In brief
Work-related back, neck and shoulder pain often starts slowly, and employees do not report it because they think "it will pass"; by the time work is lost, the problem has long since become established. An effective prevention programme has four links: early and penalty-free reporting of pain, assessment by the workplace physician, time-limited and written job adaptation, and feeding the results back into the risk assessment. Ergonomics training is part of this programme but is not enough on its own.
Why are musculoskeletal disorders noticed late?
Musculoskeletal disorders are problems affecting the muscles, tendons, nerves and joints of the back, neck, shoulders, elbows and wrists, and they usually develop over weeks and months. Unlike a workplace accident, they have no specific moment. The employee first feels tiredness and aches in the evenings, then the pain lasts into the morning, and finally they become unable to work.
There are three reasons why they are noticed late in the workplace: the pain is put down to "age, sleep or sport"; the employee fears that complaining will cost them their job; and the supervisor does not see pain as an OHS issue. As a result, the first record is often a sick note or a long absence.
The main risk factors are well known: heavy and frequent lifting, repetitive hand and arm movements, overhead and forward-bent work, staying in the same posture for long periods, vibrating tools and pressure on the pace of work. Assembly lines, garment workshops and warehouses in Bursa and the surrounding provinces are jobs where these factors are found together. Rather than measuring the factors, this article describes a prevention programme that sets out what the workplace will do when pain starts.
The four links of the prevention programme
The aim of the programme is to catch pain at the earliest possible stage and to fit the work to the employee without taking them away from it. The table below summarises the links and those responsible:
| Link | What is done? | Who? | Record |
|---|---|---|---|
| 1. Early reporting | Complaints of pain and numbness are reported on a simple form | Employee, supervisor | Reporting form |
| 2. Physician assessment | Examination, job analysis, referral if necessary | Workplace physician, workplace nurse | Personal health file |
| 3. Job adaptation | Time-limited, written adaptation; a suitable task on return to work | Physician recommends, employer approves | Adaptation form |
| 4. Feedback | The workstation is corrected, the risk assessment updated | OHS specialist, department supervisor | Risk assessment, action list |
If these links work in isolation from each other, the programme does not work. For example, if the physician recommends a job adaptation but the workstation does not change, the same complaint comes back as soon as the adaptation ends.
1. Early reporting: getting pain on record
Work-related back pain and neck pain are the OHS problems that are easiest to solve on the day they are reported. For this, reporting must be easy and penalty-free:
- One-page form: On a body map, the employee marks where the pain is, how long it has lasted, which task makes it worse and whether there is numbness or loss of strength.
- The supervisor's role: The supervisor does not argue about the complaint; they have the form filled in and refer the employee to the workplace nurse or physician.
- Criteria for referral to the physician: Pain lasting longer than two weeks, pain spreading to the arm or leg, numbness, tingling, pain that wakes the person at night and loss of strength are passed to the physician the same day.
- Confidentiality: The health-related part of the form stays in the health file; only the work restriction is notified to the department supervisor. Art. 15 of Law No. 6331 provides for the confidentiality of health information.
The workplace physician's duties also include investigating whether there is a link between health-related absences and workplace hazards (Regulation on Workplace Physicians and Other Health Personnel Art. 9/2-c-6). Reporting forms are the most valuable data for this investigation.
2. Assessment by the workplace physician
The physician's assessment should not be limited to an examination. A good assessment includes these steps:
- History and examination: The onset of the complaint, its relationship to work, previous conditions.
- Job analysis: The physician or nurse observes the employee's workstation on site; the load lifted, the number of repetitions and posture are noted. If necessary, scoring is done with the OHS specialist using a method such as REBA or RULA; for the methods, see our article on REBA and RULA ergonomic risk analysis.
- Referral: If the findings warrant it, the employee is referred to the relevant specialty. Cases provisionally diagnosed as occupational disease are referred to healthcare providers authorised by the SGK (Law No. 6331 Art. 14/3).
- Recommendation: Temporary restrictions for the employee and correction proposals for the workstation are notified to the employer in writing.
When an employee who has been off work on a sick note returns, a return-to-work examination is carried out if they request it (Law No. 6331 Art. 15). For an employee whose working in their previous job is found to be inadvisable, the physician recommends a job suited to their current health and submits it for the employer's approval (Physician Regulation Art. 9/2-c-7). We explained how this examination works in our article on the return-to-work examination.
3. Job adaptation: temporary and permanent solutions
Job adaptation is not just an instruction to "move them to light duties". An adaptation that does not write down what changes and for how long reverts to the old arrangement within a few days. Tie the adaptation to three rules: it should be time-limited, it should be in writing, and at the end of the period it should be reassessed by the physician.
| Complaint | Example of temporary adaptation | Permanent engineering solution |
|---|---|---|
| Back pain, in lifting work | Not lifting loads above a certain weight, two-person lifting | Lifting aid, a table or lift bringing the load to waist height |
| Neck pain, screen or fine assembly work | Frequent short breaks, job rotation | Adjusting screen and bench height, a part-holding jig |
| Shoulder pain, overhead work | Temporary exemption from overhead tasks | A fixture that rotates the product, a work platform |
| Wrist, repetitive movement | Rotation between stations | Changing the tool handle, rearrangement reducing the number of repetitions |
| Standing for long periods | Alternating sit-stand arrangement | Adjustable sitting support, anti-fatigue flooring |
When making a job adaptation, the employment law aspect of decisions that would change the employee's pay or status should be assessed separately. The aim of the programme is not to remove the employee from work but to keep them in work in good health.
4. Fixing the workstation: feeding back into the risk assessment
When a second complaint comes from the same workstation, the problem lies no longer with the person but with the work. Health surveillance results are among the situations that require the risk assessment to be renewed regardless of its validity period. At this point, the following legal provisions offer guidance:
- Art. 5 of the Regulation on Manual Handling first requires a work organisation that removes the need for manual handling of loads; if handling is unavoidable, measures are taken by assessing the characteristics of the load, the effort required, the environment and the requirements of the task. For calculating lifting limits, see our article on how much weight can be lifted: NIOSH.
- Art. 7 of the Regulation on Health and Safety Measures in Work with Display Screen Equipment requires operators to take periodic breaks or rotate to other tasks; for office arrangements, our article on office ergonomics offers guidance.
- For complaints caused by repetition and pace on assembly lines, you can use the correction methods in our article on repetitive movements and assembly lines.
Workstation correction and the employee's adaptation should be tracked on the same action list. In its risk assessment work, Bursa Sistemer OSGB enters findings from health surveillance into the risk row for the relevant workstation.
5. Ergonomics training: more than lifting technique
Ergonomics training is a necessary but, on its own, insufficient part of the programme. Teaching correct lifting technique without changing the workstation places the problem on the employee. Good training includes:
- The early signs of pain and how to report them.
- Using the adjustment options at the workstation (bench, screen, chair, aids).
- Lifting, pushing and pulling techniques; using auxiliary equipment. For details, see our article on manual handling and lifting technique.
- Why breaks and job rotation matter.
Art. 6 of the display screen equipment regulation requires training to cover resting the eyes and the musculoskeletal system, as well as rest breaks and exercises. These topics can be placed in the job-specific risks part of basic OHS training. For examples from assembly lines, see our automotive supply industry page. In Bursa Sistemer OSGB's workplace physician service, we run this programme together with the periodic examination schedule; you can track examination dates with the OHS calendar tool.
Frequently Asked Questions
Does a lumbar disc herniation count as an occupational disease?
The SGK Health Board decides whether a disease counts as an occupational disease; the relationship to work and the conditions of exposure are assessed. If the workplace physician makes a provisional diagnosis of occupational disease, they refer the case to a healthcare provider authorised by the SGK. For the general process, see our article on what an occupational disease is.
Can an employee with a cervical disc herniation continue in the same job?
The workplace physician makes this decision by assessing the employee's condition and the requirements of the job together. In most cases, the employee can stay in their job with workstation adjustments and time-limited restrictions; if their previous job is inadvisable, the physician recommends a suitable job and submits it for the employer's approval.
How long does a job adaptation last?
The legislation does not set a fixed period. The adaptation should be limited to the period set by the physician; at the end of the period the employee should be reassessed, and the decision should be extended, changed or ended in writing.
Is ergonomics training mandatory?
There is no separate heading called "ergonomics training"; however, the manual handling and display screen equipment regulations require training on the related risks. These topics should be covered in the job-specific risks part of basic OHS training, according to the real conditions of the job.
A physician assigned for the time your hazard class requires: pre-employment and periodic examinations, fitness-for-work reports and health surveillance.
Bursa SİSTEMER OSGB Technical Team — written from the field experience of our OHS specialists and workplace physicians. Legal information is valid as of the publication/update date; contact us for an assessment specific to your business.