Dealing with MSDs

Occupational Health reports from the recent IRS conference, exploring the
issues surrounding musculoskeletal disorders, caused or made worse by workplace
activity.  By Greta Thornbory

The Health & Safety Executive (HSE) estimates that more than 1 million
people a year suffer from musculoskeletal disorders (MSDs), caused or made
worse by a workplace activity. This is by far the biggest cause of sickness
absence lasting more than three days in the UK. Recent statistics reveal that
more than one-third of these injuries were a result of manual handling.1

Generally speaking, MSDs fall into two main categories – lower back pain and
upper-limb disorders (ULDs).

This one-day conference, followed by a one-day workshop on MSD, explored the
effects of MSDs on both the employer and the employee, highlighting the
ergonomic and other measures that can be used to reduce the incidence of MSDs.

Trevor Shaw, head of ergonomics and human performance at the HSE, discussed
the government approach to MSDs, and reducing the cost to companies, employers
and society. He mentioned the government targets in Securing Health Together,2
and quoted recent statistics (see box right), saying that work-related back pain
remains the biggest issue to be dealt with.

Shaw quoted the New Zealand research that found that preventative
initiatives focusing on primary and secondary prevention did not lead to a
reduction in MSD compensation claims.3 He added that there is a need to tackle
acute episodes of back pain early to prevent them from becoming chronic. Shaw
also commented on the Whitehall research that found that back pain related
sickness absence is inversely related to grade.4 Other research had found that
although ergonomics were an important aspect in reducing back problems, equally
so are the psychosocial factors.5,6

Bupa’s Jill Pollock, head of wellness strategic accounts and former
kinesiologist, reminded us that 80 to 90 per cent of all MSDs will get better
within four to six weeks, and that the remaining 10 to 20 per cent are complex,
and pose the greatest risk of developing into a chronic disease if not treated

She explained the enormous physical cost to the employee and just how much
OH can be the ‘gatekeepers’ in securing good health by an integrated and
co-ordinated treatment plan for the individual. Pollock offered the key players
an integrated approach to the management of MSDs (see box, top of page 19).

Serena Bartys reported on research work being undertaken on behalf of the
HSE – the results of which are not yet published. Her research involves the
psychosocial risk factors and absence due to MSDs, looking particularly into
what causes non-recovery from MSD and the progression towards disability and
prolonged work loss.

Her work reiterated the findings from Pollock in that a small proportion of
individuals will become disabled,7 and that "the longer somebody is off
work, the less likely they are to return to work". For the results of
Bartys’ research, check the HSE website later this year.

Ian Randle, from Hu Tech Associates Ltd, introduced the subject of workplace
ergonomics. He gave the definition of ergonomics as:

– the designing of workplaces, equipment and jobs to fit people

– fitting the task and equipment to the worker

– the scientific basis for a user-centred approach to design.

He said that to do this, it is necessary to consider the:

– characteristics of the user

– task to be undertaken

– equipment to be used

– environment it is to be used in.

There are health effects from poor ergonomics, and this not only includes
MSDs but also stress-related conditions due to poor usability and
dissatisfaction. For the employer, it also results in poor quality work and
poor productivity.

The main ergonomics risk factors, which cause ULDs, are awkward wrist and/or
arm postures, undesirable force, and high rates of repetition, prolonged
duration or inadequate rest. Problems can occur if any one of these is present
– the more factors that are combined, the greater the risk. Other factors that
influence the risk of ULDs are mechanical pressure from poor hand tools,
vibration, cold, psychosocial factors and stress.

Randle recommended ways to reduce the risks to health (see box right), and
touched on the Manual Handling Regulations.8 He went on to outline the role of
ergonomics in eliminating and reducing MSD risks by designing workstations that
fit the users, and equipment that does not require excessive force or awkward
postures to operate. Designing tasks and organising jobs to minimise repetition
and allow variation in working postures and method can also reduce MSD risk. He
referred to the Provision and Use of Work Equipment Regulations 1998 ACoP Reg
4,9 which states that when selecting work equipment, employers should take
account of ergonomic risks.

Penny Hunking, from Energise Nutrition, rounded off the day by talking about
energy levels, the Employee Energy Report and the importance of good nutrition
in health and wellness.

The Employee Energy Report was a study that looked at the association of
dietary habits, exercise and activity/energy levels at work. Not surprisingly,
the findings of the study showed that people were not eating a well-balanced
diet and that their intake of carbohydrates and fat were well above UK
recommendations. The study concluded that an improvement in diet and exercise
might enhance performance in the workplace.

The second day was a practical workshop, beginning with an ergonomic risk
assessment workshop by Margaret Hanson, who spent some time explaining the
ergonomic approach to risk assessment.

She recommended, as did Shaw and Randle, the HSE booklet, Upper Limb
disorders in the workplace,10 which emphasises the need for an integrated
approach to managing ULDs.

It also recognises that psychosocial factors need to be considered in
conjunction with physical risk, and includes a detailed risk assessment list.

She went on to introduce various risk assessment checklists, including the
MAC,11 and the risk assessment in context of management of MSDs.

As this was a workshop, delegates spent time undertaking a risk assessment
using a Proforma, and followed the guidelines while watching the action on a
video. They were able to ask questions and seek advice as to how to deal with
the problems identified.

During the afternoon session, Hunking took a workshop with Jane Wake on
‘Exercise for health’. Some of the statistics quoted were quite alarming – only
30 per cent of new members actually visit a health club once a week in the
first month after joining, and within three months, 40 per cent fail to visit
even once a week. Lack of time is given as the biggest reason for not
exercising. The delegates were given a series of exercises that can be done in
the workplace, at or around the desk. Thinking back to the beginning of the
first day, when much was made of the part poor posture plays in the development
of MSDs, it was interesting to see how they encompassed these simple exercises
in developing good posture. Other examples of exercise at work included
positioning photocopiers, printers, and faxes away from the desks and
encouraging people to use the stairs.

Melanie Miles, from Well Aware OHS, ended the conference with a workshop on
policy writing, giving key points on why to develop polices and who should be
involved. The delegates then worked on items they felt should go into a policy,
as well as looking at working examples of good practice.

The conference and workshop was designed to explore the issues surrounding
MSDs that were caused or made worse by workplace activity. We heard about the
statistics, the causes of MSD, and the measures that can be used through
policy, risk assessment, control and monitoring to reduce the incidence of the
biggest cause of long term sickness absence in the UK.



2. Securing health together, HSE, 2000

3. Chronic back pain – a national strategy, Shief J, Turner P, 1997,
Occupational Health Review

4. Whitehall 11 Study, Hemingway et al, 1997, London: HMSO

5. Psychological intervention programme, in addition to ergonomics and
manual handling ones, are needed to reduce back injuries in nurses, Burton et
al, 1997, Occupational Medicine 47 25-37

6. British School of Osteopathy Symposium, 1997

7. Screening to identify people at risk of long-term incapacity for work: a
conceptual and scientific review, Waddell G, Burton AK, Main CJ, London: Royal
Society of Medicine Press, 2003

8. Manual Handling Operations Regulations 1992 Guidance on the Regulations
L23 (second edition), 1998, HSE Books

9. Provision and Use of Work Equipment Regs Approved Code of Practice, 1998,
HSE Books

10. Upper limb disorders in the workplace HSG60 (Rev), 2002, HSE Books

11. Manual handling assessment charts, 2003, HSE Books

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