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November 27, 2008

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Back pain – health and safety

Musculoskeletal disorders are by far the most commonly reported health and safety problems in British workplaces, and, within the MSD ‘family’, back complaints are the most prevalent.1 But, argues Percy Smith, the majority are not actually caused by work and should be reported and recorded as work-related injuries, rather than lost-time accidents.

For some time now, I have been concerned about the reporting and recording of injuries suffered by people undertaking manual-handling activities. Many of these recorded and reported incidents do not have what could be described as an ‘accident event’ attached to the incident. Nor, on investigation, do they all have a discernible causal sequence associated with them.

As the Faculty of Occupational Health (FOH) concedes: “Not all back pain is caused by work – but factors at work which may trigger it, or make it worse, are some of the easiest to tackle effectively.”2 The Manual Handling Operations Regulations also offer a hierarchy of control measures.3

However, despite our best efforts and doing everything possible to prevent back injury, there is still a number of such events that is difficult to explain. For example, in the electricity-generating industry, there have been several injuries where people have injured their backs while undertaking tasks. In many of these cases it has been difficult, in the subsequent investigation, to find fault with the system of work being employed.

(It is assumed, for the purposes of this short article, that all proper risk assessment, as required by the Manual Handling Regulations, has been properly completed, and that an ergonomic fit has been achieved between the worker involved and the task. It is also assumed that, after investigation, no adjustments to the task are viewed as necessary or desirable, and that the system of work remains exactly as it was before the incident.)

It is my contention that many of these incidents, which are reported to the regulator as lost-time accidents (LTAs), are, in fact, injuries triggered by work activity that have little to do with the task being performed at the time they occur. They may be, as the FOH says, ‘triggers’ but they are not ‘causes’. The causes of many such injuries are, as the FOH also infers, often not occupation-related.

I myself have suffered lower-back pain. The trigger for mine was putting on my trousers in the morning while getting dressed for work, and I was off work for six weeks! In my case, by circumstance, the back pain was triggered at home but it could just as easily have happened at work, as I was donning my overalls. Why should it become an LTA if it occurred after I had got to work that day?

A simple rule of thumb

Many, if not all, lower-back injuries are unique to the individual who suffers them so, in any incident involving back pain or muscular strain, there is a simple rule of thumb that the health and safety practitioner can follow to assess the situation and determine if the incident is unique to an individual: Would another person, similar in every way to the injured person, doing the same job, in the same way, using the same equipment and the same procedures, suffer the same injury?

If the answer is ‘probably’, then the event may well be an accident; if the answer is ‘unlikely’, then it may be better to categorise the incident as a work-related injury, whether or not time is actually lost.

The following real incidents examine this issue in context.

Example 1:

As part of his normal duties a person is required to open a roller-shutter door. The operating handle for the door is close to the ground at the latching point. The person has done this task regularly for a number of years, as have several of his colleagues.

On this occasion, as the person bends to reach for the handle, without ever touching it, his back ‘goes’. He is off work for a week.

As a result of this incident, following an investigation, there is no change to working practices, no change to work equipment and, in fact, no change to any aspect of the task at all.

So how can this be classified as a lost-time accident? What is the accident event? If a causal event cannot be identified, only a triggering one, then it could be concluded that the injury is as a result of the physiology of the individual involved, unique to that person and therefore not an LTA.

There are myriad possible reasons for an individual suffering such an injury, including low fitness levels, smoking, obesity, cold weather, sports injury, etc. Many of these are lifestyle choices and are not occupational factors.

If all system of work-related contributory causes can be eliminated, then it would seem unreasonable to report this incident as an LTA; it might be more appropriately termed a ‘work-related injury’, with or without lost time. This, to me, would seem a more accurate categorisation.

Example 2

A person is a highly-skilled CNC lathe operator. As part of his routine tasks he is required to load blank steel billets on to the machine. These weigh approximately 3kg each. When placing one of these on the machine chuck, his back ‘goes’ and he is subsequently off work for two days. The person weighs 19 stone, smokes 20 cigarettes a day, drinks between 10 and 20 units of alcohol a week, and has a sedentary lifestyle.

The incident is reported as a lost-time accident. However, after investigation, no changes are made to any aspect of the system of work, as they are considered completely adequate for the task in hand, and as ergonomically attuned as is reasonably practicable.

Again, it is my contention that this injury is unique to this individual. I stress that it is not my intention to criticise people for their lifestyle choices. As long as it is legal, and does not have a direct impact on workplace safety, people may do as they wish outside the work environment. Nevertheless, it seems unreasonable to log such incidents against company statistics as accidents when, in fact, the company cannot be shown to be at fault in any way.

The fairly standard remedial action after events like these two examples is to send the individual involved for additional training in manual handling on their return to work. This, however, does nothing to prevent the same thing from happening again, and merely offers the fig leaf that ‘something has been done’.

Various studies, including one published in the British Medical Journal earlier this year, have indicated that training in manual handling, and even the issue and use of lifting equipment, do not lead to a reduction in this type of injury.4 The study concluded that: “There is no evidence to support the use of advice or training in working techniques, with or without lifting equipment, for preventing back pain or consequent disability. The findings challenge current widespread practice of advising workers on correct lifting technique.”

The pressure to be seen to be doing something is significant but really, all it does is create a false sense of security. Although more difficult, it would be far better to admit that most, if not all, of these injuries (providing, of course, they are not connected to the system of work being employed) would be more accurately classified as work-related injuries, rather than accidents.

Reporting and recording

Other than its statutory reporting requirements, how incidents are recorded within an organisation is its own business. But if such back-injury incidents were to be re-categorised as suggested, what effect would this have on regulatory reporting requirements?

Firstly, the method of reporting these incidents would change, in that, if it were proved by investigation that the back-injury incident was indeed primarily due to the physiological make-up of the individual involved, then these incidents would become work-related injuries, and would be recorded under occupational health statistics. As there would, in effect, be no accident event, they would not have to be reported under RIDDOR.

This, in turn, would have the following effects:

* The statistics on accidents assembled using RIDDOR reports would be more accurate;

* The statistics on work-related injuries would be more accurate and therefore more helpful in formulating more effective well-being/preventative measures;

* As a result of these more accurate statistics, there would be improved focus on true accidents, where there is a possibility of preventing recurrence; and consequently

* Resources would be more effectively deployed.


I remain convinced that many back injuries are mis-reported as lost-time accidents when they would be more accurately categorised as work-related injuries. I believe that considering such incidents in the proper context would lead to a significant improvement in statistics accuracy and, consequently, resource allocation. Back injuries are, in the main, unique to the individual and, providing all proper pre-work assessment has taken place and the system of work is deemed satisfactory, they are not caused as a result of an accident but rather are triggered by work activity. Accurate data recording is, I believe, essential to avoid confusion between the two.


1 HSE (2008): Health and Safety Statistics 2007/08, HSE Books –

2 FOH (2000): Back Pain at Work: A Guide for People at Work and Their Employers

3 Manual Handling Operations Regulations 1992 –


4 British Medical Journal (Jan 2008): ‘Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review’

About the author

Percy Smith is the health and safety co-ordinator for the Generation division of RWE npower. He joined the power generation industry some eight years ago, with a background in aviation engineering and safety. Percy holds an MSc in occupational health and safety management from Portsmouth University.

Approaches to managing the risks associated Musculoskeletal disorders

In this episode of the Safety & Health Podcast, we hear from Matt Birtles, Principal Ergonomics Consultant at HSE’s Science and Research Centre, about the different approaches to managing the risks associated with Musculoskeletal disorders.

Matt, an ergonomics and human factors expert, shares his thoughts on why MSDs are important, the various prevalent rates across the UK, what you can do within your own organisation and the Risk Management process surrounding MSD’s.

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Dr. Peter Roenfeldt
Dr. Peter Roenfeldt
5 months ago

In light of Percy Smith’s astute observation on the differentiation between work-related injuries and lost-time accidents, especially concerning back pain, it’s pivotal to understand the protocols and educational guidance available for rehabilitation and prevention. When considering the multifaceted reasons behind such injuries, as Smith mentions – from lifestyle choices to physiological uniqueness – the approach to treatment and education becomes essential. For a deeper dive into this, I recommend “Comparing Chiropractic and Physiotherapy Protocols with a Focus on Patient Education for Empowered Rehabilitation“. It elucidates the contrasts and commonalities between two prevalent rehabilitation approaches, emphasizing the empowerment of the patient… Read more »