PD CEN/TR 12349:2023

BSI Standards Publication

Mechanical vibration — Guide to the health

effects of vibration on the human body
PD CEN/TR 12349:2023 PUBLISHED DOCUMENT

National foreword
This Published Document is the UK implementation of
CEN/TR 12349:2023. It supersedes PD 12349:1997, which is withdrawn.
The UK participation in its preparation was entrusted to
Technical Committee GME/21/6, Human exposure to mechanical
vibration and shock.
A list of organizations represented on this committee can be obtained on
request to its committee manager.
Contractual and legal considerations
This publication has been prepared in good faith, however no
representation, warranty, assurance or undertaking (express or
implied) is or will be made, and no responsibility or liability is or will be
accepted by BSI in relation to the adequacy, accuracy, completeness or
reasonableness of this publication. All and any such responsibility and
liability is expressly disclaimed to the full extent permitted by the law.
This publication is provided as is, and is to be used at the
recipient’s own risk.
The recipient is advised to consider seeking professional guidance with
respect to its use of this publication.
This publication is not intended to constitute a contract. Users are
responsible for its correct application.
This publication is not to be regarded as a British Standard.
© The British Standards Institution 2023
Published by BSI Standards Limited 2023
ISBN 978 0 539 25479 2
ICS 13.160
Compliance with a Published Document cannot confer immunity
from legal obligations.
This Published Document was published under the authority of the
Standards Policy and Strategy Committee on 31 August 2023.

Amendments/corrigenda issued since publication

Date Text affected
 PD CEN/TR 12349:2023

TECHNICAL REPORT CEN/TR 12349

RAPPORT TECHNIQUE
TECHNISCHER REPORT August 2023

ICS 13.160 Supersedes CR 12349:1996

English Version

Mechanical vibration - Guide to the health effects of

vibration on the human body
Vibrations mécaniques - Guide concernant les effets Mechanische Schwingungen - Leitfaden über die
des vibrations sur la santé du corps humain Wirkung von Schwingungen auf die Gesundheit des
Menschen

This Technical Report was approved by CEN on 9 July 2023. It has been drawn up by the Technical Committee CEN/TC 231.

CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,
Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway,
Poland, Portugal, Republic of North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Türkiye and
United Kingdom.

EUROPEAN COMMITTEE FOR STANDARDIZATION

COMITÉ EUROPÉEN DE NORMALISATION
EUROPÄISCHES KOMITEE FÜR NORMUNG

CEN-CENELEC Management Centre: Rue de la Science 23, B-1040 Brussels

© 2023 CEN All rights of exploitation in any form and by any means reserved Ref. No. CEN/TR 12349:2023 E
worldwide for CEN national Members.
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Contents Page
European foreword ............................................................................................................................................ 3
Introduction .......................................................................................................................................................... 4
1 Scope.......................................................................................................................................................... 5
2 Normative references.......................................................................................................................... 5
3 Terms and definitions ......................................................................................................................... 5
4 Hand-transmitted vibration.............................................................................................................. 5
4.1 General...................................................................................................................................................... 5
4.2 Vascular disorders ............................................................................................................................... 6
4.3 Neurological disorders ....................................................................................................................... 7
4.4 Musculoskeletal disorders ................................................................................................................ 8
4.4.1 Skeletal – bone and joint disorders ................................................................................................ 8
4.4.2 Muscular................................................................................................................................................... 9
4.5 Other disorders ..................................................................................................................................... 9
5 Whole-body vibration ......................................................................................................................... 9
5.1 General...................................................................................................................................................... 9
5.2 Low-back pain and back disorders............................................................................................... 10
5.3 Foot-transmitted vibration ............................................................................................................. 10
5.4 Other disorders ................................................................................................................................... 11
5.4.1 Neck-shoulder disorders.................................................................................................................. 11
5.4.2 Digestive disorders ............................................................................................................................ 11
5.4.3 Reproductive effects – stillbirth .................................................................................................... 11
5.4.4 Circulatory disorders ........................................................................................................................ 11
5.4.5 Cochleo-vestibular effects ............................................................................................................... 11
Annex A (informative) Prevention............................................................................................................. 12
Annex B (informative) Glossary.................................................................................................................. 14
Bibliography ....................................................................................................................................................... 16

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European foreword

This document (CEN/TR 12349:2023) has been prepared by Technical Committee CEN/TC 231
“Mechanical vibration and shock”, the secretariat of which is held by DIN.

Attention is drawn to the possibility that some of the elements of this document may be the subject of
patent rights. CEN shall not be held responsible for identifying any or all such patent rights.

This document supersedes CR 12349:1996.

The main changes compared to the previous edition are as follows:

• general information about foot transmitted vibration included;

• subclauses on “Prevention” moved to new informative Annex A;

• glossary moved to Annex B;

• editorial revision to comply with CEN Internal Regulations.

Any feedback and questions on this document should be directed to the users’ national standards body.
A complete listing of these bodies can be found on the CEN website.

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Introduction

This document is an update of the 1st version from 1996 and it provides a short overview of the
knowledge of the possible effects of vibration on the human body at work. It is an informative document
which presents general background information for the user of the different European Standards on
vibration. Information about existing approaches for prevention is provided in the informative Annex A.
A glossary with important terms is listed in Annex B.
Mechanical vibration arises from a wide variety of processes and operations performed in industry, craft,
forestry and agriculture, and public utilities. Vibrations are mainly caused by powered processes, hand-
held and hand-guided tools, workpieces, or by vehicles. Occupational exposure to vibration can lead to
health risks including occupational diseases. Exposure to harmful vibration can induce several
complaints and health disorders, mainly at the upper limbs and the lower back. A comprehensive
knowledge of effects of vibration on the body with risks for safety and health at work is essential to
implement appropriate technical, administrative/organisational, personal protective measures and
medical preventive measures.
This knowledge forms the basis for the EU Vibration Directive 2002/44/EC, its national implementation
at EU Member States and the continuous updating of this regulatory framework by new scientific
knowledge including the technical and medical guides to avoid or minimize occupational risks by
vibration exposure at work.

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1 Scope
The aim of this document is to provide information on the possible adverse health effects caused by
exposure to vibration at work. The report addresses manufacturers, companies which introduce
machinery on the EU market as well as employers and employees using vibrating machinery in order to
improve their understanding of the possible health problems arising from occupational exposure to
vibration.
This document is limited to the effects on health and does not cover the potential effects of vibration on
comfort, human performance, or vibration perception. Most of the information on whole-body vibration
in this document is based upon data available from research on human response to vibration of seated
persons. There are only few data on the effects of vibration on persons in standing, reclining or recumbent
positions.
The information on both hand-transmitted vibration and whole-body vibration is based upon data from
laboratory research on acute effects as well as upon data from epidemiologic field-studies at workplaces.
Additional information can be obtained from the scientific literature.

2 Normative references
There are no normative references in this document.

3 Terms and definitions

No terms and definitions are listed in this document.
ISO and IEC maintain terminological databases for use in standardization at the following addresses:
• ISO Online browsing platform: available at https://www.iso.org/obp

• IEC Electropedia: available at https://www.electropedia.org/

4 Hand-transmitted vibration
4.1 General

Powered processes and tools which expose operators’ hands to vibration are widespread in several
industrial and craft activities. Occupational exposure to hand-transmitted vibration can arise from
rotating and percussive hand-held power tools used in the manufacturing industry, craft, quarrying,
mining and construction, forestry and agriculture, and public utilities. Exposure to hand-transmitted
vibration can also occur from vibrating workpieces held in the hands of the operator, and from hand-held
vibrating controls such as motorcycle bars or vehicle steering wheels.
It has been estimated that 1,7 % to 3,6 % of the workers in the European countries are exposed to
potentially harmful hand-transmitted vibration.
The term hand-arm vibration (HAV) syndrome is commonly used to refer to the complex of peripheral
vascular, neurological and musculoskeletal disorders associated with exposure to hand-transmitted
vibration. Workers exposed to hand-transmitted vibration can be affected with neurological and/or
vascular disorders separately or simultaneously. Excessive exposure to hand-transmitted vibration can
include disturbances in finger blood flow, and in neurological and locomotor functions of the hand and
arm. Vascular disorders and bone and joints abnormalities caused by hand-transmitted vibration are
compensated occupational diseases in several countries. These disorders are also included in a European
schedule of recognized occupational diseases.
The vibration related diseases as listed at the European schedule of occupational diseases.

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This is the background for the exposure action and limit values given in the EU Directive Vibration
connected with corresponding mandatory preventive measures.
4.2 Vascular disorders

Workers exposed to hand-transmitted vibration can complain of episodes of pale or white finger usually
triggered by cold exposure. This disorder, due to temporary abolition of blood circulation to the fingers,
is called Raynaud’s phenomenon (after Maurice Raynaud, a French physician who first described it in
1862). It is believed that vibration can disturb the digital circulation making it more sensitive to the
vasoconstrictive action of cold.
To explain cold-induced Raynaud’s phenomenon in vibration-exposed workers, some investigators
invoke an exaggerated central vasoconstrictor reflex caused by prolonged exposure to harmful vibration,
while others tend to emphasize the role of vibration-induced local changes in the digital vessels.
Various synonyms have been used to describe vibration-induced vascular disorders: dead or white finger,
Raynaud’s phenomenon of occupational origin, traumatic vasospastic disease, and, more recently,
vibration-induced white finger (VWF). VWF is a prescribed disease in many countries.
Initially attacks of blanching involve the tips at one or more fingers, but, with continued exposure to
vibration, the blanching can extend to the base of the fingers. Sometimes, an attack of blanching is
followed by cyanosis, i.e. a bluish discoloration of the affected fingers due to increased extraction of
oxygen from the sluggish digital circulation. In the recovery phase, commonly accelerated by warmth or
local massage, redness, eventually associated with pain, can appear in the affected fingers as a result of a
reactive increase of blood flow in the cutaneous vessels. The blanching attacks are more common in
winter than in summer and last from a few minutes to more than one hour. The duration varies with the
intensity of the triggering stimuli, the attack is usually ending when the entire body is warmed.
If vibration exposure continues, the blanching attacks become more frequent and can occur all year
around. In rare advanced cases, repeated and severe finger blanching attacks can lead to trophic changes
(ulceration or gangrene) in the skin of the fingertips. During the attack the affected workers can
experience a complete loss of touch sensation and manipulative dexterity, which can interfere with work
activity increasing the risk for acute injuries due to accidents. In occupational medicine various staging
systems for the classification of VWF have been developed. A grading scale proposed at the Stockholm
Workshop 86 is reported in Table 1. This scale is also included in EN ISO 5349-1:2001, Annex B.
Table 1 — The Stockholm Workshop scale for staging cold-induced Raynaud’s phenomenon in
the hand-arm vibration syndrome

Stage Grade Symptoms

0 — No attacks
1v Mild Occasional attacks affecting only the tips of one or more fingers
Occasional attacks affecting distal and middle (rarely also proximal)
2v Moderate
phalanges of one or more fingers
3v Severe Frequent attacks affecting all phalanges of most fingers
4v Very severe As in stage 3, with trophic skin changes in the fingertips
Key:
v vascular component

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Several laboratory tests are used to diagnose white finger objectively. Most of these tests are based on
cold provocation and the measurement of finger skin temperature or digital blood flow and pressure
before, during and after cooling of the fingers and hands (see ISO 14835-1 and ISO 14835-2).
Epidemiologic studies have demonstrated that the prevalence of VWF varies widely, from 0 % to 100 %.
It appears that the probability and severity of white finger symptoms is influenced by several factors such
as
• the characteristics of vibration exposure (frequency, magnitude, direction, impulsiveness, duration),

• the type of tool and work process,

• the environmental conditions (temperature, air flow, humidity, noise),

• some biodynamic and ergonomic factors (grip force, push force, arm position), and

• various individual characteristics (susceptibility, diseases and agents, e.g. smoking and certain
medicines, affecting the peripheral circulation).

Thus, there is a complex relationship between vibration exposure and the development of white finger
symptoms. Epidemiologic studies have shown that the occurrence of VWF increases with increasing
duration of vibration exposure. There is some evidence that the cumulative exposure before the
appearance of finger blanching is approximately inversely proportional to the magnitude of the vibration
exposure (i.e. if the vibration magnitudes are doubled, a halving of the years of exposure is necessary to
produce the same effect).
Since the late 1970s a decrease in the incidence of VWF has been reported among active forestry workers
in both Europe and Japan after the introduction of anti-vibration chain saws and administrative measures
curtailing the saw usage time together with endeavours to reduce exposure to other harmful work
environment (e.g. cold, and physical stress). Recovery from VWF has also been reported among retired
forestry workers. Similar findings are not yet available for tools of other type.
4.3 Neurological disorders

Workers exposed to hand-transmitted vibration can experience tingling and numbness in their fingers
and hands. If vibration exposure continues, these symptoms tend to worsen and can interfere with work
capacity and life activities. Vibration-exposed workers can exhibit a reduction in the normal sense of
touch and temperature as well as an impairment of manual dexterity at the clinical examination. As an
effect of hand-transmitted vibration, also a reduction of the vibration sensitivity of the skin of the
fingertips can be found. Epidemiologic surveys of vibration-exposed workers show that the prevalence
of peripheral neurological disorders varies from a few percent to more than 80 %, and that sensory loss
affects users of a wide range of tool type. It seems that sensorineural disturbances can develop
independently of other vibration-induced disorders, probably reflecting different pathological
mechanisms.
A classification for the neurological component of the HAV syndrome was proposed at the Stockholm
Workshop 86, consisting of three stages according to the symptoms complained and the results of clinical
neurological examination and psychophysical testing methods such as tactile discrimination, vibrotactile
perception, and precision manipulation (see Table 2). This scale is also included in EN ISO 5349-1:2001,
Annex B.

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Table 2 — Sensorineural stages of the hand-arm vibration syndrome according to the Stockholm
Workshop scale

Stage Signs and symptoms

0SN Exposed to vibration but no symptoms
1SN Intermittent numbness, with or without tingling
2SN Intermittent or persistent numbness, reduced sensory perception
Intermittent or persistent numbness, reduced tactile discrimination and/or manipulative
3SN
dexterity
Key:
SN sensorineural component

Vibration-exposed workers can sometimes show signs and symptoms of entrapment neuropathies, such
as carpal tunnel syndrome (CTS), a disorder due to compression of the median nerve as it passes through
an anatomical tunnel in the wrist. CTS seems to be a common disorder in some occupational groups using
vibrating tools such as rock-drillers, platers and forestry workers. It is believed that ergonomic stressors
acting on the hand and wrist (repetitive movements, forceful gripping, awkward postures), in
combination with vibration can cause CTS in workers handling vibrating tools. CTS is acknowledged by
most of the EU Member States as occupational disease.
4.4 Musculoskeletal disorders
4.4.1 Skeletal – bone and joint disorders

Vibration-induced bone and joint disorders are a controversial matter:

a) Early radiological investigations revealed a high prevalence of bone vacuoles and cysts in the hands
and wrists of vibration-exposed workers, other studies have shown no significant increase with
respect to manual workers not exposed to vibration.

b) Excess occurrence of wrist and elbow osteoarthrosis as well as ossifications at the sites of tendon
insertion, mostly at the elbow, have been found in miners, road construction workers and metal-
working operators exposed to shock and low-frequency vibration (<50 Hz) of high magnitude from
pneumatic percussive tools.

c) An excess prevalence of Kienböck’s disease (lunate malacia) and pseudoarthrosis of the scaphoid
bone in the wrist has also been reported by a few investigators.

An increased prevalence of degenerative bone and joint disorders in the upper limbs of workers exposed
to mid- or high-frequency vibration arising from chain saws or grinding operation. Heavy physical effort,
forceful gripping and various biomechanical factors can also account for the higher occurrence of skeletal
injuries found in workers operating percussive tools. Local pain, swelling, and joint stiffness and
deformities can be associated with radiological findings of bone and joint degeneration.
In some countries (e.g. France, Germany, Italy), bone and joint disorders occurring in workers using hand-
held vibrating tools are considered to be an occupational disease and the affected workers are
compensated.

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4.4.2 Muscular

For workers with prolonged exposure to vibration muscular weakness, pain in the hands, arms and
shoulders, and diminished muscle force are known. Vibration exposure has also been found to be
associated with a reduction of hand-grip strength. In some individuals muscle fatigue can cause disability.
Direct mechanical injury or peripheral nerve damage have been suggested as possible aetiological factors
for muscle symptoms. Other work-related disorders have been reported in vibration-exposed workers,
such as tendinitis and tenosynovitis (i.e. inflammation of tendons and their sheaths) in the upper limbs,
and Dupuytren’s contracture, a disease of the fascial tissues of the palm of the hand. These disorders seem
to be related to ergonomic stress factors arising from heavy manual work, and the association with hand-
transmitted vibration is not completely known.
4.5 Other disorders

Some studies indicate that in workers affected with VWF, hearing loss is greater than that expected on
the basis of ageing and noise exposure from vibrating tools. It has been suggested that VWF subjects can
have an additional risk of hearing impairment due to vibration-induced vasoconstriction of the blood
vessels supplying the inner ear.
In addition to peripheral disorders, other adverse health effects involving the endocrine and central
nervous system of vibration-exposed workers have been reported by Russian and Japanese investigators.
The clinical picture, called “vibration disease”, includes signs and symptoms related to dysfunction of the
higher centres of the brain (e.g. persistent fatigue, headache, irritability, sleep disturbances, impotence,
electroencephalographic abnormalities). These findings can only be interpreted with caution and further
carefully designed epidemiologic and clinical research work is needed to confirm the hypothesis of an
association between disorders of the central nervous system and exposure to hand-transmitted
vibration.

5 Whole-body vibration
5.1 General

The mechanical vibration transmitted by the seat or by the feet in vehicles (land, air, water), on ships and
vibrating surfaces is called whole-body vibration (WBV). Exposure to WBV is a widespread occupational
factor that can cause adverse effects on health. According to estimates conducted in some European
countries, 4 % to 7 % of all employees are exposed to potentially harmful WBV. Important high-risk
groups are drivers of off-road vehicles (e.g. earth-moving, forestry and agricultural machines), drivers of
industrial trucks and busses, crane-operators, helicopter pilots, and ship crews.
This WBV is often complex, contains many frequencies, occurs in several directions and changes over
time. The transmission of vibration to the body is also dependent on body posture. The effects of vibration
can therefore be complex. Exposure to WBV causes a distribution of motions and forces within the human
body. There can be large biological variations between subjects with respect to effects. WBV can cause
sensations (e.g. discomfort or annoyance), influence human performance capability and/or present a
health and safety risk. Low-frequency vibration of the body (with a frequency generally below 0,5 Hz)
can cause motion sickness.
Most of the research on effects of WBV on the human body has concentrated on acute effects, discomfort
or decreased performance. Less is known about health effects of long-term exposure. However,
biodynamic research as well as epidemiologic studies have given evidence for an elevated risk of health
impairment due to long-term exposure to WBV. Mainly the lumbar spine and the connected nervous
system can be affected. With a lower probability, the neck-shoulder, the digestive system, the female
reproductive organs, the peripheral veins, and the vestibular system are affected by WBV.

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5.2 Low-back pain and back disorders

Long-term exposure to occupational WBV is strongly associated with low-back trouble. Most of the
research on adverse health effects from WBV deals with the musculoskeletal system, in particular, the
lumbar spine. From epidemiologic research there is positive evidence that WBV can be harmful to the
spinal system. The results of epidemiologic studies show a higher prevalence rate of low-back pain,
herniated disc and early degeneration (spondylosis deformans, osteochondrosis intervertebralis,
arthrosis deformans) of the spine in exposed groups. There is a trend to higher risks with exposure to
higher intensity levels. Increased duration of the vibration and increased intensity are assumed to
increase the risk, while periods of rest reduce the risk. There is also some indication that transient (shock-
type) vertical WBV exposure can present an elevated risk.
Based on available epidemiologic data, firm conclusions on an exposure-response relationship cannot be
drawn. For this purpose, reliable data on vibration exposure, the exposure time history, selection of the
study population and the contributing occupational environment are often not available. Besides, the
reported effects are not specific for vibration exposure and there are many contributing and/or effect-
modifying factors in this relationship.
Both epidemiologic and experimental researches are still going on to clarify the exact working
mechanism by which WBV leads to adverse health effects on the spine. Although several hypotheses on
working mechanisms have been proposed, the hypothesis that the mechanical overloading due to
vibration leads to premature degeneration of the lumbar spine has been generally accepted during the
last years. Recent biomechanical data have also provided cooperating mechanisms: muscle fatigue,
reduced disc height and bending of the spinal column can be regarded as “conditioning effects” leading
to a high strain on the vertebral column. If the exposure is high (peak values) or continued during longer
time without sufficient recovery, this can result in a “direct (mechanical) effect”: fatigue failure and
impaired nutrition of the disc. Several data show that in particular the combination of prolonged sitting
and exposure to WBV (which is often the case in vehicles) can increase the risk of spinal damage. In this
development other individual factors can play a role: working posture, anthropometric characteristics,
muscle tone, physical workload, and individual susceptibility (age, pre-existing disorders, muscle force,
etc.).
Driving of vehicles does not only involve exposure to WBV but also to several other back-straining factors.
The most important being prolonged sitting in often constrained and poor postures (e.g. frequent
twisting of the spine), frequent lifting and material handling (e.g. drivers of delivery trucks), traumatic
injuries, unexpected movements, and unfavourable climatic conditions.
In some countries (e.g. Belgium, Germany) back disorders occurring in workers exposed to WBV are,
under certain conditions regarding intensity and duration of exposure, considered to be an occupational
disease which is compensable.
5.3 Foot-transmitted vibration

Foot-transmitted vibration (FTV) occurs when a worker is exposed to vibration through the feet, for
instance when standing to operate mobile equipment such as locomotives and forklifts. Exposure to FTV
has been linked to the development of vibration-induced white feet (VWFt), a vascular disorder with
reduced circulation to the toes causing blanching. Neurological symptoms, such as tingling and numbness
of the toes and a reduced sense of temperature and touch, have been reported as well.
The known literature does not allow drawing firm conclusions about the relationship between the
vibration characteristics (amplitude and frequency content), the exposure time, and the severity of
neurological/ vascular damages.
Comparison between the biomechanical response of the hand and of the foot shows that vibration
transmissibility at the wrist is similar to the response at the ankle. The toe resonance frequency is higher
than the finger resonance frequency, but in the same order of magnitude. Toe resonance frequency
strongly depend on the posture and on the shoe characteristics.

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The similarity between vibration transmissibility of hand-transmitted vibration and FTV suggests that
the use of HAV standards are possibly be more appropriate for assessing the possibility of developing
vascular and neurological feet disorders.
Specific standards for the evaluation of FTV exposure are necessary.
5.4 Other disorders
5.4.1 Neck-shoulder disorders

WBV containing frequencies within the fundamental resonance frequency of the body can cause severe
motion of the shoulders. This leads to increased response from the muscles in the body region. Many
drivers complain about disorders in the neck-shoulder. Several ergonomic factors can be suspected to
give raise to these complaints, e.g. twisted head postures, hand-lever manoeuvring, stress and WBV.
However, heretofore the few epidemiologic studies which have been performed have only shown a
weaker relationship between neck-shoulder disorders and WBV.
5.4.2 Digestive disorders

From experimental research on acute effects, it is known that exposure to WBV can lead to increased
gastro-intestinal activity. Several studies have been undertaken to determine the long-term effects of
WBV on the digestive system. In some studies, an increased prevalence of gastro-intestinal complaints,
peptic ulcer and gastritis was found in drivers of vibrating vehicles. Some other studies did not find
adverse effects. However, the few “positive” epidemiologic studies only showed slight associations, even
for the populations which were most exposed, and some of these studies failed to control for important
possible confounders (e.g. smoking, alcohol, dietary habits, shift work, stress). The question whether
exposure to WBV can lead to digestive disorders therefore remains open; it is likely to be at most a minor
effect.
5.4.3 Reproductive effects – stillbirth

Vibration can have some specific effects on women. Disorders of menstruation, internal inflammation
and abnormal childbirth in women exposed to 40 Hz to 55 Hz vibration in the concrete-industry were
reported, but the studies were not very informative. In a large study of spontaneous abortion and
stillbirth without congenital defect it was found that there was a greater than expected incidence of
stillbirth among women exposed to vibration in the transport sector. Further research is needed.
5.4.4 Circulatory disorders

In the literature a relation between WBV and the occurrence of varicose veins and haemorrhoids is
suggested. In this relationship, WBV seems to be rather an additional factor that acts in combination with
the long-term sitting posture of drivers. An elevated intra-abdominal pressure is assumed to play a role
in the pathogenic mechanism. The evidence is however weak.
5.4.5 Cochleo-vestibular effects

Long-term exposure to WBV is supposed to potentiate noise-induced hearing loss. Simultaneous noise
and vibration exposure show higher temporary threshold shifts of hearing in the higher frequencies
(6 kHz to 10 kHz) than exposure to noise separately. The pathogenic mechanism for this effect has not
yet been clarified. A decreased vestibular excitability and a higher prevalence of multiple vestibular
disturbances were found in WBV exposed workers but a causal link remains dubious since WBV with
very low and high intensities was linked with an increase of vestibular disorders, whereas workers
exposed to WBV of medium intensity did not exhibit impairments.

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Annex A
(informative)

Prevention

A.1 Hand-transmitted vibration

The implementation of technical, administrative and medical procedures can prevent injuries or
disorders caused by hand-transmitted vibration. Guidelines on preventive procedures are included in
CEN/TR 1030-2 and the EN ISO 5349 series. Prevention includes technical measures aimed at
elimination or reduction of hand-transmitted vibration at the source, appropriate information and advice
to employers and employees, instruction to adopt safe and correct work practices, and medical
preventive guidance.
No adequate personal protective equipment against hand-transmitted vibration is presently available.
Gloves are useful to protect the fingers and hands from traumas and to maintain them warm. To proof
the effectiveness of gloves at attenuating vibration EN ISO 10819 can be used. Heating systems for hand
grips of motor chain saws have been proved to be a very effective prevention measure in forestry work.
Since continuous exposure to vibration is believed to increase vibration hazard, it is a good idea to include
rest periods in work schedules. A 10 min rest break for each hour of continuous vibration exposure as
well as the use of warm rest rooms or cabins have been suggested as preventive measures.
The aims of health surveillance are to inform the worker on the potential risk associated with vibration
exposure, to assess health status and to diagnose vibration-induced disorders at an early stage.
Performing pre-exposure medical screening and periodic clinical examinations at regular intervals on
vibration-exposed workers is reasonable. These examinations can provide information on whether and
to what extent there are health concerns about the exposure. The following approach exists.
First screening (pre-exposure screening)
A record of the subject’s personal, work and medical history at the first screening examination helps to
identify any health risk of the employee. Any condition which can be aggravated by exposure to vibration
(e.g. constitutional tendency to white-finger disease, some forms of secondary Raynaud’s phenomenon,
past injuries to the upper limbs causing circulatory disturbances or deformity of bones and joints,
neurological disorders) can be detected during this examination. This includes recording the use of some
drugs which can affect peripheral circulation (e.g. β-blocking agents). A complete neurological, vascular
and osteoarticular physical examination is performed by a qualified physician. Advising the worker to
wear adequate clothing to keep the entire body warm, and to avoid or minimize the smoking of tobacco
are further preventive measures.
Periodic examination (periodic health re-assessment)
Periodic health re-assessment with a regular interval (e.g. every 1 or 2 years) follow the pre-exposure
examination. At subsequent screening examination, any illness occurred since the last examination and
any symptom related to vibration exposure are recorded. The findings of the physical examination are
also reported. Specific diagnostic tests (assessment of digital circulation after local cooling,
neurophysiological investigations) are decided by the physician on the basis of the worker’s symptoms
and the results of clinical examination. The diagnostic tests are selected and performed by specialists.
Observation of finger blanching is an important diagnostic marker. Vibration-exposed workers are
instructed to report and demonstrate finger blanching when it first occurs or if there is deterioration.
Physicians and their staff record these pathological events. Making a decision about avoidance or
reduction of vibration exposure for the affected worker after considering the severity of symptoms, the
characteristics of the entire working process, and other aspects related to the company’s medical policy

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and the legislation of the country. However, for workers who reach stage 2v vascular on the Stockholm
Workshop scale further exposure to hand-transmitted vibration does not seem reasonable.

A.2 Whole-body vibration

On many workplaces exposure to WBV is still not recognized as a serious problem and many occupational
health and safety services have a lack of experience in prevention of adverse health effects. Different
elements of prevention can be distinguished: technical prevention aimed at elimination or reduction of
WBV (procedures to select suspension seats according to the dynamic characteristics of the vehicle or to
isolate machines are given in EN ISO 10326-1 and EN 1299), organizational changes in the work, personal
protection and medical prevention. In most cases only a combination of preventive actions will lead to a
successful reduction in vibration exposure.
In addition to technical measures, improvement of the ergonomic lay-out, in particular the forced
working posture, and of climatic factors, limitation of the vibration exposure duration and medical
guidance are important tools for prevention. Giving appropriate information and advice to employers
and employees and instruction in safe and correct work practices is good practice. As personal protective
equipment against WBV is not available, information, knowledge and tools enabling employees to cope
with risk factors and early effects are basic in the maintenance of health and safety at the workplace.
Medical guidance (surveillance of health) is reasonable for all workers who will be exposed to
occupational WBV. Occupational health physicians conversant with possible effects of mechanical
vibration and shock on human subjects are suitable for this guidance. Prior to employment education
includes informing any worker who will be exposed to WBV of the possible adverse effects on health. This
information comprises also the possible preventive measures to be taken by the employee.
A comprehensive pre-exposure medical examination includes: a work history with special reference to
exposure to WBV in the past and to other work-related risk factors of low-back pain, a medical history
and a physical examination with special reference to the musculoskeletal system. To diagnose vibration-
induced disorders at an early stage the pre-exposure examination is followed by periodical health
examination with a regular interval (e.g. every 2 or 4 years). The examination also includes a consultation
of the occupational health physician to exposed workers who have symptoms or disorders, or who are
otherwise concerned about their health.
The following medical conditions are considered to increase the risk of WBV exposure: recurrent
episodes of chronic back pain, distinct premature (not related to age) degenerative changes of the spine,
intervertebral disc disorders, increased stiffness of the spine (e.g. after surgical treatment), a history of
spinal injury with fracture of vertebrae, chronic gastritis and/or peptic ulcers, pregnancy. These
conditions can be considered as contra-indications to further severe exposure.

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Annex B
(informative)

Glossary

Arthrosis deformans degeneration of a joint leading to deformation

Bone cyst an abnormal cavity in the bone structure
Carpal tunnel syndrome symptoms of numbness, tingling, or burning pain on the palmar
surfaces of the thumb, index, middle, and ring fingers, occurring mostly
at night, caused by compression or irritation of the median nerve as it
passes through a tunnel formed by the wrist (carpal) bones. Signs of
impaired hand function and disability can develop.
Cochleo-vestibular effects effects on the cochlea and the vestibular system; components of the
inner ear
CTS carpal tunnel syndrome
Cyanosis bluish discoloration of the skin due to deficient oxygenation of the
blood
Dupuytren’s contracture thickening of the fibrous lining of the palm of the hand preventing the
straightening of the fingers, mainly the ring and little finger
Epidemiology the study of the occurrence – prevalence and incidence – of diseases or
disorders in a population. Occupational epidemiology investigates the
relation between exposure to work risk factors and their possible
adverse health effects.
FTV foot-transmitted vibration
Gastritis inflammation of the stomach
Hand-arm vibration the complex of symptoms and signs (neurological, vascular, and
syndrome musculoskeletal) associated with disorders produced by hand-
transmitted vibration
HAV hand-arm vibration
Herniated disc a protrusion of the nucleus pulposus of the intervertebral disc in the
vertebral canal; this can exert pressure on the spinal cord or on nerve
fibres
Kienböck’s disease a disorder of mineralization (malacia) of the lunate bone in the wrist
Incidence the number of new cases of a disease or disorder in a population over a
specified period of time
lntervertebral disc flexible pads between the vertebrae with a soft jelly-like core, the
nucleus pulposus and the annulus fibrosus: a ring of fibre which forms
the circumference
Motion sickness vomiting, nausea or malaise provoked by actual or perceived motion of
the body or its surroundings
Osteoarthrosis bone and joint degeneration

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Osteochondrosis degeneration of the joints and the bony surroundings between the
intervertebralis vertebrae
Peptic ulcers ulcers of the stomach or the first part of the small intestine
Prevalence the number of existing cases of disease or disorder in a given
population at a specified time
Raynaud’s phenomenon attacks of finger blanching due to insufficient circulation of blood as a
result of digital vasoconstriction usually triggered by cold or emotion.
(Primary Raynaud’s disease, when the symptom of finger blanching
cannot be attributed to any specific cause. Secondary Raynaud’s
phenomenon, when some causes can be identified. Vibration-induced
white finger, a secondary form of Raynaud’s phenomenon caused by
exposure to hand-transmitted vibration)
Sensorineural disorders abnormalities in the sensation of light touch, pain, temperature,
vibration and deep pressure; impairment of discriminative sensory
function (two-point discrimination, appreciation of texture, size, and
shape)
Tendinitis inflammation of a tendon
Tenosynovitis inflammation of a tendon and its sheat
Vasoconstriction narrowing of the lumen of blood vessels, especially as a result of an
increased contraction of the muscle wall of the blood vessel
VWFt vibration-induced white feet
VWF vibration-induced white finger (see Raynaud’s phenomenon)
WBV whole-body vibration

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Bibliography

[1] BONGERS. P.; BOSHUIZEN, H. Back disorders and whole-body vibration at work. Thesis University
of Amsterdam, Amsterdam, 1990, ISBN 90-9003668-7

[2] BOVENZI. M. Medical aspects of the hand-arm vibration syndrome. Int. J. Ind. Ergon. 1990, 6
pp. 61–73

[3] CHRIST, E. et al. Vibration at work (ISSA brochure). Published by the International section
Research of ISSA, Institut National de Recherche et de Sécurité (INRS), 30, rue Olivier-Noyer, F-
75680 Paris Cedex 14, 1989

[4] DUPUIS. H.; ZERLETT, G. The effects of whole-body vibration. Springer-Verlag, Berlin, Heidelberg,
New York, Tokyo, 1986

[5] GOGGINS. K. A., TARABINI, M., LIEVERS, W. B., AND EGER, T. R. Biomechanical response of the
human foot when standing in a natural position while exposed to vertical vibration from 10–
200 Hz. Ergonomics. 2019, 62 (5) pp. 644–656

[6] GRIFFIN. M. J. Handbook of human vibration. Academic Press, London, 1990

[7] HULSOF. C. T. J.; VELDHUIJZEN VAN ZANTEN, O. B. A. Whole-body vibration and low-back pain —
A review of epidemiological studies. Int. Arch. Occup. Environ. Health. 1987, 59 pp. 205–220

[8] PELMEAR. P. L.; TAYLOR, W.; WASSERMAN, D. E. (eds.). Hand-arm vibration — A comprehensive
guide for occupational health professionals. Van Nostrand Reinhold, New York, 1992,
ISBN 0-442-01250-0

[9] SEIDEL. H. Selected health risk caused by long-term whole-body vibration. Am. J. Ind. Med. 1993,
23 pp. 589–604

[10] Stockholm Workshop 86, Symptomatology and diagnostic methods in the hand-arm vibration
syndrome. Scand. J. Work Environ. Health. 1987, 4 pp. 271–388

[11] CEN/TR 1030-2, Hand-arm vibration - Guidelines for vibration hazards reduction - Part 2:
Management measures at the workplace

[12] EN 1299, Mechanical vibration and shock — Vibration isolation of machines — Information for the
application of source isolation

[13] EN ISO 5349-1:2001, Mechanical vibration - Measurement and evaluation of human exposure to
hand-transmitted vibration - Part 1: General requirements (ISO 5349-1:2001)

[14] EN ISO 5349-2, Mechanical vibration - Measurement and evaluation of human exposure to hand-
transmitted vibration - Part 2: Practical guidance for measurement at the workplace (ISO 5349-2)

[15] EN ISO 10326-1, Mechanical vibration - Laboratory method for evaluating vehicle seat vibration -
Part 1: Basic requirements (ISO 10326-1)

[16] EN ISO 10819, Mechanical vibration and shock - Hand-arm vibration - Measurement and evaluation
of the vibration transmissibility of gloves at the palm of the hand (ISO 10819)

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[17] CEN Guide 414:2017, Safety of machinery - Rules for the drafting and presentation of safety
standards

[18] ISO 14835-1, Mechanical vibration and shock — Cold provocation tests for the assessment of
peripheral vascular function — Part 1: Measurement and evaluation of finger skin temperature

[19] ISO 14835-2, Mechanical vibration and shock — Cold provocation tests for the assessment of
peripheral vascular function — Part 2: Measurement and evaluation of finger systolic blood pressure

[20] EU Directive vibration 2002/44/EC

17
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