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'' Challenging HSE Guidance on Safer Lifting Practice ''

Osteopathic Solutions Gareth Milner

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About the Author Gareth Milner
00:00 / 02:19

What is the Core Message of this Blog …


The UK’s Health & Safety Executive is failing People who perform Manual Handling Tasks, as their guidance for lifting is NEGLIGENT! Now using their colour in the MAC Tool for Unacceptable Level of Risk … NEGLIGENT!

Your possible immediate thoughts (or maybe out loud) … ‘Whoa Mr Milner! You are talking about the Great Britain’s Authority on Health & Safety. That’s a bold statement you make there?!’


My reply … ‘In work and personal life, it pays to be open-minded*. Willing to consider new ideas. Unprejudiced by others, and the common consensus.’

If you are open minded you can skip to where the THUMBS UP IMAGE      

is below.


Let me pose the following question … ‘Do you know how to lift an inanimate load correctly?’ … nah that’s not right … ‘Do you know how to lift an inanimate load with body use and positioning bang on?’


‘What do you mean bang-on Mr Milner?’

‘So that you maximise body power and minimise musculoskeletal strain.’


‘YES Mr Milner … don’t discredit my NEBOSH Diploma.’


‘Ok, what about advising People when they have knee pain, a back injury, an old ankle fracture from a motorcycle accident et cetera. Can you prescribe them Best Practice Lifting Techique?’

'Well ...'


‘Are you 100%, categorically, no-doubts, your life depends on it …. SURE?’

If you are SURE, have you studied Human Biomechanics? If you are learnt in Manual Handling Technique, having attended an Instructor/ Train the Trainer Course. Was the Instructor an Expert in Human Biomechanics. A Physiotherapist? A Chiropractor? Or like myself a Qualified Osteopath?

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We can always #ProfessionallyDevelop. If you feel you can’t you have reached your Profession’s zenith. Even if you have reached this Mount Everest of your Profession, here’s why you should CARE about my Core Message of this Blog post.


You have a body. Your only body for your life. A body that when damaged, with the constraints of current Medical Practice, cannot be un-damaged. You lift inanimate loads every day, don’t you. You want an un-damaged body. Reason 1 to CARE.

As a Professional in your Industry, you clearly went into it with a mind-set of ‘I want to feel respect from others.’ And to get this respect you will need to give the right advice in a varied subject matter. You need to be armed with Knowledge, but not it’s curse. Reason 2 to CARE.

You are responsible for the Health & Safety of . . .  People. Insert the amount in the DOT, DOT, DOT. These People care, just like you, that they go home with an undamaged body. One that doesn’t hurt. One that doesn’t need the help of an Orthopaedic Surgeon. One that doesn't get them addicted to Opiate/ Narcotic Prescription Pain Killers. Reason 3 to CARE.


Is that enough Reasons?


Negligently taught Manual Handling ‘techniques’ cause chronic musculoskeletal pain.


Negligently taught Manual Handling ‘techniques’ cause debilitating Spinal Disc and Joint Injuries.


I qualified as an Osteopath in 2004 at The European School of Osteopathy.


One of the skill bases I learnt, both theoretically and practically, was the Clinical Diagnosis and Physical Therapeutic intervention of Osteopathic Manipulative Techniques to improve the lives of people who had suffered prolapsed discs in their lower backs.


Within this Degree I studied the Pre-Eminent Biomechanics Publications Joint Structure & Function written by Biomechanics Experts Cynthia Norkin and Pamela Levangie, as well as The Physiology of the Joints written by A I Kapandji.


Whilst writing this insightful* post I read Made to Stick by American Brothers Chip and Dan Heath. In fact exchange ‘reading’ to read it 5 times and listened to the AudioBook 5 times. Their messages … have stuck. The content of my Blog post has the following inherency:


1. My messages are SIMPLE. Zero human biomechanics jargon. Understandable for ALL.

2. UNEXPECTED. There will be points, themes and ideas that surprise you.

3. CONCRETENESS. Facts and visuals that are as concrete as mixing portland cement, water, sand and gravel.

4. Written by someone who has read the most Pre-Eminent Biomechanics Publications the World has so far seen. Not forgetting an #Osteopathy Bachelor of Science 4 Year Degree. CREDIBLE.

5. EMOTION. Chronic pain creates an emotion. If YOU experience chronic pain, you will know all to well that this emotion is as far away from positive … as Land’s End is from John O’Groats. Negligently taught Manual Handling ‘techniques’ cause chronic musculoskeletal pain.

6. STORIES. We will hear Real Life People’s accounts of what their body was telling them when they perform HSE Guidance Lifting and Best Practice Homo Sapien** Lifting.


*My prediction as to what many will describe it.

**As should have been performed since Lucy, the homonid, was roaming the Jungles.


What are my intentions with this post?


It is NOT to ruffle any feathers at the HSE. I have no interest in this. They can decide if they want their feathers ruffled. I have passion in this subject. It is personal to me. What being an (accident caused) chronic neck pain sufferer, every day.


My crusade since founding Osteopathic Solutions in 2010, has been to spread the Back (and Musculoskeletal) Health bug to as many adults as is possible. In being involved in this industry since 2007, I have met 100s of Health of Safety Professionals who don’t take this subject seriously. Yes … DON’T. I know. Think a job change is needed for them. I don't say Career. If they are reading this, here’s Tip 2 from Sorry! We’re Closed.

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Written for Health, Safety & Wellbeing Professionals and Business Owners in Sorry! We're ClosedOsteopathic Solutions Ltd Director & Osteopath Gareth Milner puts his 17 years of Manual Handling Risk Management experience into his first Book. Through real life Business trauma of Injury at Work Claim payouts and 50 hand-picked, Manual Handling Risk Management gems of actionable Tips, Gareth presents a remarkable recipe for ensuring your Business stays open, profitable and not supplying that former Employee with a 5 star, all inclusive holiday to the Maldives.

Hello, to the Open Minded.

My core message .... ‘The UK’s HSE is failing people who perform Manual Handling Tasks, as the guidance for lifting is NEGLIGENT!


Fact. Evidenced. Genuinely. Certainly. Gospelly. Is that even an adverb?!

In writing this 'Very Helpful*' Blog post I referred to numerous Research Papers on Lifting Practice on PubMed. The best being ‘Lifting Techniques: Why Are We Not Using Evidence To Optimize Movement?’ You can read this here (but not yet!).

The Summary of this Paper was that ... 


‘Clinicians must find the optimal dosage of physical stress to address all aspects of the movement system to minimize the risk of injury.’

*Thanks to Yvonne Newell, Expert Moving and Handing Advisor at Salisbury NHS Foundation Trust for her positive comment about this post.


This paper, written by Nick Washmuth, Professor (pictured) in Physical Therapy at Samford University consistently mentioned Physical Therapists as the go-to Professionals in giving advice/ teaching best practice lifting; Physical Therapists being Osteopaths, Chiropractors and Physiotherapists.

What I read in Nick’s paper validated what myself and our Team of Occupational Osteopaths & Physiotherapists have been teaching for years, across the UK, and now in Malta.

Sorry! We're Closed AudioBook by Gareth Milner.jpg

Tip 10 - Recognise Experts from the
Jack of All Trades

In Tip 10, I give Health & Safety Professionals more awareness in detecting whether a Supplier is a Manual Handling Risk Management Expert ... or not. 

The UK’s Health & Safety Executive, with Head Office in Bootle (Merseyside) is currently headed up by Sarah Albon (since 2019).


Of course, Sarah has had a lot to do over the last 4 years, what with The Elites’ (manipulating Bullying People in Power) bug thing, you know the C-word. 

She heads up a Management Board that simply saves lives. Many young lives I am sure. They represent good. They do good.


When going on holiday, you would have seen the same if not similar. You know, the Construction sites where workers wear little PPE. No hard hats. The Construction sites where falling to die, is possible from many jumping points. The Holiday transfer/ Coach Operators where men stand on to of the coach lowering your luggage (with a top-heavy forward bend of the truck I must add). Ferries in the Med where gaps ARE THERE … I repeat ARE THERE … for parents to suffer life long despair. So I make the following statement LOUD and CLEAR, perhaps even with an electric megaphone (that's not me to the right)…


‘The UK’s HSE do a GREAT Job when it comes to preventing deaths in Industry and in normal day-to-day Life’


I hope this statement unruffles feathers. It should.

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But …. and it needs to be a bigger ‘but’ than that … BUT regarding Manual Handling, the importance for them is just not there. Look at their Timeline here.


I mean, during the early 90s they are more interested in 1991 when The World Wide Web was created. Of course, helpful if you happen to stumble across this page when writing a dissertation on the ‘History of the Internet’, which you likely won’t.


No mention of the Manual Handling Operations Regulations.

No mention of the MAC Tool … well perhaps better that way.

Tip 18 - Ditch the Tools

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Feathers ready to be ruffled … This is why.


The HSE have an Ergonomics Team at their Science and Research Centre. Here are a few definitions of Ergonomics from the 1991 started World Wide Web …


1.       Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system.

2.       Ergonomics is the process of designing or arranging workplaces, products and systems so that they fit the people who use them. Most people have heard of ergonomics and think it is something to do with seating or with the design of car controls and instruments – and it is… but it is so much more. Ergonomics applies to the design of anything that involves people – workspaces, sports and leisure, health and safety. 

The first part of my ‘Louis Theroux’ style HSE investigation started here on their Training Arm, now re-branded (after a week of all day meetings brainstorming names) as 'Solutions from HSE'. Wouldn’t you love to know what that Government re-brand cost the public … actually, well … maybe not.

The HSE Course focuses on Risk Assessment and the use of the MAC and RAPP Tools. Manual Handling is a physical subject, right? People at your Business, lift and lug sh#t all day, every day, don’t they? They don’t push a pencil. They don’t push and pull a mouse.

The HSE definition of Manual Handling on their website states ‘Manual handling means transporting or supporting a load by hand or bodily force. It includes lifting, putting down, pushing, pulling, carrying or moving loads. A load can be an object, person or animal.’

So therefore, I ask the HSE a reasonable, valid question ...


Why, as the UK’s Authority on Health & Safety, including Manual Handling, do you not provide a Course that has Practical Handling Techniques Focus?

In fact, wearing my punchy Journalist hat (like the one he's wearing) minus the cigarette, I posed this question on a LinkedIn direct message to Matt Birtles, Principal Ergonomics Consultant at the HSE's Science and Research Centre; and this was his reply ...


'' Yes, I can, although it is purely my opinion rather than HSE's corporate opinion if that makes sense.  There are a couple of reasons we don't deliver Manual Handling (MH) technique training.  The first is that the scientific evidence base for MH technique training doesn't show that it's beneficial for reducing the prevalence of injuries.  This may be a problem with the training or perhaps a problem with the science, but HSE are a science led organisation it (the scientific evidence) just doesn't enable us to demonstrate that this would be a good use of HSE time.

MH technique training needs to be specific and tailored for each organisation, showing the workers how to do their tasks in their work environment using their tools and work pieces.  It should also incorporate the specific outcomes of risk assessments for their work.  Employers often don't wish to share all of this information with HSE due to our regulatory role, and there are others in the UK who can (and do) do this better than we could.

We purposely attempt to have a more direct impact at the risk assessment/risk reduction stage which is higher in the hierarchy or controls.  This is why we develop simple and effective risk assessment tools and run MH Risk Assessment Training to show how to use them and then provide the guidance on what technique training should incorporate. ''


Matt Birtles, Principal Ergonomics Consultant

Tip 3 -
Do a Branson!

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For me, this was a rather Politician style of reply. As the HSE are, in Matthew’s words, a ‘Science led organisation’ …. would it not then be simple for them to action a Scientific Study into Best Practice Biomechanics of Lifting? .... You would think so.


Simply put, if the HSE’s Team were Experts in Manual Handling, surely they would actually have Courses that contain the content of physical moving of stuff, or in the words of the majority of Manual Operatives across the UK … ‘We generally handle heavy sh!t’.


There is an avoidance of Practical Handling Courses. There are NO clear, biomechanically sound guidelines when it comes to Practical Handling Techniques.


Returning to the title of this Blog post '' Challenging HSE Guidance on Safer Lifting Practice ''


Load up the following page with a nice cup of tea, perhaps with a cheeky biscuit. Have a read through the written content and watch the video (shown below).

In the words of Catchphrase’s Roy Walker ‘Say what you see!’


So, you saw that the first part was a man in a very awkward working environment, under racking in a warehouse. A hazardous Manual Handling task that cannot be performed safely for the body, unless the pallet is removed from under the racking. Concur? …. Good.

Next, a Delivery Operative (shown in the gallery to the right) lifting a boxed load from the van, likely with a spinal twist to the left. He lowers it onto the sack barrow with a side bend (to the right) of his back, as he didn’t move his feet. He then pushes the sack barrow, predominantly by using his trunk bodyweight, with minimal PUSH-OFF with the leg muscles.

With these examples, I will cut the HSE and NEBOSH some slack. They are showing real Iife Manual Handling examples, done in a way People do, naturally.


But now I will join together that slack. You know the one I just cut.

In the same Course Explainer Video (above), the man is lifting from racking. This is simply a statement of what they believe is safer handling technique and practice for this task. As in Tip 17 Open Your Eagle Eyes from Sorry! We’re Closed, with your Eagle Eyes opened this is what you will see.

Tip 11 - Train as a Bio-Mechanic
00:00 / 08:01
Tip 17 - Open your Eagle Eyes
00:00 / 09:04
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Left rotation (twist) through his neck. Imbalanced loading onto the left leg with a medial  (internal) left hip rotation* and torsion through the knee, strain into the cruciate ligaments*. Compression through left sacro-iliac* and overstretching the right ilio-lumbar ligamentand lower back muscles*.

*All shown in the gallery below. Click to view images.

The NEBOSH HSE Certificate in Manual Handling Risk Assessment Course, as the website page states, has been ‘developed by NEBOSH and Ergonomists from Great Britain’s Health & Safety Regulator.’


Let’s move on in this Course's Explainer Video. At 35 seconds, you will see the left foot is angled away from the right foot, with the feet at slightly wider than hip width apart. It is an awkward load that does enforce some unavoidable spinal twisting. However, if you have read my IHASCO Blog (further insightful reading after this!) you would have understood why this Base of Support has Biomechanical lifting (and  lowering) errors a plenty. We will revisit the HSE Guidance for Base of Support shortly.

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At 44 seconds in this Course Explainer Video, the position for lifting the load is different. Is this intentional? He is closer to the load. But still twisting his neck and spine. Nonetheless, not much good there, when it comes to Best Practice Biomechanics.


And now at 47 seconds (shown below right) please for the Lord of God tell me that they are saying this is hazardous handling practice. Here lowering a load to ground level with a huge spinal twist, and trunk forward bend.

Yet again, in this UK seriously flawed industry, conflicting advice, now from the worst possible sources ... NEBOSH and The UK’s Health & Safety Regulator. OMG!

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In the last statement on this Explainer Video it is stated ‘Protect your people from some of the most common workplace injuries with the NEBOSH HSE Certificate in Manual Handling Risk Assessment.’


I know this is a bold statement and not entirely correct, but I feel it could be written ‘Harm your people … from some of the most common workplace injuries …’ Wouldn’t sell many Courses that statement, would it?!


We’re gonna take a break from all this HSE bashing as I feel a headache coming on. Did you know headaches can be caused by strained/ damaged neck structures? Yes, actually! The phenomenon is called Cervicogenic Headaches. The sort you would get if you handled loads like this video shows. Whoops … that was a bash wasn’t it.


Phewwwwwwwwww! Let another Expert in Human Biomechanics join the discussion.


Frankly, I bow down to Nicholas. 1. He’s a Professor. 2. He wears Professor’s glasses. Mine are only from Specsavers. 


I have 2 things in common with him though @gosc_uk , like me he’s an Expert in Physical Therapy. Armed with my Osteopathy degree, I have some back up to state that. Also, I have the same number of letters after my name. Look we are more equal now. Let’s delve into Nicholas' insightful paper published on PubMed which you can read here.

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The Paper swiftly discusses standard lifting techniques (shown above from the PubMed Paper) being A. The Stoop. B. The Squat. C. The Semi-Squat. 

Professor of Physical Therapy and Paper Author, Nicholas Washmuth rightly describes The Stoop as ‘lifting with your back’; The The Squat as ‘lifting with your legs’ and The Semi-Squat as ‘midway between stoop and squat’ with this meaning lifting with both your back and your legs.

One technique he doesN’T discuss is a technique we teach for loads with moderate weight and size; especially for People who have suffered disc injuries, called The Lunge Lift. This is a technique we generally include in our Bespoke 3 Hour Practical Skills Course and Bespoke Instructor Programmes.



CPD Group Accredited
CPD Group Accredited


Humans are lazy animals … especially since the C-word. Don’t you think? Nicolas states ‘stoop lifting is more metabolically efficient and less challenging to the cardiopulmonary system.’ This also goes for pushing and pulling of loads with overuse of bodyweight. Click the image of this PubMed paper below to read it (but don't forget to come back!)

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Not up for stretching the grey matter today? Fair enough, life's tiring. Here are the key points from Professor Nicholas' paper:

1. There is a common belief among clinicians that stoop technique leads to intervertebral disc herniations, which is a primary reason clinicians oppose stoop lifting. 

2. Clinicians must find the optimal dosage of physical stress to address all aspects of the movement system to minimize the risk of injury.


3. There is no universal consensus on the optimal lifting technique which will satisfy every situation; however, there may be a lifting technique that optimizes movement to achieve a specific outcome. 


4. Lifting is also a documented risk factor for low back pain (LBP) ... Therefore, it is essential that Physical Therapists provide lifting education and interventions for our patients. 


5. Evidence suggests subjects with LBP, when asked to lift, utIlize the squat technique


6. “What is the optimal lifting technique” is that “it depends.” The authors suggest a more appropriate, alternative question that should be asked: “which lifting technique optimizes movement to complete the task as hand?”


7. If the goal is to optimize movement by calming tissue down, the therapist should prescribe the lifting technique that incorporates kinematic patterns that do not excessively load tissues that may not be able to currently handle the stress.


8. Those patients with high levels of patellofemoral pain may benefit from stoop lifting, where the knee flexion angle is minimal and remains relatively static, while those patients with resolving or lower pain may benefit from squat lifting for optimal quadriceps activation.

9. A patient presents with a discogenic LBP, where their pain is reproduced with prolonged sitting, forward bending, and lifting anything heavier than 10 pounds. In an acute case, this patient would benefit from a lifting technique that prevents exacerbation of symptoms (calm tissue down), and in a chronic case, a lifting technique should be used that allows the patient to control or manage their symptoms while maintaining their independence (improving work capacity). Evidence suggests that patients with LBP prefer the squat technique, indicating that squat lifting may be best indicated for this patient while in the acute stage.


10. Evidence supports each technique in different scenarios; therefore, clinicians need to start asking alternative questions: How can movement be optimized by calming tissue down, building tissue up, or improving work capacity? This question cannot be answered without in depth, integrative knowledge of the movement system and its component elements.

We will revert back to these points later in this Blog post, simplifying them; removing the medical jargon.

Professor Nicholas, states consistently that only Physical Therapists, being Experts in Human Biomechanics, should be giving Patients, and when they are not in Clinic ...  now People; individually prescribed Lifting advice.

I agree with all of Nicholas' points above, from an Osteopath’s perspective. For me professionally and personally, reading the range of PubMed Papers, but most notably Nicholas’, underpinned what we have been teaching since 2010.

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Here is our Lifting Manifesto:


''At Osteopathic Solutions we teach a prescriptive, individualised lifting technique that is relevant to the individual’s body, within the context of flexibility, strength and associated musculoskeletal disorders, there and then, alongside the size, weight and shape of the inanimate load, maximising lifting power and minimising musculoskeletal strain.''


Further down this Blog post you can read specific content about our Lifting Manifesto, and view photos and videos of it in action.


The Burger Analogy


Who doesn't love a Burger? The meaty (or Beyond Meaty) taste. The crisp lettuce. The tangy pickles and ketchup. The runny cheese. The flavoursome bun.


Now let's run the Burger through your 'What is Healthy Food?' schema filter. The result, they are unhealthy. We all know that. The high saturated fat and salt content. The high calorific content. 

Now I propose the following situation. You have a 24 hour period. You have only 1 meal you can eat. You have the following choice. 1. You DON'T eat anything 2. You eat a McDonald's Burger (which one would choose?). 3. You eat a Salad box with life enriching avocado, quinoa and lean chicken. Unless you are a Vegetarian (like I was for many years), it goes without saying, be honest you would chose 2)., meat or soya based. Now, let's look at the health side of the three options. 1. VERY UNHEALTHY  2. UNHEALTHY (but certainly better than eating nothing)  3. SUPER HEALTHY.


Now with this Burger Analogy at the forefront of your mind, now the three Lifting options detailed in this Blog post.





*Of course I agree with this HSE Guidance ... 'Each employer shall, so far as reasonably practicable, avoid the need for his employees to undertake any Manual Handling operations at work which involve a risk to their being injured.'

An Osteopath's Perspective


When I was a practising Osteopath, working in Clinics in Surrey and West London, as you expect People would consult me with Lower Back Pain. Looking back, I would say out of 100 new Patients (or People as I prefer to call them), around 20 People would directly say that lifting was the cause of their pain, and the reason they booked their appointment. Let’s look at a few examples.

Jim the 45 year old Mechanic reporting ‘I bent over and lifted a tyre all wrong, and my back went into spasm gov. I’ve ad to cancel all me work now. A sh!tshow! Can you fix me back today gov?’ 

Philip, 35 years old; a keen golfer ... ‘I can’t believe that I went to pick the ball out of the hole*, I must add, got a birdie, and BOOM, an extremely painful shooting pain went down my right leg, like a bolt of lightning.’ This is a classic case of The Straw that Broke the Camel’s Back. Philip had been lifting his golf bag for 17 holes, repeatedly rapidly yanking it up from the ground with a forward bend, side bend and twist, gripping with the right arm all the time and ‘locked up’ his Sacro-Iliac joint irritating the right spinal nerve. It took the final bend forward (as photo below) standing on the right leg, counterbalancing with the left leg, to make the lower back muscles spasm.

Tip 33 - Grow the Osteopathic Profession
00:00 / 19:04

Margaret, the 60 year old enthusiastic gardener ... ‘Dear, I was getting the perennials ready for summer and lifted the watering can. My back immediately slipped out of position, and I immediately called my Husband telling him to get the Gardener round sharpish. He’s in the waiting room. Not the Gardener Dear.’

OK, so a quick snippet of a day in the life of a Physical Therapist. It didn’t take long on the 1991 started World Wide Web to find out that the UK is facing a Back Pain epidemic. It’s almost as if Back Pain is infectious it is so bad that this Guardian article states … ‘Almost a million people in the UK are too sick to work because of back or neck ailments, according to official data, which threatens to derail ministers’ efforts to expand the workforce and grow the economy. According to a Guardian analysis of publicly available figures, the welfare bill for people with back problems alone has tripled in two decades to £1.4bn a year, and is up by more than a quarter compared with before the pandemic.’

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Back Pain has been a problem for us humans for 1000s of years. It isn’t a new thing. Going from quadrupeds to bipedalism put more strain on our lower backs as the lower lumbar spine had more compressional loading into the discs and joints.


Sorry my phone's ringing. I better take it. ‘Hello, who’s this? Sorry, was that David Attenborough? Leave it to me, did you say?’ 


Swiftly returning to the Core Message of this Blog Post. The negligence of the HSE regarding Lifting guidance. Take a break for 5-10 minutes and visit

What did you see? What did you NOT see? 


I then saw this page

If you can’t take your eyes off this Blog Post I have screenshotted the HSE’s Grade D attempt at giving visible Lifting advice in the gallery below.

I will be direct on this one. Are the HSE, and their Chief Ergonomist Matthew Birtles taking Manual Handling seriously?

Now I am left scratching my head, rather like the HSE mannequin approaching that box to lift. Think he doesn’t know how to lift.


If the HSE's Chief Exec Sarah Albon and Matthew Birtles are reading this, from my Book Sorry! We're Closed here’s: 


Tip 2 - Take Manual Handling Fucking* Seriously


Tip 3 - Do a Branson!


Tip 13 - Suffer a MSD, Yourself!


I think my 2 year old boy Tate Milner could do a better job with the lifting advice. Tate does a serious squat when lifting the medicine ball. He's a Beast of a Boy. A World Strong Man in the making.

*Swearing frees us of the feelings of anger or frustration we hold and allows expression for them. 

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Let’s look at the positives of the HSE guidance.

  • Recommendations for lifting aids, or making improvements to the task, load or working environment. Of course if a load is too heavy/ bulky for one person; the task for example is extremely high repetition; and the working environment enforces hazardous lifting posture then no matter how much OPTIMAL* Handling Technique is performed MSDs will happen.

  • A mini-risk assessment before the lifting task is best practice for the individual.

  • 'If you can't get close to the load, try to slide it towards your body before you try to lift it.' Solid advice there.

  • And solid advice here ... 'Slight bending of your back, hips and knees at the start of the lift is preferable to either fully flexing your back (stooping) or fully flexing your hips and knees (full/deep squatting).'

  • This was a common one I saw when delivering Training amongst those who 1. Didn't Listen 2. Didn't Understand .... 'Don't flex your back any further while lifting. This can happen if your legs begin to straighten before you start to raise the load.' If you encounter this, to help your message stick, tell the Person .... 'The load must come off the ground as you straighten your legs.'

  • The guidance on avoiding twisting; using the feet to move (once lifted); lifting smoothly and within your capabilities is all good advice. 

*Notice the use of Optimal as opposed to Good.

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That’s it. Hardly ground breaking.


There should be a Scientifically Researched Paper by the HSE on Lifting Practice (underpinned by a Consultancy Team of UK Physical Therapists being Osteopaths, Chiropractors and Physiotherapists) encompassing common tasks, loads and environments, as well as advice for People with common MSDs including Lower Back and Knee injuries, featuring images to support learning, all downloadable for free. Something we have done actually.


LinkedIn connect with me and I will email you our 'Setting UK Standards' Manual Handling Instructor (Risk) Assessor Course Booklet in PDF format. Please also feel free to join me on my Q&As at 3pm each Friday.

Let’s take a short break from the core message of this Blog post. When writing my post DigiTrain®. A Health & Safety Professional's Must Have! back in 2022, there were 11 topics (shown below) that were taught in the NEBOSH Diploma. 

Out of the topics, don’t you agree that Psychological Health, Chemical and Biological agents, Fire, and Electricity represent a clear and potentially immediate risk of serious harm or even death to a person, within the working environment. Of course, as you are most likely NEBOSH and/ or IOSH qualified yourself, reading this, you will know what you need to know about these subjects, maybe not about Psychological Health (as you are not a qualified Psychiatrist) if you are being honest, but you will know how to prevent serious harm and death in your employees’ operational environments. With these subjects, let me pose the following questions …

Are there any subjects where there is conflicting messages or ambiguity? 

Are there any subjects where the advice/ best practices you have been taught are wrong?


I ask these questions as I don’t know myself if there are. Assumptions are never really good, but I assume there aren’t, or if there are, they aren’t that important.


1. Why we should manage workplace health & safety

2. How health & safety management systems work & what they look like

3. Managing risk – understanding people & processes

4. Health & safety monitoring & measuring

5. Physical & psychological health

6. Musculoskeletal health

7. Chemical & biological agents

8. General workplace issues

9. Work equipment

10. Fire

11. Electricity

Diana in minefield.jpg

If there were subjects where (seriously) wrong Health & Safety advice was given then working in a UK manufacturing site, warehouse, airport, food production factory, school etc. could be a potential minefield for the employees. You might just see Diana raising awareness (God bless her soul).

Certain wrong procedures with Chemical and Biological agents could cause serious burns, lung disease and maybe immediate death, as some practices were not best practice. Working at heights; some recommendations could increase the risk of fatal falls. Fires could more likely happen in certain situations and environments. 

Physics could show us the power of electricity, to the detriment of human beings. What I am saying is, if these subjects are sown up, nothing to question there, written in stone, then why is there so much ambiguity and lack of Expertise when it comes to Manual Handling, a practical … practice. It is lucky for the HSE that having a back spasm can’t lead to death. Although a prolapsed disc can through kidney failure, which is extremely scary, in fact. It is lucky for the HSE that the person walking, or perhaps hobbling around with an arthritic knee (caused by their bad … wait a minute … negligent lifting advice) won’t die because they have bone contacting bone, and minimal joint cartilage, in one or both knees. These sorts of stories don’t make the papers, do they? It’s like, if it isn’t brought to the media’s attention, or maybe your attention, it isn’t happening or going on. With this though in mind, in order to help Health & Safety Professionals have more awareness on what is happening in the joints of their employees, I produced our MSD Score Form. Click the image to the right to read the 19th Tip from Sorry! We're Closed ...  Download MSD Score Form.

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LinkedIn connect with me asking 'Gareth, can I have your MSD Score Form, please*' and I will reply 'Of course you can as you were so polite, here it is.' If you say 'Gimme that MSD Form' ... I might not reply. 

*From what I have seen, since 2020 across the UK, there has been a distinct drop in the highly favorable attribute of 'Gratitude'. Possibly a highly contagious virus called 'Ungrateful-20' was let out into the world by The Elites. When Sorry! We're Closed was published in 2022 we gave 100 copies out FREE in the following months. Only a handful of People within Health & Safety showed gratitude. Some complained on the phone that they didn't get their copy on time. Have you seen cases of 'Ungrateful-20'? If you have, share them with me on LinkedIn.


In the Book Upstream: The Quest to Solve Problems Before They Happen, New York Times bestselling Author Dan Heath (who also co-wrote Made to Stick) explores how to prevent problems before they happen, drawing on insights from hundreds of interviews with unconventional problem solvers.

So often in life, we get stuck in a cycle of response. We put out fires. We deal with emergencies. We stay downstream, handling one problem after another, but we never make our way upstream to fix the systems that caused the problems. Cops chase robbers, doctors treat patients with chronic illnesses, and call-center reps address customer complaints. But many crimes, chronic illnesses, and customer complaints are preventable. So why do our efforts skew so heavily toward reaction rather than prevention?



Our MSD Score Form is the 'upstream' approach to Manual Handling Risk Management and preventing Workplace Musculoskeletal Disorders. Try this approach.


1. Firstly, purchase Sorry! We're Closed for only £14.99 here. As this is a serious #PersonalProfessionalDevelopment Publication and bespoke to 'YOUR Health & Safety Industry', don't wait for your Employer's Credit Card. For only £14.99 you will become an Expert in prevention of MSDs. Not just at work. At home too.

2. Read it front to back. Recommended in a Starbucks; on a park bench; at your favourite local pub etc. i.e. NOT at work ... you won't get the chance.

3. Risk Assess your Manual Handling Operations (remember Ditch The Tools!). If you don't have time, our Expert Occupational Osteopath can do it for you. MSD Risk Reduction Solution a plenty! Check this out here.

4. At the same time, action the MSD Score Form for all manual Operatives. And with the results, focus your immediate attention to the People who are suffering most with a Musculoskeletal Disorder (or Disorders) i.e. those who score highest for pain levels. The ones with current Back and/ or Neck Pain should be urgent focuses for you.

When writing Sorry! We're Closed I interviewed 7 People who suffered debilitating MSDs caused in most part by the negligence of their Employer with respect to managing Manual Handling risks. This formed the True Stories of Business Regret section of the Book. One of these People was paid out to the tune of £160,980. Ouch! You can listen to this Story below.

True Stories of Business Regret - Story 3
00:00 / 06:56
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& here Judge Rinder is our damning evidence of the UK HSE's Manual Handling Negligence ...

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We have all heard the idiom one step forward, two steps back ... meaning you make progress but then experience events that cause you to be further behind than you were when you made the progress. 

With the HSE guidance on foot position/ base of support you are taking one step forward and one step back, both literally and metaphorically. Their guidance states ... 'Adopt a stable position. Your feet should be apart with one leg in front of the other (alongside the load if it is on the ground) to increase stability. You should be prepared to move your feet during the lift to keep a stable posture.' 

Now, a mini Anatomy Lesson on the human pelvis. On the right drawing the 2 bones with a light grey are called the Iliac bones. We have a left 'Ilium' and right 'Ilium', that make up the Iliac bones. The dark grey bone is called the Sacrum. You will see 2 lumbar vertebrae sitting on top of the sacrum. Connected to the left Ilium is the left hip joint (between the left femoral bone and the left Ilium). Connected to the right Ilium is the right hip joint (between the right femoral bone and the right Ilium).

Now, a mini Biomechanics Lesson on the human pelvis, taking place at The European School of Osteopathy, where I studied. Emma Farrell's illustration below from Tip 11 - Train as a Bio-Mechanic.

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With thanks to Joint Structure & Function by Levangie & Norkin ... and my Osteopathy Degree ... for giving me this Expertise. More concreteness with this statement ...

If you have one foot in front of the other as your Base of Support you will cause an Iliac counter torsion and Sacral side bending and rotation, causing the opposite side bend and rotation in the 5th lumbar vertebrae, and resulting facet joint strain at the L5/S1 joints.

Now you have been upskilled and educated in some basic Human Anatomy and Biomechanics, I will now talk a basic Osteopathic Philosophy. Within our body we have the occurrence of what us Osteopaths call Somatic Dysfunctions. These are the same as what Chiropractors call Subluxations. Within the spine, this is when a vertebrae becomes significantly misaligned, compressing spinal nerves and disturbing optimal nerve function.

Simply put the HSE's guidance of 'one leg in front of the other' WILL causeSomatic Dysfunction at the L5/ S1 spinal joint. 


So what does this L5/ S1 Joint Somatic Dysfunction cause? 

I will just address the Biomechanical/ Musculoskeletal results:

1. Generalised Lower Back Pain

2. Back Muscle Spasms

3. Sciatica 

4. Herniated* L5/ S1 intervertebral disc

5. Prolapsed* L5/ S1 intervertebral disc

6. Spondylosis and Joint Osteoarthritis

7. Spinal Stenosis (X-ray image below)

8. Back Surgery (hopefully just one trip to the Surgeon's knife)

9. Chronic high levels of pain, every day

10. Reliance on Opiate/ Narcotic Painkillers

11. Possible addiction to Alcohol

12. Depression



*Commonly referred in layman's terms as a Slipped disc.

Harsh but true.

For you, as the Responsible Health & Safety Manager, numbers 13. and 14. are on YOUR watch.

Now here's where the HSE's contradictions start. In the image of the feet, shown again below, taken from the HSE's Good Handling Techniques page, the feet appear more or less level. The left hip is rotated outwards (externally in biomechanical parlance). In fact around 45 degrees outwards, approaching its full range of outwards rotation. 

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With this left hip position, the ball of the hip joint is jammed again the front hip ligament. Anatomy lesson continued ... a ligament joins bone to bone giving joint stability. Repetition of this foot position, with heavy inanimate loads, day in day out, WILL cause Hip Osteoarthritis and place the Person on an Orthopaedic Surgeon's LONNNNNNNNNNNG waiting list. In the image below it states Femoral Retroversion, which Google defines as 'a rotational or torsional deformity in which the femur twists backward (outward) relative to the knee.' I underlined deformity. Whoops, I did it again. Now what does deformity mean ... the state of being deformed. Not very useful that one. I will just get to the point. Lift heavy sh!t every day like this and you will have a knackered hip.

OK, so the HSE are stating in written text that one leg (i.e. foot) should be in front of the other. But then at the same time show on their image (above left) the feet basically level but with both hips rotated outwards. What's that noise? It sounds like an alarm. And it's getting louder. OMG! My ears are in agony. That was the NOVICE ALERT ALARM!!

The HSE guidance mentions 'your feet should be apart'. How much apart? Hip width? Slightly wider than hip width? Shoulder width? Slightly wider than shoulder width? In the image above left, it looks like slightly wider than hip width apart. This is simply too narrow to enable in their words ... 'Keep the load close to your waist.'

A good question for you to ask is 'So, what will happen with the Spinal position, say with a bulky and heavy load?'

That's a good question. It will pull the Spine forward into a forward bent or stooped position, hazardous for the neck and lower back. The HSE say 'Don't flex your back any further while lifting.' Lifting with your feet this narrow enforces a flexed back.

Avoiding fully flexing of your hips and knees (full/ deep squatting) is rightly stated. This part of the HSE guidance hasn't stuck with the Online Course Provider IHASCO. Below right is a still from their frightfully negligent Online Manual Handling Training Programme. Sadly for the UK's population, a Programme that has been very successful in this digital era. In Part 3 of this Blog post we will be looking at what so-called Manual Handling Experts are teaching across the UK. 

'' Chronic Knee Pain & Back Spasms here I come ''

Head and Neck HSE lifting guidance states ‘Keep your head up when handling. Look ahead not down at the load once it is held securely.’

Everybody has seen the Child's Play Video. While we are here Safetycare describes as ... 'Child's Play delivers the powerful yet simple message that correct lifting and carrying techniques are essential if injury is to be avoided. The program is a fun, fresh and entertaining way to explore the fundamentals of correct lifting and carrying as practiced by the experts: Children. Safetycare. The experts in Manual Handling Safety Training DVDs and Videos.'

I don't want to burst their bubble but Safetycare is a Manual Handling novice with a capital n. Of course, I expect they will be an Expert in other subjects. Just not this one.

Their Video shows the little boy looking ahead (presumably at the camera crew thinking 'Am I getting paid for this?') damaging his poor little neck. Tantamount to child abuse this. The lower neck joints' cartilage (C4, C5, C6) is being compressed, creating micro-trauma. If he practices this throughout his teens, he will set up a painful future with the need to regularly consult Physical Therapists for chronic neck and shoulder pain.

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Now an exercise. I ask you to get out of your chair, stand up and do the following … although don’t if you get easily dizzy. Simply bend you neck backwards (like the young man to the right). What do you feel? A crack or click sound? A sharp pain? Or just uncomfortable? Take a seat again. You might need to take those pain killers on your desk now or in your Man/ Woman bag. What you have just done is put your neck joints against each other. Joints, in their wisdom, won’t thank you for this. Now when you are lifting a sh!t heavy load next time, not only will you be putting your head in an Osteoarthritis causing position, but you will also increase the risk of a seriously painful neck muscle spasm, the type that needs us Osteopaths to immediately fix. This quite obvious hazardous practice, like the full squatting IHASCO (and many other Manual Handling novices teach), always baffles me. It just looks painful doesn’t it. Sort of stares you in the face when you see it.


The Traffic Warden Analogy


Most people who pass their driving test, know what to do on the road. At a roundabout, we wait for a safe gap to go. It's very simple isn't it, whether we face rush hour or not. 

The jobsworth Traffic Warden. What feeling do you have when you come across one of these 'officials who uphold petty rules even at the expense of humanity or common sense?' Ok, a bit deep but that's what Google calls them. That feeling? Irritance?


These Authoritative Officials may argue, maybe backed up by data, that their presence reduces accidents or more rightly called collisions. But in my eyes, and the majority* they are a nuisance and make things worse. Every day I come across 2 Traffic Wardens at a roundabout who jam up the traffic. Long lines of frustrated commuters who can't decide themselves when to go at the roundabout. Traffic Wardens must have one of the highest incidence of Upper Limb RSI, what with all that arm waving.

The HSE, when it comes to Manual Handling, are rather like Traffic Wardens ... they are trying to make things better, but are blindly making things (i.e. levels of MSDs) worse.

*If we did an Opinion Poll

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Part 3 will go live Wednesday 5th June!

In Part 3, we will be taking a look at 5 Manual Handling Training Providers who show little Expertise in this subject of Lifting, some very well known Providers in fact, shown below.

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Part 4 will go live Wednesday 12th June!

In Part 4, I will provide a framework for Optimised Lifting Biomechanics, on an individual (with specific MSDs) prescriptive level; at the same time offering you the opportunity to compare this framework with HSE guidance. 

Part 5, the Final Part will go live Wednesday 19th June!

In the Final Part of this Blog Post that has gathered huge internet traction across the UK, we will be looking at the Legal aspect of your Employees NOT performing HSE recommended Lifting Practice, following Optimal Lifting Biomechanics that our Truly Expert Team of Occupational Osteopaths and Physiotherapists deliver across the UK and Malta.

With regards to the Legal aspect; how you can protect your Business if an Employee does put in any form of Musculoskeletal Injury at Work Claim, being mindful following our Optimal Lifting Biomechanics will make this less likely than following the HSE's negligent guidance.

We leave you with this proverb '' Wrong is wrong, even if everyone is doing it. Right is right, even if no one is doing it. ''

Osteopathic Solutions
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