Summary Manual handling is often the cause of musculoskeletal injuries—especially to the back—and has been the subject of many studies and prevention efforts over the years. Handler training is a common avenue of prevention. One of the prevalent training approaches consists in teaching basic guidelines, reflected in standard techniques that handlers are supposed to apply at all times. Recent studies question the effects of such training, and some shed a new light on the realities of manual handling. Handlers with many years of experience use methods that are more diversified than what is taught in training. Their challenge is not so much to apply a predefined technique as to adapt their work methods to the varying situations they encounter. A rethinking of training programs is critical in order to remain relevant to handlers’ activities. We propose an approach focused on competencies and rules, rather than standard techniques. This report—based on a critical literature review, exchanges by a group of experts and references to a theoretical framework that incorporates notions from four different disciplines—describes the proposed approach and its theoretical foundations, and offers practical tools for designing training programs that are more realistic and specific to the workplace. We present a three-phase strategy for workplace implementation, with the key imperative of starting from actual work situations and the work methods already in use, rather than imposing methods from the outside. Although training is central to our approach, the conditions likely to influence the presence of risk in handling operations are also considered. Taking work conditions into account means providing operators with ways to exercise and develop their skills. Time considerations and the competence of the people giving the training—two aspects likely to impede the implementation of this approach—are discussed as well. In addition, comments are offered on the rules of manual handling, which are key to this approach, and we include comments on the limitations of the approach itself.