Health and Safety
Executive / Commission
Musculoskeletal disorders
Musculoskeletal Disorders (MSDs) affect muscles, joints, tendons and other parts of the musculoskeletal system. They are the most common occupational illness in Great Britain. Injury can happen while doing any activity that involves some movement of the body, from heavy lifting to typing. Workers in almost every sort of job are at some risk. However, there are certain tasks and factors that increase the risk such as:
Generally there is an increased risk of injury when a number of these risk factors are combined.
Although very common, MSDs can usually be eliminated or prevented by using a commonsense approach and assessing the risks in the workplace.
Risk factors causing MSDs can be found in virtually every workplace from commerce to agriculture, health services, construction and haulage.
MSD is a broad umbrella label for many types of aches and pains and treatment will be determined by the exact medical diagnosis. Most cases can be satisfactorily dealt with by your GP. Chartered physiotherapists can be most helpful in the assessment and treatment of these disorders. Occasionally, it may be necessary for your GP to refer you to see a specialist such as a consultant in orthopaedics or rheumatology.
There are a variety of precautionary measures an employer can take to reduce the risk of MSDs. The appropriate control measures can depend upon the sort of work your employees carry out and what it is ‘reasonably practical’ for your company to do. The first step is to assess all the MSD risks the tasks generate. Next, try to eliminate as many of them as possible, by redesigning the tasks or providing mechanical aids. When considering precautionary measures, ensure that you consult you workforce as they often have first hand knowledge of the risks associated with a specific task or tasks. Once the precautionary measures have been introduced you should monitor their effectiveness and ensure that any new risks have not been introduced.
HSE has produced a number of publications to help you with your choice of precautionary measure some of which may be specific to your industry.
There are a very wide range of common work operations that can cause MSDs. However, employees performing tasks that include any of the following risk factors are at most risk of developing some type of MSD.
Remember: generally there is an increased risk of injury when a number of these risk factors are acting in combination.
The general advice to those suffering with back pain is to stay active and try simple pain relief. However, if the pain persists or causes extreme discomfort you should contact your GP for medical advice. In many situations there are a variety of simple and cost effective measures that can be taken to reduce the risk of Musculoskeletal Disorders (MSDs) at work for example taking regular breaks and job rotation but this will depend on your particular situation. It is important to bear in mind with any back pain that the current advice is
We cannot comment on specific cases as this depends on the individual's case and particular set of circumstances. It is important to realise that not all MSDs, including back pain, can be prevented so early reporting of symptoms, proper treatment and suitable rehabilitation are essential. Statistics show that the longer people are off work the more likely they are to never return to the workforce. We are working hard to educate and support employers in how to prevent both back pain and MSDs in the workplace and if they do occur, how they can ensure people return to work and do not suffer a recurrence.
If you belong to a trades union, you should speak to a safety representative who will relay your issues to your employer. If you are still worried, you can obtain advice on your specific situation by contacting HSE infoline which is your first point of contact with HSE. Infoline is a ‘one-stop’ shop, providing you with rapid access to HSE’s wealth of health and safety information, and access to expert advice and guidance. Any enquiry received by HSE Infoline is treated in confidence.
The HSE is not in a position to offer advice on the treatment of back pain. It is not its public role and any advice given might cut across the responsibilities of others. The best medical advice is to stay active, take painkillers if necessary and consult your GP if you experience severe pain, or the pain persists or suddenly gets worse. It may be necessary for your GP to refer you to see a specialist consultant or a medical practitioner to check that the condition is not serious. Because back pain has many causes, a precise diagnosis is not always possible, and this makes management of the pain all the more important. For further information visit the back pain section of this website.
NHS Direct gives useful advice on best treatments for back pain. Other organisations such as Back Care and the Chartered Society of Physiotherapy may also be able to help.
There is no single correct way to lift. The content of any training in good handling technique should be tailored to the particular situation or individual circumstances under which the manual handling takes place. However HSE has published guidance which contains a list which illustrates some important points which are relevant to a two handed symmetrical list, i.e. a lift using both hands that takes place in front of the body. This list is contained in a free leaflet ' Getting to grips with Manual Handling: A short guide for employers' which is available on the HSE website http://www.hse.gov.uk/pubns/indg143.pdf. Full details of the range of factors that need to be taken in to account when assessing the risks from manual handling and the steps that need to be taken to control those risks are set out in 'Manual Handling - Manual Handling Operations at Work Regulations 1992' - Guidance on the Regulations (2004 revision) which is available from HSE Books price £8.95.
You may also find it helpful to visit our Risk Assessment and Lifting Operations sections of this website.
The Manual Handling Operations Regulations 1992 (as amended) do not prohibit all manual handling and therefore do not require "no lifting" policies. However, this does not mean that employers are able to 'pass on' the risk to employees. There needs to be a balance in approach to ensure that where people are involved:
Further information is contained in HSG 2250 Handling Home Care ISBN 0 7176 22282 which is available from HSE Books.
Further advice can be obtained from either HSE's Central and Local Government Education and Research Unit, Tel: 01245 706246 if you query relates to care homes: or Health Services Unit Tel: 01582 444312 if it relates to a hospital.
The law does not include maximum weight limits.The main legal requirements require avoidance or control of risk. HSE does not recommend weight limits. The Manual Handling Operations Regulations (MHOR) guidance gives basic guideline figures for lifting and lowering which indicate when a more detailed risk assessment should be carried out.
If it does have to be moved then can it be moved mechanically, for example by using a handling aid such as a pallet truck, electric or hand powered hoist, or a conveyor? Advice on the many different types of lifting and handling aids is contained in INDG398 Are you making the best use of lifting and handling aids [417kb]
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If manual lifting is the only option there are a number of things that can be done to reduce the risk including:
1. Your employer has a legal obligation under the 'Manual Handling Operations Regulations 1992’ (the 2004 revision of the guidance on these regulations is available from HSE Books price £8.95) . Employers must make a sufficient and suitable risk assessment to identify the possibility of risk to employees from the manual handling of loads. This is a legal requirement and the regulations should be complied with.
The Regulations set out a hierarchy of measures that should be followed to reduce the risks from manual handling. These are set out in regulation 4(1) and are as follows:
For specific advice on your situation, you should contact HSE Infoline. Infoline is your first point of contact with HSE. It’s a ‘one-stop’ shop, providing you with rapid access to HSE’s wealth of health and safety information, and access to expert advice and guidance. Any enquiry received by HSE Infoline is treated in confidence.
A risk assessment is a careful examination of what could cause harm to people in the
workplace. Doing a risk assessment will help employers identify the significant risks in their workplace, and avoid wasted effort by effectively targeting these. A good risk assessment will help avoid accidents and ill health, which can not only ruin lives, but can also increase costs to business through lost output, compensation claims and higher insurance premiums. For more about risk assessment see our Risk Management website.
Often when you implement control measures to reduce the risk of MSDs it can take some time for the changes to take effect. When an employee has reported a work related MSD it can take time for the symptoms to subside and the employee might not immediately feel the benefit of the measures you have introduced. Monitoring the effects of control measures is most important.
It is recommended that you work with your employee to try and identify those aspects of the job which are associated with their complaints. Actively managing a situation by seeking out information from the employee on symptoms over a period of time may help to identify whether the situation is resolving itself or still deteriorating. Questionnaires using body maps can be used to track how the region of discomfort varies and the intensity of pain changes.
In may be appropriate to reduce the exposure of individuals to a specific task and its risk factors by increasing the range of tasks which are undertaken. Again monitoring of symptoms over time will help determine if these measures are successful.
Once you have done all that is reasonably practical in the way of physical measures, it might be necessary to address organisational and psychological questions. If a person is being bullied, has minimal control over the pace of their work or has low social support at work, the psychological problems may be expressed as physical ones.
Non-work activities, such as sports, hobbies or domestic activities, can contain the similar risks to those found in the workplace and unless these are controlled as well the problem could persist.
More information about the MAC is available on the MAC website. The MAC charts help to identify high-risk manual handling activities. They were made available to HSE and local authority inspectors in November 2002, and the general public in August 2003. They are suitable for use by employers, employees and their representatives.
Reporting accidents and ill health is a legal requirement. The HSEs RIDDOR website provides more information. Duties under the Regulations are contained in a basic explanatory leaflet RIDDOR Ring and Report (MISC769) [117kb] .
Workers should be encouraged to report injuries. An accurate record of accidents and ill health enables an analysis to be undertaken and preventive measures put in place.
For specific advice on your situation, you should contact Infoline. Infoline is your first point of contact with HSE. Infoline is a ‘one-stop’ shop, providing you with rapid access to HSE’s wealth of health and safety information, and access to expert advice and guidance. Any enquiry received by HSE Infoline is treated in confidence.
If you are a member of a Union it may also help to speak to your Union Safety Rep.
Although training is an important component in proper risk management, it should not be assumed that the provision of training alone will ensure safe manual handling. This should be supplemented with appropriate monitoring and review of procedures to measure the effectiveness of the training. The need to report problems, whether they are unsafe working conditions or accidents, will need to be reinforced by good supervision outside the formal part of any training . An employer has a legal obligation under the Management of Health and Safety at Work Regulations 1992, to ensure that employees are provided with health and safety information and training. Further details can be found in the current Manual Handling guidance L23 ISBN 0 7176 2823 – available from HSE Books.
HSE cannot advocate any particular company in relation to H&S training. There is no accreditation scheme.
Recent research has identified 6 key areas which were needed for successful interventions, the main principals for dealing with MSDs at work are:
The guidance and advice we offer is deliberately not prescriptive, it offers employers and workers the opportunity to adopt an approach that suits the risks facing them in their workplace.
Employers do have duties set out in the Manual Handling Operations Regulations and the Display Screen Equipment Regulations. Employers also have duties under the Health and Safety at Work Act to protect the health of their workers.
There are a variety of alternative /Complementary therapies and while HSE recognises their usefulness to some people, we cannot endorse or recommend specific therapies or treatments. Where there is a sound scientific basis of effectiveness, HSE has included general reference to treatment in its publications.
Yes, if you are a display screen “user” as defined in the Health and Safety (Display Screen Equipment) Regulations. You will be a “user” if you habitually use a VDU as a significant part of your normal work. If this applies you can ask your employer to provide and pay for an eye and eyesight test. There is also an entitlement to further tests at regular intervals; the optometrist doing the first test can recommend when the next should be.
If you are an employee who uses a visual display unit (VDU) as a significant part of your normal work, your employer has to provide an eye test if you request one. This is to help prevent visual discomfort. Employers are only required to pay for spectacles if the test shows that special ones are needed for your VDU work and normal ones cannot be used. Only a small minority of people need special spectacles, which typically have prescription lenses for the intermediate distance at which the VDU screen is viewed. More information on VDU work, eyesight and avoiding other health problems is in the HSE booklet Working with VDUs [PDF].
The Health and Safety (Display Screen Equipment) Regulations require employers to plan for breaks or changes of activity for VDU users, but do not specify their timing or length.
The need for breaks depends upon the nature and intensity of the work. In most tasks, natural breaks or pauses occur as a consequence of the inherent organisation of the work. Whenever possible, jobs at display screens should be designed to consist of a mix of screen-based and non screen-based work to prevent fatigue and to vary visual and mental demands. Where the job unavoidably contains spells of intensive display screen work (whether using the keyboard or input device, reading the screen, or a mixture of the two), these should be broken up by periods of non-intensive, non-display screen work. Where work cannot be so organised, e.g. in jobs requiring only data or text entry requiring sustained attention and concentration, deliberate breaks or pauses must be introduced.
Where the display screen work involves intensive use of the keyboard, any activity that would demand broadly similar use of the arms or hands should be avoided during breaks. Similarly, if the display screen work is visually demanding any activities during breaks should be of a different visual character. Breaks must also allow users to vary their posture. Exercise routines which include blinking, stretching and focusing eyes on distant objects can be helpful and could be covered in training programmes.
It is not appropriate to lay down requirements for breaks which apply to all types of work; it is the nature and mix of demands made by the job which determine the length of break necessary to prevent fatigue. But some general guidance can be given:
DSE risk assessment should be carried out whenever circumstances change significantly. This includes a new person using the computer, a substantial change to the type of work being carried out and a major change to the equipment, software, furniture or work environment being used .
Employers have duties under the Health and Safety (Display Screen Equipment) Regulations to assess and reduce risks, ensure workstations meet minimum requirements, plan work so there are breaks or changes of activity, provide eye tests on request, and provide health and safety training and information.
You can help avoid aches and pains by various simple steps like adjusting your chair and VDU equipment to find a comfortable position, using good keyboard and mouse technique, and varying your activities or taking breaks to avoid sitting in the same position for long periods. There is more detailed advice in Working with VDUs.
There is no legal requirement for any particular desk size but to reduce risks, work surfaces need to be large enough to accommodate all the things needed for the work and allow the user to find a comfortable working position.