Damon Peterson BSc (Hons) Ost Med Osteopaths For Industry Ltd

1. Musculoskeletal Disorders Management and Prevention Damon Peterson BSc (Hons) Ost Med Osteopaths For Industry Ltd

2. “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health” Hippocrates 460 – 377 BC

3. Musculoskeletal Disorders-Management and Prevention • MSD – understanding the issues • Legal framework/Health and Safety Law • Strategies for risk reduction and injury management • Rehabilitation – case study

4. Musculoskeletal disorders • 49% of adults report low back pain annually • 30% of adults become chronic sufferers • 85% of sufferers receive no specific diagnosis • The cost to the NHS is £512million per year • MSD’s cost society £5.7 billion (1995/1996)

5. Musculoskeletal disorders in the workplace Where do the problems exist? • Manual handling • Display screen equipment • Upper limb disorders Are all MSD’s work related?

6. Accidents causing injury

7. Site of handling accidents

8. Type of handling injury

9. Commonest factors behind MSD • Force:forceful movement • Posture:awkward/sustained or static • Repetition:focusing to specific tissue • Duration:body tissue unable to recover • Vibration:whole body or upper limb

10. 7 Cervical Vertebrae 12 Thoracic Vertebrae 5 Lumbar Vertebrae Sacrum and Pelvis The spine

11. The spine Spinal Cord Vertebrae Nerves Emerging from Spinal Canal Discs

12. Mechanical loading and the process of injury • Most musculoskeletal disorders have a multifactorial aetiology and focusing on the culminating event may give a false picture of the causes • The majority of MSD’s are cumulative and occur over time • Specific tissue or groups of different tissue working in combination can become irritated by repeated or prolonged loading

13. Warning signs • Injury and illness records • Jobs which workers are reluctant to do • Jobs where workers complain of discomfort • Workers having made adaptations to workstations, tools or chairs • Workers requesting to be deployed or taken off a job • Splints or bandages being warn, and/or • Use of pain-killers Adapted from: Upper Limb Disorders in Workplace, HSE publication

14. Legal requirements • Health and Safety at Work etc. Act 1974 • Management of Health and Safety at Work Regulations 1999 • Workplace (Health, Safety and Welfare) Regulations 1992 • Health and Safety (Display Screen Equipment) Regulations 1992 • Provision and Use of Work Equipment Regulations 1998 • Personal Protective Equipment at Work Regulations 1992 • Manual Handling Operations Regulations 1992 • Reporting of Injuries, Diseases and Dangerous Occurrences Regulation 1995 (RIDDOR)

15. HSE initiative for 2005 Backs! 2005

16. Seven-stage approach to the holistic management of MSD I Understand the issues and commit to action II Create the right organisational environment III Assess the risk of MSD in your workplace Reduce the risk of MSD in your workplace IV V Educate and inform your workplace Manage any episodes of MSD VI Carry out regular checks on programme effectiveness VII Adapted from: Upper Limb Disorders in Workplace, HSE publication

17. Manual Handling Operations Regulations 1992 (as amended)

18. Duties of Employers A VOID - hazardous manual handling operations where reasonably practicable A SSESS - hazardous manual handling operations which cannot be avoided R EMOVE - identified risk factors R EDUCE - the risk of injury M ONITOR - changes made MHT - manual handling training

19. Full height 10 kg (22 lb) 5 kg (11 lb) 7 kg (15 lb) 3 kg (7 lb) Shoulder height 20 kg (44 lb) 10 kg (22 lb) 13 kg (29 lb) 7 kg (15 lb) Elbow height 15 kg (33 lb) 25 kg (55 lb) 16 kg (35 lb) 10 kg (22 lb) Knuckle height 20 kg (44 lb) 10 kg (22 lb) 13 kg (29 lb) 7 kg (15 lb) Mid lower height 10 kg (22 lb) 5 kg (11 lb) 7 kg (15 lb) 3 kg (7 lb) Risk assessment filter 3 kg (7 lb)

20. Manual Handling Assessment Charts - MAC

21. Training – myths and reality • Habits of a lifetime • Technique vs. principles • ‘Real world’ training • Cultural change

22. Manage any episodes of MSI • Reporting and recording • Referral • Diagnosis and return to work • Surveillance Adapted from: Upper Limb Disorders in Workplace, HSE publication

23. Healthcare provider relationships rhematology pain management osteopathy/ physiotherapy occupational health M S I general practice orthopaedic surgery rehabilitation medicine psychology

24. British Polythene Industries plc (bpi) – Case Study “Savings of £12 for every £1 spent” “This rehabilitation scheme created the solutions we needed in terms of health and safety and occupational health. It was popular with the workforce and their representatives, and it made excellent business sense” Andy Collinson, Group Health & Safety Manager, bpi

25. British Polythene Industries plc (bpi) – Case Study Ensure: • ‘Champion’ of the Service is in place at outset Select the Right Supplier: • fast and convenient access to treatment centre(s) • case by case feedback progress reporting (free from confidentiality constraints) • centralised efficient administration support with referrals managed through to resolution • advice and assistance from supplier in implementing the service especially with educating the workforce

26. Musculoskeletal Injury Management malingering unjustified absence work related non-work related access to treatment

27. British Polythene Industries plc (bpi) – Case Study Practicalities of Rehabilitation • define process of referral and escalation process • ensure proper clear lines of communication and responsibility with service provider • ensure site management is supported by service provider (medical advice on individual cases) • facilitate graduated return to full duties for those employees who require it • readdress prevention if necessary

28. British Polythene Industries plc (bpi) – Case Study Rehabilitation Statistics • over 90% of injuries assessed and treatment started within 72 hours • between 60% - 80% of employees do not take time off, even though they have been referred for treatment Taken from MMS National Ltd yearly collated figures for all industries 2004/2005

29. Total Number of Treatments for Concluded Referrals Taken from MMS National Ltd yearly collated figures for all industries 2004/2005

30. 21% 32% Work-related Non Work-related Unspecified 47% Taken from MMS National Ltd yearly collated figures for all industries 2004/2005 Work-Related Breakdown

31. Fit For Work Analysis 6% 4% Yes No Restricted 90% Taken from MMS National Ltd yearly collated figures for all industries 2004/2005

32. What are the consequences of not managing MSI’s • Loss of earnings • Loss of ability to work • Problems in quality control and productivity • Decrease in efficiency • Sickness absence • Costs of staff replacement and training • The risk of litigation • The risk of bad publicity • A rise in insurance premiums and costs of compensation to injured workers • The human cost of pain Adapted from: Upper Limb Disorders in Workplace, HSE publication Adapted from: Upper Limb Disorders in Workplace, HSE publication

33. Musculoskeletal Disorders-Management and Prevention Rehabilitation and Return to Work • Prevention: • Assess and Reduce the Risk • Feedback: • Monitor and Improve