Body mapping for MSDs - using individual body maps

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Kees Peereboom and Nicolien de Langen, vhp human performance Netherlands

The background to body mapping

Body mapping is a technique to gain information about hazards and ill-health effects in work, first developed by community groups and trade unions, and meanwhile adapted by educators in a variety of settings. It is used as a means of pooling information on worker health problems, using visual images, and it is an alternative to using surveys. The results of using this data-gathering and reporting technique can be fed into the risk assessment and subsequent used to review processes. One of the main reasons this should be promoted is that body mapping has been shown to be very effective in gathering information and helping ordinary workers do something in relation to the health and safety risks that can affect them.  There's no need for expensive consultants, complex questionnaires or intrusive medicals. All you need is a group of workers, some paper, some pens and coloured stickers or sticky notes and ofcourse: somebody to guide the session. In this way, body mapping makes it possible – for instance by pointing out musculoskeletal disorders (MSDs) - to identify workplace problems in a collective way, so that patterns are identified among a group of workers and this can be tackled as a group, rather than an individual having to argue alone about workplace injuries. The more workers that report the same symptoms, the more likely it is that the working environment is a factor. Body mapping is an easy applicable and important method that offers simple guidance to encourage workers to speak up about their musculoskeletal pain and workplace problems. It can also be used for other types of symptoms. Body mapping should be considered as an important method to increase awareness about MSDs and assist the risk assessment process. It takes a similar approach to another method known as hazard mapping.

What is body mapping?

A picture is worth a thousand words! A body map is a chart showing the front and back view of a body.  Workers can record, in a pictorial form, their MSD problems on these charts. Workers simply mark on these body maps where they experience MSD problems and they add some basic background information. They don’t have to write down anything, it’s all pictorial and it’s all about ticking boxes. It’s not difficult, it’s easy, and it’s time effective. No language skills are required.  In this way, body mapping can be a way of identifying common patterns of health problems amongst workers in a particular workplace, normally doing the same or similar job. Keep in mind that identifying health complaints does not mean you can state with certainty that the causes are all work-related. Body mapping is an excellent tool to help highlight areas for direct action or for further investigation. Especially when performed by a group of workers, body maps are helpful to assess working conditions. Workers share their knowledge of MSD problems, they feel involved and start thinking and talking about solutions on work-related health problems. Body mapping is a participatory approach that puts workers first.

Why use body mapping?

The effects of the working environment on workers’ health are not always easy to assess. When something is wrong in the workplace this can be noticed during an inspection, but it is far more difficult to find out how work might be harming workers’ bodies. This is where body mapping comes in. There are many different forms, but the body mapping presented here concerns MSDs. The main question is; can (potential) MSD causes in workplaces be identified and if so, can they be prioritized? In order to make this work, convincing stakeholders of this approach is key. One needs to be able to explain the reasons to work with body mapping.

The benefits of body mapping are summarized here:

…it’s free

…is simple to use

…it’s time effective

…no need for experts

…it requires a minimum amount of paperwork

…the paperwork needed is supplied ready-made, you only have to print it

…there is no need to write words, it’s all visual, so…

…it overcomes problems of literacy and language

…is more easily and widely understood than most intervention approaches

…it involves workers, is participatory and makes workers talk and think about healthy work

…uses workers experience and knowledge to paint detailed pictures about risks, nobody

   assesses their work better than they do!

…it raises awareness and encourages discussion and analysis which helps to improve work and

   workstations

…often delivers quick and simple wins’ to get the ball rolling’

…it involves workers in risk assessment and monitoring of their workstations

…helps employers to meet requirements (risk assessment and prevention, worker consultation) and cover

  liabilities

…and: …it’s is fun!

Risk assessment and body mapping

Employers must evaluate risks to the safety and health of workers and implement prevention and control measures. Workers carry important information on workplace risks and health damage, and should therefore be involved in the process of identifying problems and possible solutions. This is why employers are obliged by law to consult workers and allow them to take part in discussions on questions relating to safety and health at work. Body mapping is a way to allow workers to actively participate in the identification of hazards and solutions. The results can be an important complement to other sources of information for risk assessment process: Information gathered in the framework of body mapping together with data from health surveillance, risk assessment with checklists and online tools provide information about both workplace and health problems in the company and can guide preventive and protective measures and solutions. If the company has an occupational physician, this person can assist with the interpretation of outcomes and ensuring that the results can be used in the company’s health strategy.

How does body mapping of MSDs work?

Step 1: Appoint a facilitator to organize the session(s)

This can be the employer, a supervisor, a co-worker or a union representative. This does not need to be someone with MSD knowledge. The facilitator organises and prepares a body mapping session by inviting the participants, making sure there is a meeting room, printing sufficient body maps (one for each participant) and supplying coloured stickers (pens or tape could also be used). Materials for printing are included in this article (one body map chart, one Instructions for the body map and one information gathering sheet).  The larger the print the better, so A3 is preferred over A4. It is advised to perform sessions with 6 to 10 participants.

INSTRUCTIONS FOR WORKING WITH YOUR BODY MAP

Indicate on the body charts where you feel aches and pains as follows:

1. Place the dots place a yellow dot when you experience MSD complaints (disorders, injuries, aches, pains, stiffness, bruises) ocurring at work that:

  • are present for less than a week or occur now and then and/or
  • do not bother me at home after work
  • place a red dot when you experience MSD complaints (disorders, injuries, aches, pains, stiffness, bruises) occurring at work that:
  • are present for a longer period, at least for more than one week and/or
  • bother me after work at home as well (in the evening or the next morning)

2. Give each dot a unique number (1,2,3,4,5,6 etc).

For each numbered red or yellow dot on the body map chart you tick two boxes (tick one box in the row A) ‘my complaint is’ and tick one box in the row B) ‘I believe that primary cause is’.

 Number 1: Tick the correct box:
A) My complaint is: Caused by work Not caused by work I do not know or do not wish to share this
B) I believe the primary cause is: Overstrain (applying force, working in awkward or prolonged postures, tiring work) Incidents and/or accidents I do not know or do not wish to share this
Number 2: Tick the correct box:
A) My complaint is: Caused by work Not caused by work I do not know or do not wish to share this
B) I believe the primary cause is: Overstrain (applying force, working in awkward or prolonged postures, tiring work) Incidents and/or accidents I do not know or do not wish to share this
Number 3: Tick the correct box:
A) My complaint is: Caused by work Not caused by work I do not know or do not wish to share this
B) I believe the primary cause is: Overstrain (applying force, working in awkward or prolonged postures, tiring work) Incidents and/or accidents I do not know or do not wish to share this
Number 4: Tick the correct box:
A) My complaint is: Caused by work Not caused by work I do not know or do not wish to share this
B) I believe the primary cause is: Overstrain (applying force, working in awkward or prolonged postures, tiring work) Incidents and/or accidents I do not know or do not wish to share this
Number 5: Tick the correct box:
A) My complaint is: Caused by work Not caused by work I do not know or do not wish to share this
B) I believe the primary cause is: Overstrain (applying force, working in awkward or prolonged postures, tiring work) Incidents and/or accidents I do not know or do not wish to share this
Number 6: Tick the correct box:
A) My complaint is: Caused by work Not caused by work I do not know or do not wish to share this
B) I believe the primary cause is: Overstrain (applying force, working in awkward or prolonged postures, tiring work) Incidents and/or accidents I do not know or do not wish to share this
Number 7: Tick the correct box:
A) My complaint is: Caused by work Not caused by work I do not know or do not wish to share this
B) I believe the primary cause is: Overstrain (applying force, working in awkward or prolonged postures, tiring work) Incidents and/or accidents I do not know or do not wish to share this

A session will take 45 minutes to a maximum of one hour, depending on the number of participants and the level of discussion. When performing several sessions it is advised to combine workers that work within the same departments or workers that perform tasks that are similar. Keep in mind:

  • Mapping works best when workers feel safe and comfortable that the information they are about to reveal cannot be used against them in any way
  • Workers will be more open in discussing issues when they are in groups consisting only of other workers, supported by a facilitator that they can trust
  • The primary role of the facilitator is to ask questions and to gather information, not to make a diagnosis or draw conclusions

Step 2: The session (45-60 minutes in total)

At the beginning of the scheduled session the facilitator welcomes the participants and explains the ‘what and the why of body mapping’ (see above).

Before conducting any mapping exercises, the facilitator must inform the workers on the rules:

  • Participation is completely voluntary
  • It is up to them how much they want to reveal to each other, since some of the information in the mapping exercises may be personal of nature
  • The issue of confidentiality is a top priority when information is gathered through mapping
  • No names or any other means of identification are to be used on the maps in order to protect workers privacy
  • Everybody agrees that they will not reveal to anyone outside of the group any personal information
  • It is also important to agree to whom the maps will be shown. During mapping activities, workers can decide collectively who will see the maps. They may wish to show the maps to:
    • the workers and the facilitator only
    • other worker groups or a worker health and safety committee
    • trade union representatives
  • Workers are asked if the employer may see the information gathering sheet because this may be very helpful to solve problems and no personal information is included.
INFORMATION GATHERING SHEET
front legs


back legs


front arms/ shoulders


back arms/ shoulders


front trunk


back trunk


head/neck/ shoulders
Yellows
Reds
Work related
Non work related
Overstrain  related
Incidents or accidents related
Fill in the table with the correct number in each cell

The table helps you distinguish the following priorities:

  • Solving problems caused by red dots have priority over solving problems caused by yellow dots
  • Yellow dots are important to because they indicate future red dots
  • The employer should primarily focus on work related MSDs
  • If there are a lot of non-work related issues, the employer should think about what he can do with life style issues outside of work, general fitness etc.
  • Overstrain related MSDs usually are related to tasks, postures, applying force, prolonged postures, basis workstation design, logistic means and/or tiring work
  • Incidents or accidents related MSDs might, but not necessarily have to, be related to work pace, long working hours, difficult circumstances (language problems, noise, heat, lack of sight)

Write key words in top priority cells concerning solutions mentioned by the workers


The facilitator explains to the participants what MSDs are:

Body mapping chart
Body mapping chart
Musculoskeletal disorders (MSDs) are:
  • disorders, injuries, aches, pains, stiffness, bruises concerning….
  • the human musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons and structures that support limbs, neck and back. Basically this relates to any body part that is related to making you move around.
  • MSDs can arise from a sudden exertion (e.g., lifting a heavy object)[2], or they can arise from making the same motions repeatedly, or from exposure to force, vibration or awkward posture.

MSDs can affect different parts of the body, we focus on:

  • front legs
  • back legs
  • front arms/shoulders
  • back arms/shoulders
  • front trunk
  • back trunk
  • head/neck/shoulders

(Allow 15 minutes).

The body mapping will be performed by the workers. Every workers fills in his or her own body map by himself or herself, according to the ‘Instructions for working with your body map’

The facilitator provides some red and yellow tape, stickers or coloured pens and asks the workers to stick the body maps to the wall. The outcomes are elaborated and discussed. While discussing, the facilitator fills in the information gathering sheet. In this way all information will be on one single piece of paper. Filling in just means marking zones on the body map, no words are needed

The facilitator can use his smartphone/ digital camera to make a picture .In this way, the information gathering sheet can be projected on a screen or a wall with a beamer if available. This would be helpful, but this is not essential.

(Allow 15 minutes).

  • Looking at the gathered information sheets there is then a discussion on what ideas workers have to tackle the MSDs that have been reported. The facilitator takes short notes on this. The facilitator asks these questions:
    • Overlooking all body charts: are there common pains/ailments?
    • Overlooking common pains/ailments: are there common causes?
    • What types of work/task is mainly causing problems?
    • Identify if there are other health problems linked to MSDs e.g. work pace, noise, dimmed sight, dangerous situations etc.
    • As a result of doing this body map session is there an immediate issue/problem that needs to be raised with the employer?
    • Do the workers have final suggestions on type of solutions?

(Allow 25 minutes).

  • (If more time is available) Do workers have any proposals for priorities in the short and long term?

At the end of the session, the facilitator explains again what will be done with the material. Due to privacy reasons, it is advised to let the workers keep their own body mapping sheet. The facilitator collects the gathering information sheet. On this sheet no connection between individual workers and MSDs is allowed. Finally, the facilitator tells the workers when they will be informed about actions that will be undertaken by means of follow up. This type of feedback will motivate workers.

(Maximum 5 minutes).

Step 3: Follow up

  • Supplying the gathered information sheet to the employer for making improvements, so they can be discussed as part of the risk assessment process
  • Keeping the workers informed. Follow-up sessions can be planned to discuss proposals further
  • If changes and/or improvements are being made, celebrate this and connect this to the body mapping session.
  • Repeating the body mapping at a later date could also contribute to evaluating if any changes have been successful in reducing MSDs
  • Of course, usually not every problem can be solved within in a few days, but making some improvements shortly after the session is strongly advised. Workers then experience especially that their efforts are rewarding.

Conclusion

Body mapping is not a substitute for formal risk assessments, but it can provide useful input to a risk assessment. The results of mapping can be discussed among workers as well as by safety committees, etc. If the results of a mapping exercise have been used as part of the original risk assessment, it can then be redone, after introducing control measures, to help see how well they are working. Moreover, by comparing the symptoms of workers working in the same area, or doing the same tasks, common themes can be identified. These can then be compared with those of different groups from the same workplace to see how problems differ between jobs. To help get a gender perspective, the techniques can be used with groups of women only or men only and the results compared.

Sources of information

Existing EU-OSHA resources on body mapping:

EU-OSHA – Conversation starter 7: Using body mapping to collect data on early symptoms of MSDs, in Conversation starters for workplace discussions about musculoskeletal disorders pp13

EU-OSHA, Healthy workers, thriving companies - a practical guide to wellbeing at work: view  pp77 and annex 2

EU-OSHA - New approaches to engaging young people in occupational health and safety, article Magazine 9 Safe start ! pp39

Napo for primary schools body wise activity lesson 2

Napo MSD training activity ‘Know the early signs of MSDs’, in Napo in the Workplace– Understanding MSDs

Other sources

Canadian Department of Agriculture / New Eyes: see SH 12

Women’s health, safety and well-being at work / Unite Guide women and OSH: page 17

International Labour Organisation (ILO) / Barefoot research guide

International Labour Organisation (ILO) / Tutor guide

Public and Commercial Services Union, London UK / Body Mapping Toolkit

Health and Safety Executive UK (HSE) / Body mapping tool

Health and Safety Executive UK (HSE) / Managing musculoskeletal disorders in checkout work, A brief guide

American Chronic Pain Association USA / Pain management Tools

Medical School University of Michigan USA /Michigan Body Map UMICH

Pain Research Group USA / Brief Pain Inventory

Edmonton Symptom Assessment System (ESAS) Canada / Symptom assessment scale

Chartered Society of Physiotherapy/ Body Mapping for Health & Safety

Occupational safety and Health for Ontario workers

Australia Asia worker links body mapping workshop

Occupational Health Clinics for Ontario Workers Canada / APP on ergonomic assessment

Hazards Magazine, DIY Research resources

Wigmorising website / contains sections on body and workplace mapping

Arbejdsstilsynet Denmark / A little animated 3D figure guides eight steps with questions

Messing, K., Vézina, N., Eve, M,. Ouellet, S., Tissot, F., Couture, V,. Riel, J,. 2008, Body maps: an indicator of physical pain for worker-oriented ergonomic interventions, Policy and Practice in Health and Safety vol 6 no2

Videos:

The body map, what is it?

Live coverage of a body mapping session

Ontario Mentoring Coalition, Live coverage of a body mapping session

Boingboing Resilience, Live coverage of a body mapping session


Contributors

Palmer