Manual handling injuries at the gym
Working out at the gym is everyones business from education to big companies. In the US, schools have introduced physical activities such as weight training in their daily program. This is because researchers agreed that children doing physical exercises often have better grades at school. Big companies have found out that healthy employees are more productive and so pays fitness club for their employees.
Like a phoenix, gyms have been reborn a number of times with names like weight rooms, fitness rooms and gyms which overlapped over and over again. Gyms were originally found in unhealthy neglected neighbourhood, located in wet basements, with poor lighting and ventilation leading to a strong smell of dried sweat and unsanitary condition. For decades, this was the bad image associated with gyms until the end of the 1960’s and certainly was no place for women to set foot, but this has certainly changed with recent technological development with fitness equipment on the front scene making it hardly recognisable to people still living into the old stereotype. This firstly changed by giving members new activities like running, cycling and walking which traditionally was considered as outdoor activities, today’s gyms offer state of the art equipment with digital readout displaying exercising programs, duration and intensity of exercise, calories burned etc. The atmosphere itself has drastically changed, from a badly lit smelly place, to an air conditioned atmosphere with good lighting, nice sound system, mirrors on the wall and TV showing how to exercise have made gym a pleasant and user friendly place to work out. Due to these improvements, the clientele which were mostly composed of muscle bound hulks has diversify into a recreational area for gentlemen, ladies, teenagers and elders wanting to keep fit but also a place for rehabilitation of individuals after an accident or illness. Today gyms is a $12.2 billion a year industries according to statistics from the International Health, Racquet and Sports club Association (IHRSA) and it is especially developed in the US where one corporate opens branches of gym in each states. An example of this is The Bally Total Fitness chain. It has more than 400 clubs around the US, 4 millions of customers and yearly revenue of about $1 billion. Statistic in the US shows an increase of gym members from 20.8 million in 1992 to 33.8 million in 2002. Western Europe such as Germany and England shows the same trend with a business estimated of $5 billion per year. The common age group found in gym in the US are 35-54 years with a percentage of 36.5%, 18-34 years with a percentage of 31%, 55 and above years with a percentage of 22.5%, 12-17 years with a percentage of 6% and 6-11 years with a percentage of 4%. (Yigal Pinchas, 2006).
Benefits of physical activity in gym
Physical activity in gym helps promote physical fitness for our body that is increase in cardiovascular endurance which strengthen the muscle of the heart and blood vessels when using treadmill and bicycle, promote bone density and makes then more solid as the weight put stress on the bones which in response increase their density to make them more solid and so prevent diseases such as osteoporosis (Osteoporosis happens when the bones decrease in mass making it more fragile), increased muscle mass not only increase our strength but also makes us burn more calories as lean muscle mass fires up our metabolism during work out and even after as the body needs energy to maintain this new muscle mass (Shawn LeBrun, 2002; Yigal Pinchas, 2006).
The gym population comprises of everyone from children, adolescents, adults to seniors. These groups of people have different goals for training in gym from trying to keep fit and control body weight to conditioning the body to perform at its highest level in competition so it is not uncommon to see professional sports men to workout at the gym at the same time with people doing rehabilitation exercises. (Yigal Pinchas, 2006)
Cases of gym accidents:
With the increase number of people going to gym, the risk of accident happening in them increased. Gym injuries can range from minor injuries such as small superficial cuts and bruises to severe sprain and strain, crushed body parts and rarely death. Weight room injuries has wake public awareness when a University of Southern California American football player star was injured to his throat and was lucky to survive when his bench press bar slipped from his hand and fell on him. Mr Stafon Johnson received a load of 275 pound nearly 125 kg on his throat and had to undergo multiple neck and throat surgeries. He couldn’t speak for months because of his injuries. Another severe case of injury happened when another American football player nearly got his fingers ripped off while training in the weight room ( Josh Staph, 2010). Reed Remington was doing shoulder press with a load of 165 pound (75 kg), when he found out he didn’t have enough strength to push it up from head level, he arched his back to try to lock it out but lost balance while doing so, so he tried to throw the weight bar in front of his head but ended up having the bar hitting his head while falling down, his right hand got caught between the weight and the apparatus holding the weight which crushed his index finger and ripped it off. After surgery, Reed Remington had to stay at hospital for five days and 3 weeks at home for recovery (Tim Rogers, 2010).
Cost of Manual handling injuries:
Manual handling of loads is describe as the action of lifting, pulling & pushing, moving, lowering, holding and carrying any objects using the force generated from the human body.
As seen above, weight training injury takes a lot of time to heal up, leading to temporary impairment and sometimes permanent disabilities if the injury is severe. This affects the income of a working people, his social life and family life and the company currently employing him.
With gym getting more popular these days, more and more people are adopting weight training in their lifestyle. According to a statistic report published in THE NEW YORK TIMES, weight training injuries are on the raise due to it gaining popularity and trainees dropping their weight where they shouldn’t. From year 1990 to 2007 data collected shows us that nearly one million Americans end up at emergency section in the hospital due to weight lifting injuries and that a yearly increase of 48 percents were noticed in that period. According to The American Journal of Sports Medicine, of the 970,000 people injured, 82 percent were men but this trend is changing, number of injuries among women doing weight training is on the rise yearly with 63 percent as opposed to men which is 46 percent. This may be due to the increase of women adopting gym training in their lifestyle. People between the age 13 to 24 recorded the most number of injuries but concern is rising with people between 45 to above as they have recorded the greatest increase of weight training injuries as many of them want to delay or regain the muscle loss due to ageing (Jane E Brody, 2010)
The most common injures encountered among women were in the region of their feet and legs while in men the majority were in the region of the torso and hand. Fractures were mostly reported among women while men suffered more from sprain and strain. Most of the injuries encountered were by dropping weight on themselves with body parts being crushed or by getting hit by the equipment they are exercising. Loss of balance, overexertion and muscle pull formed 14 percent of injuries which were treated at emergency rooms and 90 percent of the injuries happened while using free weight than weight machine (Nicholas Bakalar, 2010)
In Mauritius the average income of workers is about Rs18,247 monthly according to a survey done by the Mauritius Employers’ Federation. (Nilen Kattany, 2011). This have give rise to different gym service facilities offered to Mauritian across the country. They are categories by the number of service they offer, from new sophisticated ergonomic well maintained state of the art weight machine, free weight and coaching system, sauna facility, air conditioned room, good lighting to old out of fashion weight machine from the 1960, Weight machine constructed by owner of the gym by welding iron bars which sometimes isn’t ergonomic for everyone as it isn’t adjustable, bad flooring as the owner hasn’t repaired the floor which was damaged by dropping free weight on it which create a risk of slip, trip and falls , no coaching system such as municipal gym multi sport complex where you have the weight machine and free weight but no one to spot you which can lead to accidents for example being crushed under a bench press bar, coaching system but with unqualified coach, congested areas where there are too many members training at the same time and you have the risk of being hit by someone training with a weight while moving around and poorly maintained weight machine. Gyms offering good services are quite expensive in Mauritius with a monthly membership fees of Rs1000 to more so most Mauritian (especially teenagers due to their low income) prefer to train in gym offering low to medium services where monthly fees may range from free (Municipal Gym Multisport complex) to Rs 900 making them more exposed to weight training injuries.
Aim and Objectives:
To minimise the risk of manual handling injuries in Weight training Gym.
To identify the risk elements contributing to manual handling injuries in weight training exercises.
Identify common weight training exercises which has a significant risk of bodily injuries.
Assess the risk of bodily injuries due to gym environment, individual factors such gender and age
Give recommendation to minimise the risk of the accidents.
Manual handling of loads is describe as the action of lifting, pulling & pushing, moving, lowering, holding and carrying any objects whether lively or dead by using the force generated by the human body.
The Occupational safety and health act 2005 (OSHA 2005 )
The Occupational safety and health act 2005 points out the legal requirement for health and safety that an employer has to abide. Although OSHA 2005 focus mainly on employees, it is the duty of the employer to ensure that people other than his employees are not affected by health and safety issues arising during operation of his business
Section 5 General duties of employers:
According to section (5)(2) General duties of employers, the employer shall, so far as is reasonably practicable, ” provide and maintain a safe working environment”, “provide and maintain any plant or system of work”, “maintain any place of work under his control that is safe and without risks to health”, “ensure that use, handling, of articles is safe and without risks to health” and “provide information, instruction, training and supervision as is necessary to ensure the safety and health at work of his employees”.
Section 10 Risk assessment by employer:
Section 10 of OSHA 2005 stressed out the legal obligation of an employer to carry out a risk assessment. “Every employer shall, within 30 days of the start of operation of his undertaking, make a suitable and sufficient assessment of any risk to the safety and health to which any employee is exposed whilst he is at work”, “and any risk to the safety and health of any person not in his employment”.
Section 84 Manual handling operation:
According to this section, every employer shall (a) so far so far as is reasonably practicable, avoid the need for his employees to undertake any manual handling operations at work which involve a risk of bodily injury (b) where it is not reasonably practicable to avoid the need for his employees to undertake any manual handling operations at work which involve a risk of bodily injury-
take appropriate steps to reduce the risk of bodily injury to those employees arising out of their undertaking any such manual handling operations to the lowest level reasonably practicable.
take appropriate steps to provide any of those employees who are undertaking such manual handling operations with general indications and precise information on the weight and nature of each load to be handled.
provide sufficient training in the safe techniques or methods of manual lifting and handling to any employee who is required in the normal course of his work regularly to lift, carry or move loads exceeding 18 kilograms for any employee
Section 84 (3) defines manual handling as any transporting or supporting of a load, including the lifting, putting down, pushing, pulling, carrying or moving thereof by hand or by bodily force. This definition reflect exactly the exercises practiced in weight training exercises.
Although these legislation focus mainly on employees, it is the legal duty of the employer to ensure the safety and health of any visitors visiting the workplace. By applying these measures to the gym, it will not only affect the health and safety of the employees but also have an impact on the visitors which will reduce the likelihood of fines and any civil prosecutions due to injuries. According to OSHA 2005, the maximal penalty under this act is RS75,000 and a maximum of 1 year imprisonment.
In this subsection, we will go into detail about the different types of people frequenting the gym, They are divided into different age group and needs to train in gyms. They are namely children, adolescents, adults, seniors,
Children are described as someone under the age of twelve. Children before this age weren’t allowed to workout in gym in the US as there was fear that children practicing weight training would be prone to injuries such as damaged growth cartilage which would stunt their growth. Research done by Docherty, Wenger, Collis, & Quinney, Hetherington also concluded that weight training at this age was futile as none of their research could demonstrate any adequate increase in strength and muscle mass from test subject doing weight training at this age. Their theory for this result was it was because children lack sufficient androgens in their blood at this age (Androgen is the hormone responsible for the development of skeletal muscle mass). Theory about children being at more risk of injuries when practicing weight training was confirmed by report published by the US Consumer Product Safety Commission in the year 1987 which found out that of the 8543 weight training related injuries most of them were younger than 14 years old. But recent research done by Faigenbaum, Milliken, Moulton, & Westcott in 2007 discovered that properly designed resistance training exercise (weight training) for children and adolescents increased their muscle strength and decreased the likely hood of injuries and that data from previous research was inaccurate as training exercises use to collect data was for adult. (Aleksandar IgnjatoviÄ‡ et Al, 2009). Doing weight training at this age proved to contribute for better posture, improved self confidence, contribute to improve motor abilities and intramuscular coordination. These data proved to be much relevant when we realise that children school back pack bags that they carry weights approximately 32 percent of their total body weight so training at gym will help consolidate the weaker muscle group and help them in their daily life. Before starting any exercises, the child should be examined by a physician to determine its physical condition. Training at this age should be strictly supervised, light weight should be use until he or she learn the proper techniques, add weight slowly when 8 to 15 repetition is performed easily and exercises should be design to work all muscle groups and be performed to full extension of joint movement. To gain strength, workout should at least be 20 to 30 minutes long and be done 2 to 3 times weekly with gradual increase of training weight or repetition when strength of muscle improves. Due to skeletal and physical immaturity children should avoid any form of competitive weight training such as bodybuilding, power lifting, weight lifting as they would be tempted to lift maximal weight to compete. (PEDIATRICS, 2001; Yigal Pinchas, 2006 )
Adolescent is described as someone between the age of 12 and 17 years old. Physical activity at this age is crucial for achieving the optimum development and growth potential of the body. This is because after these ages, the skeletal system will start to hardened and will be less stimulated by physical exercises and development of the skeletal system will stunt even if weight training exercises is used. Strength training at this age can be done with free weights, weight training machine and by using the body own weight. Strength training at this age must be strictly supervised such as frequency of training, types of exercises done, intensity and duration of exercises to ensure strength increase of the adolescent and minimum risk of injuries (Yigal Pinchas, 2006) . At this age, muscle size, strength and power are lost easily after 6 weeks of total rest so maintenance exercises is a must so as to conserve progress. Adolescent strength training can improve the athletic performance in sports such as American football where strength and size of body matters. Despite theories that strength training helps to reduced or stop sport related muscular skeletal injuries in adolescent scientific research have failed to confirm it but recent research suggests that there is a possible reduction in sports-related knee ligament injuries in teenage girls when strength training is combined with plyometric exercises. (Pediatrics, 2008) The National Electronic Injury Surveillance System (NEISS) use by the US Consumer Product Safety Commission has estimated from year 1991 to 1996 that 20 940 to 26 120 injuries happened annually in individual less than 21 years old. Data collected from NEISS and other studies reported that 40 to 70 percent of the injuries were from muscle strain and most muscle strain occurred in lumbar back area. Before starting any exercises, the adolescent should be examined by a physician to determine its physical condition. Training at this age should be strictly supervised, light weight should be use until he or she learn the proper techniques, add weight slowly when 8 to 15 repetition is performed easily and exercises should be design to work all muscle groups and be performed to full extension of joint movement. To gain strength, workout should at least be 20 to 30 minutes long and be done 2 to 3 times weekly with gradual increase of training weight or repetition when strength of muscle improves. Due to skeletal and physical immaturity adolescent should avoid any form of competitive weight training such as bodybuilding, power lifting, and weight lifting as they would be tempted to lift maximal weight to compete (PEDIATRICS, 2001). Most adolescents in Mauritius are influence by western cultures where muscular bodies are seen everywhere in movies or advertisement. More are them are tempted these days to engage in weight training and prefer to go in low services gym as they don’t have enough money, common problem in these gym are they are not supervised and adolescents want rapid results where they lift weight without learning the proper lifting techniques and often exaggerate on weight size to gain muscle quickly which most of the time lead to serious injuries such as back problems.
Most of the adult that come to work out in gym do so to keep fit as they have come to accept that exercises is necessary to have a sound physical and mental health. At this stage the body is fully developed and ready to accept complex training, increased load, frequencies and duration of exercises (Yigal Pinchas, 2006). With most people working in offices these days and health problem such as overweight and cardiovascular problem at their doorsteps, physical activity has become very important these days. According to the Centers for Disease Control and Prevention (CDC) about 600,000 people died of heart disease each year in the US, in Mauritius, concern is rising about heart diseases when diabetic and obesity which always leads to heart problem is on the rise (CDC, 2013). Since 1987, Mauritius has recorded an increase of 60 % of diabetic among adult. Nearly half of Mauritian between the age of 25 to 74 is either diabetic or pre-diabetic (Mauritius News Team, 2010). Weight training is one of the solutions to the problem as it can reduce fat by increasing the metabolic rate of the body on short and long term. This is due to the fact that weight training builds lean muscle which metabolise fat in the body to grow. But weight training can also cause injuries if done carelessly. According to data collected from 100 emergency departments, men were more injured than women from weight training exercises (82.3%). This may be due to the fact that more men lift weight than women. Most of the injuries happened due to free weight (90.4%) and most of these injuries happened when the users drop the free weight on themselves or hit themselves by mistakes while using it (65.5%). The upper trunk and lower trunk were the most injured body part on men with 25.3% and 19.7% respectively. The most common diagnostic resulting from these injuries was sprain and strain with 46.1%. Women suffered more from foot injuries and fractures than men. (Zachary Y. Kerr et al, 2010).
At this age where muscle loss and other illness such as osteoporosis and cardiovascular diseases happens gradually with ageing, physical activity is a must in order to keep the body fit and away from these illness. At this age working out using weight is a good way to increase muscle mass and reduce fats in the body while in the same time increase bone density to combat some of the osteoporosis and loss of balance due to weakened muscle. Exercises should be supervise by a qualified instructor as frequency, intensity, number of repetition, duration of the exercises and type of exercises would be different from those of the other age group. Senior should always consult a doctor before doing any form of exercises due to the fact that most of the time they have orthopaedic issues such as joint problem and cardiac problem and special type of exercises should be designed for them to eliminate any exercises that can pose a health risk. Senior should visit gym 3 times weekly to gain adequate strength and a rest time of 48 hours between sessions. Exercises should be design so as all muscle groups and joints are trained equally per week, duration of session should be at least 20 minutes but no more than 45 minutes. When progress in strength is seen, repetition or weight should be added in each exercise. But due to orthopaedic and cardiac problem, weight addition could be a problem so other factors like repetition could compensate this problem (Darryn S. Willoughby, 2009). According to statistic, the number of injuries among old people is on the rise. Most of the injuries happen while they used weight training machine. The most common injuries were overexertion and while doing exercises that involve pulling and lifting exercises.
ANATOMY AND PHYSIOLOGY:
To understand how these different types of injuries occur and how to prevent them, we must understand how the human body work.
Anatomy of the spine
The spine is a column comprising of different material namely bones, tendons, ligaments, muscles, cartilages and nerves all assemble together to form a very strong yet flexible structure in areas such as the neck and lower back.
(Wikipedia, 2006)C:UsersDavidDesktopgymNew folderGray_111_-_Vertebral_column-coloured.png
The lumbar spine is in the lower back area where the 5 last vertebrae the L1 to L5 bones are found like seen in the picture above. The vertebrae are the 33 bones in the shape of a disc that connects together to form the vertebral column, the vertebra has a hole in the middle where the spinal cord passes through and so acts as a protection and support. The lumbar spine bears the load of the body and absorbs any stress from movement such as lifting or carrying heavy objects. This is why the vertebra bones are bigger in this area.
Each vertebra sits and is separated by an intervertebral disc and prevents the rubbing of these bones. The intervetebral disc has 2 layers the outer ring called the annulus and the inner ring called nucleus. The annulus is made of fibres bands criss-crossing each other and attaches both the upper and lower vertebrae together. The nucleus, the inner ring is filled with a gel like substance called the nucleus and act as a cushion between both vertebra. The intervetebral disc function like coil spring where the annulus compress both vertebrae together and the nucleus being and uncompressible liquid push the vertebrae away so a gap between both vertebrae is formed. This gap allows the nucleus being uncompressible to work like a ball bearing where the vertebrae roll on it and so making the vertebral column flexible. With age, the intervertebral disc loses progressively the ability to absorb the liquid making the nucleus and so it becomes flatter and brittle resulting in loss of height (Tonya Hines, 2013)
C:UsersDavidDesktopgymNew folderPE-AnatSpine_Figure4b.jpg C:UsersDavidDesktopgymNew folderPE-AnatSpine_Figure4a.jpg
Why back injuries occur?
Most of the time, back pain injuries occur due to injuries and degeneration of the intervertebral discs. Degeneration happens due to wear and tear of the intervertebral discs while doing movement such lifting heavy weight, bending over which put stress on the disc. While doing these movements, compression of the intervertebral disc happens and can move the disc toward the spinal cord and surrounding nerve. This displacement results in the compression of the spinal nerve and put strain on nearby ligaments which causes the back pain. Movement where both twisting and bending occurs put more stress on the spine