Managing musculoskeletal disorders in the workplace: prevention and practical solutions

Musculoskeletal disorders (MSDs) are a key concern for health and safety practitioners, as the Labour Force Survey shows they affect a significant portion of the working population (2023/24). MSDs are disorders that impact muscles, ligaments, tendons, nerves, joints and other soft tissues, often due to the cumulative effects of physical work (see HSG60, HSE).

Photograph: iStock/kadmy

During our time at the Health and Safety Executive (HSE), we’ve often heard people say MSDs are just ‘part of the job’, unavoidable or too complex to manage. While it’s true that many kinds of work can contribute to or worsen MSDs – and that not all are entirely preventable – we want to highlight that work-related MSD risks can be assessed and controlled. In fact, many MSDs can be prevented through quick and straightforward measures.

Why managing MSD risks matters

There are compelling reasons to manage MSD risks proactively. In addition to a moral duty of care, two key reasons include legal compliance and financial return on investment (ROI). The ROI discussion usually incorporates the fact that losses due to sickness absence are reduced but should also figure in the fact that tasks can become less strenuous and so less fatiguing on a workforce, improving overall efficiency and quality of output as well as ensuring that the demands/characteristics of the job are acceptable to the workforce.

Despite the relative simplicity of some preventative steps, MSD cases remain common in the workplace.

MSD prevalence and impact

In 2023, 18.4 per cent of adults aged 16 and over reported long-term musculoskeletal issues (Office for Health Improvement & Disparities). MSDs accounted for 32 per cent of all reported work-related health issues in 2023/24, with an estimated 543,000 workers affected. Commonly impacted areas include the upper limbs or neck (37 per cent), back (43 per cent) and lower limbs (20 per cent). They impact similar numbers of men and women and rates are higher for workers aged 45 and over (Labour Force Survey 2023/24).

MSDs are most prevalent amongst those in skilled construction trades; those working as process, plant and machine operatives; and those working in the caring, leisure, and other administrative and service occupations (Labour Force Survey 2023/24). However, MSDs can be found across the full range of industries, and negatively impact individuals and businesses across the country.

Prior to the coronavirus pandemic, the rate of self-reported work-related musculoskeletal disorders showed a generally downward trend. The current rate is similar to the 2018/19 pre-coronavirus level.

The graph below shows the prevalence rates of MSDs reducing over the last 20 years. The increase in the rates around 2006 occurred just after the HSE’s national ‘Better Backs’ campaign, where efforts were made to increase awareness of MSDs amongst the UK workforces. Instead of reducing the rates, it is arguable that this may have temporarily driven them up as workers who just accepted MSDs as inevitable started to come forward, report them and get them dealt with. This arguably led to the ongoing decrease in the subsequent years, although it does also provide a word of warning and call to have courage to anybody starting up initiatives now – as well as encouragement that it will be worthwhile in the long term.

Causes of MSDs in the workplace

Work-related MSDs commonly develop over time, often because of the physical tasks that individuals carry out as part of their normal work on a daily basis. People sometimes report that an injury was triggered by an innocuous discrete event (such as sneezing or picking up something from the floor), but this episode of pain can be the result of longer-term accumulation of damage to the affected tissues.

MSDs, such as low back pain, can be caused by the manual handling (lifting, lowering, carrying, pushing and pulling) of loads; undertaking repetitive tasks; adopting static, awkward or uncomfortable postures, especially those that involve bending, crouching, stooping, stretching, twisting, reaching or any combination of these. Whole-body vibration is an additional risk factor for some types of MSDs; relevant tasks include driving for extended periods without frequent breaks; driving over rough ground; and operating heavy machinery (such as excavators).

Upper limb disorders are typically caused by prolonged repetitive work, particularly using the same hand or arm to make repetitive actions; uncomfortable or awkward working postures; sustained or excessive force application; a pace of work that does not allow sufficient recovery between movements; a lack of suitable rest breaks; and working with hand-held power tools for long periods of time.

MSD risk assessment: where to begin

So how do we go about reducing and managing the risks of MSDs to reduce the number of symptoms or injuries in the workforce?

Reducing MSD risks starts with identifying high-risk tasks. HSE recommends involving workers in this process, using tools like HSE’s Body Mapping Tool. This tool engages workers by getting them to mark areas they feel discomfort on a body map. With enough workers involved, this approach helps to identify common areas of discomfort and leads to understanding the tasks that are linked to aches or injuries. Undertaking body mapping can also help businesses identify activities that their existing MSD risk management system may have missed. Repeating a body mapping exercise periodically can ensure that existing risk control measures remain effective.

Once the tasks have been identified, it’s important to know what the key risk factors and the levels of risk are. Knowing this will help you prioritise where to start focusing attention on potential risk controls. To achieve this, risk assessment is an essential next step, and the HSE MSD assessment tools should make this straightforward even for the novice assessor. HSE offers three tools for assessing common physical tasks: lifting, carrying, and repetitive hand intensive tasks. These are the Manual Handling Assessment Charts (MAC) Tool, Risk Assessment of Pushing and Pulling (RAPP) tool and Assessment of Repetitive Tasks (ART) tool.

Each of the HSE tools follow a similar process, by listing the key risk factors in a flow chart (see below) and guiding the assessor to score each risk factor against a traffic light system indicating low, medium, high, or occasionally very high risk.

Source: HSE

The eight most common risk factors for manual lifting are listed in this particular flowchart, and against each risk factor the assessment criteria and the ranges for low, medium and high-risk levels are given. The assessor just needs to observe and understand the task and follow the flowchart while referring to the pages of guidance. Here are a few tips to get you started:

• Identify and start with the higher risk tasks. You may already know what the higher risk task are but if not, ask the workers, perhaps during a Body Mapping Tool Workers might not talk in terms of levels of risks (yet) but they will certainly be able to point out the tasks which they feel are the hardest, that they least like to do, or that are most tiring.
• Let the tools be your guide. Make sure to carefully read the guidance and descriptions in the tools for the risk ranges (low, medium and high).
• Assess the worst-case scenario for the activity. The hardest elements of any task in the worst circumstances are what you want to identify (and fix) as it is likely that these contribute most to the overall risk.
• Give yourself time – while many assessments will take just a few minutes to produce, some, especially the more complex tasks, can take a bit longer. So, consider video recording the more complex operations so you can play them back to identify postures, rates of repetition and other details that you might miss when you are first observing. A mobile phone video of the task capturing the worker’s whole body or upper limb postures throughout the activity is typically good enough for most assessments.

As with identifying the high-risk tasks, it is essential to continue to engage with the workers when doing your risk assessments. The people doing the jobs know the most about what makes the tasks difficult or how they feel during ‘worst case’ scenarios. At this stage, worker engagement will help to ensure that workers understand the kinds of risks that they may be exposed to. This is an important part of any training (such as manual handling training) and this engagement will be informative for the workers, for yourself and for your trainers. The traffic light systems in the HSE tools should enable this by simplifying risk level ratings to colour bands.

Louisa Wood is an ergonomics and human factors specialist at the Health and Safety Executive (HSE). Photograph: HSE

The HSE tools are freely available in different formats, including published printed versions, online as PDFs (Portable Document Format) you can download and print yourself, and most recently as interactive online versions, enabling you to use a smartphone to run through your assessment at the worksite and email yourself the outcomes. HSE also runs regular training courses that include how to get the most out of the tools.

Risk controls

Implementing reasonably practicable controls means looking for and adopting ways of making the job less risky, which usually gives the added benefits of making the job easier, less fatiguing and often more efficient. These considerations should be guided by the assessment outcomes and, once again, by worker engagement. The workers will be the users of any lifting aids, trolleys and handling devices you suggest after all, and so asking them what they think will work best (practicability) will vastly increase the likelihood of success and uptake of the new work systems.

Where an assessment shows high risk levels against certain risk factors, this indicates where controls would be most beneficial. For example, if a MAC tool assessment of a lifting task reveals that the highest-level risk factors are load weight and vertical lift region (due to lifting heavy items from floor level, for example) then consideration of risk controls should focus on making the loads lighter and handling them closer to waist level.

Researching risk controls can feel like finding the ideal gift, and involves finding the right balance between cost, effectiveness, acceptability to the workers and fit with the task. It helps very much to know what is available on the market, especially where the increase in the number of electrically powered devices can really be a game changer.

Looking through the various good practice guides produced by HSE and sector-specific health and safety trade associations and forums, perusing the various manual handling solution providers’ web pages, and a day out to visit a materials handling exhibition or show will be highly informative. It may be beneficial to invite prospective suppliers to come and look as they will have a lot of experience to bring. 

If you start to narrow down potential solutions to reduce risk, once again turn to your best source of task knowledge and talk with the workers who are doing the jobs. Show them potential options from catalogues, pictures from the internet or your own rough sketches of solutions and gather opinion on potential benefits and pitfalls. Wherever you can, hire equipment to try out before buying, and gather the opinions of workers before purchasing.

Do not be put off if your solution does not eliminate all risk. As MSDs are generally cumulative in their nature, however, even small changes, such as workplace ergonomic design changes or simple solutions can reduce longer-term risk. Improvements to the task are where we get the lasting benefits for all workers from this entire process.

Assessment of MSD risk is only part of the process – it is implementing effective control measures that makes the difference. Not only does this comply with legal duties, but it will potentially ensure you have a healthier workforce, increased productivity and reduced absenteeism due to MSD pain or discomfort.

Photograph: HSE

HSE is looking to award businesses that have made simple changes to their workplace, task or activities to reduce the MSD risk to their employees.

These changes could include reducing lifting, pushing or pulling activities, reducing awkward postures while using equipment or removing the need for manual handling altogether.  

If you are an employer in the UK and you have made design changes that have reduced musculoskeletal risks in your workplace, then nominate yourselves for the awards.    

Help other businesses to consider how they too can prevent ill health by nominating your design change for the awards. We’ll celebrate your design solution and share your story with industry to showcase innovation and good practice.

Further details on how to enter and case studies of previous winners are available at Risk reduction through design awards 2024/25 – News – HSE.

Louisa Wood is an ergonomics and human factors specialist and Matt Birtles is a human factors team leader and ergonomist at the Health and Safety Executive.

For more information see:

hse.gov.uk/msd

HSE will be demonstrating its MSD digital risk assessment tools on its stand and mini-theatre at the SHW Live (Safety, Health and Wellbeing Live) exhibition and conference in Manchester on 22–23 January. See:

safetyhealthwellbeing.live