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HR health and wellbeing special 4/6: No employer can afford to ignore musculo-skeletal cases

Musculo-skeletal injuries have, according to official statistics, been decreasing slightly since 2009, but no employer can afford to ignore a problem that is resulting in over 150,000 new cases a year – and certain areas of the country are clearly bucking the national trend.

Frances Molloy, chief executive at Liverpool consultancy Health@Work, says: "We see a lot more of musculo-skeletal problems, because employers aren't carrying out the necessary risk assessments they should be. Some don't seem to realise that health and safety legislation requires them to be conducting display screen assessments, which include work-based assessments - and checking people have the right chairs and desks."

An assessment by a suitable occupational health doctor or nurse can often save hundreds of pounds being spent on unnecessary additional equipment, because an existing chair may be quite adequate if properly adjusted. But there are clearly situations in which ergonomic chairs are necessary.

Beth Johnston, group HR director at consultancy Personal Group, says: "We have had two employees during recent years who have been able to get quite a lot of relief from having specialist chairs. One had a long-standing back problem before joining us and the other changed jobs within our firm, from a field-based role to a largely sedentary one. Without these chairs, which only cost a few hundred pounds each, they wouldn't have been able to perform their roles and their condition would have deteriorated." Many safeguards that can be introduced to protect against musculo-skeletal problems in fact cost nothing.

Regular movement to prevent the body from stiffening up can, for example, be increased by not having waste bins next to desks, having only one photocopier per office and encouraging the use of stairs rather than lifts.

Pamela Gellatly, CEO of Healthcare RM, says: "Unfortunately, the implementation of the Manual Handling Regulations in 1992 has resulted in people being taught that lifting is bad for you, but if you are conditioned and physically active, you are more likely to avoid injury and not have problems with pain.

"A lot of people nowadays are not taking appropriate exercise. There needs to be a mixture of strength, flexibility and cardiovascular exercise and it must be conditioned to the sort of work the employee is doing and to address any potential imbalances," Gellatly added.

Even something as straightforward as encouraging the use of headsets when phoning can make a significant difference. For example, the results released this January of a study conducted by Plantronics and Anglo-European College of Chiropractic have shown physical comfort can improve drastically by replacing the telephone handset with a headset. Half of respondents doing this found that head, neck, shoulder and back pain totally disappeared, and two-thirds of the remainder reported a decrease in such pain.

Once musculo-skeletal problems have actually arisen, there is a clear trend towards using surgery only as a last resort, particularly with back problems.

Mike O'Donnell, chief medical officer at Atos Healthcare, says: "NICE guidance shows that surgical interventions are rarely helpful for chronic back pain, unless there is a clearly defined lesion, such as a prolapsed disc. For short-term back pain, the best thing to do is to try and stay as mobile as possible. Massages can be helpful to alleviate pain, as can hot and cold and pain killers."

But private medical insurance providers are still coughing up for their fair share of surgical operations. For example, Simplyhealth reports 60% of its benefit costs in the musculo-skeletal area are surgery-related and 40% are out-patient- and therapy-related. Sometimes, surgery can be entirely appropriate for conditions such as severe osteoarthritis of the hip, damage to cartilage within the knee and joint replacements.

Henry Goodall, president of the Society of Occupational Medicine, explains: "A joint replacement will give someone five to 10 years of active working life when they might otherwise have had to retire. But obese people can do worse than others after joint replacement operations, because they may be less fit generally or have weaker muscles or cardiovascular problems. All these things tend to make recovery longer after surgery."

But surgery is being increasingly reserved for when the condition has gone beyond the scope of conservative treatments such as physiotherapy, osteopathy, chiropractic or acupuncture.

Employers who can't afford to offer PMI can therefore still greatly increase the chances of employees seeking timely intervention for musculo-skeletal conditions by offering cash plans.

Paul Gambon, head of sales at Medicash, says: "When a manager reminds someone they have cash plan cover for things such as complementary therapies or specialist consultations, they are less reluctant to seek private help, and if you tackle an injury early you can greatly reduce the chances of aggravation and absenteeism."

But once someone has actually been absent for any length of time, employers should ensure that they make a graded return over a four to six week period. Even something as seemingly straightforward as sitting on a chair requires core muscles to be exercised to avoid slumping. Making any reasonable adjustments necessary to accommodate a return should also be a high priority.

Perry Timms, head of HR, talent and organisational development at Big Lottery Fund, adds: "The starting point around reasonable adjustments is to take medical advice, in which both GPs and occupational health can play a big part.

"It is a dialogue between the individual and you as the employer regarding your duty of care. Failure by a company to comply could result in the employee leaving or even seeking legal recourse."

Human musculo-skeletal system

The musculo-skeletal system (also known as the locomotor system) is an organ system that gives humans the ability to move using the muscular and skeletal systems. The musculo-skeletal system provides form, support, stability and movement to the body. Although it is commonly used to describe back complaints, there is a range of musculo-skeletal disorders that can affect people.

The vital statistics

Labour Force Survey:

  • There were 508,000 musculo-skeletal problems in the UK in 2010/11 (out of 1,152,000 work-related illnesses)
  • New musculo-skeletal cases were 158,000, down from 190,000 in 2009/10

Simplyhealth/CIPD annual Absence Management Survey:

  • The 2011 survey found that musculo-skeletal injuries, excluding back pain, accounted for 17% of manual and 7% of non-manual long-term absence in the UK, compared to 22% and 12% respectively in the 2010 survey
  • Back pain accounted for 11% of manual and 4% of non-manual long-term absence in the UK in the 2011 survey, compared to 12% and 5% respectively in the 2010 survey

The 2011 survey refers to data from June 2010 to June 2011 while the 2010 survey refers to data from January to December 2009

Case study: Norton Rose

Law firm Norton Rose has been offering its 1,100 staff subsidised chair massages for over two years, and seems to have been reaping concrete rewards as a result. An analysis at the end of 2010 showed that physiotherapy claims on its PMI scheme had reduced, thereby helping to keep medical costs and absenteeism down.

Twenty-minute massages provided by employee wellbeing company, energiseYou, are available twice a week and the company pays for half the £20 cost. The sessions, which are normally fully booked, are used by around 40 or 50 staff a week.

Mandy Campell, pensions and benefits manager at Norton Rose, says: "The massages can catch any work-related upper limb disorders very early on before they become chronic conditions. They also generally reduce back, shoulder and neck pain and can relieve stress and tension for those sitting at desks for long periods. When I raised the idea with the board initially, it fitted in well with our wellness policy, so we agreed at the outset to do it as a trial with no fixed end date. It has been so well received that there would be an outcry if we took it away."

Workstation assessments for anyone who joins, moves desk, becomes pregnant or has other health issues that need to be addressed also help to safeguard against musculo-skeletal problems, while a private GP service with Roodlane Medical can normally enable anyone suffering pain or discomfort to get a same-day appointment and, if referred, to get a next-day appointment for physiotherapy.

Case study: Legal & General

Vanessa Sallows demonstrates that it is possible to pursue a successful career with a long-term musculo-skeletal condition. The 47-year-old director of Legal & General suffers from chronic arthritis and spondylosis of the spine and is permanently on medication for both.

The outer part of her left leg is still paralysed, but surgery in 1999 for a herniated disc cured her of a lot of pain and increased her mobility.

The operation necessitated her taking eight weeks off work from her previous employer Sun Life Financial of Canada, followed by a phased return over a four-week period. The company was very supportive, paying for physiotherapy, providing her with an ergonomic chair and enabling her to take advantage of flexitime when her arthritis was playing up.

Since joining Legal & General in 2004, Sallows has also benefited from similar support and has only ever had to take the odd day off - the longest spell being five consecutive days in 2005.

She says: "Fortunately, working for employers with expertise in workplace health has benefited me in allowing me to remain at work. If I hadn't had the support I needed, I may have had to change jobs or even retire early. If the employer is proactive, the seemingly most hopeless cases can continue to make a valuable contribution to the workplace and even to progress significantly in their career development. It is especially important to allow people return to work gradually after an operation, as even the most extraordinarily resilient may struggle to come back full-time."