Musculoskeletal disorders

Musculoskeletal disorders (MSD's) are the most common occupational illness in Great Britain, affecting more than 1.1 million people a year

MSD's affect muscles, joints, tendons and other parts of the musculoskeletal system

Results from the latest survey of self-reported work-related illness (SWI03/04) indicate that in 2003/04 an estimated prevalence of 1,108,000 people in Great Britain suffered from a musculoskeletal disorder which, in their opinion, was caused or made worse by their current or past work. This equates to 2600 per 100,000 people (2.6%) who have ever worked in Great Britain.

Risk factors causing MSD's can be found in virtually every workplace from commerce to agriculture, health services to construction. An estimated 11.8 million working days a year are lost to work-related MSD's

Areas that can create a risk include:

For people who worked in the previous 12 months in England and Wales, comparisons between the five SWI surveys based on a restricted coverage indicate that the estimated prevalence rate in 2003/04 was similar to that in 2001/02, but higher than in 1998/99 and lower than in 1990 and 1995. All these differences were statistically significant. · SWI03/04 estimated that 18% of sufferers, 204 000 people ever employed, first became aware of their work-related musculoskeletal disorder in the previous 12 months. In terms of people employed in the last 12 months, this equates to an estimated incidence rate of 640 per 100 000 (0.64%).

Each year thousands of new cases of musculoskeletal disorders require some level of specialist intervention. An estimated 5 700 cases were seen for the first time in 2003 by rheumatologists and occupational physicians reporting to the MOSS (Musculoskeletal Occupational Surveillance Scheme) and OPRA (Occupational Physicians Reporting Activity) surveillance schemes. This was somewhat lower than over the preceding 5 year period, when around an estimated 8 000 cases were seen each year. It is too soon to judge whether this change reflects any real decline in the incidence of musculoskeletal disorders.

In 2002/03, there were 390 new cases assessed for disablement benefit due to a prescribed musculoskeletal disorder under the IIS (Industrial Injuries Scheme). The number of assessed cases reached a peak in 1992/93 and has decreased each year since then until 2002/03 when the number of assessed cases increased and was higher than the number assessed in 2000/01.

Occupations carrying above average prevalence rates in an earlier SWI survey conducted in 2001/02 (SWI01/02) included skilled trades (e.g. painters and decorators, carpenters and joiners) and process plant and machine operatives (e.g. heavy goods vehicle drivers). Skilled trades also carried an above average incidence rate. Those employed as metal plate workers, shipwrights and riveters had the highest average annual incidence rate reported by rheumatologists to MOSS between 2001 and 2003. This was followed by typists and road construction operatives.

According to SWI01/02, industries carrying the highest prevalence rates in 2001/02 included: agriculture, hunting, forestry and fishing; construction; health and social work; and manufacturing. Public administration and defence carried an above average incidence rate. Mining and quarrying, the manufacture of wearing apparel: dressing and dyeing of fur, the manufacture of other transport equipment and the manufacture of motor vehicles, trailers and semi-trailers were amongst those industries with the highest average annual incidence rates reported by rheumatologists to MOSS between 2001 and 2003.

SWI03/04 estimated that 11.8 million working days (full-day equivalent) were lost in 2003/04 through musculoskeletal disorders caused or made worse by work. On average, each person suffering took an estimated 19.4 days off in that 12 month period. This equates to an annual loss of 52 000 days per 100 000 workers.

Overall scale

Musculoskeletal disorders were the most commonly reported type of work-related illness in each of the five surveys of self-reported work-related illness (SWI90, SWI95, SWI98/99, SWI01/02 and SWI03/04). Headline results from the latest survey (SWI03/04) have recently become available. These indicate that in 2003/04 an estimated prevalence of 1 108 000 people in Great Britain suffered from a musculoskeletal disorder caused or made worse by their current or past work. This equates to 2600 per 100 000 of people (2.6%) who have ever worked in Great Britain. Around two-fifths of these (468 000) suffered from a disorder mainly affecting their back, 448 000 from a disorder mainly affecting their upper limbs or neck, and 192 000 mainly affecting their lower limbs, as shown in SWI03/04 Table 3. Of the estimated prevalence of work-related musculoskeletal disorders in 2003/04, an estimated 204 000 were new (incidence) cases. Among people employed in the last 12 months, this equates to an estimated incidence rate of 640 per 100 000 (0.64%).
Since January 1996, occupational physicians have reported new cases of musculoskeletal disorders, along with other occupational diseases to OPRA. Since October 1997 rheumatologists have been reporting to MOSS, the surveillance scheme for musculoskeletal disorders caused by work. Table THORM01 shows that occupational physicians reporting to OPRA saw an estimated 3 626 new cases of work-related musculoskeletal disorders in 2003 and a further estimated 2 061 individuals were seen by rheumatologists reporting to MOSS. In 2003, upper limb disorders accounted for just over half of all diagnoses made by rheumatologists and occupational physicians in the MOSS and OPRA schemes. Of these, an estimated 13% were Raynauds/Hand Arm Vibration Syndrome (HAV)/Vibration White Finger (VWF). Spine or back disorders (neck/thoracic spine, lumbar spine/trunk) accounted for around a third of diagnoses, whilst lower limb disorders (hip/knee/leg, ankle/foot) comprised an estimated 6% of all diagnoses.

The Industrial Injuries Scheme (IIS) provides statistics on the number of assessed cases confirmed as having some disability (1% or more) from a 'prescribed disease'. However, from 2001/02 onwards a small number of cases with 0% disability are included (from April 2002 onwards assessments where the claimant has been found to be suffering, but where there has been no loss of faculty have been included). A limited number of specifically work-related musculoskeletal disorders are classed as prescribed diseases under the scheme, namely beat hand, beat elbow, beat knee, cramp of the hand or forearm and inflammation of tendons of the hand, forearm or associated tendon sheaths (tenosynovitis). Beat hand and beat elbow are grouped together because of small numbers. Except for beat knee these are all upper limb disorders. Table IIS03 shows that in 2002/03 there were 390 new cases assessed for disablement benefit due to a prescribed musculoskeletal disorder under the Industrial Injuries Scheme (see Figure 1 below). A further 1 035 new cases of carpal tunnel syndrome were assessed for disablement benefit. Of the newly assessed cases of musculoskeletal disorders, 68% were tenosynovitis. Of the claims assessed in 2002/03, Table IIS04 shows that 36% of cases were assessed as having 14% or greater disability.

Note: From April 2002 the figures include a small number of cases where the claimant has been assessed as suffering but with no loss of faculty, or where the percentage disability had not been coded at the time of publication due to the provisional nature of the data.

Age and Gender

Detailed information by age and gender is not yet available from SWI03/04, so the latest information relates to 2001/02. SWI01/02 [1] Table 4.1 shows that an estimated 644 000 males and 482 000 females believed that they were suffering from a work-related musculoskeletal disorder in 2001/02. The prevalence rate of 3.0 % for males ever employed was statistically significantly higher than the corresponding rate of 2.2% for females. For both males and females, the oldest working age group (55-64 years for males and 55-59 years for females) carried the highest prevalence rate. Their respective rates of 4.9% and 3.7% were statistically significantly higher than the overall rate for the relevant gender. Other age groups carrying above average rates were the 45-54 year age group for both males and females, the 60-74 year age group for females and the 65-74 year age group for males. All four groups had rates which were statistically significantly higher than the corresponding gender-specific rate.

SWI01/02 Table 4.2 shows that the estimated incidence of work-related musculoskeletal disorders from SWI01/02 was higher for males than for females - an estimated 137 000 males and 103 000 females. However, for people working in the last 12 months the incidence rates for males and females were of a similar order, at 0.78% and 0.73% respectively. For males, none of the four age groups (16-34 years, 35-44 years, 45-54 years and 55+ years) had a rate which was statistically significantly higher than the overall male rate. For females, the rate for those aged 45-54 years, at 1.0%, was statistically significantly higher than the rate for all females.
Musculoskeletal conditions affecting the hand/wrist/arm (excluding Raynauds/HAV/VWF) were the most commonly reported new cases to the MOSS and OPRA schemes, with around 48% more cases reported for females than males in the six-year period 1998-2003, as shown in Table THORM01. Males were reported to have more conditions affecting the lumbar spine/trunk and lower limbs (hip/knee/leg, ankle/foot) than females in this period but generally fewer conditions affecting the neck/thoracic spine.

Table THORM02 gives the percentage age distribution of new cases of musculoskeletal disorders reported to MOSS and OPRA over the three-year period 2001 to 2003. Rheumatologists see a wider age range of people than occupational physicians as the latter almost exclusively see people who have not yet retired. For MOSS and OPRA combined, 80% of new cases seen by specialists in the three-year period 2001 to 2003 were between the ages of 25 and 54. The age group most commonly seen by rheumatologists was 45-54, whilst the 35-44 year age group was the most commonly seen by occupational physicians.

For beat conditions, all but just a few of the cases assessed under the Industrial Injuries Scheme in 2002/03 were males, whereas three-quarters of assessed cases for hand and forearm conditions (which include cramp of the hand or forearm and tenosynovitis) were females, as shown in Table IIS03.

Country and Region

The latest information that is currently available by country and region relates to 2001/02. SWI01/021 Table 4.3 shows the estimated prevalence and rates of self-reported musculoskeletal disorders caused or made worse by work, by country and government office region, for people ever employed. The estimated prevalence rate of 2.2% for Scotland was statistically significantly lower than that of 2.6% for England, as well as the overall rate for Great Britain. With rates of around 3%, the South West and Yorkshire and the Humber carried statistically significantly higher rates than those for England and Great Britain. SWI01/02 Table 4.4 gives estimated incidence rates for people working in the last 12 months. The rates for England and Scotland were of a similar order (sample numbers were too small to provide an estimate for Wales) with 0.80% and 0.59% of people who worked in the last 12 months respectively. Within England, most of the government office regions carried similar incidence rates, none of which was statistically significantly higher than the rates for England or Great Britain.

For the three-year period 2001 to 2003, Table THORM03 gives the annual average estimated number of new cases of musculoskeletal disorders reported to MOSS and OPRA by country and diagnostic category. As expected, most cases (an estimated 6 251 individuals) were seen on average each year by rheumatologists and occupational physicians in England. An estimated 243 individuals were seen on average each year in Wales and a further 707 in Scotland.
Table IIS02 gives a breakdown of the number of new cases assessed for disablement benefit under the Industrial Injuries Scheme by country, from 1995/96 to 2002/03. From April 2002 onwards, the figures include assessments where the claimant has been found to be suffering, but where there has been no loss of faculty. England has followed the same pattern as Great Britain with the number of assessed cases falling each year until 2001/02 but increasing in 2002/03. The number of assessed cases in Scotland and Wales has generally fallen each year. The only exceptions were between 1995/96 and 1996/97 when the number in Scotland increased, between 1997/98 and 1998/99 when the number in Wales remained constant and between 2000/01 and 2001/02 when the number in Wales rose and the corresponding number in Scotland remained constant.

Occupation

Detailed information by occupation is not yet available from SWI03/04, so the latest information relates to 2001/021. The Labour Force Survey only provides occupation details about the current or the most recent job (if currently not working) in the last 8 years. Therefore SWI01/02 occupational (classified using SOC2000) prevalence rates were restricted to the current or most recent job in that time period and illnesses associated with these jobs. Incidence rates were restricted to people employed in the last 12 months. Two broad occupation groups carried the highest prevalence rates for people employed in the last 8 years in the SWI01/02 survey: skilled trades occupations and process, plant and machine operatives. Each had overall estimated prevalence rates of over 3%. Within the first of these groups the occupation skilled construction and building trades carried a rate of over 5%. Other occupations with raised rates included protective service occupations; health and social welfare associate professionals; elementary trades, plant and storage related occupations; and caring personal service occupations. In terms of incidence, at an estimated 1% of people who worked in the last 12 months, skilled trades occupations (such as in construction) carried an above average rate in the SWI01/02 survey, as shown in SWI01/02 Table 4.15.

Where the number of actual cases reported by rheumatologists and/or occupational physicians in Great Britain to MOSS/OPRA in the years 2001-03 is sufficiently large, Table THORM08 gives the annual average estimated number of new cases and the estimated average annual incidence rates of work-related musculoskeletal disorders per 100 000 workers by occupation. Because the rates based on OPRA data will be affected by the coverage of occupational physicians, comparisons between different occupations should be based on rates from MOSS alone. With an estimated average annual incidence rate of 345 per 100 000 workers, those employed as metal plate workers, shipwrights and riveters carried the highest rate by far. This was followed by typists and road construction operatives, with respective estimated rates of 162 and 146 per 100 000 workers.

Industry

Again, the most recent information that is currently available relates to 2001/021. As for occupation, the Labour Force Survey only provides industry details about the current or the most recent job (if currently not working) in the last 8 years. Therefore SWI01/02 industry prevalence rates were restricted to the current or most recent job in that time period and illnesses associated with these jobs. Incidence rates were restricted to people employed in the last 12 months. For people who worked in the last 8 years, the industries carrying the highest prevalence rates in the SWI01/02 survey included agriculture, hunting, forestry and fishing and construction, with rates of around 3.7% and health and social work and manufacturing, with rates of around 2.5%, as shown in SWI01/02 Table 4.16. In terms of incidence, public administration and defence carried an above average rate, affecting an estimated 1.1% of people who worked in the last 12 months, as shown in SWI01/02 Table 4.17.

Where the number of actual cases reported by rheumatologists and/or occupational physicians in Great Britain to MOSS/OPRA in the years 2001-03 is sufficiently large, Table THORM09 gives the annual average estimated number of new cases and the estimated average annual incidence rates of work-related musculoskeletal disorders per 100 000 workers by industry. Because the rates based on OPRA data will be affected by the coverage of occupational physicians, comparisons between different industries should be based on rates from MOSS alone. With an estimated average annual incidence rate of 59 per 100 000 workers, mining and quarrying carried the highest rate. However the marked contraction of the coal mining industry over recent years has exaggerated the rate of mining and quarrying compared with other industries, and hence this estimate should be treated with caution. The industries with the next highest rates were the manufacture of wearing apparel: dressing and dyeing of fur, the manufacture of other transport equipment and the manufacture of motor vehicles, trailers and semi-trailers with respective estimated rates of 41, 31 and 27 per 100 000 workers.

Table IIS10 presents an analysis of the average rates of new assessments under the Industrial Injuries Scheme in 2001-2003 by industry. It shows that the extraction, energy and water supply industries had the highest rate of assessed cases with 16 cases per 100 000 employees. Manufacturing had the second highest rate, with 4 cases per 100 000 employees. From April 2002 onwards, the IIS figures include assessments where the claimant has been found to be suffering, but where there has been no loss of faculty.

Socio-Economic Classification

Detailed information by socio-economic classification is not yet available from SWI03/04, so the latest information relates to 2001/02. SWI01/021 Table 4.13 gives the estimated prevalence, incidence and associated rates of self-reported musculoskeletal disorders caused or made worse by the current job, by socio-economic classification. With estimated rates of over 2% of current workers, those classified as small employers and own account workers (socio-economic group 4) and lower supervisory and technical occupations (socio-economic group 5) carried the highest prevalence rates of musculoskeletal disorders ascribed to the current job in SWI01/02. Individuals classified as lower supervisory and technical also carried the highest incidence rate, with an estimated 1.1% of current workers.

Contributing Factors

Respondents to the SWI95 survey were asked their opinion of what caused (at work) their musculoskeletal disorder. Over a half of people thought that manual handling activities, mainly lifting, were the cause, 28% believed the posture they adopt at work caused the problem and 18% thought that their musculoskeletal disorder was a result of repetitive work.
Trends

Restricting SWI90, SWI95, SWI01/02 and SWI03/04 data sets to people who worked in the last 12 months and making a number of adjustments for inconsistencies between the five surveys (see Chapter 8 of the SWI01/02 published report [1.8mb] for further details) enables the prevalence rates from each of the SWI surveys to be compared. SWI03/04 table 2 shows that the estimated prevalence rate of self-reported work-related musculoskeletal disorders for England and Wales in 2003/04 was similar to that in 2001/02, but higher than in 1998/99 and lower than in 1990 and 1995. All these differences were statistically significant. It is also possible to compare the incidence rates from the latest two SWI surveys. For people working in the last 12 months in Great Britain, SWI03/04 table 6 shows that the estimated incidence rate for musculoskeletal disorders of 640 per 100 000 (0.64%) in 2003/04 was statistically significantly lower than the corresponding rate of 750 in 2001/02.

Table THORM01 shows that the estimated number of first visits to MOSS and OPRA specialists remained fairly stable between 1998 and 2002, at around 8 000 a year (ranging from an estimated 7 666 in 1998 to 8 635 in 1999). However, in 2003 the estimated number of first visits fell to 5 687. This is largely due to a sharp fall in the number of upper limb disorder cases reported by occupational physicians. A first investigation has revealed no changes to the reporting network or procedures that would explain this change. Many of the participants in this reporting network report cases on a single randomly chosen month in each year. This introduces the possibility of chance variation in the flow of cases to each participant being reflected in the final annual number. The change between 2002 and 2003 is at the limit of what might be expected on such chance variation. It is too soon to judge whether this change reflects any real decline in the incidence of musculoskeletal disorders.

Table IIS03 shows that the number of new cases assessed under the Industrial Injuries Scheme as having 1% or more disability has fallen each year from 1 280 in 1992/93 to 360 in 2001/02. However in 2002/03 there has been a rise to 390 cases, which is higher than the 375 cases assessed in 2000/01 (from April 2002 the figures include a small number of assessments with 0% disability).

Days Lost

SWI03/04 estimated that 11.8 million working days (full-day equivalent) were lost in the previous 12 months due to a work-related musculoskeletal disorder, as shown in SWI03/04 Table 1 Each person suffering from such a condition took an estimated 19.4 days off work on average in this period, equating to an annual loss of 52 000 days per 100 000 workers.

Cost to Employers

The HSE has estimated that work-related musculoskeletal disorders cost employers between £590 million and £624 million (1995/96 prices). The costs, which have been estimated using results from SWI95, are based on a number of assumptions and are only intended to be broadly indicative (1).
Links to other HSE pages

· Musculoskeletal home page
These pages explain what HSE is doing to tackle key issues as well as providing access to a range of information about MSD's
References cited
1. The costs to Britain of workplace accidents and work-related ill health in 1995/96. HSE Books, ISBN 0717617092.
Tables mentioned on this page
· SWI03/04 Table 1
Estimated days (full-day equivalent) off work and associated rates in 2001/02 and 2003/04 due to a self-reported work-related illness or workplace injury
· SWI03/04 Table 2
Comparison of estimated 1990, 1995, 1998/99, 2001/02 and 2003/04 prevalence and rates of self-reported illness caused or made worse by work, by type of complaint, for people working in the last 12 months in England and Wales
· SWI03/04 Table 3
Comparison of estimated 2001/02 and 2003/04 prevalence and rates of self-reported illness caused or made worse by work, by type of illness, for people ever employed
· SWI03/04 Table 6
Comparison of estimated 2001/02 and 2003/04 incidence and rates of self-reported illness caused or made worse by work, by type of illness
· SWI01/02 Table 4.1
Estimated 2001/02 prevalence and rates (%) of self-reported musculoskeletal disorders caused or made worse by work, by age and gender, for people ever employed
· SWI01/02 Table 4.2
Estimated 2001/02 incidence and rates (%) of self-reported musculoskeletal disorders caused or made worse by work, by age and gender
· SWI01/02 Table 4.3
Estimated 2001/02 prevalence and rates (%) of self-reported musculoskeletal disorders caused or made worse by work, by country and government office region within England, for people ever employed
· SWI01/02 Table 4.4
Estimated 2001/02 incidence and rates (%) of self-reported musculoskeletal disorders caused or made worse by work, by country and government office region within England
· SWI01/02 Table 4.13
Estimated 2001/02 prevalence, incidence and associated rates (%) of self-reported musculoskeletal disorders caused or made worse by current job, by socio-economic classification
· SWI01/02 Table 4.15
Estimated 2001/02 incidence and rates (%) of self-reported musculoskeletal disorders caused or made worse by current or most recent job, by occupational major and sub-major group
· SWI01/02 Table 4.16
Estimated 2001/02 prevalence and rates (%) of self-reported musculoskeletal disorders caused or made worse by current or most recent job, by industry section, for people working in the last 8 years
· SWI01/02 Table 4.17
Estimated 2001/02 incidence and rates (%) of self-reported musculoskeletal disorders caused or made worse by current or most recent job, by industry section
· SWI01/02 Table 8.5
Comparison of estimated 1990, 1995, 1998/99 and 2001/02 prevalence and rates (%) of self-reported illness caused or made worse by work, by type of complaint, for people working in the last 12 months in England and Wales
· SWI01/02 Table 8.6
Comparison of estimated 1995, 1998/99 and 2001/02 prevalence and rates (%) of self-reported illness caused or made worse by work, by type of complaint, for people working in the last 12 months in Great Britain
· SWI01/02 Table 8.9
Roughly comparable 1995 and 2001/02 estimated incidence and rates (%) of self-reported illness caused or made worse by work, by type of complaint, in Great Britain
· Table THORM01
Work-related musculoskeletal disorders: estimated number of cases reported by rheumatologists and occupational physicians to MOSS/OPRA by sex and diagnostic category
· Table THORM02
Work-related musculoskeletal disorders: percentage age distribution of estimated cases reported by rheumatologists and occupational physicians to MOSS/OPRA by sex and diagnostic category, for 2000-2002
· Table THORM03
Work-related musculoskeletal disorders: estimated number of cases reported by rheumatologists and occupational physicians to MOSS/OPRA by country and diagnostic category, 2000-2002
· Table THORM08
Work-related musculoskeletal disorders: estimated number of cases reported by rheumatologists and occupational physicians to MOSS/OPRA and estimated rates per 100 000 workers per year, by occupation
· Table THORM09
Work-related musculoskeletal disorders: estimated number of cases reported by rheumatologists and occupational physicians to MOSS/OPRA and estimated rates per 100 000 workers per year, by industry
· Table IIS02
Prescribed industrial diseases: non-lung diseases in England, Wales and Scotland, by disease
· Table IIS03
Prescribed industrial diseases other than lung diseases: new cases of assessed disablement by disease
· Table IIS04
Prescribed industrial diseases other than lung diseases: new cases of assessed disablement by award status
· Table IIS10
Prescribed diseases: average rates of new assessments in 2000-2002 per 100 000 employees in each industry
[1] More detailed information from SWI03/04 and revised SWI01/02 estimates will be published in Spring 2005. See data sources