Occupational Health: Myths, Myth Busting, and Management Pathways
Explore the common myths surrounding musculoskeletal injuries in the workplace, debunked by occupational health professionals. Learn about the importance of Cognitive Behavioral Therapy (CBT) and effective management pathways for employees, illustrated through a case study.
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Occupational Health Successful Case Histories Lara Carmel (Head of Workplace Health and Wellbeing) Sarah Lyster (Occupational Health Advisor) Wednesday 25th March 2015
Myths regarding MSK injury Muscle or joint pain = Serious Injury. Work / Activity is the cause Time off work is needed as part of the treatment Cannot return to work until 100% pain free
Myth Busting By Occupational Health Professionals and advisors post assessment: Hurt does not equal harm MSK problems are common in all populations and rarely caused by work Often sick leave is not required and temporary work accommodation is usually sufficient. Activity leads to faster and more sustained recovery. MSK Conditions are rarely made worse by continuing to work.
The risks of not Myth Busting Employee continues to believe that work is the cause of his pain. Employee believes permanent avoidance of certain tasks is the key to recovery. There can be permanent sometimes unnecessary exclusion from certain tasks The employee does not return to full duties
Cognitive Behavioural Therapy CBT: The way patient feels about their pain affects how they feel and subsequently behave. Poor Management will lead to further disability and potentially increase pain Use a CBT approach to identify unhelpful thoughts and help patient s come out of their vicious cycles of disability.
Management Pathway Support Employee from day one Manage in work on as near to normal duties as possible. Encourage Self Management If RTW goals not hit reassess regularly. If no improvements in the first week refer Ensure line manager talks to person about workload/ tasks/ schedules to identify how employee maybe maintained in work.
Case Study: Fred 49 Year Old Male Tripped over crate at work I ve damaged my back Line Manager keen to say (Don t come back till you are 100% fit)
GP Fred has pulled a muscle Not surprising he has a manual job He needs rest and stay off work Sick note for 2 weeks
2 Weeks Later No one has bothered to contact me from work GP has said pain should be settling by now Must be more serious than I thought
3 Weeks Later Chiropractor took an X-ray which showed severe wear and tear in my spine. He was surprised that I had not suffered severe pain before. He says I will need regular re-alignment throughout my life due to a misalignment of my spine.
4 Weeks Later I was so fed up with resting so did some digging I only did one hour but I was in agony Since then I have been in bed taking more painkillers My uncle had pain like mine and he ended up in a wheelchair. Is it Genetic? Pain is a warning sign to damage so I d better not do any exercise.
GP Fred is making too much of his back. He is now walking around like a stick of rock. I have prescribed some anti- inflammatories and signed him off again. Fred s Wife I am very concerned about Fred, we had to turn down a meal with neighbours as he can t sit for long and is embarrassed. I am doing everything at home. Something needs to be done urgently Occupational Health We have become aware that Fred is off sick. He tells us his GP is very concerned and doesn t think that he will be back for some time.
8 Weeks Later The Chiropractor says I am too bad and he can t help me any further, He says my job has a lot to answer for. I've been on the internet. The advice is helpful but I am also worried that I may have cancer. Someone saw me out shopping and now my manager thinks I m swinging the lead.
Twenty Weeks Later Fred s Wife: I may have to give up my job to look after Fred Fred: At last I saw a surgeon today and he has ordered a scan. My X-ray show that I have something called Spondylosis and that my spine is crumbling. What will I be like in ten years?
Twenty Four Weeks Later Fred s Wife Fred is getting into a nice routine and beginning to accept he will not go back to work Work needs to medically retire him so that we can get on with our lives.
OH Rehab Pathway All parties at all times should: Promote a stay at work culture Use workplace as site for effective rehabilitation Adopt health promotion role Encourage employees to help themselves maintaining activity Ensure risk assessments are up to date Encourage all staff to think of recovery time in terms of days and weeks not months.
GPs identified 4 key factors in their involvement in RTW: Preserving the doctor patient relationship was paramount There was a perceived conflict between obligations to patients and their employer or the benefits system Shortage of time and OH expertise Some GPs felt it was their role to concentrate on treatment
Phased RTW What are light duties? Phased RTW Functional Relevant to normal job Incremental manageable increase in duties reducing the physical and psychological anxiety related to each task
OH Role in facilitating Number of shifts Time on shifts Time on tasks Alternating tasks Number of rest breaks Offering a buddy system Number of repetitions Depth of bend/lift Height / length of stretch Decrease / Increase weight Early OH interventions is essential
Notes on the FITNOTE Information on the statement is advice to the patient and is not binding to the employer. It recognises that GPs have little or no training in Occupational Health. Therefore their advice is general only. The member of staff, manager, HR & OH should discuss how RTW will be managed. The advice on the statement is not binding to the employer who may take advice from an Occupational Health Professional. A final fit note is not required before the employee can return to work.
CBT CBT 5 Systems Environment Thoughts Emotions Behaviours Physiology
CBT Steve Environment Thoughts CBT 5 Systems I can t return to work yet because of my pain I can t do my normal hobbies Beliefs about needing to be 100% fit before going to work Beliefs about Pain being bad I might loose my job Beliefs that he has no transferable skills I need to protect my back from damage If I rest when I am in pain it will protect my back I will damage my back if I over do it and will never be able to work again Accident at work 3 months ago Given different information from health practitoners Relationship with wife deteriorating Employers not been in touch Physiology Low back pain Poor Sleep Behaviours Emotions Seen by GP, PT, OH Nurse Sickness Absence Stopped going to the gym Stopped normal hobbies Stopping and resting when in pain Protecting back Resting Cautious Movements Worry about back worsening Mood Worsened Snappy Low Fear of Losing Job
CBT Cathy Environment Thoughts CBT 5 Systems New role in University Finance Problems New Flat New Relationship Worried about debt can t pay Worried will lose flat Can t pay bills Should not have been promoted I might lose my job if make mistake Everyone thinks I m hopeless Physiology Ibs Headaches Sleep deprivation Feeling tired all the time Behaviours Emotions Getting in Early Staying late Not going out Takeaways Not going to gym Taking odd days out Tearful Anxious Short Tempered
Occupational Health Occupational Health Service General Enquiries Tel: 01206 872399 Email: ohquery@essex.ac.uk Room 3.109 Kate Shawcross Occupational Health Assistant Part-time: Monday - Wednesday Tel: 2399 Email: kshawc Lara Carmel Head of Workplace Health & Well being Tel: 3793 Email: lcarmel Carol Pengelly Occupational Health Administrator Part-time: Thursday - Friday Tel: 2399 Email: cdpeng Sarah Lyster Occupational Health Advisor Tel: 4129 Email: slyster Chloe Oddi Occupational Health Administrator HHS Part-time: Tuesday Thursday Tel: 07775003932 (Students) Email: coddi
