Back pain

Most people encounter back pain at some point in their life.

Usually, back pain is not caused by anything serious and will settle within a matter of days or weeks. For most people affected by back pain, episodes are nearly always short-lived.

Lower 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 something more serious.

There are things that employers and workers can do to manage back pain and other musculoskeletal disorders (MSDs) in the workplace.

Evidence shows that good industrial relations, job satisfaction and partnership between employers and employees are key elements in the successful management of back pain issues.

 

Risk factors for back pain

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.  

Many other factors can increase the risk of developing back pain. These include:

• 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 a persons risk for back pain
• smoking - smokers are at greater risk of developing back pain than non-smokers (this is due to reduced oxygen supply to the spinal discs and decreased blood oxygen from the effects of nicotine on constriction of the arteries)
• physical fitness - the strength and endurance of the back and abdominal muscles have been shown to be related to the development of back pain (physical fitness and conditioning of muscles can help 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 because 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 (anxiety, depression, job dissatisfaction or stress at work can place employees at increased risk for developing chronic back pain)

Psychosocial risk factors can affect an employee’s physical health. Psychosocial risk factors relate to the interaction between a person and their social or work environment and the influences on their behaviour.

Within the work setting, examples of psychosocial risk factors include:

• 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.

Advice for employers

Causes of back 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:

• manual handling - movement of loads by bodily force including lifting, lowering, carrying, pushing or pulling
• 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, stretching, twisting and reaching
• duration - maintaining the same position for long periods of time for example, working with computers, driving long distances, or working when fatigued
• vibration - driving mobile machines or other work vehicles over poor surfaces as a main part of a worker’s role
• cold temperature - working in low temperature environments for example, outdoor working in winter
• display screen equipment (DSE) – for workers who use DSE daily, for continuous periods of an hour or more, such as PCs, laptops, tablets and smartphones

Preventing back pain

What can I do to help protect employees?

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

Active work is good for your employees and can have a positive impact on an individuals' physical and mental well-being. 

The idea that manual handling is ‘bad for employees’ is a myth but, if active or physical work is approached with poor technique, it can sometimes contribute to health conditions like back pain and other MSDs such as muscular aches and strains.

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

What steps should I take to reduce the risk of back pain in the workplace?

Carry out a risk assessment to identify any work activities that can cause back pain and then implement the hierarchy of control to manage the associated risks as follows:

Elimination:

• avoid work activities that can cause back pain
• where reasonably practicable, redesign tasks or processes
• consider automation or mechanisation of a task or process to remove the need for any physical interaction by workers, whilst making sure to avoid introducing new risks
• provide work equipment for lifting or carrying, for example conveyor system or lift truck

Substitution:

• decrease the overall weight of loads by splitting it into smaller sections/weight
• consider whether a task would require team handling

Engineering controls:

• use lifting equipment and/or mechanical aids which can make physical job roles easier and safer to perform as well as reduce the risk of injury, for example by moving loads on wheels/trolleys or hoists
• provide better handles on loads
• adjust the heights of workstations
• ensure work areas are ergonomically designed
• maintain lifting/mechanical aids and equipment

Administrative controls:

• adapt work practices to ensure that employees are not overworked
• provide safe systems of work to assist your employees in their duties
• provide information, instruction, training and supervision on safe ways to work and the correct use of work equipment or aids
• consult regularly with the employees on their health and well-being to help you identify concerns and developing trends - some people are more susceptible to back pain than others, so it is important to consult employees in the risk assessment process
• talk to employees and get them to suggest ideas and discuss possible solutions for high-risk tasks/activities - 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 (take action to address any outcomes from these discussions)
• make changes to the work environment and work style as far as is practical, i.e. vary tasks to give employees a range of postures
• consider job rotation - this helps reduce physical and mental fatigue
• respond promptly when an individual employee reports back pain
• encourage employees to warm up to prepare their bodies for heavy or repetitive work (for example, 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
• ensure employees take allocated breaks and don’t work excessively long hours
• make employees aware of the predisposing factors for back pain, for example, poor physical fitness, psychosocial issues, and smoking
• consider basic ‘health promotion in the workplace’ tips - this might include advice or information about walk or cycle to work schemes and providing information sessions for employees on important health issues

Personal Protective Equipment (PPE):

• provide employees with suitable PPE that can reduce the risks of developing back pain, for example, anti-fatigue slip-resistant footwear or grip gloves

Early access to advice and helping employees return to work

An 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.

Schemes like The Condition Management Programme (CMP) are available to help people manage their health condition to allow them to progress towards, move into and stay in employment. The programme is led by healthcare professionals, such as occupational therapists, physiotherapists and mental health nurses.

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 four to six weeks, you can invest in a particular type of scheme to help restore function to the employee. This is called a functional restoration programme.  

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. 

These 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.

Advice for employees

Knowing what the risks are can help you to reduce the possibility of developing back pain.

Back pain is not usually due to any serious damage or disease. The pain usually improves within days or a few weeks, at least enough to get on with normal daily activities.  

Only a few people have back pain that is caused by a more serious issue such as a slipped disc or a trapped nerve and even these usually get better by themselves.

Investigations (X-rays and MRI scans) in the first four to six weeks are generally not beneficial unless there are warning signs present. Such investigations can detect serious spinal injuries which are very rare, but they don’t usually help in ordinary back pain.  

Advice on how to help yourself

At work:

• you have a duty to look after your own health and safety, including your back
• co-operate with arrangements your employer introduces to reduce risks - this may be through systems or equipment in place for you to use or a system of reporting accidents, near misses or symptoms of ill health
• ensure you are competent in the tasks you do (receive tailored training and follow advice you’re given)
• think about the movements your job requires you to carry out regularly and try to eliminate movements that are not benefiting your health and limit your productivity - you can achieve this through developing better working postures

Movements you should try to avoid should include:

• awkward or uncomfortable positions (for example, working with arms away from your body or with your back bent and twisted)
• using too much force
• placing too much strain on one side of your body

Report pain or any other symptoms to your employer promptly.

Good posture

Correct posture and transfer of your body weight in movement is really important for good health. If you adopt the correct postures for the tasks you do at work and at home:

• your back, neck and other joints will remain healthy and strong
• you will breathe deeper and more freely
• you will be at a reduced risk of developing problems
• your internal organs will be able to work more efficiently

Poor posture is often the result of bad habits developed over a lifetime, such as slouching, but can also result from:

• obesity
• fatigue
• stress and anxiety
• poor lifting and handling technique

In good posture, your head, shoulders, spine and hip joints will adopt correct alignment. Whether you are standing, sitting, or leaning you should aim to avoid undue stress and strain on your joints. This will help you feel:

• stronger
• less tired
• fewer aches and pains

Warning signs of back pain

If you do have back pain and suddenly notice any of the following symptoms, which are rare, you should seek urgent medical advice:

• difficulty passing or controlling urine
• numbness or tingling around your buttocks or genitals
• pain, numbness, pins and needles/tingling, or weakness in both legs
• unsteadiness on your feet
• severe pain which gets worse over several weeks (especially at night or when lying down)
• recent accident/trauma
• unexplained weight loss
• history of cancer
• feeling unwell/fever

Dealing with back pain

What you do in the early stages of back pain is very important. Resting for more than a day or two does not usually help and may prolong the pain and your recovery. For most lower back pain self-help is key to recovery.

In the early stages of back pain:

• avoid bed rest - prolonged bed rest may slow your recovery
• stay active (including work) - your back is designed for movement so the sooner you start doing your ordinary activities the better
• correctly use prescribed pain killers (Paracetamol or non-steroidal anti-inflammatory drugs)
• hot or cold compress applied to the sore area may help
• seek help from a qualified professional for example, GP, osteopath, physiotherapist or chiropractor
• a short course of manipulation/acupuncture can help relieve back pain for some
• a structured exercise programme tailored to your needs (to include aerobic activity, muscle strengthening, postural control and stretches) may help relieve pain
• stay at work - or early return to work, with reasonable adjustments in place if needed

Next stages:

• steadily increase your level of activity
• do a little bit more each day if the pain has been restricting your movement
• do not stay in one position for too long
• get up and stretch regularly
• move about and take some walks, building up your activity as you get stronger
• stay at work if you can in order to keep active and recover from the pain - if you have a lot of lifting or other risk factors in your job, talk to your employer and tell them about tasks that will be difficult
• even if the pain is particularly severe you can still try to do most daily activities or hobbies

We are not suggesting it will be easy to get your back moving when it is painful. Try to find activity that suits you and steadily increase your level of activity.

Back pain and work

Suffering from back pain does not mean an individual must automatically be off work.

However, long-term unemployment can be a serious consequence of back pain. Your employer and you, play a very important role in keeping you at work.

Report back pain to your employer and to your safety representative if there is one in your workplace.

What your employer can do to help?

Your employer must protect the health and safety of their workforce by law.

They must:

• perform risk assessments and put in place reasonable measures to reduce that risk
• provide information and training about safe ways of work
• act on any reports of ill health caused by work - if an employee returns after a period of absence, the employer needs to make sure that their health is not made worse by their job
• make changes to work environment and work style as far as is practical
• provide equipment to assist in your duties
• provide reasonable adjustments to the workplace if a worker is disabled under the definition in the Disability Discrimination Act 1995 (DDA)
• consider basic ‘health promotion in the workplace’ tips, for example walk or cycle to work schemes

Planned return to work

• talk to your employer and safety representative about ways to ensure a safe return to work
• develop a plan for progressive return to work as your physical work capacity improves
• your employer may be able to put you in touch with occupational health support

Changes to work activities

It is important to work with your employer to enable a return to work. Helpful strategies for return to work may include:

• suggesting alternatives and rotation between activities - this may help an early return to normal work
• reducing the duration of work for the first few weeks - this may help reduce risk of further pain
• working a half normal shift (about four hours at first) - this may improve pain tolerance

Staying in employment - Top tips

• stay or become more physically active
• warm up a little, to prepare your body for work for heavy or repetitive work - you should do this at the beginning of the day and after rest periods
• get up and stretch
• use good technique/adopt neutral work postures
• don’t overstretch to perform a task - move closer
• make good use of equipment designed to help you with strenuous tasks
• rotate repetitive activities/vary your tasks to avoid the same movements for prolonged periods using the same parts of your body
• take rest periods or have ‘micro breaks’ regularly
• sit up comfortably in a chair that supports your lower back
• during computer work, ensure that you adjust your chair height so that your forearms are comfortably resting on the desk and your elbows are roughly at right angles
• don’t skip meals and do drink water regularly
• make sure clothes fit properly so you can move freely and maintain a comfortable temperature - cold muscles are more likely to suffer injury
• seek advice from a physiotherapist about specific exercises that will help you develop the strength of your muscles and improve your fitness so you can manage the demands of your job

Off work and suffering back pain

If there is no occupational health provider available, your GP or safety representative may be able to discuss possible work restrictions or adjustments.  

You should discuss your needs and can also suggest any practical workplace adaptations or alterations which might help you to cope while you return to full time working.  

Also keep in regular contact with your employer to make them aware of your situation, and to discuss what adjustments might be needed once you are ready to return.  

Key Legislation

• Disability Discrimination Act 1995 (legislation.gov.uk)
• Health and Safety at Work (Northern Ireland) Order 1978 (legislation.gov.uk)
• Health and Safety at Work (Amendment) (Northern Ireland) Order 1998 (legislation.gov.uk)
• Management of Health and Safety at Work Regulations (Northern Ireland) 2000 (legislation.gov.uk)
• The Management of Health and Safety at Work (Amendment) Regulations (Northern Ireland) 2006 (legislation.gov.uk)
• The Manual Handling Operations Regulations (Northern Ireland) 1992 (legislation.gov.uk)
• Workplace (Health, Safety and Welfare) Regulations (Northern Ireland) 1993 (legislation.gov.uk)

Please note that these links are to the original legislation, visitors should verify for themselves whether legislation is in force or whether it has been amended or repealed by subsequent legislation.

Resources

• BackCare
• BackCare - Top 10 Tips for Back Pain
• Back pain - NHS
• Backworks Northern Ireland - Back In Work: Managing back pain in the workplace leaflet  
• Display screen equipment (DSE)
• Manual handling
• Mental well-being at work
• Musculoskeletal disorders (MSDs)
• Sickness absence
• The Condition Management Programme (CMP)
• Work-related stress
• Workplace Health