With more than 50 years’ experience in the local and international flooring industry, Denver Coleman, Chairman of Polyflor SA, answers questions posed by installers, architects and readers. In this issue he discusses the connection between flooring and musculoskeletal injuries.

“We are about to revamp our frail care facility. Many of our staff – particularly those who spend a large percentage of their day on their feet – suffer from foot, back and other musculoskeletal injuries, which impacts on their work ability and absentee rates. Our resident Physiotherapist suggested that we should carefully consider our new choice of flooring to help prevent these injuries. We generally use vinyl floors in our healthcare facilities. Can you recommend which floor we should use to help our staff and do you have research to back this up?” – Dennis, Gauteng

This is an interesting and important question for a number of reasons. Flooring can impact the health and safety of staff in an environment. In the healthcare sector, questions are often asked about the slip-resistant and VOC emission properties of floors, but it is not that often that healthcare facilities consider the long-term impact of floors on the musculoskeletal health of their staff. It’s a great question to ask.

A soft but hygienic and easy-to-clean floor is ideal
Good quality, independent research in this area is scarce, particularly with specific reference to vinyl flooring. Available evidence suggests that the shock absorbing properties of both protective shoes and work station mats can help minimise acute and chronic musculoskeletal symptoms and discomfort in the legs and lower back. Softer floors provide better support for the feet, require less muscle effort to walk across, ensure improved stride length, speed and stability and a lower incidence of reported lower back/leg pain. A soft but hygienic and easy-to-clean vinyl is therefore often the floor of choice in a healthcare facility.

One excellent, independent study, conducted in Sweden in 2011 by the Department of Public Health and Clinical Medicine, gives some valuable insights, however, space does not allow a full analysis and discussion of this paper (https://www.ncbi.nlm.nih.gov/pubmed/21846283). This study compared various musculoskeletal symptoms of pain and fatigue in a group of 91 female nursing assistants in a geriatric care facility where the floor had originally been a homogeneous 2mm vinyl and was replaced with a 4mm heterogeneous vinyl floor (1.5mm wear layer and 2.5mm foam layer).

Symptoms were measured in subjects whilst working on the old floor and 6 weeks, 1 year and 2 years after the new floor was installed. The study did control for change in shoes to ensure that this did not confound the results. The 2mm vinyl floor had a shock absorption of 0.6% and a vertical deformation of 0.2mm whilst the new 4mm floor had a shock absorption of 8% and a vertical deformation of 0.4mm.

In a nutshell, this study suggests that the change in the shock absorption properties of the floor resulted in improvements in musculoskeletal symptoms (particularly lower back and foot complaints) from as early as 6 weeks after the new floor was installed and that these changes persisted for at least 2 years (at which point analysis was stopped).

Protecting staff from musculoskeletal fatigue, pain and injury
Whilst this is only one study and more well-controlled research is needed, this research should make us think about what are most appropriate floors to protect staff from musculoskeletal fatigue, pain and injury in our healthcare facilities. Whilst homogeneous flooring is routinely used in healthcare facilities in South Africa, it might be time to start asking whether a thicker, more shock absorbent heterogenous floor should be used in areas where staff are on their feet for extended periods. Generally, this flooring also has wonderful acoustic properties which is also a huge benefit in a healthcare environment. This must balance against durability of the floor but it is important to understand needs and options and make an informed choice.

For more information, visit www.polyflor.co.za or call +27 (11) 609 3500.