Musculoskeletal Disorders and Work-Based Performance
Musculoskeletal disorders (MSDs) is an umbrella term for painful conditions of the muscles, joints and bones. The European Agency for Safety and Health at Work state that MSDs are the most common work-related health problem in Europe, with 25% of workers complaining of backache and 23% reporting muscular pains(1). In the UK, the Health and Safety Executive (HSE) estimates that MSDs cost employers between £590 million and £624 million per year(2). Given this, reducing the risk of MSDs, and optimising recovery when they do occur, is of vital importance for employers.
Two of the most common and costly of these MSDs are low back pain and Upper Limb Disorders (ULDs).
Low back pain
Low back pain has reached epidemic proportions in our society with 58 to 70% of the population experiencing back pain at some point in their life and between 15 and 37% of the population experiencing it within any 12-month period(3,4). Thankfully, 90% of cases of back pain resolve themselves within 6-weeks of the onset of pain. However, the sheer number of people affected still makes it a very costly condition that imposes a large burden on the individual, society and employers alike.
One in Six Working Days are Lost to Low Back pain
The NHS spends more than £1 billion per year on back-related pain, including £512 million on hospital costs, £141 million on GP consultations and £150.6 million on physiotherapy treatments(4). According to the Health and Safety Executive, one in six working days are lost to low back pain and each individual that is affected has an average of 19 days off work(2). Given the negative impact that back pain has on productivity and absenteeism(1), reducing these figures by reducing risk of MSDs is likely to be extremely beneficial for employers.
Frustratingly, 80% to 90% of episodes of low back pain have no identifiable cause and are therefore termed non-specific low back pain. Whilst there may be no discernible cause, a number of risk factors have been identified that may, if tackled effectively, allow for an increase in prevention and reduction in risk. At present, the best predictor of an episode of back pain is a history of previous episodes, whilst additional risk factors are stated below(5), although it is an area of contentious debate(6).
• Obesity
• Smoking
• Whole-Body Vibrations (such as with prolonged motor vehicle driving)
• Sedentary Lifestyle
Employers Should Consider Assessing Work Requirements on a Case-By-Case Basis
When back pain does occur, current evidence suggests that avoiding bed rest and encouraging a return to regular physical activity is one of the most effective strategies for improving pain(8). A review of workplace interventions for rehabilitation of back pain concluded that there is substantial evidence that modifying work based duties can reduce time lost per episode of back pain by at least 30%(1). In addition, the Institute of Ergonomics and Human Factors (IEHF) state that sitting in a static posture increases stress in the back, neck, shoulders, arms and legs, and in, particular, can add large amounts of pressure to the back muscles and spinal discs, whilst slouching in a chair can overstretch spinal ligaments and strain the discs and surrounding structures of the spine(7). This means that employers should consider assessing work requirements for employees on a case-by-case basis, with particular emphasis on reducing heavy lifting and improving workstation set up to avoid slouched postures.
Psychosocial and Work Environment Factors are the Best Predictors of Long Term Disability
Interestingly, and very importantly for employers, psychosocial and work environment factors are more predictive of long term disability than findings from a physical examination. Persistent back pain after an acute episode is associated with psychological distress, dissatisfaction with employment, poor relationships with co-workers and supervisors, low levels of physical activity, poor self-rated health, smoking status and poor spinal movement(8,9).
In summary, back pain is a very common condition that has negative impacts on productivity and absenteeism. At present, the majority of cases are of indiscernible cause, but appear to be related to obesity, smoking and a sedentary lifestyle. However, employers should also focus on fostering a happy, supportive working environment that encourages regular movement and breaks from desks, all of which appear to be important in reducing risk of back pain.
Upper Limb Disorders (ULDs)
Upper Limb Disorder (ULD) is a generic term which includes specific diagnoses and non-specific complaints of the upper limb including the neck and shoulder. They may be referred to as repetitive strain injuries (RSIs), cumulative trauma disorder or occupational overuse syndrome. However it is recognised that many people experience ULD’s whether they work or not, and often home activities are equally as problematic as work activities. Some of the conditions that fall within the category of ULD’s include Carpal Tunnel Syndrome, Lateral Epicondylitis (Tennis Elbow), and tendonitis in the shoulder, wrist or hand(10).
Upper Limb Disorders Cost UK Employers 5.4 Million Working Days Each Year
Around 500,000 workers in the UK have reported a work related upper limb disorder with a collective loss of 5.4 million working days lost due to sick leave in one year11. However, there remains uncertainty over the classification and diagnosis for upper limb disorders(12) and, in many cases, no specific diagnosis can be established. Complaints are therefore often labelled non-specific(10,13), and are often referred to as “Regional Pain Syndromes”.
Although work has a limited overall role in the cause of ULDs(12), work is generally therapeutic and must be an essential part of the management of ULDs(14). Employers have a legal duty under the Health and Safety at Work Act 1974 and Management of Health and Safety at Work Regulations 1999 to undertake risk assessments to help to prevent work-related ULDs or to prevent current cases from getting worse(15). However, attempts at prevention have not had a significant impact and Burton et al (2008) state that ‘…management of cases shows more promise than attempts at primary prevention’. As a result of this, a good understanding of factors influencing ULDs is important, with a biopsychosocial approach to assessing and managing ULDs being essential(12). A biopsychosocial approach is one that explores the biological (physical) psychological and social factors that all combine to influence how an individual copes at work and home with an ULD. Suitable interventions can then be used by appropriate health professionals (primarily Physiotherapists) to manage the condition.
Upper Limb Disorders Workplace Risk Assessment
The Health and Safety Executive recommend employers assess the risk of ULDs within the working environment by considering the following three areas(15):
1. Task-related factors:
Repetition – the more frequently a task is repeated, the greater the risk
Working posture – if they are awkward and/or held for prolonged periods in a static or fixed position
Use of force and load repeatedly or over long duration
2. Environment-related factors:
Working environment – includes the length of time of the task in each shift, plus the number of working days the task is performed
Organisational factors – high workloads, tight deadlines, lack of control of the work (increasing stress levels),
3. Worker-related factors:
New employees may need time to acquire skills/rate of work
Differences in competence and skills
Workers of varying body sizes
Health status and disability
Reducing the Risk of Upper Limb Disorders in the Working Environment
As such, employer’s attempts at reducing risk of occurrence and reoccurrence of ULDs should be based around the following(15):
1. Reducing repetition of movements
2. Finding a comfortable working position
3. Reducing the load or frequency of lifting
4. Improving the working environment (i.e. avoiding extreme temperatures)
5. Providing a supportive and open culture in which employee’s feel comfortable to highlight work issues.
In summary, ULDs are a group of conditions that affect the arm, shoulder and neck. They can have a significant impact on productivity and absenteeism and are therefore important for employers to manage effectively. There are many risk factors for ULDs including repetition, static postures and environmental issues. If an ULD continues, it is important that the employee is assessed by a health professional that is competent in recognising biopsychosocial factors. It is also necessary to recognise the fundamental shift in the management of ULDs and work should be seen as an important part of recovery – not the end of it14.
About Author: Kathryn Young is a Chartered Physiotherapist with a speciality in Occupational Health and Ergonomics (OH&E) for Nuffield Health.
References
1. European Agency for Safety and Health at Work, (2007). Work-related musculoskeletal disorders: Back to work report.
2. Health and Safety Executive, (1997). The costs of accidents at work, HS(G)96, 2nd Ed. HSE Books
3. American College of Sports Medicine, (2003). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Leeds: Human Kinetics
4. NHS (www.nhs.co.uk/conditions). Back Pain.
5. Ehrman, J.K., (2009). Clinical Exercise Physiology (2nd Ed.). Leeds: Human Kinetics
6. Koes, B.W., et al, (2006). Diagnosis and treatment of low back pain. British Medical Journal, 332; 1430 – 1434
7. Institute of Ergonomics & Human Factors (www.ergnomics.org.uk). Office work doesn’t have to be a pain.
8. McCance, K.L., and Huether, S.E., (2006). Pathophysiology: The Biologic Basis for Disease in Adults and Children. St. Louis, Missouri: Elsevier Mosby
9. Maher, C.G., (2004). Effective physical treatment for chronic low back pain. Orthopedic Clinics of North America, 35 (1); 57 – 64
10. van Tulder, M., Malmivaara, A., and Koes, B., (2007). Repetitive Strain Injury. The Lancet, 369 (9575); 1815 – 1822
11. Repetitive Strain Injury Organisation. Employment and legal aspects of repetitive strain injuries.
12. Burton, A.K., et al, (2008). Management of Upper Limb Disorders and the Biopsychosocial Model. Health and Safety Executive
13. Brooks, P., (1993). Repetitive strain injury does not exist as a separate medical condition. British Medical Journal, 307; 1298
14. Waddell, G., and Burton, A.K., (2004). Concepts of Rehabilitation for the Management of Common Health Problems. London: The Stationary Office
15. Health and Safety Executive Leaflet. Aching arms (or RSI) in small business. Is ill health due to upper limb disorder a problem in your workplace?
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