Following the report of a manual task injury or musculoskeletal disorder, it is important that an investigation (a systematic examination of the risk factors and possible cause) be conducted and the risk factors that may cause or aggravate the condition be controlled to stop the injury from becoming worst or recurring in the same or other workers exposed to the same conditions.

Take the time to choose the right people to conduct the investigation. When conducting a manual task injury investigation, the following people should be considered for to be part of the investigation:

• safety representatives where they exist;
• line manager/supervisor;
• a safety person from the work site; and
• people with the relevant knowledge of manual task risk factors, how to assess them, sources of risks and controls to implement and review (eg. ergonomists, OSH specialists, musculoskeletal or manual task specialists).

It is important that the injured worker be consulted particularly to provide information about the possible work related risk factors they believe are associated with any manual task injury or musculoskeletal disorder to gain a clearer understanding of the mechanism of injury.  The injured worker’s perspective of what may have lead to the problem usually provides vital clues as to what went wrong and why.  They often also have appropriate ideas about what controls may be put in place to reduce the risk of re-injury or further aggravation of the injury.

During the investigation it is important that the investigators look for causes, not blame. Systems fail for many reasons and the people involved are often not the cause of the incident.

Investigations should:

• Aim to prevent recurrence of injury to the injured worker
• Aim to prevent similar type of injuries in other workers exposed to the same risk factors
• Be a team approach (safety rep, line manager/supervisor, safety personnel, person/s with relevant knowledge)
• Follow a systematic and methodical procedure
• Prompt the investigator to look for several key elements, such as events prior to incident, events during incident, direct and indirect risk factors that are associated with the manual task, cumulative risk factors from other aspects of the job, sources of risks and whether current controls are effective.
• Answer key questions about the situation such as WHO, WHAT, WHEN, WHERE, HOW and WHY.
• Determine a summary of the findings of the manual task injury or musculoskeletal disorder (conclusion) and recommendations for improvement (controls), if any.

Further information

• Tips for investigating accidents and incidents
• WORKSHEET: Manual tasks incident investigation (word)

Treating a musculoskeletal disorder early and early return to work to an appropriate role are important aspects of reducing the severity of the condition and length of recovery.

Workers should be encouraged to report musculoskeletal signs and symptoms, such as discomfort, pain, numbness, tingling or weakness early on, so that risk assessments may be conducted and risk can be managed sooner rather than later.

When signs and symptoms of musculoskeletal disorders present, early referral to a health professional for a clear diagnosis, education and treatment (if required) is important. Receiving education from a health professional about the diagnosis and potential work-related risk factors associated with the condition is important for both the affected worker and their managers, so that the risk factors may be assessed and controlled.

Specific information about injury management or work rehabilitation may be obtained from WorkCover WA

Further information

• WorkCover WA - Injury management: a guide for employers

Despite the high numbers of Musculoskeletal Disorders (MSDs), the key messages about this condition are that:

• you can do things to prevent or minimise MSDs
• the prevention measures are cost effective
• you cannot prevent all MSDs before they occur, so early reporting of symptoms, proper treatment and suitable rehabilitation is essential.

Most people have back pain at some time. Usually the pain is not caused by anything serious and it settles within a matter of days or weeks.

Back pain can be caused by many work situations. The exact cause is often unclear, but back pain is more common in roles that involve:

• heavy manual labour, and handling tasks in heavy industry;
• manual handling in awkward places, like delivery work;
• repetitive tasks, such as manual packing of goods;
• sitting at a workstation for a long period of time if the workstation is not correctly arranged or adjusted to fit the person, eg working with computers;
• driving long distances or driving over rough ground, particularly if the seat is not, or cannot be, properly adjusted or adequately sprung;
• operating heavy equipment, such as an excavator;
• stooping, bending over or crouching (poor posture);
• pushing, pulling or dragging loads that require excessive force;
• working beyond normal abilities and limits, and when physically overtired;
• stretching, twisting and reaching;

Tips for employers:

The longer a worker is off work with back pain, the less likely it becomes that they will return. However, by intervening early and putting in place return to work arrangements, you can avoid losing workers through long-term sickness. Some of the key actions employers can do include:

• Always maintain regular contact with the absent employee so you can help them keep motivated and prepare the individual for their return.
• Prepare and agree a return to work plan with a goal for the individual to be back doing their original job after a certain number of days or weeks. A return to work plan should:
  • be regularly reviewed to ensure that progress is made;
  • provide helpful transitional work arrangements that may include a gradual increase in hours or allowing more time for certain tasks to be completed;
  • be tailored to the individual.
• An investigation or risk assessment to identify possible causes and aggravating factors of work-related back pain, and controlling (by eliminating or minimising) these risk factors is important.
• Sometimes simple adjustments at work can help the individual concerned and prevent others becoming ill or injured.

Tips for workers with back pain:

The WA Health Department has 4 key messages for individuals with back pain and they are:

• Take control
• Stay positive
• Stay active
• Stay at work

Here are some other important messages to help you manage your back pain:

• there is a lot you can do yourself to manage your pain
• most people recover fully
• stay active if possible: moving helps reduce pain
• maintain your usual activities
• stay at work if possible
• stay positive
• avoid prolonged bed rest
• X-rays or other imaging are usually not required.

Further advice about acute and chronic back pain can be found in the WA Health Department, Consumer’s Guide to Managing Back Pain.  Information for employers and workers with back pain is also available from the UK’s Health and Safety Executive (HSE).

This information does not replace medical advice from your GP. If in doubt, check with your GP or health professional.

References and link:

• WA Health Department - Consumer’s guide to managing back pain This guide is for consumers with back pain who want to know more about how to effectively manage their pain
• Health and Safety Executive (HSE). Musculoskeletal Disorders: Back Pain 

The term Upper Limb Disorders (ULDs) includes the condition known as Occupational Overuse Syndrome (OOS)’ and "repetitive strain injury" (RSI), these two terms are not interchangeable with upper limb disorders because OOS and RSI do not cover all upper limb disorders. ULD is used as an umbrella term for a range of disorders of the hand, wrist, arm, shoulder and neck. It covers those conditions, with specific medical diagnoses (e.g. shoulder tendonitis, de quervain’s, carpal tunnel syndrome), and other conditions where there is pain without specific symptoms.

Symptoms may include:

• tenderness
• aches and pain
• stiffness
• weakness
• tingling
• numbness
• cramp
• swelling

ULDs can be caused by many work situations. ULD is associated with various risk factors including:

• Repetitive work
• Uncomfortable working postures
• Sustained or excessive force
• Carrying out a task for a long period of time
• Poor working environment and organisation (eg temperature, lighting and work pressure, job demands, work breaks or lack of them, job control)
• Hand-arm vibration (eg. from prolonged use of powered tools)

Tips for employers:

The way the work is organised and managed can make a significant contribution to reducing the risk of ULDs as well as make them worse.  Workers may be more likely to suffer an upper limb problem if exposed to more than one risk factor or if one risk factor is very intense.

When signs and symptoms of ULDs present, early referral to a health professional for a clear diagnosis, education and treatment (if required) is important. Receiving education from a health professional about the diagnosis and potential work-related risk factors associated with the condition is important for both the affected worker and their managers, so that the risk factors may be assessed and controlled. Treating a ULD early, and early return to work to an appropriate role which does not aggravate the condition, are important aspects of reducing the severity of the condition and length of recovery.

People with ULDs usually completely recover if the problem is recognised early, clearly diagnosed and treated appropriately.

Points to consider:

• ULD problems can be specific to an individual and each person is different and will need to be dealt with on a case by case basis.  It is important for a clear diagnosis to be made for each ULD as this will determine and influence the treatment, return to work programme and prognosis.
• If a task is causing or contributing to a ULD, the worker may need to stop doing that task for a time. Temporary modified duties could assist with recovery.
• An investigation or risk assessment to identify possible causes and aggravating factors of work-related upper limb disorders and controlling (by eliminating or minimising) these risk factors is important prior to re-exposing the worker to these conditions. Sometimes simple adjustments can help the individual concerned and prevent others becoming ill or injured.
• Return to work plans need to be agreed by all parties and actively reviewed. If the worker with a ULD has been off work, it is possible to return before all the symptoms have cleared up totally, provided that there isn't contrary medical advice
• You will need to have systems in place to help workers to return to work.  WorkCover WA provides information about this.

Tips for workers with ULDs:

It is important that you report ULD symptoms (as described above) as soon as possible (along with any others which are concerning you) as help could be available.

Overall you should not panic if you are suffering symptoms. People with ULDs usually completely recover if the problem is recognised early and treated appropriately.  Also once your employer knows about problems in the workplace something can be done to reduce the likelihood of the problem recurring once you have recovered.

By reporting symptoms early, your employer will have information from which he can assess whether there is a problem and they may want to observe your job. Other workers may be having similar problems and unless someone reports the problem it may not be tackled. There may need to be adaptations to your workplace such as the tools or equipment you use, or to the organisation of the work such as rest breaks, pace of the work, or the work environment such as the temperature or lighting. These adaptations may be permanent and apply to a group of workers or may be temporary and specific for you as an individual whilst you are dealing with a current problem or recovering from your symptoms.

Your employer may be able to refer you to a Doctor (occupational health provider or General Practitioner (GP)) for some medical help.  A Doctor will: 

• Be able to assess your symptoms and may diagnose a specific condition if you have one. 
• Ask about your work tasks to try to determine what the main contributors may be. 

If your workplace does not have access to this type of support you may need to go and see your GP and explain to them the symptoms you have and the type of work that you do. They should be able to provide some help and advice on your specific problem or refer you to another health professional who can.