Musculoskeletal health in the workplace - prevention and intervention

According to the work-related musculoskeletal (MSK) disorders in Britain report 2022/23, published by the Health and Safety Executive:

• 473,000 workers suffer from MSK symptoms. This is an increase of 3,000 from the previous reporting period.

MSK symptoms are often caused by work-related injuries such as incorrect handling, or not having equipment in the workplace personally adjusted. With a recent increase in staff working from home, unsuitable home office set-up has also been a large contributor to the issue.

MSK disorders can include back pain, neck or arm strains and diseases of the joints. All parts of the workforce can be affected by MSK. It is one of the most common reasons for sickness absence in the NHS. 
 

Prevention and early intervention

Preventing MSK disorders and long-term absences should be a high priority for any organisation. To effectively manage MSK diseases, organisations are advised to implement a robust MSK policy to support staff with this issue.

Ways to prevent work-related injuries include:

• regularly checking the accident book and sickness absence records to spot trends and MSK hot-spots in the workplace
• pinpointing the root causes of the trends you identify. Do staff have sufficient and suitable equipment to carry out their roles? Are there staffing shortages causing additional pressure on employees and increasing risk of injury?
• personalising your approach to suit the nature of the working environment. For example, surgeons may require different intervention and equipment to prevent back injuries than office workers and porters
• reviewing risk assessments regularly and when necessary
• having information and advice on work-related injuries and MSK disorders readily available
• providing work-station assessments for employees, including those working from home, and ensuring these are regularly reassessed upon changing circumstances. 
• raising awareness of the importance of regular movement and exercise to aid prevention. Put dedicated time into calendars to remind staff to move away from desks and stretch regularly. This is particularly important for staff working in office settings, and for those required to stay at their desk with limited opportunities to move. 
• ensuring staff who may be particularly vulnerable to have priority access to risk assessments and treatment. For example, staff returning from maternity leave who may be breastfeeding, and those with underlying health problems that are risk factors for MSK conditions.

Upskill your staff and managers

It is important that staff understand how to prevent injuries, and spot and manage symptoms of MSK disorders. Research shows that healthcare roles such as nursing often require carrying out tasks such as lifting patients, which can result in disabling MSK injuries. 

It has also been found that managers often find it difficult to support colleagues with MSK symptoms and to understand their work capacity. It is suggested that organisations should motivate employees to look after their health and make changes at organisational level so managers can manage supportively.

Employers should therefore:

• create a culture that enables managers to be compassionate and supportive. Read our blog by Michael West on implementing effective teamworking, psychological safety and compassionate leadership
• encourage managers to have regular health and wellbeing conversations with staff to help identify any issues in good time
• train both staff and managers to understand how to prevent injuries and spot and manage symptoms correctly
• create pathways through occupational health/physiotherapy where staff can quickly and easily access services to treat and manage their symptoms. Read how you can set up a rapid access to treatment and rehabilitation service for staff
• use multiple channels to raise awareness of available support and implement myth busting into your approach. Read our health and wellbeing communications guide on how you can effectively reach your target audience
• enable your staff to speak up when they feel working conditions are unsafe through access to freedom to speak up champions. Familiarise yourself with our raising concerns employer actions guide.
   

What are NHS organisations doing?

Royal National Orthopaedic Hospital NHS Trust  

Data from the occupational health (OH) service indicated an increase in MSK complaints related to staff working from home. The wellbeing team reflected on how working from home was rapidly implemented during social-distancing measures and may have missed opportunities to support staff to review their home set-ups. 

As a result, the staff wellbeing lead posted an all-staff communication reminding staff of good ergonomics and desk set-ups in relation to MSK pain and discomfort. The communication shared the OH data, provided action steps for staff to follow if they were concerned about their home set-up. It also included how to do a home equipment review and practical guidance on setting up a home-working space.

Royal United Hospital Bath NHS Foundation Trust

The trust run wellbeing drop-in sessions specifically for porters and domestic services staff who have high levels of MSK recorded absence and a low rate of digital engagement. During the sessions staff are offered the opportunity to discuss any wellbeing matters, are offered printed copies of the wellbeing handbooks and if supported to complete staff physio referral forms (if needed). Physiotherapy posters are also displayed throughout the trust detailing how staff can access this service.

Epsom and St Helier University Hospitals NHS Trust

Epsom and St Helier University Hospitals NHS Trust introduced a fast-track programme for staff off sick with musculoskeletal health issues, offering them an appointment with physiotherapy as soon as a referral is made to occupational health for musculoskeletal support. They also developed a video for those involved in moving and handling duties and introduced desk-based exercises. They saw a decrease in time off work for back related causes of musculoskeletal absence; and non-back related causes of musculoskeletal sickness have now steadied.
 

Further resources

• Musculoskeletal health in the workplace - Updated guidance from the Staff Council's Health, Safety and Wellbeing Group (HSWG), aimed at staff at all levels of NHS organisations, to help promote, protect and support musculoskeletal health.
• Wellbeing and managing MSK conditions - The Local Government Association provides joint pain advice to enable staff to self-manage symptoms.
• MSK Health Toolkit for employers and further education institutions - A toolkit for employers and further education institutions launched in October 2022 from The Society of Occupational Medicine (SOM), the British Society for Rheumatology and the Office for Health Improvement and Disparities. It covers information on how to support adolescents and young adults with MSK issues.
• Musculoskeletal Core Capabilities Framework 2018 - Skills for Health, with Health Education England, NHS England, Public Health England and the Arthritis and Musculoskeletal Alliance (ARMA) launched this framework for practitioners who will be first point of contact for people with MSK conditions. Read more about the role of MSK first contact practitioners here.
• Musculoskeletal Health Toolkit for Employers - A toolkit from Business in the Community (BITC), designed to help employers build a culture that champions good mental and physical health and provides a greater understanding of how to help those who need support.
• NHS Health and Wellbeing Framework - This NHS England framework sets out the standards for supporting staff to feel well, healthy and happy at work.
• The National Institute for Health and Care Research (NIHR) - A summary of research showing that an intervention to encourage office workers to stand and move reduced their sitting time after one year. 
• Sickness Absence Toolkit - NHS Employers toolkit providing further information on musculoskeletal disorders and the prevention of long-term sickness absence.
• The Pain at Work (PAW) Toolkit - A toolkit designed to provide free, online resources, supportive information, and advice and guidance for people at work who have chronic or persistent pain.