Information for Employers

By far the greatest area of discomfort that we see coming from sitting based occupations is discomfort in the neck/upper back/upper limb (NUBUL).

There exists a very complex relationship between neck, shoulder and upper limb. From an anatomical perspective, the neck and shoulder area contains many important structures. Muscles, ligaments, discs, nerves, arteries and veins in this vicinity can all can cause or refer pain locally into the neck or distally into the shoulder and upper limb.

From a biomechanical perspective, the distal forces are heavy and the distal muscles relatively weak. Poor posture and poor technique leads to altered biomechanics which can cause central and distal discomfort, pain or injury.

Sitting based occupations can also lead to discomfort in the lower back (LB).

Although you can get discomfort or pain associated with sitting, LB injury is more likely to be event triggered. This may be from lifting or other such injury, which may be exacerbated by working postures and also contribute to NUBUL problems.

Discomfort, pain and injury that is common to sitting based occupations includes:

• Some forms of headache
• Pain in neck - including muscle, ligament, facet or disc injuries
• Pain in the upper back/shoulder region
• Shoulder pain including rotator cuff tears, sub-acromial bursitis or capsular sprains
• Nerve pain such as thoracic or pseudo-thoracic outlet syndrome
• Pain in the upper arm – very likely to be referred from the neck or shoulder but will also include any peripheral nerve entrapments or actual shoulder muscle or ligament injuries
• Pain in the lower arm – very likely to be referred from the neck or shoulder but will also include peripheral nerve entrapments, lateral (golfers elbow) or medial (tennis elbow) epicondylagia or actual elbow muscle or ligament injuries
• Pain in the wrist, hand or fingers – very likely to be referred from the neck or shoulder but will also include peripheral nerve entrapments such as carpal tunnel syndrome or actual wrist/hand/finger muscle or ligament injuries
• Pain in the middle back
• Pain in the lower back including muscle, ligament, facet or disc injuries
• Pain in the buttock, upper leg, lower leg or foot.

Injuries associated purely with standing are rare but the way we stand can have a big impact on our alignment and postural muscle strength.

Poor alignment and weak postural muscles can therefore increase the risk of injury associated with sitting or more likely lifting and handling.

Discomfort, pain and injury that is common to standing based occupations includes:

• Some forms of headache
• Pain in neck - including muscle, ligament, facet or disc injuries
• Pain in the upper back/shoulder region
• Nerve pain such as thoracic or pseudo-thoracic outlet syndrome
• Pain in the upper arm – very likely to be referred from the neck or shoulder
• Pain in the lower arm – very likely to be referred from the neck or shoulder
• Pain in the wrist, hand or fingers – very likely to be referred from the neck or shoulder
• Pain in the middle back
• Pain in the lower back - including muscle, ligament, facet or disc injuries
• Pain in the buttock, upper leg, lower leg or foot very likely to be referred from the lower back or pelvis but will also include peripheral nerve entrapments or actual muscle or ligament injuries – such as meniscal injuries, patello-femoral pain, patella tendonopathy, plical/bursal injuries, Achilles pain, heel pain, plantar fascia pain, or neuroma.

By far the greatest area of discomfort that we see in the workplace is in the neck/upper back/upper limb (NUBUL). This is because we use our arms to interact with the world and although sitting is thought of traditionally as static, it is actually a very dynamic activity.

We are also using our hands to interact with the computer and as such by definition handling the mouse and keyboard. Many jobs involve other types of repetitive upper limb handling but not lifting, such as sorting, hairdressing or production line work.

True lifting injuries are relatively common in jobs that involve heavy repetitive loads but it is very important to realise that it is rarely one event that triggers an injury. It is much more likely to be an accumulation of many factors.

Discomfort, pain and injury that is common to occupations that involve a lifting and handling include:

• Some forms of headache
• Pain in neck - including muscle, ligament, facet or disc injuries
• Pain in the upper back/shoulder region
• Shoulder pain including rotator cuff tears, sub-acromial bursitis or capsular sprains
• Nerve pain such as thoracic or pseudo-thoracic outlet syndrome
• Pain in the upper arm – very likely to be referred from the neck or shoulder but will also include any peripheral nerve entrapments or actual shoulder muscle or ligament injuries
• Pain in the lower arm – very likely to be referred from the neck or shoulder but will also include peripheral nerve entrapments, lateral (golfers elbow) or medial (tennis elbow) epicondylagia or actual elbow muscle or ligament injuries
• Pain in the wrist, hand or fingers – very likely to be referred from the neck or shoulder but will also include peripheral nerve entrapments such as carpal tunnel syndrome or actual wrist/hand/finger muscle or ligament injuries
• Pain in the middle back
• Pain in the lower back including muscle, ligament, facet or disc injuries
• Pain in the buttock, upper leg, lower leg or foot very likely to be referred from the lower back or pelvis but will also include peripheral nerve entrapments or actual muscle or ligament injuries – and including meniscal injuries, patello-femoral pain, patella tendonopathy, plical/bursal injuries, Achilles pain, heel pain, plantar fascia pain, or neuroma.

Non-work injuries can occur frequently dependent on the age and demographics of the working population.

Whilst employers are not responsible for these they will still have an impact on productivity and the assessment, treatment and injury rehabilitation is out of the employer’s control.

Non-work injury can lead to LTI and therefore significantly overload other staff. Having a management plan to deal with these including; getting good early advice from an experienced physiotherapist, recommendations on likely considerations regarding time out of work or on alternative duties and whether temporary staff may be required, can have a significant impact on outcomes for the individual and ultimately for the workplace.