Observations^[1]

1. Washing hands frequently takes oils out of the skin and lowers the ph of the skin.
2. A number of salons were equipped with free standing basins - See Figure 1.
3. For comfortable use, the top of the basin should be below the elbow when the upper arm is in a vertical position - See Figure 2.
4. All the basins observed were of a fixed height design and many were attached to the wall - See Figure 3.
5. Shorter operators have to reach up and over the edge by lifting their shoulders and moving the elbows out from the body. This makes it difficult to apply the necessary force to wash, rinse and massage the hair. No footstools or platforms were in use that would have improved the height of the hairdresser.
6. Working from the side of the basin requires bending and twisting the spine and reaching across the client's head to wash the far side of the head. The wrists are bent.
7. The back, shoulders, arms and wrists are working outside the desired range of movement.

Risk

1. Discomfort, pain and possible MSD injury.

Figure 1. Standing behind a free standing basin. Desirable- no twisting.

Long description for Figure 1

Figure 2. Massaging the hair

Long description for Figure 2

Figure 3. Difficult side access to the basin - Undesirable.

Long description for Figure 3

Interventions

1. Basins should be free standing - See Figure 1.
2. The taps and nozzle should not interfere with the hairdresser's access to the client's head.
3. Hairdressers should stand behind the basin or move around the basin to use the most comfortable position.
4. A preferred position is to work from the back of the basin and limit the back movement to reaching forward. This position will also improve the wrist angles - See Figure 2.
5. See more comments in the section 'Equipment, Basins'.
6. The design and use of basins should be reviewed by the Industry and product providers.

Combing

Combing determines the position of the section to be worked on. The technique of holding and working the comb can determine the postures adopted for the rest of the task.

The comb can be held with a knife grip (as in a table knife - See Figures 4 and 6) over the comb or from below with a spoon grip (K Janes - See Figures 5 and 7).

The spoon grip:

• allows the comb to be rotated in the fingers and reduces the movement of the wrist
• assists in positioning the elbow below the shoulder and closer to the side of the body.
• requires a longer comb.
• There is more information in the section on combs.

Observations

1. There are two ways of holding the section of hair:
   1. between the first and second fingers side by side (See Figure 18.)
   2. between the first and second fingers with the first finger under the second finger. (K Janes - See Figures 8 and 9).

Risk

1. Discomfort and pain in the finger muscles.
2. Cuts to the skin between the fingers

Interventions

1. The crossed finger grip is preferred. There is a difference in the force the fingers can exert when moved sideways and when moved up and down. Less effort is needed for the crossed finger grip.
2. Fingers pressed together sideways, do not press evenly against each other and there can be gaps where there is no or a reduced grip on the hair.
3. Fingers pressed together one on top of the other, have no gaps and so provide a grip on all of the hair in the section
4. The fingers, one on top of the other, close the gap between the fingers and protect the skin from scissor cuts.
5. With crossed fingers, the section is presented on a different angle and this reduces the rotation of both wrists.

Observations

1. Included these undesired positions and movements.
   1. The back bent like a banana - See Figure 10.
   2. The back twisted - See Figure 11.
   3. The head bent over - See Figure 11.
   4. The elbows above shoulder height and in a static position - See Figure 11.
   5. Cutting from above - See Figure 12.
   6. The shoulders lifted.
   7. The wrists bent fully and rotated beyond the mid-range of movement - See Figure 13.
   8. A static position held for more than a minute.
   9. "When I get a sore back I use a cutting stool."

Other hairdressers demonstrated these desired, 'good practice' positions and movements

1. The back upright and in a neutral position with no twisting - See Figure 14.
2. Adjusting the height of the client's head by adjusting the chair height and using the stool to enable good arm and wrist positions to be in the mid range of their possible movements up - down or sideways - See Figures 15 - 22.
3. The elbows between the side of the body and out to 45 degrees. Occasional movement up to shoulder height.
4. Static positions held for less than 5 seconds.

Figure 4: Knife Grip of the Comb - elbow out, shoulders maybe raised - Undesirable

Long description for Figure 4

Figure 5: Spoon grip of the comb - elbow not held out - Desirable.

Long description for Figure 5

Figure 6: Knife handle grip - Undesirable

Long description for Figure 6

Figure 7: Spoon grip with elbow down - Desirable.

Long description for Figure 7

Figure 8: Combing using a spoon grip with the elbow down - preferred.

Long description for Figure 8

Note also the 'finger crossed' grip - the bottom of the second finger is pressing against the top of the first finger - Desirable.

Figure 9: Combing using a knife grip with the elbow up - Undesirable.

Long description for Figure 9

Figure 10: Bending forward - Undesirable.

Long description for Figure 10

Figure 11: Back slightly twisted and head bent over - Undesirable

Long description for Figure 11

Also - pistol grip of dryer with elbow up undesirable.

Figure 12: Cutting over the top of the head. Undesirable elbow and wrist position.

Long description for Figure 12

Figure 13. Standing. Undesirable elbow height and wrist angle.

Long description for Figure 13

Figure 14: Using stool and sitting erect with the back in its natural curve - Desirable.

Long description for Figure 14

Figure 15: Sitting with client's head at a convenient level. Elbow down and wrist straight - preferred.

Long description for Figure 15

Figure 16: Showing the desirable comb and scissor hold.

Long descriptions for Figure 16

Figure 17: Section held closer to the head and in a lower position with the elbow down - Desirable.

Long description for Figure 17

Figure 18: Shows the finger hold. The section is lower and close to the head. The right wrist is in a neutral position - Desirable.

Long description for Figure 18

Figure 19: Bending forward. This position causes an undesirable bending of the right wrist.

Long description for Figure 19

Figure 20: Section lowered and arms lowered - Desirable.

Long description for Figure 20

Figure 21: Section lowered below the top of the head and arms now in a desirable position

Long description for Figure 21

Figure 22: Section held out from the head with the elbow up (undesirable position).

Long description for Figure 22

Risks

1. The undesired postures and movements contribute to the risk of discomfort, pain and MSD.

Interventions

1. A 'good practice' technique for cutting hair should be developed and adopted by the Industry.
2. Those teaching and training apprentices and new entrants to the Industry need to adopt and use 'good practice' techniques, as example and demonstration are essential to the learning process. It is very difficult to teach a technique that the teacher does not use.
3. To avoid discomfort and pain and for those with pain, hairdressers need to evaluate their techniques, consider the risks and, embark on a planned change process.
4. Those who teach cutting techniques have a responsibility to demonstrate and use 'good practices and techniques'.
5. Scissors that allow the wrists to be in a neutral, mid range of movement and the thumb movement towards the first finger should be used. See section 5.1 for information on scissors.

Observations

1. Dry hair being cut that floats in the air.
2. Tufts of wet hair than can fly off the comb.
3. Ordinary clothing with open necks and tops not reaching below the waist.
4. Open type shoes.

Risk

1. The entry of short lengths of hair into the skin or body openings causing irritation and possible infection.

Interventions

1. Wet the hair and keep it wet.
2. Avoid flicking the comb and clippers.
3. Wear clothing or preferably an apron that covers the whole body.
4. Avoid shaking the apron after use.
5. Wear closed type shoes.

Observation

1. Included these undesired positions and postures.
   1. The relative heights of the client's head and the hairdressers arms being outside the desired range requiring bending, stooping and undesired wrist angles - See Figures 23 and 24.
   2. The elbows were above the shoulder.
   3. The dryer arm being held at a constant height with static muscles for an undesired length of time.
   4. Using the pistol grip of the dryer all the time.
   5. Repetitive twisting of the brush wrist for undesired periods of time.
   6. Rapid twisting of the wrist (dryer). How rapid do these movements need to be to ensure the temperature felt by the client is comfortable and achieves the desired level of fluffing?
   7. Twisting of the dryer wrist beyond the mid-range of movement when using a pistol grip.
   8. Bending and twisting the back to see the section.

1. Other hairdressers included these desired, 'good practice' positions.
   1. Adjusting the height of the client's head and using a stool to enable good arm and wrists positions and movement with good vision of the section - See Figures 25 - 27.
   2. The elbows below the 45 degree angle most of the time.
   3. Holding static arm positions for less than ten seconds at a time.
   4. The dryer arm being regularly relaxed by lowering it to straighten the arm when changing position around the head.
   5. The use of both pistol and barrel grips of the dryer to suit the position of the section.
   6. Twirling the brush instead of twisting the wrist.
   7. Maintaining an erect back posture.
   8. Alternating the hands holding the dryer and brush during the task.

Risks

1. The undesired postures and movements contribute to the risk of discomfort and pain.

Interventions

1. Develop and adopt a 'good practice' technique for blow waving.
2. In the meantime adopt the observed desired techniques listed above.

Figure 23: Pistol grip of dryer with elbow up - undesirable.

Long description for Figure 23

Figure 24: Pistol grip of dryer with elbow up - undesirable.

Long description for Figure 24

Figure 25: Barrel grip of dryer with elbow down - desirable.

Long description for Figure 25

Figure 26: Barrel grip of dryer with elbow down - desirable.

Long description for Figure 26

Figure 27: Barrel grip of dryer - desirable.

Long description for Figure 27

Observations

1. The following undesired positions and movements were observed.
   1. Bending forward and twisting the back.
   2. Elbows above the shoulders.
   3. A shoulder lifted.
   4. Undesired wrist angles.
   5. Bending the knees.
   6. Not adjusting the height of the chair.
   7. Not using a stool or not adjusting the stool height.

1. Other hairdressers included these desired, 'good practice' positions and movements.
   1. Having the client's head at the optimum height for the top half of the head and using a stool for the lower half of the head to enable good arm and wrists positions and movement, with good vision of the section.
   2. Elbows below the 45 degree angle.
   3. Shoulders down.
   4. Standing erect and keeping the back in a neutral position with no twisting

Risks

1. The undesired postures and movements contribute to the risk of discomfort, pain and possible MSD.

Interventions

1. Adjusting the height of the client's head and using a stool to enable desired arm and wrists positions and movement and, with good vision of the section.
2. Standing erect without twisting.
3. Using a technique that keeps the shoulders level and the elbow below 45 degrees.
4. A 'good practice' technique for colouring hair should be developed and adopted by the Industry.

Observations

1. The task can take up to an hour.
2. The task requires precision finger work and concentration.
3. The hairdresser can carry out the whole task without a break.
4. Not matching the height of the work sections with the desired hand height causing bending over and some twisting.
5. Wrists bent beyond the mid-range of movement.

Risks

1. Fatigue and discomfort, pain and possible MSD in the fingers, wrists and back.

Interventions

1. Use a stool and adjust it frequently.
2. Make frequent changes in client height and vary the hairdresser's postures and so avoid undesired postures.
3. Alternating standing with sitting to reduce the standing time.
4. Find a reason to walk away from the task for 10 seconds every 10 minutes during the task.
5. Do exercises - stretch and flex the shoulders, arms, wrists and fingers.

Observations

1. Elbows and arms above the shoulders.
2. The tongs are held at right angles to the line of movement and this puts strain on the wrists.

Risks

1. The development of discomfort and pain from the shoulders to the fingers.

Interventions

1. Sharing the pulling work with another hairdresser.
2. Alternate the hands holding the tongs.
3. Frequently lowering the arms and, stretching and relaxing the shoulders, arms and wrists and fingers.
4. Consider moving the feet to move away from the client as the tongs move down the section.
5. Have the client sitting as low as possible - Note that a chair that allowed the client to lie back might make this task easier.

Observation

1. Hairdressers bending and twisting the back to place the head in a position for clear vision.
2. Bringing the eyes and head closer to the client's head for better vision interferes with the desired positions and movements of the hands, arms, shoulders and back.
3. Bending the neck forward.
4. Young people predominating in the industry - glasses not being so prevalent, along with a tendency to prefer contact lenses

Risk

1. Causing undesired posture and thus contributing discomfort, pain and possible MSD.
2. Can cause headaches.

Interventions

1. If the hairdresser can't see the work when standing erect, then vision correction (glasses or contact lenses) should be worn. Prescription glasses would have the advantage of providing some protection to the eyes.
2. When visiting an Optometrist the hairdresser should discuss the tasks to be performed and mime them. This will allow the Optometrist to identify the distances from the eyes to the work when standing erect and sitting.
3. A variety of corrective types are available - bifocals, trifocals, progressive lenses or lenses specially provided for the work in question.
4. The hairdresser's hands are often below the level of the eyes and the hairdresser looks down at their hands. Looking down can be achieved by:
   1. the eyes looking down
   2. the head tilting forward at the joint with the neck or
   3. the neck bending.
5. To lessen the load on the neck muscles, use the eyes to look down and tilt the head. It may take a little while to learn to tilt the head instead of bending the neck. Using tilting will reduce the risk of an MSD.
6. How to tilt the head:
7. To tilt the head, look straight ahead, and then tuck in the chin. This will tilt the head forward at the top joint of the spine with the head. Practice is needed to do this 'tuck and tilt'.
8. Wear glasses when handling chemicals, especially when mixing,

Observations

1. Cuts to the comb hand occur to hairdressers at some time.
2. Scars are evident.
3. Cuts can happen in the beginning of the day, when stressed and at the end of the day as fatigue sets in.

Risks

1. Is usually more of a nuisance value. Affects client relationships. Short hairs could enter the cut.

Interventions

1. Cover cuts immediately.
2. Start working at a moderate pace and work up to top speed.
3. Take steps to remedy the onset of fatigue as the shift proceeds.
4. Use a technique to minimise the risk of cutting the hand. Use the crossed finger grip already described to hold the section.

Observations

1. Most observations are listed in the preceding sections on technique.
2. One hairdressing task may not be the sole cause of discomfort and pain. It is more often the collective and cumulative workload that causes discomfort and pain.
3. Working outside the mid-range of movement of a joint causes an unequal load on the joint and the muscles that flex it. This is particularly relevant in hairdressing for the shoulders, elbows, wrists and fingers.
4. Adopting postures with the back bent and twisted.
5. Bending the neck.
6. Lack of recovery breaks during a task - a few seconds every few minutes.
7. Holding static muscle positions especially with the elbow near or above the shoulder.
8. Lack of recovery time during the day - a few minutes every 30 minutes - especially when the day is very busy and late nights are being worked.
9. The onset of fatigue as a busy day progresses.
10. Rapid repetitive movements. Do they need to be so rapid?
11. A question of adequate quality sleep time.
12. Wearing high heeled shoes.
13. Not exercising the calf muscles to help move the blood up the legs as the hairdresser moves around the chair.

Interventions

1. Develop Industry 'good practice" work techniques.
2. See the sections on Eyesight and Tilting the Head.
3. Improve understanding and knowledge of the healthy functioning of the musculoskeletal system including:
   1. the delivery of blood to, in and from the muscles
   2. the movement of fluids in the muscle tissues
   3. how tendons and joints are lubricated
   4. the recovery of muscles, tendons and joints.
4. is, the basic factors related to the onset of discomfort and pain.
5. Without understanding and knowledge, better work techniques are less likely to be adopted. Only enough knowledge is necessary to understand the processes and be motivated to adopt good practice.
6. The adoption of micro pauses, stretching and exercise during the work period.
7. Taking breaks as stated in the section, Hours of Work and breaks to reduce fatigue and thus reduce the risk of MSD.
8. Exercising the calf muscles by lifting the heels off the ground when moving around the chair from the beginning of every day.
9. Wear low heeled shoes from the beginning of every day.

If discomfort occurs take action immediately to ensure pain does not develop.

It is important to take steps to minimise the likelihood of discomfort progressing to more significant and regular pain. Early signs of discomfort in muscles, tendons and joints should be taken seriously.

• Check and correct work techniques and allowing for muscle recovery time with micro pauses and breaks.
• Talk with a hairdresser who trains apprentices in 'good practice' technique or consult a safety professional who is knowledgeable in hairdressing techniques.
• Check if personal stress levels have increased recently. These can trigger or increase discomfort and pain.

If the discomfort continues consult your GP who will advise on the best course of action. This may include review by another health professional for example a physiotherapist or an Occupational Medicine Physician.

Once pain sets in, it will take longer to cure. The sooner a pain disorder is identified, the better the outcome.

If you have had significant pain for a number of years and may be considering leaving the Industry:

• Try changing your work techniques and practices, and improving your fitness and general health.
• If this does not control the pain, have an assessment by someone like an Occupational Medicine Physician skilled in pain treatment. It may be possible to reduce your pain and increase your ability to work.

All salons should have a procedure for the treatment of discomfort and the early treatment of pain.

Alternating the hands

Observations

1. Hairdressers who have had serious MSD have a common factor of keeping really fit. Some have a regular programme of gym work and one was a triathlon competitor.
2. "In our salon with 10 staff, we have a gym fitness programme. No RSI".
3. Of the hairdressers interviewed with pain, few undertook exercise and none had a regular exercise programme.
4. The salons that claimed no MSD for more than 5 years stated they worked in a happy supportive environment.

Risks

1. Lack of fitness and good health can increase the risk of developing MSD.

Interventions

1. Have a fitness programme that can be a simple walking programme several times a week. Walk at a pace that will raise the breathing and heart rates.
2. The Industry should develop an exercise programme aimed at muscle conditioning and strengthening, and at cardiovascular condition.
3. This programme should be part of the trainees induction programme.
4. See the Appendix about breaks and exercises.