Back pain - advice for employers

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Low back pain is common and can be extremely painful. It can be difficult to cope with the severe pain but fortunately it is rarely due to serious disease. There are things that employers can do to manage back pain and other musculoskeletal disorders (MSDs) in the workplace. People can be helped to remain in work or helped to make an earlier return to work.

Legal duties 

Employers have a legal obligation to protect the health and safety of their employees and other people who might be affected by what they do. Some health and safety regulations are particularly relevant to dealing with back pain in the workplace.

The Management of Health and Safety at Work Regulations (Northern Ireland) 2000 regulation 3 requires that all employers assess the risks to the health and safety of their employees while they are at work.

The Manual Handling Operations Regulations (Northern Ireland) 1992 require an employer to carry out a risk assessment on the manual handling tasks that pose a risk of injury.  

Health and Safety (Display Screen Equipment) Regulations 1992 as amended (DSE Regulations) - some users of visual display units may get aches and pains, including back pain. The regulations set out what employers need to do if their employees are habitual users of DSE. Specific advice on DSE and the DSE regulations.

The Control of Vibration at Work Regulations (Northern Ireland) 2005 - regular long-term exposure to whole body vibration (WBV) is associated with back pain. The regulations require an employer to take actions to protect persons against risk to their health and safety arising from exposure to vibration at work. More information can be found at the HSE’s vibration website.

Back pain in the workplace 

Causes of pain

Back pain can be caused by different work factors. The exact cause is often unclear, but back pain is more common in occupational roles that involve:

  • repetitive tasks - such as manual packing of goods
  • force - heavy manual labour, handling tasks, pushing and pulling loads that require excessive force
  • posture - poor/ awkward postures such as stooping, bending over or crouching
  • duration - maintaining the same position for long periods of time e.g. working with computers or driving long distances. Also working when physically overtired
  • vibration - operating vibration tools
  • cold temperature - working in low temperature environments e.g. outdoor working in winter

Things to remember about risk factors for back pain

Risk factors may be experienced during non-occupational activities. In addressing any issue of back pain it would be a mistake to focus solely on the workplace.  As individuals we are all different, the variation exists for example in our size, shape, strength, endurance, flexibility, knowledge, experience and skill.  Two individuals exposed to the same combination of risk factors and to the same degree will respond differently.  One employee may NOT experience any discomfort, while another might develop back pain.  Other predisposing factors can also increase  the risk of  developing back pain.

Consult your employees

You have a legal duty to consult with all your employees or their elected representatives.  Talking to your staff is good because they know what they find difficult and often have good ideas about how to improve things.
Involving employees and safety representatives in discussions about how to improve health and safety will also make it easier to agree changes and employees will be more likely to follow procedures that they have helped to design.  Some people are more susceptible to back pain than others, so it is important to consult employees in the risk assessment process.

Predisposing factors

Many factors increase the risk of developing back pain.

Some of these factors are important risk factors for the development of persistent back pain.

  • previous back injury - the single best predictor of back pain is a previous injury. Relapses are common after a significant episode of back pain
  • alcohol and drug abuse - alcohol and illicit drug use have been shown to increase one’s risk for back pain
  • smoking - studies have shown that smokers are at greater risk of developing back pain than non-smokers. It is thought to be due to reduced oxygen supply to the spinal discs and decreased blood oxygen from the effects of nicotine on constriction of the arteries
  • level of activity (physical fitness) - the strength and endurance of the back and abdominal muscles have been shown to be related to the development of back pain. Studies have shown that physical fitness and conditioning may prevent back injuries
  • obesity - studies have shown an increase in back pain in obese individuals
  • sports and hobbies- such as skiing, gymnastics and contact sports such as football and rugby increase the risk of developing back pain as a result of injury
  • psychological and social factors- it is increasingly recognised that a wide variety of psychological and social factors can increase the risk of back pain. Research has shown anxiety, depression, job dissatisfaction, mental stress at work can place people at increased risk for developing chronic back pain

Risk assessment

Risk assessment is a five stage process and involves:

  • looking for the risks (hazards) 
  • deciding who might be harmed 
  • evaluating the risks and deciding whether the existing precautions are adequate or whether more should be done
  • recording your findings and telling your employees about them
  • reviewing your assessment and revising it if necessary, for example if the work changes significantly; if there is an accident; or when someone returns to work after sickness or injury, or suffers a change in their health, that could affect or be affected by their work

General advice on how to carry out a risk assessment is contained in the HSE (GB) risk assessment document.

Risk assessment aids, tools and checklists

A number of risk assessment aids, tools or checklists have been developed that will help you assess the risks from some of the manual handling activities that your workers may carry out.

A body mapping tool can be used to collect some basic statistical information from your employees on pain experienced during working. It draws on direct experience of employees themselves and it helps develop an understanding of the shared risk-factors in the work they do.

If your employees are carrying out manual labour then you will need to consider a risk assessment tool that assesses the risks of manual handling. HSE have also produced the Manual Handling Assessment Chart (MAC), which can be used to help identify high-risk tasks. The MAC does not comprise a full risk assessment, as some aspects, such as pushing and pulling, are not covered. For more information consult HSE (Manual Handling Assessment Chart (MAC)).

If your employees work with computers then you will need to perform a display screen equipment (DSE) risk assessment VDU workstation checklist.

If your employees’ work duties involve repetitive or forceful actions, twisting, pushing, pulling, lifting, reaching movements or poor posture, they may be at risk of upper limb disorders (ULDs) and back pain and therefore you will need to carry out a ULD risk assessment.

The filter  and risk assessment worksheets featured in the guidance booklet Upper limb disorders in the workplace can be used as an aid to risk assessment.  They are intended to help employers identify the potential risks and possible ways to reduce them.

Manual handling risk assessments and specific tools

Things to remember about manual handling risk assessments:

  • risk assessments are not an end in themselves they are a structured approach to analysing risk and should point the way to practical solutions
  • a risk assessment should cover all standard operations, including cleaning and maintenance activities. It should reflect how the work is actually done
  • the main areas to focus on are the task - load, working environment and individual capability

Once the risk assessment is completed you should now review ways in which to eliminate or reduce the risk of employees developing back injury in your workplace.

This will often involve redesigning the task (to reduce the amount of manual handling or exposure to the risks) and may involve the introduction of mechanical lifting aids that can support the weight of the load and therefore potentially reduce the risk of back injury.

There are a number of different companies that produce manual handling lifting aids to reduce the manual handling risks to the employee and therefore reduce the risk of developing back pain.

The  leaflet 'Making the best use of lifting and handling aids' provides information of some of the different aids available. This list is not exhaustive and there are a number of different aids available for a variety of different work processes.

The guidance on the Manual Handling Regulations contains a risk assessment filter to help you screen out low risk manual handling activities.

The filter allows you to identify those manual handling tasks that may be categorised as hazardous and pose a risk of injury. As a result a more detailed risk assessment is required.

Application of the filter guidelines will provide a reasonable level of protection to around 95% of working men and women. However, the guidelines should not be regarded as safe weight limits for lifting.

There is no threshold below which manual handling operations may be regarded as 'safe'. Even operations lying within the boundary mapped out by the guidelines should be avoided or made less demanding wherever it is reasonably practicable to do so.

Industry specific guidance

HSE have also produced guidance specific to certain industries or activities on reducing the risks of back pain.

Other risk factors

Research has shown that there are other risk factors that can affect an employee’s physical health.

Within the work setting, examples of these other risk factors are:

  • high workloads
  • tight deadlines
  • lack of control of the work and working methods
  • working relationships with supervisors and colleagues

These risk factors can lead not only to stress but also to back pain. For example, stress related changes in the body, such as increased muscle tension, could make employees more susceptible to back pain, or changes in behaviour such as not taking breaks to try to cope with deadlines.

These other risk factors are also known as psychosocial risk factors. Psychosocial risk factors are about the interaction between a person and their social or work environment and the influences on their behaviour.

You may also like to look at HSE’s web pages on tackling work related stress and the management standards. The management standards give advice on issues like work load and patterns.

 

Preventing back pain

Active work is good for your employees.

Active work has a positive impact on individuals' physical and mental wellbeing. 

The idea that manual handling or repetitive movements is ‘bad for employees’ is a myth but it is true active work approached wrongly can sometimes contribute to health conditions like back pain and other musculoskeletal disorders (MSDS) such as muscular aches and strains.

What can I do to help protect employees?

As an employer you have legal obligations to provide safe and healthy workplaces for employees.

The physical demands of some tasks like manual handling, lifting, bending and driving heavy vehicles can trigger an episode or make an existing back pain worse.

Take steps to reduce the risk of back pain in the workplace.

You should:  

  • provide information, training and supervision on safe ways to work
  • carry out risk assessments conducted by trained assessors to minimise risks
  • provide safe equipment to assist your employees in their duties
  • consult regularly with the employees on their health and well being to help you identify concerns and developing trends
  • take actions to address any outcomes from these discussions
  • respond promptly when an individual employee reports back pain
  • talk to employees and get them to suggest ideas and discuss possible solutions for high risk tasks/activities
  • make changes to work environment and work style as far as is practical i.e. vary tasks to give employees a range of postures
  • consider ways in which  you can make jobs physically easier and safer to perform, e.g. by moving loads on wheels, providing better handles on loads, adjusting heights of worktops etc
  • consider Job Enlargement/ Job Rotation- to reduce physical and mental fatigue
  • encourage employees to warm up to prepare their bodies for heavy or repetitive work (e.g. general stretch of all major muscle groups or gentle jog on the spot)
  • encourage employees to adopt correct postures for the tasks they do at work and home
  • ensure employees take allocated breaks and leave work on time
  • make employees aware of the predisposing factors for back pain e.g. poor physical fitness, psychosocial issues and smoking
  • consider basic ‘health promotion in the work place’ tips. This might include advice or information about walk or cycle to work schemes and providing information sessions for employees on important health issues

Early access to advice and helping employees return to work

The occupational health professional will be able to highlight any work factors that are causing difficulty and should liaise with supervisors or managers if necessary in order to help the person stay at work or return to work. Some cases will require monitoring by occupational health professionals with a review of progress at regular intervals. Some individuals such as those with a serious condition or serious back injury may be under the care of their GP or hospital specialist.

While they are absent from work long term, occupational health professionals will be in a position to liaise with the GP or specialist to gain further information on the diagnosis and the plans for medical management including time frames. This will enable you to plan your work and arrange for cover as needed.

Early access to advice

This service could be used for employees with back symptoms who are still at work or any who are on sick leave.

Occupational health professionals with experience of back problems and workplace situations (occupational physiotherapists, occupational therapists or other appropriate health professionals) are able to give appropriate advice via face- to-face appointments or telephone contact.  The system should include assessment of clinical priority. Severe conditions linked to back pain are rare. An individual with serious symptoms would be directed to seek medical attention as appropriate as they may need urgent treatment from the NHS.  Other individuals can be reassured and given appropriate advice with a follow up contact arranged if necessary.

Extra help in returning to work

If someone is off work or unable to work normally due to back pain or injury and they have continued to have problems for 4-6 weeks, you can invest in a particular type of scheme to help restore function to the employee. This is called a functional restoration programme.  There is strong evidence from good quality research for the effectiveness of this process. Gradual strengthening takes place under the supervision of occupational physiotherapists or occupational therapists.  These professionals are able to assist employees to overcome any barriers such as fear of further injury and get them to carry out work-oriented tasks with the aim of going back to the original job.  You should be aware that an exercise programme is not the same as a functional restoration programme and will not give the same benefits to the employee. 

This is a real life example of where functional restoration was used to help employees return to work:

Royal Mail paid occupational physiotherapists to run a programme that had a success rate of 67%. In this scheme, employees had a history of extensive problems, suffering e.g. a prolapsed disc or back injury, and had been off work for periods such as 14 months. They had many years of potential employment ahead of them and had physically-demanding jobs, including lifting heavy mail bags. Most of these employees were able to return to work after a programme lasting typically just 10 weeks. They returned to full duties and were able to go back to active leisure pursuits like football.

The evidence indicates that these special programmes can prevent long-term back pain and be highly cost-effective, especially when individuals are selected as needing this approach, for example, those who have been having problems for at least 4 weeks and are not optimistic about being able to resume their normal job in the future.