Medical Weblog

While it’s up to you to make sure that you take sensible precautions at home to protect your health, it’s a different matter when you’re at work where the demands of the job or the facilities provided for doing it can force you into a situation where damage to your back can result.

Sciatica and back pain are. of course, part of a much wider range of, at times, work-related ailments of all kinds that fall under the broad label of ‘musculoskeletal disorders’, a term that encompasses those conditions that affect the bones and muscles of the body and the tissues that hold them together.

Musculoskeletal problems often arise from tasks performed while employed, and each year more than half a million cases are reported as being caused by work. Says the Health and Safety Executive (HSE): “The potential to cause these conditions exists in most workplaces – although certain types of work are more often associated with musculoskeletal disorders than others, such as poultry processing, clothing manufacture, keyboard operation, nursing and assembly line work.”

According to the HSE, the causes fall into three main categories:

Manual handling and lifting – poorly designed tasks and incorrect lifting techniques and posture all increase the risk to workers. More than 55,000 injuries due to handling, lifting or carrying accidents are reported yearly.

Repetitive work – where work is done too quickly, such as in piecework, or where the work rate is controlled by a machine. This can be a particular problem when combined with the need for force; where the operator is positioned badly; or where the job is not varied enough.

Unsuitable posture – often caused by poor seating arrangements or by reaching and stretching awkwardly.

While a specific injury to the affected part can be detected in many instances of work-related disorders, in others, pain and discomfort may be the only evidence of problems, as in the case of chronic back pain or sciatica.

The HSE firmly believes that most of these problems can be avoided, often through relatively simple corrective action, such as perhaps modifying how a job is performed, or through re-siting parts of machinery or adapting seating positions.

The responsibility for preventing health problems caused by working conditions is one that is shared to a large extent by both the employee and the employer, and these can be summed up as follows:

The employer has a legal duty to safeguard the employee’s health and safety, and should identify tasks which could cause problems and take steps to improve the situation.

The employee must, however, exercise care and follow good work practices, particularly where lifting and carrying are involved. It is also up to the employee to ensure that any workstation is correctly adjusted when adequate adjustment is possible. Spelling this out more fully, current relevant legislation includes:

- Section 2 of the Health and Safety at Work etc Act 1974 (HSW Act) which places a duty on employers to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all their employees.

Section 6 of this Act also places a duty on manufacturers, designers, suppliers and importers of articles for use at work to ensure, so far as is reasonably practicable, that the article is so designed and constructed as to be safe and without risks to health.

Under section 7 of the Act, employees have to take reasonable care for their own health and safety and that of others who may be affected by what they do (or fail to do); they also have to cooperate with their employer, so far as is necessary, to enable

the employer to comply with legal duties.

It must be noted that the HSW Act deals with general duties and does not provide specific requirements on the prevention of particular ailments. However, various Regulations are more to the point as far as reducing the risk of back pain or injury are concerned, as shown below.

The Management of Health and Safety at Work Regulations 1992 (the Management Regulations) include requirements for employers to:

Assess risks to health or safety.

Arrange for the effective planning, organisation, control, monitoring and review of preventive and protective measures.

Appoint competent people to assist the employer in complying with health and safety law.

Cooperate and coordinate health and safety actions where the activities of different employers interact.

Provide appropriate health surveillance, information and training.

The Provision and Use of Work Equipment Regulations 1992 place duties on employers concerning the safe and proper use of work equipment. The risk assessment carried out under the Management Regulations, as mentioned above, is intended to help employers select work equipment and assess its suitability.

The Health and Safety (Display Screen Equipment) Regulations 1992 are directed mainly to protect employees who habitually use display screen equipment as a significant part of their normal work. Employers have duties to:

Assess and reduce risks.

Make sure new workstations meet minimum requirements covering equipment, furniture, the working environment, task design and software. There was a transition period until 31 December 1996 for existing workstations

Provide breaks or changes of activity, information and training.

While the health risks most commonly associated with operating computers and other VDUs are upper limb disorders (including repetitive strain injury) and sight problems, back troubles can easily arise from inadequate seating and a lack of breaks in the day’s work.

The Manual Handling Operations Regulations 1992 require the avoidance or reduction of risk where the manual handling of loads involves a risk of injury.

The Workplace (Health, Safety and Welfare) Regulations 1992 include requirements for lighting, workspace, workstation arrangements, seating and facilities for rest.

The Supply of Machinery (Safety) Regulations 1992 apply to the supply of new machinery which will need to meet relevant essential health and safety requirements.

Taken together, the HSW Act and the various Regulations put a strong onus upon any employer to ensure that everything reasonable be done to prevent employees from contracting work-related ailments. Despite that, it remains a fact that many sufferers from back problems certainly attribute their difficulties to conditions at work. Should you think that your health problems are due to unsatisfactory work practices, this is what the HSE says you should do:

In the first instance, consult your doctor, giving as much information as is possible to enable him to decide whether or not your condition is likely to be due to your work. In some cases individuals suffering from specified conditions can get state compensation under the Industrial Injuries Prescribed Diseases Regulations. Ask your doctor about this or get leaflet N12 from your nearest Social Security office.

If you suffer from symptoms which may be attributable to work, particularly if they recur, then it is important to tell your doctor and employer. If you have a works nurse or doctor, then you should also tell them about your problem. You may also want your union representative to know that -you think your job is affecting you. If you are off sick for more than seven days your doctor will inform your employer of the cause via a sick note.

You can also contact a doctor or nurse from your local Employment Medical Advisory Service. You’ll find them at your local office of the Health and Safety Executive.

If you need more information, contact the HSE’s Information Centre on 0541 545500.

Additionally, should you develop a musculoskeletal disorder that makes it difficult for you to continue with your current job or you are out of work, you can get advice from your local Job Centre on assessment and rehabilitation schemes, registration as a disabled person, job retention, work aids for people with disabilities and help with job applications.

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Support groups now exist for many serious and debilitating illnesses, and depression is no exception in this regard. Such organizations provide up-to-date information and meetings to help members and their families cope with depression. A listing of available support groups that deal with depression and related disorders is provided in the Resources chapter at the end of this book.

Recovery or 12-step groups are modelled on the principles set down by Alcoholics Anonymous, which was the first such group to be developed. There are currently recovery groups for drug addicts, sex and love addicts, compulsive gamblers, overeaters and the adult children of alcoholics. There are also separate groups for the spouses, partners or family members of those who participate in these various groups. Recovery groups combine a programme consisting of working through a series of specific steps with fellowship, support and simple wisdom. In meetings people learn that they are not alone in their unhappiness. They are encouraged to talk freely and are listened to in a non-judgemental way without being challenged or confronted. There is a spirit of respect for what people have to say and the problems they are grappling with.

I have encouraged many of my patients with depressions and addictions to go to an appropriate recovery group, often with good results. At times I have managed to locate another group member who is willing to pick the newcomer up and take him or her to a meeting of the group. I have encountered considerable reluctance in my patients to go along with this suggestion and they have frequently cited concerns about confidentiality and their professional reputations. Nevertheless, all those who have followed my suggestion have found such groups to be quite valuable. It is very important in choosing a group to pick one where you feel you can identify with the other group members. Token contributions are requested of members. I often appeal to the ordinary human instinct (possibly genetically programmed) for finding a bargain, by pointing out to my patients that at 50 pence a meeting, recovery groups are the best deal in town.

Even if one is not an addict, these groups might still be helpful and, given the large number of groups available, it is usually not difficult to find one where you feel at home. One of my patients, a woman in her mid-sixties, has suffered from severe intermittent depressions for decades despite my best efforts at medicating her with multiple anti-depressants including St John’s Wort. She would qualify as an adult child of an alcoholic as her mother was drunk through much of her childhood and died of cirrhosis of the liver when the patient was a young girl. She was reluctant, however, to go to a recovery group, so I shared with her some of the slogans that members of recovery groups often repeat to themselves and to others by way of encouragement.

To my surprise, this extremely sophisticated woman, a veteran of many years of all sorts of psychotherapy, repeated the slogans to herself several times and wrote them down carefully every day. The slogans I shared were:

One day at a time.

Just get your body there; the rest will follow.

Fake it till you make it.

These are all useful slogans for the depressed person, who amplifies his or her troubles and projects them into the distant future. Take one day at a time, the slogan urges. If you consider all possible future problems at once they will seem overwhelming and you can drown in a sea of sorrows. In the case of an addict, this can drive a person to drink, drugs or acting out in some addictive way.

In a depressive person, it can drive one to despair. In contemplating some professional or social commitment, a depressed person frequently asks, ‘How can I possibly handle it?’ Just get there, urges the slogan. Often your automatic pilot will take over and see you through. In a song written to encourage those in despair, the singer Billy Joel counsels the listener not to forget his second wind but rather to wait for the momentum to kick in. My patient used this way of thinking to help her get to a wedding which she had no wish to attend. Once there, however, she surprised herself by having quite a good time and afterwards felt very pleased that she had been able to come through for her friends and family. The slogan ‘fake it till you make it’ suggests that if you pretend you are managing, you might be surprised to discover that you really are managing after all. Things may turn out this way for all sorts of reasons. First, the anticipation of the task or event may be worse than the thing itself. In certain types of depression it is impossible to anticipate pleasure, but once placed in a pleasurable situation you may actually be capable of enjoying it. Another reason why you might make it after you fake it is related to daily or circadian rhythms of mood, whereby it is common for a person’s depression to be at its worst in the morning and to improve as the day wears on.

Some people balk at recovery groups because many of the steps are geared round the concept of a Higher Power and, as such, may offend a person’s religious sentiments or lack thereof. Nevertheless, the whole matter is generally handled with a light touch and in a non-coercive way that many people find acceptable.

In summary, support groups offer invaluable information and encouragement around specific illnesses including depression, while recovery groups provide fellowship, wisdom and tangible assistance for people with all manner of sorrows and problems.

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