual handling of loads, e.g. when they lift or hold luggage. Just one wrong move can cause lower back pain. Twisting, turning and bending of the back while lifting can put strain on the back even when lifting light baggage. This is aggravated by the fact that taxi drivers spend most of their time confined in the seat of the taxi. This restricts muscle relaxation and may cause musculoskeletal disorders when lifting loads.

Assisting disabled passengers and persons with reduced mobility and handling heavy equipment such as wheelchairs Lifting heavy and awkward wheelchairs without assistance puts taxi drivers and ambulance drivers at risk of injury to the back and shoulders. Employers should ensure that a risk assessment of manual handling has been done for the transport of wheelchair users^[37].

Other drivers

Many others driving for work will have to bring in equipment that they need for their work with them (e.g. electricians, maintenance workers, cleaning workers, sales workers, health care workers). This can include tools, technical equipment, laptops and other office equipment. Wheeled bags, cases or boxes may be helpful. Equipment should be put in the boot of the car, not on the back seat where awkward postures may be needed to remove it from the vehicle.

Safe loading and unloading – Tips for drivers and employers

Risk reduction measures which may include the use of handling equipment, other engineering interventions or changing the way the work is done. It is important to use good lifting techniques, these are often not sufficient on their own.

Tips for Employers^[38][39]

• Identify and assess the risk of loading and unloading the truck, coupling and uncoupling, transport of wheel chair users
• Eliminate or reduce the risk:
  • Minimise manual handling activities
  • Provide handling aids/lifting equipment, e.g. trolleys, ramps, forklift trucks, tail lifts on trucks, stair climbers, extended telescope belt conveyor and a variable height pallet truck to transfer from a truck at a loading bay
• Manage the remaining risks:
  • Plan enough time to handle loads and baggage
  • Improve planning of the layout of goods in the vehicle
  • Two workers to lift or awkward heavy loads
  • Prevent other risk factors which might play a role (such as stress)
  • Provide instruction and training on handling heavy loads, (safe lifting techniques including for two workers lifting together) and using equipment safely.

Tips for drivers^[40][41]

• Use handling aids/help from colleagues
• Practice good manual handling technique
  • Bend your knees, not your back!
  • Turn your whole body, don’t twist
  • Carry objects close to your body

• Take breaks
• Avoid lifting shortly after prolonged sitting, do some stretching exercises, walk around first
• Climb down from the vehicle, do not jump!

Good lifting techniques - Tips for drivers

• Keep the load close to the body
• Keep your body in a natural, upright posture,
• Keep the heaviest side of the load next to the body
• Avoid twisting the back or leaning sideways
• Bend your knees if possible
• Use two-handed lifting
• Reduce carrying distances where possible

Working from the vehicle

Many drivers use their car like a mobile office. While this should be avoided if possible, some working from the vehicle may be inevitable. Working from a vehicle can include using a laptop, carrying out paper work, and making phone calls. All these activities can result in poor postures, which can cause musculoskeletal disorders (MSD) and back problems. In addition, many drivers may not be aware of putting themselves at risk.

Poor postures from these activities can involve:

• Static and awkward postures
• Twisting and leaning to one side
• Leaning forward
• Slouching

Safe working from the vehicle – tips for workers

Ideally workers should not work in the vehicle, for example by getting out to make phone calls, and walk at the same time. Where working in the vehicle cannot be avoided, a leaflet published by Loughborough University provide some practical tips^[42](table 2)

A general advice for workers: Avoid working from the car, find a more suitable place to work (e.g. cafe, rest area).

Table 2: Working from the vehicle – Tips on how to help minimise this risk (adapted from guidance from Loughborough University)

Back care, fitness and health promotion

Driving is a stressful job, due to heavy traffic, prolonged sitting in static position, stress from loading and unloading, poor work organisation and more. A large number of driver related risk factors are related to health: stress, sleepiness, distraction, unhealthy diet, alcohol abuse, smoking, lack of exercise, etc. (go to Driving for work)^[43].

Employers have a duty to ensure that staff are fit for work, including for driving. Driver wellbeing and promotion of fitness should be considered, including:

• instruction by medical professionals on improving posture whilst sitting in the driving seat, learning how to stretch muscles and reduce muscular tension;
• stress management courses;
• voluntary physical fitness programmes
• facilitate exercising to prevent MSDs: e.g. In-cabin fitness training with gym accessories, stretching exercises, yoga for truck drivers
• support healthy lifestyles, e.g. balanced nutrition

There are several things drivers can do to take care of their back and prevent back pain:

• Regular physical activity will help keep the back strong and flexible. Workers should add moments of activity into their schedule, e.g. by taking the stairs instead of the elevator, cycling to work, walking 20 minutes
• Maintain a good posture. Poor posture can strain ligaments in the back. Learning and practising good posture can help prevent back pain. Use safe lifting techniques

Good practice examples

Managing risks to drivers in road transport (EU)

This EU-OSHA report presents a number of case studies showing examples of initiatives and interventions that have been implemented to manage OSH risks in road transport. The cases featured in this report cover a number of different risks to occupational drivers such as ergonomics,

loading and unloading vehicles, whole body vibrations, violence, stress and health promotion. The cases were collected from throughout Europe, sourced from national and international passenger transport organisations and road haulage organisations, government organisations and NGOs, accident prevention organisations, occupational health and safety organisations, government transport ministries and agencies, trade unions and trade associations.

A number of cases focused on issues to improve the ergonomics of the driver’s working environment. They include correct seat adjustment, and ergonomic and technologic improvement of the driver’s cabs^[45].

Taxistars.eu - Training for taxi drivers (EU)

The project Taxistars.eu, funded with support from the European Commission, developed an innovative ICT-based learning programme tailored to taxi drivers. The consortium of the project consists of nine partners from eight EU Member States (Austria, Belgium,

Cyprus, Finland, Germany, Greece, Italy and Spain). The aim of the project was to improve the professional training in the taxi-sector and to ensure a safer, more effective, competitive and high quality road transport system in the EU.

Modul 2 deals with ergonomics and focuses on following topics:

• Ergonomic and driving - Do you know how to avoid repetitive driving injuries?
• Correct driving position - Seat adjustment: Why does it matter and how is it done?
• Seat belt - What’s your reason for not wearing one?
• Lifting and loading - Lifting safety: how to prevent back injuries
• Each chapter is accompanied with self-reflection questions.
• The training programme is available in seven languages and is accessible on mobile devices

The training programme is an attractive and easy to use tool. It is available at the e-learning platform as well in as smartphone/tablet training application. The training programme is available in seven languages^[46].

VeSafe (EU)

VeSafe interactive e-guide was commissioned by the European Commission. The consortium of the project consists of partners from six EU Member States. VeSafe provides many good practices as well as an overview of relevant regulations and information in three key aspects of vehicle risks:

• safe driving for work
• workplace transport safety
• working on or near a road.

Currently the e-guide includes two good practice examples related to ergonomics^[35].

Vehicle Ergonomics - Best Practice Guide (UK)

Loughborough University provide guidance on their website ‘Driving Ergonomics’^[47] on a range of issues associated with driving. These can be used by organisations to help manage and minimise the risk of driving-related musculoskeletal troubles. Poor seated postures are generally considered to contribute to musculoskeletal pain. The vehicle ergonomics best practice guide helps drivers to adjust their seat, allowing for a better overall driving position. The guidance consists of eight pictures including short explanations and tips. Following the posture guide make sure that drivers are sitting correctly^[48].

Stay fit – join in! (Bleiben Sie fit-machen Sie mit!) (DE)

Bus drivers are sitting in the same position every day for eight hours. They suffer from pain in the back, neck, arms and legs. The German statutory accident insurance VBG provides tips for bus drivers on how to stay fit and on how to prevent back pain. Drivers who sit for a long time in the bus need breaks with exercises. This brochure gives useful tips for exercises. Pictures show the exercises: start activities – three minutes for your back and arm - two minutes for your legs –calm down in two minutes – relaxation^[49].

Stay fit on long trips (Fit auf langen Fahrten)

Truckers spend so much time on the road that it can be difficult to get exercise in. The statutory accident insurance for the transport sector published a guideline with exercises and steps that truck drivers can take to stay fit. Drivers will find short exercises to work out in the cab, around the truck, while brushing teeth, and stretching exercises while lying in bed^[50].