Fast track back to work

Musculoskeletal disorders cost sufferers and employers a lot of time, money
and distress, but research suggests that the sooner treatment is offered, the
better, by Janice Kaye

Musculoskeletal disorder (MSD) is one of the greatest challenges for
occupational health.

Although the risks in the working environment from MSD can be managed and
controlled, away from work, the causes of injury can be found in every corner
of life, far beyond the influence of good working practices. The size of the
problem is not in question:

– An annual loss of almost 13 million working days due to back pain

– Musculoskeletal disorder affecting 1.1 million people a year

– A cost to society of £10bn a year, requiring up to 12 million GP

– Accounting for 60 per cent of all absenteeism, the cost of MSD has been
rising steadily at £500m a year2

Tackling the issue

Attempts to tackle the issue have focused mainly on work practices. In 1992,
the Health and Safety Executive (HSE) established the Manual Handling
Operations Regulations, a framework within which employers might reduce manual
handling injury. The following year, it launched Getting to Grips with Handling
Problems, and later, HSE Manual Handling – Solutions you can Handle. Back in
Work started in 1999 with funded back pain projects in the workplace, with a
view to developing good practice models.

The messages promoted by these initiatives are now widely accepted. Proper
assessments of the task at hand, the loads involved, the working environment
and the individuals’ capabilities are now all essential practices. Also key is
that there is no substitute for the provision of good manual handling training
when the avoidance of manual handling operations is impossible.

Risk factors for MSD are recognised in virtually every workplace. While the
HSE’s key message is that things can be done to minimise incidents of MSD and
that measures are cost effective, it accepts that you cannot prevent them all,
and that early reporting, proper treatment and suitable rehabilitation are

MSD is most visible in human and financial terms in the workplace, but its
origins are as likely to be found at home or on the sports field, far beyond
the employers’ sphere of responsibility and liability. But when it affects an
individual’s ability to work, the employer is faced with the consequences,
despite having had no control over its cause.

Quick turnaround

Resistance to the idea of funding occupational health and rehabilitation
schemes for disorders that are often unrelated to work is understandable. But
if attention is shifted pragmatically on to the cost savings by getting employees
back to work quickly, occupational rehabilitation makes good business sense.

Getting people back to work quickly is now also the medical view. In a
review of current research, The Royal College of General Practitioners
concludes that bed rest for two to seven days is worse than a placebo or
ordinary activity, and that prolonged bed rest may lead to chronic disability.
It recommends manipulative treatment for pain relief and for patients who fail
to return to normal activities; ‘in acute and sub-acute back pain, manipulation
provides better short term improvement in pain and activity levels and higher
levels of patient satisfaction than the treatments to which it has been

This assumes the availability of resources. The OH professional faces the
challenge of finding qualified osteopaths, physical therapists or chiropractors
at short notice, at any number of locations around the country. There is the
additional challenge of managing rehabilitation and absence from work, while
learning as much as possible from each incident for ongoing risk assessment.

Osteopaths for Industry has been providing manual handling training to staff
and in-house trainers for 16 years; the organisation is the sole training
provider for the 7,000 active personnel in the London Fire Brigade. Its work
has brought it close to the MSD issue, and it saw the need for nationwide
fast-track treatment linked to the management of the absence and a reporting
system that identified black spots.

Four years ago, it created MMS National Ltd to provide absence management
and rehabilitation services for the OH profession. The company established a
network of 3,000 chiropractors, osteopaths and physical therapists, and created
a system of fast-track rehabilitation, absence management and standardised data
gathering, which has been proven with clients such as Excel Treadteam, Greggs
plc and British Polythene Industries.

Clients retain control of the whole episode, from injury to return to work.
It gives them the tool to monitor company-wide rates of injury, identify risk
areas and develop preventative strategies.

Any musculoskeletal condition is treated within 72 hours by a therapist
based close to the injured worker. The genuine musculoskeletal injury responds
well to early treatment and clients have seen the average absence period shrink
from 28 working days lost to four days; 75 per cent of MMS National referrals
do not take time off at all other than for treatment sessions, and the company
frequently sees client MSD-related absenteeism halved.

The service is established on a pay-as-you-go basis, and any size of
organisation can benefit; from those with a handful of workers to large
companies with thousands of employees across the UK.

It is the experience of many client companies that the service is
self-financing. Absence rates are reduced for legitimate conditions, while the
prospect of quick treatment and a proactive absence management structure
creates a powerful deterrent to malingerers.

Providing a musculoskeletal injury referral service can be seen in many
lights. It is part economic expedient and part OH necessity; part risk
assessment tool, part perk, and part malingerers’ disincentive.


The Revitalising Health and Safety strategy set goals to reduce the incidence
of work-related illness caused by MSDs by 12 per cent, and the number of
working days lost to MSDs by 15 per cent by 2004. Increased inspections and new
manual handling assessment tools are all part of the compliance element of this
long-term OH plan. Increased fines, sentences and other disincentives for
breaches of health and safety legislation, as well as streamlining the law
itself, are all documented Government and HSC objectives.

Back pain, musculoskeletal injury and repetitive strain injury are a huge
burden and quite rightly a high-profile target for the HSE. Appropriate
intervention, early access to treatment and feedback into risk management have
proven to work on many levels as the only real response to increasing financial
and regulatory pressure on employers to address the problem.

Janice Kaye, a trained osteopath, is managing director of MMS National Ltd
and of Osteopaths for Industry Ltd, which provides preventative training, and
musculoskeletal injury and absence management services on a countrywide basis
across the UK and Ireland


1. HSE (1998), Self-reporting work related illness in 1995; results from a
household survey

2. The Back Pain Revolution, by Gordon Waddell, Churchill & Livingston,
first published 1998

BPI’s injury and absenteeism challenge

British Polythene Industries (BPI) is
an international company with 3,000 employees across 38 sites in the UK, and a
further 2,000 across 45 companies worldwide. In the late 1990s, before the
current focus on musculoskeletal disorder (MSD), the company was looking for an
answer to spiralling injury and absenteeism rates across its UK workforce.

Andy Collinson, group health and safety manager for the
company, was researching a solution that would work across many levels. It
needed to rehabilitate those injured as effectively as possible and thereby
reduce absenteeism. It had to be seen as good for the workforce and, therefore,
receive union acceptance. It also had to make good business sense.

He discovered that prevention and treatment were being
addressed  together by Osteopaths for
Industry and MMS National. While the organisation provided preventative
training, the key was a service that treats injuries within a few hours,
oversees each absence and provides a company-wide view on MSD problem areas.

In 1998, before it employed MMS National, each incident of MSD
absence at BPI resulted in an average of 26 working days lost. The following
year – the first using the system – the number of lost days was down to four
for each MSD absence.

"Over the first year, we substantially reduced BPI’s lost
days from handling injuries. In financial terms, the benefits outweigh the
costs by 12:1. We were able to make a case for improvement, prioritise areas
and demonstrate the impact we have had from hard measurable facts," says

In 2001, more than 400 members of staff were referred to MMS
National. Each had an average of four treatments, and more than 75 per cent
remained at work while undergoing therapy. It does not matter if the injury
occurred at work or at home, because any type of back injury will demand early
attention or risk lengthy rehabilitation; 74 per cent of BPI’s injuries were
non-work related.

Only 19 per cent of the referrals had to take time off work. A
further 17 per cent were temporarily put on restricted duties and 64 per cent
were fit for work.

Musculoskeletal injury responds well to early treatment, and
this contrasts with the traditional route of dealing with musculoskeletal
injury through GP prescriptions and sick notes, which often results in costly
long-term absence.  

"This rehabilitation scheme created the solutions we
needed in terms of health and safety and occupational health. It was popular
with the workforce and their representatives, and it made excellent business
sense; for every pound we spent on the scheme, we made a saving of £12,"
says Collinson.

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