Truck drivers have been referred to as the "most visible invisible worker." We see trucks every day but rarely do we interact with the driver behind the wheel. We take for granted the many goods and services that those drivers bring to us day in and day out. Truck drivers deliver everything from automobiles to flour and they are the only mode of transportation that can bring goods from door to door. The United States trucking industry delivers most of the country's over-land freight and is vital to our manufacturing, construction, transportation and warehousing.
Few of us have a real appreciation of how challenging truckers' jobs can be from a physical perspective - until we take time to analyze their job responsibilities. The trucking industry has embraced the concept of pre-hire functional screening perhaps more than other industries. Rehabilitation clinics have the opportunity to serve these companies through functional screening, injury prevention and post-injury rehabilitation.
However, clinicians who do not have experience with the trucking industry need to educate themselves before having their first marketing encounter with a trucking company executive. A basic knowledge and understanding of driver job responsibilities, types of trucks, and Department of Transportation rules and regulations is essential.
This column will share insight gained through conducting job analysis, performing post-offer/pre-hire screens and treating injured workers in the trucking industry. As clinicians working in this industry we need to consider several important factors: 1) the typical duties (in addition to driving) that a driver performs; 2) the types of equipment used and how that affects job duties; 3) the special problems that co-morbidities such as diabetes, hypertension, and obesity have on their career; 4) the unique challenges that
long-haul drivers face in leading a healthy lifestyle; and 5) the federal agencies that regulate the trucking industry.
In addition to driving, before heading out on the road commercial drivers must do a pre-trip truck inspection. This inspection includes three primary components: 1) Checking under the hood of the cab; 2) Checking the perimeter of tractor and trailer; and 3) Checking the function of the equipment inside the cab. To perform the pre-trip inspection, drivers need to squat and sometimes crawl or duck walk to inspect under the truck. They also need to be able to open the hood and climb into the cab. While these tasks may not be difficult for a healthy driver, a driver with knee, low-back or shoulder injuries may find these tasks difficult if not impossible. If balance is an issue, climbing and rising from a squatting position may be impaired.
Depending on the company, drivers may or may not have to handle their cargo or perform loading or unloading or maintenance functions. Materials handling can include cargo of various sizes and weights, hoses for filling tanks, tarps to cover flatbed cargo, chains or straps to secure the tarps and loads on flatbed trucks. Climbing can be required onto flat bed loads, into vans or onto the sides and tops of tankers and into the cab of the tractor. Repetitive bending/stooping and squatting are often required for folding tarps. Prolonged sitting is a major component of driving and not unlike the office environment, prolonged sitting carries with it the facilitation of 1) forward head and rounded shoulders; 2) flexed thoracic spine with weakness of the peri-scapular, thoracic spine and hip extensor muscles; 3) tight pectorals, hip flexors and hamstrings.
Types of Equipment and Affect on Job Responsibilities
In general, there are 3 main types of trucks 1) Flatbed; 2) Vans; and 3) Tankers. Drivers working with all three types of equipment have to be able to open and close the hood of the truck, pull the fifth wheel release (mechanism that releases the truck cab from the trailer). Forces required to open the hood can range from 50 to 60 pounds, depending upon the equipment. Forces in the neighborhood of 75 pounds may be required to pull the fifth wheel release.
In addition to these basic driver responsibilities, flatbed drivers typically are lifting tarps (large pieces of canvas or plastic that cover the loads while in transit) and securing the loads onto the flatbed with straps and chains. Flatbed drivers also need to have adequate balance to climb up on the flat bed and walk around often very narrow edges of a loaded flatbed or to climb on top of the load to remove or adjust the tarp. If the wind catches the tarp they are handling while on the load, drivers must be prepared to deal
with significant and unpredictable forces.
Van drivers' physical job requirements vary greatly depending upon whether they must unload their cargo and whether their loads are palletized and handled with a forklift or must be manually lifted. Even drivers who do not have to unload may have to handle cargo if the load shifts during transit. In the case of a load shift, the driver may need to pull off to the side of the road and physically adjust the load without mechanical assistance. Opening and closing van doors and pulling loading ramps from the truck can require considerable forces.
Tanker drivers have distinct responsibilities that include climbing on the ladders leading up to the top of the tanker, walking or crawling on top of the tanker, and pulling hoses charged with liquid or powder. While at the trucking company terminal, they will likely have access to fall protection equipment for the climbing. However, once they reach their customer's location, the fall protection equipment may not be available. For these drivers balance and agility are essential for safe and successful performance of the job.
Special Issues with Co-Morbidities in Drivers
In addition to passing any functional tests, the driver must pass a Department of Transportation (DOT) physical examination. The physical exam can be administered by physician, nurse practitioner, physician's assistant, chiropractor or osteopath. A variety of medical diagnoses may affect a person's ability to hold a commercial driver's license if the condition interferes with safe operation of a
commercial motor vehicle.1,2
As part of the hiring process, some drivers will have their DOT physical exam prior to the functional testing. If the DOT physical is performed prior to functional test, drivers with the above listed conditions may be eliminated from the hiring process before they arrive for functional test. Others will have the DOTphysical exam after the functional test. In the latter case, many individuals with the excluded diagnoses have not been eliminated. When the clinician performing the functional exam takes a medical history prior to starting the functional test, drivers may be reluctant to admit to some of their diagnoses for fear of being eliminated from the applicant pool. One method for addressing this reluctance is to ask not only about diagnoses, but also about medications taken.
Medications for hypertension often affect the heart rate response to exertion. The functional testing system should incorporates heart rate into the scoring system and include alternative scoring for the individual who is taking heart rate modifying drugs.
Driving a truck for long haul deliveries requires that drivers lead a lifestyle with unique challenges. They are away from home for long stretches of time. They have limited food choices at truck stops and little to no access to gym facilities for exercise. Drivers sit for long periods of time and then climb out of the trucks sometimes to encounter wet, slippery, icy or snowy conditions and sometimes must
perform physical work. They are also exposed to long periods of whole body vibration which is well known to negatively affect the health and durability of the intervertebral discs of the spine. In addition, the static position required for prolonged sitting likely affects joint proprioception of the hips, knees and ankles. None of these lifestyle issues promote maintenance of healthy weight, strength, balance and cardiovascular conditioning.
The regulatory landscape that governs the trucking industry spans both state and federal agencies and is complex. The primary federal agency involved in the regulation of trucking companies is the Department of Transportation (DOT). The Federal Motor Carrier Safety Administration (FMCSA) is a department within the DOT. The FMCSA sets and enforces the Motor Carrier Safety Regulations (FMCSR) which set safety standards for the design, manufacture, and operation of transportation equipment. The FMCSA
regulates, among other things, the number of hours a driver can drive without rest, the inspection and repair of trucks and trailers, and the interstate transportation of hazardous material.1
OSHA regulations govern the responsibilities of employers to ensure truckers' safety at the locations where they travel to deliver and pick up their loads. There are two state agencies that have regulatory authority over the trucking industry in each state the Public Utilities Commission (PUC) and the Department of Motor Vehicles (DMV). The Tariff and License branch in the transportation division of the PUC regulates intrastate trucking. Intrastate trucking refers to freight shipments commencing and concluding within the state. The PUC issues operating permits and sets minimum and maximum intrastate freight rates. The PUC requires trucking firms, depending on the size of the annual gross receipts, to file quarterly and/or annual reports. The DMV requires the registration of vehicles and licensing of drivers. DMV records when a specific vehicle was licensed and placed in service.
As a result of the physical demands of the work and the chronic deconditioning experienced by commercial truck drivers, injuries are not uncommon. The Bureau of Labor Statistics ranks trucking among those industries with the highest rates of injury.4,5 The most frequent injuries involve the low back, shoulders and knees. The most frequent mechanisms of injury include musculoskeletal strains and sprains caused by over exertion and slips, trips and falls. In flatbed trucking, shoulder injuries tend to occur with tarp handling. With other types of equipment, pulling the fifth wheel release and opening and closing van doors can create shoulder injuries. The back injuries occur most frequently with tarp and load handling.
Slips, trips and falls occur as drivers enter and leave the cabs of the trucks and as they climb onto the flatbed trailers, into the rear of the vans or up onto the tankers.
Developing Post-Offer Screens for Trucking Companies
If you are developing a post-offer/pre-hire screen for the company, it is imperative to perform a job analysis on which you can base the screen. The job analysis should document the percent of day spent performing the various physical demands of the job and the weights handled and forces exerted. It's also important to determine the distances over which those forces must be handled. All of these parameters need to be considered when developing a functional screen. The job analysis protocol needs to be systematic and comprehensive, covering all essential functions of the job.
Since there are significant Americans with Disabilities Act Amendment Act (ADAAA) and Equal Employment Opportunity Commission (EEOC) considerations for developing functional screens, consulting a national organization with experience developing these screens is advised. In addition, the functional testing protocol used for screening should have research documenting its reliability and
validity. The research validation is another advantage that the national firm that specializes in functional screening can address.
The trucking industry is obviously one that can benefit from the prevention strategies and treatment interventions of a knowledgeable health care provider. As therapists, we have knowledge of anatomy, physiology, biomechanics, and injury and illness that is ideal for addressing injuries in the trucking industry. Our skills in functional assessment, job analysis, employee education and treatment of
workplace injuries can converge to help trucking companies reduce injuries and facilitate return to work.
Adding industry knowledge enhances our basic skills and makes us a better partner in injury prevention and management.
Deborah E. Lechner is president of ErgoScience Inc.