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8.9 million working days lost to work related musculoskeletal disorders

In 2016/17 507,000 workers suffered for work related musculoskeletal disorders (MSK) losing 8.9 million working days. Construction, transport and storage, health and social work activities and agriculture have the highest rates.

There is a general downward trend since 2001 but still approximately 1500 in every 100 000 workers have a new or longstanding MSK disorders annually.

In 2016/17, the following working days were lost due to work-related MSK issues

• Back disorders - 3.2 million days with an average number of days lost per case of 16.5 days, 

• Work Related Upper Limb Disorders (WRULDs) - 3.9 million working days lost, this equated to 17.2 days per case

• Work Related Lower Limb Disorders - 1.8 million days were lost with a rate of 21.1 days lost per case.

Men are more likely than women to get MSK disorders and they become more common the older we get.

And not just in the UK, according to the latest figures of the European Survey on Working Conditions, 24.7% of the European workers complain of backache, 22.8% of muscular pains, 45.5% report working in painful or tiring positions while 35% are required to handle heavy loads in their work. Pain in the lower limbs may be as important as pain in the upper limbs, although this is less commonly reported in the recognised occupational musculoskeletal disease reporting systems. 

And it’s not a standalone problem; evidence shows MSK disorders cross- react with mental health issues.

Perceived work environment influenced psychological distress and also influenced the reporting of MSK disorders. The mechanism is thought to be that adverse psychosocial environments may impair coping behaviours, leading in turn to impaired mental health, tension, and consequent MSK symptoms. Studies have shown that ‘abnormal’ scores on a measure of psychological distress precede, rather than affect, episodes of back pain and a 10 year follow up study showed that psychological distress at baseline (23 years) more than doubled the later risk of low back pain at age 33 years. Therefore, psychological distress is highlighted as a primary cause, rather than an outcome, of MSK pain. 

There are many causes of MSK symptoms, but obesity consistently appears in studies as a key factor in the onset and progression of conditions of the hip, knee, ankle, foot and shoulder. The majority of research has focused on the impact of obesity on bone and joint disorders, such as the risk of fracture and osteoarthritis. However, emerging evidence indicates that obesity may also have a profound effect on soft-tissue structures, such as tendon and cartilage. 

Obesity substantially increases the risk of OA and other MSK conditions such as back pain, with the risk of developing knee arthritis appearing to be similar to that of developing high blood pressure or Type 2 Diabetes. Those who are obese are twice as likely to get osteoarthritis of the knee than those of recommended weight and the very obese are 14 times more likely to develop persistent knee pain than slim individuals.

So, what does this mean for businesses?

At its most basic, the older and fatter we get, the more likely we are to get MSK disorders and if we have mental health issues that will also increase the problem. The general population is getting older and the number of young workers is decreasing, and they are fatter than they have ever been. This shows no signs of improving as there is a large percentage of obese school children. Obesity is increasing in the population of the UK and as we all know we are all going to have to work for longer. Mental health problems are also increasing in frequency in the population with a significant number of people first affected in childhood.

A perfect storm of future problems for businesses. 

A wellbeing strategy that addresses mental health, physical health and proactive health initiatives is needed by organisations now more than ever and access to sound Occupational Health (OH) provision for employees helps with managing all these issues.

Occupational Health (OH) is a branch of healthcare that is concerned with the relationship and interaction between health and work.  An effective OH service aims to achieve the following.

• Protect workers against work related health risks

• Monitor the health of workers with specific health checks over time

• Ensure the fitness of workers to work safely and effectively

• Reduce absence due to work related and non-work related illness

• Advise on rehabilitation programmes after long term illness or injury

• Enhance preventive and proactive wellbeing through health education, skills development and promotional programmes

The climate of employment means that organisations need to consider how they are going to address the upcoming demographic and fitness issues that are predicted to be arriving now and in the next decade. Return on Investment (ROI) for OH is especially easy to measure around MSK with figures ranging £5-11 benefit for every £1 spent. For general wellbeing interventions the ROI is between 1:1 to 34:1 but the studies are of variable quality.

But considering the risk to business, the question now needs to move from what is the ROI a business gets from its investment in the health of its staff to what is the risk from not investing. With all the evidence now available about the public health risks and an aging workforce, the question a responsible business should be asking should not be “Why should we invest in OH advice and intervention?” but now the question really must be “What possible reason is there for not investing in OH advice and intervention?”


Dr Lucy Wright

Chief Medical Officer Optima Health on behalf of the Society of Occupational Medicine