Challenges of Diagnostic and Statistical Manual of Mental Disorders (DSM) Standards

Emotional wellness is an intricate cooperation between organic, mental, and social factors, any of these can fortify or debilitate a psychological issue (Nolen-Hoeksema, 2010). Psychological well-being specialists and professionals have differed for a considerable length of time over the propriety of utilizing the Diagnostic and Statistical Manual of Mental Disorders (DSM), to characterize and analyse dysfunctional behaviour. This article will intend to discuss how appropriate universal standards – in particular the DSM – is in the definition and diagnosis of mental illness. Inside the paper will be substantial and clear supporting proof regarding why it is a valuable apparatus, alongside basic investigation about why it is maybe not the most suitable instrument, because of inclinations and defects that it contains. Significant research proof will be given where suitable, with the end condensing all substance and giving a substantial response to the inquiry posed.

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Mental Illness can be seen from a wide range of perspectives, no single model of mental distress can totally clarify the ailment, to completely comprehend a person’s troubles, a few perspectives are normally considered (Bhui and Bhugra, 2002). Models, for example, Supernatural, Biological, Diathesis Stress Model, Biopsychosocial, or Moral Theory, all hold substantial clarifications with regards to the causation of psychological maladjustment. The establishments of the present characterizations in DSM 5 depend on Emil Kraepelin’s hypothesis, that the starting point of psychological sickness is a natural and hereditary breakdown, he characterized several clutters, in view of manifestations, and assembled them as per shared symptomatic examples (DeVries, Muller, Moller and Sausgstad, 2008).

The DSM sketched out inside this report depends on the Biological/Medical model, this argues that there is a natural or physical reason for the confusion recognized (Deacon, 2013).

Pioneer and Rodgers (2014) guarantee psychological wellness and trouble is impacted in 2 different ways, through pop culture for example regular language, media, writing and so forth, that are devoured by a large portion of a general public’s populace, and through expert talks, the language utilized by experts.

It has been contended that dispositions to mental health mirror an absence of comprehension and learning of what mental trouble is (Quinn, Williams and Weisz, 2015). Along these lines, instead of simply depend on clinical judgment, the DSM is utilized as an optional apparatus. There is additionally disarray encompassing Mental Disorder through the differing wording utilized. Psychological well-being; Mental Illness and Mental trouble are altogether utilized conversely yet get from altogether different points of view. Experts are no less insusceptible to societal impact or preferences about practices, and it is guaranteed that recognizing this is simply the initial step to turning into a mindful specialist who can distinguish and review any biased convictions and avoid misdiagnosis (Corrigan, 2004).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) was first created in 1952, by the American Psychiatric Association, it is an order framework to help Mental Health clinicians to convey utilizing a mutual demonstrative language. This manual is accessible for all clinical, instructive and investigate people, to help them in sketching out, diagnosing and conveying the most proper treatment to people who are experiencing a Mental Disorder. (American Psychiatric Association, 2013).

The DSM goes about as a guide, to aid the right determination of dysfunctional behaviour, by sketching out explicit criteria that connotes side effects of psychological well-being issue, this utilized with clinical judgment, analyse and enable treatment to start, similarly for the conclusion to be exact a few side effects of certain disarranges must not be available for finding to happen (Nolen-Hoeksema, 2010).

Right now, the DSM is in its fifth release, containing more than 400 illness’. It has experienced numerous modifications since its first distribution with some ‘new’ illness’ included and others excluded, a few scientists guarantee such amendments are fundamental, to reflect changes in the mental and psychiatric professions alongside societal change. It has been contended anyway that the proceeding with development opens the entryway for misjudgement and could conceivably analyse a regular issue in a person, to a genuine issue requiring treatment (Kawa and Giordano, 2012). One of the most outstanding explanations behind the ongoing update was the drive to guarantee better arrangement with the International Classification of Diseases (ICD) utilized by the World Health Organization (Regier, Kuhl and Kupfer, 2013).

Even though there are numerous substantial reactions of the DSM, there is equivalent help for its utilization, and the guideline for what it stands. Given that Mental Health issues are on the ascent in the public arena today, having such a demonstrative guide accessible to wellbeing experts is important in the finding and treatment of influenced people. Even though blemishes are clear, it is yet the most valuable instrument accessible to clinicians now (First, 2010).

Numerous endeavours have been made to group emotional well-being conditions, for example, Brain science: surveying synapses (Suris, Holliday and North), or, frameworks estimating the mental elements of character (Katon and Walker, 1998; Bech, 2016; Blagov, Patrick, Oost, Goodman and Pugh, 2016). Be that as it may, they demonstrated to be fruitless in working in certifiable conditions (Stein, Lund and Nesse, 2013).

The DSM manual without a doubt consolidates tremendous pragmatic learning in a valuable arrangement that regardless of the defects, plans to diminish the weight of enduring because of mental issue. The all-inclusive utilization of the DSM additionally considers specialists to grow further medicines for different mental issue, with the consequences of such medications commonly shared crosswise over callings, such proof-based medications are more vigorously depended upon than when they are not exactly tried (Clark, Cuthbert, Lewis-Ferandez, Narrow and Reed, 2017). Likewise, the experimental information gave from such medicines is priceless to seeing such ailments.

The production of the DSM helped people and patients to even more likely comprehend mental issue and how indications show, present and in the long run are dealt with, diminishing the boorish practices and marks of shame that were encompassing psychological sickness at the time (Mayes and Horwitz, 2005). Thusly the DSM features the difficulties looked by human services experts in diagnosing and treating psychological maladjustment, with Wittchen, Jacobi, Rehm, Gustavsson and Svensson (2011) detailing that every year 38.2% of the populace in Europe experience the ill effects of a psychological issue, when contrasted with results with earlier years, with higher outcomes mostly because of the consideration of new issue, they further case that over 33% of the complete populace experience the ill effects of mental issue yet short of what 33% get any treatment which subsequently affirms the challenges experts face.

The advancement made in the neurosciences and brain research made the DSM have different amendments, such corrections are never last, they only mirror the best agreement with respect to investigate at the given time, such modifications are vital and help hold a typical global language of psychopathology (Ghaemi, 2014). The way that such amendments have occurred demonstrates the useful idea of endeavours to order a wide range of disarranges, characterizing and diagnosing mental issue can never be totally objective or dependent on science alone as there is an absence of natural markers in emotional well-being, just as analysis reflecting key social qualities.

The DSM 5 demonstrates a huge improvement in its treatment of culture contrasted with the past release, by supplanting ‘culture-bound disorders’ with three ideas; culture disorders, social phrases of pain and social clarifications of misery or saw causes. This helps the clinician in not just illustration from symptomatic experience, accessible classifications of sickness and the measurements that the disease may go, yet additionally perceives every individual’s emotional experience. This can possibly enable clinicians to maintain a strategic distance from the issue of misdiagnosis, improve helpful adequacy and explain social the study of disease transmission (Cummings, 2013). Besides, to address culture, the current DSM 5 gives rules in tending to social varieties, clinicians presently give more consideration to giving indications joined the learning of the way of life to which the individual has a place.

Be that as it may, despite such clear requirement for such an all-inclusive framework there are numerous reactions of the DSM that question its fittingness at characterizing and diagnosing dysfunctional behaviour.

The modifications themselves even though asserted are vital are regularly scrutinized by specialists, in that every correction sees no adequate changes made (First, 2017). One regular analysis all through is unwavering quality, paying little respect to modifications being made, dependability is as yet a critical issue. Rosenhan’s (1975) pivotal revelation into the dependability of determination lifted the cover on the likelihood of misdiagnosis, much research has been attempted into this factor with specialists guaranteeing concurrence on analysis ordinarily just achieving 70% or lower (Ahmedani and Perron, 2013; Frances, First, Pincus, Kutchins and Kirk, 2005; Hitchens, 2012). Frances and Widiger (2012) when amending DSM-IV reported that not at all like the past modifications’ analysis did not depend as solely on the agreement of specialists, it was progressively educated by and dependent on got experimental information. In any case, it is guaranteed that the conclusion understanding recently referenced achieving just 70% is because of the sufferer basically not revealing encounters to the clinician consequently derivations must be made, this frequently prompts callings naming the characterization framework as straight and engaging (Okasha, 2009). This additionally prompts examples of conduct being ‘medicalised’ with an absence of experimental establishing. Teacher Allen Frances straightforwardly asserts that over medicalisation currently happens, with different issue presently put under ‘umbrella’ terms, this is a sweeping term used to portray numerous gatherings of related things, for instance, Anxiety issue contains, Post Traumatic Stress Disorder, Social nervousness issue, Phobias and numerous others (Frances, 2013).

Numerous psychological issues converge into another, the DSM 5 attempts to address the issue of comorbidity, by fusing the dimensional methodology, as opposed to simply the clear-cut methodology however with Disorders, for example, despondency, tension co-happens almost 60% of the time (Lamers, Oppen, Comijis, Smit, Spinhoven, Balkom and Anton, 2011). A few side effects when exhibited appear in a wide range of determinations, for instance Sadness is recorded as a measure side effect in excess of 14 issue, the classes are not discrete enough to separate among scatters, and if comorbidity is clear it isn’t distinct that the right drug is being endorsed for the right issue. Also, the DSM is a geological guide of side effects that doesn’t immediate the expert to the genuine basic instruments that drive and keep up the confusion (Nolen-Hoeksema, 2010).

Emotional wellness treatment is the most astounding zone of spending in the NHS, with the financial expenses in England assessed to be around £105.2 billion every year (, 2018). In the United States of America, psychological well-being treatment is a trillion dollar business, to such an extent that an article rose in 2011 that connected the taskforce who were modifying DSM-IV to have direct connects to the pharmacological business, 56 % of board individuals had at least one money related relationship with the pharmaceutical business, and all the more alarmingly 100% of the ‘Temperament issue’s and Schizophrenia and other Psychotic Disorders board, had budgetary connections to medication organizations, in spite of the fact that they guarded such connections as simply a ‘necessity’ and ‘fundamental’ to medicines, despite everything it raises the likelihood of conceivable monetary consequences when gathering the manual (Cosgrove, Krimsky, Vijayaraghavan and Schneider, 2006).

There are various impacts of society and culture on Mental Distress, in this manner, the consideration accessible must be receptive to the social and social setting of racial and ethnic minorities (Snowden, 2012). A few parts of culture influence people with sets of side effects regular in their general public however not others, these are alluded to as ‘culture bound disorders’. Culture can impact whether the individual will look for assistance in the main case, and show how much disgrace is appended to analysis, it is in this way basic that the way of life of the individual and expert is perceived in characterizing and diagnosing psychological sickness (Nolen-Hoeksema, 2010).

Another normal discussion is the degree to which findings of psychological instabilities are widespread crosswise over societies. There are altogether different indicative practices over the world, an examination study looking over 47 American specialists and 52 Indian therapists was directed, they were solicited to rank manifestations from misery, lunacy and psychosis from side effect records imprinted in the DSM. The prerequisite was to rank indications from 1-10 with 1 being the most and 10, the least observed, the outcomes demonstrated that the Indian specialists appraised physical side effects higher than their American partners. Similarly, the Indian therapists positioned rough conduct and outrage above progressively unobtrusive indications of intense craziness (Jeffery, 2015). Research claims Asian patients are bound to report physical manifestations and not enthusiastic issues, supporting the view that people in various societies specifically present side effects of psychological instability in socially adequate ways (Sue, Cheng, Saad and Chu, 2012)

Ethic bunches all vary in clarifying conduct, a few side effects present in various issue are endured in one society, could be viewed distinctively in another and comparatively treated in an unexpected way. For instance, schizophrenia frequently can bring about visualizations, in some non-western societies visual or sound-related pipedreams with a religious substance are a typical piece of religious experience, saw from a western culture these side effects might be fundamentally the same as psychosis in any case, are regularizing to the patients’ sub gathering (Banerjee, 2012).

The clinician likewise can be affected in conclusion with express or understood inclinations, such predispositions can be oblivious, for example, stereotyping being utilized as a psychological alternate route. Cochrane and Sashidharan (1995) found that Afro-Caribbean settlers in the United Kingdom are multiple times almost certain determined to have schizophrenia than white individuals. Cohen and Wahl (2010) explored current writing on frames of mind of emotional wellness experts about dysfunctional behaviour, albeit just 19 studies were utilized, and uncovered a general uplifting demeanour to psychological sickness, proof of negative mentalities and desires were as yet obvious, especially identified with social acknowledgment.

Then again in a deliberate survey of 102 overall populace-based investigation of Attention Deficit Hyperactivity Disorder, critical varieties in predominance rates of the confusion crosswise over landmasses were accounted for (Canino and Alegria, 2008). Such varieties have been credited to the separation of instruments, strategies and definitions, which at that point prompts the explanation that if there is such an absence of indicative consistency inside one culture, the undertaking to accomplish consistency crosswise over societies is a troublesome one.

There has additionally been research directed into class predisposition of patients, where it is asserted that patients who are of lower class are endorsed physical medications more than mental medicines, and have less fortunate visualization (Garb, 1997). Furthermore sexual orientation predisposition in the DSM has additionally been featured, the DSM underlines ladies are more defenceless to psychological maladjustment than men, in any case, Affi (2007) reports that unmistakably sex contrasts do exist in the public eye, by moving toward emotional well-being from a sex point of view gives direction to the proper recognizable proof and treatment from the human services framework, by moving toward psychological wellness along these lines recognizes natural and social factors and empowers the expert to be delicate to how sex disparity influences wellbeing results.

The present version of DSM was overwhelmingly contradicted by numerous psychological well-being affiliations, guaranteeing possibly destructive changes were being made, with choices that apparently needed logical help and challenged sound judgment, one such change is the expansion of Disruptive Mood Dysregulation Disorder. Over the most recent two decades kid psychiatry has just observed multiple times increment in Autistic issue and a significantly increasing of Attention Deficit Disorder determination, bringing about numerous kids presently requiring sedated, in any case, it is contended that as opposed to including another confusion, possibly curing powerless kids, specialists ought to be progressively instructed about precisely diagnosing kids, rather than transforming the normal hissy fit into a psychological issue (Dobbs, 2012).

Thus, Grief has now turned out to be Major Depressive Disorder, again further medicalizing people and trivializing the expectable, and important passionate response that happens with the departure of a friend or family member, overlooking the versatility that accompanies time and the acknowledge of confinements of life (Kavan and Barone, 2014).

In summary the DSM is a helpful apparatus to help clinicians in diagnosing emotional wellness, with the plan to kill the turmoil or carry it under better control to improve the prosperity of the patient. Notwithstanding, there is no assurance that determination is right with research guaranteeing there is a half shot of foreseeing and effectively treating a psychological issue (Aboraya, Rankin, France, El-missiry and John, 2006). Additionally, the way that the DSM isn’t the main order framework utilized universally shows that there is some vulnerability about the procedure of conclusion, it simply speaks to the convictions of society at the present time, as society acknowledges increasingly, more supposedly is dropped from DSM, as was seen with homosexuality. Which at that point leads into the subject of such issue being dropped from the DSM, this could conceivably derive that numerous people have been under prescription and analysed as rationally sick when in truth they were not, they just lived in a general public that did not acknowledge their conduct, so were named as rationally sick, such marks can be destructive in themselves.

Regarding whether the DSM is proper to characterize and analyse generally, it can’t be denied that it is an incredibly valuable device that has helped with diagnosing, treating and helping numerous people defeat different mental issue, in any case, in spite of the positives recently sketched out, the analysis is huge and the proof they give recommend it’s anything but a suitable device for definition and conclusion. By characterizing and diagnosing following the therapeutic model itself raises numerous issues, drugs are endorsed to treat a concoction unevenness, anyway testing legitimacy of a substance awkwardness existing in numerous clutters has not been straightforwardly demonstrated (Leo and Lacasse, 2007). People can encounter genuine symptoms from prescription which can make them stop treatment, which means backslide would be likely and could possibly cause higher dangers like suicide (Aboray, Rankin, France El-Missiry and John, 2006). DSM, just spotlights on the physical reasons for mental trouble, overlooking natural impact, notwithstanding ecological issues possibly setting off the pain in the primary occasion (Schmidt, 2007). Significant in any case, is that psychological well-being, paying little mind to supporting proof is hard for clinicians to analyse in light of the absence of organic markers in numerous scatters, dependence is on the specialists in the field and the accord of this gathered data, to manage towards a plausible determination. In spite of the fact that not positive it does possibly empower the person to get treatment and help them begin their adventure to improved emotional wellness.


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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.

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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).
Gym population:
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.
Problem Statement:
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 Ignjatović 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.
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.
C:UsersDavidDesktopgymNew folderIllu_vertebral_column.jpg
(Wikipedia, 2006)C:UsersDavidDesktopgymNew folderGray_111_-_Vertebral_column-coloured.png
Lumbar spine:
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.
Intervertebral discs
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

Identification of Manual Handling Hazards



The main legislation that governs for the Health and Safety of people in the work place in Ireland is:

Safety, Health and Welfare at Work Act 2005 (as amended).[i]

General Application Regulations 2007 (as amended), as implemented under the 2005 Act. [ii]

The 2005 Act applies to all employers, employees and self-employed people in their work environments.

Duties of the Employer and Employee

The above Act describes the duties of the employer and employee, Section 8 of the above Act states that employers have a duty to guarantee employees’ safety, health and welfare at work to a level that is reasonably practicable.

The employer’s duties include, among other things, to:

create a safe work environment with safe equipment and plant.

create safe work systems, including safe access and egress.

prevent risks from exposure to a substance or to physical agents and noise.

avoid any improper conduct/behaviour which is a risk to other employees.

offer information, instruction & training to employees.

provide PPE to employees.

appoint a Safety Officer.

report accidents and dangerous incidences.

The employee’s duties include among other things, to:

take reasonable care of their health and safety and of other people while in the work environment.

not to be involved in any inappropriate behaviour that will case a risk to themselves or other people.

undertake any required assessment, medical or other if requested by the employer

report any defects which could endanger others.

not to be under the influence of drink or drugs in the workplace.

wear PPE.

Health and Safety Authority (HSA).

The Health and Safety Authority is the national statutory regulatory body for the 2005 Act and are responsible for regulating health and safety in the workplace.

General Application Regulations 2007 (as Amended) [iii]

Practically all of the laws that apply to employment, that are specific to health and safety are found in the General Application Regulations 2007, which hold the legal requirements on fifteen areas of health and safety, the manual handling of loads is contained in Chapter 4 of Part 2.

The 2007 Regulations further defines the role of the employer under Regulation 69, Duties of the employer, these outline that the employer will: –

Manual Handling

Regulation 68 of the General Application Regulations 2007 describes the Manual handling of loads as:-

“any transporting or supporting of a load by one or more employees and includes lifting, putting down, pushing, pulling, carrying or moving a load, which, by reason of its characteristics or of unfavourable ergonomic conditions, involves risk, particularly of back injuries to employees.”

Regulations implemented under the Safety, Health and Welfare at Work Act 2005, requires that a risk assessment be carried out on all work tasks which involve manual handling activity.

Risk Assessment

A risk assessment is a systematic and critical examination of a work place for the purpose of identifying hazards, assessing the risk associated with these hazards and deciding on appropriate control measures, which should include both engineering and organisational, reduced to the lowest possible and acceptable level to avoid or reduce the risk of musculoskeletal injury.  The assessment should be produced in a written statement which will safeguard: –

The health and safety of employees while in the work environment

The health and safety of other people who might be in the work environment, i.e. customers.

Regulation 69, Schedule 3 of the Manual Handling of Loads Regulations outlines the following risk factors to be assessed as part of a manual handling risk assessment: –[iv]


(Task) Requirement of the Activity what are the risks involved in the task, over-frequent or over prolonged effort.


(Individual) Physical effort required is the individual capable of carrying out the task, will it result in injury.


(Load) Characteristics of the load is it too heavy, too large, will it case a change in the centre of gravity.


(Environment) Characteristics of the Working Environment is the area safe to carry out the task.

The risk assessment should contain a list of prioritised actions which develop, sustain and improve control measures.

These control measures are known as ‘the hierarchy of controls’: –

Elimination (preventing users from coming in contact with the Hazard)

Substitution (changing the hazard for a safer one)

Housekeeping (a neat and tidy work place)

Isolation (isolate the hazard down to the least number of users coming in contact with it)

Environmental control (proper lighting and heating)

Ventilation (proper ventilation of the user’s space)

Safety Awareness (the locating of safety signs, notices posters etc.)

Training and supervision (the proper training and supervision for the user)

Personal Protective Equipment. (regarded as the last resort when the above is not practically possible)


As the health and safety officer within in our service, and following a number of manual handling injures in the service over the last twelve months, one of which was reportable to the HSA under the Safety, Health and Welfare at Work (General Application) Regulations 2016,

“all employers and self-employed persons are legally obliged to report the injury of an employee as a result of an accident while at work. Injuries must be reported if your employee is unable to carry out their normal work for more than three consecutive days, excluding the day of the accident.”

and resulted in a visit by an Officer from the HSA, who has instructed us to submit an updated risk assessment within 30 days.

Aims and Objectives

The Aim and Objective is to identify Manual Handling hazards that have led to the increased number of manual handling injures in our service in the year ending December 2018. In doing so I will evaluate the risks associated with these hazards by carrying out a risk assessment on these hazards which will determine the risk ratings and what measures should be taken to protect the health and safety of the employees and users of the building, with regard to the legal requirements under the Safety, Health and Welfare at Work Act, 2005.

Our Organisation

Our service provides residential and day services for adults with severe/profound intellectual disabilities, associated medical conditions and challenging behaviours.

The service has residential centres across the County and a day care facility which the residential services users can attend supported by their staff. The day care centre accommodates a variety of activities for the service users including treatments, therapy, therapeutic and social activities.  The building also serves as the main administrative offices for the service.


Identification of the Manual Handling Tasks

– Use of hoists and glide rail hoists

Transferring service users from wheel chairs to therapy chairs and ball pits is part of the daily activity for the staff.  During the review it has been discovered that the motor in one of the guiderails in the main therapy room was not in proper working and staff members had been transferring service users manually from their wheelchairs, there was no record of the reporting of the issue to either myself or management. I carried out a risk assessment attached here in identifying control measures for implementation.





– Use of Trolleys and Carts

Transferring of stores that are delivered to the day centre for collection on a weekly basis, by staff from one residence. During the review it was discovered that there was a potential for injury to staff loading and unloading stores supplies from Day Centre to transport and from transport into home. A risk assessment was carried out and attached here in identifying control measures and actions for implementation and review.





[iv] Manual Handling Induction – Gill Education