How can line managers and HR professionals work with occupational health to manage musculoskeletal disorders in the workplace? Kath Taylor and Jonathan Daniel find out.
Each year, 140 million working days are lost to sickness absence (Black, 2011). Approximately 60% of this absence is due to musculoskeletal disorders (MSDs), such as back pain, or upper and lower limb pain. Who should manage the return to work or full duties of an employee who has had an MSD? How do they make decisions with regard to the type of work that this employee could be doing, and how quickly they can return to full duties? What happens if the return to work fails?
Without the support of an OH professional, the responsibility for managing employees with an MSD rests predominantly with line managers. Without any specific training or knowledge of the conditions that they are dealing with, they are the ones to whom the MSD problems are initially reported. They then have to make decisions about whether or not the individual is fit to continue, which duties they should be doing and for how long, and when and how they should return to work.
Often there is a mismatch between what the employee feels they should be doing and what the line manager needs to have the worker do. How is this to be resolved? GP guidelines on fit notes can be vague and they are highly unlikely to be job specific. The line manager is not a health professional and cannot be expected to know recovery times following an acute MSD episode. Let us also not underestimate the “fear factor”. If employers, employees and GPs are all fearful of the effect that returning to work may have on the individual’s condition, it could be a very protracted process.
Due to a lack of specific knowledge among all parties, employees may remain on light duties unnecessarily for months, or even years. Physiotherapists know that the longer it takes to get an employee back to work or full duties, the less likely that the return to work will be completed successfully (Chartered Society of Physiotherapy, 2014). There are many pressures on line managers and it is understandable that they may feel that managing a return to work of a colleague is not a priority. However, if the line manager does not take on this role, who will? With a few basic guiding principles, the process of returning staff to work or full duties can be greatly improved.
Role of physiotherapists
Specialist physiotherapists working in OH are trained to look at all the issues that may affect a return-to-work process. They use a biopsychosocial or flags-based approach to assessment, which was developed in the 1990s to identify and manage psychosocial factors in low back pain. This means that they look at the biological issues, ie the physical aspects of any given MSD complaint, and formulate an accurate diagnosis.
The psychological issues around working with an MSD are then considered. This means looking at what beliefs about the condition the individual may have that affect their ability to perform their job. Lastly, physiotherapists tackle the social issues, asking how having an MSD could affect an individual’s personal and professional life. They then treat, rehabilitate, assess workstations, make amendments and advise on a return to work and full duties.
The biopsychosocial approach is not new, but it requires specific training and there can be considerable difficulty in determining how this approach should be applied. Without an OH professional on site there can be many grey areas. The return-to-work process can be difficult and this can lead to frustrations and breakdown in communication on both sides, resulting in costly delays to employers and employees.
To be really effective, it is desirable that all parties have a working understanding of the factors that influence the return to work process, ie the flags. This would include line managers, senior managers, HR professionals and OH. This understanding does not have to be exhaustive, but a basic understanding of concerns that can affect an individual’s behaviour can prove to be very productive in terms of management.
The role of HR in managing MSDs is to liaise with all parties to help ensure that the sickness absence and return-to-work process runs as smoothly as possible, without unnecessary delays. It is not uncommon for employees to state that they feel they are being treated differently to a colleague who has the same problem.
HR and MSDs in the workplace
HR professionals, like line managers, are not health professionals and have to rely on the information given to them by the individual, GP or musculoskeletal specialist to guide them as to how quickly the individual should return to work or full duties. Quite often this information is vague, relayed informally, and is open to the interpretation of each of those involved. Best practice would involve HR and line managers working to specific protocols that guide all parties smoothly through the process of returning to work, such as those devised by Kendal and Burton (2009).
One of the most important factors in this framework is that each part of the process is time specific. HR departments should make it their priority to maintain contact with employees. If an individual misses a target for return to work, another should be put in place to keep the process on track. Protocols make the return-to-work process much fairer because colleagues are all treated in the same way at the same point in their return. If the process is completely transparent and agreed by staff leaders and unions, issues of perceived inequalities can be avoided. In this way, line managers can be supported in their efforts to return colleagues to full duties.
Often, a difficulty in the return-to-work process is a lack of amended duties. This is particularly difficult in a heavy lifting work environment. How do you make the transition from being off work and doing very little physical activity to doing 12-hour shifts handling heavy goods in a warehouse? In many instances, employees, despite being ready and willing to work, have been turned away because they are unable to fulfil their role.
Amending duties of staff with MSDs
This situation has been avoided in some workplaces when physiotherapists point out the many ways in which duties can be amended. It may require line managers to be creative in their approach to amending duties. It may also be that companies actively seek ways in which to reorganise work tasks with a view to providing viable and productive short-term options for those with health conditions. It is important for all to recognise that the priority is to keep staff in work wherever practically possible. This can significantly reduce sickness absence and add to the satisfaction experienced by all parties in the process.
We know from the Black report that around 90% of MSDs are compatible with some form of work. It is essential that all line managers are aware of this and are able to inform their employees. To help with this, there is written advice available from the Health and Safety Executive, which can be accessed by HR or line managers, on how to manage MSDs in the workplace. The benefit of having this type of advice to hand is that it is impartial and indirectly provided by a specialist and not based on the opinion of an individual. This can form part of a basic early intervention programme.
Where further recovery is not forthcoming, it is appropriate that the employee is encouraged to seek more specialist advice with the support of their employers. There will always be a percentage of employees for whom further intervention will be inevitable, but for many, the correct advice early on in the process will give them the reassurance that work in general is not harmful and can be a very positive factor in recovering from an MSD. These employers also have the benefit of encouraging self-reliance and reducing the need for the intervention of a health professional (as advocated by Johnson et al (2013)).
At all stages of the return-to-work process, the views of the employee should be taken into consideration. Gross et al (2006) encourage us to ask questions of the employee, to find out any concerns, fears or expectations about the worker’s injury, their pain, future recovery and return to work. A graded return to work, including amended or light duties can then be discussed, taking into account the worker’s concerns. As such, the return to work becomes a collaborative process and is much more likely to be effective than one that is dictated and inflexible.
Another factor to consider is the ability to manage musculoskeletal disorders in an ageing workforce. The average age of retirement is 64.7 for men and 63.1 for women. The Department for Work and Pensions said in its business plan that it would like the average to rise by as much as six months every year. Prevalence of self-reported musculoskeletal disorders was found to rise to 51% by the age of 61. However, evidence indicates that individual attitudes and skill sets are the major determinants of performance, and not age (Council for Work and Health, 2014).
It is vital in the current climate that all concerned parties are informed as to both the needs and the benefits of employing and retaining the older workforce. HR professionals, line managers and senior managers all need to know that with some minimal adjustments, workers with joint conditions and other age-related health problems can often be accommodated successfully and remain valued and productive members of the workplace.
FitBack, providers of occupational health physiotherapy and health and wellbeing Initiatives to businesses, have designed a course specifically for HR professionals, line managers and occupational health staff looking at their ole in the management of MSD absence. The course which is running across the UK in 2015.
Black C, Frost D (2011). “Health at work – an independent review of sickness absence”.
Chartered Society of Physiotherapy (2014). “Fitness for work”.
Johnston V, Jull G, Sheppard DM, Ellis N (2013). “Applying principles of self-management to facilitate workers to return to or remain at work with musculoskeletal conditions”. Manual Therapy; 18, pp.217-280.
Kendall NAS, Burton AK, Main CJ, Watson PJ (2009). “Tackling musculoskeletal problems: a guide for the clinic and workplace – identifying obstacles using the psychosocial flags framework”. London: The Stationery Office.
Gross D, Lowe A, La Roque D, Muir I (2006). “Disability management of injured workers: A best practices resource guide for physical therapists”. College of Physical Therapists of Alberta.