Bank administrator Mary’s life was turned upside down when a simple thumb injury became a debilitating whole body pain. Here, her consultant explains what her workplace could have done to prevent her condition.
Mention the words back, neck or hand injury and we’re more likely to think of people whose job it is to lug heavy loads as the most affected, but musculoskeletal disorders can affect anyone.
In HSE’s latest statistics for the year 2016/17, nursing, postal workers and cleaning staff all emerged as jobs with a high risk of developing MSDs.
In fact, recent research has suggested that ergonomic hazards have been reintroduced into some workplaces. In the postal industry, where once workers developed bad backs through lifting heavy sacks of mail, automated mail-processing equipment is now increasing the risk of crippling low back problems as well as musculoskeletal disorders of the upper body, according to the National Institute for Occupational Safety and Health in the USA.
In the UK, the main postal workers union, the Communication Workers Union (CWU) suggested that postal workers representing 0.7 per cent of the UK workforce reported 10 per cent of all cases of work-related MSDs in 2015.
Professor Karen Walker-Bone, professor and honorary consultant in Occupational Rheumatology at Southampton General Hospital, says that many workplaces need to face up to their roles and responsibilities when it comes to preventing MSDs.
Speaking at HSE’s MSD summit this March, she told of the particularly traumatic journey of one patient. She retells the moving story for Safety Management here.
A new feeling of pain
“Mary, a 47-year-old former bank administrator, came to see me as a patient with chronic pain affecting her neck, shoulder and whole arm. The problems started with a pain that began in her thumb joint two years ago, which was associated with her work. It could all have gone so differently.
The story began when she was recruited to do office administration, working with machines which sorted and organised envelopes.
But over the next five-six years, two staff members retired and were not replaced. Her job description was subtly altered and, as well as the machine work, she was required to hand-sort letters into pigeon holes.
Initially, she was dealing with 1,300 letters a day, but this workload gradually and steadily increased and 1,300 went up to 13,000 letters per day, all of which had to be completed by a fixed deadline of 2.30pm. More demands were being made of her, deadlines were very tight and Mary was feeling pressured at work.
One day, Mary woke up with a new feeling of pain in her left thumb. Over two days the pain progressed quickly, such that she had acute locking of the interphalangeal (middle) joint in her left thumb. Her left thumb was stuck and wouldn’t move. She was also getting pain going up the border of her left hand.
The first day after her thumb locking, she went to work and reported the pain and symptoms to the line manager.
She was sent home to rest. She did that for 13 days – coming into work, but being told to go home again – before the occupational health team met her and then she was advised not to keep coming back to work and instead go to her GP.
At this point, her GP prescribed her with non-steroid anti-inflammatories, wrist support and physiotherapy. Despite this, there was a steady progression of symptoms.
Her hand was becoming painful all the time, particularly around the thumb, radial border of the hand and forearm. Gradually over six months it started to radiate towards the elbow and it became more and more difficult for Mary to use her arm.
A long-term condition
Mary came to me as a patient two years after experiencing these symptoms. By that time she had been made redundant from the bank, was taking statutory sick pay and attending the Job Centre.
Her symptoms were now all the way up her body involving her hand, shoulder and neck. Mary described her pain to me as ‘chronic /unrelenting’, she was markedly disabled despite being on strong painkillers and the anti-inflammatory drugs.
Experiencing this debilitating condition for quite a long time now, Mary has adopted a type of behaviour that is very difficult to change in a person’s mind. She was extremely angry and has felt ignored and let down by the bank.
What could her employers have done differently to help Mary?
Changes in her work organisation and minimal control on workloads and lack of support for that work – all were undesirable elements. Risk assessments to prevent exposures that are repetitive and excessive are important, but of course things change – Mary’s risk assessment for when she started would no longer be applicable as her work changed.
Partly, it’s down to line management – a good line manager should have been mindful of changes impacting on workload. Could they have rotated Mary’s tasks with other team members? Or shared her tasks to help her complete the work?
Then there was her occupational advice, ‘go home and don’t come back until you are better’. This made her feel hugely undervalued because she’d actually gone to work trying to remain in the workplace when her symptoms began, which is actually unusual in an employee. But she was given the expectation of ‘don’t come back till you are 100 per cent better’. She should have been encouraged to remain in work but given alternative tasks.
In a person with early musculoskeletal pain we need to work with them, talk to them, take them seriously and listen to their concerns. We need to encourage them to stay in the workplace. We want them to stay active. There’s no good evidence that stopping work will help – rotating and changing the nature of the exposure, yes – but not stopping altogether. It doesn’t work [see sickness absence graph below] – look at what happened to Mary. She wasn’t given the chance to do a different job, her duties weren’t amended and she immediately lost contact with her colleagues.
Dangers of medicalisation
The GP did things by the book in referring Mary on for treatment, but then the problem is the healthcare sector is not set up for rapid treatment. There was a long wait to see the physio and by the time she did, she had got worse, and she had got medicalised.
Simple pain relief is to be encouraged because it enables you to be active, but too much medicalising is also dangerous. Most people with transient MSD symptoms do not need doctors. We need to educate our workforce and the general public that over-treatment can cause harm. People need to remain in control of their own symptoms, if at all possible.
We need to think about the consequences for an individual not engaging in the workplace for any length of time. Mary developed chronic problems as a result of not being in the workplace – she was being pushed towards the slippery slope of disability and long-term sickness.
If an employee leaves work permanently on health grounds, you could say the organisation has completely failed them. You should be asking, what could we do differently to prevent this happening to the next person and what could we have done to enable a successful return? It isn’t always the individual’s fault. I would argue it wasn’t Mary’s fault.”
The name of the patient has been changed in this story.
Information on managing MSD at: www.hse.gov.uk/msd/index.htm
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