Overwhelming evidence makes it clear that good musculoskeletal health underpins a person’s ability to live and work well[1],[2],[3]. It is also fundamental to healthy ageing, quality of life and independence beyond working years[4],[5],[6].
Workplace legislation is in place to prevent and reduce Musculoskeletal disorders (MSDs) with employers having an obligation to ensure the safety and health of employees. Yet, data shows MSDs remain the most common work-related problem in the EU[7],[8],[9]. Backache and muscular pains in the upper limbs are the most common reported problems, with around three in every five workers affected[9].
MSDs in the education workforce often overlooked and under reported[10],[11]. The primary focus of education settings is most often the needs of children and awareness of MSDs within the education sector (in training, when at work and amongst school leadership) is low.
Studies suggest MSD complaints are frequently high within education sector workers globally, with perceived on-going MSDs up to 95%[12]. 82% of early years teachers and teaching assistants experienced work-related MSDs at least once a week, yet only 8% had officially reported symptoms to their employer[11]. Other research supports the significant burden of pain with chronic characteristics in the education workforce with 98% of early childhood educators reporting pain carrying out work-related tasks and with average onset of pain >12 months[13].
Direct and indirect costs of work-related MSDs to individuals, society (including healthcare systems) and organisations are vast[14]. Additionally pertinent for the education sector is that there is a positive association with teacher wellbeing and pupil performance[15].
Encouragingly, MSDs are preventable. This article gives a holistic approach to tacking MSDs in teachers and teaching assistants. By identifying risk factors and incorporating health and wellbeing as an integrated, collaborative approach, focused on health promotion and a culture of prevention, improvements can be made to musculoskeletal health which will benefit both staff and students.
Risk Factors and Effects of MSDs in Teachers and Teaching Assistants
Musculoskeletal disorders affect the body’s bones, muscles, joints, ligaments/tendons, and nerves. Various symptoms present depending on the pathophysiological mechanisms of the structures affected but symptoms tend to include: pain, fatigue, stiffness and restricted joint movement, sensory loss and numbness (including sciatica) and localised swelling.
MSDs associated with long-term health conditions for example, pain, joint stiffness and fatigue associated with rheumatoid arthritis, osteoarthritis, systemic lupus, fibromyalgia, osteoporosis and ankylosing spondylitis can also be exacerbated by work.
Additional risk factors to teachers and teaching assistants include:
Physical inactivity - Physical activity maintains and improves strength and flexibility of the body’s muscles and joints, improves circulation and associated joint and muscle nutrition, maintains and improves balance to reduce the risk of falls and improves emotional wellbeing, all factors which contribute to musculoskeletal (MSK) health.
Studies show increased physical exercise in educators is associated with a lower incidence of MSD in the upper body[15] and practitioners who increase the amount of exercise they undertake show decrease in overall MSDs[15],[19].
Unhealthy working environment – A healthy workplace design and physical environment incorporates ergonomics,movement, areas for rest and considers noise, lighting, temperature and air quality. It is a particular challenge to address the ergonomic requirements of adult workers with the learning needs of children, especially in low, “child-height” environments.
A higher “perception of inappropriate infrastructures” (including noise, lighting, temperature, cleaning, ventilation, size and furniture is significantly associated with higher MSD reporting in elementary teachers[22].
Older age – Increased length of employment is a strong predictor of increased MSDs in teachers[21],[22]. It should be noted that teachers are working longer as retirement ages are increased. MSDs can begin in young workers with cumulative effects presenting later in life.
High Body Mass Index – Being overweight increases strain on the body’s musculoskeletal system and being obese increases the risk of developing osteoarthritis of the knee[25]. Maintaining a healthy weight with balanced nutrition assists body repair and bone heath which helps prevent osteoporosis[26] (and the risk of fractures) in later life.
Vitamin D and Calcium Deficiency – Adequate Vitamin D and Calcium are required for bone health. Deficiency can result in reduced bone mineral density which increases the risk of fractures from falls (one of the most serious musculoskeletal problems in the older population[24].
Smoking – In the general population, smokers and ex-smokers experience 60% more pain in the back, neck and legs and a 114% increase in disabling lower back pain[24]. Smoking reduces bone mineral density, particularly among post-menopausal women. It is associated with more bone fractures and slower healing and associated with up to a 40% increase in the risk of hip fractures among men[24]. Studies support a higher incidence of MSDs associated with smoking in teachers[15],[19].
MSDs can develop quickly or build slowly over time. Once developed they can adversely affect many aspects of life, including work and leisure activities, ability to take care of our mental and physical health, ability to drive and can lead to absence from work.
Mental health and physical health are inter-related and MSDs and mental ill health frequently co-exist[2]. People with depression are at a greater risk of developing back pain, depression is 4 times more likely in people with persistent back pain and living with MSD pain can lead feelings of anxiety and depression[24]. Mental health also impacts a person’s ability to cope with and recover from MSDs[24].
Effective awareness and management of MSDs helps reduce risk and improves employee wellbeing, no matter what size a school is.
Additional benefits include:
Fewer injuries to teachers and teaching assistants
Reduced risk of work-related ill health and sickness absence
Improved morale and reduced stress
Improved staffing levels, attendance and productivity
Improved professional care and teaching to children
Managing MSD risks in the education workforce
Working with children is a physically and emotionally demanding role. Numerous, inter-relating factors contribute to musculoskeletal health in teachers and teaching assistants.
Figure 1: Musculoskeletal Health for Teachers and Teaching Assistants wheel (created for EU-OSHA Healthy Workplaces: Lighten the Load 2020-2022 campaign)
Risk assessment is about identifying and taking sensible measures to control risks in the workplace, with the aim to make the risk of someone being injured (employee, visitor or child) as low as possible.
A hazard is something which can cause harm. A risk is the chance, however large or small, that a hazard could cause harm.
Risk assessment should be carried out by someone who:
is competent to do so (has the right skills, knowledge and experience)
involves workers and their representatives in the process
understands when specialist help or advice may be needed.
Identify MSD hazards
Look for hazards which may result in harm when working with children. Employees, or their representatives, can give first-hand experience of what happens in practice; so can those who only work with children occasionally. Hazard mapping and body mapping, involving workers are useful adjuncts to risk assessment. The main areas to consider involve the working environment and practitioner health and safety.
Who might be harmed?
Decide who might be harmed and how. This will usually be the teacher or teaching assistant, but it might also include children or visitors. Consideration should be given to groups who may be particularly at risk of MSDs, such as: new starters, employees returning to work, those with pre-existing medical conditions, new and expectant mothers or those working long hours.
Evaluate the risks
Having identified the hazards, decide how likely it is that harm will occur. It is not always possible to eliminate risks but employers have legal responsibilities to do everything reasonably practicable to protect people from harm.
Record your findings
Significant findings should be recorded, focussing on prevention measures. Together with accident investigations and consultation with workers, changes to working practice can be identified with additional measures put in place to further reduce MSD risks.
Regularly review
MSD risk assessment should be regularly reviewed to ensure continuous sustainability and long-term improvement.
There is no set frequency for carrying out a review, but the risks to those who work with children, and others need to be suitably controlled.
Changing circumstances may also prompt a review, for example: an increasing number of children on role; changing ratios or a reduced number of employees; children with specific moving and handling needs; the acquiring of new equipment; or buildings expansion or redesign. If anything significant changes, a risk assessment should be checked and updated.
MSD Prevention guidance for teachers and teaching assistants
The following measures can help effectively manage MSDs in schools. It is useful to think “Healthier working environment” and “Safer practitioner” for individual workplaces.
Healthier working environment
Seating, Furniture and Equipment
A range of safe, appropriate seating to meet the needs of the workforce is offered.
Practitioner health and safety (ergonomics) is considered when purchasing new seating, furniture and equipment.
Seating, furniture and equipment is in good working order and meets health and safety requirements.
Seating, furniture and equipment is inspected and maintained at regular intervals, in line with manufacturer’s recommendations and maintenance schedules.
Manual handling equipment is provided and used appropriately by employees.
Unsafe equipment is removed immediately from service and reported to a named contact.
Storage
Furniture and equipment are safely stored with clear access to minimise practitioner lifting, carrying and awkward postures.
Mobile storage solutions are considered and used where possible.
Workplace Design
Employees have access to adult height desks and chairs for written/computer work and access to adult height sinks (or can use a washing up bowl in standing).
Consideration is given to practitioners’ working postures with equipment provided to support low, “child height” working.
Floors are even, unobstructed, and well-lit, and doorways (including of storage areas) are accessible.
Children’s independence is encouraged to access their own resources and equipment, especially at mealtimes to reduce lifting.
Movement, rest breaks and hydration are encouraged throughout the day.
Timetabling allows as much time as possible for children to be independent and for fewer room changes for staff carrying resources.
Employees are asked about their seating requirements and workstation/classroom set up.
New design and build consultations include workplace health and safety needs of practitioners.
Safer practitioner
Training
Regular, setting-specific manual handling training, which includes lifting and moving children in a range of situations and postural awareness for employees is provided.
Employees and volunteers working regularly on computer or mobile devices complete VDU training.
Knowledge
Teachers and teaching assistants are aware of MSD risks in their workplace and how to reduce them (in the classroom, outdoor learning and at a computer).
Practitioners know how to carry out routine safety checks on mobile and safety equipment and report any faults.
Teaching and teaching assistants are competent and capable of doing their work in a way that is safe for them and other people.
Practitioners know how to recognise and report early symptoms of MSD ill health via a clear reporting system and are encouraged to do so by school leadership.
Healthy Lifestyle advice is promoted and initiatives supported (e.g. active travel, physically active school challenges, healthy eating menus, workload recognition, sleep).
For MSD measures to be effective, trusted, proactive leadership is necessary with collaborative working within and between organisations. Additional early intervention and return to work advice can be obtained from occupational health and safety advisors.
Importantly, research shows an increasing number of children and young people are experiencing MSDs, and at an earlier age as lifestyles impact musculoskeletal health[27],[28],[29]. Pre-existing MSDs can be carried into future workplaces having consequences for children, young people and organisations[30].
Workplace health has proven to be a successful business asset and strategy for improving the health of employees and quality of the working environment. For the education sector, workplace health interventions for teachers and teaching assistants also improve learning experiences and educational outcomes for children and young people.
Holistic MSD management requires an integrated approach recognising physical, social and emotional influences with a focus on prevention (with self-management) and early intervention.
A collaborative, multidimensional effective approach includes: whole-school interventions promoting health, improved MSK health and ergonomics training of educators and school leaders, liaison with school designers and occupational health professionals to improve teaching and learning environments, MSD risk awareness and healthy lifestyle engagement for education employees, together with health and safety education for children and young people.
There is enormous opportunity for greater, combined impact to tackle MSDs in the education sector.
Data collection will be required to understand local needs and measure impacts. However, there is a genuine desire for healthy and successful teachers and teaching assistants, together with healthy and achieving children and young people.
[17]https://www.researchgate.net/publication/256461435 Pillastrini, P., Mugnai, R., Bertozzi, L., Costi, S., Curti, S., Mattioli, S., Violante, F.S. (2009). Effectiveness of an at-work exercise program in the prevention and management of neck and low back complaints in nursery school teachers. Ind Health, 47(4):349-354
[19]https://phcfm.org/index.php/phcfm/article/view/1819 Elias, H. E., Downing, R., & Mwangi, A. (2019). Low back pain among primary school teachers in Rural Kenya: Prevalence and contributing factors. African journal of primary health care & family medicine, 11(1), 1-7
[21]https://ijph.tums.ac.ir/index.php/ijph/article/view/6158 Anuar, N. F. M., Rasdi, I., Saliluddin, S. M., & Abidin, E. Z. (2016). Work task and job satisfaction predicting low back pain among secondary school teachers in Putrajaya. Iranian Journal of Public Health, 45(Supple 1), 85-92.
[23]https://pubmed.ncbi.nlm.nih.gov/31563385/ Coledam, D. H. C., Júnior, R. P., Ribeiro, E. A. G., & de Oliveira, A. R. (2018). Factors associated with musculoskeletal disorders and disability in elementary teachers: A cross-sectional study. Journal of Bodywork and Movement Therapies. 23. Pp.658-665
