Work Related Musculoskeletal Disorders in UK Early Years and Primary Teaching Professionals


Lorna Taylor, a Chartered Physiotherapist working within primary and early year’s settings and campaigner for improved back health, shares the findings of her survey, the first of its kind in the UK.


There is much anecdotal evidence amongst education professionals about the aches and pains they experience at work and also from healthcare professionals (e.g. physiotherapists, chiropractors, osteopaths) who treat them – and understandably so because of the low working heights and their associated risks naturally encountered. However, it does not make it acceptable.

What are Musculo-skeletal Disorders (MSDs)?

MSDs, defined by the Health and Safety Executive (HSE) “include problems such as low back pain, joint injuries and repetitive strain injuries of various sorts”. Areas which can create a risk include (HSE):

  • Repetitive and heavy lifting
  • bending and twisting repeating an action too frequently
  • uncomfortable working position
  • exerting too much force
  • working too long without breaks
  • adverse working environment (e.g. hot. cold)
  • psychosocial factors (e.g. high job demands, time pressures and lack of control)
  • not receiving and acting upon reports of symptoms quick enough

The HSE has identified MSDs as a priority because although “they have the potential to ruin people’s lives and they impose heavy costs on employers and society, “you can do things to prevent or minimise MSDs and prevention measures are cost effective”.


The purpose of this study was to establish the prevalence, type, frequency and cause of self reported MSDs in a snapshot sample of early years and primary education professionals. Information was also gathered on reporting, absence and staff coping strategies. The aim was for the results to help identify problem areas and initiate the formation of a strategy to tackle MSD ill-health for an important, often overlooked specific sector of employees. A summary of key points can be found below – full results can be obtained from ………


A self administered anonymous questionnaire was mailed to a random selection of members of Voice – the Union for education professionals. In addition, members of Voice and the National Union of Teachers were invited to respond online.

705 questionnaires were received (436 paper, 269 online). Age group of children worked with was 48% (333), Infants, 31% (215) Pre-school, and 21% (147) Juniors.

Key Findings (see corresponding graph for further detail)

  • Reported career prevalence of work-related MSDs 98% (Fig 1)
  • 88% reported experiencing back pain (Fig 1)
  • 82% experienced MSDs once a week or more (Fig 2)
  • 38% had been off work
  • 70% had received treatment to ease their symptoms (NHS, private or both)
  • Only 8% had officially recorded it
  • 99.5% thought Work-related MSDs in the education profession were underreported (Fig 3)

Work activities causing discomfort were:

  • 91% bending over low tables
  • 85% sitting on children’s chairs
  • 71% kneeling at low tables/on the floor (Fig 4)

98% (690) of respondents reported discomfort which they felt was work-related (caused or exacerbated) at some point in their career. The most prevalent discomfort reported was back pain (88% / 614), followed by neck and shoulder pain (73% / 511).

The spine is a vulnerable structure, it has to be strong (to keep us upright) and also flexible (to allow movement). It is highly susceptible to cumulative strain injury (gradual onset of pain, which becomes more frequent and severe with time if poor postures and insufficient recovery continue).

In addition to the above, open responses included discomfort in: arms, wrists, feet and ankles. Alarmingly, several respondents had received hip, knee and back surgery to reduce their pain – two Reception staff members in their 30s had undergone back surgery.

Fig 1 also highlights that the type of MSD reported is not dependent on Service Years. A similar level of back pain was reported by staff who had worked with young children for less than 5 years as it was in those who had worked over 20 years, so it is not necessarily age related.

Fig 2 Reported frequency of MSDs


82% (559) of respondents reported experiencing discomfort once a week or more. Over a third (36%/245) reported daily pain. 7% (46) rarely experienced discomfort which they felt was work related.

38% (263) had been off work and 70% (483) had received treatment to ease their pain – either self-financed/private, NHS or, in a quarter of cases, both. Private treatment included: physiotherapy, chiropractic, osteopathy, acupuncture, massage, podiatry and orthopaedic surgery.

Only 8% (57) of respondents had officially recorded their work-related discomfort, despite nearly half (48%/327) visiting their GP and 83% (559) discussing it with friends and family. 11% (76) did not mention their discomfort to anyone and only 1% (9) contacted their Union.

The following graph (Fig 3) shows why 99.5% (686) of respondents feel that workrelated musculo-skeletal discomfort in the education profession is under reported. 77% (528) feel because it is “accepted as part of the job”, over half (55%/384) because they are “unaware of reporting systems in place” and alarmingly over a third (37%/256) because of “fear of jeopardising career”.

The vast majority of open responses suggested “people don’t realise these pains are related to the work conditions – comes on slowly and unsure of cause”. Others included: that they are often considered age or stress related, “It is not taken seriously by many people”, “hidden problems are not seen as important”, “reminded that there is no money” or “made to feel ALL money should be spent on the children and not staff discomfort”.

Fig 3 Reported reasons for under reporting of MSDs in the education profession (Q9)

The following graph (Fig 4) shows the top 3 work activities which respondents felt caused / contributed to their discomfort were:

  • 91% (635) bending over low tables
  • 85% (594) sitting on children’s chairs and
  • 71% (499) kneeling

In addition to the above, other job tasks associated with their compliant included: Manual handling activities (lifting/carrying children – off climbing equipment, for nappy changes, if they have fallen), putting up / preparing displays, working at child height computers or bent over laptops in class, standing all day, constantly picking things up from the floor, removing heavy boxes from above head height, working at low fixed height whiteboards, physically assisting children with special needs and/or unpredictable behaviour, being outside for long periods in the cold and wet.

Fig 4 Work activities which staff feel cause/contribute to their discomfort

Coping strategies

Many staff said that they could no longer sit on the floor, worked part-time supply rather than full time, moved to work with older children and some were forced to take ill-health retirement. Several self-financed regular treatment “I visit my physiotherapist every 2 months (since 2000)”.

Staff (working in special needs) really valued the manual handling training they received and felt all should receive it. Many respondents felt they should have access to improved information and training (manual handling, posture, ergonomics, causes and equipment) in particular trainee teachers, many citing “it is too late for me” or “you don’t realise that smaller aches and pains you are regularly experiencing early in your career are contributing to serious long term damage”.

Other copping strategies included staff discovering ways to lessen their pain themselves: “I bend my knees to pick things up”, “I use a chair to wash up”, but many agreed, simply avoiding the activity was not the answer as “fewer staff are left to do hazardous tasks, so are at more risk themselves”.

What next?

The results of this survey show an extremely high prevalence of work related musculo-skeletal discomfort in early years and primary professionals, the high level of under-reporting and impact it is having on individuals themselves, despite legislation in place to protect employees.

A final thought-provoking comment “when I worked in a local authority office, I had people come and assess my work station and make sure everything was at the right height for H&S, and then working for the same authority as a teacher, we have fixed (not wheeled or adjustable) chairs at our mini desks, PCs at whatever height and weird angles (if connected to the interactive whiteboard) it happens to be. We have to sit or kneel to work on the floor with the smallest children, sit on those TINY chairs and be bent over their tables uncomfortably”.

There are over 1 million primary teachers, teaching assistants, nursery nurses and playgroup leaders (Labour Force Survey 09/10) and evidence is now not only anecdotal. Given the recognised risks of acquiring Musculo-skeletal disorders, It is perhaps time for further research into this area, a raising of National awareness and the formation of a strategy (focusing on prevention and practical solutions) to tackle MSD ill-health for an important, often overlooked specific sector of employees.