Work-related MSDs

photo of pair of human hands

Knowledge update: new references added to reading list

On this page you'll find a host of information on work-related musculoskeletal disorders in physiotherapists, including news on the CSP's own research study. Use the links below to find out more:

 

Work-related musculoskeletal disorders in physiotherapists: the CSP's MSD report

Musculoskeletal disorders (MSDs) are one of the most common causes of severe long-term pain and physical disability and are considered one of the biggest health problems facing workers today. But how are physiotherapists and physiotherapy assistants affected by work-related MSDs?

The CSP has researched this subject extensively and has produced a report - Work-related musculoskeletal disorders affecting members of the CSP. Based on a survey of 3,661 physiotherapists, physiotherapy assistants and physiotherapy students on clinical placement, the report discusses the results of what is the largest health and safety study the CSP has ever undertaken.

Included in the report:

  • Injury statistics of CSP members (over 40 tables)
  • What type of injury matters most to physiotherapists
  • Career stage where most injuries occur
  • Injuries by clinical setting
  • Use of mobilisation techniques and thumb injury
  • Job risk factors CSP members implicate in their injury
  • Physiotherapists' responses to injury
  • Preventive strategies adopted to avoid reinjury
  • Case studies

 

The report compares the prevalence of work-related MSDs in CSP members to that found in physical therapists in Australia, Canada, Kuwait, Slovenia, Turkey and the USA.

Key Messages

Amongst the report's key messages are:

  • Younger physiotherapists and newly qualified graduates are most at risk and most in need of intervention services aimed at reducing injury rates
  • Under-reporting of injury is rife: reporting of injury must be encouraged if MSDs are not to remain an 'invisible' problem in the workplace

 

The report considers the challenges faced by the profession if the relatively high levels of work-related musculoskeletal injury are to be tackled effectively. These include:

  • Information rich, practice poor? Implications for clinical educators and training
  • Inducted into illness? Why we need a fresh look at induction programmes, rotations, mentoring and more supervision in the early years
  • The culture of physiotherapy: why the profession needs to work towards a new paradigm of physiotherapy practice
  • Individual action: six steps to better workplace health
  • Taken to task: addressing the workplace environment

 

The information gathered from the study and included in the report provides the CSP, for the first time, with baseline data on the prevalence of work-related musculoskeletal disorders amongst members and adds to the growing body of survey evidence on MSDs and physiotherapists. The findings and conclusions contained in the report are relevant to all strands of the physiotherapy profession. Physiotherapy departments and physiotherapy schools are encouraged to invest in a copy of the report.

Obtaining a copy of the report

'Work-related musculoskeletal disorders affecting members of the Chartered Society of Physiotherapy' (ISBN: 1904400140) costs £10 (members); £12.50 (non-members). Orders can be placed with the Enquiry Handling Unit on 020 7306 6666 or email enquiries@csp.org.uk. Cheques (made payable to the Chartered Society of Physiotherapy) should be sent to the EHU at 14 Bedford Row, London WC1R 4ED (credit card payments also accepted). The report can also be ordered online via our webshop.

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Reaction to the MSD report

"May I congratulate the CSP on such a comprehensive and informative survey of MSDs among its membership."

Lord Hunt, Parliamentary Under Secretary of State for Work and Pensions. (Download a copy of Lord Hunt's full response).
"This is a massive piece of work and so much fascinating data - well done to put it all together."

Jacqui Smith, Editor - Occupational Health Physiotherapy (OHP), former Chair of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE)
"Our group of Scottish safety reps all agree that the report is very worthwhile and gives us food for thought. Within our own trust we are currently looking at the content of our manual handling training for physiotherapists. This is as a direct result of the MSD Report."

Elaine McFadden, Co-Chair, CSP’s National Group of Regional Safety Representatives - CSP safety rep at Ayrshire Central Hospital
"A very interesting report highlighting the dangers younger or newly qualified physiotherapists are exposed to in their new professions. It has provided the evidence to make us all sit up and take notice of how important our body position and action is in our practice sessions (plinth height, joint angles, forces and body movements). A thought provoking report that every student should read."

Karl Rudkin, CSP Students Executive Committee Chair

Background to the CSP's study

In June 2003 the CSP's Employment Relations & Union Services (ERUS) function surveyed a 10% sample of the CSP's membership on their experiences of work-related musculoskeletal disorders (MSDs). The sample included over 3,600 physiotherapists, physiotherapy assistants and physiotherapy students far enough into their degree to have embarked on clinical placement. The survey also investigated general work-related ill-health.

This large scale study was conducted partly in response to a motion at the CSP's 1999 Annual Representative Conference (ARC), which read:
"Conference calls upon the CSP to investigate and raise awareness of the extent of strain injuries to the joints in the hand as experienced by physiotherapists. These injuries may be directly linked to the use of physiotherapy techniques and impact on physiotherapists working lives as well as covering long term disability."

National Group of Regional Safety Representatives

Although the ARC motion referred only to hands, the CSP's study encompasses a wider range of musculoskeletal problems. Musculoskeletal disorders affecting physiotherapists are of international academic interest. One Australian study (Cromie et al, 2000), for example, found that lifetime prevalence of work-related MSDs amongst physiotherapists may reach as high as 91%, with younger physiotherapists (ie those below the age of 30) more at risk. The CSP's study was interested to see if Cromie's findings were replicated in UK physiotherapists. If so, there could potentially be serious implications for the profession and for the government's target of increasing the numbers of physiotherapists in the NHS by 59% to 24,800 by 2009 (the government's recruitment strategy may be undermined if there is a retention problem because of work-related ill-health).

Some 2,688 questionnaires were returned out of 3,661 mailed out in our study, achieving a response rate of 73.4%. We would like to thank all the CSP members who returned their survey questionnaires. Your assistance is greatly appreciated.

The results of the study - the MSD Project - were presented and discussed at the following during 2004:
  • a fringe meeting at the CSP's Annual Representatives Conference (ARC) in Newcastle on Wednesday 12 May
  • the conference of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE) in Edinburgh on Thursday 13 May
  • the Fifth International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders (PREMUS) in Zurich, Switzerland, 11-15 July
    More information on PREMUS
  • the National Back Exchange Conference, Hinckley, Leicestershire, 21 September
  • CSP Congress, Birmingham, 8-10 October

During 2005 presentations on the MSD results have been made to CSP safety reps around the UK. If you are interested in using the slides from the presentation in your own workplace, to raise awareness of the issue amongst colleagues for example, you can download a copy of the PowerPoint presentation at the foot of this page.

The MSD results have also been discussed in more detail during meetings with NHS Employers and the Health and Safety Commission.

Call for Case Studies: your examples of good practice wanted

Our meeting with the Health and Safety Commission, held on 14 November 2005 and attended by HSC Chair Bill Callaghan and the head of the MSD Priority Programme Unit, John Price, was especially useful. The HSC are keen to gather more specific information on good practice preventive strategies physiotherapists adopt to avoid injury in the workplace. While we collected some data on these during our survey, these examples were necessarily confidential and anonymous. Consequently, we are now putting out a ‘Help Wanted’ for real-life case studies where successful interventions have been put in place to prevent, or reduce the risk of, work-related musculoskeletal injury.

We are interested in gathering examples of good practice on several levels. For example:

  • what do you do in your day-to-day job that successfully minimises the risk of injury?
  • as a physiotherapy manager, have you implemented a particular strategy for building in flexibility in the electronic bookings system so staff are not faced with treating a stream of ‘heavy-duty’ patients, or have you introduced an effective risk assessment policy that pays particular attention to the risk of work-related MSDs?
  • as a CSP safety representative, what measures have you successfully introduced in partnership with your management to tackle the problem of work-related MSDs?

 

We are interested in all elements of good practice, great or small, that we can disseminate more widely, via the HSC and here on our own website. Please consider if you are in a position to share examples of successful practice with the HSC and contact Warren Glover, Research & Policy Officer, CSP Employment Relations & Union Services, on 020 7306 6675 or email gloverw@csp.org.uk if you feel you can help.

This is a great opportunity to showcase some examples of effective practice employed by physiotherapists. The sharing of examples of successful approaches to tackling work-related MSDs is an important first step in raising awareness amongst colleagues and encouraging best practice behaviour.

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MSD article in Physiotherapy, Volume 91, Number 3 (2005) 138-147 and further suggested reading

An article on the CSP's MSD results was published in the September 2005 issue of Physiotherapy, Volume 91, Number 3, 138-147. The CSP's study is the largest of its kind anywhere in the world and adds to the growing body of research into work-related musculoskeletal disorders affecting physiotherapists and physiotherapy assistants. If you are interested in other research, the following are suggested reading:

  • Beynon C and Reilly T (2002). 'Epidemiology of musculoskeletal disorders in a sample of British nurses and physiotherapists', in: Reilly T (ed) (2002) Musculoskeletal Disorders in Health-related Occupations, IOS Press, Amsterdam.
  • Blizzard P (1991). 'Save Our Thumbs', Physiotherapy, 77, 8, 573-574
  • Bork B E, Cook T M, Rosecrance J C, Engelhardt K A, Thomason M-E J, Wauford I J and Worley R K (1996). 'Work-related Musculoskeletal Disorders Among Physical Therapists', Physical Therapy, 76, 8, 827-835
  • Caragianis S (2002). 'The prevalence of occupational injuries among hand therapists in Australia and New Zealand', Journal of Hand Therapy, 15, 234-241
  • Cromie, J E, Robertson, V J and Best, M O (2000). 'Work-Related Musculoskeletal Disorders in Physical Therapists: Prevalence, Severity, Risks and Responses', Physical Therapy, 80, 4, 336-351
  • Cromie, J E, Robertson, V J and Best, M O (2001). 'Occupational health and safety in physiotherapy: Guidelines for practice', Australian Journal of Physiotherapy, 47, 43-51
  • Cromie, J E, Robertson, V J and Best, M O (2002). 'Work-Related Musculoskeletal Disorders and the Culture of Physical Therapy', Physical Therapy, 82, 5, 459-472
  • Fosnaught M (1999). 'Injuries on the job: PTs at risk', PT Magazine, 4, 35-40
  • Graham L and Gray H (2005). 'Recently qualified physiotherapists' perceptions of work-related musculoskeletal disorders', International Journal of Therapy and Rehabilitation, Vol 12, No 7, July 2005
  • Hignett S (1995). 'Fitting the Work to the Physiotherapist', Physiotherapy, 81, 9, 549-552
  • Holder N L, Clark H A, DiBlasio J M, Hughes C L, Scherpf J W, Harding L and Shepard K F (1999). 'Cause, Prevalence, and Response to Occupational Musculoskeletal Injuries Reported by Physical Therapists and Physical Therapy Assistants', Physical Therapy, 79, 7, 642-652
  • Jordan G G (1990). 'Mobiliser stress' (letter), Physiotherapy, 76, 12, 758
  • Leighton D J and Beynon C (2002). 'The Identification and Measurement of Risk', in: Reilly T (ed) (2002) Musculoskeletal Disorders in Health-related Occupations, IOS Press, Amsterdam.
  • Maher G C, Latimer J and Starkey I (2002). 'An evaluation of Superthumb and the Kneeshaw device as manual therapy tools', Australian Journal of Physiotherapy, 48, 25-30 and 154-156.
  • McMahon M, Stiller K and Trott P (2006). 'The prevalence of thumb problems in Australian physiotherapists is high: an observational study', Australian Journal of Physiotherapy 2006, Vol 52, 287-292
  • Mierzejewski M and Kumar S (1997). 'Prevalence of low back pain among physical therapists in Edmonton, Canada' Disability and Rehabilitation, 1997; Vol 19, No 8, 309-317
  • Molumphy M, Unger B, Jensen G M and Lopopolo R B (1985). 'Incidence of Work-Related Low Back Pain in Physical Therapists', Physical Therapy, 65, 4, 482-486
  • Nyland L J and Grimmer K A (2003) 'Is undergraduate physotherapy study a risk factor for low back pain? A prevalence study of LBP in physiotherapy students', BMC Musculoskeltal Disorders, 4: 22 www.biomedcentral.com/1471-2474/4/22
  • Reglar P and James G (1999). 'Thumb pain in physiotherapists: a preliminary study', British Journal of Therapy and Rehabilitation', 6: 505-509
  • Reilly T (ed) 2002). Musculoskeletal Disorders in Health-related Occupations, IOS Press, Amsterdam.
  • Rugelj D (2003) 'Low back pain and other work-related musculoskeletal problems among physiotherapists', Applied Ergonomics, 34, 6, 635-639
  • Salik Y and Ozcan A (2004) 'Work-related musculoskeletal disorders: A survey of physical therapists in Izmir - Turkey'. BMC Musculoskeletal Disorders, 5:27. www.biomedcentral.com/1471-2474/5/27
  • Scholey M and Hair M (1989) 'Back pain in physiotherapists involved in back care education' Ergonomics, 1989, Vol 32, No 2, 179-19
  • Scholey M and Hair M (1989) 'The problem of back pain in physiotherapists' Physiotherapy Practice (1989), 5, 183-192
  • Shehab D, Al-Jarallah K, Moussa M A A and Adham N (2003) 'Prevalence of Low Back Pain among Physical Therapists in Kuwait', Medical Principles and Practice, 12:224-230
  • Snodgrass S J, Rivett D A, Chiarelli P, Bates A M and Rowe L J (2003) 'Factors related to thumb pain in physiotherapists', Australian Journal of Physiotherapy, Vol 49, 243-250
  • Wajon A, Ada L (2003). 'Prevalence of thumb pain in physical therapists practicing spinal manipulative therapy', Journal of Hand Therapy 16, 237-244
  • West, D J and Gardner, D (2001). 'Occupational injuries of physiotherapists in North and Central Queensland', Australian Journal of Physiotherapy, 47, 179-186

 

MSD questions in Parliament

Several questions on work-related musculoskeletal disorders in physiotherapists were posed in the House of Lords in June 2005 by CSP President Professor the Baroness Finlay of Llandaff:
Baroness Finlay of Llandaff asked Her Majesty's Government:

How many physiotherapists were absent from work for three months or longer because of work-related musculo-skeletal disorder; what steps are being taken to reduce long-term sick leave because of work-related musculo-skeletal injury; and how many physiotherapists are given the option of alternative duty programmes; and [HL572]

What they are doing to ensure that physiotherapy departments put in place effective strategies to prevent work-related injury, particularly musculo-skeletal injury. [HL573]

Lord Warner:

The Department of Health's survey of sickness rate in the National Health Service does not collect information broken down by staff group or reason for absence.

The national "Back in Work" campaign launched in 2002 is aimed at reducing back and musculo-skeletal injuries to staff in the National Health Service. The campaign is targeted at all staff, from porters to physiotherapists. Guidance on safer lifting and handling techniques, and examples of good practice, including offering alternative work as part of rehabilitation of staff is available at www.nhs.uk/backinwork. "Back in Work" is supported by a number of partner organisations, including the Chartered Society of Physiotherapy.

While physiotherapy departments are primarily concerned with providing a service to patients, physiotherapists may be providing a service to staff as part of local strategies on preventive measures to reduce sickness rates in their organisation.

Baroness Finlay of Llandaff asked Her Majesty's Government:

What percentage of National Health Service trusts and primary care trusts in England offer on-site occupational health services to staff.

Lord Warner:

All National Health Service trusts must provide staff with access to occupational health services. This is not required to be on-site and information on the percentage of on-site provision is not centrally collected.

Department of Health data confirmed that in 2003 all NHS trusts were meeting this requirement and there are currently 220 occupational health units in the NHS in England.

National 'Back in Work' campaign

The CSP is supporting the national 'Back in Work' campaign: see their website for more information.

Downloadable Documents

See the 'related documents' section immediately below for all download links. These include:

  • Health & Safety Briefing: Work-related Musculoskeletal Disorders - Headline results of the CSP's research study (August 2005)
  • An A4 summary of the results of the study (conference handout as presented at PREMUS)
  • The Powerpoint presentation used at ARC 2004

 

In addition, you can download a pdf of a hand injuries poster we have produced and have circulated to all CSP safety reps and stewards. Lord Hunt's response to the MSD report can also be downloaded by using the appropriate link below.

More information on the MSD Project can be obtained from Warren Glover, Research & Policy Officer, CSP Employment Relations & Union Services, on 020 7306 6675 or email gloverw@csp.org.uk.

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