Ahmad Shakir Mohd Saudi et al., Int. J. Res. Pharm. Sci.

, 9(SPL2), 83-87

ORIGINAL ARTICLE

INTERNATIONAL JOURNAL OF RESEARCH IN

PHARMACEUTICAL SCIENCES
Published by Pharmascope Publications Journal Home Page: www.pharmascope.org/ijrps

An ergonomic assessment of musculoskeletal disorders among airport bag

handlers: A case study in Malaysia
Vishnu Ganesan3, Ahmad Shakir Mohd Saudi*1,2, Arvind Balakrishnan1, Nur Zahidah Shafii1, Mohd
Khairul Amri Kamarudin4, Mohamed Zul Fadhli Khairuddin1, Nur Azma Amin1, Izuddin Fahmy
Abu1, Ilyas Syafiq Darul Ridzuan1
1Universiti Kuala Lumpur, Institute of Medical Science Technology (UniKL MESTECH), 43000, Kajang,
Selangor, Malaysia
2Cybersecurity and System Research Unit, Faculty Science and Technology, Universiti Sains Islam Ma-

laysia, 71800 Nilai, Negeri Sembilan, Malaysia

3Faculty Science and Technology, Open University Malaysia, 40100, Shah Alam, Selangor, Malaysia
4East Coast Environmental Research Institute, Universiti Sultan Zainal Abidin, Gong Badak, 21300

Kuala Nerus, Terengganu, Malaysia

Article History: ABSTRACT

Received on: 02.10.2018 Flight baggage handlers are highly exposed to risk factors associated with
Revised on: 14.12.2018 musculoskeletal disorders. It is a grave issue that needs to be highlighted
Accepted on: 17.12.2018 since the aviation industry in Malaysia is continuously growing to support
ongoing demand. Hence it is imperative to have an efficient working practice
Keywords: to smooth the entire airline operation. This study aimed to i) identify an as-
sociation between heavy lifting with musculoskeletal disorders among flight
baggage handlers; and ii) determine the association between age with lower
The flight baggage han-
back pain prevalence among flight baggage handlers. The data were collected
dler,
using the Nordic Musculoskeletal Questionnaire (NMQ), daily observation
Musculoskeletal disor-
and informal interviews. Findings of this study demonstrated that the major-
der,
ity of bag handlers in the study area suffer from musculoskeletal disorder
Nordic Musculoskeletal
(MSD) problem caused by their daily routine work. The most affected body
Questionnaire,
parts of these workers are lower back, upper arm and shoulder whereby
Occupational health
more than 60% of the workers have reported suffering from MSD symptoms
in these body parts. It is evident from this study that the prevalence of MSDs
among airport baggage handlers is high. Thus an effective MSD prevention is
highly essential. Prevention of MSD in the workplace requires a strong com-
mitment between the employer and employees within an organisation. The
employer is fully responsible in providing a safe workplace, a sound ergo-
nomic principle and proper training on health and safety for all employees.

* Corresponding Author INTRODUCTION

Name: Dr. Ahmad Shakir Mohd Saudi Flight baggage handlers are exposed to many
Phone: +603-87395894 safety and health hazards that could potentially
Email: [email protected] lead to serious injury. The main tasks of a flight
baggage handler include transferring baggage be-
ISSN: 0975-7538 tween carts and aircraft, and pushing and pulling
DOI: https://doi.org/10.26452/ijrps.v9iSPL2.1746 heavy baggage often in standing, kneeling, bend-
ing, squatting and stretching postures mostly in
Production and Hosted by the tarmac area of the airport and within the con-
fined space of the narrow-bodied aircraft. As a con-
Pharmascope.org sequence, these strenuous activities could poten-
© 2018 Pharmascope Publications. All rights reserved.
tially lead to musculoskeletal disorders (MSDs), ei-

© Pharmascope Publications | International Journal of Research in Pharmaceutical Sciences 83

 Ahmad Shakir Mohd Saudi et al., Int. J. Res. Pharm. Sci., 9(SPL2), 83-87

ther temporarily or permanently, among the bag- ramp employees work on shifts of about eight
gage handlers (Saudi et al., 2017). It is vital for the hours per shift. Baggage handlers, however, are of-
aviation industry to commence a sound strategy to ten required to work overtime, particularly during
overcome these problems. peak seasons.
Aviation industry plays an important role in devel- The questionnaire survey was carried out on the
oping the Malaysian economy and helps to boost following scheduled dates to get as many respond-
the growth of other economic sectors such as tour- ents as possible to participate in this survey:
ism, hospitality, education, and global trade. The
25/5/2017 (Thursday): 1st shift, 2nd shift and 3rd
dynamicity of the Malaysian aviation industry
shift
showed rapid growth in the passenger traffic for
both domestic and international travelling. In con- 26/5/2017 (Friday): 4th shift, 5th shift and 6th shift
sequence, Malaysia is currently the 18th largest
27/5/2017 (Saturday): 2nd shift, 4th shift and 6th
civil aviation market in the world in terms of air
shift
passenger traffic; in 2014, Malaysia contributed to
Structured Questionnaire
1.5% of the world’s passenger traffic. During the
last decade (2005 to 2015), the volume of passen- The questionnaire was divided into three sections
ger traffic at all Malaysian airports grew from 7.2% as follows:
and exceeded 83 million passenger flow by the end
• Section A: General questions
of 2015 (CAPA, 2017). The increment in passenger
• Section B: Locations and tasks that are most
volume is due to the growing popularity of Malay-
likely to cause injury
sia as an Asian travel hub and the rising of Kuala
Lumpur as one of the international financial cen- • Section C: Musculoskeletal discomfort based
tres (De Beck and Herman, 2000). on Nordic Musculoskeletal questionnaire to
assess musculoskeletal symptoms.
In the aviation industry, aircraft ground handling is
a must-have service required by all aircraft follow- RESULTS AND DISCUSSION
ing their arrival at the terminal gate. One of the ser- Heavy lifting is associated with musculoskele-
vices offered through ground handling is baggage tal disorders among baggage handlers
handling operation. A baggage handler is responsi-
26% of respondents failed to perform any stretch-
ble for loading and unloading passenger baggage,
ing exercises prior to working as the activity was
parcels, as well as commercial postal freight mate-
not made compulsory by their supervisors (Table
rials for both inbound and outbound flights (Daw-
3). When further questioned about the state of
son et al., 2009).
their health, 76% of respondents have experienced
The nature of baggage handling activity exposes any kind of health problems resulting from their
workers to various health and safety hazards, po- daily task as a baggage handler and 66% respond-
tentially leading to work-related MSDs. Further- ents reported having injuries that reduced their
more, baggage handlers are also subjected to vari- ability to handle baggage. The most common injury
ous job hazards, including difficult weather condi- area was the shoulder (74%), followed by the back
tions, as they are required to cover all working (66%), upper arms (54%), neck (40%), and the hip
ground in the airport as well as inside the aircraft. (26%). These findings confirm that heavy lifting is
A summary of the manual handling activities in the associated with musculoskeletal disorder con-
airport is listed in Table 1. sistent with previous studies (Dell, 1997; Dell
Due to the gravity of this problem, the study was 1998; Gangopadhyay and Dev, 2014; Gasibat et al.,
aimed to i) identify if heavy lifting is associated 2017).
with MSD among baggage handlers; and ii) deter- Manual work location and tasks likely to cause
mine whether age is a factor for the prevalence of injuries
lower back pain among baggage handlers.
In Section B of the questionnaire, respondents
MATERIALS AND METHODS were asked to rank locations and nature of their
tasks according to the safety, from the highest to
Data Collection
the lowest risk. The four locations identified (Table
50 respondents out of 138 ramp employees who 4) were: i) tarmac area outside the aircraft; ii) bag-
are baggage handlers at one of the aviation compa- gage room; iii) inside the compartment of narrow-
nies in Malaysia were recruited in this study. The bodied aircraft, and iv) inside wide-body aircraft
baggage handlers were predominantly male, with bulk hold.
a ratio of 90:10 (male=124: female=14) and were
directly involved in the handling of passenger bag- 46% of respondents experienced an injury while
gage and cargo items at the tarmac area. These working inside the compartment of the narrow-

84 © Pharmascope Publications | International Journal of Research in Pharmaceutical Sciences

 Ahmad Shakir Mohd Saudi et al., Int. J. Res. Pharm. Sci., 9(SPL2), 83-87

Table 1: The manual handling activities at the airport

Type Activities
• Baggage handling on the ramp
Inbound • Baggage handling in the luggage hall
• Baggage handling in the reclaim area
• Baggage check-in process
• Baggage handling in the baggage hall
Outbound
• Baggage handling on the ramp
• Baggage stacking in the aircraft hold
• Passenger check-in process
• Assistance with boarding
Persons with disabilities/mobility
• Wheelchair services
• Lift on/off aircraft
Table 2: Frequency of respondents involved in the study
Variable Frequency
Male: 44 (88%)
Gender
Female: 6 (12%)
18-24 years old Male: 26 (52%), Female: 4(8%)
Age Range: 25-30 years old Male: 13 (26%), Female: 2 (4%)
≥31 years old Male: 5 (10%), Female: 0 (0%)
<3 years: 18 (36%)
Length of employment 3-5 years: 12 (24%)
>5 years: 20 (40%)
1: 0 (0%)
Number of shifts per week 2: 19 (38%)
3: 31 (62%)
Table 3: General question responses by bag handler respondents
Questions Yes No
Do you do warm-up exercises (stretch-
37 (74%) 13 (26%)
ing) before and after lifting baggage?
Are this stretching exercises enforced by
your supervisor before and after lifting 16 (32%) 34 (68%)
baggage?
Do you have any health problems result-
ing from your daily task as a baggage 38 (76%) 12 (24%)
handler?
Has this injury reduced your ability to
33 (66%) 17 (34%)
handle baggage?
Upper
Question Back Shoulder Neck Hips
Arm
Please indicate the body parts most af- 33 20 27 13
37 (74%)
fected by your daily tasks (66%) (40%) (54%) (26%)
Table 4: Manual handling location most likely to cause injury
Location Frequency (Percentage) n=50
Working inside compartment of narrow-body aircraft 23 (46%)
On the tarmac outside aircraft 17 (34%)
Lifting in the baggage room 9 (18%)
Working inside wide-body aircraft bulk hold 1 (2%)

bodied aircraft while 34% of respondents experi- In addition, respondents were also requested to
enced an injury while working in the tarmac area. rank in order the nature of manual baggage han-
Another 18% experienced an injury while lifting in dling tasks from least likely to most likely to cause
the baggage area while the least injury location injury onto baggage handlers. The four main tasks
was inside the wide-body aircraft bulk hold (2%). identified were: i) lifting baggage handling off from
conveyor belts into baggage trucks; ii) lifting bag-
gage from baggage trucks directly into aircraft; iii)
© Pharmascope Publications | International Journal of Research in Pharmaceutical Sciences 85
 Ahmad Shakir Mohd Saudi et al., Int. J. Res. Pharm. Sci., 9(SPL2), 83-87

Table 5: Manual handling tasks ranked most likely to cause injury

Activities Frequency (Percentage)
Stacking baggage inside the baggage compartment of narrow-
19 (38%)
bodied aircraft
Lifting baggage from baggage trucks directly into aircraft 17 (34%)
Lifting baggage off from conveyor belts into baggage trucks 9 (18%)
Pushing and pulling loaded baggage carts 5 (10%)
Table 6: Frequency table of respondents’ self-reported pain by body parts
During the last 12
Have you in the last 12 During the past 7 days
months have you been
months been affected have you been troubled
Body Parts prevented from doing
by pain, discomfort or by pain associated with
(n=50) your normal work be-
numbness in this part this part
cause of the pain
Yes No Yes No Yes No
Neck 15 (30%) 35(70%) 13 (26%) 37 (74%) 5 (10%) 45 (90%)
Shoulders 38 (76%) 12 (24%) 36 (72%) 14 (28%) 33 (66%) 17 (34%)
Elbows 28 (56%) 22 (44%) 21 (42%) 25 (50%) 8 (16%) 42 (84%)
Wrists/Hands 31 (62%) 15 (30%) 27 (54%) 23 (46%) 11 (22%) 39 (78%)
Upper Back 14 (28%) 36 (72%) 9 (18%) 41 (82%) 3 (6%) 47 (94%)
Lower Back 44 (88%) 6 (12%) 39 (78%) 11 (22%) 28 (56%) 22 (44%)
Hips/Thighs 21 (42%) 29 (58%) 18 (36%) 32 (64%) 18 (36%) 32 (64%)
Knees 41 (82%) 9 (18%) 37 (74%) 13 (26%) 31 (62%) 19 (38%)
Ankles/Feet 12 (24%) 38 (76%) 10 (20%) 40 (80%) 4 (8%) 46 (92%)
Table 7: Frequency table for the most frequently affected body parts (Comparison between
past 12 months and last 7 days)
Prevented from doing work for last 12 Had trouble during the last 7
Parts
months (n=50) days (n=50)
Shoulder 38 (76%) 33 (66%)
Lower Back 44 (88%) 28 (56%)
Upper arms 41 (82%) 31 (62%)
pushing and pulling loaded baggage carts, and iv) conditions experienced by individuals (Benjamin
stacking baggage inside the baggage compartment and Wilson, 2005). Our results showed that heavy
in the narrow-bodied aircraft (Table 5). lifting inflicted several physical symptoms to the
participants (Table 6). The three highest affected
As listed in Table 5, the majority of respondents
body parts in the last twelve months are causing
(38%) reported that stacking baggage inside the
pain, discomfort or numbness are the lower back
baggage compartment of narrow-bodied aircraft
region with the highest score of 88%, followed by
was the most likely task to cause injury followed by
the knees (82%) and shoulders (76%). 78% of re-
34% respondents who felt lifting baggage from
spondents were affected by pain in their lower
baggage trucks directly into aircraft can cause
back, 74% were affected by pain in their knees and
them injuries, while 18% reported experiencing
another 72% experienced pain in their shoulders
pain while lifting baggage off from conveyor belts
which prevented them from performing their nor-
into baggage trucks. The handling task that was
mal work. When asked which body parts are most
thought to least likely to cause injury is the pushing
associated with pain for the last seven days, 66%
and pulling loaded baggage carts. All the injuries
experienced pain in the shoulders, 62% in the
may occur because baggage handlers must adopt
knees and 56% in the lower back.
harmful postures when lifting, stacking and un-
loading heavy baggage (Thomas et al., 1995; Ta- In terms of frequency, the most often affected body
pley and Ripley, 2005). parts in the last twelve months is the lower back
(88%) followed by upper arms (82%) and shoul-
Factors and Prevalence of Musculoskeletal
der (76%), as summarized in Table 7. While in the
Symptoms
short term, the body part most affected in the last
All respondents, aged 18 to 31 years, reported ex- seven days was the shoulder (66%), followed by
periencing pain in certain body parts which sug- upper arms 62% and the lower back 56%. Our
gests that age is not a factor for the prevalence of findings suggest that the prevalence of musculo-
MSD. Factors that could contribute to the progres- skeletal symptoms when handling heavy baggage
sion of MSDs include physical and psychosocial among airport workers are prominently evident.
86 © Pharmascope Publications | International Journal of Research in Pharmaceutical Sciences
 Ahmad Shakir Mohd Saudi et al., Int. J. Res. Pharm. Sci., 9(SPL2), 83-87

MSDs can cause a significant level of interference Dell, G. 1998. Airline baggage handlers back inju-
with work routine; thus, our findings are alarming ries: A survey of baggage handler opinion on
and shall be further investigated for intervention causes and prevention. Safety Science Monitor,
to take place and prevent further damages (Ber- 2(2), 6.
nard, 1997; Rosskam, 2003). The prevention of
Gangopadhyay, S. and Dev, S. 2014. Design and
MSD requires good synergy between employer and
evaluation of ergonomic interventions for the
employees. The employer is responsible for
prevention of musculoskeletal disorders in India.
providing a safe workplace, proper training, and a
Annals of Occupation and Environmental Medi-
sound ergonomic principle for all employees. The
cine, 26(18), 1-6.
aviation industry and Occupational Safety and
Health (OSH) regulators worldwide must provide Gasibat, Q., Simbak, N. and Aziz, A. A. 2017. Stretch-
an initiative in setting realistic standards across ing Exercises to Prevent Work-related Musculo-
the industry to address the safety hazards exposed skeletal Disorders - A Review Article. American
to baggage handlers. Journal of Sports Science and Medicine, 5(2), 27-
37.
CONCLUSION
Rosskam, E. 2003. Airport check-in work: Conse-
The prevalence of MSDs among airport baggage
quences for worker health and management
handlers have been positively documented in this
practices. Ergonomic Society, 5, 263-266.
study. Thus, an effective intervention programme
is highly recommended to ensure the safety and Saudi, A. S. M., Rahman, R. A., Mahmud, M., Ishak, R.,
wellbeing of workers are taken care of. All the avi- Ridzuan, I. S. D., Azid, A., Juahir, H. and Saudi, M.
ation stakeholders must partake an active role in H. M. 2017. The Effectiveness of Ergonomic Prac-
strategizing solutions to this issue as providing a tice in Preventing Musculoskeletal Disorder
safe working environment relies on the coopera- Among Asian Construction Workers: Case Study
tion of all parties concerned, namely the airport in Kuala Lumpur, Malaysia. Advanced Science Let-
operators, owners of airlines, aircraft manufactur- ters, 23, 11391-11394.
ers and also the baggage handlers.
Tapley, S. and Ripley, D. 2005. Baggage handling in
REFERENCES narrow-bodied aircraft: Identification of assess-
ment of musculoskeletal injury risk factors.
Benjamin, K. and Wilson, S. 2005. Facts and mis-
Health and Safety Executive Report.
conceptions about age, health status and employ-
ability. Health and Safety Laboratory, Buxton Re- Thomas, R. G., Van Baar, C. E. and Van Der Stee, M.
port, Report HSL/2005/20. J. 1995. Baggage handling postures and the de-
sign of conveyors. Journal of Applied Ergonomics,
Bernard, B. P. 1997. Musculoskeletal disorders and
26(2), 123-127.
workplace factors. A critical review of epidemio-
logic evidence for work-related musculoskeletal
disorders of the neck, upper extremity, and low
back. (2nd Ed.) National Institute for Occupa-
tional Safety and Health, Cincinnati.
Centre for Aviation (CAPA). 2017. Malaysian 2017
aviation outlook: passenger growth may reach
15% as Air Asia, Malindo and MAS expand. Airline
Leader, 39.
Dawson, A. P., Steele, E. J., Hodges, P. W., and Stew-
art, S. 2009. Development and test-retest reliabil-
ity of an extended version of the Nordic Musculo-
skeletal Questionnaire (NMQ-E): a screening in-
strument for musculoskeletal pain. Journal of
Pain, 10, 517-526.
De Beck, O. and Herman, V. 2000. Research on
work-related low back disorders. Bulbar: Euro-
pean Agency for Safety and Health at work.
Dell, G. 1997. The causes and prevention of bag-
gage handler back injuries: A survey of airline
safety professionals. Safety Science Monitor,
3(3),87-96.

© Pharmascope Publications | International Journal of Research in Pharmaceutical Sciences 87