Back Care Awareness Week takes place from 7 to 11 October 2019, offering an opportunity to raise awareness about the prevention of back pain in the workplace at a time when the recommended approach to occupational musculoskeletal disorders is shifting significantly. Vicky Powell looks at some of the main drivers for change in this important area of work-related health.

Understanding MSDs

Back pain and related conditions present a major problem for employers in the UK today, accounting for a massive 35% of all cases of work-related ill health.

In terms of working days lost, on average, during 2017/18, workers suffering with musculoskeletal disorders (MSDs) took around 14 days off sick.

But what exactly are MSDs? Simply put, MSDs affect the muscles, bones, and joints. The term MSD therefore covers any injury, damage or disorder of the joints or other tissues in the upper or lower limbs or the back. Generally these conditions tend to be grouped as follows.

  • Upper limb disorders: These include pain and disorders of the neck, shoulders and arms, with examples including carpal tunnel syndrome, tenosynovitis and arthritis of the hand joints.

  • Lower limb disorders: These are pain and disorders affecting the legs from hips to toes, including the knees, ankles and feet. Common work-related conditions in this category include hip and knee osteoarthritis, knee bursitis, and varicose veins of the lower legs.

  • Back pain: The Health and Safety Executive (HSE) defines back pain as any ache, pain, tension, or disorder that affects the muscles or bones of the back, from the base of the neck to the hips. Causes may include damage to the muscles or the bones of the spine and ribs or to the discs between the vertebrae.

Of the three categories above, it should also be noted that disorders of the back and upper limbs are the most common.

A new approach to MSDs: moving from generic training to design

There is nothing new about the challenges of back pain at work. MSDs have been in the top one or two positions for indicators such as sickness absence and cases of work-related ill health for many years. What is different, however, is that the HSE’s approach to MSDs is undergoing significant change at the moment, specifically with regard to its general prioritisation as well as specific issues, such as training and the design of work activities.

In the last year or so, the health and safety watchdog has indicated repeatedly that it is making several changes in its regulation, management and prioritisation of MSDs.

in its Health Priority Plan on Musculoskeletal Disorders the HSE said it wants to see significant improvements in preventing and controlling exposure to MSDs, especially in construction, manufacturing, agriculture, logistics and transport, waste and recycling, and health and social care.

The Priority Plan also strongly emphasises the watchdog’s desire to see a shift in emphasis away from manual handling training and towards risk elimination and reduction through design.

In early 2018 new online guidance from the HSE on getting help with manual handling warned that general, off-the-shelf training in lifting techniques is “an ineffective way of controlling the risks of manual handling”.

This view has been backed up by research which has shown that generic manual handling training is not effective in controlling the risks of manual handling in a business.

Instead, the HSE has been encouraging a risk reduction through design approach. One method it is using to emphasise this approach is by means of an award scheme that focuses on how ergonomics-based design changes can reduce the risks of work-related MSDs.

Sponsored by the HSE and the Chartered Institute of Ergonomics and Human Factors (CIEHF), the Risk Reduction through Design Award Scheme nominates and highlights design changes that have made a real impact within organisations.

The winner for 2018 was Henry Brothers Ltd and Construction & Procurement Delivery (CPD) for its reduction of manual handling risks by innovative off-site solutions where equipment was manufactured under more controlled factory conditions.

Raising the regulatory profile on MSDs

Another key point raised within the HSE’s Health Priority Plan on Musculoskeletal Disorders was its strategy to increase the HSE’s and local authorities’ regulatory profile in relation to MSDs.

The HSE’s current Go Home Healthy campaign is targeting MSDs, work-related stress including anxiety and depression, as well as occupational lung disease.

The HSE’s campaign has been highlighting low-cost solutions to improve manual handling, such as in the case of a copper wire manufacturer which reduced manual handling risks by working with a lifting aids manufacturer to develop simple engineered solutions.

The initiative is also showing how design solutions can reduce the risk of MSDs. For example, within the NHS, a community nurse named Linda Harris developed a new height-adjustable trolley and footbath made of stainless steel which allows patients’ leg ulcers to be bathed and dressed at a height that is suitable for the patient and the nurse.

Commenting on the new work design, Sheila Marriot, Regional Director, Royal College of Nursing, East Midlands, said, “The invention of the Harris Trolley shows the value of empowering frontline nurses in how patient care is designed as well as delivered. In this case, the result is a win-win because patients have a good care experience and nurses can practise more comfortably and reduce the risk of sustaining injuries”.

Another area of interest for the HSE is its work to reduce job-related MSDs using communication, partnerships and, finally, increased regulatory activity in the highest-risk sectors with evidence-based interventions. The emphasis in this regard has been on best practice and solutions that work for specific sectors.

Work-related stress and MSDs

It’s interesting that the HSE has chosen to focus on both MSDs and work-related stress in its Go Home Healthy campaign. Together, stress, depression, anxiety and MSDs account for 79% of all cases of work-related ill health in the UK.

Out of a total of 26.8 million working days lost due to ill health in Britain, stress, depression or anxiety and MSDs accounted for the majority of days lost due to work-related ill health, 15.4 million and 6.6 million respectively. Therefore, together, work-related stress and MSDs account for over 80% of all working days lost due to ill health.

By tackling just these two work-related issues, there is the potential to reduce 80% of all working days lost.

The links however are more than merely statistical. There is growing consensus in the occupational health world that psychosocial factors and work-related stress, besides being a hazard in its own right, are another cause of some MSDs.

The HSE has pointed out that there can be stress-related changes in the body (such as increased muscle tension) that can make people more susceptible to musculoskeletal problems.

Equally workers may change their behaviour, for example doing without rest breaks to try to cope with deadlines when they are feeling stressed.

Therefore, in tackling back pain at work it is important to look at the traditional physical risk factors, such as force, posture and repetition, but also to identify and control psychosocial factors.

The best way to achieve this, according to the HSE, is by using an ergonomic approach, which looks at achieving the best “fit” between the work, the working environment and the needs and capabilities of the worker.

The HSE warns that many manual handling jobs are not well designed and may lead to psychosocial risks.

The HSE says that ways to reduce the risks of psychosocial factors in the context of manual handling could include:

  • reducing the monotony of tasks where appropriate

  • ensuring reasonable workloads (neither too much or too little), deadlines and demands

  • ensuring good communication and reporting of problems

  • encouraging teamwork

  • monitoring and control of shift work or overtime working

  • reducing or monitoring payment systems which work on piece rate

  • providing appropriate training.

As with physical risk factors, psychosocial issues are best addressed by full consultation and with the involvement of the workforce.

Back pain at work — the future

The overall economic cost of MSDs in Britain, based on the latest available estimates, is just over £2 billion.

However, we now know that calling in a trainer for some generic manual handling advice aimed at workers will do little to control and manage manual handling risks or back pain at work. Instead employers would do better to look at best practice in their own industry and first learn about what has really worked, on a practical level, to remove and minimise manual handling risks.

At the time of writing, the HSE was informally consulting on updating INDG143 Manual Handling at Work: A brief guide and it has confirmed it will also in future be consulting on revisions to leaflet INDG171 Upper Limb Disorders in the Workplace. Clearly, this is an area which is firmly under the spotlight.

It is worth noting too that although there may be a current shift away from generic training alone, instruction and training of workers will remain an essential part of best practice in manual handling, so useful training certainly can’t be jettisoned.

The new approach to back pain will require employers and their managers to use a practical, intelligent approach that will consider risk elimination and reduction through design, while also integrating all the risks in the workplace. Best practice will need to be truly holistic and also fully consider all MSD risks, including those less traditionally considered such as work-related stress, anxiety and depression.

The renowned organisational psychologist Professor Sir Cary Cooper CBE once said, “People can go to Occupational Health and say, ‘Oh my back is really bad.’ It’s easier to say that, than to say, ‘I’m suffering from depression.’

“So a lot of the musculoskeletal has a stress link to it. It’s a big problem for us.”

For in-depth information and advice, see your Croner-i topic on Musculoskeletal Disorders.

If you need an occupational health report to help you support an employee with a health matter affecting their work, contact Health Assured, the UK’s leading employee assistance programme and wellbeing services provider: 0844 891 0350.

Last reviewed 7 October 2019