Occupational Health

by Anna Harrington

Musculoskeletal disorders – the manager’s role

The Manual Handling Operations Regulations 1992, as amended in 2002, apply to a wide range of manual handling activities, including lifting, lowering, pushing, pulling or carrying. The load may be either inanimate, such as a box or a trolley, or animate – a person or an animal (Health and Safety Executive).

Within these duties, employers have a requirement to

  • Avoid ordering activities which have a risk of injury
  • Assess the risk
  • Reduce the risk as far as is reasonably practicable.

Employee responsibilities include

  • Following appropriate systems of work laid down for their safety
  • Making proper use of equipment provided for their safety
  • Co-operating with their employer on health and safety matters
  • Informing the employer if they identify hazardous handling activities
  • Taking care to ensure that their activities do not put others at risk.

In addition, the Display Screen Equipment Regulations 1993 and Management of Health and Safety at Work Regulations 1999 will apply to the management and prevention of MSDs at work.

Assessment and control

The employer needs first to recognise that the problem is a MSD. They can do this through good sickness absence management:

  • Being aware of the reasons for sickness
  • Being aware of performance and so able to recognise when there is deterioration and investigate why
  • Being aware of the risks associated with tasks and how the risks are managed.

Employers will not be involved in the treatment of MSDs, but should be aware of any side effects from treatment that may increase risks in the workplace. For example, some pain killers can cause drowsiness, so you should limit the use of machinery and driving.

When the manager comes to recognise that the individual has an MSD problem, they need to act promptly.

  • Investigate the workplace cause, through a risk assessment. The aims are to look for system failings, to ensure other employees are not put at risk, to find and implement solutions that will reduce the risk.
  • Discuss with the individual ways to enable them to remain active and at work safely. Once serious damage/illness has been ruled out by the doctor, the ethos behind the management of MSDs is to keep the person active and connected with the workplace.
  • After four weeks, do not hesitate on intervening with supportive guidance and active management, as it is more likely that psychosocial barriers will impede return to work, rather than a more serious injury or illness. Before this time, intervention is unlikely to be necessary or cost-effective, but managers need to remain in contact with employees.
  • Use the system of flags (see below) and a Stepped approach to managing the problem. This has been researched and suggested as the best method for back problems and non-specific arm pain; however it can be applied to other MSD problems.
  • Advise the person to take painkillers and keep active.
  • Refer them to occupational health.
  • Use the Stepped approach.

The flag system is used to identify barriers to return to work. It can be used to develop plans of action. It can be useful in the management of all MSDs, but especially back and neck problems and non-specific arm pain (WRULD, RSI).

  • Yellow – person; thoughts, feelings and behaviours
  • Blue – workplace; a perception that work may cause harm and further injury, making a return to work unlikely and causing poor job satisfaction
  • Black – context –both the workplace social community, and society as a whole.

The timing of intervention is critical, and it is recommended that a Stepped approach be deployed.

It is suggested that interventions before four weeks’ absence are unnecessary and unlikely to be cost-effective and may even be obstructive.

Between four and 12 weeks, there’s a 10 to 40 per cent risk of the person still being off work one year later. The best time to start to implement interventions is around the four-week mark, but this assumes that the usual methods of remaining in contact with the employee and involving him/her in work decisions and progress are performed (see Management of sickness absence).

Factors affecting the risk of musculoskeletal injury

The factors which increase the risk of musculoskeletal injury will be associated with the individual, the task, method, frequency, environment and workplace, and psycho-social factors, such as stress levels, employee engagement/motivation and relationships.

Initially, the potential of MSD injury must be identified through a workplace hazard-spotting exercise. Then it will be necessary to make a risk assessment, using the appropriate method.

The acronym TILE – task, individual, load and environment – is a useful tool with which to highlight aspects of the task which are likely to cause harm.


What is required in the task – does it require the worker to use strained postures, such as twisting, bending or stooping? Does the task require the employee to use excessive force or effort? Does the task require repetitive movement, or is the individual unable to take regular rests or breaks?

If the load needs to be lifted, then it should be kept as close to the waist as possible, as the risk of injury increases the further away from this advised lifting zone the task demands.


Attributes and attitudes that relate to the individual can affect the level of risk.

  • Age – older employees may have joint stiffness and reduced strength.
  • Gender – males tend to be stronger than females. Pregnant women and those who have recently given birth are at an increased level of risk, as the hormones associated with giving birth soften the ligaments, which can then become over stretched; also the increase in body size and weight can raise the level of risk.
  • Attitude – the personality, character and age of the individual will make it easier or more difficult for them to follow and adhere to the rules and guidance associated with the task. For example, a young male worker in a macho environment may want to impress his ‘mates’ with the amount of work he is able to do.


What is the nature of the load? Risk increases with certain characteristics: if it is unstable, damp/wet, difficult to hold, irregular shape or blocks the carrier’s vision.


Environmental factors which increase the risk include

  • Poor lighting
  • Uneven surface
  • Variable temperatures or climatic conditions, such as wind
  • Anything that restricts movement, such as personal protective clothing (ppe).

Further tools

TILE gives little recognition to psycho-social factors. It is also too simple an analysis of task, as it relates more to moving and handling than to workstation use or other repetitive tasks.

It is likely that a more in-depth and specific assessment will be required. MAC (Manual Handling Assessment Chart) is an HSE assessment tool that can be used on-line for assessing the lifting and handling tasks of individuals and teams. It uses a traffic-light system to grade the risk.

ART (assessment of repetitive tasks) is an on-line HSE assessment tool to be used on repetitive tasks that use the upper limbs. It is not designed to be used for display screen equipment users.

A specific assessment should be made for users of display screen equipment. This assessment should consider

  • User posture
  • Workstation set up
  • User training in the correct set up and use of display screen equipment
  • User training in the tasks required of him/her
  • Lighting, noise, air quality
  • Psycho-social factors – stress, work community
  • Regularity and frequency of breaks.

See also the topic Posture and Comfort.

Non-work related activities

It has to be recognised that MSDs are also caused and aggravated by non-work activities, such as hobbies. The same risk factors apply at home as in the workplace. As their manager, you should discuss with the individual any non-work activities that may be aggravating symptoms or resulting in an accumulative affect. It is likely that management of the risk factors would apply to the non-work activities, but you have to recognise that you have no rights to ‘force’ the individual to make changes. Emphasising the impact on the individual’s work and the efforts that are made in the workplace to manage the risks may help persuade the individual to make changes is his/her personal life.