Why driving can be a pain in the back
In many organisations, the most comfortable company cars are provided for the most senior members of staff. But recent research shows that investing in appropriate cars for the more lowly, high-mileage salesperson is likely to pay dividends by reducing days lost through back pain. Research by three ergonomists, Professor Mark Porter and Dr Diane Gyi of Loughborough University and Helen Williams of the HJ Consultancy, Marlow, has found that lower-back pain is a problem for high-mileage business drivers. Their most recent study, Reducing back pain in high mileage business drivers,1 was one of 19 pilot projects funded by the Department of Health and the HSE as part of the "Back in work - developing good practice" initiative.
The researchers found that in most companies studied, more than half of high-mileage business drivers reported having lower-back pain in the previous 12 months. Causes included:
The researchers have used the results of the study to produce recommendations for managing the health and safety of business drivers, particularly high exposure drivers (those who cover more than 25,000 miles a year or drive for more than four hours a day).2 To maximise health and safety benefits, they say it is imperative that good and comfortable postures are adopted in the car: drivers should adopt a range of driving positions and make frequent changes to help delay the onset of discomfort. Poor posture leads to wear and tear in the spine, which can leave it vulnerable to injury.
Policy and risk assessment
In managing the health and safety of company drivers, the researchers advise employers to look at individual company car policies, risk management, use of the car as an office and lifestyle. They suggest that employers make a company car policy - covering driver exposure and general health and safety, fitness for work and training (see box 1) - an element of an organisation's main health and safety policy.
Determining fitness for work should include the regular use of risk assessments. The project team recommends a three-stage filter system to identify "at-risk" drivers and to ensure urgent action. The first stage uses a questionnaire for all drivers. This includes a driving discomfort chart, which allows the respondent to identify the degree and location of discomfort, and asks questions on driving exposure (hours/miles), the use of the car as an office, medical history and lifestyle. Those drivers identified as being more "at risk" move to the second stage of the process.
Drivers who have high exposure (at least 25,000 miles a year or more than four hours a day) or who are already experiencing driving-related discomfort undergo a detailed risk assessment interview. This checklist-driven interview covers anthropometry (the measurement of the human body), posture and seat design, and enables the assessor to identify drivers in need of urgent action (the third stage of the process). These will be drivers with severe pain or a medical history of lower-back injury, with an inappropriate car, high driving exposure or other risk factors.
Drivers in this category will need continuous support until their risk is deemed to be low. Risk reduction can include: additional training; medical input; reduced exposure to driving; a change of car; change of daily tasks; a change of lifestyle; and specialist advice (eg ergonomist, physiotherapist). Assessments need to be regularly reviewed and updated, for example on receipt of a different car or a change of tasks.
The car as an office
Using the car as an office can lead drivers to adopt postures that exacerbate back pain. To reduce the chances of injury, the researchers recommend that, generally, drivers should avoid static and awkward postures, twisting and leaning to one side, leaning forward, slouching and letting the lower back flatten, and reaching with the arms outstretched. For example, if a laptop computer is used on the passenger seat, the driver is forced to twist and stretch to use it. Similarly, carrying out paperwork can lead to poor posture, with drivers leaning forward to write on their lap. The researchers recommend that alternative and suitable work environments be found where good postures can be adopted.
The researchers identify several other office activities that can increase the risk of driver back pain. For instance, drivers should not have to stretch to reach a mobile phone cradle. If a "hands-free" mobile phone kit is fitted the cradle, microphone and speaker should be positioned to encourage good posture and the phone should only be used when the car is stationary and parked. Also, drivers should not have to twist and lift with arms outstretched. To avoid this, equipment should not be stored on front and back seats or in footwells. All equipment should be stored in the boot, so that people don't have to twist to get out of the car. Manual handling should be avoided where possible: if unavoidable, the risks should always be assessed beforehand. When lifting equipment into and out of the boot, the driver needs to be able to stand close to the load, and stretching should be minimised by ensuring loads are secured as close to the boot sill as possible. Drivers should park close to the "drop-off" point; if a load is carried for an excessive distance, physical stresses are prolonged, leading to fatigue and an increased risk of injury. Extra care is required after long journeys and in cold temperatures.
Driver actions
The Highway Code recommends that drivers take a break of at least 15 minutes after two hours at the wheel, although it may be necessary to take more frequent breaks to avoid discomfort. When drivers stop for breaks, they should change their position, for example by getting out of the car and walking about.
Drivers should also be aware of the influence that lifestyle can have on the risk of lower-back pain: a "pain-free" back is dependent on many factors, including good posture and regular exercise, and it is important to maintain basic fitness. The researchers recommend that drivers assess their lifestyle so as to be aware of non-work-related risk factors (employers can help by providing information on good practice). For example, exercises help keep muscles toned and joints mobile - the researchers refer to an exercise leaflet produced by the Chartered Society of Physiotherapy (CSP), Don't be a statistic - look after your back, although they add that qualified medical advice should be sought on which exercises should be undertaken. The CSP has also just published a leaflet summarising the advice given on the website, Take the pain out of driving.3
The researchers stress the importance of drivers "listening" to their bodies and not driving when experiencing discomfort. If drivers feel discomfort, they should inform the appropriate person within their company and see their GP.
Car selection
The research highlights factors that employers should consider when selecting vehicles for company drivers.
Continuing support
The management of lower-back pain in drivers does not stop with the selection of an appropriate car. On delivery of a new car, the driver should be given:
If the car proves uncomfortable, the company needs a system to ensure a suitable alternative is quickly allocated to the driver and further test-drives are undertaken to check that the alternative vehicle is suitable.
In practice
"Driving is an unusual task because very few people regard the car as a workplace," says Porter. "However, our discussions with the HSE make it clear that they should, and that risk assessment should include the risk of chronic musculoskeletal pain." In the study, the researchers worked closely with 11 companies, which were provided with training on the use of the risk assessments. The team also pointed out that spending a few hundred pounds on a fully adjustable seat and steering wheel could have financial benefits in terms of reduced sickness absence.
The researchers stress two important points in relation to car selection: the need for adjustment to accommodate different sizes of driver; and that there is no perfect posture - a driver needs to be able to adopt a variety of good postures. Adjustment is useful because it allows a driver to modify posture during driving, and this is easiest using electronic adjustment controls.
The work with the companies, insist the researchers, changed attitudes. Drivers reported greater awareness of the musculoskeletal risks of driving and changed their behaviour accordingly. For example, some stopped doing paperwork in the car. Many fleet managers said they had been unaware of the issue of lower-back pain in drivers before the research started. Some said they would introduce risk assessment for all drivers, while others said they would do it for all drivers who reported back problems or for all drivers who drove more than 25,000 miles a year.
"We got a variety of responses, all encouraging," says Porter. "But it would be nice to get some additional funding to be able to go back further down the line and see how useful the work has been." This would involve evaluating the effectiveness of the work undertaken to date, and establishing best practice for drivers. The team will continue disseminating the results of their research through driver clinics, individual driver assessments and through their website.
Porter also has a message for manufacturers: "Cars should be highly, and easily, adjustable. Unfortunately, this slots straight into the executive model category. We hope that in future, manufacturers will provide high adjustability across their model range. There are signs that this is starting to happen."
1www.signupweb.net/Project_Summaries/Driven_to_Agony.htm
3The Chartered Society of Physiotherapy, 14 Bedford Row, London WC1R 4ED, tel: 020 7306 6666, fax: 020 7306 6611, www.csp.org.uk .
4www.drivingergonomics.com, go to "Posture", go to "Initial position and posture guide".
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The researchers suggest that employers draw up a company car policy and include it within the general health and safety policy. The company car policy should include the following. Driver exposure and general health and safety
Fitness for work
Training
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