Multidisciplinary approach to MSDs

 Joe Patton, senior occupational health and ergonomic adviser to Allied Bakeries, introduced his occupational healthcare programme, which has reduced sickness absence and early retirement due to musculoskeletal problems.1

Patton had begun by profiling the company’s sickness absence form certificates and categorising them into: those not wanted at work in the food industry – for example, diarrhoea; and common recovery – for example, influenza, post surgery and possible work-related disorders.

By prioritising health improvement initiatives and progress against targets, the number of cases of sickness absence fell by 20% and work days lost by 30% – a reduction of 3,437 sickness absence days over three years.

Judith Pitt-Brooke presented two case studies on the impact of occupational physiotherapy in the management of MSDs for Walkers Snack Food Ltd and Johnson Controls. This was achieved using a multidisciplinary approach involving OH, ergonomics, safety team reps and team leaders.

A clinical physiotherapy service provides early intervention, prevents further injuries and co-ordinates existing injuries for a rapid return to work.
Professor Kim Burton, director of the Spinal Research Unit at University of Huddersfield, said that decades of healthcare research and practice have not managed to alter the figures for MSDs.

Back pain and work disability have increased in all industrialised populations, and have done so noticeably since 1985 in the UK – so have the Manual Handling Regulations exacerbated the issue?

Reported lower back pain (LBP) at work needs to identify whether it is work caused or work aggravated – following other activities outside work. Heavy manual work can cause irreparable mechanical overload damage, ‘but not in modern workplaces’, says Burton, when much of heavy manual handling has been automated, mechanised or has disappeared.

Burton encouraged OH professionals to look at the European Guidelines on LBP,2 and said prevention may require a cultural shift in the way it is viewed.

Absence resulting from LBP can be reduced by psychosocial interventions in the workplace.3 Much of Burton’s work can be found in The Back Book and Concepts of Rehabilitation.4,5 Evaluation of The Back Book showed a significant reduction in disadvantageous beliefs, and similar results were received from trials in France, the US and Australia, combining the Back Book’s message with a population-backed campaign.6

A recent piece of research, Tackling Obstacles to recovery in an occupational setting, is on the HSE site.

Dr Brian Isbell, chairman of the Department of Complementary Therapies at University of Westminster, introduced the concept of integrated healthcare and a holistic approach to the prevention and treatment of MSDs.

To work effectively, complementary therapists need to possess biomedical, practitioner and research skills, as well as experience working in multidisciplinary and NHS settings. Complementary therapies may contribute to the MSDs at the structural, chemical, mind body, psychotherapeutic or self-help level.

Dr Ian Randall described the factors that ergonomics considers, including the characteristics of the user, the task to be undertaken, the physical and social environment and the equipment used. He highlighted the main risk factors resulting in MSDs as: postures, forceful actions, repetition and prolonged duration.

Randall said there is evidence that stress and MSDs are closely linked with the Robens study, concluding that “interventions designed to reduce the risk of MSDs need to consider both physical work factors and psychosocial work risk factors”.7 Randal concluded that ergonomics methods are useful in reducing MSDs, but not in isolation; both physical and psychosocial risk factors must be considered.

Dr Phil Bell, clinical director, musculoskeletal services at Bupa Wellness, said the UK has the highest rate of working age incapacity in the EU (UK: 7%; Germany: 2.1%; France: 0.3%).

Explaining the de-socialisation, loss of self-esteem, guilt and blame combined with often a small amount of pain and disability, Bell reiterated the use of rehabilitation services and the Pathways to Health programmes pilots. His suggested solution is a national provider network of multidisciplinary, integrated units, providing the cost-effective, functional restoration-vocational rehabilitation, reconditioning programmes, with the emphasis on return to work.

The prevention and treatment of MSDs requires multidisciplinary teamwork around evidence-based principles, with full management support and sound policies, including clear procedures and support for rehabilitation.


1. Patton J et al (2004) Raising Standards, Occupational Health, October 2004
3. Symonds T, Burton K, Tillotson M, Main C, Spine 1995; 20: 2738-2745
4. Burton et al (2002) The Back Book, London TSO,
5. Waddell G Burton K (2004) Concepts of Rehabilitation for the management of common health problems, London TSO
6. Butchbinder et al (2001) British Medical Journal; 322: 1516-1520
7. The role of work and stress and psychological factors in the development of musculoskeletal disorders,

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